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Y3 PSYCHIATRY > Pharmacology of Antidepressants and Mood Stabilisers > Flashcards

Pharmacology of Antidepressants and Mood Stabilisers Flashcards

1
Q

How do monamine oxidase inhibitors work? Give an example of each of the types

A

Slow down breakdown of neurotransmitters by inhibiting MAO enzyme
Phenelzine (iireversible)
Moclobemide (reversible)

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2
Q

List some TCA’s

A

Amitriptyline
Clomipramine
Imipramine
Dosulepin

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3
Q

List some SSRI’s

A

Fluoxetine
Citalopram
Sertraline
Paroxetine

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4
Q

Whereabouts in the synapse do MAO inhibitors act? What is their action?

A

Presynaptic terminal

Inhibit MAO A and B enzyme to prevent breakdown of NT into metabolites

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5
Q

Whereabouts in the synapse do TCA’s act? What is their action?

A

Synaptic cleft

Block reuptake oof monoamines (NA and 5HT) into presynaptic terminals

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6
Q

Whereabouts in the synapse do SSRI’s act? What is their action?

A

Presynaptic terminal

Selectively inhibit reuptake of 5HT from the synaptic cleft

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7
Q

Which SSRI’s can inhibit CYP450 system?

A

Fluoxetine

Paroxetine

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8
Q

List some adverse effects of SSRI’s

A

Nausea, headache, sweating, vivid dreams
Sexual dysfunction
Hyponatraemia in elderly
Short-term anxiety

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9
Q

List some adverse effects of TCA’s

A

Anticholinergic - Constipation, dry mouth, blurred vision, urinary retension
Sedation
Weight gain
CV - postural hypotension, tachycardia, arrhythmias
Cardiotoxic overdose

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10
Q

List the clinical uses of antidepressants

A 
Moderate-severe depression
Dysthymia
Generalised anxiety
Panic disorder, OCD, PTSD
Premenstrual dysphoric disorder
Bulimia nervosa
Neuropathic pain
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11
Q

List types of monoamine reuptake inhibitors

A

Tricyclics
Other non-selective reuptake inhibitors
Selective serotonin reuptake inhibitors
NA reuptake inhibitors

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12
Q

What is the ‘monamine hypothesis’ for depression. How do anti-depressants work to counteract this?

A

Depression results from a functional deficit of monoamine transmitters esp. serotonin, NA
Antidepressant act to increase monoaminergic transmission by increasing NT levels

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13
Q

List side effects of monoamine oxidase inhibitors

A

‘Cheese reaction’/hypertensive crisis - inhibiting MAOA enzyme prevents breakdown and transmission of amines
Potentiate effects of other drugs e.g. barbiturates by decreasing their metabolism
Postural hypotension
Insomnia
Peripheral oedema

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14
Q

Give examples of SNRIs, and state their of action

A

Venlafaxine
Duloxetine
Block reuptake of both monoamines into presynaptic terminals

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15
Q

Whereabouts in the synapse do atypical antidepressants act? Give some examples. List some side effects

A 
Postsynaptic terminal (on the receptor)
Mirtazapine (mixed receptor effects)
Bupropion (dopamine uptake inhibitor)
Weight gain, sedation, constipation, dizziness/ falls
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16
Q

What two antidepressants can be combined to reduce side effects?

A

SSRIs

Atypical antidepressant - mirtazapine

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17
Q

What group of the population should SSRIs be prescribed cautiously in? Why?

A

Young adults

Transient increased in suicidal/ aggressive/ self-harm ideas

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18
Q

What is the purpose of prescribing in bipolar disorder?

A

ACUTE: reduce mood in episodes of mania and increase in episodes of depression
LONG-TERM: stabilise mood and prevent recurrence of both mania and depression (prophylaxis)

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19
Q

List the three classes of drugs prescribed most commonly in bipolar disorder. Give examples.

A

Lithium
Anticonvulsants - valproic acid, lamotrigine, carbamazepine
Antipsychotics - quetiapine, ariprazole, alanzopine, lurasidone

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20
Q

What is the mechanism of action of lithium carbonate?

