Psychopharmacology Flashcards
1
Q
What are the main classes of anti-depressants?
A
SSRIs SNRIs Mirtazapine TCAs MAOIs
2
Q
What are the indications for anti-depressants?
A
Unipolar depression Bipolar depression Schizoaffective disorder OCD Panic disorder Social phobia PTSD
3
Q
What is the mechanism of SSRIs?
A
Blocks presynaptic serotonin reuptake -> increases serotonin concentration in synaptic cleft
4
Q
What are the indications for SSRIs?
A
Depression Panic disorder Bulimia nervosa (fluoxetine) OCD PTSD GAD
5
Q
What are examples of SSRIs?
A
Sertraline
Citalopram
Fluoxetine
6
Q
What are the side effects of SSRIs?
A
GI disturbance Agitation on initiation Sweating Tremore Sexual dysfunction Serotonin syndrome
7
Q
What are the symptoms of serotonin syndrome?
A
Cognitive
- headacges
- agitation
- hypomania
Autonomic
- shivering
- sweatin
- N+D
- tachycardia
Somatic
- myoclonus
- hyperreflexia
- tremor
8
Q
What are contraindications for SSRIs?
A
Mania
NSAIDs
Warfarin/heparin/aspirin
Triptans
9
Q
What is a risk on stopping SSRIs?
A
Discontinuation syndrome
10
Q
What are the features of discontinuation syndrome?
A
Sweating Shakes Agitiation Insomnia Hypomania Irritability Nausea
11
Q
How is serotonin syndrome managed?
A
Stop treatment
Supportive measures
12
Q
What is the mechanism of SNRIs?
A
Block serotonin and noradrenaline reuptake
13
Q
What are examples of SNRIs?
A
Venlafaxine
Duloxetine
14
Q
What are the indications for an SNRI?
A
Second line - depression + anxiety
15
Q
What are the side effects of SNRIs?
A
Nausea
Dry mouth
Sexual dysfunction
Sedation
16
Q
What are contraindications for SNRIs?
A
Cardiac arrhythmias
Uncontrolled hypertension
17
Q
What class is mirtazapine?
A
NASSA - noradrenaline-serotonin specific antidepressant
18
Q
What is the mechanism of mirtazapine?
A
5HT-2 + 5HT-3 antagonist
Weak noradrenaline reuptake blacker
Anti-histaminergic properties
19
Q
What are the indications for mirtazapine?
A
Second line for depression who suffer with insomnia or could benefit from weight gain
20
Q
What are the side effects of mirtazapine?
A
Increased appetitie Weight gain Sedation Dry mouth Oedema
21
Q
What is the mechanism of TCAs?
A
Inhibit reuptake of adrenaline and serotonin in the synaptic cleft
Affinity for cholinergic receptors
22
Q
What are examples of TCAs?
A
Amitriptylline
Imipramine
23
Q
Whar are the indications for TCAs?
A
Depression
Neuropathic pain
Nocturnal enuresis in children
24
Q
What are the side effects of TCAs?
A
Anti-cholinergic
- dry mouth
- constipation
- urinary retention
- blurred vision
Arrythmias - QT prolongation
Hypersensitivity reactions
Weight gain
Sexual dysfunction
25
What are contraindications for TCAs?
Cardiac disese
Mania
Severe liver disease
Agranulocytosis
26
What do you need to be aware of when prescribing TCAs?
Risk of overdose - lethal
27
What is the mechanism of MAOIs?
Inactivate monoamine oxidase enxymes that oxidise
- dopamine
- noradrenaline
- serotonin
- tyramine
28
What are examples of MAOIs?
Phenelzine
Isocarboxide
Moclobemide
29
What are indications for MAOIs?
Third line for depression
30
What are side effects of MAOIs?
```
Postural hypotension
Arrhythmias
Drowsiness
Increased appetite/weight gain
Sexual disturbances
```
31
What are contraindications for MAOIs?
Acute confusional states
| Phaeochromocytoma
32
What are the indications for anti-psychotics?
Schizophrenia
Schizoaffective disorder
Bipolar disorder
Psychosis
33
What are the types of anti-psychotic?
