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Psychopharmacology Flashcards

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
What is the first line treatment for depression?
SSRIs
26
What are side effects of SSRIs
GI upset / bleeding , insomnia, suicidal thoughts, arrhythmias
27
What is the bad possible side effect of SSRIs ? What symptoms do you get?
Serotonin syndrome Altered mental state, neuromuscular excitations, autonomic hyperactivity (Confusion, agitated, dilated pupils, nausea, diarrhoea, tachycardia, sweating, tremor ....)
28
Managment of serotonin syndrome
IV fluids Removal of causative drug Benzodiazepine -> reduce agitation / seizures Severe cases -> cyproheptadine (periactin) (blocks serotonin production )
29
Egs of SNRIs
Venlafaxine, duloxetine
30
Side effects of SNRIs
GI, headaches, abnormal dreams, insomnia
31
What are MAOIs? What do they do?
Monoamine oxidase inhibitors | Block breakdown of monoamines (dopamine, serotonin, noradrenaline)
32
What are the side effects of MAOIs? What also needs to be considered?
``` Weight gain, sexual dysfunction, sleep disturbance Hypertensive crisis (Tyramine rich foods) ```
33
Egs of some foods high in tyramine
Cheese, beer, fish, wine,
34
Example of a tricyclic? How do they work?
Amitriptaline | Decrease re-uptake of serotonin and NA -> increased availability for neurotransmitters
35
Which antidepressant is often used for neuropathic pain?
Amitriptyline
36
What mechanism for side effects with tricyclics ? Egs?
Block muscarinic and cholinergic receptors | Dry mouth, constipation, urinary retention, sedation, hypotension, ecg changes
37
Egs of mood stabilisers
Lithium, Sodium valproate, carbamazepine, lamotrigine
38
What is used for acute treatment of mania?
Lithium
39
Things to remember when using lithium
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
What is ebsteins anomaly?
Congenital heart defect | Tricuspid valve leaflets displaced towards right ventricle
41
What are the risk for lithium toxicity
Sudden dehydration - eg on holiday Overdose Other medications Systemic illness
42
Sx of lithium toxicity ?
Tremor, hypereflexia, seizures, heart block
43
Management of lithium toxicity
Rehydrate, haemodialysis , stop lithium
44
Typical / atypical antipsychotic which reduce D2/D3 transmission the most?
Typical
45
``` Which class of antipsychotic is the most potent antagonist for... SHT2a? Cholinergic, adrenic, histaminergic? ```
SHT2a - atypical | C, A, H - typical
46
Usual choice for aggressive behaviour on wards?
Haloperidol ± benzodiazepine
47
Why are most antipsychotics not used in dementia? Which can be used and for how long?.
Risk of stroke and impairment of glycaemic control | Risperidone - <6wks
48
Common classes and side effects of antipsychotics
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
What side effects of antipsychotics are the most troublesome for patients
MOvement disorders, weight gain, sexual dysfunction, sedation
50
Why do typical antipsychotic have more ESPEs?
More potent dopaminergic effects
51
Which antipsychotic particularly bad for postural hypotension
Chlorpromazine
52
What should be monitored with long term antipsychotics?
BMI, ECG, | bloods (FBC, U&E), lipids, LFTs, glucose, HbA1C, prolactin
53
Major side effects of clozapine? Others?
Seizures, agranulocytosis Hypersalivation, constipation, hypo/per tension, fever, nausea, nocturnal enuresis, weight gain
54
How long should you stay on antipsychotics
2 years
55
Why do you get GI bleeding with SSRIs?
Inhibit platelet aggregation
56
What is the risk of SSRIs in older people?
Hyponatraemia
57
Egs of antimanic drugs?
Lithium, valproic acid, lamotrigine
58
Uses for lithium ? What do you need to monitor ?
``` affective disorder (prophylaxis), acute mania, schitzoaffective, aggression -Augmentation of antidepressants in resistant depression ``` Thyroid and renal function
