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Psychiatry > Psychopharmacology > Flashcards

Psychopharmacology Flashcards

1
Q

What are indications for antisepressants?

A
  • unipolar + bipolar depression
  • organic mood disorders
  • schizoaffective disorder
  • anxiety disorders
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2
Q

Typically, how long is the delay between the start of antidepressant treatment and symptom improvement?

A

3-6 weeks

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3
Q

What should be done if there is no symptomatic improvement after 2 months on antidepressants?

A
  • switch antidepressant
  • or augment with another agent
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4
Q

What are the different classifications of antidepressants?

A
  • tricyclic antidepressants (TCAs)
  • monoamine oxidase inhibitors (MAOIs)
  • selective serotonin reuptake inhibitors (SSRIs)
  • serotonin/noradrenalin reuptake inhibitors (SNRIs)
  • novel antidepressants
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5
Q

What are the charaterisitics of trycyclic antidepressants (TCAs)?

A
  • very affective
  • many side effects
  • antihistaminic (sedation, weight gain)
  • anticholinergic (dry mouth/eyes, constipation, memory defects, delirium)
  • antiadrenergic (orthostatic hypotension, sedation, sexual dysfunction)
  • lethal in overdose
  • can cause QT lengthening
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6
Q

How do tertiary TCAs work and what are some example drugs?

A
  • act mainly on serotonin receptors
  • tertiary amine side chain, cross react, cause side effects
  • imipramine
  • amitriptyline
  • doxepin
  • clomipramine
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7
Q

How do secondary TCAs work and what are some example drugs?

A
  • mainly block noradrenaline receptors
  • side effects less severe
  • desipramine
  • notrtripptyline
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8
Q

How do monoamine oxidase inhibitors (MAOIs) work?

A
  • bind irreversibly to monoamine oxidase, prevents inactivation of; norepinephrine, dopamine, serotonin
  • very effective for depression
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9
Q

What are the side effects of monoamine oxidase inhibitors (MAOIs)?

A
  • orthostatic hypotension
  • weight gain
  • dry mouth
  • sedation
  • sexual dysfunction
  • sleep disturbance
  • hypertensive crisis- if taken with tyramine-rich foods (cheese, red wine, processed meat, beans)
  • serotonin syndrome- if taken with med inc. serotonin or sympathmimetic actions
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10
Q

What are the symptoms and complications of serotonin syndrome?

A
  • abdominal pain, diarrhoea, sweats
  • tachycardia
  • HTN
  • myoclonus
  • irritability, delirium
  • hyperpyrexia
  • cardiovascular shock
  • death

* must wait 2 weeks when switching from SSRIs to MAOIs

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11
Q

How do selective serotonin reuptake inhibitors (SSRIs) work, what are their side effects and what are some example drugs?

A
  • block presynaptic serotonin reuptake
  • treat anxiety + depression
  • little risk of overdose
  • GI upset
  • sexual dysfunction
  • SSRI activation syndrome
  • SSRI discontinuation syndrome
  • setraline
  • citalopram
  • fluoxetine (prozac)
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12
Q

What is activation syndrome and discontinuation syndrome?

A

Activation syndrome:

  • nausea, anxious, restlessness, suicidal tendencies
  • a few days

Discontinuation syndrome:

  • nausea, anxious, agitation, disequilibrium, dysphoria
  • not a craving
  • inc. risk if short half-life
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13
Q

How do serotonin/norepinephrine reuptake inhibitors work and what are some example drugs?

A
  • inhibit serotonin + norepinephrine reuptake
  • without the effects of TCAs
  • for depression, anxiety, neuropathic pain
  • duloxetine
  • mirtazapine
  • buproprion
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14
Q

What are the options following resistance to treatment of antidepressants?

A
  • combination of antidepressants
  • adjunctive treatment with lithium
  • adjunctive treatment with atypical antipsychotic
  • ECT
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15
Q

What are the different classes of mood stabilisers and what are the indications for their use?

A
  • lithium
  • anticonvulsants
  • antipsychotics
  • bipolar
  • cyclothymia
  • schizoaffective
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16
Q

What are the benefits of lithium?

A
  • only medication to dec. suicide rates
  • effective prophylaxis of mania + depressive episodes in BAD
  • good response if:
  • prior long-term response
  • family member had good response
  • classic pure mania
  • mania followed by depression
17
Q

What must be done when prescribing lithium?