Typical
| Atypical
34
What are examples of typical anti-psychotics?
Haloperidol
Chlorpromazine
Flupentixol
35
What are examples of atypical anti-psychotics?
```
Olanzapine
Risperidone
Quetiapine
Aripiprazole
Clozapine
```
36
What type of anti-psychotic is used first line for schizophrenia?
Atypical antipsychotic
37
What is the mechanism of anti-pyschotics?
Block dopamine receptors via
- mesocortical pathway
- mesolimbic pathway
- nigrostriatal pathway
- tuberofundibular pathway
38
What is the mesocortical pathway?
Ventral tegmentum-> cerebral cortex
Negative symptoms + cognitive disorders
39
What is the mesolimbic pathway?
Ventral tegmentum -> limbic system
Hallucinations, delusions + thought disorders
40
What is the nigrostriatal pathway?
Substantia nigra -> basal ganglia
Movement regulation
41
What is the tuberofundibular pathway?
Hypothalamus -> anterior pituitary
Prolactin release
42
When is clozapine used?
3rd line for schizophrenia
After 2 other anti-pyschotics have failed
43
What are side effects of anti-psychotics?
Extra-pyramidal side effects
- parkinsonism
- akathisia
- dystonia
- tardive dyskinesia
Anti-muscarinic
- blurred vision
- urinary retention
- constipation
- dry mouth
Anti-histaminergic
- sedation
- weight gain
Prolonged QTc
Neuroleptic malignant syndrome
44
What is the akathisia?
Upleasant feeling of restlessness
45
What is dystonia?
Acute painfil muscle contractions
46
What is tardive dyskinesia?
Late onset of choreoathetoid movement
47
How are extra-pyramidal side effects managed?
Anti-cholinergics
48
What is neuroleptic malignant syndrome?
Life threatening condition seen in patients taking antipsychotic medications
49
What are the features of NMS?
```
Fever
Muscular rigidity
Confusion
Autonomic instability
Raised CK
Deranged LFTs
```
50
How is NMS managed?
Stop anti-psychotic
IV fluids
Dantrolene
Bromocriptine
51
What is dantrolene?
Muscle relaxant
52
What is bromocriptine?
Dopamine agonist
53
What specific side effects does clozapine have?
Agranulocytosis
GI hypersensitivity
Hypersalivation
54
How is the risk of agranulocytosis with clozapine managed?
FBC weekly for first 18 weeks, then fortnightly up to a year, then monthly
55
What are contraindications for anti-psychotics?
Comatose states
CNS depression
Phaeochromocytoma
56
What anti-psychotic monitoring is done at baseline?
```
FBC
U&Es
LFTs
Fasting blood glucose
Lipids
ECG
BP
Prolactin
Weight
CK
```
57
What anti-psychotic monitoring should be done at 3 months?
```
Weight
FBC
U&Es
LFTs
Lipids
```
58
What anti-psychotic monitoring should be done at 6 months?
Fasting blood glucose
| Prolactin
59
What anti-psychotic monitoring should be done annually?
```
FBC
U&Es
LFTs
Lipids
Prolactin
Weight
```
60
What are the indications for mood stabilisers?
Bipolar affective disorder
Cyclothymia
Schizoaffective disorder
61
What are examples of mood stabilisers?
Lithium
Sodium valproate
Carbamazepine
Lamotrigine
62
What is the first line drug for bipolar?
Lithium
63
What is the mechanism of lithium?
Unknown
64
What are the side effects of lithium?
```
GI distubrnaces
Leucocytosis
Impaired renal function
Tremor
Thyroid abnormalities
Weight gain
```
65
How long should a patient be on lithium for?
Minimum 18 months
66
What lithium monitoring needs to be done at baseline?
```
U&Es
FBC
TFTs
Pregnancy test
ECG
```
67
How often should U&Es be checked while on lithium?
6 months
68
How often should TFTs be checked while on lithium?
12 months
69
How often should lithium levels be monitored?
