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Psychiatry > Psychopharmacology > Flashcards

Psychopharmacology Flashcards

1
Q

What are the main classes of anti-depressants?

A 
SSRIs
SNRIs
Mirtazapine
TCAs
MAOIs
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2
Q

What are the indications for anti-depressants?

A 
Unipolar depression 
Bipolar depression 
Schizoaffective disorder
OCD
Panic disorder
Social phobia
PTSD
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3
Q

What is the mechanism of SSRIs?

A

Blocks presynaptic serotonin reuptake -> increases serotonin concentration in synaptic cleft

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4
Q

What are the indications for SSRIs?

A 
Depression 
Panic disorder
Bulimia nervosa (fluoxetine)
OCD
PTSD
GAD
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5
Q

What are examples of SSRIs?

A

Sertraline
Citalopram
Fluoxetine

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6
Q

What are the side effects of SSRIs?

A 
GI disturbance
Agitation on initiation 
Sweating 
Tremore
Sexual dysfunction 
Serotonin syndrome
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7
Q

What are the symptoms of serotonin syndrome?

A

Cognitive

  • headacges
  • agitation
  • hypomania

Autonomic

  • shivering
  • sweatin
  • N+D
  • tachycardia

Somatic

  • myoclonus
  • hyperreflexia
  • tremor
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8
Q

What are contraindications for SSRIs?

A

Mania
NSAIDs
Warfarin/heparin/aspirin
Triptans

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9
Q

What is a risk on stopping SSRIs?

A

Discontinuation syndrome

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10
Q

What are the features of discontinuation syndrome?

A 
Sweating 
Shakes
Agitiation 
Insomnia
Hypomania
Irritability 
Nausea
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11
Q

How is serotonin syndrome managed?

A

Stop treatment

Supportive measures

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12
Q

What is the mechanism of SNRIs?

A

Block serotonin and noradrenaline reuptake

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13
Q

What are examples of SNRIs?

A

Venlafaxine

Duloxetine

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14
Q

What are the indications for an SNRI?

A

Second line - depression + anxiety

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15
Q

What are the side effects of SNRIs?

A

Nausea
Dry mouth
Sexual dysfunction
Sedation

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16
Q

What are contraindications for SNRIs?

A

Cardiac arrhythmias

Uncontrolled hypertension

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17
Q

What class is mirtazapine?

A

NASSA - noradrenaline-serotonin specific antidepressant

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18
Q

What is the mechanism of mirtazapine?

A

5HT-2 + 5HT-3 antagonist
Weak noradrenaline reuptake blacker
Anti-histaminergic properties

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19
Q

What are the indications for mirtazapine?

A

Second line for depression who suffer with insomnia or could benefit from weight gain

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20
Q

What are the side effects of mirtazapine?

A 
Increased appetitie
Weight gain 
Sedation 
Dry mouth 
Oedema
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21
Q

What is the mechanism of TCAs?

A

Inhibit reuptake of adrenaline and serotonin in the synaptic cleft
Affinity for cholinergic receptors

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22
Q

What are examples of TCAs?

A

Amitriptylline

Imipramine

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23
Q

Whar are the indications for TCAs?

A

Depression
Neuropathic pain
Nocturnal enuresis in children

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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

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25
Q

What are contraindications for TCAs?

A

Cardiac disese
Mania
Severe liver disease
Agranulocytosis

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26
Q

What do you need to be aware of when prescribing TCAs?

A

Risk of overdose - lethal

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27
Q

What is the mechanism of MAOIs?

A

Inactivate monoamine oxidase enxymes that oxidise

  • dopamine
  • noradrenaline
  • serotonin
  • tyramine
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28
Q

What are examples of MAOIs?

A

Phenelzine
Isocarboxide
Moclobemide

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29
Q

What are indications for MAOIs?

A

Third line for depression

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30
Q

What are side effects of MAOIs?

A 
Postural hypotension 
Arrhythmias
Drowsiness
Increased appetite/weight gain 
Sexual disturbances
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31
Q

What are contraindications for MAOIs?

A

Acute confusional states

Phaeochromocytoma

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32
Q

What are the indications for anti-psychotics?

A

Schizophrenia
Schizoaffective disorder
Bipolar disorder
Psychosis

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33
Q

What are the types of anti-psychotic?

