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Psychiatry > Psychopharmacology > Flashcards

Psychopharmacology Flashcards

1
Q

name the main classes of antidepressants

A
  • tricyclic antidepressants
  • SSRI
  • SNRI
  • MAOI
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2
Q

how long should a trial of antidepressants last at least, and why?

A

a trial should last at least 2 months, as there is a delay in response once therapeutic dose is reached

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3
Q

what types of tricyclic antidepressants exist?

A

secondary

tertiary

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4
Q

name a few examples of tertiary tricyclic antidepressants

A

amitryptiline
imipramine
clomipramine
doxepin

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5
Q

name a few side effects of tricyclic antidepressants

A
  • anticholinergic effects (consipation, dry mouth, blurred vision)
  • antihistaminic effects (sedation, weight gain)
  • antiadrenergic effects (hypotension, sexual dysfunction)
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6
Q

name a potentially dangerous cardiac side effect of TCAs

A

QT lengthening

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7
Q

what’s the difference between tertiary and secondary TCAs?

A

secondary TCAs are active metabolites of tertiary TCAs

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8
Q

what is the main action of tertiary TCAs?

A

block serotonin reuptake

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9
Q

what is the main action of secondary TCAs?

A

block the noradrenaline reuptake

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10
Q

what is the main action of MAOIs?

A

they bind irreversibly to monoamine oxidase, so that amines like dopamine, serotonin and noradrenaline aren’t inactivated

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11
Q

why can MAOIs cause serotonin syndrome when taken with SSRIs?

A

because SSRIs increase the amount of serotonin in the system, and MAOIs stop it from being broken down - leads to excessive serotonin

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12
Q

what is serotonin syndrome?

A

it’s a combination of symptoms that can be caused by an excess of serotonin due to combining 2+ antidepressants

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13
Q

can serotonin syndrome occur from only one antidepressant drug?

A

not likely, as toxic doses of serotonin are normally not achieved by one drug. it is most likely to occur when a combination of two drugs is given, or during an overlap period between one treatment and another

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14
Q

how long should you wait when putting a patient from SSRIs to MAOIs and why?

A

2 weeks (or 5 weeks for fluoxetine which has long half-life), to avoid overlap which could cause serotonin syndrome

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15
Q

name a few SSRI drugs

A 
fluoxetine
citalopram
setraline
paroxetine
escitalopram
fluvoxamine
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16
Q

how does serotonin syndrome present?

A 
sweating
shivering
fever
abdominal pain
dilated pupils
increased reflexes
myoclonus
irritability
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17
Q

name the two main serotonin-noradrenaline receptor inhibitors (SNRIs)

A

duloxetine

venlafaxine

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18
Q

what are the similarities between TCAs and SNRIs?

A

similarities: block both serotonin and noradrenaline reuptake
differences: don’t have the anticholinergic, antiadrenergic and antihistaminic side effects

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19
Q

what is a common side effect from taking SSRIs/SNRIs that affects compliance?

A

sexual dysfunction

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20
Q

which antidepressant drugs cause QT prolongation?

A

TCAs
venlafaxine
citalopram at high doses

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21
Q

name a few antihistaminic side effects caused by some antidepressants

A 
increased appetite
drowsiness
dry mouth
weight gain
constipation
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22
Q

which antidepressant drugs cause the most severe sedation?

A

paroxetine
mirtazapine
tricyclics

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23
Q

at which treatment stage of depression do novel antidepressants normally come in?

A

they are used to augment SSRIs or other antidepressants when symptoms have not resolved

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24
Q

name two antidepressants which can be used as augmenting agents

A

mirtazapine

bupropion

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25
Q

what is a common side effect of mirtazapine and why?

A

heavy sedation, because it has strong antihistaminic effects

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26
Q

name some risks of using bupropion for depression

A

it may cause anxiety and seizures

27
Q

what is the first line treatment of someone who presents with depression for the first time?

A

SSRI - sertraline, citalopram or fluoxetine

28
Q

what are the most common generic side effects noted with antidepressants?

A

sexual dysfunction
sedation
GI upset

29
Q

why should patients who are prescribed antidepressants have a trial period of at least 2 months?

A

because it can take a few weeks for the drug to have a therapeutic effect

30
Q

what is the general principle for choosing an antidepressant, and why?

A

choose the antidepressant based on patient’s comorbidities and past response, as the efficacy is similar for all antidepressants and the main differences are in the side effect profile

31
Q

would you give a SNRI to a patient presenting with depression for the first time?

A

no

32
Q

what is the general stepwise rule for prescribing antidepressants?

