Pharmacology Flashcards
(120 cards)
1
Q
what is the monoamine hypothesis
A
depression results from a functional deficit of monoamine transmitters in particular serotonin (5HT) and noradrenaline
2
Q
what does serotonin influence
A
mood sleep feeding behaviour sensory perception
3
Q
what is the post-synaptic serotonin receptor
A
5-HT
4
Q
what is the post-synaptic noradrenaline receptor
A
a1
b
5
Q
serotonin is synthesised in the presynaptic neurone from what
A
tryptophan
6
Q
noradrenaline is synthesised in the presynaptic neurone from what
A
tyrosine
7
Q
when serotonin and noradrenaline are reuptaken into the presynaptic neurone what breaks them down
A
Monoamine oxidase
8
Q
give an example of a reversible MAOI
A
moclobemide
9
Q
give an example of an irreversible MAOI
A
phenelzine
10
Q
what is a major side effect of MAOIs
A
cheese reaction
11
Q
what is a cheese reaction
A
hypertensive crisis caused by a build up of tyramine
12
Q
how does a hypertensive/cheese reaction occur
A
MAOIs block MAO-A in the gut and liver which breaks down dietary tyramine. The build up of tyramine causes NA release which makes BP skyrocket
or by interaction with other drugs that potentiate amine transmission e.g. other antidepressants (SSRI, TCA), pseudoephedrine
13
Q
what foods should be avoided when taking MAOI
A
foods that have been aged or fermented
red wine
cheese
soy
14
Q
what other issues arise with MAOI
A
potentiate the effects of other drugs
15
Q
what are some side effects of MAOI
A
insomnia, postural hypotension, peripheral oedema, dizziness
16
Q
what drugs can MAOIs potentiate the action of
A
TCAs, barbiturates, morphine, ethanol, pseudoephedrine
17
Q
how do TCAs work
A
block the reuptake of noradrenaline and serotonin into presynaptic terminals by blocking their transporters
18
Q
what additional actions do TCAs have and what does this lead to
A
also block dopamine, histamine and muscarinic Ach receptors leading to lots of side effects
19
Q
give 6 examples of tricyclics
A
imipramine amitriptyline clomipramine doxepin dosulepin lofepramine
20
Q
what are some side effects of tricyclics
A
cardiovascular
anticholinergic
weight gain and sedation
21
Q
TCAs are ____ in overdose
A
cardiotoxic in overdose
22
Q
what are the anticholinergic side effects of TCAs
A
blurred vision dry mouth constipation urinary retention sexual dysfunction
23
Q
what are some cardiovascular effects of TCAs
A
postural hypotension
tachycardia
arrhythmias - QT prolongation
24
Q
give 5 examples of SSRIs
A
fluoxetine sertraline citalopram escitalopram paroxetine
25
how do SSRIs work
selectively block the reuptake of serotonin (5HT) from the synaptic cleft
26
what are some things to be careful of when using SSRIs in the elderly
hyponatraemia and falls
27
what are some things to be careful of when using SSRIs in young people
transient increase in suicidality in first few weeks
28
what are some side effects of SSRIs
```
increased anxiety, sweating
vivid dreams, insomnia
head ache
sexual dysfunction
GI upset
```
29
what kind of GI symptoms do you get with SSRIs
nausea
abdominal pain
constipation
increased risk of GI bleed
30
when does the nausea with SSRIs usually settle
2 weeks
31
SSRIs are ____ in overdose
safe
32
what should be done when stopping an SSRI and why
taper dose as assoc. with withdrawal
33
some SSRIs can alter drug levels - how?
