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MRCPsych - paper A > Psychopharmacology > Flashcards

Psychopharmacology Flashcards

1
Q

Amisulpride - class

A
  • Benzamide
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2
Q

Aripiprazole - class

A
  • Arylpiperidylindole
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3
Q

Asenapine

A
  • Acute mania in bipolar I, sublingual
  • High affinity for 5-HT, alpha-adrenoreceptors, D1-4 and H1/H2.
  • Less efficacious than risperidone or olanzapine
  • Higher EPSEs than most atypicals, unlikely to raise prolactin, less weight gain
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4
Q

Clozapine - class

A
  • Dibenzodiazepine
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5
Q

Lurasidone - mechanism and side effects

A
  • Antagonist at alpha-receptors, D1/2 and 5-HT

- EPSEs likely, less weight gain and QTc

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6
Q

Olanzapine - class and mechanism

A
  • Thienobenzadiazepine

- Broad receptor antagonism

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7
Q

Paliperidone

A
  • Main hepatic metabolite of risperidone, lower bioavailability (twice dose)
  • Useful in hepatic failure, renally excreted
  • Higher EPSEs and prolactin; mod weight gain, no QTc changes.
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8
Q

Quetiapine - class and mechanism

A
  • Dibenzothiazepine

- Broad receptor antagonism

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9
Q

Risperidone - class

A
  • Benzoxazole
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10
Q

Sertindole - side effects

A
  • Strict ECG monitoring due to QTc prolongation
  • Nasal congestion, decreased ejaculatory volume, postural hypotension
  • Occasionally raised LFTs
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11
Q

Thioridizine - class

A
  • Piperidine
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12
Q

Trifluoperazine - class

A
  • Piperizine
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13
Q

Haloperidol - class

A
  • Butyrophenone
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14
Q

Flupenthixol - class and use

A
  • Thioxanthene

- Depressed patients

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15
Q

Chlorpromazine - class

A
  • Aliphatic phenothiazine
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16
Q

Bupropion - mechanism

A

Norepinephrine-dopamine re-uptake inhibitor and nicotinic acetylcholine receptor antagonist

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17
Q

SSRIs - metabolism and side effects

A
  • Hepatically metabolised

- GI upset, sedation, dizziness, sexual dysfunction, SIADH, bleeding (platelets), convulsions, agitation

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18
Q

Venlafaxine - mechanism and side-effects

A
  • 5-HT and NARI

- Hypertension, seizures, dry mouth, urinary retention, sweating

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19
Q

Trazodone - mechanism

A
  • Weak 5-HT reuptake inhibition

- 5-HT2 antagonist, therefore lower sexual dysfunction than SSRIs

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20
Q

Modafinil

A

Psychostimulant used in narcolepsy, obstructive sleep apnoea, chronic shift work, adjunct in depression

Similar to amphetamines, but without dependence or tendency to precipitate psychosis

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21
Q

Mirtazapine - mechanism

A
  • Alpha adrenergic, 5-HT and H1 antagonist
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22
Q

TCAs - mechanism and metabolism

A
  • 5-HT reuptake inhibition and/or NA reuptake inhibition
  • Hepatically metabolised
  • alcohol potentiates
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23
Q

Moclobemide

A

Reversible MAOI with short half-life

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24
Q

Contraindications to MAOIs

A 
Cardiovascular or cerebrovascular disease
Phaeochromocytoma
Hyperthyroidism
Hepatic disease
Delirium
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25
Q

Side-effects of MAOIs

A

peripheral oedema, postural hypotension, nausea, sweating, tremor, insomnia

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26
Q

Causes of hypertensive crisis with MAOIs

A

Tyramine containing foods and phenylephrine

Treated with phentolamine, phenoxybenzamine or chlorpromazine

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27
Q

Side-effects of TCAs

A

Anticholinergic - dry mouth, blurred vision, constipation, retention

Antihistaminergic - sedation, weight gain

Alpha-adrenoceptor - postural hypotension

Cardiotoxicity - QTc, arrhythmias, ST-elevation

Neurotoxicity - delirium, movement disorders, seizures, coma

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28
Q

Mirtazapine - side-effcts

A

sedation, weight gain, abnormal dreams and blood dyscrasia

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29
Q

Trazodone - side-effects

A

GI upset, sedation, hypotension, priapism

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30
Q

Agomelatine - mechanism and monitoring

A
  • Agonist at melatonin MT receptors
  • Antagonist at 5-HT2C receptors
  • LFT monitoring required
31
Q

Symptoms of antidepressant discontinuation syndrome

A

sleep disturbance, increased dreams, GI disturbance, mood disturbance, EPSE, lethargy, headache

32
Q

Symptoms of serotonin syndrome

A

confusion, myoclonic jerks, hyperreflexia, pyrexia, sweating, autonomic instability, GI symptoms, mood changes

