Anti-psychotics Flashcards
BZDs: Class, suffix, moa, adr, contraindications
Anxiolytics, insomia, GA (only IV BZDs)
-“zolam” and -“zepam”
Bind to BZD sites in CNS to potentiate GABA activity
Increase Cl- channel opening and Cl- influx
GABA-dependent
Drowsiness, anterograde amnesia, floppy child, cardiac and respi depression, tolerance, dependence and withdrawal symptoms
Potential for abuse
Short-acting BZD, mode of administration, t1/2
Midazolam, IV, 2h
Intermediate-acting BZD, mode of administration, t1/2
Alprazolam (oral), lorazepam (IV), 8h
Long-acting BZD: mode of administration
Clonazepam (oral), diazepam (IV)
Important point to take note for using BZD as insomnia drug
Faster sleep onset but poorer sleep quality (reduced REM)
Non-BZD: Names, moa, adr, contraindications
Zolpidine, zolpiclone
Similar MOA to BZDs
Increased anxiety on withdrawal, also need to take note of TDW
When to suspect depression?
Symptoms persist for at least 2 weeks and is severe enough to interfere with normal functioning
Function of GABA
Inhibitory neurotransmitter, acts as interneuron to modulate impulses
Hypothesis on which antidepressants are based upon
That depression is due to reduced levels of post-synaptic monoamines (serotonin, dopamine, norepinephrine)
SSRI: Class, names, moa, adr, DDI, contraindications
First-line antidepressant
Fluoxetine, escitalopram, sertraline, paroxetine
Blocking reabsorption of serotonin by inhibiting SERT, increase post-synaptic serotonin
Allows for longer stimulation of receptor cells
Anxiety, hyponatremia, weight changes, headache nausea, sexual dysfunction
CYP450 INHIBITOR, cannot take with MAOI/St.John’s for risk of serotonin syndrome
TCA: Class, names, moa, adr, contraindications
Antidepressant
Amitriptyline, imipramine
Similar to SSRI (blocks SERT), but also has anticholinergic and antihistamine effects
Sedation, fatigue, tachy, arrythmia
Not suitable for elderly: Postural hypot, glaucoma, urinary reten, constipation (anticholinergic effects)
Why are TCAs less safe than SSRIs, despite SSRIs having more DDIs and being more expensive?
Fatality in overdose, dangerous especially if patients have suicidal tendencies
Advantage of long-term antidepressant use
Increase BDNF expression in hippocampus, protects neurons from neurotoxic damage, enhances NA, SE neuron growth
Hypothesis on which antipsychotics are based upon
That psychoses is due to excessive dopamine in mesocortico-limbic system
Typical antipsychotics: Name, moa, adr, contraindications
Haloperidol
High potency. Blocks D2>5-HT2 in extrapyramidal system, limbic midbrain and frontal cortex
EXTRAPYRAMIDAL REACTIONS (Acute dystonia, parkinsonism, tardive dyskinesia, malignant syndrome)
Anticholinergic effects, neuroleptic malignant syndrome (rare)
