Psychopharmacology Flashcards
When should a response be seen to antidepressants?
Sometimes 1 week
Mostly 2 week
Max effect 4-6weeks
What is first line antidepressant pharmacology?
SSRI
What happens if the SSRI isn’t working
Dose Changes
Augmentation:
What are the SE of SSRIs?
HypoN
GI bleeds- take after food
Suicidal ideation (esp Paroxetine)
What are the TCA SE?
HypoT
Tachy
Prolonged QT
What are the MAOI SE?
Hypertensive crisis
Which medications are you most likely to see discontinuation symptoms with?
Paroxetine
Venlofaxine
What are the effects of blocking histamine receptors?
Drowsiness
Weight gain
What are the effects of blocking alpha receptors?
Hypertension
What are the differences between 1st & 2nd gen antipsychotics?
1: Motor/neuro effects, Cheaper, weight gain, tar dive dyskinsesia, prolonged QT
2: Metabolic effects, More expensive, dyslipidaemia, changes to glucose
Both: Changes to seizure threshold,
No difference in efficacy difference more in tolerance
What is Mirtazipine?
Presynaptic alpha2-adrenoreceptor antagonist
Increases central noradrenergic & serotonergic neurotransmission
Few antimuscarinic effects
Causes sedation during initial treatment.
What is the treatment algorithm for antipsychotics?
Oral
Assess 2-3weeks: No effect- change drug/dose, some effect= continue for 4 weeks
Clozapine: After 2antipsychotics unsuccessful, >1 2nd gen
Continue: 1-2years
Why are:
Clozapine & Carbamezapine
Metoclopramide & Antipsychotics
Erythromycin & Quetiapine
not prescribed together?
CC: Agranularcytosis
MA: Inc dopamine imbalance- Movement & stiffness SE
EQ: Prolonged QTc
What is the indications for Lithium?
Moderate-Severe mania
Prophylaxis of Bipolar
When is Li toxicity seen?
> 1.5mmol/l
What regular monitoring is required for Li?
Bloods: TFTs, Ca, eGFR* (6monthly), Li levels
Weight (Can cause weight gain)
ECG
*Li totally renally excreted
What is a common side effect on initiating Li?
Tremor
Increase thirst
Can Li be used with the following:
SSRI
Thiazide
NSAIDs
SSRI: Okay to use together
Thiazide: No, slow renal excretion consider Furosemide, risk Li toxicity
NSAIDs: No, Nephrotoxicity & direct competition between Na & Li for excretion- risk Li toxicity
What are the indications of Valproate?
Mania
Bipolar- Not as effective as Lithium
What are the contraindications of Valproate
Women of child bearing age
What are the potential SE of Valproate?
Gastric irritation
Dose related tremor
Hair loss with curly regrowth
Thrombocytopenia
What are the indications for Carbamazepine?
Mood stabiliser Epilepsy Trigeminal neuralgia Bipolar (unresponsive to Lithium) 3rd line prophylactic for mania
Can the following drugs be used with Carbamazepine: Clozapine Valproate Paroxetine Lorazepam Lithium Furosemide
C- NO V- YES P- YES Lo- YES Li- YES F- YES
What are the SE of carbamazepine?
Agranulocytosis
HypoN
What are the indications of anxiolytics?
E.g Benzo's, Pregabalin, SSRI GAD (Pregabalin) PTSD OCD BDD Social Phobia. Chronic...treatment often partially successful Prone to ADR Actually: 2-4weeks
What are the indications for hypnotics?
Severe Insomnia (induces sleep) E.g: Benzos (short term), Zolpidem, Zopiclone, antihistamines (Promethazine) Risk of dependence with 'Z' drugs
What are the indications for hypnotics?
Severe Insomnia (induces sleep) E.g: Benzos (short term), Zolpidem, Zopiclone, antihistamines (Promethazine) Risk of dependence with 'Z' drugs More careful use in >65yo: Falls risk CI: Alcohol (additive effect!!)
Which are the short & long acting Benzo’s?
S: Loprazolam, Lormetazepam, Temazepam
L:
Which are the short & long acting Benzo’s?
S: <10hours Loprazolam, Lormetazepam, Temazepam
L: >15hours Nitrazepam, Flurazepam, Diazepam, Alprazolam, Clobazam, Chlordiazepoxide
What are the side effects associated with hyperprolactinaemia?
SE of antipsychotic meds Gynaecomastia Galactorrhoea Reduced sperm count Reduced libido Amenorrhoea
