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Psychiatry > Psycho-Pharmacology > Flashcards

Psycho-Pharmacology Flashcards

1
Q

How long do antidepressants take to kick in?

A

3-4 weeks

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2
Q

How long do anti-psychotics take to kick in?

A

up to 6 weeks

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3
Q

Indications for antidepressants

A 
Unipolar and bipolar depression 
organic mood disorders
schizoaffective disorder
anxiety disorders including OCD
Panic
social phobia 
PTSD
premenstrual dysphoric disorder
impulsivity associated with personality disorders
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4
Q

How long would you try an antidepressant for if no improvement is seen and you switch to another antidepressant or augment with another agent?

A

At least two months

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5
Q

4 types of antidepressant drugs

A

Tricyclics (TCA)
Monoamine Oxidase Inhibitor (MOIs)
Selective Serotonin Reuptake Inhibitors (SSRIs)
Serotonin/Noradrenaline Reuptake Inhibitors (SNRIs)
Novel antidepressants

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6
Q

Side effects of TCAs

A 
VERY HIGH SIDE EFFECT PROFILE 
antihistaminic
anticholinergic 
antiadrenergic 
QT lengthening
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7
Q

How much of TCA would it take for an overdose?

A

LETHAL in overdose

even a one week supply can be lethal

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8
Q

Side effects of tertiary TCAs

A

antihistaminic (sedation and weight gain)
Anticholintergic (dry mouth, dry eyes, constipation, memory deficits and potentially delirium)
antiadrenergic (orthostatic hypotension, sedation, sexual dysfunction)

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9
Q

What do tertiary TCAs predominately act on?

A

Serotonin Receptors

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10
Q

Examples of tertiary TCAs

A

Imipramine
Amytriptyline
Doxepin
Clomipramine

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11
Q

Side effects of secondary TCAs

A

Same as TCAs but generally less severe

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12
Q

Examples of secondary TCAs

A

Desipramine

Noritriptyline

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13
Q

What would be used to treat depression

A

Start with SSRI then switch

to SNRI

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14
Q

What are monoamine oxidase inhibitors (MAOIs) very effective for?

A

Depression

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15
Q

Side effects of MAOIs

A 
orthrostatic hypotension 
weight gain 
dry mouth 
sedation 
Sexual dysfunction 
sleep disturbance
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16
Q

What reaction can occur with MAOIS?

A

Cheese reaction - hypertensive crisis when MAIOs are taken with tyramine rich foods or symphatomimetics

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17
Q

What syndrome can develop if MAOIs are taken with meds that increase serotonin or have sympahtetomimetic actions?

A

Serotonin syndrome

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18
Q

What do SSRIs do?

A

Block the presynaptic serotonin reuptake

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19
Q

What does SSRI treat?

A

Both depressive and anxiety symptoms

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20
Q

Side effects of SSRI

A 
GI upset
Sexual dysfunction (30+)
anxiety 
restlessness 
nervousness 
insomnia 
fatigue or sedation 
dizziness
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21
Q

How toxic are SSRIs?

A

Pretty untoxic

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22
Q

Stopping SSRIs can give what?

A

A discontinuation syndrome with agitation, nausea, disequilibrium and dysphoria - but only lasts 1 week

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23
Q

3 examples of SSRIs

A

Paroxetine
Sertraline
Fluoxetine (Prozac)

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24
Q

What do SNRIs do?

A

Inhibit both serotonin and noradrenergic reuptake like TCAs but without antihistamine, antiadrenic or anticholingergic side effects

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25
Q

What are SNRIs used for?

A

Depression
Anxiety
Neuropathic pain

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26
Q

Examples of SNRIs

A

Venlafaxine

Duloxetine

27
Q

Examples of novel antidepressants

A

Mirtazapine

Burproprion

28
Q

How to treat if treatment resistance

A

Combination of antidepressants e.g. SSRI or SNRI with Mirtazepine
Adjunctive treatment with lithium
Adjunctive treatment with atypical antipsychotic e.g. quetiapine
ECT

29
Q

How to treat depression

A

Start with SSRI

then if need to switch to SNRI

30
Q

What is treatment prophylaxis?

A

Once better, keep on medication for a period of time so do not become unwell again

31
Q

Treatment prophylaxis for a first episode

A

Keep on current dosage for 6 months - 1 year once better

32
Q

Treatment prophylaxis for second episode

A

Keep on current doseage for 2 years

33
Q

Treatment prophylaxis for third episode

A

Keep on current doseage for however long it takes e.g. possibly 3 years

34
Q

Indications for mood stabilisers

A

Bipolar
Cyclothymia
Schizoaffective

35
Q

Classes of mood stabilisers

A

Lithium
Anticonvulsants
Antipsychotics

36
Q

What is the only medication to reduce the suicide rate

A

lithium

37
Q

Factors predicting a positive response to lithium

A

Prior long term response
Family member with good response
Classic pure mania
Mania is followed by depression

38
Q

Before start lithium, what do you do?