A

Typical

Atypical

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34
Q

What are examples of typical anti-psychotics?

A

Haloperidol
Chlorpromazine
Flupentixol

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35
Q

What are examples of atypical anti-psychotics?

A 
Olanzapine
Risperidone
Quetiapine
Aripiprazole
Clozapine
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36
Q

What type of anti-psychotic is used first line for schizophrenia?

A

Atypical antipsychotic

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37
Q

What is the mechanism of anti-pyschotics?

A

Block dopamine receptors via

  • mesocortical pathway
  • mesolimbic pathway
  • nigrostriatal pathway
  • tuberofundibular pathway
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38
Q

What is the mesocortical pathway?

A

Ventral tegmentum-> cerebral cortex

Negative symptoms + cognitive disorders

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39
Q

What is the mesolimbic pathway?

A

Ventral tegmentum -> limbic system

Hallucinations, delusions + thought disorders

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40
Q

What is the nigrostriatal pathway?

A

Substantia nigra -> basal ganglia

Movement regulation

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41
Q

What is the tuberofundibular pathway?

A

Hypothalamus -> anterior pituitary

Prolactin release

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42
Q

When is clozapine used?

A

3rd line for schizophrenia

After 2 other anti-pyschotics have failed

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43
Q

What are side effects of anti-psychotics?

A

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

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44
Q

What is the akathisia?

A

Upleasant feeling of restlessness

45
Q

What is dystonia?

A

Acute painfil muscle contractions

46
Q

What is tardive dyskinesia?

A

Late onset of choreoathetoid movement

47
Q

How are extra-pyramidal side effects managed?

A

Anti-cholinergics

48
Q

What is neuroleptic malignant syndrome?

A

Life threatening condition seen in patients taking antipsychotic medications

49
Q

What are the features of NMS?

A 
Fever
Muscular rigidity 
Confusion 
Autonomic instability 
Raised CK 
Deranged LFTs
50
Q

How is NMS managed?

A

Stop anti-psychotic
IV fluids
Dantrolene
Bromocriptine

51
Q

What is dantrolene?

A

Muscle relaxant

52
Q

What is bromocriptine?

A

Dopamine agonist

53
Q

What specific side effects does clozapine have?

A

Agranulocytosis
GI hypersensitivity
Hypersalivation

54
Q

How is the risk of agranulocytosis with clozapine managed?

A

FBC weekly for first 18 weeks, then fortnightly up to a year, then monthly

55
Q

What are contraindications for anti-psychotics?

A

Comatose states
CNS depression
Phaeochromocytoma

56
Q

What anti-psychotic monitoring is done at baseline?

A 
FBC
U&Es
LFTs
Fasting blood glucose
Lipids
ECG
BP 
Prolactin
Weight
CK
57
Q

What anti-psychotic monitoring should be done at 3 months?

A 
Weight
FBC
U&Es
LFTs
Lipids
58
Q

What anti-psychotic monitoring should be done at 6 months?

A

Fasting blood glucose

Prolactin

59
Q

What anti-psychotic monitoring should be done annually?

A 
FBC
U&Es
LFTs
Lipids
Prolactin 
Weight
60
Q

What are the indications for mood stabilisers?

A

Bipolar affective disorder
Cyclothymia
Schizoaffective disorder

61
Q

What are examples of mood stabilisers?

A

Lithium
Sodium valproate
Carbamazepine
Lamotrigine

62
Q

What is the first line drug for bipolar?

63
Q

What is the mechanism of lithium?

64
Q

What are the side effects of lithium?

A 
GI distubrnaces
Leucocytosis 
Impaired renal function 
Tremor 
Thyroid abnormalities
Weight gain
65
Q

How long should a patient be on lithium for?

A

Minimum 18 months

66
Q

What lithium monitoring needs to be done at baseline?

A 
U&Es
FBC
TFTs
Pregnancy test
ECG
67
Q

How often should U&Es be checked while on lithium?

68
Q

How often should TFTs be checked while on lithium?

69
Q

How often should lithium levels be monitored?

A

12 hours after 1st dose
Weekly until range 0.4-1 mmol/L
3 monthly once stable

70
Q

What are the signs of mild lithium toxicity?

A

Lithium 1.5-2 mmol/L

D+V
Ataxia
Dizziness
Slurred speech

71
Q

What are the signs of moderate lithium toxicity?

