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3a psychiatry > Psychopharmacology > Flashcards

Psychopharmacology Flashcards

1
Q

Give 4 conditions that are treated with antipsychotics

A
  • schizophrenia
  • delirium in dementia
  • mania
  • psychosis
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2
Q

What is the mechanism of action of typical antipsychotics

A

Dopamine D2 receptor antagonists, blocking dopaminergic transmission in:
* mesolimbic and mesocortical regions - antipsychotic effects
* nigrostriatal regions - motor side effects

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3
Q

Give 4 extrapyramidal side effects of typical antipsychotics

A
  • Parkinsonism
  • acute dystonia
  • akathisia - restlessness
  • Tardive dyskinesia - abnormal movements, particularly affecting the face
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4
Q

What is acute dystonia

A

sustained muscle contraction (e.g. torticollis, oculogyric crisis)

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5
Q

What is tardive dyskinesia

A
  • abnormal, involuntary movements
  • mc is chewing and pouting jaw
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6
Q

When does tardive dyskinesia usually present in relation to antipsychotics

A

presents after taking typical antipsychotics for a long time

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7
Q

What causes extrapyramidal effects from typical antipsychotics

A

these result if the blockade of dopamine receptors in the nigrostriatal pathways exceed 80%

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8
Q

Give 3 examples of typical antipsychotics

A
  • haloperidol
  • chlorpromazine
  • Prochlorperazine
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9
Q

What is the mechanism of action of atypical antipsychotics

A

antagonist to:
* D1 and/or 2 receptors
* 5HT2 receptor - prevent reuptake of serotonin
* histamine 1 receptor
* alpha 1 adrenoreceptor

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10
Q

Give 3 examples of atypical antipsychotics

A
  • risperidone
  • olanzapine
  • quetiapine
  • aripiprazole
  • clozapine
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11
Q

Give 6 side effects of antipsychotics

A
  • anticholinergic effects
  • weight gain (atypical)
  • drowsiness and cognitive impairment
  • raised prolactin
  • Impaired glucose tolerance -> diabetes (typical)
  • reduced seizure threshold
  • prolonged QT interval
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12
Q

Give 2 potential risks of antipsychotic medications in elderly patients?

A
  • increased risk of stroke
  • increased risk of venous thromboembolism
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13
Q

Which antipsychotic should be considered in patients struggling with symptoms of raised prolactin

A

aripiprazole

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14
Q

When is clozapine most commonly used

A

treatment resistant schizophrenia - when 2 or more antipsychotics have not worked after 6-8w each

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15
Q

Why is clozapine not first line with other atypical antipsychotics and how is it monitored

A
  • lots of adverse effects so requires close monitoring
  • Clozapine monitoring system - advice on drug dosage depending on blood results
  • only consultant psychiatrists can prescribe
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16
Q

Give 5 adverse effects of clozapine

A
  • Myocarditis
  • Agranulocytosis / neutropenia
  • Reduced seizure threshold
  • Constipation
  • Hypersalivation
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17
Q

What effect does smoking have on clozapine

A
  • Dose adjustment of clozapine might be necessary if smoking is started or stopped during treatment
  • smoking cessation can cause a rise in clozapine blood levels
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18
Q

What is neuroleptic malignant syndrome

A
  • rare, potentially life threatening reaction that can occur in response to taking antipsychotics
  • occurs within hours to days of starting an antipsychotic
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19
Q

Give 4 key features of neuroleptic malignant syndrome

A
  • Rigidity
  • Delirium/ altered consciousness
  • Fluctuating bp and tachycardia
  • hyperthermia/ pyrexia
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20
Q

Give 2 key blood test findings of neuroleptic malignant syndrome

A
  • Raised creatine kinase (AKI secondary to rhabdomyolysis)
  • leucocytosis
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21
Q

How is neuroleptic malignant syndrome managed

A
  • stopping the causative medication
  • dopamine agonist (bromocriptine)
  • IV fluids to prevent renal failure
  • benzodiazepines for agitation
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22
Q

Give 5 examples of selective serotonin reuptake inhibitors (SSRIs)