inhibit CP450 enzyme
34
how do SNRIs work
block the reuptake of noradrenaline and 5HT into the pre-synaptic terminals
35
give 2 examples of SNRIs
venlafaxine
| duloxetine
36
what is another time when duloxetine is used
stress incontinence
37
what are the side effects of SNRIs
GI upset similar to SSRIs
| cardiovascular
38
what cardiovascular side effects do you get with SNRIs
hypertension
palpitations
dizziness
39
why are SNRIs preferred to TCAs
lack major receptor blocking properties of TCAs so more limited range of SEs
40
how does mirtazapine work
blocks a2, 5HT2 and 5HT3 presynaptic receptors
| - noradrenaline, serotonin and histamine
41
why is mirtazapine beneficial when given with an SSRI
blocks serotonergic side effects
42
what are some side effects of mirtazapine
sedation and weight gain
43
how does bupropion work
dopamine uptake inhibitor
44
how does trazadone work
potent serotonin and noradrenaline receptor antagonist
45
what is the main side effect of trazadone
sedation
46
when should patients be reviewed after starting antidepressant
2 weeks
47
how long should treatment be continued before switching drug
should have treatment for 4 weeks (6 in elderly)
48
following remission how long should an antidepressant be continued
6 months
49
how long should patients be treated for GAD
12 months
50
Patients with a history of recurrent depression should receive maintenance treatment for _____
at least 2 years
51
what should be considered in all patients who develop drowsiness, confusion, or convulsions while taking an antidepressant
hyponatraemia
52
what is 1st line in the treatment of depression
SSRI
53
if the SSRI doesn't work what should you consider
dose increase
swap drug
combine drug
or augment
54
what drug could you combine the SSRI with
mirtazapine
55
what can be used to augment the SSRI
antipsychotic or lithium
56
what could be considered in severe refractory depression
ECT
57
what are absolute contraindications to ECT
recent MI (3 months)
recent CVA
intracranial mass lesion
phaeochromocytoma
58
what are relative contraindications to ECT
```
angina
CHF
severe pulmonary disease
severe osteoporosis
pregnancy
```
59
if a patient with capacity is detained under the MHA and is refusing ECT can you give it anyway
no
60
what are some side effects of ECT
```
headache
memory problems
muscle aches
confusion
nausea
```
61
when is lithium used
LT treatment of bipolar to stabilise mood and prevent recurrence of both depression and mania
62
lithium is normally given as
lithium carbonate
63
how does lithium work
blocks phosphatidylinositol pathway
| inhibits glycogen synthase kinase 3B
64
when are lithium levels checked
12 hours post dose
| levels checked weekly until stable then 3 monthly
65
over what level is lithium toxic
> 1.5 mmol/L
66
what are some side effects of lithium
```
metallic taste in mouth
polydipsia, polyuria
tremor
hypothyroidism
LT reduced renal function / nephrogenic DI
weight gain
```
67
what does lithium toxicity look like
D+V, course tremor, ataxia, myoclonus, drowsiness, coma
| convulsions, confusion, seizures, restlessness, electrolyte disturbance, renal failure, arrhythmia (QTP) , death
68
what drug should lithium not be given with and why
NSAID --> renal impairment
69
what is the treatment of lithium toxicity
stop lithium
| gastric lavage or dialysis depending on severity
70
is lithium safe in pregnancy
not in first trimester - teratogenic
71
name 3 anticonvulsants sometimes used in LT treatment of bipolar
valproic acid
lamotrigine
carbamazepine
72
what can valproate cause if given during pregnancy
neural tube defects
73
how does valproate work
inhibits enzymes that block GABA
74
what are some side effects of valproate and carbamazepine
drowsiness
ataxia
cardiovascular effects
induces liver enzymes
75
what is there a very small risk of when taking lamotrigine
stevens johnson syndrome
76
what is the first line treatment in acute bipolar mania
antipsychotic
| olanzapine, quetiapine, risperidone
77
what is the first line treatment in acute bipolar depression
antipsychotic + antidepressant
| quetiapine, olanzapine) (fluoxetine
78
how do antipsychotics work
dopamine D2 receptor antagonists blocking dopaminergic transmission in the mesolimbic pathways
79
are typical or atypical antipsychotics associated with EPSEs
typical
80
give 2 examples of typical antipsychotics
haloperidol
| chlorpromazine
81
what EPSEs can typical antipsychotics cause
