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PHRM2012 > Mental Health > Flashcards

Mental Health Flashcards

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1
Q

Name the 5 Ds involved in diagnostic approaches

A 
Deviation (from normal behaviours) 
Dysfunction (inability to complete normal tasks)
Distress 
Danger 
Duration (long duration of symptoms)
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2
Q

What are the 4 Ps in the aetiology (cause) of mental illnesses?

A

Predisposition
Precipitating factors
Perpetuating behaviours
Protective (do they have support / protection)

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3
Q

Which two manuals are used to diagnose mental illnesses?

A

DSM 5

ICD 11 - chapter 6

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4
Q

Compare prevalence and incidence

A

Prevalence = proportion of people who have a condition at a particular time

Incidence = proportion or rate of people who develop a condition at a particular time

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5
Q

How can pharmacotherapy aid non-pharmacological therapy?

A

Drugs may calm patients down which opens them up more to the psychotherapy and increases the efficacy of other treatment methods

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6
Q

What does RIMA stand for

A

Reversible inhibitor of mono-amines

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7
Q

Imipramine and clomipramine are examples of…

A

Tricyclic antidepressants

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8
Q

Amitriptyline is a…

A

TCA

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9
Q

Mirtazapine belongs to which class of antidepressants

A

5-HT inhibitor

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10
Q

Fluoxetine, setraline and citalopram are examples of which antidepressant class?

A

SSRI

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11
Q

Name 2 SNRIs

A

Venlafaxine and nefazodone

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12
Q

Symptoms of depression can be categorised into which 3 categories?

A

Activity
Cognition
Emotion

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13
Q

How many symptoms are required for diagnosis? What duration of the symptoms is required?

A

Need to display at least 5 symptoms for at least 2 weeks

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14
Q

Define anhedonia

A

Inability to feel pleasure in normally pleasurable activities

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15
Q

In addition to blocking the reuptake of NA and 5-HT, which other receptor do TCAs act on?

A

M1 and H1

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16
Q

How does the vomiting reflex get suppressed in TCA overdose

A

Increase in 5-HT3 increases nausea and vomiting, but antagonism of M1 and H1 cause anti-nausea and in overdose, you cannot vomit

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17
Q

TCAs act on H1 receptors which causes what ADRs?

A

Sedation and weight gain

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18
Q

What ADR arises from TCAs acting on alpha1 adrenoreceptors?

A

Postural hypotension

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19
Q

TCAs act on M1 receptors. What ADRs does this cause

A

Dry mouth, urinary retention, constipation, pupil dilation / blurred vision, etc
Like the SNS

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20
Q

TCAs block sodium channels, which causes what side effects?

A

Arrhythmia

Seizures

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21
Q

Which TCA is the most sedating?

A

Amitryptiline

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22
Q

Which PK characteristic would increase the likelihood of a drug having withdrawal symptoms?

A

Short half life

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23
Q

Bruxism, a side effect of SSRIs, is what?

A

Clenching jaw / grinding teeth

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24
Q

Name 3 common side effects of SSRIs.

