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Psychiatry > Pharmacology > Flashcards

Pharmacology Flashcards

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1
Q

Name the SSRIs.

A 
Fluoxetine
Setraline
Citalopram
Escitalopram
Paroxetine
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2
Q

What is the mechanism of action of the SSRIs?

A

Specifically inhibit serotonin reuptake at the pre-synaptic membrane, increasing the serotonin concentration in the synaptic cleft.

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3
Q

What are some advantages of using an SSRI over other types of anti-depressants?

A

Less sedating
Fewer anti-muscarinic effects
Lower risk of cardiotoxicity
Safer in overdose

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4
Q

What are some ADRs of SSRIs?

A

GI disturbances (nausea, vomiting, dyspepsia, diarrhoea, constipation, abdominal pain)
Altered appetite
Drowsiness OR insomnia
Sexual dysfunction

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5
Q

Name the TCAs.

A

Amitryptilline
Imipramine
Lofepramine
Nortryptilline

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6
Q

What is the mechanism of action of the TCAs?

A

Inhibit reuptake of serotonin and NA at the pre-synaptic membrane, increasing their concentrations in the synaptic cleft.

Also block serotonergic, alpha-adrenergicm histaminic and muscarinic receptors.

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7
Q

What are some ADRs of TCAs?

A

Sedation, weight gain, dry mouth, constipation, urinary retention, blurred vision, tachycardia, arrythmias, nausea, drowsiness.

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8
Q

What are the PK of TCAs? (absorption/metabolism)

A

Absorbed by the gut
Lipid soluble
Metabolised by the liver

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9
Q

What are the PK of SSRIs? (absorption/metabolism)

A

Almost completely absorbed from gut and metabolised by liver

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10
Q

Give an example of a NaSSA.

A

Mirtazapine

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11
Q

What is the mechanism of action of mirtazapine?

A

Enhances serotonin and NA neurotranmission.

Also classed as a TCA as well as a NaSSA

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12
Q

What are the indications for mirtazapine?

A

Severe depression, PTSD

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13
Q

What are some contra-indications for mirtazapine?

A

Renal impairment
Pregnancy
Hepatic impairment
Jaundice

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14
Q

What are the ADRs of mirtazapine?

A 
Weight gain
Sedation
Hallucinations 
Confusion
Mania
Postural hypotension
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15
Q

Name the SNRIs.

A

Venlafaxine

Duloxetine

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16
Q

What is the mechanism of action of SNRIs?

A

Inhibit the re-uptake of serotonin and noradrenaline at the pre-synaptic membrane, increasing their concentration at the synaptic cleft.

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17
Q

What are the ADRs of SNRIs?

A

Same as SSRIs (GI disturbances, appetite changes, sleep disturbances)
PLUS increased BP, dry mouth, hyponatraemia

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18
Q

Name the MAOIs.

A

Isocarboxacid

Phenelzine

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19
Q

What is the mechanism of action of the MAOIs?

A

Inhibit the enzyme monoamine oxidase.
Prevents inactivation of monoamines (serotonin, NA, dopamine) within the neurone, causing excess neurotransmitter to diffuse into the synaptic cleft.

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20
Q

Why are MAOIs not often used?

A

Drug-food interactions -
MAOIs also inhibit the breakdown of tyramine, a chemical found in cheese. In excess, tyramine causes the release of large amounts of catecholamines, resulting in a hypertensive crisis.

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21
Q

What are the signs/symptoms of a hypertensive crisis?

A 
HYPERTENSION
Occipital headache
Stiff neck
Tachycardia
Nausea
Cardiac arrythmias
Seizures
Stroke
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22
Q

Name the typical antipsychotics.

A

Haloperidol

Chlorpromazine

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23
Q

Name the atypical antipsychotics.

A 
Olanzapine
Risperidone
Clozapine
Quetiapine
Aripiprazole
Paliperidone
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24
Q

What is the mechanism of action of antipsychotics?

A

Inhibition of the dopamine D2 receptors in the CNS (some have actions at other receptors as well)

