Therapeutics of Psychiatric Disorders

Question 1

What are the goals of pharmacotherapy for major depression?

Answer 1

prevention of relapse, minimise symptoms and side effects, improve QoL

Question 2

When is pharm treatment stopped for px with major depression?

Answer 2

when they are considered recovered

Question 3

What is cognitive behavioural therapy and when is it recommended for major depression?

Answer 3

CBT is formal, non-pharm treatment process delivered by a psychologist, recommended before and during pharm treatment

Question 4

What is pharm treatment choice guided by in major depression?

Answer 4

previous AD use, compliance, OD risk, med interactions

Question 5

T/F: ADs can be combined

Answer 5

false

Question 6

What classes of AD carry a high risk of harm in OD, why, and what drugs are recommended for px with high risk of OD?

Answer 6

MOA-Is, TCA, venlafaxine due to narrow therapeutic window
SSRIs recommended for high risk OD px

Question 7

What AD meds should be avoided in px susceptible to poor compliance ?

Answer 7

those with short half life carry high risk of withdrawal when stopped abruptly, avoid MAO-Is, TCAs and SNRIs

Question 8

What are the symptoms and causes of serotonin toxicity?

Answer 8

symptoms: agitation, insomnia, confusion, tachycardia, HTN
causes: OD, med interactions

Question 9

What is the danger when using St John’s Wort?

Answer 9

induces hepatic enzymes and contributes to serotonin toxicity

Question 10

MOA of TCAs?

Answer 10

TCAs inhibit reuptake of noradrenaline and serotonin into presynaptic terminals

Question 11

Discuss practice points for TCAs

Answer 11

gradual reduction in dose needed to avoid withdrawal effects, increased suicidal ideation may occur when starting treatment: monitoring important

Question 12

MOA of SSRIs

Answer 12

selective inhibition of reuptake of serotonin

Question 13

What class of AD is fluoxetine and what is the counselling advice?

Answer 13

fluoxetine is an SSRI
counselling advice: very long half-life, interactions may occur long after treatment cessation, dose tapering not usually required, can take a few weeks to reach steady state

Question 14

What class of AD is escitalopram and what is some counselling advice for it?

Answer 14

SSRI
counselling advice: short half-life so ensure px doesn’t stop taking it abruptly, 2-4 week trial recommended

Question 15

What class of AD is sertraline and what is some counselling advice?

Answer 15

sertraline is an SSRI
Counselling advice: short half-life so ensure px doesn’t stop taking it abruptly, 2-4 week trial recommended

Question 16

MOA SNRI

Answer 16

inhibit reuptake of serotonin and norepinephrine

Question 17

Practice points of SNRIs

Answer 17

check BP before starting as it can cause increase, do not stop taking abruptly to avoid withdrawal effects, increased suicidal ideation may occur when starting: monitoring important

Question 18

What does MAO-I stand for in AD

Answer 18

monoamine oxidase inhibitors

Question 19

MOA MAO-I

Answer 19

irreversible inhibition of MAO-A and B, increasing synaptic concentration of serotonin, noradrenaline, adrenaline, and dopamine, prevents enzymatic breakdown

Question 20

Complete the table
Drug Recommendation
Gradual withdrawal generally
unnecessary, wait 14 days
before starting new AD

        Withdraw gradually to prevent 
            withdrawal, wait 2-4 days before 
            starting new AD

       Withdraw gradually, wait 1-2 days 
          before starting new AD

Answer 20

1) fluoxetine and vortioxetine
2) TCAs, SSRIs
3) SNRIs

Question 21

Why do we need to wait 7-14 days after stopping fluoxetine to start new AD?

Answer 21

need to wait as fluoxetine has very long half life and can cause interactions long after cessation

Question 22

Describe short term pharm management of GAD

Answer 22

short term: benzodiazepine, intention to slow over-reactive CNS responses

Question 23

Describe long term pharm management of GAD

Answer 23

SSRIs, SNRIs, help stabilize NTs and avoid peaks and troughs

Question 24

Describe aim of treating schizophrenia

Answer 24

aim to treat psychoses, facilitate and improve recovery, prevent relapse, improve QoL, prevent suicide

Question 25

Describe the MOA of typical antipsychotics and give some examples of meds

Answer 25

block dopamine 2 receptors
haloperidol, prochlorperazine

Question 26

MOA of atypical antipsychotics and give examples of meds

Answer 26

block dopamine 1,2,4, and 5HT2 receptors
clozapine, risperidone

Question 27

What is the benefit of injectable antipsychotics

Answer 27

improve compliance in px who forget to take PO as they are long-acting