A

Lithium 2-2.5 mmol/L

N+V
Anorexia
Blurred vision
Clonic limbs

72
Q

What are the signs of severe lithium toxicity?

A

Lithium >2.5 mmol/L

Generalised convulsions
Oliguria
Renal failure

73
Q

How is lithium toxicity managed?

A

IV fluids

+/- dialysis

74
Q

Which drugs does lithium interact with?

A

NSAIDs
Diuretics
ACEi

75
Q

What is the mechanism of sodium valproate?

A

Inhibit GABA catabolism

76
Q

What are the side effects of sodium valproate?

A 
GI disturbances
Weight gain 
Sedation 
Thrombocytopenia 
Reversible hair loss 
Tremor
77
Q

What baseline monitoring needs to be done on sodium valproate?

A 
FBC
LFTs
PT 
Pregnancy test
Weight
78
Q

What monitoring needs to be done at 6 months on sodium valproate?

A

LFTs
FBC
Weight

79
Q

What is the mechanism of carbamazepine?

A

Blocks voltage dependent sodium channels

Reduces glutamate release

80
Q

What are the indications for carbamazepine?

A

Mania (not 1st line)

BAPD - not responsive to lithium

81
Q

What are the side effects of carbamazepine?

A 
GI disturbances
Dermatitis 
Dizziness
Hyponatraemia
Blood disorders
82
Q

What monitoring is required on carbamazepine?

A

Base line

  • FBC
  • U+Es
  • LFTs
  • weight

Check FBC after a week

83
Q

What are contraindications for carbamazepine?

A

AV conduction abnormalities

Acute porphyria

84
Q

What is the mechanism of lamotrigine?

A

Inhibit sodium and calcium channels in presynaptic neurons

85
Q

What are the indications for lamotrigine?

A

Bipolar depression - least teratogenic so used in women of child bearing age

86
Q

What are the side effects of lamotrigine?

A

GI disturbances
Rash
Headach
Tremor

87
Q

What monitoring is required on lamotrigine?

A

Baseline

  • FBC
  • LFTs
  • U&Es
88
Q

What classes are used as anxiolytics?

A 
Beta blockers
Benzodiazepones 
Pregabalin 
Buspirone 
'Z' drugs
89
Q

What is the mechanism of beta blockers?

A

Reduces autonomic nervous system activation

90
Q

When are beta blockers used in anxiety?

A

Symptomatic relieg

91
Q

What are the examples of long acting benzodiazepines?

A

Diazepam

Clonazepam

92
Q

What is the duration of action for long acting benzodiazepines?

93
Q

What are examples of short acting benzodiazepines?

A

Lorazepam
Midazolam
Temazepam

94
Q

What is the duration of action of short acting benzodiazepines?

95
Q

What are the indications for benzodiazepines?

A 
Insomnia 
Anxiety disroders
Delirium tremens
Alcohol detoxification 
Acute psychosis 
Violent behaviour
96
Q

What is the mechanism of action of benzodiazepines?

A

GABA potentiator

Reduces excitability of neurones

97
Q

What are the side effects of benzodiazepines?

A 
Drowsiness
Lightheadedness
Confusion 
Ataxia 
Dependence
98
Q

What are features of benzodiazepine overdose?

A 
Ataxia
Dysarthria 
Nystagmus 
Coma
Respiratory depression
99
Q

How is benzodiazepine overdose managed?

A

IV flumazenil

100
Q

What is the mechanism of pregabalin?

A

Inhibitor of glutamate, noradrenaline and substance P

101
Q

What are indications for pregabalin?

A

GAD

Neuropathic pain

102
Q

What are side effects of pregabalin?

A

Dizziness
Drowsiness
Sefation
Blurred vision

103
Q

What is the mechanism of buspirone?

A

5HT-1A agonist

104
Q

What is the indication for buspirone?

A

Non-sedating anxiolytic

105
Q

Wha are the side effects of buspirone?

A

Nausea
Headache
Light-headedness

106
Q

What are the ‘z’ drugs?

A

Zopiclone
Zolpidem
Zaleplon

107
Q

What is the mechanism of ‘z’ drugs?

A

Enhance GABA transmission

108
Q

How long can ‘z’ drugs be used?

A

2 weeks

5 days out of 7

Psychiatry (22 decks)

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