Psychopharmacology

Question 1

Indications for antidepressants

Answer 1

Unipolar and bipolar depression
Organic mood disorders
Schizoaffective disorder
Anxiety disorders including OCD
Panic
Social phobia
PTSD
Premenstrual dysphoric disorder
Impulsivity associated with personality disorders

Question 2

Guidelines for antidepressant use

Answer 2

Antidepressant efficacy is similar so selection is based on past history of a response, side effect profile and coexisting medical conditions
Trial for at least two months before changing dose or medication

Question 3

Classification of antidepressants

Answer 3

Tricyclics (TCAs)
Monoamine Oxidase Inhibitors (MAOIs)
Selective Serotonin Reuptake Inhibitors (SSRIs)
Serotonin/Noradrenaline Reuptake Inhibitors (SNRIs)
Novel antidepressants

Question 4

Side effects of TCA’s

Answer 4

Antihistaminic (sedation and weight gain)

Anticholinergic (dry mouth, dry eyes, constipation, memory deficits and potentially delirium)

Antiadrenergic (orthostatic hypotension, sedation, sexual dysfunction)

Lethal in overdose

Question 5

Which receptors do tertiary TCA’s predominantly act on?

Answer 5

Serotonin

Question 6

What do secondary TCA’s primarily block?

Answer 6

Noradrenaline

Question 7

Examples of tertiary TCA’s

Answer 7

Imipramine
Amitriptyline
Doxepin
Clomipramine

Question 8

Metabolites of tertiary amines

Answer 8

Desipramine

Notrtriptyline

Question 9

Examples of secondary TCA’s

Answer 9

Desipramine

Nortriptyline

Question 10

How do MOAI’s work?

Answer 10

Bind irreversibly to monoamine oxidase thereby preventing inactivation of amines such as norepinephrine, dopamine and serotonin leading to increased synaptic levels

Question 11

Side effects of MOAI’s

Answer 11

Orthostatic hypotension
Weight gain
Dry mouth
Sedation
Sexual dysfunction
Sleep disturbance

Question 12

Serotonin syndrome symptoms

Answer 12

Abdominal pain
Diarrhoea
Sweats
Tachycardia
HTN
Myoclonus
Irritability
Delirium

Can lead to =>
Hyperpyrexia
Cardiovascular shock
Death

Question 13

What causes serotonin syndrome?

Answer 13

If MAOI’s are taken with medications that increase serotonin or have sympathomimetic actions

Question 14

How do SSRI’s work?

Answer 14

Block the presynaptic serotonin reuptake

Question 15

What are SSRI’s generally used to treat?

Answer 15

Both anxiety and depressive symptoms

Question 16

Common side effects of SSRI’s

Answer 16

GI upset
Sexual dysfunction
Anxiety
Restlessness
Nervousness
Insomnia
Fatigue or sedation
Dizziness

Question 17

Types of SSRI

Answer 17

Fluoxetine
Sertraline
Paroxetine (for PTSD)
Escitalopram (anxiety, panic disorder and social anxiety)

Question 18

How do SNRI’s work?

Answer 18

Inhibit both serotonin and noradrenergic reuptake like the TCAS but without the antihistamine, antiadrenergic or anticholinergic side effects

Question 19

What are SNRI’s used for?

Answer 19

Depression, anxiety and possibly neuropathic pain

Question 20

Types of SNRI

Answer 20

Venlafaxine

Duloxetine

Question 21

Novel antidepressants

Answer 21

Mirtazapine

Buproprion

Question 22

Indications for mood stabilisers

Answer 22

Bipolar
Cyclothymia
Schizoaffective

Question 23

Classes of mood stabiliser

Answer 23

Lithium
Anticonvulsants
Antipsychotics

Question 24

Side effects of lithium

Answer 24

GI distress including reduced appetite, nausea/vomiting, diarrhoea
Thyroid abnormalities
Nonsignificant leukocytosis
Polyuria/polydypsia secondary to ADH antagonism
Hair loss, acne
Reduces seizure threshold, cognitive slowing, intention tremor

Question 25

Anticonvulsants

Answer 25

Sodium valproate Carbamazepine Lamotrigine

Question 26

Why would lithium be used instead of sodium valproate if it is better tolerated?

Answer 26

Sodium valproate is as effective as lithium in mania prophylaxis but is not as effective in depression prophylaxis

Question 27

Sodium valproate side effects

Answer 27

Thrombocytopenia and platelet dysfunction Nausea, vomiting, weight gain Sedation, tremor Increased risk of neural tube defect secondary to reduction in folic acid Hair loss

Question 28

What is carbamazepine the first line agent for?

Answer 28

Acute mania and mania prohylaxis

Question 29

Carbamazepine side effects

Answer 29

``` Rash- most common SE seen Nausea, vomiting, diarrhea Sedation, dizziness, ataxia, confusion AV conduction delays Aplastic anemia and agranulocytosis Water retention due to vasopressin-like effect which can result in hyponatremia ```

Question 30

Lamotrigine side effects

Answer 30

Nausea/vomiting Sedation, dizziness, ataxia and confusion Toxic epidermal necrolysis and Stevens Johnson's Syndrome - character/severity of rash is not a good predictor of severity of reaction, therefore, if ANY rash develops, discontinue use immediately Blood dyscrasias

Question 31

Indications for use of antipsychotics

Answer 31

Schizophrenia Schizoaffective disorder Bipolar disorder- for mood stabilization and/or when psychotic features are present Psychotic depression Augmenting agent in treatment resistant anxiety disorders

Question 32

How do atypical antipsychotics work?

Answer 32

Serotonin-dopamine 2 antagonists (SDAs)

Question 33

Antipsychotic side effects

Answer 33

Tardive Dyskinesia Neuroleptic Malignant Syndrome Extrapyramidal side effects

Question 34

Agents for EPS

Answer 34

Anticholinergics Dopamine facilitators Beta-blockers

Question 35

What are anxiolytics used to treat?

Answer 35

Panic disorder Generalized anxiety disorder Substance-related disorders and their withdrawal Insomnias and parasomnias

Question 36

What are benzodiazepines used for?

Answer 36

Insomnia Parasomnias Anxiety disorders CNS depressant withdrawal protocols

Question 37

Benzodiazepines side effects

Answer 37

``` Somnolence Cognitive deficits Amnesia Disinhibition Tolerance Dependence ```