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HLSC 220 Pharmacotherapeutics for Health Professionals 💊 > Psychotherapeutic Drugs: antipsychotics, antidepressants, bipolar disorder drugs and anxiolytics - Ch. 34, 35, 36 & 38 > Flashcards

Psychotherapeutic Drugs: antipsychotics, antidepressants, bipolar disorder drugs and anxiolytics - Ch. 34, 35, 36 & 38 Flashcards

1
Q

What are the 3 main emotion/mental health disorders treated with psychotherapeutic drugs?

A

Anxiety
Mood (affective) disorders
Psychoses

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2
Q

Anxiety

A

Unpleasant emotional state
-Perception of real or perceived dangers

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3
Q

Mood (affective) disorders

A

Mania (abnormally pronounced emotions)
Depression (abnormally reduced emotions)
-Bipolar disorder - periodic swings

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4
Q

Psychosis

A

Major emotion disorder, impaired ability to participate in everyday life
Loss of contact with reality
-Schizophrenia
-Depressive and drug-induced psychoses

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5
Q

What monoamine NTs are depleted in Depression?

A

Catecholamines
-Norepinephrin (NE)

Indolamines
-Serotonin (5-HT)

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6
Q

What are the kinds of antidepressants?

A

New-generation
Tricyclic antidepressants (TCA)
Monoamine oxidase inhibitors (MAOIs)

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7
Q

What are the newer-generation antidepressants?

A

Selective serotonin reuoptake inhibitors (SSRIs)
Mixed serotonin and NE reuptake inhibitors (SNRI)
NE reuptake inhibitors

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8
Q

What re the most commonly prescribed drugs for depression?

A

SSRIs

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9
Q

Examples of SSRIs?

A

Sertraline (Zoloft)
fluoxetine (Prozac)
paroxetine (Paxil)
fluvoxamine
citalopram (celexa)

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10
Q

How long can SSRIs take to have effects?

A

2-6 weeks

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11
Q

What is the mechanism of action of SSRIs?

A

Selectively inhibit 5-HT reuptake
-Increased serotonin concentration. in the synapse
little or no effect on NE or DA reuptake

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12
Q

What advantage do SSRIs have over tricyclics and MAOIs?

A

Little to no effect on CV system

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13
Q

What are SSRIs used for?

A

Major depressive disorder
Bipolar affective disorder (in combination)
Eating disorders
OCD
Panic attacks
Myoclonus (quick, involuntary muscle jerk)

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14
Q

What adverse effects are associated with SSRIs?

A

CNS: headache, nervousness, insomnia, fatigue
GI: nausea
Sexual dysfunction, weight gain
Serotonin syndrome

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15
Q

What are symptoms serotonin syndrome?

A

Cognitive: Confusion, agitation and restlessness
Autonomic: tachycardia, hypertension, hyperthermia, sweating
Neuromuscular: clonus, hyperreflexia, tremor

-Occur within 2-72 hours

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16
Q

Examples of SNRI?

A

Venlafaxine
duloxetine

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17
Q

Tricyclic antidepressants are considered what type of drug?

A

Second-line
-fail SSRIs or other newer-gen
-Adjunct therapy w/ newer-gen drugs

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18
Q

What are Tricyclic antidepressants used for?

A

Depression
Childhood enuresis
OCD
Adjunctive analgesics
Trigeminal neuralgia

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19
Q

Examples of Tricyclic antidepressants?

A

Amitriptyline
imipramine
desipramine
clomipramine

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20
Q

Which Tricyclic antidepressants is used for childhood enuresis?

A

Imipramine

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21
Q

Which Tricyclic antidepressants is used for OCD?

A

clomipramine

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22
Q

What do Tricyclic antidepressants do?

A

Blockade of NE reuptake
Blockade of 5-HT reuptake

Receptor block of:
Mucarinic (cholinergic) receptors
alpha1-adrenoreceptors
H1 receptors

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23
Q

What adverse effects are associated with Tricyclic antidepressants?

