Drugs action and side effects

Question 1

Treatment of GAD?

Answer 1

CBT
SSRI/SNRI
Pregabalin; long term
Benzo (short term)

Question 2

Treatment of panic disorder?

Answer 2

CBT
SSRI/SNRI/ TCA
Benzo (short term)

Question 3

Treatment of specific phobias?

Answer 3

Behavioural therapy; exposure
Add CBT if necessary
SSRI/SNRI if required

Question 4

Treatment of social phobia?

Answer 4

CBT
SSRI/SNRI
Benzo

Question 5

Treatment of OCD?

Answer 5

CBT (including response prevention)

SSRI/ Clomipramine (TCA)

Question 6

Action of benzodiazepines?

Answer 6

GABA-A receptor is an inhibitory ionotropic receptor
In the presence of GABA, the ion channel allows chloride ion influx
Membrane hyperpolarisation
Inhibitory postsynaptic potential
Benzodiazepines enhance the effect of GABA via allosteric modulation

Question 7

What do agonists at the benzodiazepine site on the GABA-A receptor cause?

Answer 7

Relaxation and anticonvulsant effects

Question 8

What do antagonists at the benzodiazepine site on the GABA-A receptor cause?

Answer 8

Anxiety

Proconvulsant

Question 9

What other drugs act on the BZD site on the GABA-A receptor?

Answer 9

Alcohol

Barbituates

Question 10

Adverse effects of BZD?

Answer 10

Sedation and psychomotor impairment
Discontinuation/ withdrawal problems
Dependency and abuse
Alcohol interaction 
Can worsen co-morbid depression

Question 11

What properties do psychiatric drugs need to have?

Answer 11

Lipophilic/ hydrophobic to pass through the BBB

Question 12

Clinical uses of antidepressant drugs?

Answer 12

Moderate to severe depression 
Dysthymia
GAS
Panic disorder/ OCD/ PTSD
Premenstrual dysphoric disorder
Bulimia nervosa
Neuropathic pain

Question 13

What are examples of monoamine reuptake inhibitors?

Answer 13

TCAs
SSRI
NA reuptake inibitors
SNRI

Question 14

Monoamine transmitters

Answer 14

NA
5-HT
Dopamine

Question 15

Base amino acid of serotonin?

Answer 15

Typtophan

Question 16

Base amino acid of NA?

Answer 16

Tyrosine

Question 17

Examples of MAO inhibitors?

Answer 17

Phenelzine

Moclobemide

Question 18

Mode of action of MAO inhibitord?

Answer 18

Irreversible (phenelzine) or reversible (moclobemide) inhibitors of MAO-A and B

Question 19

Side effects of MAO inhibitors?

Answer 19

Cheese reaction/ hypertensive crisis: inhibition of MAO-A in gut preventing breakdown of dietary tyramine and multiple drugs that potentiate amine transmission (pseudoephedrine) 
Potentials barbiturates
Insomnia
Postural hypotension 
Peripheral oedema

Question 20

Examples of TCAs?

Answer 20

Impiramide
Dosulepin
Amitriptyline
Lofepramine

Question 21

Mode of action of TCAs

Answer 21

Blocks reuptake of monoamines (mainly NA and 5-HT) into the presynaptic terminas

Question 22

Common side effects of TCAs?

Answer 22

Anticholinergic; blurred vision, dry mouth, constipation, urinary retention
Sedation
Weight gain
CV; postural hypotension, tachycardia, arrhythmias
Cardiotoxic in overdose; do NOT give post MI or in IHD

Question 23

Examples of SSRIs?

Answer 23

Fluoxetine
Citalopram
Escitalopram
Sertraline
Paroxetine

Question 24

Mode of action of SSRIs?

Answer 24

Selectivity inhibit reuptake of serotonin (5-HT) from the synaptic cleft

Question 25

Common side effects of SSRIs?

Answer 25

``` Nausea Headache Sweating/ vivid dreams Worsened anxiety Sexual dysfunction Hyponatraemia (elderly) Transient increase in self harm and suicidal ideation in under 25 Discontinuation effects ```

Question 26

Examples of SNRIs?

Answer 26

Venlafaxine | Duloxetine

Question 27

Mode of action of SNRIs?

Answer 27

Block reuptake of monoamines NA and 5-HT into presynaptic terminals

Question 28

Side effects of SNRIS?

Answer 28

Similar to SSRIs | Lack major receptor-blocking actions so more limited range of side effects that TCAs

Question 29

What does mirtazapine act on?

Answer 29

Alpha 2 5-HT2 5-HT3

Question 30

When is mirtazapine useful?

Answer 30

For weight gain and sedation; if weight loss and insomnia are issues

Question 31

Example of dopamine uptake inhibitor

Answer 31

Buproprion

Question 32

Mode of action of lithium

Answer 32

Blocks phosphatidylinositol pathway or inhibit glycogen synthase kinase 3-beta

Question 33

When should blood levels of lithium be checked?

Answer 33

12 hours post dose then 1 week

Question 34

Side effects of lithium at therapeutic doses?

Answer 34

``` Dry mouth/ strange taste Polydipsia and polyuria Tremor Hypothyroidism Long term reduced renal function Nephrogenic DI Wt gain ```

Question 35

Toxic effects of lithium in overdose?

Answer 35

``` Vomiting Diarrhoea Ataxia/ coarse tremor Drowsiness Convulsions Coma ```

Question 36

What anticonvulsants are used as mood stabilisers?

Answer 36

Valproic acid (mainly mania) Lamotrigine (mainly depression) Carbamazepine

Question 37

Side effects of lamotrigine?

Answer 37

Stevens johnson syndrome

Question 38

Side effects of valproate and carbamazepine?

Answer 38

Drowsiness Ataxia CV effects Induces liver enzymes

Question 39

Can valorpate be given in pregnancy?

Answer 39

NO; neural tube defects

Question 40

Which antipsychotics are used as mood stabilisers?

Answer 40

Quetiapine Aripiprazole Olanzapine Lurasidone

Question 41

Mode of action of atypical antipsychotics?

Answer 41

D2 antagonism | 5-HT antagonism

Question 42

Side effects of antipsychotics?

Answer 42

Sedation, weight gain, metabolic syndrome | Extra-pyramidal

Question 43

What extrapyramidal side effects are associated with antipsychotics?

Answer 43

Acute dystonic reaction; hours to days, muscle spasms. Tx with acetylcholine antagonists (procyclidine) Akathisia (can't stay still) - restless leg syndrome Parkinsonism - ridigity, tremor, bradykinesia Tardive dyskinesia - years to develop

Question 44

Risperidone mode of action

Answer 44

Dopamine D2, 5-HT2, alpha-1 and histamine-1 receptor antagonist