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Psychiatry > Psychopharmacology > Flashcards

Psychopharmacology Flashcards

1
Q

List some indications for antidepressant use

A

Unipolar and bipolar depression,
Organic mood disorders,
Schizoaffective disorder,
Anxiety disorders (OCD, panic, social phobia, PTSD, premenstrual dysphoric disorder, impulsivity associated with personality disorders.)

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2
Q

How long is the typical delay between therapeutic dose and symptom improvement?

A

3-6 weeks

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3
Q

How long should you wait before either switching to another antidepressant/augmenting due to no improvement?

A

At least 2 months

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4
Q

List some classifications of antidepressants?

A
  • Tricyclics (TCAs)
  • Monoamine Oxidase Inhibitors (MAOIs)
  • Selective Serotonin Reuptake Inhibitors (SSRIs)
  • Serotonin/Noradrenaline Reuptake Inhibitors (SNRIs)
  • Novel antidepressants
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5
Q

What are some of the side effects of TCAs?

A
  • Antihistaminic (Sedation, Weight gain)
  • Anticholinergic (Dry mouth, dry eyes, constipation etc)
  • Antiadrenergic (Othostatic hypotension, sexual dysfunction)
  • Lethal in overdose
  • QT lengthening
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6
Q

List some examples of tertiary TCAs

A

Imipramine
Amitriptyline
Doxepin
Clompiramine

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7
Q

List some examples of secondary TCAs

A

Desipramine

Notrtriptyline

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8
Q

List some side effects of MAOIs

A

Orthostatic hypotension, weight gain, dry mouth, sedation, sexual dysfunction and sleep disturbance

Hypertensive reaction with tyramine-rich foods (Cheese reaction!)

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9
Q

What symptoms may take place in serotonin syndrome?

A 
Abdominal pain
Diarrhoea
Sweating
Tachycardia
Hypertension
Myoclonus
Irritability
Delirium
Hyperpyrexia
Shock
Death

(Need to wait 2 weeks before switching from SSRI to MAOI)

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10
Q

List some common side effects of SSRIs

A 
GI upset
Sexual dysfunction
Nervousness
Insomnia
Fatigue
Sedation
Dizziness
Discontinutation syndrome (Agitation, nausea, disequilibrium, dysphoria)
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11
Q

List some examples of SSRIs

A 
Paroxetine
Sertraline
Fluoxetine
Citalopram
Escitalopram
Fluvoxamine
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12
Q

Which SSRI may be good for patients with noncompliance issues?

A

Fluoxetine

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13
Q

List some examples of SNRIs

A

Venlafaxine

Duloxetine

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14
Q

What SNRI may be useful for physical symptoms of depression?

A

Duloxetine

Also for neuropathic pain!

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15
Q

List some examples of novel antidepressants

A

Mirtazapine

Buproprion

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16
Q

What can be used in treatment resistant depression?

A
  • Combination - eg SSRI/SNRI + Mirtazepine
  • Adjunctive lithium
  • Adjunctive atypical antipsychotic (eg Quetipaine)
  • ECT
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17
Q

List some indications for mood stabiliser use?

A
  • Bipolar
  • Cyclothymia
  • Scizoaffective
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18
Q

List some classes of mood stabiliser

A

Lithium
Anticonvulsants
Antipsychotics

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19
Q

What is the only medication to reduce suicide rate?

A

Lithium

20
Q

What factors predict good response rate to lithium?

A
  • Prior long-term response or family member with good response
  • Classic pure mania
  • Mania is followed by depression
21
Q

What things need to be checked before commencing lithium?

A
  • Baseline U+E
  • TSH
  • Check pregnancy test in women (Ebstein’s anomaly risk)
22
Q

How often do lithium levels need checked after steady state is achieved?