59
What to do in lithium toxicity?
Cessation of lithium, fluid therapy (restore GFR)
60
Which drugs have adverse interactions with lithium? | What are some other CIs
NSAIDs, calcium channel blockers, some Abx Renal, cardiac, thyroid, Addison’s disease
61
``` Lithium concentration levels Ineffective Therapeutic Toxic What can cause the level to go toxic? ```
<0.4mmol/L 0.4-1.0 >1.0 Dehydration / diuretics
62
Signs of lithium toxicity ?
D&V, tremor, ataxia, slurred speech, drowsy, confusion, coma
63
When is valproic acid often used?> what are common side effects?
Bipolar prophylaxis | Nausea, gastric irritation, diarrhoea, weight gain
64
When is lamotrigine often used? Side effects?
Depressive prophlaxis | Stephen Johnson syndrome, aseptic meningitis, drowsiness, Diplopoda, leukopenia, insomnia, nausea
65
Bar the side effects what is the other important consideration with lamotrigine?
Affects metabolism of other drugs - including oral contraceptives -> need alternative contraception
66
Are all antimanic teratogenic
Yes
67
Usual drug for ADHD ? Side effects
Methylphenidate (Atomoxetine is other) Decreased appetite, weight loss, anxiety, agitation, insomnia
68
Benzodiazepines indications? What should you do before prescribing?
Insomnia, GAD (short term), alcohol withdrawal, violent behaviour -2nd line in refractory epilepsy Exclude underlying conditions Eg depression
69
Usual method of administration for benzodiazepines ? When would you use alternative?
Oral | Violent / status eplileptus
70
Egs of short acting vs long acting benzodiazepines
Short - Lorazepam, oxazepam | Long - Diazepam, nitrazepam
71
What is zopiclone
Anticonvulsant / muscle relaxant
72
What is buspirone used for ? Mechanism?
Short term treatment of anxiety | SHT1 partial agonist
73
What is the similar mechanism for benzodiazepines, zopiclone, buspirone?
Potential GABA
74
Benzodiazepines side effects
Drowsiness / light headed next day, amnesia, dependence, disinhibition, ataxia (falls risk indicator) Potential alcohol / sedatives so can be dangerous
75
Signs of a benzo overdose? What would you give?
Respiratory depression, dysarthria, ataxia, drowsiness Flumazenil (benzo receptor antagonist)
76
Sx of benzo withdrawal?
Anxiety, shakiness, abdo cramps | Sometimes - persecutory hallucinations, seizures, perceptual disturbance
77
How long should benzos be prescribed for ideally ?
No more than 2-4 weeks as can take months to wean off if dependant
78
What other common complaint do patients have after coming off benzos
Increased dreaming - rebound affect as benzos inhibit REM
79
Indications for ECT
Severe depressive illness | Prolonged / severe mania, catatonia, unresponsive depression
80
What needs to happen after ECT in depression
Subsequent treatment to prevent relapse
81
What are the physiological effects of ECT
Serotonin, noradrenalin, dopamine release Hypothalmic / pituitary hormone release Synapto / neuro genesis Transient increase in blood brain barrier permeability
82
When does the patient have to consent for ECT ?
Before each treatment
83
When can ECT be given to a patient lacking capacity?
Doesn’t conflict with advance decision + Independent consultant agrees / before agreement in an emergency
84
CIs for ECT
Raised ICP Recent stroke Recent mi Crescendo angina
85
What is the antidote for benzodiazepines ?
Flumanzenil - competitive inhibitor
86
Features / complications / management of neuroleptic malignant syndrome
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
Hypnotic drugs
Benos, Z drugs Melatonin Axiolytics in short term but NOT FOR GENERALISED. Anxiety disorders are CBT >> SSRIs >> pregabalin
88
Drugs for mood stabilisers
lithium olanzapine anticonvulsants -carc, valproate lamotrigine
89
third line after 2x SSRIs
mirtazpeine or another antidepressant that isn't an SSRI

Psych (14 decks)

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