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Psychiatry > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

How long after starting treatment do symptoms of depression begin to improve?

A

Delay of typically 3-6 weeks before symptoms improve

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2
Q

How long should you wait before switching to a different anti-depressant if no improvement of symptoms?

A

Trial of 2 months

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3
Q

How long should someone be on anti-depressants after 1 depressive episode?

A

6 months-year

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4
Q

How long should someone be on anti-depressants after 2 depressive episodes?

A

2 years

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5
Q

How long should someone be on anti-depressants after 3 despressive episodes?

A

Lifelong

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6
Q

What is the order of anti-depressant prescribing?

A

Selective Serotonin Reuptake Inhibitor (SSRI)

Second SSRI or augment with another agent

Serotonin/Noradrenaline Reuptake Inhibitor (SNRI) or novel

Tricyclic Antidepressants (TCAs) or Monoamine Oxidase Inhibitors (MOI), Lithium

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7
Q

Give the classifications of anti-depressants?

A

Tricyclics (TCAs)

Monoamine Oxidase Inhibitors (MAOIs)

Selective Serotonin Reuptake Inhibitors (SSRIs)

Serotonin/Noradrenaline Reuptake Inhibitors (SNRIs)

Novel antidepressants

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8
Q

Give example of tertiary TCA

A

Amitriptyline

Imipramine

Doxepin

Clomipramine

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9
Q

Give side effects of TCAs

A

Antihistaminic

  • Sedation
  • Weight gain

Anticholinergic

  • Dry mouth
  • Dry eyes
  • Constipation
  • Memory deficits
  • Potentially delirium

Antiadrenergic

  • Orthostatic hypotension
  • Sedation
  • Sexual dysfunction
  • Overflow incontinence
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10
Q

Give example of secondary TCA

A

Notrtriptyline

Desipramine

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11
Q

Give side effects of MAOIs

A

Orthostatic hypotension

Weight gain

Dry mouth

Sedation

Sexual dysfunction

sleep disturbance

Hypertensive Crisis/Cheese Reaction

  • Can develop when MAOI’s are taken with tyramine-rich foods or sympathomimetics (Cheese, fava beans, wine, processed meat)
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12
Q

How does serotonin syndrome present?

A

Abdominal pain

Diarrhoea

Sweats/extremes of temperature

Tachycardia

HTN

Irritability

Delirium

Hypertonia

Hyperreflexia

Clonus

Can lead to hyperpyrexia, cardiovascular shock and death

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13
Q

Give example of MAOI

A

Phenelzine

Rasagiline

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14
Q

Give side effects of SSRIs

A

GI upset

Sexual dysfunction

Anxiety/restlessness

Insomnia

Sedation/fatigue

Dizziness

Very little risk of cardiotoxicity in overdose

GI bleeding

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15
Q

How does discontinuation syndrome present?

A

Agitation

Nausea

Sweating

Difficulty sleeping

Diarrhoea

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16
Q

Give examples of SSRIs

A

Paroxetine

Sertraline

Fluoxetine

Citlopram

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17
Q

Give example of SNRI

A

Duloxetine

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18
Q

Give pros of Paroxetine

A

Short half life with no active metabolite meaning no build-up, which is good if hypomania develops

Sedating properties (dose at night) offers good initial relief from anxiety and insomnia

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19
Q

Give pros of Sertraline

A

Short half life with lower build-up of metabolites

Less sedating when compared to paroxetine

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20
Q

Give pros of Fluoxetine

A

Long half life so decreased incidence of discontinuation syndromes, good for patients with noncompliance issues

Initially activating so my provide increased energy

Secondary to long half life, can give one 20mg tablet to taper someone off SSRI when trying to prevent SSRI discontinuation

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21
Q

Give example of a novel antidepressant

A

Buproprion

Mirtazapine

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22
Q

Give side effects of Mirtazapine

A

Increases serum cholesterol

Sedating/Drowsiness

Weight gain/increased appetite

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23
Q

What is the mechanism of action of Mirtazapine?

A

Noradrenergic and specific serotonergic antidepressant which increases release of neurotramsitters by blocking alpha2 adrenoreceptors

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24
Q

What is the SSRI of choice in children and adolescents?

A

Fluoxetine

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25
Q

What is the SSRI of choice post MI or unstable angina?

A

Sertraline

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26
Q

What is the most common side effect of SSRIs?

A

GI symptoms

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27
Q

What should be prescribed if a patient is taking an SSRI and NSAID?

A

PPI for GI protection

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28
Q

Give specific side effects of Citalopram?

A

QT prolongation

Sedation

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29
Q

What medications can cause adverse drug reactions with SSRIs?

A

NSAIDS

  • Avoid prescribing or give with PPI

Warfarin/Heparin and Aspirin

  • Due to increased bleeding risk
  • NICE guidelines recommend avoiding SSRIs and considering mirtazapine

Triptans

  • Increased risk of serotonin syndrome

MAOIs

  • Increased risk of serotonin syndrome
30
Q

How long should SSRIs be reduced to avoid discontinuation syndrome?

A

4 weeks

31
Q

Which SSRI has an increased risk of discontinuation syndrome?

A

Paroxetine

32
Q

How do SSRIs affect pregnancy?

A

During the first trimester gives a small increased risk of congenital heart defects

Third trimester can result in persistent pulmonary hypertension of the newborn
Paroxetine has an increased risk of congenital malformations, particularly in the first trimester

33
Q

What medication is known to reduce suicide rate?

A

Lithium

34
Q

Give side effects of lithium?