A

Every 3 months

23
Q

List some potential side effects of lithium

A
  • GI distress - reduced appetite, nausea/vomiting, diarrhoea
  • Thyroid abnormalities
  • Nonsignificant leukocytosis
  • Polyuria/polydypsia secondary to ADH antagonism.
  • Hair loss, acne
  • Reduces seizure threshold, cognitive slowing, intention tremor
24
Q

What are the effects of lithium toxicity

A

Mild (1.5-2.0) - Vomiting, diarrhoea, dizziness, slurred speech, nystagmus

Moderate (2-2.5) - +Blurred vision, clonic limb movements, convulsions, delirium

Severe - + generalised convulsions, oliguria, renal failure

25
Q

What is the therapeutic range of lithium?

A

0.6-1.2

26
Q

List some examples of anticonvulsants?

A

Vaproic acid (Depakote)
Carbamazepine
Lamotrigine

27
Q

What things need to be checked before commencing valproic acid?

A

Baseline LFTs
Pregnancy test
FBC

28
Q

What are some side effects of valproic acid?

A
  • Thrombocytopenia and platelet dysfunction
  • Nausea, vomiting, weight gain
  • Sedation, tremor
  • Neural tube defect
  • Hair loss
29
Q

What things need to be checked before commencing carbamazepine?

A

Baseline LFTs
FBC
ECG

30
Q

What are some common side effects of carbamazepine?

A
  • Rash
  • Nausea, vomiting, diarrhoea
  • Sedation, dizziness, ataxia, confusion
  • AV conduction delays
  • Aplastic anemia and agranulocytosis
  • Water retention -> Hyponatremia
31
Q

What are some common side effects of lamotrigine?

A

-Nausea/vomiting
-Sedation, dizziness, ataxia, confusion
-Toxic epidermal necrolysis
-Stevens Johnson’s syndrome
etc

32
Q

List some antipsychotic drugs that may be used in bipolar disroder

A
  • Aripiprazole
  • Risperidone
  • Quetiapine
  • Olanzapine
33
Q

What are some indications for antipsychotics?

A
  • Schizophrenia
  • Schizoaffective disorder
  • Bipolar disorder for mood stabilisation
  • Psychotic depression
  • Treatment resistant anxiety disorders
34
Q

What key pathways are affected by dopamine in the brain?

A
  • Mesocortical
  • Mesolimbic
  • Nigrostriatal
  • Tuberoinfundibular
35
Q

What pathway in the brain is responsible for negative symptoms in schizophrenia?

A

Mesocortical pathway

36
Q

What pathway in the brain is responsible for positive symptoms in schizophrenia?

A

Mesolimbic pathway

37
Q

What receptors do typical antipsychotics act on?

A

D2 dopamine receptor (Antagonists)

38
Q

List some examples of typical antipsychotics

A 
Fluphenazine
Haloperidol
Pimozide
Chlorpromazine
Thioridazine
39
Q

What receptors do atypical antipsychotics act on?

A

Serotonin-dopamine 2 antagonists

40
Q

List some examples of atypical antipsychotics

A 
Risperidone
Olanzepine
Quetiapine
Aripiprazole
Clozapine
41
Q

List some adverse effects of antipsychotic medications

A
  • Tardve dyskinesia
  • Extrapyramidal side effects (Acute dystonia, Parkinsonisms, Akathisia)
  • Neuroleptic Maligant Syndrome
42
Q

What agents may be used to counter extrapyramidal side effects?

A
  • Anticholinergics (Benztropine, trihexyphenidyl, diphenhydramine)
  • Dopamine facilitators (Amantadine)
  • Beta-bockers (Propanolol)
43
Q

What are some indications for anxiolytics?

A
  • Panic disorder
  • Generalised anxiety disorder
  • Substance-related disorders
44
Q

List some examples of anxiolytics

A

Buspirone

Benzodiazpines

45
Q

When may bezodiazepine be used?

A
  • Insomnia, parasomnias, anxiety disorders

- CNS depressant withdrawal

46
Q

What are some side effects of benzodiazapines?

A 
Somnolence
Cognitive deficits
Amnesia
Disinhibition
Tolerance
Dependence

Psychiatry (15 decks)

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