Therapeutics of Psychiatric Disorders Flashcards
What are the goals of pharmacotherapy for major depression?
prevention of relapse, minimise symptoms and side effects, improve QoL
When is pharm treatment stopped for px with major depression?
when they are considered recovered
What is cognitive behavioural therapy and when is it recommended for major depression?
CBT is formal, non-pharm treatment process delivered by a psychologist, recommended before and during pharm treatment
What is pharm treatment choice guided by in major depression?
previous AD use, compliance, OD risk, med interactions
T/F: ADs can be combined
false
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?
MOA-Is, TCA, venlafaxine due to narrow therapeutic window
SSRIs recommended for high risk OD px
What AD meds should be avoided in px susceptible to poor compliance ?
those with short half life carry high risk of withdrawal when stopped abruptly, avoid MAO-Is, TCAs and SNRIs
What are the symptoms and causes of serotonin toxicity?
symptoms: agitation, insomnia, confusion, tachycardia, HTN
causes: OD, med interactions
What is the danger when using St John’s Wort?
induces hepatic enzymes and contributes to serotonin toxicity
MOA of TCAs?
TCAs inhibit reuptake of noradrenaline and serotonin into presynaptic terminals
Discuss practice points for TCAs
gradual reduction in dose needed to avoid withdrawal effects, increased suicidal ideation may occur when starting treatment: monitoring important
MOA of SSRIs
selective inhibition of reuptake of serotonin
What class of AD is fluoxetine and what is the counselling advice?
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
What class of AD is escitalopram and what is some counselling advice for it?
SSRI
counselling advice: short half-life so ensure px doesn’t stop taking it abruptly, 2-4 week trial recommended
What class of AD is sertraline and what is some counselling advice?
sertraline is an SSRI
Counselling advice: short half-life so ensure px doesn’t stop taking it abruptly, 2-4 week trial recommended
MOA SNRI
inhibit reuptake of serotonin and norepinephrine
Practice points of SNRIs
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
What does MAO-I stand for in AD
monoamine oxidase inhibitors
MOA MAO-I
irreversible inhibition of MAO-A and B, increasing synaptic concentration of serotonin, noradrenaline, adrenaline, and dopamine, prevents enzymatic breakdown
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
1) fluoxetine and vortioxetine
2) TCAs, SSRIs
3) SNRIs
Why do we need to wait 7-14 days after stopping fluoxetine to start new AD?
need to wait as fluoxetine has very long half life and can cause interactions long after cessation
Describe short term pharm management of GAD
short term: benzodiazepine, intention to slow over-reactive CNS responses
Describe long term pharm management of GAD
SSRIs, SNRIs, help stabilize NTs and avoid peaks and troughs
Describe aim of treating schizophrenia
aim to treat psychoses, facilitate and improve recovery, prevent relapse, improve QoL, prevent suicide
Describe the MOA of typical antipsychotics and give some examples of meds
block dopamine 2 receptors
haloperidol, prochlorperazine
MOA of atypical antipsychotics and give examples of meds
block dopamine 1,2,4, and 5HT2 receptors
clozapine, risperidone
What is the benefit of injectable antipsychotics
improve compliance in px who forget to take PO as they are long-acting
