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Psychiatry > Lecture 4 Pharmacological Treatments of Affective and Anxiety Disorder > Flashcards

Lecture 4 Pharmacological Treatments of Affective and Anxiety Disorder Flashcards

1
Q

What is the mechanism of Tertiary Tricyclics

A

Inhibit both serotonin and noradrenergic reuptake

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2
Q

What type of drugs are Imipramime
Amitriptyline
Doxepin
Clomipramine

A

Tertiary TCA

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3
Q

What are the indications of TCA

A

Depressive illness (particularly where sedation is required)

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4
Q

What are the side effects of TCA

A

Antihistaminic, anticholinergic, antiadrenrgic, QT lengthening

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5
Q

What are the contraindications for TCA

A

Arrhythmias

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6
Q

What is the mechanism of secondary TCAs

A

Primarily block noradrenaline

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7
Q

Name 2 examples of secondary TCAs

A

Desipramine, notriptyline

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8
Q

What additional use can TCAs be used for

A

Neuropathic pain

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9
Q

What is the mechanism of Monamine Oxidase Inhibitors

A

Bind irreversibly to monamine oxidase and prevents inactivation of norepinephrine, dopamine and serotonin

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10
Q

Name 2 examples of MAOIs

A

Isocarboxazid

Phenelzine

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11
Q

What are the side effects of MAOIs

A 
Orthostatic hypotension
Weight gain
Dry mouth
Sedation
Serotonin syndrome
Cheese reaction
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12
Q

What is Serotonin syndrome

A

Serotonin syndrome occurs when the levels of a chemical called serotonin in your brain become too high

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13
Q

What is a Cheese Reaction

A

An acute attack of hypertension that can occur in a person taking a monoamine oxidase inhibitor (MAOI) drug who eats cheese, caused by an interaction of the MAOI with tyramine

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14
Q

What are MAOIs used to treat

A

Anxiety and depressive symptoms

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15
Q

What additional measure can you take when prescribing MAOIs

A

Monitor blood pressure

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16
Q

Name 2 contraindications of MAOIs

A

Cerebrovascular disease

Phaechromocytoma

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17
Q

What is the mechanism of SSRIs

A

Block presynaptic serotonin reuptake

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18
Q

Name 2 examples of SSRI

A

Fluoxetine (Prozac)
Sertaline
Citalopram

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19
Q

Name contraindications for SSRIs

A

Hepatic illness
Multi-pharmacy
Poorly controlled epilepsy
Manic phase

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20
Q

What is the mechanism of SNRI

A

Inhibit both serotnin and noradrenergic reuptake like TCA but without antihistamine, antiadrenergic or anticholinergic side effects.

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21
Q

Name an example of SNRI

A

Venlafaxine

Duloxetine

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22
Q

What is SNRIs used to treat

A

Depression

Neuropathic pain

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23
Q

What are the contraindication for SNRIs

A

High BP
Diabetes
Cardiovascular problems

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24
Q

What is the mechanism of Mertazapine

A

presynaptic a2-adrenoreceptor antagonist which increases central noradrenergic and serotonergic neurotransmission.

25
Q

What are the side effects of Mirtazapine

A

Increased serum cholesetrol

Weight gain

26
Q

What is Mirtazapine used to treat

A

Anxiety and Depressive symptoms

27
Q

What are the contraindications for Mirtazapine

A

Diabetes
Cardiac disorders
Elderly
Hypotension

28
Q

What is Lithium

A

Mood stabiliser

29
Q

What is the use of lithium

A

Effective long term prophylaxis of both mania and depressive episodes

Can be prescribed alongside antipsychotic

30
Q

What additional measures should be carried out when administering lithium

A

LFT
Pregnancy test
FBC

31
Q

To treat BPD an antipsychotic can be prescribed alongside

A

Lithium

Sodium Valproate

32
Q

What is the first line treatment for acute mania and mania prophylaxis

A

Carbamazepine (Tegretol)

