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Year 4 - Pysch > psychopharmacology > Flashcards

psychopharmacology Flashcards

1
Q

what does SSRO stand for

A

selective serotonin reuptake inhibitor

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2
Q

MOA for SSRI

A

it inhibits the reuptake of serotonin from the synaptic cleft of the neuron so more neurotransmitter is present to reduce the psycho/biological symptoms of affecteive disorder etc

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3
Q

indication of SSRI

A

moderate to severe depression
(mild depression as well but only after the failure of psycho treatment)

panic disorder

obsessive control disorder

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4
Q

SE of SSRI

A

GI upset
hypersensitive
appetite and weight disturbance (up/down)
hyponatraemia (esp in an elderly patient)
inc suicidal thought (esp in the young patient)
reduce seizure threshold
reduce QT intervals
inc bleeding risks
serotonin syndrome
sudden withdraw (GI upset, serotonin syndrome)

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5
Q

what is serotonin syndrome

A

it is a triad of altered mental state, neuromuscular excitation, autonomic hyperactivity

altered mental state - agitation, confusion, hypomania, hallucination, coma

neuromuscular excitation - myoclonus hyperreflexia tremor

autonomic hyperactivity - shivering, hyperthermia, sweating, tachycardia, N+V)

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6
Q

C/I in SSRI

A

young patient - (inc suicidal risks)

epileptic patient

hepatic impairment

peptic ulcers disease (SSRI inc risk of peptic ulcer if not PPI cover)

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7
Q

Interaction of SSRI

A

other monoamine inhibitors (eg tricyclic, SNRI - serotonin syndrome

should prescribe with PPI cover if patient using NSAIDs ( peptic ulcer risks)

anticoagulants - bleeding risk

drugs that inc QT intervals

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8
Q

what are some examples of SSRI

A

sertraline
citalopram
flouxentine
escitalopram

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9
Q

what are some examples of tricyclic anti-depressants

A

amitriptyline

lofepramine

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10
Q

MOA of tricyclic anti-depressants?

A

blocks, 5HT (serotonin), noradrenaline (H1, alph1, alph2 and dopamine) receptros

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11
Q

indications for tricyclic depressants

A

2nd line treatment for moderate-severe depressions

off licences - pain management

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12
Q

SE of tricyclic anti-depressants

A

anti-muscarinic - dry mouth, constipation, urinary retention. blurred vision

H1 & alpha 1 - sedation, hypotension, cardio adverse event - inc QT and In QRS, convulsion, hallucination and mania

dopamine - sexual dysfunction, breast changes and sextrapyramidal symptoms

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13
Q

symptoms of an overdose of tricyclic anti-depressants

A

sedation, hypotension, convulsion, hallunciation, resp failure, fetal

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14
Q

symptoms of sudden withdrawal of tricyclic antidepressants

A

GI upset, influenza-like symptoms, sleep disturbance, neuro signs

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15
Q

C/I of tricyclic anti-depressants

A 
elderly 
constipated patients 
inc ocular pressure 
eliptic patient 
CVD 
prostatic hypertrophy
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16
Q

interaction of tricyclic anti-depressants

A

monoamine inhibitors

SSRI

17
Q

What does SNRI stands for

A

Serotonin & noradrenaline reuptake inhibitor

18
Q

Examples of SNRI

A

Venlafexine

Mirtrazepine

19
Q

MOA of SNRI

A

Block serotonin and noradrenaline fro being broken down in the synaptic cleft of the neurone

Venlafaxine - blocks H1 receptor
Mitrazepine - blocks alpha 1 receptor in the neurone

20
Q

Indictions for SNRI

A

Alternative option of major depression (if SSRI not working)

Generalised anxiety disorder

21
Q

SE of SNRI

A

GI upset - dry mouth, constipation, N+V, weight changes

Neuro - convulsion, abnor dreams, confusion, headache

Hyponatreamia

Serotonin syndrome

Inc suicidal risks

22
Q

What can venlafaxine cause as a side effect of treatment

A

Inc QT intervals leading to arrhythmia

23
Q

What are the symptoms of student withdrawal of mitrazapine

A

GI upsets
Convulsion
Sleep disturbances
Influenza like symptoms

24
Q

Interaction of SNRI?

A

Other monoaminse inhibitors

25
Q

C/I of SNRI

A

elderly
Hepatic impairment
venlafaxine - CVD
Eliplipsy

26
Q

what are the meds used for maintenance therapy in schizophrenia?

A

antipsychotics
antidepressants
lithium
ECT (last resrot)

27
Q

what are some examples of atypical antipsychotics

A 
risperidone 
olanzapine 
quietiapine 
palliperidone
clozapine
28
Q

what are some examples of typical antipsychotics

A

halloperidol
chlopromazine
fluphenazine
flupenthixol

29
Q

MOA of antipsychotics

A

post-synaptic dopamine receptor blocker

30
Q

which antipsychotics have depot form?

A

rispiderone
palliperidone
olanzapine

31
Q

Other than the 4 dopamine pathways which antipsychotics work on, what other pathway does antipsychotics work on?

A

anti-cholinergic - urinary retention, blurred vision, constipation, dry mouth,
anti-histamine - sedation and weight gain
anti-adrenergic - sexual dysfunction, postural hypotension

32
Q

what blood tests are required before commencing antipsychotics

A
  • bloods  FBC, U&Es, LFT, BM/HbA1c, prolactin, lipid & cholesterol
  • physical  weight, BP, pulse rate
  • ECG  risk of prolonged QTc/arrythmias  esp if high BP, hx of cardiovascular disease, smoker
33
Q

what are the 5 conditions which antipsychotics can cause

A 
acute dystonia 
akithisia 
parkinson like symptoms 
tardive dyskinesia 
hyperprolactinaemia
34
Q

how would you treat the 5 conditions which antipsychotics cause

A

acute dystonia - medical emergency, admission + procyclidine or benztropine
akithisia - propanolol, procyclidine and benzo
parkinson like symptoms - stop the meds and treat with procyclidine
tardive dyskinesia - not much you can do, can try tetrabenzene
hyperprolactinaemia - change meds

35
Q

what is a neuroleptic malignant syndrome?

A

• rare but potentially fatal idiopathic response to antipsychotics  medical emergency

36
Q

pathophysiology of neuroleptic malignant syndrome

A

• caused by blockage of dopaminergic hypothalamospinal tracts (normally monitor sympathetic neurons) by antipsychotics which are dopamine D2 receptor blocker

37
Q

symptoms of neuroleptic malignant syndrome

A 
hyperthermia 
diaphresis
tachycardia
tachypnoea 
muscle rigidity 
altered mental state - confusion, delirium, stupor
38
Q

ix required for neuroleptic malignant syndrome

A

FBC (leucocytosis, raised WCC) , creatine kinase (elevated), U&Es (normal in NMS), brain CT/MRI (to exclude other things)

39
Q

treatment for neuroleptic malignant syndrome

A

immediate transfer to hospital, stop antipyschotics, maintain hydration and airways /colling blankets, Bromocriptine (reverse dopamine blockade), dantrolene (stops muscle spams)

Year 4 - Pysch (6 decks)

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