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Psychiatry > PsychoPharmacology > Flashcards

PsychoPharmacology Flashcards

1
Q

what are some indications for antidepressants?

A 
> unipolar depression
> schizoaffective disorders
> bipolar depression
> organic mood disorders
> anxiety disorders
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2
Q

name 4 classes of antidepressants

A

> tricyclic antidepressants
monoamine oxidase inhibitors
selective serotonin reuptake inhibitors
novel antidepressants

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3
Q

what are some downsides of tricyclic antidepressants?

A 
> side effect profile
 - antihistamine
 - anticholinergic
 - antiadrenergic
> lethal in overdose
> cause QT lengthening syndrome
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4
Q

name some tertiary tricyclic antidepressants

A

> amitriptyline
clomipramine
imipramine
doxepin

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5
Q

what do tertiary tricyclic antidepressants act on?

A

serotonin receptors

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6
Q

what are the anticholinergic effects of TCA’s?

A

> dry eyes and mouth
constipation
memory deficits
potential delirium

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7
Q

what are the antiadrenergic effects of TCA’s?

A

> sedation
sexual dysfunction
orthostatic hypotension

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8
Q

what are the antihistaminic effects of TCA’s?

A

dry eyes and mouth

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9
Q

what is the action of secondary TCA’s?

A

primarily block noradrenaline

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10
Q

name some secondary TCA’s

A

> desipramine

> nortriptyline

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11
Q

what is the action of monoamine oxidase inhibitors?

A

bind irreversibly to monoamine oxidase preventing inactivation of amines such as norepinephrine, dopamine and serotonin increasing the synaptic levels

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12
Q

what are some side effects of monoamine oxidase inhibitors?

A 
> orthostatic hypotension
> weight gain
> dry mouth
> sexual dysfunction
> sedation
> sleep disturbance
> hypertensive crisis
> serotonin syndrome
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13
Q

what is serotonin syndrome?

A 
occurring when MONI's are taken with serotonin increasing meds
> sweats
> abdominal pain
> HTN
> irritability
> delirium
> myoclonus
> tachycardia
> diarrhoea
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14
Q

what is the action of selective serotonin reuptake inhibitors?

A

blocks presynaptic serotonin reuptake

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15
Q

what are side effects of SSRI’s?

A 
> GI upset
> sexual dysfunction
> restlessness
> insomnia
> dizziness
> anxiety
> nervousness
> fatigue
> discontinuation syndrome (agitation, disequilibrium. dysphonia and nausea)
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16
Q

name some selective serotonin reuptake inhibitors

A 
> paroxetine
> sertraline
> fluoxetine
> citalopram
> escitalopram
> fluvoxamine
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17
Q

name some properties of sertraline

A

> weak P450 interaction
short half life
less sedation
requires a full stomach for max absorption

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18
Q

what are some properties of fluoxetine?

A 
> long half life
> can provide increased energy
> active metabolites may build up
> significant P450 interactions
> initially can cause anxiety and insomnia
> can induce mania
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19
Q

which SSRI has the shortest half life?

A

fluvoxamine

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20
Q

what is the action of serotonin/norepinephrine reuptake inhibitors?

A

inhibit serotonin and noradrenergic reuptake like the TCAs but without the antihistamine, antiadrenergic or anticholinergic side effects

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21
Q

name some serotonin/norepinephrine reuptake inhibitors

A

> Venlafaxine

> duloxetine

22
Q

what are some characteristics of venlafaxine?

A 
> minimal drug interactions
> almost no P450 activity
> short half life and fast renal clearance 
> cause nausea
> QT prolongation
> sexual side effects
23
Q

name some novel antidepressants

A

> mirtazapine

> buproprion

24
Q

what novel antidepressant can cause anxiety and seizures?

A

buproprion

25
Q

how is treatment resistant depression treated?

A

> combination SSRI’s/SNRI’s plus mirtazapine
adjunct with lithium
adjunct with atypical antipsychotic
ECT

26
Q

in what conditions are mood stabilisers indicated?

