Lecture 4 Pharmacological Treatments of Affective and Anxiety Disorder

Question 1

What is the mechanism of Tertiary Tricyclics

Answer 1

Inhibit both serotonin and noradrenergic reuptake

Question 2

What type of drugs are Imipramime
Amitriptyline
Doxepin
Clomipramine

Answer 2

Tertiary TCA

Question 3

What are the indications of TCA

Answer 3

Depressive illness (particularly where sedation is required)

Question 4

What are the side effects of TCA

Answer 4

Antihistaminic, anticholinergic, antiadrenrgic, QT lengthening

Question 5

What are the contraindications for TCA

Answer 5

Arrhythmias

Question 6

What is the mechanism of secondary TCAs

Answer 6

Primarily block noradrenaline

Question 7

Name 2 examples of secondary TCAs

Answer 7

Desipramine, notriptyline

Question 8

What additional use can TCAs be used for

Answer 8

Neuropathic pain

Question 9

What is the mechanism of Monamine Oxidase Inhibitors

Answer 9

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

Question 10

Name 2 examples of MAOIs

Answer 10

Isocarboxazid

Phenelzine

Question 11

What are the side effects of MAOIs

Answer 11

Orthostatic hypotension
Weight gain
Dry mouth
Sedation
Serotonin syndrome
Cheese reaction

Question 12

What is Serotonin syndrome

Answer 12

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

Question 13

What is a Cheese Reaction

Answer 13

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

Question 14

What are MAOIs used to treat

Answer 14

Anxiety and depressive symptoms

Question 15

What additional measure can you take when prescribing MAOIs

Answer 15

Monitor blood pressure

Question 16

Name 2 contraindications of MAOIs

Answer 16

Cerebrovascular disease

Phaechromocytoma

Question 17

What is the mechanism of SSRIs

Answer 17

Block presynaptic serotonin reuptake

Question 18

Name 2 examples of SSRI

Answer 18

Fluoxetine (Prozac)
Sertaline
Citalopram

Question 19

Name contraindications for SSRIs

Answer 19

Hepatic illness
Multi-pharmacy
Poorly controlled epilepsy
Manic phase

Question 20

What is the mechanism of SNRI

Answer 20

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

Question 21

Name an example of SNRI

Answer 21

Venlafaxine

Duloxetine

Question 22

What is SNRIs used to treat

Answer 22

Depression

Neuropathic pain

Question 23

What are the contraindication for SNRIs

Answer 23

High BP
Diabetes
Cardiovascular problems

Question 24

What is the mechanism of Mertazapine

Answer 24

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

Question 25

What are the side effects of Mirtazapine

Answer 25

Increased serum cholesetrol | Weight gain

Question 26

What is Mirtazapine used to treat

Answer 26

Anxiety and Depressive symptoms

Question 27

What are the contraindications for Mirtazapine

Answer 27

Diabetes Cardiac disorders Elderly Hypotension

Question 28

What is Lithium

Answer 28

Mood stabiliser

Question 29

What is the use of lithium

Answer 29

Effective long term prophylaxis of both mania and depressive episodes Can be prescribed alongside antipsychotic

Question 30

What additional measures should be carried out when administering lithium

Answer 30

LFT Pregnancy test FBC

Question 31

To treat BPD an antipsychotic can be prescribed alongside

Answer 31

Lithium | Sodium Valproate

Question 32

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

Answer 32

Carbamazepine (Tegretol)

Question 33

What should be monitored when administering Carbamazepine

Answer 33

LFT, FBC and ECG

Question 34

Name typical antipsychotics (4)

Answer 34

Fluphenazine Haloperidol Pimozide Chloropromazine

Question 35

What are the indications for typical antipsychotics

Answer 35

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

Question 36

What is the mechanism of typical antipsychotics

Answer 36

D2 dopamine receptor antagonists

Question 37

What are the side effects of typical antipsychotics

Answer 37

Extrapyramida side effects, cardiotoxic and anticholinergic adverse effects

Question 38

What are the first line treatments for schizophrenia

Answer 38

Olanzapine, Quetiapine

Question 39

What is the management for treatment resistant schizophrenia

Answer 39

Clozapine

Question 40

Name atypical antipsychotics

Answer 40

``` Olanzapine Quetiapine Clozapine Risperidone Buspirone ```

Question 41

What is the mechanism for Olanzapine Quetiapine Clozapine Risperidone

Answer 41

Serotonin-dopamine 2 antagonists

Question 42

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?

Answer 42

SSRI Sertaline Fluoxetine Citalopram

Question 43

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?

Answer 43

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

Question 44

Name the side effects of Lithium

Answer 44

GI distress Thyroid abnormalities Leukocytosis Polyuria/polydipsia

Question 45

What are the side effects of Valproic acid

Answer 45

Thrombocytopenia and platelet dysfunction

Question 46

What are the side effects of Carbamazepine

Answer 46

Rash | Aplastic anaemia and agranulocytosis

Question 47

What is the most severe side effect of Lamotrigine

Answer 47

Toxic epidermal necrolysis and Stevens Johnson's Syndrome

Question 48

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?

Answer 48

Carbamazepine (Tegretol) + Lithium

Question 49

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?

Answer 49

Valproic acid

Question 50

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?

Answer 50

Fasting blood sugar LFTs Blood cholesterol

Question 51

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

Answer 51

Risperidone, Ziprasidone or Aripiprazole are good choices.

Question 52

What is a common side effect of Risperidone

Answer 52

Akathisia

Question 53

What is Akathisia

Answer 53

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

Question 54

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

Answer 54

Anxiolytics

Question 55

Name 2 examples of Anxiolytics

Answer 55

Buspirone (Buspar) | Benzodiazapines

Question 56

What are the pros of Buspirone

Answer 56

No sedation, 5HT1A agonist

Question 57

What are the cons of Buspirone

Answer 57

Takes 2 weeks to notice results | No sedation effect to take the edge off

Question 58

What are Benzodiazepines used for

Answer 58

Insomnia, parasomnias and anxiety disorders | ETOH withdrawal