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3 PSYCH > pharmacology > Flashcards

pharmacology Flashcards

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1
Q

clinical uses of antidepressants

A 
moderate to severe depression 
dysthymia 
generalised anxiety disorder 
panic disorder, OCD, PTSD
premenstrual dysphoric disorder 
bulimia nervosa 
neuropathic pain
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2
Q

classes of antidepressants

A 
monoamine oxidase inhibitors 
tricylics 
non-selective reuptake inhibitors 
selective serotonin repute inhibitors 
noradrenaline reuptake inhibitors 
atypical drugs
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3
Q

which neurotransmitters are targeted by antidepressants

A

noradrenaline
serotonin
dopamine

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4
Q

describe the monoamine hypothesis

A

depression results from a functional deficit of monoamine transmitters, in particular serotonin and noradrenaline, therefore most drugs that treat depression act to increase monoaminergic transmission

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5
Q

examples of monoamine oxidase inhibitors

A

phenelzine

moclobemide

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6
Q

how do MAO-Is work

A

inhibit the action of MOA
serotonin/noradrenaline is not broken down
more serotonin/noradrenaline available for transport

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7
Q

side effects of MOA-Is

A 
hypertensive crisis 
potentiates actions of some other drugs 
insomnia 
postural hypotension 
peripheral oedema
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8
Q

what causes hypertensive crisis in MAO-Is and how can it be avoided

A

caused by inhibition of MAO-A in the gut by irreversible inhibitors preventing breakdown of dietary tyramine
avoid food like cheese, red wine, cured meats

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9
Q

examples of TCAs

A

imipramine
dosulepin
amitriptyline
lofepramine

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10
Q

mode of action of TCAs

A

block the reuptake of monoamines into presynaptic terminals

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11
Q

side effects of TCAs

A 
anti-cholinergic S/Es 
sedation 
weight gain
postural hypotension 
tachycardia 
arrhythmias 
cardiotoxic in OD
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12
Q

what are anti-cholinergic S/Es

A

blurred vision
dry mouth
constipation
urinary retention

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13
Q

examples of SSRIs

A

fluoxetine
citalopram/escitalopram
sertraline
paroxetine

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14
Q

mode of action of SSRIs

A

selectively inhibit reuptake of serotonin from the synaptic cleft

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15
Q

S/Es of SSRIs

A 
nausea
headache 
sweating
vivd dreams 
worsened anxiety 
sexual dysfunction 
transient increase in self-harm/suicidal ideation in <25 years
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16
Q

mode of action of SNRIs

A

block reuptake of monoamines (noradrenaline and serotonin) into presynaptic terminals

