Psychopharmacology Flashcards
What are the core symptoms of depression?
Low mood, anhedonia, decreased energy
What are the secondary symptoms of depression?
Low appetite, disturbed sleep, irritability, reduced libido, reduced concentration, hopelessness
What is the monoamine hypothesis?
Depression due to a deficiency of monoamine neurotransmitters - NA and serotonin
Evidence - certain drugs that deplete these could induce depression
MAOI block monoamine oxidase from destroying neurotransmitters
What is the neurotransmitter receptor hypothesis?
An abnormality in the receptors for monoamine transmission leads to depression
Depletion of neurotransmitter causes compensatory upregulation of post synaptic receptors
What are the types of antidepressants?
Monoamine oxidase inhibitors (used rarely now)
Monoamine uptake inhibitors (like SSRIs)
Give some examples of SSRIs
Fluoxetine, citalopram, paroxetine, sertraline
Which is the most selective of SSRIs?
Ciralopram
Name one advantage of fluoxetine
Long half life
Which is the most potent reuptake inhibitor?
Paroxetine
What are some side effects of SSRIs?
Anorexia, nausea, diarrhoea, precipitation of mania, some extrapyramidal syndromes
Can prolong QT interval?
What are the side effects of tricyclics antidepressants?
Sedation and impairment of psychomotor performance, reduction in glandular secretions, tachycardia, postural hypotension, constipation
What are some examples of SNRIs?
Venlafaxine and fluoxetine
(Second/third line drugs)
Dose dependent - lower doses serotonin action, higher doses NA
What are some side effects of SNRIs?
Same as SSRIs, sleep disturbance, increased BP, dry mouth
What are the main dopaminergic pathways?
Mesolimbic (emotion and behaviour)
Mesocortical (arousal and mood)
Nigrostriatal (the one in Parkinson’s)
Tuberoinfundibular (hypothalamus and pituitary)
What happens when a D2 antagonist acts on nigrostriatal pathway?
Extrapyramidal side effects, dyskinesia
Explain why a patient on D2 antagonists would experience sexual dysfunction
Tuberoinfundibular pathway is dopaminergic
Dopamine inhibits prolactin
Takes away the inhibition on prolactin
Hyperprolactinaemia
What are some advantages of atypical antipsychotics?
Less side effects, different preparations eg dissolvable
First line in schizophrenia
What are the side effects of atypical antipsychotics?
Extrapyramidal side effects, weight gain, increased prolactin, sedation
What is clozapine?
Atypical antipsychotic
3rd line agent
Severe side effect profile
What are the side effects of clozapine?
Severe constipation, sedation, hypersalivation, weight gain, neutropenia, agranulocytosis
Need weekly monitoring via FBC
Name some benzodiazepines
Diazepam, lorazepam
GABA-BDZ receptor complex
What is mania?
Feeling unusually excited, happy, optimistic, irritable
Overactive
Poor sleep, concentration, short attention span, rapid speech, poor judgement, increased interest in sex, psychotic symptoms - hallucinations, grandiose delusions
What are some mood stabilisers?
Lithium, sodium valproate, carbomazepine, lamotrigine
What are some uses of Lithium?
Prophylaxis of mania and depression in bipolar disorder, augmentation of antidepressants, reducing suicidality
What are some side effects of lithium?
Memory problems, thirst, polyuria, tremor, drowsiness, weight gain
Effect on kidneys, hypothyroidism, hair loss, rashes
What are the effects of lithium toxicity?
Vomiting, diarrhoea, coarse tremor, dysarthria, cognitive impairment, restlessness, agitation
How do you treat lithium toxicity?
Anticonvulsants, increased fluid intake/IV fluids, haemodilaysis (in overdose)
What are some examples of acetyl cholinesterase inhibitors?
Donepezil, galantamine, rivastigmine
What is an example of an NMDA antagonist?
Meantime
What medications can be used to treat dementia?
Acetyl cholinesterase inhibitors and NMDA antagonists
What are some important side effects of acetyl-cholinesterase inhibitors?
Nausea, vomiting, anorexia, diarrhoea, fatigue, insomnia, headache, bradycardia
What are some common side effects of memantine (an NMDA receptor antagonist)?
Hypertension, dyspnoea, headache, dizziness, drowsiness