A

Sedation
Anticholinergic effects
Orthostatic hypotension

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24
Q

Why do Tricyclic antidepressants cause sedation?

A

H1 receptor blockade
-wears off after 1-2 weeks

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25
Q

What are symptoms of anticholinergic effects?

A

Blurred vision
dry mouth
constipation
urinary retention
tachycardia

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26
Q

Why do Tricyclic antidepressants cause orthostatic hypotension?

A

Alpha1-adrenoceptor blockade

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27
Q

Tricyclic antidepressants should be used with caution in people who have what existing disorders?

A

Cardiac dyrhythmias (anticholinergic effects)
Seizures

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28
Q

Tricyclic antidepressants can be ______?

A

Lethal if overdosed
70% to 80% die before reaching the hospital
Death is from seizures or cardiac dysrhythmias

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29
Q

Is there an antidote for Tricyclic antidepressants overdose?

A

No antidote for acute toxicity

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30
Q

What is used to treat Tricyclic antidepressants overdose?

A

Decrease drug absorption with activated charcoal
speed elimination by alkalinising urine
manage seizures/dysrhythmias with drugs
basic life support

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31
Q

What are the first generation drugs for depression?

A

MAOIs
-Phenelzine

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32
Q

What are MAOIs now used for?

A

Treatment of depression when not responsive to the rdrugs

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33
Q

Disadvantage associated with MAOIs?

A

Potential to cause hypertensive crisis when taken with tyramine (cheese effect)

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34
Q

What is the mechanism of action of MAOIs?

A

Inhibit MAO enzyme in CNS and peripheral tissue
Reduced breakdown of monoamines in neurone, more released from neurones

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35
Q

What does MAO enzyme do?

A

Metabolizes monoamine (DA, 5-HT, NE) neurotransmittors

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36
Q

What adverse effects are associated with MAOIs?

A

orthostatic hypotension (most common)
CNS stimulation: Insomnia, anxiety
Cheese effect

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37
Q

What foods/drinks do MAOIs interact with?

A

Food/drinks containing Tyramine leads to hypertensive crisis

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38
Q

What is hypertensive crisis?

A

Most serious problem with MAOIs
-Severe headache, hypertension, tachycardia
Possible cerebral hemmorhage, stroke and death

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39
Q

What foods have Tyramine?

A

Aged mature cheeses (cheddar, blue, Swiss)
Smoked/pickled or aged meats
Yeast extracts (marmite)
red wines
Fava beans (Italian broad beans)

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40
Q

What must happen when switching from an SSRI to MAOI?

A

Must be a 2-5 week ‘wash out” drug free period between the two drug therapies

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41
Q

What must happen when switching from MAOI to a TCA/SSRI?

A

2 week wash out drug free perioid
Maintain diet restriction 2 weeks after MAOI cessation

42
Q

What are other drugs used for depression?

A

Bupropion
Mirtazapine
Vortioxetine

43
Q

What is bupropion?

A

block of DA and NE reuptake

44
Q

What is mirtazapine?

A

Increases release of 5-HT
antagonism at certain 5-HT receprtors

45
Q

What is vortioxetine?

A

Complex modulation of 5-HT neurotransmission
Block 5-HT reuptake, agonist against some 5-HT and antagonist at other 5-HT receptors

46
Q

What are some anxiolytic drugs?

A

Benzodiazepines (BZDs)
Antidepressants; SSRIs, SNRI
Buspirone in GAD
Antiseizure drugs in GAD and PTSD
Antipyschotics in GAD and PTSD

47
Q

What drugs used for seizures are also used in GAD?

A

Valproate
Gabapentin

48
Q

What antipsychotics are also used GAD and PTSD?

A

Olanzepine
Risperidone

49
Q

What do Benzodiazepines (BZDs) do?