A
  • baseline U + Es
  • baseline TSH
  • pregnancy test (risk of Ebstein’s anomaly)
  • monitor at 5 days, 3 months, 6 months
  • goal blood level- 0.6-1.2
18
Q

What are common side effects of lithium?

A
  • GI distresses
  • thyroid abnormalities
  • nonsignificant leukocytosis
  • polyuria/polydipsia
  • ADH antagonism
  • interstitial renal fibrosis (in few)
  • hair loss, acne
  • dec. seizure threshold, cognitive slowing, intention tremor
19
Q

What can occur as a result of lithium toxicity?

A
  • mild (1.5-2.0)- vomiting, diarrhoea, ataxia, dizziness, slurred speech, nystagmus
  • moderate (2.0-2.5)- N + V, anorexia, blurred vision, clonic limb movements, convulsions, delirium, syncope
  • severe (> 2.5)- generalised convulsions, oliguria, renal failure
20
Q

What are the benefits of valproic acid (anticonvulsant) and what must be done when prescribing it?

A
  • effective in mania prophylaxis (not depression)
  • better tolerated than lithium
  • FBC
  • LFTs
  • pregnancy test
  • start folic acid supplement (women)
  • monitor after 4/5 days
  • goal blood level- 50-125
21
Q

What are the side effects of valproic acid (anticonvulsant)?

A
  • thrombocytopenia, platelet dysfunction
  • N + V, weight gain
  • sedation, tremor
  • hair loss
  • inc. risk neural tube defect
22
Q

What are the indications for carbamazepine (anticonvulsant) and what must bbe done when prescribing it?

A
  • acute mania, mania prophylaxis
  • rapid cyclers, mixed patients
  • FBC
  • LFTs
  • ECG
  • monitor after 5 days, 1 month (adjust doses due to own metabolism)
  • goal blood level- 4-12mcg/ml
23
Q

What are the side effects of carbamazepine (anticonvulsant)?

A
  • rash (most common)
  • N + V, diarrhoea
  • sedation, diziness, ataxia, confusion
  • AV conduction delays
  • aplastic anaemia + agranulocytosis
  • water retention -> hyponatraemia
  • drug-drug interactions
24
Q

What are the side effects of lamotrigine (anticonvulsant)?

A
  • N + V
  • sedation, diziness, ataxia, confusion
  • toxic epidermal necrolysis, Steven Johnson’s syndrome

* any rash, must stop medication

25
Q

What are the indications for antipsychotics?

A
  • schizophrenia
  • schizoaffective disorder
  • bipolar disorder (mood stabilisation)
  • psychotic depression
  • resistant anxiety disorders (augmenting agent)
26
Q

How can the mesocortical pathway cause psychosis?

A
  • where negative symptoms + cognitive disorders arise
  • too little dopamine in the mesocortical pathway = psychosis
27
Q

How can the mesolimbic pathway cause psychosis?

A
  • where positive symptoms arise
  • too much dopamine in mesolimbic pathway = psychosis
28
Q

How do typical antipsychotics work?

A
  • D2 dopamine receptor antagonists
  • high potency typicals bind to bind to D2 receptors with high affinity
29
Q

What are the side effects of typical antipsychotics?

A

High potency:

  • extrapyramidal side effects
  • fluphenazine, haloperidol, pimozide

Low potency: (can interact with nondopaminergic receptors)

  • cardiotoxic
  • anticholinergic side effects
  • chlorpromazine, thioridazine
30
Q

How do atypical antipsychotics work?

A
  • serotonin-dopamine 2 antagonist (SDAs)
  • affect dopamine + serotonin
  • in the 4 key dopamine pathways of the brain
  • resperidone
  • olanzapine
  • quetiapine
  • aripiprazole
  • clozapine
31
Q

What are adverse effects of antipsychotics?

A
  • tardive dyskinesia (TD)
  • involuntary muscle movement
  • may not resolve with drug removal
  • neuroleptic malignant syndrome (NMS)
  • severe muscle rigidity
  • fever
  • altered mental status
  • autonomic instability
  • elevated WBC, CPKm LFTs
  • potentially fatal
  • extrapyramidal side effects (EPS)
  • acute dystonia
  • Parkinson syndrome
  • akathisia
32
Q

What drug are agents for extrapyramidal side effects (EPS)?

A
  • anticholinergics
  • benztropine
  • dopamine facilitators
  • amantadine
  • b-blockers
  • propanolol
33
Q

What are indications for anxiolytics?

A
  • panic disorder
  • generalised anxiety disorder
  • substance-related disorders
  • buspirone
  • benzodiazapines

Psychiatry (14 decks)

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