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Clinical pharmacology and therapeutics > Drugs for psychiatric disorders > Flashcards

Drugs for psychiatric disorders Flashcards

1
Q

List the main classes of drugs for psychiatric disorders

A 
Antidepressants
Antipsychotics
Mood stabilisers
Anxiolytics
Hypnotics
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2
Q

Name some selective serotonin reuptake inhibitors

A 
Fluoxetine 
Paroxetine
Sertraline
Citalopram
Escitalopram
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3
Q

What are the indications for selective serotonin reuptake inhibitors being prescribed?

A 
Depression
Anxiety disorders
Panic disorder
Obsessive compulsive disorder
PTSD
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4
Q

What do Selective serotonin reuptake inhibitors have in common?

A 
Indications
Mechanism of action 
Delayed onset of action (10-14 days)
Efficacy
Relative safety in overdose
Advisability of prolonged course 
Interactions
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5
Q

How do different selective serotonin reuptake inhibitors differ?

A

Half life

Side effects

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6
Q

Which SSRI has the shortest half life?

A

Paroxetine (20hrs)

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7
Q

Which SSRI has the longest half life?

A

Fluoxetine (2-4 days)

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8
Q

What is fluoxetines most common side effect?

A

Agitation

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9
Q

How do SSRIs work?

A

Block the reuptake of serotonin so more serotonin is available in the synaptic cleft

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10
Q

What is SSRI discontinuation syndrome?

A

Occurs on cessation of SSRIs especially when abrupt

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11
Q

List some symptoms of SSRI discontinuation syndrome

A

Agitation and anxiety
Dizziness and balance problems
Nausea and diarrhoea
Flu like symptoms

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12
Q

Which SSRI most commonly results in SSRI discontinuation syndrome?

A

Paroxetine

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13
Q

How do you treat SSRI discontinuation syndrome?

A

Reassurance and monitoring
Reintroduction of the drug with tapered withdrawal
Consider alternative antidepressant or anxiolytic

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14
Q

List the main tricyclic antidepressants

A

Amitriptyline
Imipramine
Lofepramine
Dothiepin

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15
Q

Why are tricyclic antidepressants rarely used as first line treatments?

A

Risk of overdose and adverse effects

Similar efficacy to SSRIs

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16
Q

Give the mechanism of action for tricyclic antidepressants

A

Bind to NA and 5HT reuptake inhibitors, increasing monoamine levels in synaptic cleft

  • Also have pronounced anticholinergic (antimuscarinic) effects
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17
Q

List the anticholinergic effects of tricyclic antidepressants

A

Dry mouth
Constipation
Urinary retention
Cognitive effects

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18
Q

List some non-anticholinergic side effects of tricyclic antidepressants

A 
Psychotropic effects - agitation and nightmares
Sexual dysfunction
Akathisia 
Muscle twitches
Cardiac arrhythmias
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19
Q

Describe the effects of tricyclic antidepressant overdose

A 
Confusion
Tachycardia
Arrhythmias
Hypotension
Mydriasis 
Seizures
Coma
Cardiorespiratory arrest
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20
Q

Name some SNRIs (serotonin and noradrenaline reuptake inhibitors)

A

Venlafaxine

Duloxetine

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21
Q

What are the side effects of Venlafaxine?

A

Headache
nausea
hypertension
Discontinuation syndrome

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22
Q

Why is duloxetine a better SNRI than venlafaxine?

A

No concern regarding hypertension

23
Q

What is moclobemide?

A

A monoamine oxidase inhibitor usually reserved for treatment resistant depression or atypical depression

24
Q

What is reboxetine?

A

Highly selective noradrenaline reuptake inhibitor

25
Q

Describe the action of monoamine oxidase inhibitors

A

Prevents the action of monoamine oxidase

Prevents serotonin, dopamine and noradrenaline being broken down

26
Q

Which foods can monoamine oxidase inhibitors interact with?

A

Most cheeses, red wine, yeast, broad bean pods, liver, fermented sausages

27
Q

What can interactions of some foods and monoamine oxidase inhibitors cause?

A

Hypertensive crisis

28
Q

What drugs can monoamine oxidase inhibitors interact with?

A

SSRIs - serotonin syndrome
Adrenaline and noradrenaline
Ldopa

29
Q

What class of antidepressant is mirtazapine?

A

NaSSA - noradrenergic and specific serotonergic antidepressant (acts on alpha 2 receptors to increase release of serotonin and noradrenaline)

30
Q

What are antipsychotics used for?