A
  • sertraline
  • citalopram
  • escitalopram
  • fluoxetine
  • paroxetine
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23
Q

Give 4 conditions that are treated with SSRIs

A
  • depression
  • anxiety
  • OCD
  • bulimia
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24
Q

Describe the mechanism of action for SSRIs

A

inhibit the reuptake of serotonin from presynaptic serotonin pumps

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25
Q

What is the first line SSRI in children and adolescents

A

fluoxetine

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26
Q

Which 2 SSRIs are most likely to lead to QT prolongation

A
  • citalopram
  • escitalopram
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27
Q

What is the SSRI of choice post myocardial infarction

A

sertraline

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28
Q

Which SSRI has an increased risk of congenital malformations, particularly in the first trimester

A

paroxetine

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29
Q

Give 5 side effects of SSRIs

A
  • GI symptoms - N+V
  • hyponatraemia
  • increased suicidality
  • sexual dysfunction
  • anxiety/ agitation
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30
Q

Why should co-prescribing NSAIDs/ aspirin with SSRIs be avoided and how is this risk minimised?

A
  • Increased risk of GI bleeding
  • co-prescribe PPi
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31
Q

What 4 drugs should be avoided when taking SSRIs due to the increased risk of serotonin syndrome

A
  • triptans
  • monoamine oxidase inhibitors
  • tramadol
  • St John’s Wort (often taken over the counter for depression)
32
Q

Name 2 recreational drugs that can cause serotonin syndrome

A
  • ecstasy
  • amphetamines
33
Q

How soon should a patient be reviewed after starting antidepressant therapy?

A

Normally after 2 weeks. For patients under 25 years or at increased risk of suicide, they should be reviewed after 1 week.

34
Q

How long should a patient continue antidepressant therapy after achieving remission?

A

At least 6 months to reduce the risk of relapse

35
Q

How should the dose of an SSRI be reduced when stopping treatment?

A

The dose should be gradually reduced over a 4-week period
* except fluoxetine; this should be tapered over the course of 6-12 weeks

36
Q

Why should antidepressants not be stopped suddenly?

A

Antidepressants should not be stopped suddenly to minimise discontinuation symptoms

37
Q

Give 5 symptoms of discontinuation syndrome

A
  • increased mood change
  • unsteadiness/ dizziness
  • paraesthesia, electric shock sensations
  • restlessness and sweating
  • insomnia/ Vivid dreams
  • GI: pain, cramps, D+V
38
Q

Which SSRI has a higher incidence of discontinuation symptoms. Give one side effect of this drug

A

paroxetine
weight gain

39
Q

Give 2 conditions that are treated with Serotonin and norepinephrine reuptake inhibitors (SNRIs)

A

Depression and anxiety

40
Q

Give 2 examples of SNRIs

A
  • venlafaxine
  • duloxetine
41
Q

Describe the mechanism of action of SNRIs

A

work by blocking the reuptake of serotonin and noradrenaline by the presynaptic membrane

42
Q

Give 3 side effects of SNRIs

A
  • hot flush
  • constipation
  • dizziness
  • dry mouth
43
Q

What drug class is mirtazapine

A

Noradrenergic and specific serotonergic antidepressant

44
Q

Describe the mechanism of action of mirtazapine

A

presynaptic alpha2-adrenoreceptor antagonist which increases central noradrenaline and serotonin

45
Q

Give 2 side effects of mirtazapine

A
  • sedation
  • increased appetite - weight gain
  • postural hypotension
46
Q

Give 2 examples of tricyclic antidepressants (TCAs)

A
  • amitriptyline
  • clomipramine
47
Q

Describe the mechanism of action of TCAs

A

They block the reuptake of serotonin and noradrenaline by the presynaptic membrane. They also have additional actions, including blocking acetylcholine and histamine receptors

