Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Psychiatry > Psychopharmacology > Flashcards

Psychopharmacology Flashcards

1
Q

What important things do you need to keep in mind when choosing medications to treat mental illnesses?

A

Choosing an agent with acceptable side effects at lowest effective dose
Avoiding DDIs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the response rate to antidepressants?

A

40%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What conditions may you treat with antidepressants?

A

Unipolar and bipolar depression, organic mood disorders, schizoaffective disorder, anxiety disorders (OCD, social phobia, panic), PTSD etc.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What must you warn your patients of when starting them on antidepressants?

A

That they take 2-4 weeks to reach their therapeutic dose (when their symptoms will improve)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Why would you start someone on prophylactic antidepressants?

A

To reduce relapse and likelihood of another episode

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

After someone first episode of depression how long should you keep them on antidepressants for?

A

6m - 1y

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

After someone second episode of depression how long should you keep them on antidepressants for?

A

2y

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

After someone third episode of depression how long should you keep them on antidepressants for?

A

Consider life long

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

In treating depression, with an antidepressant, if no improvement is seen in ____ time then either ______ or ________

A

If no improvement is seen in within 2 months, either switch to another antidepressant or augment with another agent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the different types of antidepressants?

A

SSRIs - selective serotonin reuptake inhibitors
SNRIs - serotonin/noradrenaline reuptake inhibitors
MAOIs - monoamine oxidase inhibitors
TCAs - tricyclics
Novel antidepressants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the biggest issue with TCAs?

A

Lethal in OD - DON’T GIVE TO SUICIDAL PATIENT

Unacceptable side effects - antihistaminic, anticholingeric and antiadrenergic side effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What side effects are associated with TCAs?

A

Antihistaminic - sedation, wt gain
Anticholingeric - dry mouth, eyes, constipation, memory deficits, delirium
Antiadrenergic - orthostatic hypotension, sedation, sexual dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How do tertiary TCAs work?

A

Act on serotonin receptors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are examples of tertiary TCAs?

A

Amitriptyline
Imipramine
Doxepin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are secondary TCAs?

A

Metabolites of tertiary amines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How do secondary TCAs work?

A

Block noradrenaline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the SEs of secondary TCAs?

A

Like tertiary TCAs but not as bad

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Give examples of secondary TCAs

A

Desipramine, nortriptyline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How do MAOIs work?

A

Bind irreversibly to monoamine oxidase which prevents inactivation of amines, e.g. noradrenaline, dopamine and serotonin –> higher synaptic levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the SEs for MAOIs?

A

Orthostatic hypotension, wt gain, dry mouth, sedation, sexual dysfunction, sleep disturbance

Cheese reaction when taken with tyramine rich foods

Serotonin syndrome if taken with meds increasing serotonin/have symathomimetic actions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the symptoms of serotonin syndrome?

A

Abdominal pain, diarrhoea, sweats, tachycardia, hypotension, myoclonus, irritability, delirium hyperprexia, CV shock and death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What must you do if you are switching from an SSRI to a MAOI?

A

Wait 2 weeks or 5 weeks if fluoxetine (longer half life)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is used for first line treatment of depression?

A

SSRIs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How do SSRIs work?

A

Block presynaptic reuptake of serotonin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are the SEs of SSRIs?

A

GI upset, sexual dysfunction, anxiety, restlessness, nervousness, insomnia, fatigue, sedation, dizziness

Activation syndrome
Discontinuation syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is activation syndrome?

A

For the first 2-10 days of starting SSRIs feel more anxious, agitated, nauseated and panicked

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is discontinuation syndrome?

A

On completing SSRI course, feel agitated, nauseated, dysphoric

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are the main pros and cons of paroxetine?

A

Sedating, wt gain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are the main pros and cons of sertraline?

A

GI SEs

Less sedating

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What are the main pros and cons of fluoxetine?

A 
Can be used in u18s
P450 interactions (avoid in those on lots of drugs) 
Avoid in hepatic illness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What are the main pros and cons of citalopram/escitalopram?

A

Fewer DDIs
QT lengthening
Sedating, GI SEs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What are the main pros and cons of fluvoxamine?

A

GI SEs, side effects, sedation, weakness
Inhibits liver enzymes
Analgesic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

How do SNRIs work?

A

Inhibit both serotonin and noradrenaline uptake

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What can SNRIs be used for?

A

Depression, anxiety, neuropathic pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is second line treatment for depression?

A

SNRIs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What are the two SNRIs?

A

Venlafaxine

Duloxetine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What are examples of SSRIs?

A 
Fluoxetine
Paroxetine
Sertraline
Citalopram/escitalopram
Fluvoxamine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What are the main pros and cons of venlafaxine?

