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Psychiatry > Pharmacology > Flashcards

Pharmacology Flashcards

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1
Q

list some clinical indications for antidepressants

A

moderate to severe depression
neuropathic pain
OCD, panic disorder
generalised anxiety disorder

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2
Q

depression occurs as a result of which monoamine transmitter

A

serotonin

noradrenaline

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3
Q

what is the effect of monoamine oxidase A and B

A

when there is excess serotonin and noradrenaline produced they are fed into MAO which produces a by-product of the transmitters and it is excreted out of the cell

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4
Q

describe the mode of action of monoamine oxidase inhibitors

A

either reversibly or irreversibly inhibit MAO and allow more serotonin and noradrenaline to get to the synaptic cleft

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5
Q

phenelzine and moclobemide are examples of which drug

A

monoamine oxidase inhibitors

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6
Q

list the potential side effects of monoamine oxidase inhibitors

A

cheese reaction/hypertensive crisis
insomnia
postural hypotension
peripheral oedema

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7
Q

list some examples of tricyclic antidepressants

A

imipramine
amitriptyline
dosulepin
lofepramine

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8
Q

describe the mode of action of tricyclic antidepressants

A

blocks the re-uptake of noradrenaline and 5-HT into presynaptic terminals

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9
Q

list the side effects of tricyclic antidepressants

A 
anti-cholinergic effects 
sedation 
weight gain 
postural hypotension 
arrhythmias 
cardiotoxic in overdose
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10
Q

describe anti-cholinergic side effects that may be present

A

constipation
urinary retention
dry mouth
blurred vision

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11
Q

describe the mode of action of SSRIs

A

selectively inhibit the reuptake of serotonin from the synaptic cleft

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12
Q

list some examples of SSRIs

A 
citalopram 
escitalopram 
sertraline 
paroxetine 
fluoxetine
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13
Q

what are the side effects of SSRIs

A

think hangover symptoms –> headache, nausea, worsened anxiety, sweating and vivid dreams, reduced libido and erectile dysfunction

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14
Q

what side effects must be watched for in the young and the elderly on SSRIs

A

young - suicidal ideation

elderly - hyponatraemia

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15
Q

what is the only SSRI licensed for use in under 18s

A

fluoxetine

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16
Q

give some examples of SNRIs

A

venlafaxine

duloxetine

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17
Q

what is the mode of action of SNRIs

A

act in the same way as SSRIs but rather than just allowing reuptake of serotonin they also allow the reuptake of noradrenaline

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18
Q

list some side effects of mirtazapine

A

weight gain and sedation

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19
Q

describe the efficacy between antidepressants

A

most drugs efficacy is 40-70%

usually have a delayed onset of action and take several weeks before having any effect

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20
Q

what is the indication for lithium

A

used in the treatment of mania, hypomania and bipolar affective disorder

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21
Q

describe the monitoring required for lithium

A

weekly blood tests done to check the side effects have no become toxic
these are done 12 hours after taking a tablet

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22
Q

list the side effects of lithium

A 
dry/metallic tasting mouth 
polydipsia and polyuria 
tremor 
hypothyroidism 
reduce renal function 
diabetes insipidus 
weight gain
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23
Q

list the toxic effects of lithium

Study These Flashcards
A 
vomiting 
diarrhoea 
ataxia and coarse tremor 
drowsiness 
convulsions 
coma
24
Q

list some anticonvulsants that can be used as mood stabilisers

Study These Flashcards
A

lamotrigine
carbemazepine
valproic acid

25
what are the side effects of anticonvulsants
teratogenic causing neural tube defects | CV risks
26
how long should an antidepressant be used for after recovery to prevent relapse
if first time on drug - 6 months | if been on drug before - 1 year
27
what is the first line treatment for depression
generic SSRI - commence on low dose and titrate up if needed, select SSRI based on patient wishes and side effect profile
28
outline the management of acute mania/hypomania
any second generation antipsychotic or valproate discontinue use of antidepressant as that can worsen mania hospital admission if suspected mania
29
list some examples of first generation antipsychotics
chlorpromazine haloperidol zuclopenthixol
30
list some examples of second generation antipsychotics
clozapine olanzapine quetiapine risperidone
31
what type of drug is aripiprazole
third generation antipsychotic
32
what is the mode of action of antipsychotics
specifically target D2 receptors as dopamine antagonists as there is abhorrent firing of dopaminergic neurones in schizophrenia
33
list some of the groups of side effects in antipsychotics
extra-pyramidal side effects neuroepileptic syndrome hyperprolactinaemia akathesia
34
describe extrapyramidal side effects in antipsychotics
acute dystonia - increasing muscle tone, presents within minutes parkinsonism - gradual onset over weeks tardive dyskinesia
35
what is the treatment for extra-pyramidal side effects from antipsychotics
treat with anticholinergics to get dopamine and ACh back into relative balance - procyclidine and trihexyphenidyl
36
what is neuroepileptic malignant syndrome
rare but potentially fatal condition with increasing muscle tone, pyrexia, fluctuating pulse and BP eventually leads to rhabdomyolysis - acute renal failure and then death
37
what is the management of neuroepileptic malignant syndrome
stop antipsychotic rapid cooling with renal support dopamine agonists
38
what is akathesia
inability to sit still | presents with pacing, rocking from foot to foot
39
what is the treatment of akathesia
propanolol and long acting benzodiazepine such as clonazepam
40
list some additional side effects of antipsychotics
``` anticholinergic effects weight gain postural hypotension prolonged QTc interval photosensitivity ```
41
clozapine is particularly good for positive or negative symptoms of schizophrenia
negative symptoms and antisuicidal properties
42
list some of the side effects specific to clozapine
``` agranulocytosis myocarditis constipation which can lead to obstruction and perforation weight gain sedation sialorrhoea ```
43
what is the first line treatment for schizophrenia
second generation antipsychotic and titrate dose up and try for 6-8 weeks
44
what is the second line treatment for schizophrenia
try an alternative second generation or a first generation antipsychotic
45
what is the third line treatment for schizophrenia
clozapine
46
what drugs are used to treat anxiety
benzodiazepines antidepressants pregabalin propanolol
47
what type of neurotransmitter is GABA
inhibitory neurotransmitter
48
what effect do benzodiazepines have on GABA
enhance the action of GABA, less likely that a neurone will fire an action potential
49
give some examples of benzodiazepines
midazolam diazepam loprazolam chlordiazepam
50
what are the pharmacological effects of benzodiazepines
``` muscle relaxants reduce anxiety and depression hypnosis and sedation anticonvulsant effect anterograde amnesia ```
51
list some of the clinical uses of benzodiazepines
``` acute anxiety hypnosis alcohol withdrawal mania delirium status epilepticus rapid tranquillisation ```
52
what is the main issue with taking benzodiazepines especially for a long time
tolerance and dependence - the dose taken no longer has the desired effect
53
when immediately stopping benzodiazepines, list some of the effects of withdrawal
``` abdo cramps increased anxiety blurred vision depression insomnia dizziness headaches nausea and vomiting tingling in hands and feet restlessness sensory sensitivity ```
54
what causes the withdrawal symptoms associated with benzodiazepines
chronic treatment of benzos causes reduced GABA response, when someone immediately withdraws the anxiety and convulsions occur due to reduced density of benzodiazepines receptors
55
what is the correct way of withdrawing from benzodiazepines
convert dose to daily dose of diazepam at night reduce dose but 2-2.5mg every 2-3 weeks if s/e occur, reduce dose in smaller steps

Psychiatry (14 decks)

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