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Phase 3A flashcards > Psychopharmacology > Flashcards

Psychopharmacology Flashcards

1
Q

What are the main types of drugs used in psychiatry (8)?

A
  • Antidepressants
  • Anxiolytics
  • Hypnotics
  • Antipsychotics
  • Mood stablisers
  • ADHD medications
  • Addiction medications
  • Dementia medications
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2
Q

What are the main classes of antidepressants (4)?

A
  • SSRIs
  • SNRIs (serotonin-noradrenaline reuptake inhibitors)
  • TCAs
  • MAOI (monoamine oxidase inhibitors)
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3
Q

What are 3 examples of monoamines?

A
  • Serotonin
  • Dopamine
  • Noradrenaline
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4
Q

What are 4 examples of SSRIs?

A
  • Sertraline
  • Fluoxetine
  • Citalopram
  • Paroxetine
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5
Q

When should SSRIs be taken?

A

First thing in the morning - they can disrupt sleep

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6
Q

What group of people should SSRIs not be used in?

A

Under 18s

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7
Q

What is the only SSRI licensed for under 18s?

A

Fluoxetine

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8
Q

What is the mechanism of SSRIs

A

Reduced neuronal reuptake of serotonin

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9
Q

What are some side effects of of SSRIs (8)?

A
  • Severe = increased risk of suicide in first 2 weeks
  • Increased anxiousness
  • Emotional numbness
  • Headache
  • N + V
  • Insomnia
  • Loss of libido/ anorgasmia
  • Dry mouth
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10
Q

What are some possible interactions of SSRIs when combined with other drugs (3)?

A
  • Serotonin syndrome
  • Impair hepatic metabolism
  • Hyponatraemia
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11
Q

What are some withdrawal symptoms of SSRIs (4)?

A
  • Dizziness
  • Headaches
  • Agitation
  • GI symptoms
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12
Q

What period of time should an SSRI be stopped over?

A

Gradually reduce dose over 4 week period

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13
Q

What are 2 examples of SNRIs?

A
  • Duloxetine
  • Venlafaxine
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14
Q

What is the mechanism of SNRIs?

A

Presynaptic blockade of noradrenaline and serotonin reuptake pumps

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15
Q

What are some side effects of SNRIs?

A

Same as SSRIs but often more severe/ widespread

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16
Q

What is an example of an atypical antidepressant?

A

Mirtazapine

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17
Q

What specific class is mirtazapine?

A

Noradrenergic and specific serotonergic antidepressant

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18
Q

What are some side effects of mirtazapine (6)?

A
  • Sedation
  • Weight gain
  • Headache
  • Postural hypotension
  • Dizziness
  • Tremor
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19
Q

What is an example of a TCA (3)?

A
  • Amitriptyline
  • Lofepramine
  • Imipramine
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20
Q

What are some contraindications for TCAs?

A
  • IHD
  • Arrhythmias
  • Severe liver disease
  • Suicidality (overdose risk)
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21
Q

Which TCA does not have a risk of overdose?

A

Lofepramine

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22
Q

What is the mechanism of TCAs?

A

Blockade of noradrenaline and serotonin reuptake pumps at muscarinic, alpha-adrenergic and histaminergic synapses. Has more widespread effects than SSRIs.

23
Q

What are some side effects of TCAs (8)?

A
  • Anticholinergic effects: dry mouth, constipation, blurred vision, urinary retention
  • Antiadrenergic effects: postural hypotension
  • Antihistaminergic effects: sedation and weight gain
  • Arhythmias/ long QT
24
Q

What is an example of an MAOI?

A

Phenelzine

25
Q

What circumstances should MAOIs be started?

A

In secondary care when other treatments have failed

26
Q

What is the mechanism of MAOIs?

A

Prevent the breakdown of monoamines by inhibiting monoamine oxidase A and B.

27
Q

What are some side effects of MAOIs (4)?

A
  • GI upset (N+V, constipation)
  • Dry mouth
  • Overdose risk
  • Tyramine cheese reaction
28
Q

What is tyramine cheese reaction?

A

Hypertensive crisis when MAOIs react with cheese that a patient has consumed

29
Q

What antidepressant is good for patients who also have insomnia + weight loss?

A

Mirtazapine

30
Q

Which antidepressants have a risk of overdose (3)?

A
  • Venlafaxine
  • TCAs
  • MAOIs
31
Q

When should an initial follow-up appointment be offered after starting an antidepressant?

A

Within 2 weeks

32
Q

Who should be seen in 1 week after starting antidepressants (2)?

A
  • Those with high suicide risk
  • Aged 18-25
33
Q

What is the standard antidepressant used for patients on blood thinners?

A

Mirtazapine

34
Q

What antidepressant is good for patients who also suffer from pain (2)?

A
  • TCAs
  • Duloxetine
35
Q

What psychiatric emergency is caused by antidepressants - often when used in conjunction?

A

Serotonin syndrome

36
Q

What medications are used as mood stabilisers (3)?

A
  • Lithium
  • AED (e.g. carbamazepine, valproate)
  • Gabepentin
37
Q

Why does lithium accumulate in cells?

A

It acts like Na+ (both group 1 elements) so it can enter cells via voltage gated Na channels, however it cannot leave via Na/K pump.

38
Q

What is the mechanism of lithium?

A

Complex + poorly understood - interferes with lots of enzymes

39
Q

How does lithium interact in the kidneys?

A

Excreted in the glomerulus and then reabsorbed in the proximal tubules - like sodium

40
Q

Why do lithium levels need to be monitored?

A

It has a very narrow therapeutic range and can easily cause toxicity

41
Q

What are some mild and severe side effects of lithium?

A

Mild:
* Polyuria/ dypsia
* Weight gain
* Oedema
* Fine tremor
Severe:
* Corse tremor
* Long QT/ arrhythmias
* Brisk reflexes
* Impaired conciseness

42
Q

What tests need to be done before commencing lithium (7)?

A
  • ECG
  • U&Es
  • FBC
  • TFTs
  • Renal function
  • Pregnancy
  • BMI
43
Q

How often should lithium levels be monitored?

A

Weekly until stable levels, then 3 monthly for first year, then 6 monthly

44
Q

How is lithium teratogenic?

A

Causes Ebsteins anomaly - malformation of tricuspid valve

45
Q

When is gabapentin usually used?

A

When anxiety is present along with a mood disorder such as bipolar or depression

46
Q

What are some side effects of sodium valproate (5)?

A
  • Weight gain
  • Dizziness
  • N+V
  • Tremor
  • Deranged LFTs
47
Q

What are the two broad categories of antipsychotics?

A
  • Atypical
  • Typical
48
Q

What are 2 examples of typical - first generation antipsychotics?

A
  • Chlorpromazine
  • Haloperidol
49
Q

What are 5 examples of atypical antipsychotics?

A
  • Risperidone
  • Olanzapine
  • Quetiapine
  • Aripiprazole
  • Clozapine
50
Q

What is the clinically positive (not the one that causes side effects) mechanism of antipsychotics?

A

Blockade of dopaminergic receptors (particularly D2 although also D1).
They also block 5HT2 (serotonin) receptors.

51
Q

What is the mechanism by which antipsychotics cause various side effects?

A

Histamine and ACh receptor blockade

52
Q

What are the 4 important qualities of antipsychotics?

A
  • Sedation
  • Anticholinergic activity
  • Extrapyramidal activity
  • Hypotensive effects
53
Q
A

Phase 3A flashcards (5 decks)

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