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Year 4 - Psychiatry > Psychopharmacology > Flashcards

Psychopharmacology Flashcards

1
Q

What are some of the SE of anti depressants?

A

Restlessness, agitation, nausea, GI disturbance, sexual dysfunction, suicidal ideation

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2
Q

What are some of the SEs of SSRIs?

A
  • Sertraline - safest in cardiac disease
  • Fluoxetine - Serotonin syndrome
  • Citalopram - QT prolongation
  • Paroxetine - Discontinuation syndrome
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3
Q

What are some examples of SNRI?

A

Venlafaxine, dulexetine

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4
Q

What are some of the side effects of SNRIs?

A

sedation, nausea, sexual dysfunction - more than SNRIs

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5
Q

What are the uses of SNRIs

A
  • GAD
  • Moderate depression
  • Neuropathic pain - Duloxetine - licensed for fibromyalgia
  • Venlafaxine - license in the US for neuropathic pain.
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6
Q

When is mirtazapine used and how does it work?

A

NASSA: norA and specific serotonin antidepressant

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7
Q

How is mirtazapine used?

A

Major depressive disorder

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8
Q

What does mirtazapine act on?

A

Serotonin and NorA

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9
Q

What are some of the side effects of mirtazapine?

A

Sedation and weight gain

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10
Q

What are some of the uses of tricyclics

A
  • Used for those that don’t response to SSRIs
  • Often used at low doses for neuropathic pain
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11
Q

What are some of the SEs of tricyclics?

A
  • Muscarinic
  • Histaminic
  • QT -> prolongation Arrythmia
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12
Q

Where do MAOI work? What is their MoA?

A
  • MAOI – A (work more on serotonin)
  • MAOI – B (work more on dopamine)

Inhibit neurotransmitted reuptake

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13
Q

What should be avoided with MAOI?

A
  • Tyramine - can cause a hypertensive crisis.
  • Avoid cheese, wine, pickled meats.
  • If changing anti depressant there should be a wash out period of 6 weeks
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14
Q

What is vortioxetine?

A

All different sorts of serotinergic activities • Effective • Well tolerated – most common side effect is nausea (but less severe than Venlafaxine) • Evidence for improvement in difficult to treat cognitive symptoms • Has recently entered NICE guidance, came in quite quickly as is quite cheap. Very effective. • Can only be prescribed by psychiatrists rather than primary care

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15
Q

What is discontinuation syndrome? How it is caused and what are the most common drugs causing it?

A
  • Antidepressants are not addictive but they can be difficult to stop – dependence syndrome
  • Can cause physiological effects when they are stopped
  • Sx: sweating, shakes, agitation, insomnia, headaches, irritability, GI sx: cramping, N+V, paraesthesia, clonus
  • The shorter the half-life the bigger the problem and when stopping quickly from a high dose
  • Trickiest to stop - Paroxetine and Venlafaxine
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16
Q

What are some of the sx of serotonin syndrome?

How is it managed?

A
  • Cognitive – headaches, agitation, hypomania, confusions, coma
  • Autonomic – shivering, sweating, hyperthermia, tachycardia, nausea and diarrhoea
  • Somatic – myoclonus, hyper-reflexia and tremor
  • Mx: usually supportive: fluids and monitoring.
17
Q

What are anti psychotics and which pathways do they target?

A
  • Neuroleptics: reduce dopamine activity at D2 receptors
  • Pathways:
    • Mesocortical
    • Mesolimbic
  • Unwanted pathways: nigrostriatal and tubularfundibular
18
Q

What are some of the common side effects of antipsychotics?

A
  • Sedation
  • Weight gain
  • Acute dystonia
19
Q

What is acute dystonia?

How is it managed?

A
  • Sustained, often painful, muscular spasms, producing twisted abnormal posture
  • 50% cases in the first 48 hours, 90% in first 5 days
  • Most common: oculogyric crisis, torticollis (twisted neck) opisthonus(spasm of the muscles causing backward arching of the head, neck, and spine), tongue protrustion
  • Mx:
    • Stop antipsychotic
    • Give IM + IV anti cholinergics – procycylidine - continue for 1-2 days after dystonia and consider long term prophylactic
20
Q

What are some of the examples, features, mechanisms and SEs of typical vs atypical anti psychotics?

A
21
Q

What is clozapine and when is it considered?

How is its use monitored?

A
  • D2 and 5HT2 antagonist
  • After 2 anti psychotics have not worked
  • Most effious: improvements can continue for several months after stopping use
  • FBC monitoring
    • Weekly for the first 18 weeks
    • Then every 2 weeks
    • Then monthly
22
Q

What is clozapine induced agranulocytosis and how is it managed?

A
  • Stop clozapine
  • Stop other potentially suppressing drugs e.g. sodium valproate
  • Avoid other anti psychotics for a couple of weeks where possible, though if needed ariprozole has less potential for bone marrow suppression
  • Contact consultant haematologist as an emergency
  • Avoid sources of infection. Consider prophylactic broad spectrum antibiotics
  • Lithium: sometimes used for increasing WCC and neutrophil count
  • Granulocyte colony stimulating factor (G-CSF): G-CSF – Will release white cells from bone marrow. You will get a spike but this is not a long term fix. Very pain injection
23
Q

What are some of the specific SEs of clozapine?

