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Psychiatry > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

What type of drug can effectively diffuse across the BBB?

A

Lipophilic/hydrophobic

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2
Q

Give an example of a lipophilic drug that is used for anxiety

A

Propranolol - more lipophilic than other beta blockers

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3
Q

State the uses of antidepressant drugs

A
  • moderate/severe depression
  • dysthymia
  • generalised anxiety disorder
  • panic/OCD/PTSD
  • bulimia nervosa
  • neuropathic pain
  • premenstrual dysphoric disorder
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4
Q

Name three classes of antidepressants

A

Monoamine oxidase inhibitor
Monoamine reuptake inhibitor
Atypical drugs (post synaptic)

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5
Q

Name three monoamines

A
  • dopamine
  • noradrenaline
  • 5 HT/serotonin
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6
Q

Where is serotonin produced?

A

Raphe nucleus

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7
Q

Where are most serotonin neurons located?

A

Rostral nucleus but has multiple cortical projections to areas involving mood, sleep, feeding, behaviour and sensory perception

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8
Q

Other than serotonin production what is the raphe nucleus also involved in?

A

Analgesia

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9
Q

Where is noradrenaline produced?

A

Locus coeruleus with projections to areas of arousal and emotion

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10
Q

What is the function of MAO?

A

Converts monoamines into metabolites

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11
Q

How do monoamine oxidase inhibitors work?

A

Prevent the conversion of neurotransmitter to metabolite

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12
Q

Give two examples of MAOi

A

Phenelzine (irreversible)

Moclobemide (reversible)

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13
Q

What are the side effects of MAOi?

A 
Cheese reaction 
Decreased metabolism of other drugs 
Insomnia 
Postural hypotension 
Peripheral oedema
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14
Q

Describe the cheese reaction

A

Hypertensive crisis, inhibition of MAO in the gut prevents breakdown of dietary tyramine - tyramine causes vasoconstriction and malignant hypertension

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15
Q

How do tricyclic antidepressants work?

A

Block uptake of amines by competition of nerve terminals - non-specific inhibition of noradrenaline and 5HT uptake

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16
Q

Give examples of tricyclic antidepressants

A

Imipramine
Dosulepin
Amitriptyline
Lofepramine

17
Q

What are the side effects of tricyclic antidepressants?

A

Anticholinergic syndrome, sedation, weight gain, constipation, cardiotoxic in overdose and cardiovascular effects of increased noradrenaline

18
Q

How to SSRIs work?

A

Inhibit re-uptake of 5HT from the synaptic cleft

19
Q

Give examples of SSRIs

A

Fluoxetine, citalopram, sertraline

20
Q

What are the side effects of SSRIs?

A

Nausea, headache, worsened anxiety, <25 year olds risk of increased self harm and suicidal ideation, sweating/vivid dreams, sexual dysfunction, hyponatraemia (elderly)

21
Q

How do monoamine reuptake inhibitors work?

A

Block the reuptake of monoamines - noradrenaline and 5HT into presynaptic terminals

22
Q

Give examples of monoamine reuptake inhibitors

A

Duloxetine and Venlafaxine

23
Q

What are the side effects of monoamine reuptake inhibitors?

A

Similar to SSRI but lack of major receptor blocking actions so a more limited range of side effect than tricyclics

24
Q

Name two types of atypical antidepressant

A
  • Mirtazapine (mixed receptor effects)

- Dopamine uptake inhibitor (Bupropion)

25
Q

When can mirtazapine be used?

A

With SSRI to block serotenergic side effects

26
Q

What are the side effects of mirtazapine

A

Weight gain and sedation

27
Q

How is lithium given to a patient?

A

As a salt usually lithium carbonate

28
Q

How does lithium work?

A
  • blocks phosphatidylinostol pathway
  • inhibits glycogen synthase kinase 3beta
  • modulates NO signalling
29
Q

What is the issue with lithium?

A

Requires close monitoring as it has a narrow therapeutic index - 12 hour post dose bloods (0.4-1mmol/l target)

30
Q

What are the side effects of lithium?

A

Dry mouth, diabetes insipidus, polydipsia/uria, hypothyroid, reduced renal function, weight gain

31
Q

Why must dehydration be avoided in patients who take lithium?

A

Renal tubules cannot differentiate between sodium and lithium ions, in dehydration more sodium is resorbed so more lithium is resorbed

32
Q

Describe the toxic effects of lithium

A
  • Vomiting
  • Ataxia/tremor
  • Drowsiness
  • Convulsion
  • Coma
  • Diarrhoea
33
Q

What anticonvulsants can be used long term in bipolar?

A

Valproic acid, lamotrigine, carbamazepine - sodium channel blockers

34
Q

When must valproic acid not be used?

A

Pregnancy - neural tube defect

35
Q

What is a rare side effect of lamotrigine?

A

Steven Johnson Syndrome

36
Q

What are the side effects of valproate and carbamazepine?

A

Ataxia, drowsiness, induction of liver enzymes

37
Q

Which antipsychotics can be used in bipolar?

A

Quetiapine, Aripiprazole, Olanzapine, lurasidone - act as dopamine and 5HT antagonists

38
Q

Which antipsychotics can be used in bipolar?

A

Quetiapine, Aripiprazole, Olanzapine, lurasidone, risperidone - act as dopamine and 5HT antagonists

Psychiatry (18 decks)

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