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Psychiatry > Psychopharmacy > Flashcards

Psychopharmacy Flashcards

1
Q

When are antidepressants indicated?

A 
Unipolar and bipolar depression, 
Mood disorders, 
Schizoaffective disorder, 
Anxiety disorders, 
PTSD
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2
Q

How long does it take to see the affects of antidepressants work?

A

3-6 weeks

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3
Q

What are the classifications of antidepressants?

A

Tricyclics,
Monamine oxidase inhibitors,
Selective serotonin reuptake inhibitors,
Serotonin/ noradrenaline reuptake inhibitors,
Novel antidepressants

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4
Q

Cons of TCAs

A

Lethal in overdose,
Side effects- antihistaminic, anticholinergic, antiadrenergic,
Can cause QT lengthening

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5
Q

Examples of side effects causes by tertiary TCAs

A

Antihistaminic (sedation and weight gain),
Anticholinergic (dry mouth, dry eyes, constipation, memory deficits, delirium)
Antiadrenergic (orthostatic hypotension, sedation, sexual dysfunction)

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6
Q

What receptors do tertiary TCAs mainly act on?

A

Serotonin receptors

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7
Q

Name some examples of tertiary TCAs

A

Imipramine,
Amitriptyline,
Doxxepin,
Clomipramine

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8
Q

What receptor do secondary TCAs act on?

A

Noradrenaline

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9
Q

Examples of secondary TCAs

A

Desipramine,

Notriptyline

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10
Q

How do monoamine oxidase inhibitors work?

A

Bind irreversibly to monoamine oxidase thereby preventing inactivation of amines such as norepinephrine, dopamine and serotonin leading to increased synaptic level

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11
Q

Side effects of monoamine oxidase inhibitors?

A 
Orthostatic hypotension, 
Weight gain, 
Dry mouth, 
Sedation, 
Sexual dysfunction, 
Sleep disturbance,
Cheese reaction
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12
Q

What is the cheese reaction?

A

A hypertensive crisis that can develop when MAOI’s are taken with tyramine-rich food or sympathomimetics (red wine, cheese, processed meats, beans)

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13
Q

What is serotonin syndrome

A

A condition that can develop if MAOI is taken with meds that increase serotonin or have sympathomimetic actions

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14
Q

Serotonin syndrome symptoms?

A 
Abdominal pain, 
Diarrhoea, 
Sweats, 
Tachycardia, 
Hypertension, 
Myoclonus, 
Irritability, 
Delirium,
Hyperperexia, 
Cardiovascular shock and death
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15
Q

How to avoid serotonin syndrome?

A

Wait 2 weeks before switching from an SSRI to an MAOI

And wait 5 weeks if swapping from fluoxetine

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16
Q

How do selective serotonin reuptake inhibitors (SSRIs) work?

A

Block the presynaptic serotonin reuptake

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17
Q

Side effects of SSRIs

A 
GI upset, 
Sexual dysfunction,
Anxiety,
Restlessness, 
Nervousness, 
Insomnia, 
Fatigue, 
Sedation, 
Dizziness
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18
Q

Pro of SSRIs

A

Little risk of overdose

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19
Q

Examples of SSRIs

A 
Paroxetine, 
Sertraline (common GI SE)
Fluoxetine (aka prozac, has a long half life),
Citlopram (common sedating and GI SE),
Escitalopram,
Fluvoxamine
20
Q

How do serotonin/ norepinephrine reuptake inhibitors (SNRIs) work?

A

Inhibit serotonin and noradrenergic reuptake like the TCAs but without side effects

21
Q

Examples of serotonin/norepinephrine reuptake inhibitors

A

Venlafaxine (short half life, can cause a 10-15mmHG increase in diastolic BP),
Duloxetine

22
Q

Novel antidepressants examples?

A

Mirtazapine (increases serum cholesterol, very sedating, weight gain),
Buproprion (can increase seizure risk, anxiety, agitation, insomnia)

23
Q

Best 1st line treatement for depression?

A

SSRI

Citalopram, fluoxetine, sertraline best choices

24
Q

Which SSRI have a higher chance of sedation and weight gain as side effects?

A

Paroxetine,

Mitrzapine

25
Q

How long should you keep people on antidepressants after they feel better?

A

After 1st episode- 6 months,
After 2nd episode- 2 years,
After 3rd episode- lifelong

26
Q

Indications for mood stabilisers?

A

Bipolar,
Cyclothymia,
Schizoaffective

27
Q

Classes of mood stabilisers?

A

Lithium,
Anticonvulsants,
Antipsychotics

28
Q

Factors predicting positive response to lithium?

A

Prior long term response, family member with good response,
Classic pure mania,
Mania followed by depression

29
Q

What should you check before starting lithium?

A

U&Es,
TSH,
Pregnancy test (associated with Epstein’s anomaly in 1st trimester)

30
Q

How to monitor lithium?

A

Steady state achieved after 5 days,
Check 12 hours after last dose,
Once stable check every 3 months and TSH and creatinine every 6 months

31
Q

Lithium blood level goal?

32
Q

Most common lithium side effects?

A

GI distress

  • reduced appetite,
  • n/v
  • diarrhoea
33
Q

Other lithium side effects?

A 
Thyroid abnormalities, 
No significant leukocytosis, 
Polyuria/ polydypsia,
Hair loss, 
Acne, 
Reduces seizure threshold, 
Cognitive slowing, 
Intention tremor
34
Q

Lithium toxicity levels

A

Mild- 1.5-2.0
Moderate- 2.0-2.5
Severe- >2.5

35
Q

Mild lithium toxicity signs?

A 
Vomiting, 
Diarrhoea, 
Ataxia,
Dizziness, 
Slurred speech,
Nystagmus
36
Q

Moderate lithium toxicity signs?

A 
N/v,
Anorexia, 
Blurred vision, 
Clonic limb movements, 
Convulsions, 
Delirium, 
Syncope
37
Q

Severe lithium toxicity signs

A

Generalised convulsions,
Oliguria,
Renal failure

38
Q

Examples of anticonvulsants

A

Valproic acid,
Carbamazepine,
Lamotrigine

39
Q

Factors predicting a positive response from valproic acid

A

Rapid cycling patients,
Comorbidities substance issues,
Mixed patients,
Patients with comorbidities anxiety disorders

40
Q

Tests to do before commencing valproic acid?

A

Baseline liver function tests,
Pregnancy test,
FBC

41
Q

Goal blood level of valproic acid?

42
Q

Valproic acid side effects

A 
Thrombocytopenia,
Platelet dysfunction, 
N/v,
Weight gain,
Sedation,
Tremor,
Increased risk of neural tube defect,
Hair loss
43
Q

When is carbamazepine prescribed?

A

First line agent for acute mania and mania prophylaxis

44
Q

Carbamazepine side effects?

A 
Rash, 
N/v,
Diarrhoea, 
Sedation, 
Dizziness, 
Ataxia, 
Confusion, 
AV conduction delays, 
Aplastic anaemia and agranulocytosis, 
Water retention, 
Rug-drug interactions
45
Q

Drugs that can increase carbamazepine levels/ toxicity?

A 
Acetazolamiode, 
Cimetidine, 
Diltiazem, 
Fluvoxamine,
Fluoxetine, 
Clarithromycin, 
Fluconazole, 
Metronidazole, 
Verapamil
46
Q

Side effects of lamotrigine

A

N/v,
Sedation, dizziness, ataxia, confusion,
TENS and SJS

Psychiatry (23 decks)

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