Psychopharmacology Flashcards
What are indications for using antidepressants?
Unipolar or bipolar depression
Organic mood disorders
Schizoaffective disorder
Anxiety disorders
How long does it typically take for symptoms to improve after achieving therapeutic dose?
3-6 weeks
What are the 5 classifications of antidepressants?
Tricyclics Monoamine oxidase inhibitors Selective serotonin reuptake inhibitors Serotonin/noradrenaline reuptake inhibitors Novel antidepressants
What do monoamine oxidase inhibitors do?
Bind to monamine oxidase preventing inactivation of amines such as norepineohrine, dopamine, and serotonin
What are possible side effects of MAOIs?
Weight gain Dry mouth Orthostatic hypotension Sedation Sexual dysfunction Sleep disturbance
What is the serotonin syndrome symptoms?
Abdominal pain Diarrhoea Sweats Tachycardia HTN Myoclonus Irritability Delirium
How do selective serotonin reuptake inhibitors work?
Block presynpatic serotonin reuptake
What are common side effects of SSRIs?
GI upset Sexual dysfunction Anxiety Restlessness Nervousness Insomnia Fatigue or sedation Dizziness
Why are tricyclic antidepressants potentially dangerous?
They can potentially cause antihistaminic, anticholinergic, or antiadrenergic side effects
What do TCAs cause on an ECG?
QT lengthening
Where do tertiary TCAs work?
Serotonin receptors
What are 3 examples of tertiary TCAs?
Amitriptyline
Clomipramine
Doxepin
What are antihistaminic side effects?
Sedation
Weight gain
What are anticholinergic side effects?
Dry mouth Dry eyes Constipation Memory deficits Potential delirium
What are antiadrenergic side effects?
Orthostatic hypotension
Sedation
Sexual dysfunction
How do secondary TCAs work?
Block noradrenaline
What are 2 examples of secondary TCAs?
Desipramine
Nortryptyline
What happens if you eat tyramine rich foods such as cheese or red wine while on MAOIs?
Hypertensive crisis
What is discontinuation syndrome?
Symptoms if suddenly stop taking medication
What symptoms can be found in SSRI discontinuation syndrome?
Agitation
Nausea
Disequilibrium
Dysphoria
What are examples of SSRIs?
Paroxetine Sertraline Fluoxetine Citalopram Escitalopram Fluvoxamine
How do serotonin/norepineohrine reuptake inhibitors work?
Inhibit serotonin and noradrenergic reuptake without antihistamine, anticholinergic, and antiadrenergic side effects
What are examples of SNRI?
Venlafaxine
Duloxetine
What conditions can mood stabilisers be used for?
Bipolar
Cyclothomia
Schizoaffective
What are classes of mood stabilisers?
Lithium
Anticonvulsants
Antipsychotics
What are indications for lithium?
Mania
Depressive episodes
What are predictive factors for a positive response to lithium?
Prior long-term response or family member with good response
Classic pure mania
Mania which is followed by depression
What do you need to do before starting lithium?
Baseline U&E and TSH
Don’t give to women of child-bearing age
How long does it take to achieve a stable state of lithium?
5 days
When should you check serum lithium levels?
12 hours after each dose until steady state
What is the goal for serum lithium in treatment?
Between 0.6-1.2
What are the most common side effects of lithium?
GI - reduced appetite, nausea, vomiting, diarrhoea
What are less common side effects of lithium?
Thyroid abnormalities Nonsignificant leukocytosis Polyuria/polydipsia Hair loss Acne Reduces seizure threshold
What are the different levels of lithium toxicity?
Mild - 1.5-2.0
Moderate - 2.0-2.5
Severe - >2.5
What are symptoms of mild lithium toxicity?
Vomiting Diarrhoea Ataxia Dizziness Slurred speech Nystagmus
What are symptoms of moderate lithium toxicity?
Nausea Vomiting Anorexia Blurred vision Clonic limb movements Convulsions Delirium Syncope
What are symptoms of severe lithium toxicity?
Generalised convulsions
Oliguria
Renal failure
What are examples of anticonvulsants?
Valproic acid
Carbamazepine
Lamotrigine
What are the two types of antipsychotics?
Typicals
Atypicals
What are examples of typical antipsychotics?
Fluphenazine
Haloperidol
Pimozide
How do typical antipsychotics work?
D2 dopamine receptor antagonists
What are effects of atypical antipsychotics?
Sedation
Weight gain
How do atypical antipsychotics work?
They are serotonin-dopamine 2 antagonists
What are examples of atypical antipsychotics?
Risperidone
Olanzapine
Quetiapine
Aripiprazole
What drug is beneficial for treatment resistant psychosis?
Clozapine
What are adverse effects of antipsychotics?
Involuntary muscle movements
Neuroleptic malignant syndrome
Extrapyramidal side effects
What are features of neuroleptic malignant syndrome?
Severe muscle rigidity Fever Altered mental status Autonomic instability Elevated white cell count Elevate creatinine phosphokinase Elevated LFTs
What are extrapyramidal side effects?
Acute dystonia
Parkinson syndrome
Akathisia
What medications can be given to alleviate extrapyramidal symptoms?
Anticholinergics
Dopamine facilitators
Beta-blockers
