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17. Clinical Pharmacology and Therapeutics > 22. Drugs used in Psychiatric Disease > Flashcards

22. Drugs used in Psychiatric Disease Flashcards

1
Q

What are the general action of CNS drugs?

A

Stimulators or blockers of neurotransmitter release. Or can act as inhibitors of regulatory enzymes.

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2
Q

What is the formulation of psychiatric disorders?

A

Genetic vulnerability + life events + individual personality/coping skills/social support + environmental influences.

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3
Q

What are the core symptoms of depression?

A

Low mood, anhedonia (loss of enjoyment in previously enjoyable activities).

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4
Q

What are the secondary symptoms of depression?

A

Decreased appetite, sleep disturbance, physical aches and pains, irritability, self harm or suicidal ideas/acts, psychotic symptoms.

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5
Q

What is the monoamine hypothesis of depression?

A

Deficiency of monoamine neurotransmitters (NA and serotonin) so drugs that deplete these could induce depression.

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6
Q

What is the neurotransmitter receptor hypothesis of depression?

A

Abnormality in the receptors for monoamine transmission leads to depression. So depletion of NTs causes compensatory up regulation of post synaptic receptors.

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7
Q

What is the monoamine hypothesis of gene expression for depression?

A

Deficiency in molecule functioning.

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8
Q

What are the types of antidepressants?

A

Monoamine oxidase inhibitors, monoamine uptake inhibitors, others.

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9
Q

What are the types of monoamine uptake inhibitors?

A

Non-selective noradrenalin and serotonin, selective noradrenaline or serotonin.

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10
Q

What are selective serotonin reuptake inhibitors use for?

A

Moderate to severe depression (with CBT).

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11
Q

Name an SSRI.

A

Fluoxetine, citalopram, paroxetine, sertraline.

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12
Q

What are the pharmokinetics of SSRIs? (Absorption, half lives, metabolism).

A

Absorbed in gut, long half life, metabolised in liver.

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13
Q

What are the ADRs of SSRIs?

A

Common - anorexia, nausea, diarrhoea. Rare - precipitation of mania, increased suicidal ideation.

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14
Q

Name a tricyclic antidepressant.

A

Amitryptiline, imipramine, clomipramine, lofepramine.

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15
Q

What are the actions of TCAs?

A

Inhibit NA uptake so enhanced NA neurotransmission, muscarinic cholinoceptor blockade-reduced cholinergic neurotransmission, alpha-1 adrenoceptor blockade-suppression of NA neurotransmission.

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16
Q

What are the ADRs of TCAs?

A

CNS - sedation and impairment of psychomotor performance. ANS - reduced glandular secretions. CVS - tachy, postural hypotension. GI - constipation.

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17
Q

Which drug family is more dangerous in OD - SSRIs or TCAs?

A

TCAs.

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18
Q

Name a pure non-selective monoamine uptake inhibitor (SNRIs).

A

Venlafaxine, duloxetine.

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19
Q

In what way are SNRIs dose dependent?

A

Lower doses - serotonin action, higher doses - noradrenline action.

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20
Q

What are the ADRs of SNRIs?

A

Sleep disturbance, increased BP, dry mouth, hyponatraemia, withdrawal on discontinuation.

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21
Q

What is psychosis?

A

Lack of contact with reality.

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22
Q

What are the symptoms of paranoid schizophrenia?

A

Disturbed thinking, hallucinations, delusions, unusual speech-thought disorder, behavioural change, lack of insight.

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23
Q

What is a hallucination?

A

Perception in the absence of an external stimulus.

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24
Q

What is a delusion?

A

Fixed false belief that is out of keeping with someone’s culture or religious beliefs.

25
Q

What is the dopamine theory of schizophrenia?

A

Amphetamine causes symptoms like positive ones of schizophrenia and dopamine antagonists are the best treatment.

26
Q

How is the dopamine theory of schizophrenia limited?

A

It doesn’t account for the negative symptoms.

27
Q

What are the main dopamine pathways?

A

Mesolimbic (emotional response and behaviour), mesocortical (arousal and mood), nigrostriatal, tuber-hypophyseal.

28
Q

What are the effects of D2 antagonists?

A

Nigrostriatal pathway -> Parkinsonian symptoms; mesocortical -> enhance negative symptoms; tuberoinfundibular -> hyperprolactinaemia; mesolimbic -> massively reduces positive psychotic symptoms.

29
Q

What is the suggested link between schizophrenia and 5HT function?

A

Increased 5HT has been linked with disturbed behaviours in schizophrenia.

30
Q

What is the suggested link between schizophrenia and cortical glutamate function?

