PsychoPharmacology Flashcards
what are some indications for antidepressants?
> unipolar depression > schizoaffective disorders > bipolar depression > organic mood disorders > anxiety disorders
name 4 classes of antidepressants
> tricyclic antidepressants
monoamine oxidase inhibitors
selective serotonin reuptake inhibitors
novel antidepressants
what are some downsides of tricyclic antidepressants?
> side effect profile - antihistamine - anticholinergic - antiadrenergic > lethal in overdose > cause QT lengthening syndrome
name some tertiary tricyclic antidepressants
> amitriptyline
clomipramine
imipramine
doxepin
what do tertiary tricyclic antidepressants act on?
serotonin receptors
what are the anticholinergic effects of TCA’s?
> dry eyes and mouth
constipation
memory deficits
potential delirium
what are the antiadrenergic effects of TCA’s?
> sedation
sexual dysfunction
orthostatic hypotension
what are the antihistaminic effects of TCA’s?
dry eyes and mouth
what is the action of secondary TCA’s?
primarily block noradrenaline
name some secondary TCA’s
> desipramine
> nortriptyline
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
what are some side effects of monoamine oxidase inhibitors?
> orthostatic hypotension > weight gain > dry mouth > sexual dysfunction > sedation > sleep disturbance > hypertensive crisis > serotonin syndrome
what is serotonin syndrome?
occurring when MONI's are taken with serotonin increasing meds > sweats > abdominal pain > HTN > irritability > delirium > myoclonus > tachycardia > diarrhoea
what is the action of selective serotonin reuptake inhibitors?
blocks presynaptic serotonin reuptake
what are side effects of SSRI’s?
> GI upset > sexual dysfunction > restlessness > insomnia > dizziness > anxiety > nervousness > fatigue > discontinuation syndrome (agitation, disequilibrium. dysphonia and nausea)
name some selective serotonin reuptake inhibitors
> paroxetine > sertraline > fluoxetine > citalopram > escitalopram > fluvoxamine
name some properties of sertraline
> weak P450 interaction
short half life
less sedation
requires a full stomach for max absorption
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
which SSRI has the shortest half life?
fluvoxamine
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
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
