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Psychiatry > Week 1- pharmacology of mood stabilisers > Flashcards

Week 1- pharmacology of mood stabilisers Flashcards

1
Q

When are anti-depressants used clinically?

A 
In moderate-severe depression
Anxiety disorders
Panic disorders, OCD, PTSD, 
Bulimia nervosa
Neuropathic pain
Dysthymia (persistent depressive disorder)
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2
Q

Describe the three classes of anti-depressants

A

Mono-amine reuptake inhibitors (made up of tricyclics, selective serotonin reuptake inhibitors, non selective uptake inhibitors, noradrenaline reuptake inhibitors)
Monoamine oxidase inhibitors
Atypical drugs

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3
Q

What are monoamines?

A

Refer to particular neurotransmitters- noradrenaline, dopamine and serotonin(5-HT).

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4
Q

What do monoamine reuptake inhibitors do?

A

Stop the reuptake of the monoamines (noradrenaline, serotonin and dopamine) resulting in an increase in concentrations of the neurotransmitters in the synapse.

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5
Q

What is the monoamine hypothesis?

A

Depression leads to a reduction in monoamine transmitters in particular serotonin (5-HT) and noradrenaline.
Drugs that deplete stores of monamines also cause low mood.
Drugs that treat depression increase concentrations of monoamines.

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6
Q

How do monoamine oxidase inhibitors work?

A

They can either be irreversible (phenelzine) or reversible (mocloclobemide) inhibitors of monoamine oxidase A and B.

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7
Q

Name some side effects of monoamine oxidase inhibitors

A

Potentiates effects of other drugs by decreasing their metabolism
Insomnia
Postural hypotension
Peripheral oedema

Cheese/hypersensitive crisis. Cheese contains tyramine which cannot be broken down in the gut due to the monoamine oxidase inhibitors.

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8
Q

How do tricyclic antidepressants work?

A

Block the reuptake of monoamines into presynaptic terminals.
Mainly noradrenaline and 5-HT.

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9
Q

Common side effects of tricyclic antidepressants?

A

Anticholinergic- Dry mout, blurred vision, constipation, urinary retention
Sedation
Weight gain
Cardiovascular- postural hypotension, tachycardia, arrhythmias

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10
Q

How do selective serotonin reuptake inhibitors (SSRIs) work?

A

Selectively inhibit the reuptake of serotonin from the synaptic cleft.

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11
Q

Name some examples of SSRI’s?

A

Citalopram
Fluoxetine
Sertraline
Paraoxetine

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12
Q

Common side effects of SSRIs?

A 
Nausea
Headache
Sweating/vivid dreams
Worsened anxiety
Sexual dysfunction
Hyponatraemia (in the elderly)
Transient increase in self harm.
Discontinuation effects
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13
Q

What does SNRI stand for?

A

Serotonin and noradrenaline reuptake inhibitors.

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14
Q

Name some examples of SNRI’s

A

Venlafaxine

Duloxetine

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15
Q

How do SNRI’s work?

A

Block the reuptake of monoamines in the presynaptic terminal

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16
Q

Side effects of SNRI’s

A

Similar to SSRI’s however have fewer side effects to tricyclic antidepressants

17
Q

Name some atypical antidepressant drugs

A

Mitrazapine (blocks alpha 2, 5-HT2 and 5HT3)
However can block serotonergic side effects if given with SSRI’s
Dopamine uptake inhibitors- bupropion

18
Q

NOTE ABOUT ANTIDEPRESSANTS

A

They all have delayed onset of several weeks.

Side effects will differ with dose.

19
Q

Describe the principles of treating bipolar disorder

A

Acute treatment is too raise the mood in depressive bouts and to decrease mood in manic bouts.
However long term treatment is too stabilise the mood.

20
Q

Which drug is used in bipolar disorder?

A

Lithium. Usually given as lithium carbonate.

21
Q

How does lithium work?

A

May block phosphatidylinositol pathway or inhibit glycogen synthase kinase 3B.

22
Q

Side effects of lithium

A 
Dry mouth/strange taste
Polyuria/polydipsia
Tremor
Hypothyroidism
Long term reduced renal function 
Nephrogenic diabetes insipidus 
Weight gain
23
Q

Name some toxic effects of lithium

A 
Vomiting
Diarrhoea 
Ataxia
Coarse tremor
Drowsiness
Convulsions
Coma
24
Q

What other drugs can be used in the long term treatment of bipolar disorder?

A

Anticonvulsants can be used e.g. carbamazepine and valproic acid.
Antipyschotics

25
Q

Name some side effects of using anticonvulsants in the treatment of bipolar?

A

Carbamazepine- drowsiness, ataxia, cardiovascular effects, induces liver enzymes
Valproic acid- Teratogenicity

26
Q

How do antipyschotics work in bipolar disorder?

A

Dopamine antagonism plus 5 HT antagonism

27
Q

Side effects of anti-psychotics as mood stabilisers

A

Sedation
Weight gain
Metabolic syndrome
Extra-pyramidal side effects

28
Q

Name some anti-psychotics

A

Quetiapine, Arpiprazole, Olanzapine, Lurasidone

Psychiatry (17 decks)

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