psychopharmacology Flashcards
what are pros and cons of TCAs ?
pros - very effective
cons - antihistaminic (weight gain, sedation), anticholinergic, antiadrenergic(hypotension, sexual dysfunction) side effects
lethal in overdose
can cause QT lengthening
what is the action of tertiary TCAs ?
serotonin receptor agonists
what are secondary TCAs and what is their action ?
metabolites of tertiary amines
block noradrenaline
less severe side effects
nortriptyline, desipramine
how do MAOIs work ?
bind to monoamine oxidase, prevent inactivation of amines such as norepinephrine, dopamine, serotonin - leads to increased synaptic levels
what are side effects of MAOIs ?
tyramine crisis - hypertensive crisis orthostatic hypotension weight gain dry mouth sedation sexual dysfunction sleep disturbance
what is serotonin syndrome ?
if taking MAOIs with meds that increase serotonin
abdo pain diarrhoea sweats tachycardia, HTN myoclonus irritability delirium
hyperpyrexia, shock, death
how do you avoid serotonin syndrome ?
wait 2 weeks before switching from SSRI to MAOI
except fluoxetine wait 5 weeks
what are examples of MAOIs ?
selegeline
rasagiline
how do SSRIs work ?
block presynaptic serotonin uptake
what are common side effects with SSRIs ?
GI upset sexual dysfunction anxiety restlessness nervousness insomnia fatigue sedation dizziness
what are symptoms of discontinuation syndrome ?
agitation
nausea
disequilibrium
dysphoria
what are pros and cons of paroxetine ?
pros - short half life, sedating - take at night, good initial
cons - weight gain, sedating, discontinuation syndrome
what are pros and cons of sertraline ?
pros - weak drug interaction, short h/l
cons - need full stomach, GI ADR
what are pros and cons of fluoxetine ?
pros - less discontinuation, initial activating
cons - bad for liver, ADR, initial anxiety, induce mania
what are pros and cons of citalopram ?
pros - few ADR
cons - QT prolongation, sedating, GI
what are pros and cons of escitalopram ?
pros - low ADR
cons - QT prolongation, nausea, headache
what are pros and cons of fluvoxamine ?
pros - analgesic, shortest h/l
cons - GI, headache, sedation, weakness, ADR
how do SNRIs work ?
inhibit both serotonin and noradrenergic reuptake like TCA but less side effects
what are pros and cons with venlafaxine ?
pros - low ADR, fast renal clearance
cons - HTN, nausea, discontinuation syndrome, sexual side effect, QT prolongation
what are pros and cons of duloxetine ?
pros - physical depression
cons- ADR, high drop out rate
what are pros and cons of mirtazapine ?
pros - augmented with SSRI - 5HT receptor antagonist
cons - increase cholesterol, sedating, weight gain
what are pros and cons of buproprion ?
pros - augmenting, little side effects, 2nd line ADHD
cons- seizure risk avoid in brain things, no anxiety treatment, psychotic - abuse potential
how do you manage treatment resistance ?
combo SSRI/SNRI with mirtazapine
+lithium
+atypical antipsychotic
ECT
what factors predict +ve response to lithium ?
prior long term/ FHx good response
classic pure mania
mania followed by depression
what needs to be done before starting lithium ?
baseline U+E, TSH
pregnancy test
how do you monitor someone on lithium ?
check after 5 days, 12 hours after dose
once stable check 3 months + TSH, creatinine,
then 6 months
goal 0.6-1.2
what are side effects of lithium ?
GI distress - N+V, diarrhoea thyroid abnormalities leukocytosis polyuria hair loss, acne reduced seizure threshold, cognitive slowing
what are symptoms of lithium toxicity ?
mid 1.5-2.0 - vomiting, diarrhoea, ataxia, dizziness, slurred speech
moderate 2-2.5 - N+V, anorexia, blurred vision, clonic movement, seizure, delirium, syncope
severe >2.5 - seizures, oliguria, renal failure
what factors predict positive response to valproic acid ?
rapid cycling patients
comorbid substance abuse
mixed patients
anxiety
what needs done before starting valproic acid ?
baseline LFTs
pregnancy test
FBC
start folic acid in women
how is valproic acid monitored ?
steady after 4/5 days, 12 hours after dose
repeat FBC, LFT
target 50-125
what are side effects of valproic acid ?
thrombocytopenia N+V weight gain sedation tremor hair loss
neural tube defect
what needs done before starting carbamazepine ?
baseline LFT, FBC, ECG
how is carbamazepine monitored ?
steady 5 days + 12 hours
FBC, LFTs
4-12 mcg/ml
check after 1 month
what are side effects of carbamazepine ?
rash N+V+D sedation dizziness, ataxia, confusion AV conduction delay anaemia, agranulocytosis water retention ADR - lots
what are side effects of lamotrigine ?
N+V
sedation, dizzy, ataxic, confusion
TEN, SJS - discontinue if rash
what drugs increase lamotrigine ?
VPA