A

Psychotic illness
bipolar affective disorder
adjunctive therapy for depressive episodes

behavioural disturbance in dementia and learning disabilities
conduct disorder
personality disorder
obsessive compulsive disorder
PTSD 
Anxiety disorders
31
Q

Describe the dopamine hypothesis

A

Dopaminergic drugs can produce symptoms similar to schizophrenia (psychotic symptoms)
Dopamine blocking drugs have anti-psychotic properties (D2 receptor blockade)

32
Q

Describe the serotonin hypothesis

A

Some hallucinogenic drugs have similar structure to serotonin so newer antipsychotic drugs act at serotonin receptors

33
Q

Describe the glutamate hypothesis

A

PCP glutamate agonist can produce schizophrenia like symptoms. Abnormal glutamate could play a part in schizophrenia

34
Q

Give the side effects of neuroleptics/typical antipsychotics

A

Extrapyramidal symptoms - parkinsonism, dystonia, akathisia

Tardive dyskinesia

35
Q

Give some examples of typical antipsychotics

A

Butyrophenones - haloperidol

Phenothiazones - Chlorpromazine, Trifluoperazine, Fluphenazine

Thioxanthines - Flupenthixol

36
Q

Describe atypical antipsychotics

A

Different mechanism of action - may act at serotonin receptors and less so at dopamine receptors
Less likely to cause extrapyramidal side effects

37
Q

Give some examples of atypical antipsychotics

A

Risperidone
Olanzapine
Quetiapine
Aripiprazole

38
Q

What are some problems with atypical antipsychotics

A

Metabolic syndrome and weight gain

39
Q

List the dopamine receptor blockade symptoms

A 
Extrapyramidal side effects
Parkinsonism 
Dystonia
Tardive dyskinesia 
Hyperprolactinemia
40
Q

List the muscarinic (cholinergic) receptor blockade symptoms

A 
Dizziness
Impaired memory and cognition
blurred vision
dry eyes
dry mouth
tachycardia
dyspepsia
constipation
41
Q

List the alpha adrenergic receptor blockade symptoms

A

orthostatic hypotension
palpitations
sexual dysfunction
vertigo

42
Q

Describe clozapine

A

Reserved for treatment resistant cases
Most effective antipsychotic
Need blood test monitoring - haematological side effects
hypersalivation and hypotension may occur
acts on d4 and serotonin systems

43
Q

Describe rapid tranquilisation

A

For acute aggression /agitation where risk of harm to self or others
oral first
IM
- antipsychotics - haloperidol or olanzapine
- Benzodiazepines - lorazepam or midazolam
Treat underlying cause

44
Q

List some mood stabilisers

A

Lithium
Valproate
Carbamazepine
Lamotrigine

45
Q

List the side effects of lithium

A

Short term side effects
Polydipsia and polyuria, nausea, fine tremor, loose stools

Long term side effects Hypothyroidism, renal impairment, weight gain, acne

46
Q

Describe lithium toxicity

A

Narrow therapeutic index

Coarse tremor, nausea and vomiting, ataxia and cerebellar signs, confusion

Precipitants:
- salt depletion, dehydration (e.g. in diarrhoea)

  • drug interactions-thiazides, NSAIDs deteriorating renal function
47
Q

Describe carbamazipine

A

Antimanic but less effective than lithium

Major problems with drug interactions

Induces liver enzymes so reducing levels of other agents

Other agents in turn alter CBZ metabolism

48
Q

Describe valproate

A

Effect on inhibition of Ca and Na channels

Enhances inhibitory GABA

Reduces excitatory glutamate

Equal efficacy to Li in acute mania

Ease of use

Improved tolerability

Weight gain

Teratogenic
Plus developmental disorders

49
Q

List some Commonly used benzodiazepines

A

Diazepam
Lorazepam
Clonazepam
Temazepam

Clobazam (benzo derivative)

50
Q

How are benzodiazepines used?

A

Hypnotics
Anxiolytics
“Minor tranquillisers”: role in acute tranquillisation
Management of alcohol withdrawal

Also anticonvulsant (esp. clobazam) and muscle relaxant

Bind to BZP site on GABA-A receptor
GABA is main inhibitory neurotransmitter in CNS

51
Q

Describe the issues with benzodiazepine dependence

A

Tolerance

Withdrawal: abrupt withdrawal can precipitate acute delirium, rarely psychosis, convulsions

Other withdrawal symptoms: nausea, hyperacusis, dizziness and imbalance, tinnitus, depersonalization

Avoid lengthy prescriptions

Tapered withdrawal using ‘diazepam equivalents’

52
Q

How do you manage alcohol withdrawal?

A

Reducing regimen of benzodiazepines
Vitamin supplementation
Oral
Intramuscular/intravenous
Additional aids to maintain abstinence
Acamprosate – reduces cravings
Naltrexone – reduces cravings/enjoyment via opiod receptors
Disulfiram (antabuse) – induces severe reaction if alcohol consumed
N.B. risk of fulminating hepatitis – check LFTs frequently

53
Q

Describe BUSPIRONE

A

Partial agonist at 5HT_1a receptors

Licensed for use in generalised anxiety disorder – doubts over efficacy

May have applications in other neuro/psych contexts e.g. some evidence that it decreases side effect of medication in Parkinson’s disease; may have a role in behavioural disturbance in dementia

54
Q

Describe PREGABALIN

A

Binds to, and modulates, voltage-gated calcium channels in CNS

Originally developed for use in neuropathic pain but has a growing role in anxiety and panic disorder, also in partial seizures

Clinical pharmacology and therapeutics (27 decks)

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