A
  • sexual dysfunction
  • irritability, agitation, anxiety
  • disturbed sleep (either insomnia or too much sleep)
  • serotonin toxicity
  • nausea
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25
What is the indication for use of an SNRI
It is a second line treatment to depression when multiple SSRIs have failed E.g. venlafaxine, duoloxetine
26
SNRIs have a high risk of which ADR?
Arrhythmias + high BP
27
Duloxetine and venlafaxine are examples of which class of drugs?
SNRIs
28
Roboxetine belongs to which class of medications?
NRI - noradrenaline reuptake inhibitor
29
If a patient starts on an SSRI and has no response after 2 weeks, what is the next step? If no response after that, what next?
First increase the dose. | If still no response, try another SSRI
30
If a patient has tried 2 SSRIs and had no response, what would the next step be?
Change class of medication (e.g. SNRI)
31
What are some reasons that patients might stop taking their antidepressants?
- feeling better - not feeling better - side effects - social stigma surrounding antidepressants
32
Some of the first symptoms a patient starting on SSRIs will see are...
Headache, GI upset, dizziness, bruxism
33
Some delayed side effects of SSRIs that will occur several weeks after starting treatment are...
Weight gain | Sexual dysfunction
34
List some counselling points on antidepressant withdrawal
- the symptoms are only transient - it is not the reappearance of the depression - it is not the same as substance dependence
35
What are some symptoms of antidepressant withdrawal syndrome?
Sleep disturbances, GI upset, flu-like symptoms, etc
36
What is agoraphobia
Fear and avoidance of places and situations that may cause panic, helplessness or embarrassment. Involves anxiety / panic attacks
37
What type of neurotransmitter is GABA
Inhibitory
38
Which neurotransmitter is partly responsible for panic attacks? Where does it bind to
CCK. Binds to a receptor in the basolateral amygdala
39
What are some of the physical symptoms of anxiety?
Palpitations, sweating, trembling, dry mouth, shortness of breath, etc
40
Which medication class helps with the physical symptoms of anxiety? List an example.
Beta blockers. | E.g. propranolol
41
How long do symptoms need to be present before a GAD diagnosis is made?
Needs excessive anxiety most days for at least 6 months
42
Explain how activation of the GABA-A receptor alters a cells’ polarisation.
GABA-A receptor in an ion channel. It requires 2 GABA molecules to be bound in order for the central pore to open (through a conformational change). Once open, there is an influx of chloride ions, which hyperpolarises the cell making an AP less likely.
43
What allosteric binding sites are present on the GABA-A receptor?
Benzodiazepines Barbiturates Ethanol
44
What differentiates clomipramine from other TCAs?
It has a more potent 5-HT reuptake ability
45
What is different about the dosing of SSRIs for OCD compared to depression?
Much higher. 60mg per day compared to 20-40
46
Adverse effects of TCAs are due to activation of which receptors?
H1 -> drowsiness
47
Is mirtazapine first line treatment for anxiety?
No. It is a TCA, therefore more second line
48
Lorazepam, temazepam and oxazepam are some of the —- acting benzodiazepines.
Shortest
49
Which are the longest acting benzodiazepines?
Diazepam and nitrazepam
50
Why is benzodiazepine use in the elderly so concerning?
Extended time in the system due to reduced metabolism. Could lead to confusion, delirium, and falls
51
Explain the ideal dosage regimen for benzodiazepines
No more than 4 weeks... 2 times per week only
52
How can benzodiazepine sensitisation occur and what might cause this
Sensitisation occurs with repeated use of benzodiazepines (I.e. the patient has withdrawn from the drugs several times). It means the withdrawal process gets worse with repeated use.
53
What class of drugs does nefazodone belong to?
SNRI
54
What class of drugs does venlafaxine belong to?
SNRI
55
List treatment options for obstructive sleep apnoea (OSA)
Weight loss, reduced alcohol, CPAP, modafinil
56
Define narcolepsy
Sudden onset of sleep or EDS (excessive daytime tiredness)
57
Name the 3 main sleep promoting neurotransmitters
- adenosine - GABA - ACh
58
Name medications that promote wakefulness
Caffeine Modafinil Amphetamines Etc
59
Describe the main role of pharmacists in sleep disorders
Counselling on good sleep hygiene. Daily routine, reduce screen time, exercise, dark room, etc
60
What are some of the risks of benzodiazepine use
Risk of dependence and abuse, tolerance, accumulation, difficult to withdraw from
61
Explain benzodiazepine sensitisation
Repeated BDZ use (and therefore, repeated withdrawal) can increase the severity of the withdrawal symptoms
62
What is the best benzodiazepine? (Shortest acting without any active metabolites)
Oxazepam
63
Ideal benzodiazepine duration of use?
4 weeks, only twice a week
64
Would suvorexant be ok to prescribe in a patient with poor liver function?
No. Has a long half life, and therefore has a risk of accumulation (risk is increased in liver dysfunction)
65
Describe orexin action
Wake promoting neurotransmitter
66
MOA of suvorexant
Orexin antagonist
67
Compare organic and functional psychotic disorders
Organic is where there is a clear cause and functional is where there is no cause
68
Second generation antipsychotics have a lower risk of which side effect compared to first generation?
Extrapyrimidal side effects
69
Define adjuvant
A drug, or other substance, that is used to increase the efficacy or potency of certain drugs
70
What determines use of a SGA compared to FGA?
They have similar efficacy but SGAs tend to have less side effects
71
Which drug in bipolar requires regular monitoring?
Lithium

PHRM2012 (6 decks)

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