33
Q

What should be monitored when administering Carbamazepine

A

LFT, FBC and ECG

34
Q

Name typical antipsychotics (4)

A

Fluphenazine
Haloperidol
Pimozide
Chloropromazine

35
Q

What are the indications for typical antipsychotics

A

Schizophrenia, bipolar disorder (maintenance or acute agitation/mania) treatment resistant depression

36
Q

What is the mechanism of typical antipsychotics

A

D2 dopamine receptor antagonists

37
Q

What are the side effects of typical antipsychotics

A

Extrapyramida side effects, cardiotoxic and anticholinergic adverse effects

38
Q

What are the first line treatments for schizophrenia

A

Olanzapine, Quetiapine

39
Q

What is the management for treatment resistant schizophrenia

A

Clozapine

40
Q

Name atypical antipsychotics

A 
Olanzapine
Quetiapine
Clozapine
Risperidone
Buspirone
41
Q

What is the mechanism for Olanzapine
Quetiapine
Clozapine
Risperidone

A

Serotonin-dopamine 2 antagonists

42
Q

Susie has a nonpsychotic unipolar depression with no history of hypomania or mania. She has depressed mood, hyperphagia, psychomotor retardation and hypersomnolence. What agent would you like to use for her?

A

SSRI
Sertaline
Fluoxetine
Citalopram

43
Q

Bob is a 55 year old diabetic man with mild HTN and painful diabetic neuropathy who has had previous depressive episodes and one suicide attempt. He meets criteria currently for a major depressive episode with some anxiety. He has been treated with paroxetine, sertraline and mirtazepine. His depression was improved slightly with each of these meds but never remitted. What would you like to treat him with?

A

Duloxetine (SNRI)
Act like TCAs but without side effects
Can help diabetic neuropathy

44
Q

Name the side effects of Lithium

A

GI distress
Thyroid abnormalities
Leukocytosis
Polyuria/polydipsia

45
Q

What are the side effects of Valproic acid

A

Thrombocytopenia and platelet dysfunction

46
Q

What are the side effects of Carbamazepine

A

Rash

Aplastic anaemia and agranulocytosis

47
Q

What is the most severe side effect of Lamotrigine

A

Toxic epidermal necrolysis and Stevens Johnson’s Syndrome

48
Q

33 yo woman hospitalized with her first episode of mania. She has no previous history of a depressive episode. She has no drug or ETOH history and has no medical issues. What medication would you like to start?

A

Carbamazepine (Tegretol) + Lithium

49
Q

27 yo male is admitted secondary to a manic episode. In reviewing his history you find he has 5 to 6 manic or depressive episodes a year. He has also struggled on and off with ETOH abuse. What medication would you like to start?

A

Valproic acid

50
Q

21 yo AA male with symptoms consistent with schizophrenia is admitted because of profound psychotic sx. He is treatment naïve. You plan to start an antipsychotic- what baseline blood work would you obtain?

A

Fasting blood sugar
LFTs
Blood cholesterol

51
Q

21 yo AA male with symptoms consistent with schizophrenia is admitted because of profound psychotic sx. He is treatment naïve. His cholesterol is elevated what treatment would you decide to give him

A

Risperidone, Ziprasidone or Aripiprazole are good choices.

52
Q

What is a common side effect of Risperidone

A

Akathisia

53
Q

What is Akathisia

A

Movement disorder characterised by a subjective feeling of inner restlessness accompanied by mental distress and an inability to sit still.

54
Q

How are panic disorders, GAD and substance related disorders (withdraal, insomnias and parasominias) treated

A

Anxiolytics

55
Q

Name 2 examples of Anxiolytics

A

Buspirone (Buspar)

Benzodiazapines

56
Q

What are the pros of Buspirone

A

No sedation, 5HT1A agonist

57
Q

What are the cons of Buspirone

A

Takes 2 weeks to notice results

No sedation effect to take the edge off

58
Q

What are Benzodiazepines used for

A

Insomnia, parasomnias and anxiety disorders

ETOH withdrawal

Psychiatry (16 decks)

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