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25
What is the difference between the atypical and typical antipsychotics?
Atypical antipsychotics produce fewer EP signs and are more effective at treating the negative symptoms of schizophrenia.
26
What are the indications for clozapine?
Treatment resistant schizophrenia - Failure of 2 antipsychotics - One of which should be an atypical antipsychotic - Over 6-8 weeks each
27
What are the side effects of clozapine?
AGRANULOCYTOSIS (Requires regular haemotological monitoring) Myocarditis
28
What are the side effects of typical antipsychotics?
Extrapyramidal signs: | dystonia, akathisia, Parkinson like symptoms (tremor, muscular rigidity, bradykinesia), tardive dyskinesia
29
What are the side effects of atypical antipsychotics?
Excessive weight gain (esp. olanzapine) Increased prolactin secretion (risperidone) EPSE (less common) Postural hypotension Cardiac toxicity (long QT syndrome and therefore increased risk of Torsades de Pointes)
30
What is the mechanism of action of the benzodiazepines?
Agonist at GABA-A receptors | GABA is the major inhibitory neurotransmitter in the CNS
31
What are the indications of benzos?
SHORT TERM use for anxiety disorders | Alcohol detoxification
32
What are the ADRs of benzos?
``` Drowsiness Light headedness Ataxia Confusion Amnesia ```
33
What are the indications for beta-blockers (in a psychiatric setting)?
Patients who have predominantly the somatic, autonomic symptoms of an anxiety disorder, e.g. tachycardia, tremor.
34
What is buspirone and what is it indicated for?
5-HT 1A agonist | Generalsed anxiety disorder (short term use only)
35
What are the contraindications of buspirone?
Epilepsy | Acute porphyria
36
What are the side effects of buspirone?
Light headedness Dizziness Nausea
37
What is the mechanism of the barbiturates?
Agonist of the GABA-A receptors (distinct binding site from the benzos)
38
What is the mechanism of action of pregabalin?
Inhibits glutamate, noradrenaline and substance P
39
What is pregabalin indicated in?
Generalised anxiety disorder | Neuropathic pain
40
What are some side effects of pregabalin?
Dizziness, drowsiness, blurred vision, diplopia, confusion, vivid dreams
41
Name the benzodiazepine antagonist.
Flumazenil | IV only
42
Name the hypnotic agents.
Zopiclone Zolpidem Zalepon
43
What is the mechanism of action of the hypnotic agents?
Act on the GABA-A complex
44
Name the acetylcholinesterase inhibitors.
Donepezil Galantamine Rivastigmine
45
What are the indications for acetylcholinesterase inhibitors?
Mild to moderate dementia related to Alzheimer's disease
46
What are the side effects of acetylcholinesterase inhibitors?
Nausea, vomiting Gastric and duodenal ulcers Syncope Bradycardia, AV block, MI
47
What are the contra-indications for acetylcholinesterase inhibitors?
Renal impairment (galantamine) Cardiac disease Peptic ulcer disease
48
Name the NMDA antagonist.
Memantine
49
What are the indications for memantine?
Moderate to severe dementia related to Alzheimer's disease
50
What are the side effects of memantine?
``` Constipation Hypertension Seizures Dizziness Depression ```
51
What are the contra-indications of memantine?
Renal impairment | Seizure history
52
What is the mechanism of action of disulfiram?
Inhibition of acetaldehyde dehydrogenase. | If taken with alcohol, causes facial flushing, headache, palpitations, nausea and vomiting, etc.
53
What are the side effects of disulfiram?
Fatigue | Reduced libido
54
What are the contra-indications of disulfiram?
CVS disease Hypertension Previous CVA Psychosis
55
What is the mechanism of acamprosate?
Reduces the conditioned aspects of drinking | Prevents craving induced relapses
56
What are the side effects of acamprosate?
GI disturbance | Rash
57
What are the contra-indications of acamprosate?
Severe hepatic/renal failure
58
Name the mood stabilisers.
Lithium, sodium valproate, lamotrigine, carbamazepine
59
What monitoring is required with sodium valproate?
Serum levels when indicated Annual TFT 6 monthly LFT and FBC
60
What are some side effects of sodium valproate?
Tremor, sedation, GI disturbances, headache, thrombocytopenia, hair loss
61
What monitoring is required with carbamazepine?
6 monthly serum levels | LFTs, U&Es, FBCs and annual TFTs
62
What are some side effects of carbamazepine?
Dizziness, visual disturbances, hyponatremia, oedema, GI disturbances, rashes
63
What are some contra-indications of carbamazepine?
AV node abnormalities History of bone marrow suppression Acute porphyria
64
What monitoring is required with lithium?
Serum concentration after one week, then one week after every change in dose (Serum level is aimed at 0.4-0.8 mmol/L) 6 monthly TFT and U&E
65
What are the indications for lithium?
Prophylaxis and treatment of mania, hypomania and depression in bipolar disorder Prophylaxis and treatment of recurrent unipolar depression
66
What are the side effects of lithium?
Diabetes insipidus like syndrome, nausea/GI disturbances, weight gain, FINE tremor, leukocytosis, ECG changes, metallic taste in mouth.
67
What ECG changes may be seen with lithium?
Flattened T waves | Wide QRS complexes
68
What are some contra-indications for lithium?
Low sodium diet Addison's disease Untreated hypothyroidism Cardiac rhythm disorder
69
What are some signs of lithium toxicity?
``` COARSE tremor Ataxia Dysarthria Reduced level of consciousness Convulsions Coma ```

Psychiatry (2 decks)

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