PsychoPharmacology Flashcards by Ellen Meehan

what are some indications for antidepressants?

> unipolar depression
> schizoaffective disorders
> bipolar depression
> organic mood disorders
> anxiety disorders

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name 4 classes of antidepressants

> tricyclic antidepressants
monoamine oxidase inhibitors
selective serotonin reuptake inhibitors
novel antidepressants

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what are some downsides of tricyclic antidepressants?

> side effect profile
 - antihistamine
 - anticholinergic
 - antiadrenergic
> lethal in overdose
> cause QT lengthening syndrome

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name some tertiary tricyclic antidepressants

> amitriptyline
clomipramine
imipramine
doxepin

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what do tertiary tricyclic antidepressants act on?

serotonin receptors

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what are the anticholinergic effects of TCA’s?

> dry eyes and mouth
constipation
memory deficits
potential delirium

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what are the antiadrenergic effects of TCA’s?

> sedation
sexual dysfunction
orthostatic hypotension

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what are the antihistaminic effects of TCA’s?

dry eyes and mouth

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what is the action of secondary TCA’s?

primarily block noradrenaline

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name some secondary TCA’s

> desipramine

> nortriptyline

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what is the action of monoamine oxidase inhibitors?

bind irreversibly to monoamine oxidase preventing inactivation of amines such as norepinephrine, dopamine and serotonin increasing the synaptic levels

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what are some side effects of monoamine oxidase inhibitors?

> orthostatic hypotension
> weight gain
> dry mouth
> sexual dysfunction
> sedation
> sleep disturbance
> hypertensive crisis
> serotonin syndrome

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what is serotonin syndrome?

occurring when MONI's are taken with serotonin increasing meds
> sweats
> abdominal pain
> HTN
> irritability
> delirium
> myoclonus
> tachycardia
> diarrhoea

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what is the action of selective serotonin reuptake inhibitors?

blocks presynaptic serotonin reuptake

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what are side effects of SSRI’s?

> GI upset
> sexual dysfunction
> restlessness
> insomnia
> dizziness
> anxiety
> nervousness
> fatigue
> discontinuation syndrome (agitation, disequilibrium. dysphonia and nausea)

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name some selective serotonin reuptake inhibitors

> paroxetine
> sertraline
> fluoxetine
> citalopram
> escitalopram
> fluvoxamine

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name some properties of sertraline

> weak P450 interaction
short half life
less sedation
requires a full stomach for max absorption

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what are some properties of fluoxetine?

> long half life
> can provide increased energy
> active metabolites may build up
> significant P450 interactions
> initially can cause anxiety and insomnia
> can induce mania

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which SSRI has the shortest half life?

fluvoxamine

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what is the action of serotonin/norepinephrine reuptake inhibitors?

inhibit serotonin and noradrenergic reuptake like the TCAs but without the antihistamine, antiadrenergic or anticholinergic side effects

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name some serotonin/norepinephrine reuptake inhibitors

> Venlafaxine

> duloxetine

what are some characteristics of venlafaxine?

> minimal drug interactions
> almost no P450 activity
> short half life and fast renal clearance 
> cause nausea
> QT prolongation
> sexual side effects

name some novel antidepressants

> mirtazapine

> buproprion

what novel antidepressant can cause anxiety and seizures?

buproprion

how is treatment resistant depression treated?

> combination SSRI's/SNRI's plus mirtazapine > adjunct with lithium > adjunct with atypical antipsychotic > ECT

in what conditions are mood stabilisers indicated?

> bipolar > cyclothymia > schizoaffective disorder

name some mood stabilisers

> lithium

what are the pros of lithium?

> reduces suicide rate | > long term prophylaxis for mania

what factors predict a good response to lithium?

> prior long term response/family member > classic pure mania > mania followed by depression

how is lithium used?

``` > get a baseline UandE and TSH > check pregnancy in women > monitor - a steady state is achieved at 5 days - check 12 hours after last dose - check TSH and creatinine at 6 months ```

what are the side effects of lithium?

``` > GI distress - reduced appetite - nausea/vomiting - diarrhoea > acne > thyroid abnormalities > non-significant leucocytosis > hair loss > reduced seizure threshold > cognitive slowing > intention tremor > polyuria and polydypsia ```

what is mild lithium toxicity?

``` > levels 1.5-2 > vomiting > diarrhoea > ataxia > dizziness > slurred speech > nystagmus ```

what is moderate lithium toxicity?

``` > levels 2-2.5 > nausea > vomiting > anorexia > blurred vision > clonic limb movements > convulsions > delirium > syncope ```

what is severe lithium toxicity?

> more than 2.5 > generalised convulsions > oliguria > renal failure

name an anti-convulsant

> valproic acid > carbamazepine > lamotrigine

what are some factors predicting a positive response to valproic acid?

> rapid cycling patients > comorbid substance issues > patients with co-morbid anxiety disorders

what do you want to check before beginning valproic acid

> baseline liver function > pregnancy tests > full blood count > start folic acid supplements

what monitoring is there in valproic acid?

once a steady state has been achieved after 4/5 days check 12 hours after the last dose and repeat CBC and LFT's

what are the side effects of valproic acid?

``` > thrombocytopenia > sedation > nausea/vomiting > weight gain > tremor > hair loss > increased risk of neural tube defect due to reduction in folic acid ```

what is carbamazepine indicated in?

> acute mania > mania prophylaxis > rapid cyclers > mixed patients

what is needed before carbamazepine is started?

> baseline LFT's > FBC > ECG

what monitoring is needed in carbamazepine?

> check steady state is achieved at 5 days | > check 12 hours after last dose and repeat CBC + LFT's

why do you need to check and adjust dosing after 1 month of carbamazepine?

it induces its won metabolism

what are the side effects of carbamazepine?

``` > RASH > sedation > AV conduction delays > hyponatraemia (and loads more but legit never gonna remember them all) ```

what drug class is lamotrigine in?

anticonvulsant

when are antipsychotics indicated?

``` > schizophrenia > schizoaffective disorder > bipolar disorder for mood stabilisation > psychotic depression > augmenting agent in resistant anxiety ```

name 4 key pathways in the brain affected by dopamine

> mesocortical > nigrostriatal > mesolimbic > tuberoinfundibular

name some typical antipsychotics

> haloperidol > primozide > fluphenuzide

name some atypical antipsychotics

``` > risperidone > olanzapine > quetiapine > aripiprazole > clozapine ```

what are some adverse effects of antipsychotics?

``` > tardive dyskinesia - involuntary muscle movement > extra pyramidal side effects - acute dystonia - Parkinson's syndrome - akathisia > neuroleptic malignant syndrome - fever - severe muscle rigidity - autonomic instability ```

what are ankiolytics indicated for?

> generalised anxiety disorder > substance related disorders and withdrawal > insomnias > parasomnias

name some ankiolytics

> buspirone | > benzodiazapines