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Psychopharmacology Flashcards

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1
Q

3 dopamine pathways and result if damaged?

A

Nigrostriatal -> Parkinson’s
Mesocortical -> negative Sx of psychosis
Mesolimbic -> positive Sx of psychosis

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2
Q

Which areas of the brain are key in dopamine related pathology

A

Frontal cortex

Substantia nigra, striatum, nucleus accumbens, hippocampus

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3
Q

What are the functions of dopamine?

Theory that excess dopamine causes?

A

Reward, pleasure, fine tune motor, compulsion, persevaition

Schitz

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4
Q

Key areas of brain with serotonin

A

Frontal cortex

Nucleus accumbens, raphe nucleus

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5
Q

Functions of serotonin

A

Mood, memory processing, sleep, cognition

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6
Q

Which antihistamine is used in psychosis and mania ? Other name?

A

Chlorpromazine

‘Thorazine’

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7
Q

How do antipsychotics work?

A

Block post synaptic D2 receptors

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8
Q

General difference in which Sx they treat ? And ESPEs ? For 1st vs 2nd gen antipsychotics

A

1st - better for positive

2nd - better for positive and negative - less ESPEs

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9
Q

Egs of 1st gen antipsychotics

A

Haloperidol
Chlorpromazine
Prochloroperazine
Pipothiazine

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10
Q

Egs of 2nd gen antipsychotics

A

Olanzapine
Risperidone
Quentiapine
Clozapine

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11
Q

Which antipsychotic is used for drug resistant psychosis? What might it cause?

A

Clozapine

Neutropenia -> close monitoring

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12
Q

Overactive mesolimbic pathway in schitzophrenia causes?

A

Delusions and hallucinations

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13
Q

Under active mesocortical pathway in schitzophrenia causes?

A

Blunting, anhedonia, apathy

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14
Q

How does a blockade reduce positive Sx in schitz

A

Decreases dopamine in mesolimbic pathway

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15
Q

General side effects of antipsychotics

A

Anticholinergic
Dry mouth
Decreased sweating
Tachycardia

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16
Q

What does ESPE stand for?

What are the 4 types and usual time frame for them?

A

Acute dystonic reaction - hours
Parkinsonism - days
Akasthisia - days-weeks
Tarditive dyskinesia - Months-years

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17
Q

What happens in acute dystonic reaction?

A

Muscle spasm
Acute torticolis (abnormal head / neck position)
Ocular gyratic crisis (upward deviation of eyes)

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18
Q

What do you see in Parkinsonism (ESPE)

A

Tremor

Bradykinesia

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19
Q

What is akathisia? Issue with this?

A

Reslestness - pacing and agitation

It’s often intolerable

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20
Q

What is seen in tarditive dyskinesia

A

Grimacing, tongue protrusion, lip smacking

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21
Q

What hormone is controlled by dopamine? What happens when you have an excess?

A

Prolactin

Gallactorrhoea, gynacomastia, sexual dysfunction

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22
Q

How long does it normally take for antidepressants to take effect

A

3-6 months

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23
Q

What two neurotransmitters are involved in depression

A

Decreased serotonin and noradrenaline

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24
Q

Egs of SSRIs

A

Sertraline, citalopram, escitalopram, fluoxetine

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25
Q

What is the first line treatment for depression?

A

SSRIs

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26
Q

What are side effects of SSRIs

A

GI upset / bleeding , insomnia, suicidal thoughts, arrhythmias

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27
Q

What is the bad possible side effect of SSRIs ? What symptoms do you get?

A

Serotonin syndrome
Altered mental state, neuromuscular excitations, autonomic hyperactivity
(Confusion, agitated, dilated pupils, nausea, diarrhoea, tachycardia, sweating, tremor ….)

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28
Q

Managment of serotonin syndrome

A

IV fluids
Removal of causative drug
Benzodiazepine -> reduce agitation / seizures
Severe cases -> cyproheptadine (periactin) (blocks serotonin production )

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29
Q

Egs of SNRIs

A

Venlafaxine, duloxetine

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30
Q

Side effects of SNRIs

A

GI, headaches, abnormal dreams, insomnia

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31
Q

What are MAOIs? What do they do?

A

Monoamine oxidase inhibitors

Block breakdown of monoamines (dopamine, serotonin, noradrenaline)

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32
Q

What are the side effects of MAOIs? What also needs to be considered?

