Psychopharmacology Flashcards by Giulia Uitenbosch

name the main classes of antidepressants

tricyclic antidepressants
SSRI
SNRI
MAOI

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

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

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what types of tricyclic antidepressants exist?

secondary

tertiary

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name a few examples of tertiary tricyclic antidepressants

amitryptiline
imipramine
clomipramine
doxepin

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name a few side effects of tricyclic antidepressants

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

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name a potentially dangerous cardiac side effect of TCAs

QT lengthening

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what’s the difference between tertiary and secondary TCAs?

secondary TCAs are active metabolites of tertiary TCAs

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what is the main action of tertiary TCAs?

block serotonin reuptake

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what is the main action of secondary TCAs?

block the noradrenaline reuptake

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what is the main action of MAOIs?

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

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why can MAOIs cause serotonin syndrome when taken with SSRIs?

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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what is serotonin syndrome?

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

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can serotonin syndrome occur from only one antidepressant drug?

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

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

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name a few SSRI drugs

fluoxetine
citalopram
setraline
paroxetine
escitalopram
fluvoxamine

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how does serotonin syndrome present?

sweating
shivering
fever
abdominal pain
dilated pupils
increased reflexes
myoclonus
irritability

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

duloxetine

venlafaxine

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what are the similarities between TCAs and SNRIs?

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

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

sexual dysfunction

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which antidepressant drugs cause QT prolongation?

TCAs
venlafaxine
citalopram at high doses

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name a few antihistaminic side effects caused by some antidepressants

increased appetite
drowsiness
dry mouth
weight gain
constipation

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which antidepressant drugs cause the most severe sedation?

paroxetine
mirtazapine
tricyclics

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

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

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name two antidepressants which can be used as augmenting agents

mirtazapine

bupropion

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what is a common side effect of mirtazapine and why?

heavy sedation, because it has strong antihistaminic effects

name some risks of using bupropion for depression

it may cause anxiety and seizures

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

SSRI - sertraline, citalopram or fluoxetine

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

sexual dysfunction sedation GI upset

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

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

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

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

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

what is the general stepwise rule for prescribing antidepressants?

``` 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) ```

which antidepressants can be lethal when overdosed?

tricyclic antidepressants

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

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

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

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

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

lithium valproic acid carbamazepine lamotrigine

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

``` pregnancy test (women) TSH for thyroid function U&E for renal function ```

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

- several episodes in a year - comorbidities - substance abuse - mixed mania/depression patients

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

carbamazepine

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

Steven-Johnson Syndrome | Toxic Epidermal Necrolysis

what are mood stabilisers normally used for in psychiatry?

bipolar affective disorder and mania

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

pregnancy test (females) FBC LFTs

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

because lithium can cause hypothyroidism and renal toxicity

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

because valproic acid can cause liver toxicity and agranulocytosis

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

mood stabilising drugs can be teratogenic

name the four dopaminergic pathways in the brain and their route

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

what is the difference between typical and atypical antipsychotics?

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

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

typical antipsychotics

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

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

which atypical antipsychotic drug carries the highest risk of hyperprolactinaemia?

risperidone

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

FBC lipid profile (cholesterol) blood glucose LFT

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

akathisia

what is the main side effect of benzodiazepines?

dependence

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

weight gain

what are buspirone and benzodiazepines used for?

anxiety disorders

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

clozapine

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

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

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

orthostatic hypotension

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

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

what is different about aripiprazole compared to other antipsychotics?

it acts as a partial D2 agonist

name three serious side effects which can arise due to antipsychotics

extrapyramidal symptoms neuroleptic malignant syndrome tardive dyskinesia

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

every 3 months

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

it reduces suicidal risk