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Psychiatry > Psychopharmacology > Flashcards

Psychopharmacology Flashcards

1
Q

What are the indications for antidepressants?

A

Uni and bi-polar disorders, depression, organic mood disorders, schizoaffective disorder, anxiety (OCD, panic, phobia and PTSD)

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2
Q

What is the guidelines for antidepressant use?

A

Typical delay of 3-6W after beginning

If no improvement after a trial (at least 2 months), either switch or augment

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3
Q

What are the different antidepressant classifications?

A 
TCA's
MAOI's
SSRI's
SNRI's
Novel antidepressants
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4
Q

What are TCA’s?

A

Side effects:

  • Lethal overdose (1W supply)
  • Can cause QT lengthening
  • Antihistaminic (sedation and weight gain)
  • Anticholinergic (dry mouth and eyes, constipation and memory problems)
  • Antiadrenergic (hypotension, sedation and sexual dysfunction)
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5
Q

What are some examples of TCA’s?

A

Amitriptyline and clomipramine

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6
Q

What are MAO’s?

A

Bind irreversibly to MAO = prevents inactivation of NA, dopamine and serotonin = increased synaptic levels

Side effects = hypotension, ewight gain, dry mouth, sedation and sleep disturbances

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7
Q

What are SSRI’s?

A

Block presynaptic serotonin reuptake

Side effects = GI, sexual dysfunction, anxiety, restlessness, insomnia, sedation and dizziness

Can develop discontinuation syndrome = agitation, nausea and dysphoria

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8
Q

What are some examples of SSRI’s?

A 
Paroxetine
Sertraline
Fluoxetine
Citalopram
Escitalopram
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9
Q

What are SNRI’s?

A

Inhibit serotonin and NA reuptake - like TCA’s but without the major side-effects

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10
Q

What are some example of SNRI’s?

A

Venlafaxine (no P450 action so used in geriatrics)

Duloxetine

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11
Q

What are some novel antidepressants?

A

Mirtazapine = 5HT2+3 receptor antagonist (sedating and increases cholesterol)

Buproprion = inhibition of dopanine and NA reuptake

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12
Q

What are mood stabilizers used for?

A

Bipolar
Cyclothymia
Schizoaffective

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13
Q

What are the classes of mood stabilizers?

A

Lithium
Anticonvulsants
Antipsychotics

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14
Q

What is lithium used for?

A

Only medication to reduce suicide rate

Long term prophylaxis of mania and depressive episodes

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15
Q

How is lithium used?

A

Get baseline U+E and TSH, pregnancy test

Steady state after 5 days - check 12hrs after last dose

Goal = between 0.6-1.2

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16
Q

What are the side effects of lithium?

A 
GI
Thyroid
Polyuria secondary to ADH antagonism
Hair loss
Acne
Cognitive slowing and intention tremor

Toxicity at 1.5 and above and severe if >2.5 = renal failure

17
Q

What is valproic acid?

A

Effective as lithium in mania but not in depression prophylaxis
Better tolerated

LFT’s, pregnancy and FBC before
Start folic acid

Goal = between 50-125

18
Q

What are the side effects of Valporic acid?

A 
Thrombocytopenia
Nausea and vomiting
Sedation and tremor
Increased neural tube defect
Hair loss
19
Q

What is carbamazepine?

A

First line for mania and prophylaxis

LFT’s, FBC and ECG

Goal = 4-12
Check after a month

20
Q

What are carbamazepine side effects?

A 
Rash
Nausea and vomiting
Sedation and dizziness
AV conduction delays
Water retention
Drug-drug interactions
21
Q

What are lamotrigine side effects?

A

Nausea and vomiting
Sedation and dizziness
Steven Johnson’s syndrome = rash develops then stop!

22
Q

What are antipsychotics used for?

A

Schizophrenia
Schizoaffective
Bipolar
Pyschotic depression

23
Q

What is the mesocortical pathway in the brain?

A

Projects from the tegmentum to the cerebral cortex - this is where negative symptoms and cognitive disorders arise = psychotic patient = too little dopamine

24
Q

What is the mesolimbic pathway in the brain?

A

Projects from the dopaminergic cell bodies in the ventral tegmentum to the limbic system = where positive symptoms arise (hallucinations, delusions and thought disorders = too much dopamine

25
Q

What is the nigtostriatal pathway in the brain?

A

Dopaminergic cell bodies to the substantia nigra to basal ganglia = dopamine hypoactivity = parkinsonian movements

26
Q

What is the tuberoinfundibular pathway in the brain?

A

Hypothalamus to anterior pituitary (dopamine controls prolactin release) = blocked = hyperprolactinemia (gynecomastia / galactorrhoea / reduced libido / menstural dysfunction)

27
Q

What are the typical Antipsychotics?

A

D2 dopamine receptor antagonists

E.g. haloperidol and primozide

28
Q

What are the low potency typical antipsychotics?

A

less affinity for D2 but interact with nondopaminergic = cardiotoxic and anticholinergic adverse effects = sedation + hypotension

E.g. chlorpromazine and thioridazine

29
Q

What are the atypical Antipsychotics?

A

Serotonin-dopamine 2 antagonists (SDA’s)

Atypical as affect dopamine and serotonin in the 4 key pathways

Risperidone = akathesia common SE
Olanzapine
Quetiapine
Aripiprazole
Clozapine
30
Q

What are antipsychotic side effects?

A

Tardive dyskinesia = involuntary muscle movements
Neuroleptic malignant syndrome = muscle rigidity, fever, altered mental status + potentialy fatal
Extrapyramidal side effects = dystonia, parkinson syndrome and akathisisa

31
Q

What are the agents for extrapyramidal syndrome?

A

Anticholinergics = benztropine
Dopamine facilitators = amantadine
Beta-blockers = propanolol
Watch for anticholinergic side effects if taken with other medis with anticholinergic activity like TCA’s

32
Q

What are anxiolytics?

A

Used to treat panic disorders, anxiety, substance-related disorders, insomnias

In anxiety = combination with SSRI’s or SNRI’s

33
Q

What are some examples of anxiolytics?

A 
Buspirone = 5HT1A antagonist and no sedation
Benzodiazapines = insomnia and anxiety, CNS depressant but with side effects
34
Q

What bloods would you take from a patient with schizophrenia?

A

Antipsychotics can cause dyslipidemia and abnormal LTF’s and elevated blood sugar

  • LFT’s
  • Fasting blood sugar
  • Fasting lipid profile
  • CBC

Psychiatry (17 decks)

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