33
Q

Steady state of Lithium

34
Q

Consider bipolar maintenance treatment after…

A

2 illnesses in 2 years or
3 illnesses in 5 years or
1 severe illness

35
Q

Lithium drug interactions

A

NSAIDs
Diuretics
ACE inhibitors

36
Q

Serotonin receptor that is ligand gated

37
Q

Serotonin receptors associated with nausea

38
Q

Serotonin receptors associated with circadian rhythms

39
Q

Serotonin receptor associated with insomnia, agitation and sexual dysfunction

40
Q

Pregabalin

A

GABA analogue
High affinity for calcium channels
Eliminated unchanged by kidneys

41
Q

Buspirone

A

5-HT1A Partial agonist
Short half life
Nausea, headache, dizziness, akithisia

42
Q

Disulfiram

A

Bonds irreversibly to acetaldehyde dehydrogenase

43
Q

Clozapine - efficacy

A
  • Reduces positive SCZ Sx in 60% of resistant SCZ
44
Q

Clozapine - side effects

A
  • Sedation, postural hypotension, agranulocytosis, seizures, myocarditis, cardiomyopathy, hypersalivation
45
Q

Clozapine - interactions

A
  • Avoid carbamazepine, chloramphenicol,cytotoxics, benzodiazepines, depot antipsychotics
  • SSRIs and valproate may increase levels
46
Q

Amisulpride - mechanism

A
  • Selective D2/D3 antagonism

- 5-HT7 antagonism

47
Q

Amisulpride - side effects

A
  • Low EPSE and weight gain

- prolactinaemia at higher doses

48
Q

Aripiprazole - mechanism

A
  • High affinity D2 partial agonist

- High affinity 5-HT2A

49
Q

Aripiprazole - side effects

A
  • Low EPSE at all doses
  • may decrease prolactin
  • less weight gain than other antipsychotics
  • no QTc changes
50
Q

Olanzapine - pharmacokinetics and adverse effects

A
  • Levels reduced by smoking
  • Higher plasma levels in women for same dose
  • Low EPSEs and prolactin; high sedation, weight gain, antimuscarinc SEs, glucose dysregulation.
51
Q

Quetiapine - metabolite and side effects

A
  • Key metabolite (norquetiapine) is NARI

- Low EPSEs and prolactin; high dizziness, sedation, constipation

52
Q

Risperidone - mechanism

A
  • 5-HT2A/D2 antagonism
53
Q

Risperidone - side effects

A
  • Less DI Parkinsonism than typicals

- Tachycardia, weight gain, hyperprolactinaemia

54
Q

SSRI with lowest risk of interactions

A

Citalopram

55
Q

SSRIs (2) with highest risk of interactions

A

Fluoxetine and paroxetine

56
Q

Causes of tachycardia

A 
Clozapine
TCAs
MAOIs
Antiparkinsonian
Antipsychotics (generally the older ones)
57
Q

Causes of Torsades

A

Haloperidol
Thioridazine
Mesoridazine
Chlorpromazine

58
Q

Causes of bradycardia

A

SSRIs
Lithium
Cholinesterase inhibitors

59
Q

Causes of heart block

60
Q

Causes of ST segment changes

A

Thioridazine

Chlorpromazine

61
Q

Secondary amines

A

Desipramine
Nortriptyline
Protriptyline
Amoxapine

62
Q

Zopiclone - class

A

cyclopyrrolone

63
Q

Zopiclone - contraindications

A

unstable myasthenia gravis, respiratory failure, severe sleep apnoea syndrome, breastfeeding

64
Q

Least likely to cause hyponatraemia

A

MAOIs, agomelatine

65
Q

Antidepressants licensed in nocturnal enuresis (children)

A

Amitriptyline, Imipramine, Nortriptyline

66
Q

Antidepressant licensed for phobias

A

Clomipramine

67
Q

Antidepressant licensed for cataplexy

A

Clomipramine

68
Q

Antidepressants licensed for panic disorder and agoraphobia

A

Citalopram, Escitalopram, Sertraline, Paroxetine, Venlafaxine

69
Q

Antidepressants licensed for social anxiety

A

Escitalopram, Paroxetine, Sertraline, Moclobemide, Venlafaxine

70
Q

Antidepressants licensed for general anxiety

A

Escitalopram, Paroxetine, Duloxetine, Venlafaxine

71
Q

Antidepressants licensed for OCD

A

Escitalopram, Fluoxetine, Fluvoxamine, Paroxetine, Sertraline

72
Q

Antidepressant licensed for bulimia

A

Fluoxetine

73
Q

Antidepressant licensed for PTSD

A

Paroxetine, Sertraline

74
Q

Antipsychotics least likely to cause hyperprolactinaemia

A 
Clozapine
Aripiprazole
Quetiapine
Olanzapine
Ziprasidone

MRCPsych - paper A (7 decks)

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