A 
SSRI
if doesn't work, try another SSRI
if that doesn't work, try a novel agent
if that doesn't work, try a SNRI
if that also doesn't work, try MAOI/TCA (beware comorbidities)
33
Q

which antidepressants can be lethal when overdosed?

A

tricyclic antidepressants

34
Q

how long should a patient stay on antidepressants after the first, second and third episode respectively?

A

first episode - 6 months
second episode -2 years prophylaxis
third episode - discuss life-long treatment

35
Q

what is the stepwise rule for prescribing antidepressants in case of treatment resistance?

A

antidepressant combination (SSRI/SNRI + novel)
if that’s not enough, add lithium
if that’s not enough, add atypical antipsychotic
if that’s not enough, consider ECT

36
Q

name a few drugs used to treat mania and bipolar affective disorder

A

lithium
valproic acid
carbamazepine
lamotrigine

37
Q

what tests should be done prior to prescribing lithium to a patient?

A 
pregnancy test (women)
TSH for thyroid function
U&E for renal function
38
Q

name a few factors which would promote the prescription of valproic acid to a patient with bipolar affective disorder

A
  • several episodes in a year
  • comorbidities
  • substance abuse
  • mixed mania/depression patients
39
Q

what is the first line treatment for acute mania or mania prophylaxis?

A

carbamazepine

40
Q

what is a serious side effect that could arise from giving a patient with bipolar affective disorder lamotrigine?

A

Steven-Johnson Syndrome

Toxic Epidermal Necrolysis

41
Q

what are mood stabilisers normally used for in psychiatry?

A

bipolar affective disorder and mania

42
Q

what tests should be done prior to prescribing valproic acid to a patient with bipolar affective disorder?

A

pregnancy test (females)
FBC
LFTs

43
Q

why should TSH and U&E be checked prior to prescribing lithium for bipolar patients?

A

because lithium can cause hypothyroidism and renal toxicity

44
Q

why should LFT and FBC be checked prior to prescribing valproic acid for bipolar patients?

A

because valproic acid can cause liver toxicity and agranulocytosis

45
Q

what is an important consideration when prescribing mood stabilisers to women?

A

mood stabilising drugs can be teratogenic

46
Q

name the four dopaminergic pathways in the brain and their route

A

mesocortical - VTA to cortex
mesolimbic - VTA to limbic system
nigrostriatal - substantia nigra to basal ganglia
tuberoinfundibular - hypothalamus to anterior pituitary

47
Q

what is the difference between typical and atypical antipsychotics?

A

typical antipsychotics only target dopamine receptors, whereas atypical antipsychotics target dopamine and serotonin receptors

48
Q

which class of antipsychotics is more likely to cause extrapyramidal side effects?

A

typical antipsychotics

49
Q

why do typical antipsychotics carry a higher risk of extrapyramidal side effects than atypical antipsychotics?

A

because typical antipsych’s have high affinity for D2 receptors than atypical antipsych’s

50
Q

which atypical antipsychotic drug carries the highest risk of hyperprolactinaemia?

A

risperidone

51
Q

what baseline blood tests should be done prior to starting an antipsychotic?

A

FBC
lipid profile (cholesterol)
blood glucose
LFT

52
Q

what is a common extrapyramidal side effect that can occur with antipsychotics and needs to be treated urgently?

A

akathisia

53
Q

what is the main side effect of benzodiazepines?

A

dependence

54
Q

what side effect is most common in patients taking olanzapine as an antipsychotic?

A

weight gain

55
Q

what are buspirone and benzodiazepines used for?

A

anxiety disorders

56
Q

which drug is only prescribed as an antipsychotic in the case of antipsychotic resistance?

A

clozapine

57
Q

what are the risks of prescribing high doses of risperidone as an antipsychotic?

A

it has a higher risk of causing extrapyramidal symptoms like typical antipsychotics

58
Q

what side effect is often associated with quetiapine as an antipsychotic?

A

orthostatic hypotension

59
Q

what is the rule of thirds when it comes to antipsychotic treatment?

A

1/3 of patients respond well
1/3 of patients respond intermediately well
1/3 of patient don’t respond

60
Q

what is different about aripiprazole compared to other antipsychotics?

A

it acts as a partial D2 agonist

61
Q

name three serious side effects which can arise due to antipsychotics

A

extrapyramidal symptoms
neuroleptic malignant syndrome
tardive dyskinesia

62
Q

how often should bloods be checked if someone is put on lithium?

A

every 3 months

63
Q

what is the benefit of putting someone on lithium for antidepression?

A

it reduces suicidal risk

Psychiatry (7 decks)

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