parkinsonism
Acute dystonia
Akathasia
Tardive Dyskinesia
82
what is parkinsonism
bradykinesia + resting tremor + rigidity
83
what is acute dystonia
sustained muscle contraction usually in eyes, jaw, neck
| occurs within a few hours of starting treatment
84
what is an important feature of acute dystonia
oculogyric crisis
85
what is an oculogyric crisis
restlessness, agitation and involuntary upward deviation of the eyes
86
what is akathasia
severe restlessness, constant need to wander
87
what is tardive dyskinesia
occurs with LT use, late onset of choreoathetoid movements (abnormal, involuntary)
- chewing, facial grimaces, blinking, lip smacking, pouting of jaw
88
when antipsychotics are used in the elderly there is an increased risk of what
stroke
| thromboembolism
89
what is the main advantage of atypical antipsychotics
no EPSEs
90
what drug can be used to manage EPSEs with typical antipsychotics
procyclidine, prochlorperazine
91
what are some side effects of antipsychotics in general
```
anticholinergic
sedation, weight gain, increased appetite
raised prolactin
neuroleptic malignant syndrome
prolonged QT interval
```
92
prolonged QT interval occurs particularly with what antipsychotics
haloperidol
93
atypicals more than typicals can do what
reduce seizure threshold
94
raised prolactin can lead to what
```
galactorrhoea
impaired glucose tolerance
sexual dysfunction
amenorrhoea
infertility
```
95
why do you get raised prolactin from antipsychotics
dopamine negatively feeds back on prolactin release so its blockade results in raised prolactin
96
what is neuroleptic malignant syndrome
seen with all antipsychotics but particularly typicals
- hyperthermia
- muscle rigidity and bradykinesia
- altered mental state
- autonomic dysfunction
97
what autonomic dysfunction is seen with neuroleptic malignant syndrome
tachycardia, tachypnoea, dilated pupils, sweating
98
what antipsychotics should be 1st line in schizophrenia
atypical
99
what are the side effects of atypical antipsychotics
```
weight gain, drowsiness, increased appetitie
T2DM, metabolic syndrome
hyperprolactinaemia
increased risk seizures
sexual dysfunction
```
100
name 6 atypical antipsychotics
```
clozapine
olanzapine
quetiapine
risperidone
amisulpride
aripiprazole
```
101
true/false
| EPSEs can be seen at higher doses of some atypical antipsychotics
true
102
what 2 atypical antipsychotics have the most significant weight gain
clozapine
| olanzapine (risk of dyslipidaemia and obesity)
103
which atypical antipsychotic is particularly good for raised prolactin
aripiprazole
104
with clozapine there is a risk of what
agranulocytosis
105
when should you do a FBC for someone on clozapine
```
weekly for 1st 6 months
fortnightly for next 6 months
every 4 weeks thereafter
1 month after stopping
sore throat
```
106
what should be taken before starting clozapine
ECG and FBC
107
why is an ECG needed before starting clozapine
risk of myocarditis
108
how can you treat hypersalivation caused by clozapine
hyocine hydrobromide
109
when should clozapine be used
schizophrenia that is not controlled despite use of 2 antipsychotics
110
what should someone that smokes on clozapine be told
smoking reduces levels so suddenly stopping smoking can make levels dramatically increase
111
what are the 3 parts to CBT
NATs
dysfunctional assumptions
core belief/schema
112
what is the usual course of ECT
twice a week for 3 to 6 weeks (6 to 12 sessions in total)
113
metabolic syndrome occurs more with atypicals/typicals
atypicals - 5HT2C receptors
114
antagonism of what causes sedation
H1 receptors (histamine)
115
histamine blockade also leads to what
increased appetite
116
____ blockade can reduce nausea and vomiting
histamine
117
a-adrenergic blockade can cause what
hypotension and interruption of baroreflex response --> dizziness, lightheadedness, fainting when going from sitting to standing
118
what antipsychotic would you recommend to a woman on LT lithium who wants to have a child
olanzapine - doesnt pass across placenta or into breast milk
119
what causes serotonin syndrome
Consumption of excessive amounts or multiple drugs that increase amount of serotonin
120
what are the s/s of serotonin syndrome
Cognitive: headache, anxiety, agitiation, hallucination, confusions, coma.
Autonomic: shivering, sweating, hyperthermia, tachycardia, dilated pupils, nausea and diarrhoea.
Somatic: myoclonus (twitching), tremor, rigidity, hyper reflexia
