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Psychiatry > Psychopharmacology > Flashcards

Psychopharmacology Flashcards

1
Q

When should a response be seen to antidepressants?

A

Sometimes 1 week
Mostly 2 week
Max effect 4-6weeks

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2
Q

What is first line antidepressant pharmacology?

A

SSRI

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3
Q

What happens if the SSRI isn’t working

A

Dose Changes

Augmentation:

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4
Q

What are the SE of SSRIs?

A

HypoN
GI bleeds- take after food
Suicidal ideation (esp Paroxetine)

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5
Q

What are the TCA SE?

A

HypoT
Tachy
Prolonged QT

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6
Q

What are the MAOI SE?

A

Hypertensive crisis

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7
Q

Which medications are you most likely to see discontinuation symptoms with?

A

Paroxetine

Venlofaxine

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8
Q

What are the effects of blocking histamine receptors?

A

Drowsiness

Weight gain

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9
Q

What are the effects of blocking alpha receptors?

A

Hypertension

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10
Q

What are the differences between 1st & 2nd gen antipsychotics?

A

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

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11
Q

What is Mirtazipine?

A

Presynaptic alpha2-adrenoreceptor antagonist
Increases central noradrenergic & serotonergic neurotransmission
Few antimuscarinic effects
Causes sedation during initial treatment.

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12
Q

What is the treatment algorithm for antipsychotics?

A

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

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13
Q

Why are:
Clozapine & Carbamezapine
Metoclopramide & Antipsychotics
Erythromycin & Quetiapine

not prescribed together?

A

CC: Agranularcytosis
MA: Inc dopamine imbalance- Movement & stiffness SE
EQ: Prolonged QTc

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14
Q

What is the indications for Lithium?

A

Moderate-Severe mania

Prophylaxis of Bipolar

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15
Q

When is Li toxicity seen?

A

> 1.5mmol/l

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16
Q

What regular monitoring is required for Li?

A

Bloods: TFTs, Ca, eGFR* (6monthly), Li levels
Weight (Can cause weight gain)
ECG
*Li totally renally excreted

17
Q

What is a common side effect on initiating Li?

A

Tremor

Increase thirst

18
Q

Can Li be used with the following:
SSRI
Thiazide
NSAIDs

A

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

19
Q

What are the indications of Valproate?

A

Mania

Bipolar- Not as effective as Lithium

20
Q

What are the contraindications of Valproate

A

Women of child bearing age

21
Q

What are the potential SE of Valproate?

A

Gastric irritation
Dose related tremor
Hair loss with curly regrowth
Thrombocytopenia

22
Q

What are the indications for Carbamazepine?

A 
Mood stabiliser
Epilepsy
Trigeminal neuralgia
Bipolar (unresponsive to Lithium)
3rd line prophylactic for mania
23
Q 
Can the following drugs be used with Carbamazepine:
Clozapine
Valproate
Paroxetine
Lorazepam
Lithium
Furosemide
A 
C- NO
V- YES
P- YES
Lo- YES
Li- YES
F- YES
24
Q

What are the SE of carbamazepine?

A

Agranulocytosis

HypoN

25
Q

What are the indications of anxiolytics?

A 
E.g Benzo's, Pregabalin, SSRI
GAD (Pregabalin)
PTSD
OCD
BDD
Social Phobia.
Chronic...treatment often partially successful 
Prone to ADR
Actually: 2-4weeks
26
Q

What are the indications for hypnotics?

A 
Severe Insomnia (induces sleep)
E.g: Benzos (short term), Zolpidem, Zopiclone, antihistamines (Promethazine)
Risk of dependence with 'Z' drugs
27
Q

What are the indications for hypnotics?

A 
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!!)
28
Q

Which are the short & long acting Benzo’s?

A

S: Loprazolam, Lormetazepam, Temazepam
L:

29
Q

Which are the short & long acting Benzo’s?

A

S: <10hours Loprazolam, Lormetazepam, Temazepam
L: >15hours Nitrazepam, Flurazepam, Diazepam, Alprazolam, Clobazam, Chlordiazepoxide

30
Q

What are the side effects associated with hyperprolactinaemia?

A 
SE of antipsychotic meds
Gynaecomastia
Galactorrhoea
Reduced sperm count
Reduced libido
Amenorrhoea

Psychiatry (19 decks)

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