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psychiatry > psychopharmacology in psychiatry > Flashcards

psychopharmacology in psychiatry Flashcards

1
Q

How long after prescribing antidepressants is an affect noticed

A

2-4 weeks

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2
Q

What are antidepressants used for

A

Unipolar and bipolar depression, organic mood disorders, schizoaffective disorder, anxiety disorders including OCD, panic, social phobia, PTSD

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3
Q

how do Selective serotonin reuptake inhibitors (SSRIs) work

A

Block the presynaptic serotonin reuptake

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4
Q
A
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5
Q

What are the side effects of SSRIs

A
  • GI upset
  • sexual dysfunction
  • anxiety
  • restlessness
  • nervousness
  • insomnia
  • fatigue
  • sedation
  • dizziness
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6
Q

What is activation syndrome and what are the symptoms

A

starting SSRIs causing increased serotonin in the brain with the medication which can cause nausea, increased anxiety, panic and agitation - lasts 2-10 days

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7
Q

What drug is used when trying to avoid discontinuation syndrome

A

Fluoxetine (Prozac) - due to long half life

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8
Q

What are the cons of sertaline

A

GI adverse reactions and needs a full stomach for max absorption

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9
Q

How do monoamine oxidase inhibitors (MAOIs) work

A

bind irreversibly to monoamine oxidase, preventing inactivation of amines such as norepinephrine, dopamine and serotonin leading to increased synaptic lebels

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10
Q

What are the side effects for MAOIs

A

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

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11
Q

How does serotonin syndrome occur

A

MAOIs taken with serotonin increasing meds

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12
Q

What are the symptoms of serotonin syndrome

A

Abdo pain
Diarrhoea
Irratibility
Sweats
Tachycardia
HTN
myoclonus

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13
Q
A
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14
Q

How to avoid serotonin syndrome

A

Wait 2 weeks before switching from an SSRI to a MAOI - 5 weeks if fluoxetine

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15
Q
A
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16
Q

How do Serotonin/Norepinephrine reuptake inhibitors work

A

Inhibit both serotonin and noradrenergic reuptake like the TCAS but without the antihistamine, antiadrenergic or anticholinergic side effects

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17
Q

What needs to be done before prescribing lithium

A

Baseline U+Es and TSH
Pregnancy test as tetranogenic in first trimester

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18
Q

What is the con with Mirtazapine

A

Associated with weight gain

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19
Q

What can duloxetine help with

A

Neuropathic pain
Depression
Anxiety

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20
Q

How is treatment resistant depression treated

A
  1. Combination of antidepressant like an SSRI or SNRI with Mirtazepine
  2. Adjunctive treatment with lithium
  3. Adjuctive treatment with atypical antipsychotic - quetipaine, olanzapine or aripiprazole
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21
Q

What is the treatment ladder for treatment resistant anxiety

A
  1. High dose SSRI
  2. Add on Mirtazapine with an SSRI or SNRI
  3. Adjunctive treatment with atypical antipsychotic - quetipane, olanzapine
  4. Adjuctive treatment with pregabalin or buspirone
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22
Q

How long to continue treatment after first depressive or anxiety episode

A

6 months - 1 year prophylaxis

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23
Q

How long to continue treatment after second depressive or anxiety episode

A

2 years prophylaxis

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24
Q

How long to continue treatment after third depressive or anxiety episode

A

Life long prophylaxis

25
Q

What are examples of TCAs

A

Imipramine
Amitriptyline
Doxepin
Clomipramine
Desipramine
nortriptyline

26
Q

What are mood stabilizers used for

A

Bipolar
Cyclothymia
Schizoaffective disorder

27
Q

What is the only drug that reduces suicide rate

A

Lithium

28
Q

What is lithium effective at treating

A

Prophylaxis of mania and depressive episodes

29
Q

What are the signs that lithium will be effective

A

Familt member used it with good response
Classic pure mania
Mania followed by depression