A 
Minimal DDIs
Increases diastolic BP 
Nausea
QT prolongation 
Sexual SEs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What are the main pros and cons of duloxetine?

A

Used for stress incontinence and neuropathic pain as well

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What are the two novel antidepressants?

A

Mitrazapine

Buproprion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What are the main pros and cons of mitrazapine?

A

Increases serum cholesterol
Very sedation
Wt gain

42
Q

How does mirtazapine work?

A

5HT2 and 5HT3 receptor antagonist

43
Q

What are the main pros and cons of buproprion?

A

May induce seizure risk in those with traumatic brain injury, bulimia, anorexia
Doesn’t treat anxiety
May cause psychosis

44
Q

How do you treat treatment resistant depression?

A

Combine SSRI or SNRI with mirtazapine
Augment with lithium or atypical antipsychotic
ECT

45
Q

What is ECT?

A

Electroconvulsive therapy

Stimulate an epileptic seizure under GA and muscle relaxant

46
Q

What are SEs of ECT?

A

Memory loss and headache

47
Q

What are indications for mood stabilisers?

A

Bipolar, cyclothymia, schizoaffective disorders

48
Q

What are positive factors predicting a good response to lithium?

A

Previous good response
Positive response of family member
Classic pure mania
Mania followed by depression (where mania is first episode)

49
Q

What must you do before starting lithium treatment?

A

Get baseline U&Es and TSH as kidneys and thyroid gland are affected by lithium use

50
Q

What abnormality can result from lithium use during pregnancy?

A

Ebstein’s abnormality (heart defect) in first trimester

51
Q

How does the body get rid of lithium?

A

Not metabolised by liver

Excreted by kidney

52
Q

What must you ensure to do with lithium use?

A

Do regular blood tests to ensure lithium level is between 0.6-1.2

53
Q

What are side effects of lithium use?

A

GI SEs - reduced appetite, N/V, diarrhoea
Hypothyroidism
Non-specific leucocytosis
Polyuria/polydipsia (due to ADH antagonism)
Hair loss, acne
Reduced seizure threshold, cognitive slowing, intention tremor

54
Q

What happens if blood levels of lithium are between 1.5 and 2?

A

Vomiting, diarrhoea, ataxia, dizziness, slurred speech, nystagmus

55
Q

What happens if blood levels of lithium are between 2 and 2.5?

A

Nausea, vomiting, anorexia, blurred vision, clonic limb movements, convulsions, delirium, syncope

56
Q

What happens if blood levels of lithium are over 2.5?

A

Generalised convulsions, renal failure, oliguria, death

57
Q

What must patients on lithium be aware of?

A

Illness/dehydration can cause lithium levels to increase –> lithium toxicity

58
Q

What is the classification of lithium toxicity?

A

Mild - 1.5-2
Moderate - 2-2.5
severe >2.5

59
Q

What are factors predicting a good response to valproic acid treatment?

A

Rapid cycling patients
Comorbid substance misuse
Mixed patients Patients with cormorbid anxiety

60
Q

What must you do before you start someone on sodium valproate?

A

LFTs, FBC, pregnancy test

61
Q

Why must sodium valproate be avoided in woman of childbearing age?

A

Causes neural tube defects

62
Q

What is the target level of sodium valproate?

A

50-125 but generally more on response rather than blood level

63
Q

What are the side effects of sodium valproate?

A

Thrombocytopenia, platelet dysfunction
N/V, wt gain
Sedation, tremor, hair loss

64
Q

When might you use carbamazepine?

A

First line for acute mania and mania prophylaxis

Indicated for rapid cyclers/mixed patients

65
Q

What must you do before starting someone on carbamazepine?

A

FBC, LFTs, ECG

66
Q

What SEs are associated with carbamazepine?

A 
Rash - most common
N/V, diarrhoea
Sedation, dizziness, ataxia, confusion 
AV conduction delays
Aplastic anaemia, agranulocystosis
Water retention due to vasopressin like effect which can lead to hyponatraemia
DDIs
67
Q

Apart from as a mood stabiliser and anticonvulsant, what can lamotrigine be used for?

A

Neuropathic/chronic pain

68
Q

What must you check before you start lamotrigine?

A

LFTs

69
Q

What are the side effects of lamotrigine?

A

N/V
Sedation, dizziness, ataxia, confusion
TEN/SJS
ANY RASH - STOP RX IMMEDIATELY

70
Q

Apart from lithium, sodium valproate, carbamazepine and lamotrigine what else can be used as mood stabilisers?