A 
Weight gain, sexual dysfunction, sleep disturbance 
Hypertensive crisis (Tyramine rich foods)
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33
Q

Egs of some foods high in tyramine

A

Cheese, beer, fish, wine,

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34
Q

Example of a tricyclic? How do they work?

A

Amitriptaline

Decrease re-uptake of serotonin and NA -> increased availability for neurotransmitters

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35
Q

Which antidepressant is often used for neuropathic pain?

A

Amitriptyline

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36
Q

What mechanism for side effects with tricyclics ? Egs?

A

Block muscarinic and cholinergic receptors

Dry mouth, constipation, urinary retention, sedation, hypotension, ecg changes

37
Q

Egs of mood stabilisers

A

Lithium, Sodium valproate, carbamazepine, lamotrigine

38
Q

What is used for acute treatment of mania?

A

Lithium

39
Q

Things to remember when using lithium

A

L - level 0.6-1mmol/L
I - insipidus (nephrogenic diabetes)
T- tremors
H - hydration (dry mouth, diarrhoea, thirst)
I - increased GI, skin, memory problems
U - under active thyroid
M - metallic taste / mums beware (ebsteins phenomena )

40
Q

What is ebsteins anomaly?

A

Congenital heart defect

Tricuspid valve leaflets displaced towards right ventricle

41
Q

What are the risk for lithium toxicity

A

Sudden dehydration - eg on holiday
Overdose
Other medications
Systemic illness

42
Q

Sx of lithium toxicity ?

A

Tremor, hypereflexia, seizures, heart block

43
Q

Management of lithium toxicity

A

Rehydrate, haemodialysis , stop lithium

44
Q

Typical / atypical antipsychotic which reduce D2/D3 transmission the most?

A

Typical

45
Q 
Which class of antipsychotic is the most potent antagonist for...
SHT2a? Cholinergic, adrenic, histaminergic?
A

SHT2a - atypical

C, A, H - typical

46
Q

Usual choice for aggressive behaviour on wards?

A

Haloperidol ± benzodiazepine

47
Q

Why are most antipsychotics not used in dementia? Which can be used and for how long?.

A

Risk of stroke and impairment of glycaemic control

Risperidone - <6wks

48
Q

Common classes and side effects of antipsychotics

A

Anti cholinergic - Dry mouth, urinary retention, constipation, confusion
Cardiac - prolonged QT -> arrhythmia
Antihisaminergic - sedation
Antiadrenic - impotence, postural hypotension
Neuroleptic malignant syndrome - hyper Pyrex is, autonomic instability, confusion, increased muscle tone/serum creatine phosphokinase

49
Q

What side effects of antipsychotics are the most troublesome for patients

A

MOvement disorders, weight gain, sexual dysfunction, sedation

50
Q

Why do typical antipsychotic have more ESPEs?

A

More potent dopaminergic effects

51
Q

Which antipsychotic particularly bad for postural hypotension

A

Chlorpromazine

52
Q

What should be monitored with long term antipsychotics?

A

BMI, ECG,

bloods (FBC, U&E), lipids, LFTs, glucose, HbA1C, prolactin

53
Q

Major side effects of clozapine? Others?

A

Seizures, agranulocytosis

Hypersalivation, constipation, hypo/per tension, fever, nausea, nocturnal enuresis, weight gain

54
Q

How long should you stay on antipsychotics

A

2 years

55
Q

Why do you get GI bleeding with SSRIs?

A

Inhibit platelet aggregation

56
Q

What is the risk of SSRIs in older people?

A

Hyponatraemia

57
Q

Egs of antimanic drugs?

A

Lithium, valproic acid, lamotrigine

58
Q

Uses for lithium ? What do you need to monitor ?

A 
affective disorder (prophylaxis), acute mania, schitzoaffective, aggression 
-Augmentation of antidepressants in resistant depression

Thyroid and renal function

59
Q

What to do in lithium toxicity?

A

Cessation of lithium, fluid therapy (restore GFR)

60
Q

Which drugs have adverse interactions with lithium?

What are some other CIs

A

NSAIDs, calcium channel blockers, some Abx

Renal, cardiac, thyroid, Addison’s disease

61
Q 
Lithium concentration levels 
Ineffective
Therapeutic
Toxic 
What can cause the level to go toxic?
A

<0.4mmol/L
0.4-1.0
>1.0

Dehydration / diuretics

62
Q

Signs of lithium toxicity ?