A

GI distress

Thyroid abnormalities

Reduces seizure threshold

Hair loss

Acne

Leukocytosis

Renal failure/oliguria

Weight gain

Metallic taste

Dry mouth

Coarse tremor, fine tremor is seen in therapeutic levels

35
Q

How does lithium toxicity present?

A

Coarse tremor, fine tremor is seen in therapeutic levels)

Hyperreflexia

Acute confusion

Polyuria

Seizure

Coma

Ataxia

Blurred vision

Tinnitus

36
Q

What can precipitate lithium toxicity?

A

Dehydration

Renal failure

Drugs

  • Diuretics, especially thiazides
  • ACEI and ARBS
  • NSAIDs
  • Metronidazole
37
Q

What monitoring is involved in lithium prescribing?

A

Baseline U&E and TSH before initiation

Pregnancy test

38
Q

How does lithium affect pregnancy?

A

Associated with Epstein’s anomaly in first trimester

39
Q

When after last dose should lithium levels be checked?

A

Check 8-12 hours after last dose

40
Q

Give example of a typical antipsychotic

A

Haloperidol

Pimozide

41
Q

Give examples of atypical antipsychotics

A

Risperidone

Olanzapine

Quetiapine

Clozapine

42
Q

What is the last resort antipsychotic?

A

Clozapine

Offered if patient has not responded adequately to at least 2 anti-psychotics

43
Q

Give side effects of antipsychotics

A

Neuroleptic Malignant Syndrome (NMS)

Extrapyramidal side effects (EPS)

Metabolic Syndrome

Hyperprolactinaemia

Hypertriglyceridemia

Hypercholesterolemia

44
Q

What are the extrapyramidal side effects?

A

Acute dystonia

  • Uncontrollable sustained contractions of muscles, such as inability to control gaze (oculogyric crisis)

Parkinsonism

Akathisia

  • Restlessness/inability to sit still, such as pacing up and down

Tardive dyskinesia

  • Repetitive involuntary movements usually involving the face, such as grimacing, tongue protrusion and lip smacking
45
Q

How does metabolic syndrome present?

A

Weight gain

DM, elevated blood sugars

Abnormal LFTs

Dyslipidemia

46
Q

Give side effects of clozapine specifically?

A

Agranulocytosis

Myocarditis

Hypersalivation

Weight gain

Sedation

Seizures

Idiopathic hypothermia

Constipation/intestinal obstruction

47
Q

What do you do if clozapine doses have been missed for more than 48 hours?

A

Dose needs to be re-started again slowly

48
Q

What is there an increased risk of when prescribing atypical antipsychotics in the elderly?

A

Stroke and VTE

49
Q

What should be considered in psychotic patients with non-compliance?

A

Once monthly IM antipsychotic depot injection

50
Q

How should patient’s medication be adjusted before recieving electroconvulsion therapy?

A

Reduced but not stopped

51
Q

What can hyperprolactinaemia cause?

A

Galactorrhea

Menstrual irregularities

Sexual dysfunction

Osteoporosis

Increased risk breast cancer

52
Q

What side effect does clozapine NOT cause?

A

Tardive dyskineisa

53
Q

What birth deformity can valproic acid cause?

A

Spina bifida

54
Q

What is used to treat acute dystonia?

A

Procyclidine (anti muscarinic agent)

55
Q

What is the mechanism of action of Olanzapine?

A

Mainly works via blockade of dopamine receptors, but also serotonin receptors

56
Q

How does neuroleptic malignant syndrome present?

A

It occurs within hours to days of starting an antipsychotic

Pyrexia

Muscle rigidity

Autonomic lability

  • HTN
  • Tachycardia
  • Tachypnoea

Agitated delirium with confusion

Hyperthermia

Urinary incontinence

57
Q

What investigations are used in neuroleptic malignant syndrome diagnosis?

A

>CK

AKI

  • Secondary to rhabdomyolysis

>WCC

Deranged LFT

58
Q

How is neuroleptic malignant syndrome managed?

A

Stop antipsychotic

IV fluids to prevent renal failure

Dantrolene

Bromocriptine

59
Q

What antipsychotic should be used in dementia patients?

A

Typical such as haloperidol

Atypical antipsychotics should be avoided due to increased risk of cerebrovascular events

60
Q

What is an appropriate therapeutic range for lithium?

A

0.4-1.0 mmol/l

61
Q

What is the anti-psychotic of choice in pregnancy?

A

Olanzapine

62
Q

How often should lithium levels be monitored?

A

Initially, check levels at 1 week, once stable monitor at 3 months and TSH/creatinine at 6 months

63
Q

Which atypical antipsychotic is not associated with weight gain or prolactin elevation?

A

Aripiprazole

64
Q

What is the mechanism of action of benzodiazepines?

A

enhance the effect of GABA, the main inhibitory neurotransmitter

65
Q

Give side effects of benzodiazepines

A

Somnolence

Cognitive deficits/memory loss

Disinhibition

Dependence

Respiratory depression

66
Q

What is used to treat tardive dyskinesia?

A

Tetrabenazine

67
Q

What electrolyte abnormality is associated with SSRIs?

A

Hyponatraemia

68
Q

What is the difference between typical and atypical antipsychotics?

A

Typical anti-psychotics are more effective, however atypical have less side effects

69
Q

What is used to manage the Parkinsonism of extrapyramidal side effects?

A

Procyclidine

70
Q

What is the most likely antipsychotic to cause neuroleptic malignant syndrome?

A

Haloperidol

71
Q

What can cause a rise in Clozapine levels?

A

Smoking

72
Q

What monitoring tests should be done for patients on antipsychotics?

A

FBC

U&E

LFT

Lipids

Weight

Glucose

Prolactin

BP

ECG

Psychiatry (11 decks)

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