Psychopharmacology in Psychiatry

Question 1

antidepressants

Answer 1

unipolar and bipolar depression, organic mood disorders, schizoaffective disorder, anxiety disorders, including OCD
-3 to 6 weeks to reach maximum effect

Question 2

TCAs

Answer 2

effective but potential unacceptable side effect
lethal in overdose
Tertiary
-antihistaminic (sedation and weight gain), anticholinergic (dry mouth, dry eyes, constipation, memory)
Secondary (metabolites of tertiary amines
primarily block noradrenaline

Question 3

Monoamine oxidase inhibitors

Answer 3

prevents inactivation of amines
side effects orthostatic hypotension, weight gain, dry mouth
hypertensive crisis can develop when taken with tyramine rich foods or sympathomimetics cheese red wine
serotonin syndrome include abdominal pain, diarrhea, sweats, tachcardia, can lead to hyperpyrexia,
change 2weeks wait from SSRIs to MAOis fluxotetine 5 wks

Question 4

SSRIs

Answer 4

Block presynaptic serotonin reuptake
treat both anxiety and depressive
most common side effects include GI upset
can develop a discontinuation syndrome

Question 5

Fluoxetine

Answer 5

long half life,

discontinuation syndrome can prescribe this to slowly withdraw from system

Question 6

citalopram

Answer 6

dose dependant QT interval prolongation with doses of 10 to 30mg daily

Question 7

Serotonin/ norepinephrine reuptake inhibitors

Answer 7

same effect to tricyclic but less sideaffects of the antihistamine, antiadrenergic

Question 8

Mirzatapine

Answer 8

weight gain

Question 9

treatment resistance

Answer 9

combination of antidepressants eg SSRI or SNRI with Mirtazepine
Adjunctive treatment with lithium
adjunctive treatment with aty[ical antipsychotics eg quetipaine, olanzepine

ECT

Question 10

Lithium

Answer 10

only medication to reduce suicide rate
effective in long term prophylaxis of both mania and depressive episodes
before starting- get baseline U&E and TSH,
pregnancy in first trimester is associated with Ebstein’s anomaly
blood level 0.6 to 1.2

Question 11

Valproic acid

Answer 11

effective as lithium in manic prohylaxis but not depressive
before srarted baseline liver function tests
start folic supplement in women
sideffects: thrombocytopenia, platelet dysfunction, risk of neural tube defect
for cyclic patients

Question 12

Lamotrigine

Answer 12

stevens johnson syndrome, toxic epidermal necrolysis, stop if rash