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Year 3 Psych > Psychopharmacology > Flashcards

Psychopharmacology Flashcards

1
Q

What are the principles for prescribing in psychiatry

A
  1. Establish a diagnosis
  2. identify the target symptoms that will be used to monitor therapy response
  3. Choose a suitable agent and dosage
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2
Q

How do you chose the agent and dose

A

Select an agent with acceptable side effect profile

Use the lowest acceptable dose.

Keep to simplest regime

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3
Q

Describe the management of psychiatric drugs

A

Adjust dosage for optimum benefit, safety and compliance

Keep in mind the delayed response for many psych meds and the drug to drug interactions they can have. Delay of 3-6 weeks before maximum dose is in body

If no improvement after 2 months of adequate dose, switch to another antidepressant or use another agent

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4
Q

What are antidepressants used for

A 
Unipolar depression
Bipolar depression
Organic mood disorders 
Schizoaffective disorder
Anxiety disorders, OCD
Panic attacks
Social phobia
PTSD
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5
Q

What is the best antidepressant

A

There is no one antidepressant that works better than any other as a first line treatment

Second like there is good evidence for metrazipine

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6
Q

What would influence your decision of what antidepressant to use?

A

Past history of response
Side effects profile
Other medical conditions

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7
Q

What are the different classes of antidepressants

A

Tricyclics antidepressants
Monoamine oxidase inhibitors (MAOIs)
Selective Serotonin Reuptake inhibitors (SSRI’s)
Serotonin/noradrenaline reuptake inhibitors (SNRI’s)
Novel antidepressants

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8
Q

Describe the use of tricyclics antidepressants

A

Very effective but side effects can be strong

Have an effect on seratonin and norepinephrine. Also have antihistaminic, anticholinergic, antiadrenergic affects

Can be lethal to overdose, a one week course can be lethal

Can cause QT lengthening

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9
Q

What are tertiary tricyclics

A

Have tertiary amine side chains which react with other receptors leading to more side effects

Act predominantly on serotonin receptors

Amitriptyline, Imipramine, dosepin, cloipramine

Contain active metabolites including deipramine and notrptyline

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10
Q

What are the side effects of tertiary TCA

A 
Antihstaminic affects (sedation and weight gain)
Anticholinergic affects-dry mouth, dry eyes, constipation memory deficits and potentially delirium)
Antiadrenergic affects- orthostatic hypotension, sedation, sexual dysfunction)
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11
Q

What are the secondary trycyclic antidepressants?

A

Are often metabolites of tertiary amines

Primarily block noreadrenaline

Side affects are the smae but generally less severe

E.g. Desipramine, notriptyline

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12
Q

What do you need to know about tricyclics antidperssants

A

They exist

What they do

A few names of the most common ones

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13
Q

What are monoamine oxidase inhibitors

A

Bind irreversibly to monoamine oxidase thereby preventing inactivation of aminesnsuch as norepinephrine, dopamine mad serotonin leading to increased synaptic levels

They are very effective for depression

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14
Q

What are the side effects of monoamine oxidase inhibitors

A 
Orthostatic hypotension
weight gain
Dry mouth
Sedation
Sexual Dysfunction
Sleep disturbance
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15
Q

What is the cheese reaction

A

Cheese
Red wine
Processed meats
Beans (not baked?)

Hypertensive crisis caused by MAOI’s taken with tyramine-rich foods or sympathomimetics

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16
Q

How can serotonin syndrome develop in Monoamine oxidase inhibitors

A

If MAOI’s are taken with medications that increase serotonin or have sympathomimetic actions serotonin syndrome may occur

17
Q

What is seratonin syndrome?

A 
Abdominal pain
Diarrhea
Sweats
Tachycardia
Hypertension
Myoclonus 
Irritability 
Delirium

to avoid wait two weeks before switching from an SSRI to an MAOI, except fluoxetine where need to wait 5 week due to large half life

18
Q

What do serotonin reputable inhibitors do?