A

Depress activity in brainstems and limbic system (CNS depressant)
“sedative-hypnotic”
Immediate relief

50
Q

How are benzodiazepines used?

A

Sparingly, long-term

51
Q

What effects do increasing dosages of BZDs have?

A
  1. Anxiolytic
  2. Sedation
  3. Hypnotic (promote sleep)
  4. Stupor (near-unconsciousness or insensibility)
52
Q

What are benzodiazepines used for?

A

Anxiety
Sedation
Muscle relaxation
Seizure control
Adjuvant for depression
Alcohol withdrawal

53
Q

What benzodiazepines are used as anxiolytics?

A

lorazepam (Ativan)
alprazolam
diazepam (Valium)
clonazepam

54
Q

What is the mechanism of action of Benzodiazepines?

A

Enhances effect of GABA (GABA = decrease excitability in neurons)
Decreased neuronal excitability
decrease CNS activity

55
Q

Why are BZDs safer than barbiturates in overdose?

A

BZDs = little respiratory depression given PO

56
Q

When do benzodiazepines cause respiratory depression?

A

When administered IV
or combined with opioids, alcohol and barbiturates

57
Q

What adverse effects are associated with BZDs?

A

Decreased CNS activity: Drowsiness, loss of coordination, dizziness, confusion, manual skills affected

Can be addictive (less than barbiturates)

58
Q

Examples of mood stabilisers (used for bipolar)?

A

Lithium carbonate
Drugs used for other indications:
seizure drugs
atypical antipsychotics
antidepressants (SSRIs)

59
Q

What is the first-line treatment of mania and manic depressive illness?

A

Lithium
-May be used with other meds to stabilise mood

60
Q

What is lithiums therapeutic index?

A

Narrow therapeutic range
toxicities above 2 mmol/L
death at 2.5 mmol/L

61
Q

What should maintenance serum levels of lithium range between?

A

0.4 and <1.5 mmol/L
-Most treated in 0.6-0.8 mmol/L range

62
Q

What adverse effects are associated with lithium <1.5 mmol/L?

A

Fine finger tremor
polyuria
thirst
GI upset

63
Q

What long-term adverse effects are associated with lithium?

A

Renal impairment
Goiter and hypothyroidism

64
Q

What are symptoms of Lithium toxicity >1.5 mmol/L?

A

Persistent GI upset (early sign)
Course hand tremor
Neurologic effects: Confusion, sedation, incoordination, seizures, coma

65
Q

What drugs used in seizures are also used for bipolar disorder?

A

Valproate
Carbamazepine

66
Q

What atypical antipsychotics are also used in bipolar disorder?

A

Olanzapine and quetiapine

67
Q

What drugs for depression are also used for bipolar disorder?

A

Controversial!!
Fluoxetine (not used alone)

68
Q

What are some psychotic disorders?

A

Schizophrenia
Schizoaffective disorder
Depressive or drug-induced psychoses

69
Q

What positive symptoms (exaggerations) are associated with Schizophrenia?

A

Delusions
paranoia
hallucinations
disorganised or catatonic behaviour

70
Q

What negative symptoms (loss or decrease) are associated with Schizophrenia?

A

Flat emotions
Social withdrawal
Lack of speech and self-care
Avolition (no motivation)

71
Q

What cognitive symptoms are associated with schizophrenia?

A

Disorganised thoughts and speech
memory and learning difficulties

72
Q

What are antipsychotics also known as?

A

Neuroleptics

73
Q

What are antipsychotics used for?

A

Serious mental illnesses
-schizophrenia
-bipolar affective disorder
-depressive and drug-induced pyschoses
-autism

Movement disorders
-Tourette’s syndrome

Nausea, vomiting, intractable hiccups

74
Q

What are the three major objectives of schizophrenia drug therapy?

A

Suppression of acute episodes
reduce relapse
Maintenance of the highest possible level of functioning

75
Q

What are adjunctive drugs to antipsychotics used in schizophrenia drug therapy?

