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Psychiatry > Psychopharmacy > Flashcards

Psychopharmacy Flashcards

1
Q

Antipsychotics - dopamine pathways

A

Nigrostriatal
Mesolimbic
Mesocortical
Tuberoinfundibular

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2
Q

Antipsychotics - dopamine hypothesis

A

1) hyperactivity of the mesolimbic dopamine pathways cause positive symptoms of schizophrenia
2) deficiency of dopamine in the nigrostriatal pathway accounts for negative and cognitive symptoms of schizophrenia

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3
Q

Antipsychotics - mechanism of action

A

Block dopamine receptors in the mesolimbic pathway

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4
Q

Antipsychotics - typical antipsychotic examples

A

Haloperidol
Flupentixol
Chlorpromazine hydrochloride

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5
Q

Antipsychotics - atypical antipsychotic examples

A 
Clozapine 
Quetiapine
Olanzapine 
Aripiprazole 
Risperidone
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6
Q

Antipsychotics - indications

A

Schizophrenia
Schizoid personality disorder
Bipolar affective disorder

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7
Q

Antipsychotics - movement disorder adverse effects

A 
Acute dystonia (e.g. torticollis) 
Tardive dyskinesia (hyperkinetic involuntary movements)
Akathisia (restlessness, tension)
Pseudoparkinsonism (tremor, rigidity, bradykinesia)
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8
Q

Antipsychotics - adverse autonomic effects

A

Antiadrenergic
- QTc prolonged and arrhythmias (torsade des pointes)
Anticholinergic
- dry mouth, blurred vision, constipation and urine trouble

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9
Q

Antipsychotics - adverse effects

A 
Movement disorders
Autonomic effects 
Neuroleptic malignant syndrome 
Convulsant activity 
Pigmentation 
Metabolic effects 
- weight gain
- endocrine (hyperprolactinaemia, decreased libido, sexual dysfunction and menstrual irregularities) 
Hypersensitivity 
- cholestatic jaundice 
- skin reactions (urticaria/eczema)
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10
Q

Clozapine - indications

A

Treatment resistant schizophrenia

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11
Q

Clozapine - side effects

A

Less extrapyramidal side effects than typical antipsychotics
Agranulocytosis
Weight gain

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12
Q

Clozapine - smoking risk

A

Smoking reduces the concentration of clozapine in the plasma
Smoking cessation causes an increase in clozapine levels in the plasma
- can cause dose related side effects (sedation, dizziness, hypersalivation, tachycardia, postural hypotension, constipation and seziures)

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13
Q

Mood stabilisers - available in UK

A

Lithium
Carbamazepine
Valproate

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14
Q

Mood stabilisers - indications

A

Acute mania/hypomania in bipolar
Prophylaxis in bipolar and schizoaffective disorders
Prophylaxis in recurrent depressive illness
Augment antidepressant therapy in acute depressive illness
Treating depression in bipolar

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15
Q

Mood stabilisers - what are the expected effects on the patient when using mood stabilisers

A

Decreased mental and physical overactivity
Improves psychotic features
Prevents exhaustion, sleep deprivation and poor fluid intake

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16
Q

Bipolar disorder - management

A

Mania/hypomania - lithium, carbamazepine or valproate
Antipsychotics
2nd line mood stabiliser - lamotrigine or gabapentin
Benzodiazepine - lorazepam or clonazepam
ECT

17
Q

Lithium - predictors of poor response

A

Rapid cycling or chronic depression (rapid cycling is 4 distinct periods of abnormal mood within a year)
Mixed affective states
Alcohol/drug misuse
Mood-incongruent psychotic features

18
Q

Lithium - therapeutic range

A

0.4 - 1 mmol/l

19
Q

Lithium - precautions

A

TFTs, U&Es, ECG prior to commencement
Can cause tricuspid valve deformity and affect thyroid function in fetus
Drug interactions
- NSAIDs, thiazide diuretics
Can cause dehydration
- diarrhoea and night sweats

20
Q

Lithium - adverse effects

A 
Nausea/vomiting
Diarrhoea
Cognitive dulling
Hypothyroidism 
Renal tubular necrosis - renal failure 
- this can cause a progressive decrease in renal clearance
- eGFR checked every 3 months 
Tremor
Muscle weakness
Weight gain
Hyperparathyroidism 
Nephrogenic diabetes insipidus 
- causes rise in serum ADH, causing thirst and polyuria 
- inhibits the ADH sensitive adenylate cyclase in the kidney 
Lithium toxicity
21
Q

Lithium toxicity - signs and symptoms

A 
Fine tremor - progresses to coarse tremor 
Nausea and vomiting 
Dizziness
Dysarthria 
Drowsiness
Confusion 
Fits
Coma 
Death
22
Q

Lithium toxicity - management

A

Aim is to reduce absorption and increase clearance of lithium

  • diuresis with IV fluid
  • gastric lavage
  • bowel irrigation
  • national poisons information service
23
Q

Antidepressants - basic principles of prescribing

A

Provide dose most likely to be effective
Withdraw gradually and be aware of discontinuation syndrome
Continue treatment for 4-6 months after resolution of symptoms (for single episodes)

24
Q

Antidepressants - monoamine theory of depression

A

Depression is due to relative or absolute deficiency in monoamines, receptor sensitivity or certain receptor sites in the brain

  • noradrenaline
  • dopamine
  • serotonin
25
Q

Antidepressants - classes

A

Tricyclic antidepressants e.g. amitriptyline
Selective serotonin reuptake inhibitor e.g. sertraline, fluoxetine
Serotonin and noradrenaline reuptake inhibitor
Monoamine oxidase inhibitor

26
Q

Antidepressants - time for efficacy

A

MAOI, SNRI, SSRI - around 6 weeks to take effect

TCA - 6-7 days

27
Q

SSRI - 1st line treatment

A

Citalopram followed by sertraline

Safe in overdose and can be given in heart disease

28
Q

SSRI - side effects

A 
Nausea
Anorexia
Dry mouth
Diarrhoea/constipation 
Insomnia
Dizziness
Anxiety
Fatigue
Tremor
Somnolence 
Sweating
Delayed oragasm/anorgasmia
29
Q

SSRI - overdose (serotonin syndrome)

A 
Myoclonus 
Nystagmus
Headache 
Tremor
Irritable
Confused
Agitated
Hypomania
Coma
Pyrexial 
Sweating 
Diarrhoea
Arrhythmia
Death
30
Q

SSRI - mechanism of action

A

Inhibition of presynaptic reabsorption of serotonin
Increased availability of serotonin at the synaptic cleft, so it can bind to the postsynaptic receptor, and normal action occurs

31
Q

SNRI - mechanism of action

A

Inhibition of presynaptic reabsorption of serotonin and norepinephrine
Increased availability of serotonin and norepinephrine at the synaptic cleft, so it can bind to the postsynaptic receptor, and normal action occurs

32
Q

TCA - mechanism of action

A

Stops reuptake of monoamines at presynaptic cleft

Block the action of acetylcholine

Psychiatry (17 decks)

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