A

Glutamate is an excitatory neurotransmitter, decreased function is associated with schizophrenia.

31
Q

What are the drugs used in schizophrenia?

A

First generation - haloperidal, chlorpromazine; atypical antipsychotics - olaznapine, risperideone, quetiapine; clozapine.

32
Q

What are the actions of all antipsychotics? (From hours to weeks).

A

Within hours - sedation and tranquilisation.
Hours to days - extrapyramidal side effects.
Days to weeks - antipsychotic effects and activating effect.

33
Q

Why are atypical antipsychotics more acceptable to patients with schizophrenia?

A

Less EPSE ADRs, once daily dosing, differing side effect profiles to match some patients.

34
Q

What are the ADRs of atypical antipsychotics in schizophrenia?

A

Varies drug-to-drug, EPSE at high doses, weight gain, increased prolactin, sedation.

35
Q

Which typical antipsychotic is safe in schizophrenic emergencies?

A

Haloperidol.

36
Q

What are the ADRs of typical antipsychotics in schizophrenia?

A

EPSE, neuroleptic malignant syndrome, postural hypotension, weight gain, endocrine changes, pigmentation.

37
Q

What are the toxicity risks of typical antipsychotics in schizophrenia?

A

CNS depression, cardiac toxicity, risk of sudden death with high dose.

38
Q

What makes up an anxiety disorder?

A

Fear out of proportion to situation leading to avoidance.

39
Q

What are the physical symptoms of anxiety?

A

Light headedness, shortness of breath, hot and cold flushes, nausea, palpitations, numbness, pins and needles.

40
Q

What is the treatment line of anxiety?

A

Non-pharmacological approaches, treat coexistent disorders, antidepressants, anxiolytics.

41
Q

Name a benzodiazepine.

A

Diazepam, lorazepam.

42
Q

What is the mechanism of action of benzodiazepines in anxiety?

A

Binds BDZ receptor to have inhibitory effects. Enhances GABA.

43
Q

Explain what is meant by tolerance and dependence with use of benzodiazepines.

A

Tolerance - need to increase the dose to achieve the same effect. Dependence on discontinuation of treatment - withdrawal effects.

44
Q

What are the ADRs of benzodiazepines?

A

Common - drowsiness, dizziness, pyschomotor impairment. Occasional - dry mouth, blurred vision, GI upset, ataxia, headache, reduced BP. Rare - amnesia, restlessness, rash.

45
Q

How are cases of overdose of benzodiazepines treated?

A

Support, flumazenil as antagonist to inverse BDZ receptor agonism.

46
Q

What is bipolar spectrum disorder?

A

Depression and hypomania/mania.

47
Q

What are the symptoms of bipolar spectrum disorder?

A

Unusually excited/happy/optimistic/irritable, overactive, poor concentration and short attention span, poor sleep, rapid speech, poor judgement, hypersexuality, psychotic symptoms.

48
Q

What are the mood stabilisers used in bipolar spectrum disorder?

A

Lithium, sodium valproate, carbamazepine, lamotrigine, antipsychotics.

49
Q

What is the mechanism of action of lithium?

A

Competes with Mg and Ca ion channels, increases 5HT but reduces if chronic use, attenuates effects of NT on receptors.

50
Q

Why does lithium need monitoring?

A

Due to narrow therapeutic window, need to check: renal function, thyroid function every 6 months.

51
Q

What are the uses of lithium?

A

Prophylaxis of mania and depression, augmentation of antidepressants in unipolar depression, reduce suicidality.

52
Q

What are the ADRs of lithium?

A

Memory problems, thirst, polyuria, tremor, drowsiness, weight gain.

53
Q

What are the toxic effects of lithium?

A

Vomiting, diarrhoea, coarse tremor, dysarthria, cognitive impairment, restlessness, agitation.

54
Q

How is lithium toxicity treated?

A

Supportive measures, anticonvulsants, increase fluid intake, haemodialysis.

55
Q

What are the two groups of dementia medication? Give an example of each.

A

Acetyl cholinesterase inhibitors - donepezil, galantamine, rivastigmine. NMDA antagonist - memantine.

56
Q

What is the action of AChE-I in dementia treatment?

A

Slows progression of Alzheimers.

57
Q

What are the ADRs of AChE-I?

A

Nausea, vomiting, anorexia, diarrhoea, fatigue insomnia, headache, bradycardia, worsening COPD, gastric/duodenal ulcers.

58
Q

What are the ADRs of memantine in dementia?

A

Hypertension, dyspnoea, headache, dizziness, drowsiness.

17. Clinical Pharmacology and Therapeutics (25 decks)

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