48
Q

Give 3 conditions that are treated with TCAs

A
  • depression
  • anxiety
  • chronic pain (much lower dose)
49
Q

When are TCAs contraindicated

A
  • IHD
  • arrhythmias
  • severe liver disease
  • overdose risk
50
Q

Give 4 anticholinergic side effects of TCAs

A
  • dry mouth
  • constipation
  • urinary retention
  • blurred vision
51
Q

Give 2 antiadrenergic side effects of TCAs

A
  • dizziness and palpitations
  • syncope
    (postural hypotension)
52
Q

Give 2 antihistaminergic side effects of TCAs

A
  • weight gain
  • sedation (drowsy)
53
Q

Give 4 cardiac effects of TCAs

A
  • prolonged QT
  • bundle branch block
  • arrhythmias
  • palpitations
54
Q

Give 2 conditions that are treated with lithium

A
  • mania - acute/ prophylaxis
  • treatment-resistant depression
55
Q

How is lithium monitored

A

monitoring is essential due to narrow therapeutic index
* when checking lithium levels, the sample should be taken 12 hours post-dose
* weekly blood tests until stable levels then 3 monthly
* after a change in dose, lithium levels should be taken a week later and weekly until the levels are stable.
* thyroid and renal function should be checked every 6 months

56
Q

What is the ideal serum lithium range when treating bipolar disorder

A

0.4 -1.0 mmol/L

57
Q

Give some adverse effects of lithium

A
  • fine tremor
  • nephrotoxicity - polyuria secondary to nephrogenic diabetes insipidus
  • weight gain
  • hypothyroidism
  • nausea/vomiting, diarrhoea
  • hyperparathyroidism and resultant hypercalcaemia
  • leucocytosis
58
Q

Give 4 things that may precipitate lithium toxicity

A
  • dehydration
  • renal failure
  • drugs: diuretics (thiazides), ACEi, metronidazole, NSAIDs
59
Q

Give 5 features of lithium toxicity

A
  • coarse tremor
  • hyperreflexia
  • acute confusion
  • polyuria
  • seizure
  • coma
60
Q

How is lithium toxicity managed

A
  • IV fluids with isotonic saline
  • haemodialysis may be needed in severe toxicity
61
Q

Why is lithium avoided in pregnancy

A

teratogenic - causes ebstein’s anomaly (malformation of tricuspid valve)

62
Q

Describe the mechanism of monoamine oxidase inhibitors

A
  • inhibit monoamine oxidase A and B
  • leads to accumulation of amine neurotransmitters (noradrenaline, serotonin etc)
63
Q

What are MAOIs used to treat

A

atypical/ Tx resistant depression

64
Q

Give 2 examples of MAOIs

A
  • phenelzine
  • tranylcypromine
65
Q

Give 3 side effects of monoamine oxidase inhibitors

A
  • hypertensive reactions with tyramine containing foods - eg cheese, broad beans, marmite
  • anticholinergic effects - constipation, dry mouth, confusion
  • suicidal behaviours - overdose
66
Q

What are Z drugs used for

A

initiating sleep

67
Q

Describe the mechanism of Z drugs

A

stimulate GABA receptor by binding to the alpha 2 subunit

68
Q

Give 2 examples of Z drugs

A
  • zopiclone
  • zaleplon
69
Q

Give 3 side effects of Z drugs

A
  • increase risk of falls in elderly
  • can become dependent
  • dry mouth/ bitter taste
70
Q

Describe the mechanism of benzodiazepines

A

enhance the effects of GABA by increasing the frequency of chloride channels

71
Q

Give 3 examples of benzodiazepines

A
  • lorazepam (short acting)
  • diazepam (long acting)
  • chlordiazepoxide
72
Q

What are benzodiazepines used to treat

A
  • alcohol withdrawal
  • mania
  • psychosis
  • acute agitation/ aggression
73
Q

Give 3 side effects of benzodiazepines

A
  • can be addictive long term
  • resp depression
  • CNS depressant - decreased alertness, drowsiness etc
74
Q

When are benzodiazepines contraindicated

A
  • neuromuscular resp weakness (eg myasthenia gravis)
  • respiratory disease
75
Q

Give 5 features of benzodiazepine withdrawal

A
  • insomnia
  • loss of appetite
  • perspiration
  • irritability
  • tremors
  • seizures
76
Q

How is a benzodiazepine overdose treated

A

flumazenil

3a psychiatry (10 decks)

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