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Psychiatry > Psychopharmacology > Flashcards

Psychopharmacology Flashcards

1
Q

What are TCA’s?

A

Tricyclic antidepressants

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2
Q

What affects do TCA’s have on the heart?

A

Causes QT lengthening

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3
Q

How do tertiary TCA’s produce side effects?

A

Side chains are present and cross react with other types of receptors which cause:
antihistaminic (sedation and weight gain)
anticholinergic (dry mouth and eyes, memory deficits, constipation)
antiadrenergic (orthostatic hypotension, sedation, sexual dysfunction) effects

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4
Q

What receptors do Tertiary TCAs mainly act upon?

A

Serotonin receptors

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5
Q

What do secondary TCA’s act upon?

A

They block noradrenaline and have less severe side effects

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6
Q

How do MAOIs work?

A

Bind irreversibly to MAO and prevent inactivation of norepinephrine, dopamine and serotonin which leads to increased synaptic levels

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7
Q

What are the side effects of MAOI’s?

A

Orthostatic hypotension, weight gain, dry mouth, sedation, sexual dysfunction and sleep disturbance

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8
Q

What are SSRI’s?

A

Selective serotonin reuptake inhibitors

- block the presynaptic serotonin reuptake

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9
Q

What do SSRI’s treat?

A

Anxiety and depression

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10
Q

What are the side effects of SSRI’s?

A

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

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11
Q

What are the pros and cons of paroxetine?

A

Pros

  • short half life
  • Sedating properties if dosed at night offers good initial relief from anxiety and insomnia

Cons

  • Significanant CYP2D6 inhibition
  • Sedation, weight gain
  • likely to cause a discontinuation syndrome
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12
Q

What are the pros and cons of sertraline?

A

Pros

  • Weak p450 interactions
  • Short half life with lower build up of metabolites
  • Less sedating when compared to paroxetine

Cons

  • max absorption requires a full stomach
  • Increased no. of GI adverse drug reactions
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13
Q

What are the pros and cons of fluoxetine?

A

Pro’s

  • Long half life which limits discontinuation syndrome developing
  • May provide increased energy initially

Cons

  • Long half life so active metabolites may build up
  • Significant P450 interactions so not good choice on someone on lots of meds
  • Initial activation may increase anxiety and insomnia
  • More likely to induce mania
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14
Q

What are the pros and cons of citalopram?

A

Pro

  • low inhibition of p450 so fewer drug-drug interactions
  • intermediate half life

Cons

  • QT interval prolongation with doses 10-30 mg
  • Sedating
  • GI side effects
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15
Q

Pros and cons of esciltalopram?

A

Pro

  • low overall inhibtion of p450
  • Intermediate half life
  • effective in acute response and remission

cons

  • QT level prolongation
  • nausea, headache
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16
Q

Fluvocamine pros and cons

A

Pro

  • Shortest half life
  • Analgesic properties

Cons
- GI distress, headaches, sedation, weakness

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17
Q

What do SNRI’s do?

A

Inhibit serotonin and noradrenergic reuptake like TCAs without antihistamine, antiandrinergic or anticholinergic side effects

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18
Q

Velaflaxine pros and cons?

A

Minimal drug interactions and almost p450 activity

Short half life

Cons

  • Can cause increase in diastolic BP
  • Nausea
  • Discontinuation syndrome
  • QT prolongation
  • Sexual side effects
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19
Q

Mirtazapine pros and cons

A

Pro
- Can be used as a hypnotic at lower doses

Con

  • Increase in serum cholesterol
  • Weight gain
  • Sedating
20
Q

Buproprion pros and cons?

A

Pro

  • No weight gain, sexual side effects, sedation, cardiac interations
  • Low induction of mania
  • Second line ADHD agent

Cons

  • Increases seizure risk
  • Can cause anxiety, agitation and insomnia
  • Can induce psychotic symptoms at high doses
21
Q

When are mood stabilisers indicated?

A

Bipolar disorder, cyclothymia, schizoaffective disorder

22
Q

What are the classes of mood stabilisers?

A

Lithium, anticonvulsants or antipsychotics

23
Q

What are the pros and cons of lithium?

