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4C - Psychiatry > Psychopharmacology > Flashcards

Psychopharmacology Flashcards

1
Q

what is depression

A

low mood continuing for weeks or months, and interfere with the person’s abilities to function.

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2
Q

what is the main biochemical theory for the cause of depression

A

monoamine hypothesis of depression

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3
Q

at least 5 symptoms are needed for depression diagnosis. What are the symptoms

A

Depressed mood or irritability most of the day, nearly every day
Marked loss of interest/pleasure: in all or almost all activities most of the day
Fatigue or loss of energy
Hypersomnia/insomnia
Changes in appetite/weight
Inappropriate guilt and feelings of worthlessness
Suicidal ideation and recurrent thoughts of death, or a suicide attempt or a specific plan for committing suicide
Impaired concentration/decision-making capabilities
Psychomotor agitation or retardation

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4
Q

what are the 5 grades of depression as categorised by NICE

A
  1. Sub-threshold
  2. Mild
  3. Moderate
  4. Severe
  5. Complex
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5
Q

what non-pharmacological treatment is given for mild depression

A
  1. Social support
  2. Guided self-help - leaflets
  3. Being active
  4. Psychological therapies - CBT, mindfulness
  5. General support and advice - financial etc
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6
Q

what nonpharmacological management is used to treat moderate to severe depression

A
  1. ECT (electroconvulsive therapy) - acute
  2. TMS (transcranial magnetic stimulation)
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7
Q

what are the 4 main stages of drug treatment

A
  1. symptoms control
  2. continuation
  3. relapse prevention
  4. discontinuation
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8
Q

what are the 5 main classes of antidepressants

A
  1. Tricyclic antidepressants (TCAs)
  2. Selective serotonin reuptake inhibitors (SSRIs)
  3. Serotonin noradrenaline reuptake inhibitors (SNRIs)
  4. Noradrenaline and specific serotoninergic antidepressant (NaSSA)
  5. Monoamine oxidase inhibitors (MAOIs)
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9
Q

how do TCAs work

A

Block the reuptake of noradrenaline and serotonin

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10
Q

what are some key side effects of TCAs

A

GI upsets, dry mouth, blurred vision, constipation, urinary retention, postural hypotension, cardiac arrhythmias, sedation, confusion, memory problems

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11
Q

who cannot receive TCAs

A

the elderly

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12
Q

how do SSRIs work

A

Increases the level of serotonin in the synapse by blocking the reuptake pump

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13
Q

what do SSRIs also work for

A

anxiety disorders

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14
Q

what are common side effects of SSRIs

A

gastrointestinal effects and anxiety symptoms (initially)

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15
Q

when do you use SSRIs

A

they are 1st line

fewer side effects
can use with other medications
good safety for overdose

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16
Q

what are common SNRIs side effects

A

include nausea, headache, dry mouth and sweating

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17
Q

who cannot take SNRIs

A

people with cardiovascular risk factors

18
Q

when do you use SNRIs

A

2nd and 3rd line treatment

better tolerated than TCAs
NOT safe in overdose

19
Q

how do NaSSAs work

A

Enhances the action of noradrenaline and serotonin in the synapse

20
Q

what is the main side effect to consider with NaSSAs

A

sedation, increased appetite, dizziness and dry mouth

21
Q

what else can NaSSAs be used to treat

A

helpful if patients also have sleeping problems

22
Q

how do MAOIs work

A

Inhibit (either reversibly or irreversibly) monoamine oxidase enzymes to prevent the breakdown or monoamine neurotransmitters

23
Q

who gets MAOIs

A

resistant depression

24
Q

what MUST be avoided for MAOIs

A

food and drink that contain tyramine (including alcohol)

25
Q

what happens if a person on MAOIs has high tyrosine food

A

very large sudden increase in blood pressure
(hypertensive crisis)

26
Q

all antidepressants dose low and then increase slowly except which one

A

MIRTAZAPINE
start at 30mg and then go down to 15mg/d
has less sedative effect at higher dose

27
Q

what is serotonin syndrome

A

Due to toxic hyperserotonergic state from hyperstimulation of the brain stem and spinal chord 5-HT1A and 5-HT2 receptors

28
Q

what is the progression of the signs and symptoms

A

Restlessness
Sweating
Tremor
Shivering
Muscular rigidity
Confusion
Convulsions
Death

29
Q

what are the major mediators of the symptoms of anxiety

A

noradrenaline, serotonin, dopamine, and gamma-aminobutyric acid (GABA).

30
Q

what is the short term pharmacological management of anxiety

A

Benzodiazepines
Beta-blockers (e.g. propranolol)
Antihistamines (e.g. hydroxyzine)
Antipsychotics

31
Q

what is the long term pharmacological management of anxiety

A

Antidepressants (e.g. SSRIs, TCAs, MAOIs, venlafaxine, mirtazapine)
Buspirone
Pregabalin

32
Q

how do benzodiazepines work

A

by enhancing the action of γ-aminobutyric acid (GABA) in the brain (i.e. brains natural calming neurotransmitter)

33
Q

are benzos used for short or long term treatment and why

A

short term (up to 4 weeks)

rapid onset
risk of dependence

34
Q

what are the mild and severe symptoms of benzo withdrawal

A

Mild – restlessness, tremor, agitation

Severe – depression, convulsions, psychosis

35
Q

what is the most common form of anxiety disorder

A

generalised anxiety disorder

36
Q

what is the first line treatment for GAD

A

consider a SSRI

Start slowly e.g. paroxetine 5-10mg/d or escitalopram 5mg/d for a week or so, then increasing stepwise over several weeks as tolerated

Allow 8/52 for response

37
Q

what is the first line pharmaceutical treatment for PTSD

A

Sertraline 50-200mg/d

Needs long-term treatment as relapse is common

38
Q

what do you avoid in PTSD

A

Avoid BDZs as these can be counter-productive and ineffective, except in low dose in the short-term

39
Q

what pharmaceutical treatment do you give for OCD

A

Only central serotonin enhancers are effective

40
Q

what is the first line management for social anxiety

A

SSRIs (e.g. escitalopram) and venlafaxine are licensed

4C - Psychiatry (15 decks)

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