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Psychopharmacology Flashcards

1
Q

What are the 6 different types of receptors in the brain and what is their main action?

A

GABA - inhibitory neuron

Glutamate - excitatory neuron

Serotonin + Noradrenaline - mood (low levels = depression).

Dopamine - movement (low = Parkinsons, high = Huntingtons)

Ach - memory (low = Dementia).

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2
Q

SSRIs

  • MOA
  • Used in
  • examples
  • SE
  • Interactions
  • OD risk
A

MOA

Selective antagonist of serotonin receptors on post-synaptic cleft, decreasing reuptake of 5HT into presynaptic cleft –> increased 5HT in cleft –> increased stimulation of post synaptic neurons by 5HT -> increased mood.

Used in

  • first line for depression.

Examples

  • fluoxetine (prozac)
  • sertraline.

SE

  1. GI effects: vomiting, diarrhoea, constipation, upset.
  2. Sexual dysfunction: erectile dysfunction, decreased libido, anorgasmia.
  3. Weight gain.
  4. Insomnia, restlessness.
  5. Increased suicidal ideation in first weeks.

Interactions

  • MAOIs: 5HT syndrome.
  • TCAs.

OD risk: low.

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3
Q

What are the symptoms of serotonin syndrome?

A

Cognitive

  • Dysfunction
  • restlessness
  • insomnia
  • agitation.

Hyperthermia

Nerves:

  • hyperreflexia
  • myoclonus
  • ataxia
  • tremor, shivering.

GI

  • dysfunction: vom, diarrhoea

Rhabdomyolysis (breakdown of muscle tissue).

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4
Q

SNRIs

  • MOA
  • Used for
  • egs
  • SE
  • OD risk
A

MOA

Acts on post synaptic receptors, decreasing reuptake of 5HT + Noradrenaline into presynaptic cleft-> increased 5HT+Noradrenaline in post synaptic cleft -> increased neurotransmission of 5HT + Noradrenaline.

Used for

  • severe melancholic depression.

Egs

  • venlofaxine +++
  • duloxetine

SE

5HT

  • weight gain,
  • sexual dysfunction
  • GI upset.

Norad

  • restlessness, insomnia.

OD RISK

  • low
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5
Q

MAOIs

  • MOA
  • used for
  • egs
  • SE
  • interactions
  • OD risk
A

MOA

inhibitor of mono-oxidase inhibitor-> stops breakdown of 5HT + Norad breakdown in synaptic cleft-> increased neurotransmission.

Used for

  • atypical depression

Egs

  • moclobemide

SEs

  • Hypertensive crisis if diet high in tyramine. “cheese crisis”

Interactions

  • SSRIs

OD RISK

high.

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6
Q

TCAs

  • MOA
  • Used for
  • Egs
  • SE
  • Interactions
  • OD risk
A

MOA

Selective antagonist of serotonin receptors on post-synaptic cleft, decreasing reuptake of 5HT into presynaptic cleft –> increased 5HT in cleft –> increased stimulation of post synaptic neurons by 5HT -> increased mood.

VERY NON SPECIFIC - ALSO ANTAGONISES ON:

H1, alpha-adrenoreceptors (Adrenaline), Ach receptors.

Used for

  • 2nd line: severe melancholic depression.

Egs

  • doxepin

SE

5HT: GI upset, sexual dysfunction, weight gain.

Norad: restlessness, insomnia, headache.

H1: weight gain, sedation.

Ach: dry mouth, blurred vision, constipation, glaucoma, urinary retention.

Adrenoreceptors: postural hypotension, dizziness, reflex hypotension

INTERACTIONS

  • SSRIs

OD risk

  • high.
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7
Q

NRI

  • MOA
  • EG
  • SE
A

MOA

inhibits reuptake of noradrenaline

EG

riboxetine

SE

restlessness, headache, insomnia.

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8
Q

NDRI

  • moa
  • use
  • eg.
A

MOA

noradrenaline + dopamine reuptake inhibitor.

use

smoking cessation

eg

buproprion.

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9
Q

What are other non specific effects of anti-depressants?

A

Electrolyte disturbance (hyponatremia)

Heart arrhythmias

Lowered seizure threshold.

Interactions with other medications (metabolised by cytochrome p450)

Discontinuation Syndrome.

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10
Q
A
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11
Q

Anxiolytics

  • CLASSES
  • MOA
  • EGS
  • SE
  • INDICATIONS
A
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12
Q

What are the EPSEs?

A

AAPT

Acute dystonia (muscle rigidity, ie - neck)

Akisthesia (restlessness, not distressing)

Parkinsonian sx (resting tremor, rigidity, bradykinesia- slowness of movement)

Tardive dyskinesia (unwanted muscle movements, tongue lips face neck - acutely distressing to the pt).

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13
Q

What are the primary interactions of anti-depressants?