A

Block phosphotidylinosital pathway or inhibit glycogen synthase kinase 3B

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21
Q

List some side effects of lithium

A

Dry mouth/ strange taste, polydipsia, polyuria, tremor
Reduced renal function, nephrogenic diabetes insipidus
Weight gain, hypothyroidism

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22
Q

List some toxic effects of lithium

A

Vomiting, diarrhoea
Ataxia/ coarse tremor
Drowsiness, convulsions, coma

23
Q

Give the mechanism of action of anticonvulsants as mood stabilisers

A

Block overactive pathways (block voltage-gated sodium channels which increases GABA levels)

24
Q

List side effects of anticonvulsants

A

Carbamazepine - drowsiness, ataxia, CV effects, induce liver enzymes
Valproate - teratogenicity
Lamotrigine - rash, GI upset, sedation, dizziness, ataxia, SJS

25
Q

Give the mechanism of action of anti-psychotics as mood stabilisers

A

Dopamine antagonism and 5HT antagonism

26
Q

List side effects of anti-psychotics

A

Sedation
Weight gain
Metabolic syndrome
Extra-pyramidal (aripiprazole)

27
Q

The noradrenergic system is important for…

A

Arousal

Emotion

28
Q

The serotonergic system is important for…

A

Mood, sleep, feeding behaviour, sensory perception

Analgesia

29
Q

The dopaminergic system is important for…

A

Motor control
Motivation/ reward
Prolactin release

30
Q

What class of medication is typically first line in mood disorders, and what drug specifically? When should you switch to a different class?

A

SSRIs
Escitalopram (1st line), sertraline in cardiac problems (2nd line)
Try 2 SSRIs before switching

31
Q

Which drug is typically prescribed 2nd line to SSRIs? What are the benefits?

A

NA and specific serotenergic AD - mirtrazipine
Can also be prescribed in combination
Promotes sleep and increases appetite and weight

32
Q

When should an antidepressant be reviewed after starting?

A

1-2 weeks

33
Q

How long should an antidepressant be continued for after remission, recurrence and after a 3rd episode respectively?

A

6-12 months after remission
12-24 months after recurrence
Indefinitely after a 3rd episode

34
Q

Side effects of antidepressants are usually transient. True/False?

A

True

35
Q

Outline the management of acute mania

A

Maximise antimaniac dose
Discontinue anti-depressant
Consider hospital admission

36
Q

What medications can be prescribed in an acute maniac episode?

A

1st line: antipsychotic - clarizapine, quetiapine, risperidone
Other options: lithium, valproate, carbamazepine, ECT
Benzodiazepines for symptom control

37
Q

Outline the treatment for acute bipolar depression

A

AD (typical SSRIs e.g. fluoxetine) with antimanic drug (e.g. antipsychotic - quetiapine, alanzapine, lithium, valproate, lamotrigine)
Consider ECT

38
Q

In what situation, should you avoiding prescribing an anti-depressant in acute bipolar depression?

A

Recent hypomanic episode

History of rapid cycling

39
Q

Which medication is useful in bipolar depression, if a patient would like a drug they can titrate up slowly?

A

Lamotrigine

40
Q

Outline the maintenance options in bipolar disorder

A

1st line usually lithium
Other options: antipsychotics, LAMOTRIGINE (if depressed), VALPROATE (if manic/ hypomanic)
Psychoeducation
Other psychological therapies

41
Q

What are the indications for ECT?

A

Emergency treatment of depression
High suicidal risk
Patients with psychomotor retardation
Patients who are not eating/ drinking

42
Q

What are the two main types of ECT?

A

Bitemporal

Unilateral

43
Q

Which physiological response does ECT cause?

A

Seizure lasting 15-20 seconds with quick recovery

Will need further treatment following ECT

44
Q

List the contraindications of ECT

A 
Recent MI
Recent stroke
SOL
Phaechromocytoma
Angina
CHF
Severe pulmonary disease
Severe osteoporosis
Pregnancy
45
Q

List the typical side effects of ECT

A

Tension headache

Memory/ cognitive problems

46
Q

List the types of psychological therapies that can be offered to patients

A 
CBT
Behavioural adaptation
Interpersonal therapy
Psychoeducation
Congitive behavioural analytic system of psychotherapy
47
Q

List common factors which should be considered when choosing a drug for a patient

A 
What worked for the patient before
Indications
Patient's comorbidities and risk factors
Patient preference
Safety in pregnancy/ breast feeding
Treatment of specific symptoms
Risk of overdose
Patient compliance
Dose frequency
48
Q

How long do antidepressants typically take to work?

A

2-6 weeks

49
Q

If a combination of SSRIs and mirtazapine hasn’t worked what drugs should be tried?

A

SNRIs

Venlafaxine, duloxetine

50
Q

What is the treatment for hypertensive crisis? What class of drugs is it a side effect of?

A

Phentolamine infusion

Monoamine oxidase inhibitors

51
Q

What class of drug can be prescribed if sedation is needed? Give an example

A

Serotonin 2 antagonist/ reuptake inhibitor (SARI)

Trazadone

52
Q

Semisodium valproate should be avoided in…

A

Women of child-bearing age

53
Q

List monitoring for patients on lithium

A

Lithium levels
U+Es
TFTs

54
Q

Which class of drug are major tranquilizers - antipsychotics or benzodiazepines?

A

Antipsychotics

Y3 PSYCHIATRY (23 decks)

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