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17
Q

examples of SNRIs

A

venlafaxine

duloxetine

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18
Q

SE of SNRIs

A

similar to SSRIs

more limited SEs than TCAs

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19
Q

examples of atypical antidepressant

A

mirtazapine

bupropion

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20
Q

mode of action of atypical antidepressant

A

mixed receptor effects

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21
Q

why can it be beneficial to give mirtazapine alongside an SSRI

A

can block serotenergic side effects

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22
Q

acute aims of bipolar treatment

A

reduce mood in episodes of mania

raise mood in episodes of depression

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23
Q

long term aims of bipolar treatment

A

stabilise mood and prevent recurrence of both mania and depression

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24
Q

SEs of lithium

A 
dry mouth/strange taste 
polydipsia/polyuria 
tremor 
hypothyroidism 
reduced renal function 
nephrogenic DI
weight gain
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25
symptoms of lithium toxicity
``` vomiting diarrhoea ataxia/coarse tremor drowsiness convulsions coma ```
26
which anticonvulsants can be used as mood stabilisers
valproic acid lamotrigine carbamazepine
27
which antipsychotics can be used as mood stabilisers
quetiapine aripiprazole olanzapine lurasidone
28
what is the usual first line treatment of depression
SSRIs
29
what factors should be considered when choosing an anti-depressant
``` previous response comorbidities and risk factors patient preference safety in pregnancy/breastfeeding treatment of specific symptoms risk of overdose patient's willingness to adhere to monitoring ```
30
how long do antidepressants typically take to work
2-6 weeks
31
what combination of drugs can be used to treat psychotic depression
antidepressant and antipsychotic
32
define nonresponse to an antidepressant
no response or inadequate response after 6 weeks at the maximum BNF dose or highest tolerated dose
33
how long should antidepressants be continued for after full resolution of symptoms
6-12 months after a first episode 12-24 months for a recurrence indefinitely if after a third episode
34
what is the mainstay of treatment of bipolar disorder
mood stabilisers | eg lithium, anticonvulsants and antipsychotics
35
lamotrigine is good for which bipolar symptoms
bipolar depression
36
valproate is good for which bipolar symptoms
mania/hypomania
37
which class of drugs should be avoided in bipolar
antidepressants, unless short term in severe depressive episode and always with a mood stabiliser
38
why are antidepressant less effective in treating bipolar depression
they can cause switching to mania/hypomania or mood instability
39
why should SSRIs be taken in the morning
to reduce insomnia
40
which SSRI is safest to use in cardiac conditions
sertraline
41
which SSRI is safest in epilepsy
citalopram
42
which SSRI is associated with long QTc
citalopram
43
why should TCAs be taken at night
due to sedation
44
why should TCAs be avoided in patients with suicidal intent
cardiac toxicity in OD
45
what other uses are there for TCAs
``` neuropathic pain OCD anxiety disorders migraine prophylaxis nocturnal enuresis (bedwetting) cataplexy ```
46
what class of drug is mirtazapine
noradrenergic and specific serotenrgic antidepressant
47
when might mirtazapine be prescribed
insomnia poor appetite poor response to SSRI
48
which drugs can be used in combination with mirtazapine
SSRIs | venlafaxine
49
why should mirtazapine be taken at night
sedative effect
50
why should mirtazapine not be mixed with alcohol
causes GI upset
51
when should SNRIs be taken
in the morning to avoid insomnia
52
examples of irreversible MAOIs
phenelzine | isocarboxazid
53
examples of reversible MAOIs
moclobemide
54
what is the difference between reversible and irreversible MAOIs
irreversible ones permanently block the action of MAO to prevent break down of monoamines therefore cause more side effects reversible MAOIs cause less side effects but are less effective
55
why might there be difficulty with adherence in treatment with MOAIs
three times daily dosing
56
why can MAOIs cause hypertensive crisis
tyramine is a potent releaser of noradrenaline leading to elevated BP if MAO-A is inhibited and a high-tyramine meal is taken, noradrenaline can accumulate and cause hypertensive crisis
57
symptoms of MAOI hypertensive crisis
headache SOB nosebleed anxiety
58
examples of high tyramine foods
``` cheese red wine dried/smoked/fermented meats stock cubes pate black pudding caffeine soy/tofu ```
59
how is hypertensive crisis treated
phentolamine infusion
60
what is the most effective treatment for bipolar disorder
litium carbonate
61
when should lithium be taken
at night due to sedation
62
which drugs does lithium interact with
NSAIDs ACEIs/ARBs diuretics
63
which tests must be done before initiating lithium treatment
U+Es TFTs ECG
64
which tests should be done when stabilising lithium levels
``` lithium level (12 hours last dose) U+E every 5 days until lithium level stable within therapeutic range ```
65
how often should lithium levels and U+Es be monitored during treatment
every 3 months
66
how often should TFTs be monitored during treatment
every 6 months
67
should lithium be stopped if there is evidence of hypothyroidism
hypothyroidism is usually treated with levothyroxine rather than stopping lithium
68
warning signs of lithium toxicity
``` GI upset blurred vision coarse tremor ataxia drowsiness ```
69
signs of severe lithium toxicity
``` confusion LOC seizures coma death ```
70
causes of lithium toxicity
increased dose dehydration (physical illness, lack of fluid intake, hot weather, alcohol, exercise) drug interactions reduction in salt intake
71
treatment of lithium toxicity
stop lithium IV fluids monitor renal function may need dialysis in severe cases
72
when is semisodium valproate used
bipolar mania/hypomania
73
what type of drug is semisodium valproate
anticonvulsant
74
what is the mechanism of action of semisoidum valproate
blocks voltage sensitive sodium channels to increase levels of GABA
75
why should valproate be avoided in women of childbearing age
highly teratogenic (neural tube defects)
76
which tests should be done prior to starting valproate treatment
platelet count | LFTs
77
what type of drug is lamotrigine
anticonvulsant
78
when is lamotrigine used
treatment and prophylaxis of bipolar depression | antimanic ??
79
which serious side effect is associated with lamotrigine
stevens johnson syndrome
80
which atypical antipsychotics are available as depot IM preparations
risperidone | olanzapine
81
which tests should be done prior to starting atypical antipsychotics
``` BP weight lipids blood glucose ECG FBC, U+Es, LFTs ```
82
how often should monitoring be done on patients being treated with atypical antipsychotics
at one month yearly thereafter more often depending on results and risk factors

3 PSYCH (4 decks)

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