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MD3 > Psychopharmacology > Flashcards

Psychopharmacology Flashcards

1
Q

Describe the difference between “relapse” and “recurrence” in the ocntext of depressive illness

A
  • Relapse - in the acute (6-12 week) or continuation (4-9 month) phase
  • Recurrence - in the maintenance (1+ year) phase
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2
Q

Describe how you might base the decision of duration of antidepressant therapy for patient with depressive illness

A
  • 1st episode - 6-12 months tapering
  • 2 episodes in 5 years - 3 years maintenance
  • 3+ episodes in 5 years - 5 years maintenance
  • Psychosis/suicidality - long-term treatment
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3
Q

If you thinking about commencing an antipsychotic drug, what investigations would you do before writing the script?

A
  • Side-effect of most anti-psychotics is weight gain
  • BMI, BP, fasting glucose, lipid profile, LFT, UEC, FBE
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4
Q

Which atypical antipsychotics have less risk of weight gain?

A
  • Risperidone, aripiprazole (some others)
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5
Q

Describe the onset and efficacy of antidepressant drugs.

A
  • Slow onset (2-4 weeks)
  • Response rates of 70-80% (more effective in moderate-severe depression)
  • No difference between members of the same class
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6
Q

What are some of the symptoms of a severe (biological/melancholic) depression?

A

Early morning awakening, diurnal variation, psychomotor retardation

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7
Q

What are some of the common side effects of SSRIs?

A
  • Headache, dizziness, nausea, loose stools, constipation, somnolence and insomnia, sweating, dry mouth, tremor, anxiety, restlessness, sexual dysfunction
  • Sertraline and escitalopram are the best tolerated by patients
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8
Q

What are some of the side effects of dual-acting SSRI/SNRIs?

A
  • Serotonin effects: headache, dizziness, nausea, loose stools, constipation, somnolence and insomnia, sweating, dry mouth, tremor, anxiety, restlessness, sexual dysfunction
  • Noradrenergic effects: hyponatraemia, palpitations, tachycardia, seizures
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9
Q

What are the symptoms of benzodiazepine withdrawal syndrome?

A
  • Anxiety, irritability, insomnia, palpitations, hypersensitivity to sensory stimuli, nausea, headache, tremor, sweating)
  • Reducing spontaneously within 1 to 4 weeks of stopping the benzodiazepine
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10
Q

Outline the treatment of generalised anziety disorder

A
  • Psychotherapy
  • Pharmacotherapy
    1. SSRI or venlafaxine
    2. MAOI or buspirone
    3. Diazepam
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11
Q

What are some of the adverse effects of benzodiazepines?

A
  • Disinhibition, psychomotor/cognitive impairment, withdrawal phenomena, rebound insomnia
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12
Q

List some first generation antipsychotics. What is the broad mechanism of action of these? What are the undesirable side-effects?

A
  • Chlorpromazine, flupenthixol, fluphenazine, haloperidol, zuclopenthixol
  • B-blockade (mostly DA-ergic)
  • Hyperprolactinaemia, extrapyramidal effects, weight gain, hyperglycaemia
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13
Q

List some second generation antipsychotics. What is the broad mechanism of action? What are some of the undesirable side-effects?

A
  • Amisulpride, aripiprazole, asenapine, clozapine, olanzapine, paliperidone, quetiapine, risperadone, sertindole, ziprasidone
  • B-blockade (DA-ergic as well but more selective just to basal ganglia)
  • Dyslipidaemia, hyperglycaemia, weight gain
  • Autonomics (orthostatic hypotension, sedation)
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14
Q

What antipsychotics are more likely to weight gain and cardiometabolic derangements? Which would you consider swapping to?

A
  • Clozapine, olanzapine, paliperi/risperidone
  • Aripiprazole, asenapine
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15
Q

What are some of the indications for lithium?

A
  • Bipolar disorder and unipolar depression prophylaxis, hypomanic episodes, augmentation of antidepressant drugs (psychiatrist only), schizoaffective and schizophrenia
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16
Q

What are some of the complications of lithium use? With this in mind, what tests should you order before and during treatment?

A
  • TFTs, UEC, urinalysis, creatinine clearance, FBE, ECG, with repeated TSH, creatinine)
    • While taking - trough levels
  • Memory problems, thirst, polyuria, tremor, drowsiness, weight gain, metallic taste, sexual problems
  • Renal toxicity, hypothyroidism or NT goitre, T1 pregnancy complications, diabetes insipidus
17
Q

What are the signs/symptoms of lithium toxicity? What can trigger it?

A
  • Lithium toxicity - N+V progressing through ataxia, dysarthria to stupor/coma/seizures
  • Fine tremor and hyperreflexia progresses to paralysis, rigidity, CV collapse, renal failure
  • Can be triggered by dehydration, NSAIDs, ACEIs
18
Q

What are some of the side-effects of valproate use?

A
  • Side-effects - sedation and hyperneuro effects, GI disturbance, alopecia, PCOS, hyperinsulin/androgen/lipidaemia, hepatotoxicity, pancreatitis
19
Q

List some pharmacological agents that can trigger Stevens-Johnson’s syndrome

A
  • Carbamazepine, lamotrigine, topiramate, barbiturates, fluoxetine, some NSAIDs
20
Q

What tends to distinguish atypical antipsychotics from typical antipsychotics?

A
  • Decreased incidence of extrapyramidal symptoms
  • Potential effectiveness in negative syndromes and cognitive domains
  • Better tolerabilility and therefore compliance
  • No difference in efficacy in treating positive symptoms
21
Q

Which drugs in particular should raise suspicion of serotonin syndrome?

A
  • SSRI/SNRI
  • MAOIs
  • TCAs
  • Lithium
  • Champix
22
Q

Which symptoms of schizophrenia do atypical antipsychotics work best for? Clozapine?

A
  • Positive symptoms
  • Positive AND negative
23
Q

What are some of the possible consequences of clozapine therapy?

A
  • Metabolic syndrome: hypertension, hyperlipidaemia, impaired glucose tolerance, central obesity
  • Myocarditis (eosinophilic)
  • Agranulocytosis
24
Q

What monitoring is required for clozapine therapy?

A
  • LFTs, lipids, BMI, BP, ECG, FBE, echo
  • FBE - weekly for 18 weekly then monthly
  • Lipids/ECG/echo 6/12ly
25
Q

What kind of myocarditis can clozapine cause? What does smoking do to serum levels?

A
  • Eosinophilic
  • Decreases (enzyme inducing)

MD3 (133 decks)

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