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Psychiatry Year 3 Dundee > Pharmacology > Flashcards

Pharmacology Flashcards

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1
Q

What does Monoamine Oxidase do?

A

Breaks 5-HT down into its inactive products, once it has re entered the pre synaptic bulb.

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2
Q

What do most Anti Depressants do?

A

Increase the concentration of serotonin in the synaptic cleft.

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3
Q

What is the precursor for 5HT?

A

Trytophan

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4
Q

Examples of Monoamine Oxidase inhibitors

A

Phenelzine

Moclobemide

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5
Q

Examples of monoamine neurotransmitters

A

Dopamine
Noradrenaline
5HT

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6
Q

Irreversible Monoamine Oxidase Inhibitors

A

Phenelzine

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7
Q

Reversible Monoamine Oxidase Inhibitors

A

Moclobemide

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8
Q

What severe side effect is linked to Monoamine Oxidase Inhibitors?

A

Cheese reaction

Dietary tyramine is not broken down leading to a hypertensive crisis.

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9
Q

What common side effect are linked to Monoamine Oxidase Inhibitors?

A

Insomnia
Postural hypertension
Peripheral oedema

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10
Q

How do Tricyclics work?

A

Block reuptake channels for 5-HT and Noradrenaline

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11
Q

Examples of Tricyclic antidepressants.

A

Imipramine

Amitriptyline

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12
Q

Tricyclic antidepressants have no Anticholinergic effects.

T/F

A

False they have a strong anticholinergic effect

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13
Q

What are some of the anticholinergic side effects of Tricyclic drugs?

A

Blurred Vision
Dry mouth
Constipation
Urinary retention

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14
Q

List some common side effects of Tricyclic antidepressants.

A 
Sedation 
Weight gain
postural hypertension
tachycardia
Arrhythmias
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15
Q

Why should Tricyclics never be prescribed for anyone with arrhythmias?

A

They are Cardiotoxic

Prolong QT

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16
Q

How do SSRIs work?

A

Selective Seretonin Reuptake Inhibitors

Block serotonin channels

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17
Q

Examples of SSRIs

A

Fluoxetine
Citalopram
Setraline

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18
Q

Give some common side effects of SSRIs

A 
Nausea
Headache 
Worsened anxiety
Sweating
Sexual dysfunction
Hyponatraemia - elderly
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19
Q

SSRIs should be used in patients with a history of self harm. T/F

A

False

Be careful as SSRIs linked to transient increase in Self Harm

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20
Q

Side effects of SSRIs discontinuation

A

Flu like symptoms
Insomnia
N+V

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21
Q

How do SNRIs work?

A

Seretonin Norepinephrine re-uptake inhibotors

Noradrenaline and 5HT channels are blocked

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22
Q

Examples of SNRIs

A

Venlafaxine

Dulaxetine

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23
Q

Side effects of SNRIs

A

Similar to SSRIs

Less Anticholinergic side effects

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24
Q

A Tetracyclic Antidepressant selective for α2 5-HT2 and 5-HT3 reuptake channels.