A
  • Agranulocytosis and neutropaenia
  • Reduced seizure threshold
  • Constipation -> GI hypomobility -> fatal bowel obstruction
  • Myocarditis (take a baseline ECG should be taken before starting treatment)
  • Hypersalivation
  • Urinary incontinence
24
Q

How are anti psychotics managed?

A
  • Baseline: FBC (can affect bone marrow production causing pancytopenia) ; Lipids; LFT (steatohepatitis); HbA1C. Weight. ECG. Blood pressure and pulse
    • Drugs are metabolised by liver rather than kidneys (so U+E are NOT important)
  • Weekly: Weight
  • Three months: FBC; Lipids; LFT; HbA1C. Weight. ECG. Blood pressure and pulse
  • Yearly: FBC; Lipids; LFT; HbA1C. Weight. ECG. Blood pressure and pulse
25
Q

What is neuroleptic malignant syndrome?

A
  • Rare, life-threatening reaction to antipsychotics
  • Causes: Fever, confusion, muscle rigidity, sweating, autonomic instability , delirium
  • Death usually due to: Rhabdomyolysis, renal failure, seizures
  • RFs:
    • High potency dopamine antagonists (typical antipsychotics) in antipsychotic naïve (those who have not taken them before)
    • High doses, young men and usually if restraint is involved (maybe due to rhabdomyolysis)
26
Q

How is neuroleptic malignant syndrome investigated and managed?

A
  • Ix: WCC CRP, Creatine Kinase (Most important to distinguish between NMS and Serotonin Syndrome)
  • Mx: Emergency referral to A&E; stop antipsychotics; fluid resuscitation; reduce temperature, sodium bicarbonate to alkalise the urine
    • Relax muscles – dantrolene
27
Q

Give two examples of anxiolytics?

A
  • Benzodiazapines: lorazepam (shorter half life), diazepam (longer)
    • Mechanism: Bind to GABA receptors to potentiate the effect of GABA and therefore reduce excitability of neurones.
    • Use very cautiously and for no more than six weeks (usually prescribed for 2-4 weeks)
    • SE: benzodiazapine withdrawal syndrome and paradoxical inhibition
  • Beta blockers: propanolol - Limited effectiveness for enduring anxiety disorders
    • CI: asthma
28
Q

What are some of the SEs of benzos and what happens?

A
  • Paradoxical inhibition: caused by frontal lobe supression, diinhibited behaviour more common in elderly pts
  • Benzodiazepine withdrawal symptoms
    • ​Can occur up to 3 weeks
    • Sx: insomnia, anxiety, irritability, tremor, loss of appetitve, tinnitus and perspiration
29
Q

What is the mechanism of pregabalin?

A
  • Bings to voltage gated calcium channels -> increased [GABA synthesising enzyme] -> GABA increases -> neuronal excitability decreases
  • Uses; anxiety, neuropathic pain, epilepsy
  • Indication short term use;
  • SE: sedation and weight gain
30
Q

What tablets can be used for sleeping?

A
  • Benzodiazepines: Temazepam, Lormatazepam, Nitrazepam
  • Nonbenzodiazepines: - Also called Z drugs: Zopiclone, Zolpidem - favoured but probably not much difference between the two (though Z-drugs usually favoured)
  • Potential for misuse, dependence, rebound insomnia.
  • Use for only two weeks and take for only 5 out of 7 days each week to reduce potential for tolerance
31
Q

How does lithium work and what are its uses?

A
  • Mood stabilisers
  • Narrow therapeutic window
  • Kidney excretion
32
Q

What are the SEs of lithium (short and long term)?

A

Short term

  • GI disturbance (worse on initiation)
  • Weight gain
  • Polyuria, polydipsia
  • Metallic taste
  • Fine tremor

Long term

  • Hypothyroidism (reversible)
  • Renal impairment

Lithium Toxicity: ataxia, confusion, blurred vision - increase fluid intake (dehydration precipitates)

Others: seizures, N+V diarrhoea,

ECG: T wave flattening + inversion

33
Q

How is lithium monitored?

A
  • 12h post first dose
  • Weekly after each dose change till conc. stable
  • Normal: every 3 months (stable conc)
  • Other: thyroid + kidney - every 6 months
34
Q

What drugs interact with lithium?

A

Anything messing with kidneys

  • NSAIDs
  • Acei
  • Diuretics
35
Q

What are some of the types of anti convulsants?

A
  • Sodium valproate: SE: teratogenic, LFTs - benign hepatitis
  • Carbemezapine
  • Lamotrigine. SE: stevens johnsons - T4 hypersensitivity
  • Pregabalin

SE: thrombocytopenia (check FBC), sedation, weight gain

36
Q

What are the rversible and irreversible examples of MAOIs?

A
  • Irreversible – more dangerous: Phenelzine; Isocarboxazid
  • Reversible – less dangerous: Moclobamide; Tranylcypromine
37
Q

What needs to be monitored when using venlafaxine

A

BP - caution with higher doses in Heart Disease

Year 4 - Psychiatry (3 decks)

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