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Psychiatry > Psycho-pharmacology I&II > Flashcards

Psycho-pharmacology I&II Flashcards

1
Q

What are the indications for anti-depressants?

A 
Unipolar and bipolar depression
Organic mood disorders
Schizoaffective disorder
Anxiety disorders
OCD, panic, social phobia, PTSD
Premenstrual dysphoric disorder
Impulsivity associated with personality disorders
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2
Q

What is antidepressant selected based on?

A

Past history of response
Side effect profile
Co-existing medical problems

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3
Q

What is delay for anti-depressants to work?

A

3-6wks

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4
Q

How long should trial of antidepressant be before switching?

A

At least 2mo

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5
Q

What are the classes of antidepressants?

A

Tricyclics (TCAs)
Monoamine oxidase inhibitors (MAOIs)
Selective serotonin rey-take inhibitors (SSRIs)
Serotonin/noradrenaline re-uptake inhibitors (SNRIs)
Novel antidepressants

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6
Q

What are the side effect profile of TCAs?

A

Antihistaminic: sedation and weight gain
Anticholinergic: dry mouth, dry eyes, constipation, memory deficits, potential delirium
Antiadrenergic: orthostatic hypotension, sedation, sexual dysfunction

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7
Q

Which antidepressant is lethal in overdose?

A

TCAs

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8
Q

Which antidrepressant can cause QT lengthening?

A

TCAs

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9
Q

What receptors do tertiary TCAs work on?

A

Serotonin

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10
Q

What are examples of tertiary TCAs?

A

Imipramine
Amitriptyline
Doxepin
Clomipramine

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11
Q

What are examples of secondary TCAs?

A

Desipramine

Notrtriptyline

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12
Q

What are side effects of MAOIs?

A 
Orthostatic hypotension
Weight gain
Dry mouth
Sedation
Sexual dysfunction
Sleep disturbance
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13
Q

What can happen if MAOIs taken with tyramine-rich foods?

A

Hypertensive crisis

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14
Q

What are serotonin syndrome symptoms?

A 
Abdo pain
Diarrhoea
Sweats
Tachycardia
HTN
Myoclonus
Irritability
Delirium
-->
Hyperpyrexia, CVS shock, death
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15
Q

How to avoid serotonin syndrome?

A

Wait 2 weeks before switching SSRI to MAOI

5 wks for fluxetine

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16
Q

How do MAOIs work?

A

Bind irreversibly to monoamine oxides preventing inactivation of amines e.g. norepinephrine, dopamine and serotonin

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17
Q

How do SSRis work?

A

Block presynaptic serotonin re-uptake

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18
Q

What do SSRIs treat?

A

Anxiety and depressive sx

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19
Q

What are the most common side effects of SSRIs?

A 
GI upset
Sexual dysfunction
Anxiety
Restlessness
Nervousness
Insomnia
Fatigue
Sedation
Dizziness
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20
Q

What symptoms can develop with discontinuation of SSRIs?

A

Agitation
Nausea
Disequilibrium
Dysphoria

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21
Q

What are examples of SSRIs?

A 
Paroxetine
Sertraline
Fluoxetine (Prozac)
Citalopram
Excitalopram
Fluvoxamine
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22
Q

What are the advantages of paroxetine?

A

Short half-life

Sedating properties fro anxiety/insomnia

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23
Q

What are disadvantages of paroxetine?

A

Sedating, wt gain, more anticholinergic effects

Cause discontinuation syndrome

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24
Q

What are advantages of sertraline?

A

Less sedating then paroxetine

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25
Q

What are cons of sertraline?

A

Needs full stomach

Increase GI ADR

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26
Q

What are pros of fluoxetine (Prozac)?

A

Decreased incidence discontinuation syndromes

May provide increased energy

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27
Q

What are cons of fluoxetine (Prozac)?

A

Active metabolic may build up - not good liver illness
May increase anxiety and insomnia
More likely induce mania than other SSRIs

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28
Q

Which SSRI in particular can cause QT interval prolongation?

A

Escitalopram

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29
Q

What do SNRIs inhibit?

A

Both serotonin and noradrenergic reuptake

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30
Q

What do SNRIs lack that TCAs have?

A

Antihistamine, antiadrenergic and anticholinergic side effects

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31
Q

What are examples of SNRIs?

A

Venlafaxine

Duloxetine

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32
Q

Which SNRI can cause QT prolongation?

A

Venlafaxine

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33
Q

Which SNRI can have sexual side effects?

A

Venlaxfaxine

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34
Q

What are novel antidepressant examples?

A

Mirtazapine

Buproprion

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35
Q

What novel antidepressant does not treat anxiety but cause it?

A

Buproprion

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36
Q

What are good SSRIs which are less sedating?

A

Citalopram
Fluoxetine
Sertraline

37
Q

What anti-depressants can cause sedation and weight gain?

A

Paroxetin

Mirtazapine

38
Q

What treatment would you move to if a patient has not achieved remission with SSRIs or novel agent?

A

SNRI

Dual reuptake inhibitor

39
Q

Why are TCAs not good choice in suicidal people?

A

Can overdose

40
Q

What medication has indication for neuropathic pain, depression and anxiety?

A

Duloxetine

41
Q

What are indications for mood stabilisers?

A

Bipolar
Cyclothymia
Schizoaffective disease

42
Q

What are the classes of mood stabilisers?