A

Benzodiazepines (BZDs)
Antidepressants

76
Q

When do initial effects of schizophrenia drug therapy occur?

A

1 to 2 days

77
Q

When does substantial improvement from schizophrenia drug therapy occur?

A

~2 to 4 weeks

78
Q

When do full effects of schizophrenia drug therapy develop?

A

may not develop for several months

79
Q

Which schizophrenia symptoms may respond better to schizophrenia drug therapy?

A

Positive symptoms respond better than negative or cognitive

80
Q

What are the classifications of antipsychotics?

A

First generation (Typical, conventional) FGA
Second generation (Atypical) SGA

81
Q

Examples of first generation typical antipsychotics?

A

Chlorpromazine (Largactil)
haloperidol

82
Q

Examples of second generation atypical antipsychotics?

A

Clozapine (clozaril)
Resperidone

83
Q

What is the mechanism of action of typical antipsychotics?

A

Dopamine (D2) receptor antagonists
-Block receptors in CNS
-Block histamine receptors
-block cholinergic receptors
-block alpha 1-adrenoceptors

84
Q

Where do typical antipsychotics block receptors in the CNS?

A

limbic system, basal ganglia (emotion, cognitive, motor function)
nigrostriatial pathway (motor function)

85
Q

What is responsible for typical antipsychotics most serious adverse effect?

A

DA receptor antagonism

86
Q

What is typical antipsychotics mosts serious adverse effect?

A

Extrapyramidal Motor disturbances

87
Q

What are early onset extrapyramidal symptoms?

A

Acute dystonias (abnormal muscle tension)
Pseudoparkinsonism (tremors, rigidity, bradykinesia)
Akathisia - motor restlessness

88
Q

What can reduce early onset extrapyramidal symptoms?

A

Anticholinergics
benzotropine
diphenhydramine

89
Q

What are long-term (months/years of treatment) extrapyramidal symptoms?

A

Tardive (“slow or delayed”) dyskinsia
-worm like tongue movement, lip smacking
-speaking, eating problems

-mostly irreversible

90
Q

What adverse effect of typical antipsychotics can occur 4-14 days after therapy starts?

A

Neuroleptic Malignant Syndrome

91
Q

Symptoms of Neuroleptic Malignant Syndrome?

A

Lead pipe rigidity
sudden high fever (>41°C)
BP irregularities, cardiac dysrhythmias
seizures, coma

92
Q

What other CNS adverse effects are associated with typical antipsychotics?

A

Sedation
delirium

93
Q

What dermatological adverse effects are associated with typical antipsychotics?

A

Photosensitivity
skin rash
hyperpigmentation
pruritus

94
Q

What atypical antipsychotic has very little extrapyramidal motor disturbances?

95
Q

What atypical antipsychotic has extrapyramidal motor disturbances?

A

risperidone
Resperidal Consta (IM depot injection every 2 weeks)

96
Q

What are some newer atypical antipsychotic drugs in Canada?

A

lurasidone -minimal anticholinergic action
asenapine (SL only)

97
Q

What is the mechanism of action of atypical antipsychotics?

A

Block 5-HT2 (serotonin) receptors
Les effect on DA receptors (less motor disturbances)
Block H1 receptors (sedation)
Bock cholinergic receptors (constipation)
Block alpha1-adrenoceptors (hypotension)

98
Q

What adverse effects are associated with Clozapine?

A

Haematological:
agranulocytosis (WBC)
anemia

Drooling

99
Q

What adverse effects are associated with all antipsychotics? (generally associated with atypical)

A

Weight gain
Metabolism disturbances
-blood glucose management
-plasma lipids

100
Q

What can you not take with antipsychotics?

A

CNS depressants
alcohol

HLSC 220 Pharmacotherapeutics for Health Professionals 💊 (31 decks)

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