A

SSRIs

  • MAOIs
  • TCAs

p450 system:

  • most are metabolised by p450.
  • may result in induction/inhibition of metabolic enzymes.
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14
Q

Antipsychotics: ATYPICAL

MOA

Indications

Egs

SE

Method of use.

A

MOA

Dopamine receptor antagonist, low affinity. –> decreased negative symptoms, decreased EPSE, increased generalised effects.

INDICATIONS

  • First line treatment of schizophrenia.
  • Sedating: also used in mania + anxiety disorders.

EGs

  • olanzepine
  • respiradone
  • clozapine (not first line)

SE

  1. Histamine antagonist: sedation.
  2. 5HT antagonist: GI effects, metabolic effects - weight gain.
    - impaired glucose tolerance
    - hyperlipidemia
    - weight gain

–> especially clozapine + olanzapine.

  1. Ach antagonist: dry mouth, constipation, blurred vision, urinary retention.
  2. alpha-adrenoreceptor antagonist: postural hypotension, dizziness.
  3. IM or PO.
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15
Q

Antipsychotics: TYPICAL

MOA

Indications

egs

SE

A

MOA

  • high affinity D2 receptor antagonist -> effect the nigrostriatal pathway -> decrease in positive symptoms.

Indications

  • psychosis: only if 2 atypical antipsychotics have been tried and not given results.

EGS

  • haloperidol
  • chlorpromazine.

SE

  1. EPSEs
  2. Hyperprolactinemia
    - gynocomastia
    - galactorrhea
    - infertility.
    - sexual dysfunction
    - osteoporosis
  3. Reduction in seizure threshold.
  4. Hepatic effects.
  5. Neuroleptic malignant syndrome
    - muscle rigidity
    - hyperthermia
    - sweating
    - dysphagia
    - hypertension
    - tremor
    - elevated CK

IM (haloperidol) or PO.

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16
Q

What are the main interactions to consider in antipsychotic use?

A

cytochrome p450:

  • smoking upregulates p450 and reduces serum concentration - higher doses are required for clinical effect.
  • if patient stops smoking - must see doctor first!!
17
Q

LITHIUM

MOA

Indications

SE

Interactions

Monitoring

OD Risk.

A

MOA

change in

  • receptor concentrations

- cellular second messengers

–> stabilisation of neuronal cell membranes.

INDICATIONS

Bipolar:

  • Acute mania
  • Acute depression (context: bipolar disorder)
  • Long term prophylaxis.

Depressive disorders:

  • augmentation therapy.

SE

Early

  • fatigue
  • metallic taste, thirst
  • tremor
  • polyuria
  • drowsiness.

Late

  • hypothyroidism + goitre
  • weight gain
  • hair loss
  • oedema
  • hypokalemia
  • memory impairment.

TOXICITY

  • diarrhoea
  • anorexia
  • dysarthria
  • ataxia
  • tinnitus
  • neurological damage
  • vomiting
  • blurred vision
  • confusion
  • circulatory failure
  • death.

INTERACTIONS

  • diuretics
  • NSAIDS

OD risk

  • high.

Monitoring

  • narrow therapeutic range
  • fatal in high doses
  • blood test 5 days after therapy/dose change.
  • therapeutic range: 0.5-1.2 mEq/L
  • acute mania levels
  • levels up to 0.8 ideal.
18
Q

VALPROATE + CARBAMAZEPINE

MOA

Indications

SE

interactions

monitoring

A

VALPROATE

moa - upregulation of effects of GABA, reduction in glutamate.

indications - LT prophylaxis of bipolar.

SE - irritability, tremor, weight gain, alopecia, amenorrhea, hepatotoxicity, increased neural tube defects (pregnancy)

CARBAMAZEPINE

moa - na + k channel change - increases actions of GABA

indications - LT prophylaxis of bipolar.

SE - dizziness, diplopia, ataxia, cognitive impairment, headache, nausea, vomiting, constipation, SIADH, choestatic jaundice, hypersensitivity rashes.

19
Q

CLOZAPINE

  • criteria for use
  • monitoring
  • side effects
A

CRITERIA FOR USE

  • treatment resistant psychosis
  • tardive dyskinesia.

MONITORING

  • FBC
  • ECG
  • ECHO

SE (serious)

  1. metabolic effects
  2. myocarditis
  3. agranulocytosis + neutropenia.

Common

  • constipation
  • metabolic effects
  • excess saliva production.
20
Q

Which medications are used to treat bipolar disorder?

A

Mood stabilisers

  • lithium
  • valproate (anticonvulsant)
  • carbamazepine

Antipsychotics

Benzodiazepines

Antidepressants

  • used with caution: may precipitate a manic episode.
21
Q

which antidepressant has both irreversible and reversible categories?

Mental Health (5 decks)

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