A

Pro

  • Reduces suicide rate
  • Long term prophylaxis of mania and depressive episodes

Cons

  • Many side effects including GI distress, thyroid abnormalities, Hair loss, acne, slows cognition, intention tremor etc
  • can cause lithium toxicity
24
Q

Describe mild lithium toxicity?

A

levels 1.5-2.0

Causes vomiting, diarrhea, ataxia, dizziness, slurred speech, nystagmus.

25
Q

Describe moderate lithium toxicity?

A

levels 2.0-2.5

Causes nausea, vomiting, anorexia, blurred vision, clonic limb movements, convulsions, delirium, syncope

26
Q

Describe severe lithium toxicity?

A

levels >2.5

Causes generalized convulsions, oliguria and renal failure

27
Q

Pros and cons of Valproic Acid?

A

Pro
Effective in mania prophylaxis
Well tolerated

Con
Not effective in depression prophylaxis
Disrupts platelets
Causes nausea, vomiting, weight gain, sedation and tremor

28
Q

Carbamazepine pros and cons

A

Pro

  • Can be used as first line treatment for acute mania and mania prophylaxis
  • Good for rapid cyclers

Cons

  • Rash, nausea, sedation, vomiting, ataxia, confusion, water retention
  • many drug-drug interactions
29
Q

What key pathways in the brain are affected by dopamine?

A

Mesocortical
Mesolimbic
Nigrostriatal
Tuberoinfundibular

30
Q

Name some atypical antipscyhotics

A

Rispiridone, clozapine, olanzapine

31
Q

What is discontinuation syndrome?

A

Discontinuation of a drug abruptly

Can cause different symptoms in different drug classes.

SSRIs cause nausea, headache, dizziness, chills, paraesthesia, insomnia, “electric shock” feelings in the head.

TCAs cause anxiety, insomnia, headache, motor disturbance, malaise

32
Q

What is serotonin syndrome ?

A

Influx of too much serotonin in the CNS = overstimulation of 5HT2A receptors resulting in

Cognitive Side Effects (headache, agitation, confusion, hallucinations, coma)

Autonomic Side Effects (shivering, sweating, vasoconstriction, nausea, tachycardia, diarrhoea)

Somatic Side Effect (myoclonus, hyperreflexia, tremor)

33
Q

What receptors in the brain do Atypical Antipsychotics block?

A

Dopamine receptors

34
Q

What are the side effects of atypical antipsychotics?

A

Decreased libido, abnormal menstruation, inability to ejaculate, infertility. hyperprolactinaemia, seizures, gynaecomastia, weight gain

35
Q

What are the side effects of typical antipsychotics?

A

Dry mouth, muscle stiffness, muscle cramps, tremors, weight gain and EPS

36
Q

What are EPS?

A

Extrapyramidal Side Effects:
Akathisia
Parkinsonism
Dystonia

37
Q

Name some typical antipsychotics

A

Haloperidol
Loxapine
Beriperidol

38
Q

What drugs can be used to treat dementia?

A

Cholinesterase Inhibitors
NMDA inhibitors
Antidepressants, Antipsychotics (can be used to treat the co-morbid symptoms)

39
Q

What is the effect of cholinesterase inhibitors on Alzheimers?

A

Prevent acetylcholinesterase from breaking down acetylcholine in the brain leading to an increased concentration of acetylcholine resulting in better communication between nerves in the brain

40
Q

Name some cholinesterase inhibitors?

A

Rivastigmine and Galantamine

41
Q

What is the effect of NMDA antagonists in Alzheimers?

A

blocks nerve cells within the brain from the effects of excess glutamate, thus preventing further damage

42
Q

Name an NMDA antagonist?

A

Memantine

43
Q

What are the effects of benzodiazepines?

A

Benzodiazepines enhance GABA and thus result in hypnotic, sedative and anxiolytic effects

44
Q

What are the side effects of benzodiazepines?

A

Drowsiness, dizziness, diminished alertness, decrease in concentration span, lack of coordination, decreased libido

45
Q

What are the long term effects of benzodiazepines?

A

Cognitive impairment

Tolerance and dependence

46
Q

What happens after sudden withdrawal of benzodiazepines?

A

Insomnia, tremors, GI upset, agitation, muscle spasm

47
Q

Name some benzodiazepines

A

Clonazepam, lorazepam, diazepam, zopiclone

Psychiatry (8 decks)

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