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systemic pharmaco > Drugs Used in CNS > Flashcards

Drugs Used in CNS Flashcards

1
Q

Common psychiatric conditions

A
  1. Anxiety disorder
  2. Insomnia
  3. Depressive disorder
  4. Psychosis
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2
Q

Symptoms of anxiety disorders

A
  1. Psychological symptoms
    - apprehension, fear
  2. Somatic symptoms
    - CVS - palpitations, tremors
    - Resp - chest pain, SOB
    - GIT disturbances, hyperactivity
    - Headaches, dizziness
    - Loss of libido
    - Muscle spasms
    - Insomnia
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3
Q

Definition of insomnia

A

inability to fall asleep, maintain sleep or early morning wakening, affecting the function of the next day

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4
Q

Causes of insomnia (3)

A
  1. Anxiety - increased emotional arousal
  2. Drug induced, caffeine
  3. Drug withdrawal - after chronic use of alcohol, sleeping pills
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5
Q

Drugs used for anxiety disorders & insomnia

A
  1. Benzodiazepines
    - Short Acting: Midazolam
    - Intermediate Acting: Lorazepam, Alprazolam
    - Longer Acting: Diazepam
  2. Non-benzodiazepine hypnotics
    - Zolpidem, Zopiclone
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6
Q

Mechanism of action of benzodiazepines

A
  • BZD binds to specific BZD sites in the CNS
  • increased freq of Cl channel opening - potentiates GABA actions
  • GABA dependent, overdose is safe
  • GABA is also an inhibitory neurotransmitter - helps sleep - faster onset but reduced REM & deep (stage 4) sleep compared to natural sleep (poorer quality)
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7
Q

Toxicity of benzodiazepines (6)

A
  1. CNS - increased drowsiness, decreasd motor skills, prolonged reaction time
  2. CNS - anterograde amnesia esp after IV sedation
  3. CVS - decreased BP & resp rate
  4. Paradoxical effects - excitement, garrulousness, irritability, hallucinations, outburst of rage (attributed to disinhibition by BZD)
  5. Neonatal toxicity - floppy child syndrome
  6. Tolerance, dependance, withdrawal
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8
Q

Toxicity of non-benzodiazepine hypnotics (2)

A
  1. Withdrawal anxiety

2. Abuse potential

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9
Q

Symptoms of depression (6)

A
  1. Decreased mood, interest
  2. Feeling of shame, guilt
  3. Suicidal ideation
  4. Less sleep/appetite (or more - atypical depression)
  5. Psychomotor retardation
  6. Decreased concentration, energy
  • symptoms persist for at least 2 weeks
  • severity of symptoms interfere with normal functioning
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10
Q

Non pharmacological treatment of depression

A
  • Psychological - cognitive behavioural therapy, interpersonal
  • Social, behavioural, relaxation, counselling
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11
Q

Pharmacological treatment of depression (4)

A
  1. Selective serotonin re-uptake inhibitors (SSRIs)
    - Fluoxetine, Escitalopram, Sertraline, Paroxetine
  2. Tricyclics (TCAs)
    - Amitriptyline, Imipramine
  3. Serotonin norepinephrine re-uptake inhibitors (SNRIs)
  4. NaSSa - noradrenergic & specific serotonergic antidepressants
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12
Q

Mechanism of action of antidepressants

A
  • block re-uptake transporters

- enables neurotransmitters present in synapse to continue acting on post synaptic neurons

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13
Q

Toxicity of SSRIs (4)

A
  1. Anxiety
  2. Weight loss/gain
  3. Headache, nausea
  4. Sexual dysfunction
  • no fatality in overdose
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14
Q

Toxicity of TCAs (4)

A
  1. Tachycardia, arryhthmias
  2. Postural hypotension
  3. Anti cholinergic effects - constipation, dry mouth, dry eyes, glaucoma, blurred vision
  4. CNS effects - sedation, fatigue
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15
Q

Hypotheses of psychosis (2)

A
  1. Excessive dopamine in mesocortico-limbic system

2. Abnormality in 5-HT, glutamate & other systems

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16
Q

Symptoms of schizophrenia

A
  • type of psychosis
  1. Positive symptoms
    - delusion (abnormal belief), hallucination, disorganised thinking, speech, behaviour
  2. Negative symptoms
    - avolition, affect flattening, inability to plan, poor concentration
  • duration of disturbances - 6m
  • deterioration in social/occupational function
  • anti psychotics work better on positive symptoms
17
Q

Drugs used in psychoses

A
  1. Typical (first gen)
    - Trifluoperazine
    - Haloperidol
    - Depot flupentixol
  2. Atypical (second gen)
    - Risperidone
    - Olarizapine
    - Quetiapine
    - Clozapine
18
Q

Mechanism of action of antipsychotics

A
  • blocks dopamine receptors in extrapyrimidal system, limbic midbrain, frontal cortex
  • typical blocks D2 > 5HT2 receptors, atypical blocks 5HT2 > D2
  • blocks D1, cholinergic, histaminic & alpha adrenergic
19
Q

Toxicity of typical antipsychotics (6)

A
  1. Extrapyrimidal effects
  2. Anti-adrenergic effects
  3. Anti-cholinergic effects
  4. Metabolic & endocrine effects
  5. Allergic effects
  6. others
20
Q

Toxicity of atypical antipsychotics (5)

A
  1. Agranulocytosis (2%) - clozapine
  2. Weight Gain - esp in clozapine, olanzapine
  3. Sedation - clozapine, olanzapine
  4. Extrapyrimidal (dose dep) - risperidone
  5. Metabolic syndrome - quetiapine
21
Q

Extrapyrimidal side effects (5)

A
  1. Acute Dystonia
    - spasm of muscles of tongue, face, neck, back, extraocular
  2. Parkinsonism
    - bradykinesia, rigidity, tremor, mask facies
  3. Akathisia
    - irresistable urge to move about, physical restlessness
  4. Malignant syndrome
    - catatonia, stupor, fever, unstable blood pressure, myoglobinemia, can be fatal
  5. Tardive dyskinesia
    - oral-facial dyskinesia
    - widespread chloreoathetosis
    - abnormal movement of trunk, pelvis

systemic pharmaco (18 decks)

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