A

Mirtazapine

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25
Which side effects of Mirtazapine is actually a desirable one which advocates for its use?
Sedative Use in patients who are suffering from insomnia or poor sleep. Weight gain Use in patients who are underweight
26
Some side effect so Mirtazapine.
Dry mouth | Increased appetite
27
List of Antidepressant Drugs
``` TCA MAOI SSRIs SNRIs Mirtazapine ```
28
What is the most common mood stabilising drug?
Lithium Carbonate
29
Side effects of Lithium
``` Dry mouth Polyuria Tremor Hypothyroidism Nephrogenic Diabetes Insipidus Weight gain ```
30
What are some signs a patient has toxic Lithium poisoning?
``` Diarrhoea Vomiting Ataxia Drowsiness Convulsiona Coma ```
31
List some common Anticonvulsants
Valproic acid Lamotrigine Carbamazepine
32
List some Antipsychotic drugs
Olanzapine Aripiprazole Quetiapine
33
What is the mode of action in Antipsychotic drugs?
Dopamine and 5 HT2 seretonin receptor antagonists
34
Some common side effects of Antipsychotic drugs.
Sedation Weight gain Metabolic syndrome Extra pyramidal effects
35
What are the dopamine pathways within the Brain?
``` Mesolimbic Mesocortical Nigrostriatal Tuberoinfundibular Hypothalamospinal ```
36
Where does the mesolimbic pathway originate and terminate?
Ventral Tagmatic area to the limbic region
37
What does the mesolimbic pathway control?
Memory Emotional control Personality
38
Damage or dysfunction in the mesolimbic pathway results in what?
Delusions Hallucinations Thought insertion
39
What does the mesocortical pathway control?
Higher brain function
40
What does the Nigrostriatal pathway control?
Voluntary movement
41
Damage of dysfunction in the nigrostriatal pathway results in what?
Parkinsonism - tremor bradykinesia rigidity
42
Where is the tuberoinfundibulnar pathway found?
Around the pituitary gland
43
What are the main dopamine receptors?
D1-D5
44
Where would you find D1-D2 receptors?
Limbic and striatal areas
45
Which receptor is found most commonly in the mesolimbic pathway?
D2
46
List some D2 receptor antagonists
Raclopride | Haloperidol
47
Give an example of D4 receptor agonists
Clozapine
48
What do D2 receptors do when activated ?
Inhibit adenyl cyclase Inhibit voltage gated Ca2+ channels Open K+ channels Hyperpolarise
49
What do D1 receptors do when activated ?
Stimulate cAMP
50
How does GABA affect the post synaptic membrane?
Inhibits neuronal activity by activating Cl- channels causing hyperpolarisation.
51
How do Benzodiazepines work?
Enhance the affect if GABA increasing the inhibition of postsynaptic potential
52
Describe the efficacy of Benzodiazepines?
Rapid action | Well tolerated for less than two weeks
53
What are the issues of Benzodiazepines?
``` Sedation Psychomotor impairment Withdrawal issues Dependancy and abuse Alcohol interactions- both act on same receptor Can worsen co-morbid depressions ```
54
What drugs are used in the treatment of anxiety?
``` Benzodiazepines Antidepressant drugs Buspirone Pregablin Beta Blockers Propanolol ```
55
What pathway is involved in anxiety?
Corticostriatal thalamic cortical circuit
56
What are the main neurotransmitters in the amygdala centred circuit?
``` 5 HT GABA Glutamate CRF - Corticotrophin releasing factor Norepinephrine ```
57
What is the affect of GABA on anxiety?
Reduces affect of neurones in Amygdala and Corticostriatal thalamic cortical circuit reduces anxiety
58
How do BDZ work to reduce anxiety?
BDZ enhance the action of GABA hence increasing suppression of amygdala and CTCC
59
How many types of GABA receptors are there?
A B C
60
GABA A is bound by what?
BDZ Barbiturates Alcohol
61
Activation of GABA A receptors does what?
Hyperpolarises the membrane by opening Cl- channels alowing influx of Cl- ions.
62
What properties do Ethanol, Neurosteroids and Barbiturates display?
Anxiolytic - reduce anxiety
63
Give a example of an Inverse BD2 agonist
B-Carboline
64
What properties do Inverse BD2 agonists displays i.e B-Carboline
Anxiogenic - Increase anxiety
65
What GABA antagonists are used in the treatment of BDZ overdose?
Flumazenil - Bind and block GABA A receptors
66
Give examples of Benzodiazepines.
Lorazepam Diazepam Chlordiazepam
67
What is Xanax?
Alprazolam - form of BDZ
68
What effect do BDZ have?
Reduce anxiety and aggression Hypnosis and sedation Muscle relaxent Anticonvulsant effect
69
What are some clinical uses of BDZ?
``` Acute anxiety Hypnosis Alcohol withdrawal Mania Delirium Rapid tranquillisation Status Epilepticus ```
70
Why is a BDZ "fairly safe"?
As it is unlikely to cause respiratory depression
71
What are some issues surrounding the use of BDZ?
Some have paradoxical aggression Anterograde amnesia Impaired coordinations Tolerance and dependance are risks
72
What some side effects of BDZ withdrawal?
Abdo cramps, Increased anxiety and panic attacks, Blurredvision Muscle tension, chest pain, palpitation, sweating Depression insomnia nightmares dizziness N+V restlessness
73
What causes the withdrawal symptoms from BDZ?
Chronic BDZ used reduces GABA receptors response to GABA. | Less inhibitory input, as less GABA and less receptive to its presence.
74
What are some signs of rapid BDZ withdrawal?
``` Confusion Psychosis Convulsions Tachychardia Hypertension Agitation Tremor ```
75
How do you withdraw somoene from BDZ?
Transfer over to Diazepam or Chlordiazepam - taken at night Reduce dose every 2-3 weeks - 2- 2.5 mg Time needed varies from around 4 weeks to 1 year
76
If whilst withdrawing your patient from BDZ they start to develop symptoms what do you do?
Maintain dosage
77
What does seretonin do within the amygdala?
Innervates it
78
How do SSRIs and SRNIs increase extracellular seretonin?
Blockage of the Serotonin reuptake transporters
79
How does SSRI and SRNI usage help to reduce anxiety
After chronic usage due to increased extracellular Serotonin expression of serotonin and glucocorticoid receptors is decreased - less stimulation
80
What can SSRIs be used for, anxiety and fear?
Panic disorders OCD PTSD Phobias GAD
81
What SSRIs can be used, Anxiety?
Escitalopram Paroxetine Fluoxetine
82
What can Tricyclics be used for, anxiety and fear?
OCD | Panic disorder 2nd line
83
What Tricyclic are used, anxiety.
Clomipramine | Imipramine
84
What are SNRIs used for? Anxiety disorders.
GAD
85
What SRNI is sued in GAD?
Venlafaxine
86
What are MAOI used for? Anxiety disorder.
Social Anxiety disorders
87
What MAOI is use for social anxiety disorders?
Moclobemide
88
What is Pregablins mode of action?
GABA enhancer and Ca2+ channel blocker
89
When is Pregablin used in anxiety?
Only for unresponsive disease

Psychiatry Year 3 Dundee (21 decks)

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