A

Antipsychotics (e.g. risperidone or quetiapine)
Tend to use antipsychotics with someone who has been detained with really bad mania and then use mood stabilisers after for prophylaxis

71
Q

If well enough and first episode of mania what should you give?

A

Lithium

72
Q

If really unwell and first episode of mania what should you give?

A

Antipsychotic

73
Q

What is an average starting dose of lithium?

A

800mg nocte

74
Q

What are indications for use of antipsychotics?

A

Schizophrenia, schizoaffective disorder, bipolar disorder (for mood stabilisation/when psychotic features present), psychotic depression

75
Q

What is the mesocortical pathway?

A

Dopaminergic neurons fire from VTA to cortex

In schizophrenia there is reduced dopaminergic firing over the mesocortical pathway –> negative symptoms

76
Q

What is the mesolimbic pathway?

A

Dopaminergic neurons firing from the VTA to the nucleus accumbens (limbic system)
In schizophrenia there is too much dopamine in this pathway –> positive symptoms

77
Q

What is the nigrostriatal pathway?

A

Normally responsible for co-ordination of movement

Dopaminergic neurons project from the substantia nigra to the basal ganglia

Treatment in schizophrenia reduces dopamine in this pathway which may lead to EPS

78
Q

What is the tuberoinfindibular pathway?

A

Dopaminergic neurons fire from the hypothalamus to the anterior pituitary

Antipsychotics decrease dopamine firing from this pathway –> increased prolactin

NB - increased prolactin leads to galactorrhoea and reduced FSH (leading to amenorrhoea)

79
Q

How do the typical antipsychotics work?

A

D2 dopamine receptor antagonists

80
Q

What are examples of typicals?

A

Fluphenazine, haloperidol

81
Q

What side effects are common from typicals?

A

Typicals are also anti-HAM (histamine, alpha, muscarinic) meaning they lead to sedation, weight gain, hypotension, sexual dysfunction, dry mouth, visual problems etc.

And extrapyramidal side effects & neuroepileptic malignant syndrome

82
Q

How do the atypicals work?

A

Serotonin and dopamine 2 antagonists

83
Q

What is the main difference in the atypicals and typicals?

A

Atypicals tend not to cause EPS but cause more weight gain, cholesterol raising and diabetes mellitus

84
Q

What are the various routes of administration of antipsychotics?

A

Tablets, IM, rapidly dissolving

85
Q

What is the issue with risperidone?

A

More likely to cause hyperprolactinaemia

Acts like typical >6mg

86
Q

Give examples of typicals

A

Risperidone, olanzapine, aripiprazole, quetiapine, clozapine

87
Q

What is the issue with olanzapine?

A

May cause irregular LFTs

88
Q

What are the issues with quetiapine?

A

Most likely to cause orthostatic hypotension

Only available as a tablet

89
Q

When should you use clozapine and why?

A

Treatment resistance only due to side effects
Agranulocytosis means that those on clozapine must have FBC checks

Also increased risk of seizures

90
Q

How long does it tend to take for an antipsychotic to start working?

A

6 weeks

91
Q

When is someone considered as treatment resistant?

A

When they have not responded to 2 antipsychotics (1 of which should be an atypical)

92
Q

What are the movement disorders associated with antipsychotic use (the extrapyramidal symptoms)?

A

Tardive dyskinesia
Parkinsonsim
Dystonia
Akathesia

93
Q

What is tardive dyskinesia?

A

Involuntary movements of the lips, tongue, neck e.g. lip smacking

94
Q

What is parkinsonism?

A

Symptoms exactly same as Parkinson’s disease

Cogwheel rigidity, resting tremor, shuffling gait etc.

95
Q

What is akathisia?

A

Restlessness, pacing, taping etc.

96
Q

What is dystonia?

A

Sustained muscle contraction

97
Q

How do you treat EPS?

A

Anticholingerics (e.g. benzotropine)
Dopamine facilitators, e.g. amantadine
Beta blockers for akathisia (e.g. propranolol)

98
Q

What are anxiolytics used to treat?

A

Panic disorder, GAD, substance related disorders, insomnias, parasomnias

Usually used in combo with SSRIs/SNRIs

99
Q

What are the two anxiolytics we need to know about?

A

Buspirone and benzodiazepines

100
Q

How does buspirone work?

A

5HT1A agonist

Takes around 2 weeks to work!!

101
Q

What are the side effects of benzodiazepines?

A

Somnolence, cognitive defects, amnesia, disinhibition, tolerance, dependence

102
Q

Why would you try to avoid benzos?

A

They work very quickly, but after about 10 days their effect wears off where as fluoxetine starts working then

Psychiatry (26 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions