Psychopharmacology

Question 1

What are indications for using antidepressants?

Answer 1

Unipolar or bipolar depression
Organic mood disorders
Schizoaffective disorder
Anxiety disorders

Question 2

How long does it typically take for symptoms to improve after achieving therapeutic dose?

Answer 2

3-6 weeks

Question 3

What are the 5 classifications of antidepressants?

Answer 3

Tricyclics
Monoamine oxidase inhibitors
Selective serotonin reuptake inhibitors
Serotonin/noradrenaline reuptake inhibitors
Novel antidepressants

Question 4

What do monoamine oxidase inhibitors do?

Answer 4

Bind to monamine oxidase preventing inactivation of amines such as norepineohrine, dopamine, and serotonin

Question 5

What are possible side effects of MAOIs?

Answer 5

Weight gain
Dry mouth
Orthostatic hypotension
Sedation
Sexual dysfunction
Sleep disturbance

Question 6

What is the serotonin syndrome symptoms?

Answer 6

Abdominal pain
Diarrhoea
Sweats
Tachycardia
HTN
Myoclonus
Irritability
Delirium

Question 7

How do selective serotonin reuptake inhibitors work?

Answer 7

Block presynpatic serotonin reuptake

Question 8

What are common side effects of SSRIs?

Answer 8

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

Question 9

Why are tricyclic antidepressants potentially dangerous?

Answer 9

They can potentially cause antihistaminic, anticholinergic, or antiadrenergic side effects

Question 10

What do TCAs cause on an ECG?

Answer 10

QT lengthening

Question 11

Where do tertiary TCAs work?

Answer 11

Serotonin receptors

Question 12

What are 3 examples of tertiary TCAs?

Answer 12

Amitriptyline
Clomipramine
Doxepin

Question 13

What are antihistaminic side effects?

Answer 13

Sedation

Weight gain

Question 14

What are anticholinergic side effects?

Answer 14

Dry mouth
Dry eyes
Constipation
Memory deficits
Potential delirium

Question 15

What are antiadrenergic side effects?

Answer 15

Orthostatic hypotension
Sedation
Sexual dysfunction

Question 16

How do secondary TCAs work?

Answer 16

Block noradrenaline

Question 17

What are 2 examples of secondary TCAs?

Answer 17

Desipramine

Nortryptyline

Question 18

What happens if you eat tyramine rich foods such as cheese or red wine while on MAOIs?

Answer 18

Hypertensive crisis

Question 19

What is discontinuation syndrome?

Answer 19

Symptoms if suddenly stop taking medication

Question 20

What symptoms can be found in SSRI discontinuation syndrome?

Answer 20

Agitation
Nausea
Disequilibrium
Dysphoria

Question 21

What are examples of SSRIs?

Answer 21

Paroxetine
Sertraline
Fluoxetine
Citalopram
Escitalopram
Fluvoxamine

Question 22

How do serotonin/norepineohrine reuptake inhibitors work?

Answer 22

Inhibit serotonin and noradrenergic reuptake without antihistamine, anticholinergic, and antiadrenergic side effects

Question 23

What are examples of SNRI?

Answer 23

Venlafaxine

Duloxetine

Question 24

What conditions can mood stabilisers be used for?

Answer 24

Bipolar
Cyclothomia
Schizoaffective

Question 25

What are classes of mood stabilisers?

Answer 25

Lithium Anticonvulsants Antipsychotics

Question 26

What are indications for lithium?

Answer 26

Mania | Depressive episodes

Question 27

What are predictive factors for a positive response to lithium?

Answer 27

Prior long-term response or family member with good response Classic pure mania Mania which is followed by depression

Question 28

What do you need to do before starting lithium?

Answer 28

Baseline U&E and TSH | Don't give to women of child-bearing age

Question 29

How long does it take to achieve a stable state of lithium?

Answer 29

5 days

Question 30

When should you check serum lithium levels?

Answer 30

12 hours after each dose until steady state

Question 31

What is the goal for serum lithium in treatment?

Answer 31

Between 0.6-1.2

Question 32

What are the most common side effects of lithium?

Answer 32

GI - reduced appetite, nausea, vomiting, diarrhoea

Question 33

What are less common side effects of lithium?

Answer 33

``` Thyroid abnormalities Nonsignificant leukocytosis Polyuria/polydipsia Hair loss Acne Reduces seizure threshold ```

Question 34

What are the different levels of lithium toxicity?

Answer 34

Mild - 1.5-2.0 Moderate - 2.0-2.5 Severe - >2.5

Question 35

What are symptoms of mild lithium toxicity?

Answer 35

``` Vomiting Diarrhoea Ataxia Dizziness Slurred speech Nystagmus ```

Question 36

What are symptoms of moderate lithium toxicity?

Answer 36

``` Nausea Vomiting Anorexia Blurred vision Clonic limb movements Convulsions Delirium Syncope ```

Question 37

What are symptoms of severe lithium toxicity?

Answer 37

Generalised convulsions Oliguria Renal failure

Question 38

What are examples of anticonvulsants?

Answer 38

Valproic acid Carbamazepine Lamotrigine

Question 39

What are the two types of antipsychotics?

Answer 39

Typicals | Atypicals

Question 40

What are examples of typical antipsychotics?

Answer 40

Fluphenazine Haloperidol Pimozide

Question 41

How do typical antipsychotics work?

Answer 41

D2 dopamine receptor antagonists

Question 42

What are effects of atypical antipsychotics?

Answer 42

Sedation | Weight gain

Question 43

How do atypical antipsychotics work?

Answer 43

They are serotonin-dopamine 2 antagonists

Question 44

What are examples of atypical antipsychotics?

Answer 44

Risperidone Olanzapine Quetiapine Aripiprazole

Question 45

What drug is beneficial for treatment resistant psychosis?

Answer 45

Clozapine

Question 46

What are adverse effects of antipsychotics?

Answer 46

Involuntary muscle movements Neuroleptic malignant syndrome Extrapyramidal side effects

Question 47

What are features of neuroleptic malignant syndrome?

Answer 47

``` Severe muscle rigidity Fever Altered mental status Autonomic instability Elevated white cell count Elevate creatinine phosphokinase Elevated LFTs ```

Question 48

What are extrapyramidal side effects?

Answer 48

Acute dystonia Parkinson syndrome Akathisia

Question 49

What medications can be given to alleviate extrapyramidal symptoms?

Answer 49

Anticholinergics Dopamine facilitators Beta-blockers