A

> bipolar
cyclothymia
schizoaffective disorder

27
Q

name some mood stabilisers

A

> lithium

28
Q

what are the pros of lithium?

A

> reduces suicide rate

> long term prophylaxis for mania

29
Q

what factors predict a good response to lithium?

A

> prior long term response/family member
classic pure mania
mania followed by depression

30
Q

how is lithium used?

A 
> get a baseline UandE and TSH
> check pregnancy in women
> monitor 
 - a steady state is achieved at 5 days
 - check 12 hours after last dose 
 - check TSH and creatinine at 6 months
31
Q

what are the side effects of lithium?

A 
> GI distress
 - reduced appetite
 - nausea/vomiting
 - diarrhoea
> acne
> thyroid abnormalities
> non-significant leucocytosis
> hair loss
> reduced seizure threshold
> cognitive slowing
> intention tremor
> polyuria and polydypsia
32
Q

what is mild lithium toxicity?

A 
> levels 1.5-2
> vomiting
> diarrhoea
> ataxia
> dizziness
> slurred speech
> nystagmus
33
Q

what is moderate lithium toxicity?

A 
> levels 2-2.5
> nausea
> vomiting
> anorexia
> blurred vision
> clonic limb movements
> convulsions
> delirium 
> syncope
34
Q

what is severe lithium toxicity?

A

> more than 2.5
generalised convulsions
oliguria
renal failure

35
Q

name an anti-convulsant

A

> valproic acid
carbamazepine
lamotrigine

36
Q

what are some factors predicting a positive response to valproic acid?

A

> rapid cycling patients
comorbid substance issues
patients with co-morbid anxiety disorders

37
Q

what do you want to check before beginning valproic acid

A

> baseline liver function
pregnancy tests
full blood count
start folic acid supplements

38
Q

what monitoring is there in valproic acid?

A

once a steady state has been achieved after 4/5 days check 12 hours after the last dose and repeat CBC and LFT’s

39
Q

what are the side effects of valproic acid?

A 
> thrombocytopenia
> sedation
> nausea/vomiting
> weight gain
> tremor
> hair loss
> increased risk of neural tube defect due to reduction in folic acid
40
Q

what is carbamazepine indicated in?

A

> acute mania
mania prophylaxis
rapid cyclers
mixed patients

41
Q

what is needed before carbamazepine is started?

A

> baseline LFT’s
FBC
ECG

42
Q

what monitoring is needed in carbamazepine?

A

> check steady state is achieved at 5 days

> check 12 hours after last dose and repeat CBC + LFT’s

43
Q

why do you need to check and adjust dosing after 1 month of carbamazepine?

A

it induces its won metabolism

44
Q

what are the side effects of carbamazepine?

A 
> RASH
> sedation
> AV conduction delays
> hyponatraemia
(and loads more but legit never gonna remember them all)
45
Q

what drug class is lamotrigine in?

A

anticonvulsant

46
Q

when are antipsychotics indicated?

A 
> schizophrenia
> schizoaffective disorder
> bipolar disorder for mood stabilisation
> psychotic depression
> augmenting agent in resistant anxiety
47
Q

name 4 key pathways in the brain affected by dopamine

A

> mesocortical
nigrostriatal
mesolimbic
tuberoinfundibular

48
Q

name some typical antipsychotics

A

> haloperidol
primozide
fluphenuzide

49
Q

name some atypical antipsychotics

A 
> risperidone
> olanzapine
> quetiapine
> aripiprazole
> clozapine
50
Q

what are some adverse effects of antipsychotics?

A 
> tardive dyskinesia
 - involuntary muscle movement
> extra pyramidal side effects
 - acute dystonia
 - Parkinson's syndrome
 - akathisia
> neuroleptic malignant syndrome
 - fever
 - severe muscle rigidity
 - autonomic instability
51
Q

what are ankiolytics indicated for?

A

> generalised anxiety disorder
substance related disorders and withdrawal
insomnias
parasomnias

52
Q

name some ankiolytics

A

> buspirone

> benzodiazapines

Psychiatry (10 decks)

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