12 hours after 1st dose
Weekly until range 0.4-1 mmol/L
3 monthly once stable
70
What are the signs of mild lithium toxicity?
Lithium 1.5-2 mmol/L
D+V
Ataxia
Dizziness
Slurred speech
71
What are the signs of moderate lithium toxicity?
Lithium 2-2.5 mmol/L
N+V
Anorexia
Blurred vision
Clonic limbs
72
What are the signs of severe lithium toxicity?
Lithium >2.5 mmol/L
Generalised convulsions
Oliguria
Renal failure
73
How is lithium toxicity managed?
IV fluids
| +/- dialysis
74
Which drugs does lithium interact with?
NSAIDs
Diuretics
ACEi
75
What is the mechanism of sodium valproate?
Inhibit GABA catabolism
76
What are the side effects of sodium valproate?
```
GI disturbances
Weight gain
Sedation
Thrombocytopenia
Reversible hair loss
Tremor
```
77
What baseline monitoring needs to be done on sodium valproate?
```
FBC
LFTs
PT
Pregnancy test
Weight
```
78
What monitoring needs to be done at 6 months on sodium valproate?
LFTs
FBC
Weight
79
What is the mechanism of carbamazepine?
Blocks voltage dependent sodium channels
Reduces glutamate release
80
What are the indications for carbamazepine?
Mania (not 1st line)
| BAPD - not responsive to lithium
81
What are the side effects of carbamazepine?
```
GI disturbances
Dermatitis
Dizziness
Hyponatraemia
Blood disorders
```
82
What monitoring is required on carbamazepine?
Base line
- FBC
- U+Es
- LFTs
- weight
Check FBC after a week
83
What are contraindications for carbamazepine?
AV conduction abnormalities
| Acute porphyria
84
What is the mechanism of lamotrigine?
Inhibit sodium and calcium channels in presynaptic neurons
85
What are the indications for lamotrigine?
Bipolar depression - least teratogenic so used in women of child bearing age
86
What are the side effects of lamotrigine?
GI disturbances
Rash
Headach
Tremor
87
What monitoring is required on lamotrigine?
Baseline
- FBC
- LFTs
- U&Es
88
What classes are used as anxiolytics?
```
Beta blockers
Benzodiazepones
Pregabalin
Buspirone
'Z' drugs
```
89
What is the mechanism of beta blockers?
Reduces autonomic nervous system activation
90
When are beta blockers used in anxiety?
Symptomatic relieg
91
What are the examples of long acting benzodiazepines?
Diazepam
| Clonazepam
92
What is the duration of action for long acting benzodiazepines?
>24hrs
93
What are examples of short acting benzodiazepines?
Lorazepam
Midazolam
Temazepam
94
What is the duration of action of short acting benzodiazepines?
<12 hrs
95
What are the indications for benzodiazepines?
```
Insomnia
Anxiety disroders
Delirium tremens
Alcohol detoxification
Acute psychosis
Violent behaviour
```
96
What is the mechanism of action of benzodiazepines?
GABA potentiator
Reduces excitability of neurones
97
What are the side effects of benzodiazepines?
```
Drowsiness
Lightheadedness
Confusion
Ataxia
Dependence
```
98
What are features of benzodiazepine overdose?
```
Ataxia
Dysarthria
Nystagmus
Coma
Respiratory depression
```
99
How is benzodiazepine overdose managed?
IV flumazenil
100
What is the mechanism of pregabalin?
Inhibitor of glutamate, noradrenaline and substance P
101
What are indications for pregabalin?
GAD
| Neuropathic pain
102
What are side effects of pregabalin?
Dizziness
Drowsiness
Sefation
Blurred vision
103
What is the mechanism of buspirone?
5HT-1A agonist
104
What is the indication for buspirone?
Non-sedating anxiolytic
105
Wha are the side effects of buspirone?
Nausea
Headache
Light-headedness
106
What are the 'z' drugs?
Zopiclone
Zolpidem
Zaleplon
107
What is the mechanism of 'z' drugs?
Enhance GABA transmission
108
How long can 'z' drugs be used?
2 weeks
| 5 days out of 7