A

U and Es
TSH
Pregnancy test

39
Q

Who is not meant to use lithium?

A

Women of childbearing age

40
Q

Side effects of lithium

A 
GI distress
- reduced appetite
- nausea vomiting
- diarrhoea 
Thyroid abnormalities 
Non significant leucocytosis 
Polyuria/polydipsia secondary to ADH antagonism 
Hair loss
acne 
reduces seizure threshold
cognitive slowing 
intention tremor
41
Q

Examples of anticonvulsants

A

Valproic acid
Carbamazepine
Lamotrigine

42
Q

Valproic acid has a positive response in….

A

Rapid cycling patients (F>M)
Comorbid substance issues
Mixed patients
Paitents with co morbid anxiety disorders

43
Q

Valproic acid vs Lithium

A

valproic acid as effective as lithium in mania prophylaxis

valproic acid is not as effective as lithium in depression prophylaxis

better tolerated than lithium

44
Q

Before starting valproic acid, what needs to be done?

A

Pregnancy test
Baseline LFTs
FBC
start folic acid supplement in women

45
Q

Side effects of valproic acid

A 
Thrombocytopenia and platelet dysfunction 
Nausea
Vomiting
Weight gain 
Sedation 
tremor 
increased risk of neural tube defect
hair loss
46
Q

What is carbamazepine first line for?

A

Acute mania

mania prophylaxis

47
Q

Who is indicated for carbamazepine?

A

Rapid cyclers

Mixed patients

48
Q

What should be done before carbamazepine is started?

A

LFTs
FBC
ECG

49
Q

Side effects of carbamazepine

A 
rash - MOST COMMON
nausea, vomiting, diarrhoea
sedation, dizziness, ataxia, confusion 
AV conduction delays 
Water retention resulting in hyponatraemia 
DRUG DRUG INTERACTIONS
50
Q

Side effects of Lamotrigine

A 
nausea vomiting 
sedation 
dizziness 
ataxia 
confusion 
steven johnstones syndrome 
Toxic epidermal necrolysis
51
Q

Indications for antipyschotics

A

Schizophrenia
Schizoaffective disorder
Bipolar disorder (when psychotic symptoms and/or mood stabilisation)
Psychotic depression
augmenting agents in treatment with resistant anxiety disorders

52
Q

What is the typical antipsychotic do?

A

D2 dopamine receptor antagonists

53
Q

Examples of antipsychotics

A 
Risperidone 
Olanzapine 
Quetiapine
Aripiprazole 
Clozapine
54
Q

S/Es of olanzapine

A 
Weight gain 
Hypertriglyceraemia 
Hypercholesteraemia
Hyperglycaemia 
Hyperprolactinaemia
Abnormal LFTs
55
Q

S/Es of clozapine

A

Agranulocytosis (required bloods every 6 months)
Seizures
Sedation
Weight gain
Abnormal LFTs
Hypertriglycaemia,glycermia,cholesteraemia

56
Q

What is clozapine reserved for?

A

Treatment resistant patients (due to side effect profile)

57
Q

S/Es of antipsychotics

A

Tardive dyskinesia
- involuntary muscle movements
Neuroleptic malignant syndrome
Extrapyramidal S/Es

58
Q

Presentation of neuroepileptic malignant syndrome

A 
Severe muscle rigidity 
Fever
Altered mental status 
Autonomic instability 
Elevated WBC 
Elevated LFTs and CPK
59
Q

Examples of extrapyramidal S/Es of antipsychotics

A

Acute dystonia
Parkinson syndrome
Akathisia

60
Q

What are anxiolytics used to treat?

A 
Panic disorder
Generalised anxiety
Substance related disorders and their withdrawal 
Insomnias 
Parasomnias
61
Q

Example of an anxiolytic

A

Buspirone

62
Q

What are benzodiazepines used to treat?

A

Insomnia
Parasomnias
Anxiety
CNS depressant withdrawal protocols

63
Q

S/Es of benzodiazepines

A 
Somnolence
Cognitive deficits
Amnesia 
Disinhibition 
Tolerance
DEPENDENCE
64
Q

Definition of somnolence

A

Strong desire for sleep, and sleeping for long periods when do so

Psychiatry (18 decks)

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