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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
What circumstances should MAOIs be started?
In secondary care when other treatments have failed
26
What is the mechanism of MAOIs?
Prevent the breakdown of monoamines by inhibiting monoamine oxidase A and B.
27
What are some side effects of MAOIs (4)?
* GI upset (N+V, constipation) * Dry mouth * Overdose risk * Tyramine cheese reaction
28
What is tyramine cheese reaction?
Hypertensive crisis when MAOIs react with cheese that a patient has consumed
29
What antidepressant is good for patients who also have insomnia + weight loss?
Mirtazapine
30
Which antidepressants have a risk of overdose (3)?
* Venlafaxine * TCAs * MAOIs
31
When should an initial follow-up appointment be offered after starting an antidepressant?
Within 2 weeks
32
Who should be seen in 1 week after starting antidepressants (2)?
* Those with high suicide risk * Aged 18-25
33
What is the standard antidepressant used for patients on blood thinners?
Mirtazapine
34
What antidepressant is good for patients who also suffer from pain (2)?
* TCAs * Duloxetine
35
What psychiatric emergency is caused by antidepressants - often when used in conjunction?
Serotonin syndrome
36
What medications are used as mood stabilisers (3)?
* Lithium * AED (e.g. carbamazepine, valproate) * Gabepentin
37
Why does lithium accumulate in cells?
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
What is the mechanism of lithium?
Complex + poorly understood - interferes with lots of enzymes
39
How does lithium interact in the kidneys?
Excreted in the glomerulus and then reabsorbed in the proximal tubules - like sodium
40
Why do lithium levels need to be monitored?
It has a very narrow therapeutic range and can easily cause toxicity
41
What are some mild and severe side effects of lithium?
Mild: * Polyuria/ dypsia * Weight gain * Oedema * Fine tremor Severe: * Corse tremor * Long QT/ arrhythmias * Brisk reflexes * Impaired conciseness
42
What tests need to be done before commencing lithium (7)?
* ECG * U&Es * FBC * TFTs * Renal function * Pregnancy * BMI
43
How often should lithium levels be monitored?
Weekly until stable levels, then 3 monthly for first year, then 6 monthly
44
How is lithium teratogenic?
Causes Ebsteins anomaly - malformation of tricuspid valve
45
When is gabapentin usually used?
When anxiety is present along with a mood disorder such as bipolar or depression
46
What are some side effects of sodium valproate (5)?
* Weight gain * Dizziness * N+V * Tremor * Deranged LFTs
47
What are the two broad categories of antipsychotics?
* Atypical * Typical
48
What are 2 examples of typical - first generation antipsychotics?
* Chlorpromazine * Haloperidol
49
What are 5 examples of atypical antipsychotics?
* Risperidone * Olanzapine * Quetiapine * Aripiprazole * Clozapine
50
What is the clinically positive (not the one that causes side effects) mechanism of antipsychotics?
Blockade of dopaminergic receptors (particularly D2 although also D1). They also block 5HT2 (serotonin) receptors.
51
What is the mechanism by which antipsychotics cause various side effects?
Histamine and ACh receptor blockade
52
What are the 4 important qualities of antipsychotics?
* Sedation * Anticholinergic activity * Extrapyramidal activity * Hypotensive effects
53

Phase 3A flashcards (5 decks)

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