A

D&V, tremor, ataxia, slurred speech, drowsy, confusion, coma

63
Q

When is valproic acid often used?> what are common side effects?

A

Bipolar prophylaxis

Nausea, gastric irritation, diarrhoea, weight gain

64
Q

When is lamotrigine often used? Side effects?

A

Depressive prophlaxis

Stephen Johnson syndrome, aseptic meningitis, drowsiness, Diplopoda, leukopenia, insomnia, nausea

65
Q

Bar the side effects what is the other important consideration with lamotrigine?

A

Affects metabolism of other drugs - including oral contraceptives
-> need alternative contraception

66
Q

Are all antimanic teratogenic

A

Yes

67
Q

Usual drug for ADHD ? Side effects

A

Methylphenidate
(Atomoxetine is other)

Decreased appetite, weight loss, anxiety, agitation, insomnia

68
Q

Benzodiazepines indications? What should you do before prescribing?

A

Insomnia, GAD (short term), alcohol withdrawal, violent behaviour
-2nd line in refractory epilepsy

Exclude underlying conditions Eg depression

69
Q

Usual method of administration for benzodiazepines ? When would you use alternative?

A

Oral

Violent / status eplileptus

70
Q

Egs of short acting vs long acting benzodiazepines

A

Short - Lorazepam, oxazepam

Long - Diazepam, nitrazepam

71
Q

What is zopiclone

A

Anticonvulsant / muscle relaxant

72
Q

What is buspirone used for ? Mechanism?

A

Short term treatment of anxiety

SHT1 partial agonist

73
Q

What is the similar mechanism for benzodiazepines, zopiclone, buspirone?

A

Potential GABA

74
Q

Benzodiazepines side effects

A

Drowsiness / light headed next day, amnesia, dependence, disinhibition, ataxia (falls risk indicator)

Potential alcohol / sedatives so can be dangerous

75
Q

Signs of a benzo overdose? What would you give?

A

Respiratory depression, dysarthria, ataxia, drowsiness

Flumazenil (benzo receptor antagonist)

76
Q

Sx of benzo withdrawal?

A

Anxiety, shakiness, abdo cramps

Sometimes - persecutory hallucinations, seizures, perceptual disturbance

77
Q

How long should benzos be prescribed for ideally ?

A

No more than 2-4 weeks as can take months to wean off if dependant

78
Q

What other common complaint do patients have after coming off benzos

A

Increased dreaming - rebound affect as benzos inhibit REM

79
Q

Indications for ECT

A

Severe depressive illness

Prolonged / severe mania, catatonia, unresponsive depression

80
Q

What needs to happen after ECT in depression

A

Subsequent treatment to prevent relapse

81
Q

What are the physiological effects of ECT

A

Serotonin, noradrenalin, dopamine release
Hypothalmic / pituitary hormone release
Synapto / neuro genesis
Transient increase in blood brain barrier permeability

82
Q

When does the patient have to consent for ECT ?

A

Before each treatment

83
Q

When can ECT be given to a patient lacking capacity?

A

Doesn’t conflict with advance decision
+
Independent consultant agrees / before agreement in an emergency

84
Q

CIs for ECT

A

Raised ICP
Recent stroke
Recent mi
Crescendo angina

85
Q

What is the antidote for benzodiazepines ?

A

Flumanzenil - competitive inhibitor

86
Q

Features / complications / management of neuroleptic malignant syndrome

A

Develops within 10 days of treatment with antipsychotics

CNS - fluctuating consciousness, stupor

Autonomic - hyperreflelxia, unstable BP, bradycardia, sweating / salivation, urinary incontinence

Motor - rigidity, dysphasia, dyspnea

Blood test - raised WBC and CPK

Complications - pneumonia, CV collapse, thromboembolism , renal failure

Mx
1 - stop drug
2- maintain fluid balance
3 - diazepam for muscle rigidity
4 - dantrolene for malignant hyperthermia
5-bromocriptine to get rid of dopamine blockade

87
Q

Hypnotic drugs

A

Benos, Z drugs
Melatonin

Axiolytics in short term but NOT FOR GENERALISED.

Anxiety disorders are CBT&raquo_space; SSRIs&raquo_space; pregabalin

88
Q

Drugs for mood stabilisers

A

lithium
olanzapine
anticonvulsants -carc, valproate lamotrigine

89
Q

third line after 2x SSRIs

A

mirtazpeine or another antidepressant that isn’t an SSRI

Psych (14 decks)

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