A

Lithium
Anticonvulsants
Antipsychotics

43
Q

What is the only medication to reduce suicide rate?

A

Lithium

44
Q

What are factors predicting positive response to lithium?

A

Prior long-term response or family member with good response
Classic pure mania
Mania followed by depression

45
Q

What tests should be done before starting lithium?

A

Baseline U&Es and TSH

Pregnancy

46
Q

What anomaly during the first trimester is lithium associated with?

A

Ebstein’s anomaly

47
Q

What are lithium side effects?

A

GI distress
Thyroid abnormalities
Non-significant leukocytosis
Hair loss, acne

48
Q

What is the goal blood level of lithium?

A

0.6-1.2

49
Q

What is the blood level in mild, moderate and severe lithium toxicity?

A

Mild: 1.5-2.0
Moderate: 2.0-2.5
Severe: >2.5

50
Q

What happens in mild lithium toxicity?

A

Vomiting, diarrhoea, ataxia, dizziness, slurred speech, nystagmus

51
Q

What happens in moderate lithium toxicity?

A

Nausea, vomiting, anorexia, blurred vision, clonic limb movements, convulsions, delirium, syncope

52
Q

What happens in severe lithium toxicity?

A

Generalised convulsions, oliguria, renal failure

53
Q

What is valproic acid indicated for?

A

Mania prophylaxis

54
Q

What are factors predicting a positive response to valproic acid?

A

Rapid cycling patients
Comorbid substance abuse
Mixed patients
Patients with anxiety disorders

55
Q

What tests should be done before starting valproic acid?

A

LFTs
Pregnancy test
FBC
Start folic acid women

56
Q

What is the target blood level for sodium valproate?

A

50-125

57
Q

What are valproic acid SE?

A

Thrombocytopenia, platelet dysfunction
N&V, weight gain, sedation, tremor
Neural tube defect
Hair loss

58
Q

What is the first line agent for acute mania and mania prophylaxis?

A

Carbamazepine (Tegretol)

59
Q

What tests should be done before starting carbamazepine?

A

LFTs
FBC
ECG

60
Q

What is goal blood level of carbamazepine?

A

4-12mcg/ml

61
Q

What are SE of carbamazepine?

A

Rash
N&V, diarrhoea, sedation, dizziness, ataxia, confusion
AV conduction delays

62
Q

Which mood stabiliser has many drug interactions?

A

Carbamazepine

63
Q

What are the most severe reactions to lamotrigine?

A

SJS

Toxic epidermal necrolysis

64
Q

What is the first line treatment for first episode of mania?

A

Lithium

65
Q

What is a rapid cycler?

A

4+ depressive or manic episodes/year

66
Q

What is a good choice treatment for a rapid cycler with comorbid ETOH abuse?

A

Depakote

67
Q

What is usual in LFTS in someone on anticonvulsant therapy?

A

Increase

68
Q

What are indications for use of antipsychotics?

A 
Schizophrenia
Schizoaffective disorder
Bipolar disorder for mood stabilisation and/or when psychotic features present
Psychotic depression
Treatment resistant anxiety
69
Q

Which pathway is it thought that negative symptoms arise?

A

Mesocortical

70
Q

Which pathway is it thought that positive symptoms arise?

A

Mesolimbic

71
Q

What is the problem with the mesocortical pathway for a psychotic patient?

A

Too little dopamine

72
Q

What is the problem with the mesolimbic pathway for a psychotic patient?

A

Too much dopamine

73
Q

What type of drug are typical antipsychotics?

A

D2 dopamine receptor antagonists

74
Q

What type of SE are related to typical antipsychotics?

A

Extrapyramidal

75
Q

What are atypical antipsychotics?

A

Serotonin-dopamine 2 antagonists (SDAs)

76
Q

What are examples of SDAs (atypical antipsychotics)?

A 
Risperidone
Olanzapine
Quetiapine
Aripiprazole
Clozapine
77
Q

What is the most likely atypical to induce hyperprolactinemia?

A

Risperidone

78
Q

What are SE of olanzapine?

A

Weight gain

Hypertriglyceridemia, hypercholesterolemia, hyperglycaemia

79
Q

What is the most likely atypical antipsychotic to cause orthostatic hypotension?

A

Quetiapine

80
Q

What atypical antipsychotic can cause akathisia (restless legs)?

A

Aripiprazole

81
Q

What atypical antipsychotic has large side effect profile so reserved for resistant patients?

A

Clozapine

82
Q

What atypical antipsychotic SE include agranulocytosis and increased risk of seizures?

A

Clozapine

83
Q

What are antipsychotic adverse effects?

A

Tardive dyskinesia (TD)
Neuroleptic malignant syndrome (NMS)
Extrapyramidal SE: acute dystonia, Parkinson syndrome

84
Q

What are treatments for extrapyramidal SE?

A

Anticholinergics e.g. benztropine

B-blockers e.g. propranolol

85
Q

What are baseline tests to do for atypical antipsychotics?

A

Fasting lipid profile
Fasting blood sugar
LFTs
CBC

86
Q

What are anxiolytics used to treat?

A

Panic disorder, GAD, substance-related disorders

87
Q

What are anxiolytics usually used in combination with?

A

SSRIs

SNRIs

88
Q

What are benzodiazepines used to treat?

A

Insomnia
Parasomnias
Anxiety disorders

89
Q

What are SE of bentos?

A

Somnolence
Cognitive defecits
Amnesia
Dependence

Psychiatry (15 decks)

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