A

Block the presynaptic serotonin reuptake
Treat both anxiety and depressive symptoms
Change the receptors in papez circuit (between amygdala and control centres)

19
Q

What are the side effects of SSRI’s

A

Activation syndrome (lasts a few days feel on edge, sweaty restless)

Sexual dysfunction, anorgasmia, erectile dysfunction, lack of libido

Can also cause anxiety, restlessness, nervousness, insomnia, fatigue, sedation and dizziness

Very little risk of cardio toxicity in overdose

Discontinuation syndrome (not withdrawal!) agitation, nausea, dysphoria (unsatisfactuon with life)
Lasts around a week
20
Q

Why don’t we use peroxitine much

A

Short half life causes a lot of starting syndrome and discontinuation syndrome

Can cause a lot of side effects e.g. weight gain anticholinergic affects. Likely to cause discontinuation syndrome

21
Q

What is the lecturers favourite antidepressant and why?

A

Setraline- short half life with lower builds up of metabolites (reduces discontinuation syndrome)

Not so good as can cause adverse GI drug reactions

22
Q

What is another good one?

A

Fluoxetine (Prozac)

Long half life life stays in the system for 2-3 weeks. If concerned about compliance use this one.

Good way to treat discontinuation syndrome

not good for liver disease

23
Q

What is citalopram like?

A

Similar to setraline

Has a dose dependent QT interval side effect. Dose has been lowered to 40mg

may be sedating

24
Q

What do we not use very often?

A

Fluvoxamine and escitalopram

25
Q

What should we know about SSRI’s?

A

Names

Mode of action

Activation and discontinuation syndromes

Safe in overdose

26
Q

What can they ask relating to SSRI’s in Long answers

A

What class

What ones

What would you do with a history of depression

27
Q

What are serotonin/norepinephrine reuptake inhibitors (SNRI’s)

A

Used for depression, anxiety and possibly neuropathic pain

Inhibit both serotonin and noradrenergic re uptake

do not cause antihistmaine, antiadrenergic or anticholinergic side effects

28
Q

What is venlafaxine?

A

Short half- activation and discontinuation
Can cause an increase in BP 10/15 diastolic
Sexual side effects

29
Q

What is duloxetine

A

Effective for depression with neuropathic pain
Doesn’t chase huge problem with blood pressure
Quite a good drug I’m using it more and more

30
Q

What is motraxapine

A

Causes sedation and significant weight gain
Acts on different receptors
Works at night
Associated with weight gain

31
Q

What is bupropion

A

Shit drug, only used in America. You don’t have to know

32
Q

Do the cases in the lecture they are good

A

Thank you

33
Q

For a patient who has never had treatment before and presents with depression what drugs should be used first line?

A

SSRI’s that are less sedating- fluoxetine, Cialopram, Sertraline

probably not paroxetine and mitrazapine due to weight gain and sedation

Not a dual reuptake inhibitor as treatment naive

Not a tricylic antidepressant due to side effects

34
Q

So you’ve treated someone with an antidepressant and they’ve made a full recovery, how long do you keep them on it?

A

1st episode- 6 months
Get someone better with antidepressant and those who stopped
before 6 months 70% relapse
2 years prophylaxis for 2nd episode
For 3rd episode do long term (lifetime?) prophylaxis

35
Q

All you need to know about treatment resistant depression

A

Combination of antidepressants e.g. SSRI or SNRI with mitrazepine
Adjective treatment with lithium
Adjunctive treat,ent with atypical antipsychotic e.g. quetipaine, olanzapine or aripiprazole
Make sure to balance side effect profile
Electroconvulsive therapy! Works pretty well

36
Q

How would you treat a 55 year old man with major depression, Hypertension, neuropathic pain, previous depressive episodes. Previously treated with SSRI’s and has previosuly attempted suicide

A

Duloxetine- Treats nuropathic pain, depression, hard to overdose

Not SSRI-‘s as havent worked before

Not TCA as attempted suicide

Not venflaxine due to hypertension

Year 3 Psych (33 decks)

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