30
Q

What is the goal blood level of lithium during lithium treatment

A

0.6 - 1.2

31
Q
A
32
Q

What are the side effects of lithium

A
  • GI distress such as diarrhoea and reduced appetite
  • Thyroid abnormalities
  • Polyuria/polydypsia
  • Hair loss
  • Acne
  • Cognitive slowing
  • Intention tremor
33
Q

What is seen when lithium levels reach 1.5-2 - mild lithium toxicity

A
  • vomiting
  • Diarrhoea
  • ataxia
  • dizziness
  • slurred speech
  • nystagmus
34
Q

What is seen in moderate lithium toxicity - 2-2.5

A

Nausea
vomiting
anorexia
blurred vision
chronic limb movements
convuslions
delireum

35
Q

What is seen in severe lithium toxicity >2.5

A

Generalised convulsions
Oliguria
Renal failure

36
Q

What is valproic acid effective for

A

Mania prophylaxis but not depression prophylaxis

37
Q

When should valproic acid be avoided

A

Woman of child bearing age due to neural tube defects which can occur

38
Q

What are the side effects of valproic acid

A

Thrombocytopenia and platelet dysfunction
Nausea, vomiting, weight gain
Sedation, tremor
Hair loss

39
Q
A
40
Q

What is the first line agent for acute mania and mania prophylaxis

A

Carbamazepine

41
Q

What are the side effects of carbamazepine

A

Rash - most common
Nausea, vomiting, diarrhea
Sedation, dizziness, ataxia, confusion
AV conduction delays
Aplastic anemia and agranulocytosis (<0.002%)
Water retention due to vasopressin-like effect which can result in hyponatremia
Drug-drug interactions!

42
Q

Why is lamotrigine titrated very slowly

A

If given high dose at once, can cause Steven Johnsons syndrome - if any rash develops ithe lamotrigine is stopped immediately

43
Q

What are the side effects of lamotrigine

A

Nausea
vomiting
sedation
dizziness
ataxia
confusion
Steven Johnson syndrome

44
Q

What can happen to the LFTs due to anticonvulsants

A

increase - not worrying unless it more than triples

45
Q

What are antipsychotics used for

A

Schizophrenia
Schizoaffective disorder
Bipolar
Mood stabilisation
Psychotic depression

46
Q

What can reduced dopamine cause

A

Parkinsonian movements such as rigidity, bradykinesia and tremors

47
Q

What are typical antipsychotics

A

D2 dopamine receptor antagonistics

48
Q

What are the side effects of antipsychotics

A

Tardive Dyskinesia (TD)-involuntary muscle movements that may not resolve with drug discontinuation- risk approx. 5% per year

Neuroleptic Malignant Syndrome (NMS): Characterized by severe muscle rigidity, fever, altered mental status, autonomic instability, elevated WBC, CPK and lfts. Potentially fatal.

Extrapyramidal side effects (EPS): Acute dystonia, Parkinson syndrome,

Akathisia be aware increased risk of suicide

49
Q

What should be given for the extrapyramidal side effects when using antipsychotics

A
  • Anticholinergics - benztropine, trihexyphenidyl or procyclidine
  • Beta blockers like propanalol
50
Q

What do atypical antipsychotics do

A

Serotonin dopamine 2 antagonists

51
Q
A
52
Q

What are the side effects of risperidone - atypical antipsychotic

A

Hyperprolactinemia
Weight gain
Sedation

53
Q

What is teh significant side effects of olanzapine

A

Atypical antipsychotic:

Significant weight gain
Hyperprolacinemia - less chance then risperidone
Abnormal LFTs

54
Q

Define treatment resistant schizophrenia

A

Poor response to 2 first line antipsychotics at an adequate dose for 8 weeks

55
Q

What is given for treatment resistant schizophrenia

A

Clozapine

56
Q

What are the side effects of clozapine

A

Agranulocytosis
Increased risk of seizures
Sedation
Weight gain
Abnormal LFTS
Increased risk of hypertriglyceridemia, hypercholesterolemia, hyperglycemia, including nonketotic hyperosmolar coma and death with and/or without weight gain
Increased saliva production

57
Q

What is the most common psychotic symptom

A

Lack of insight

58
Q
A

psychiatry (14 decks)

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