Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Psychiatry > Pharmacology > Flashcards

Pharmacology Flashcards

(72 cards)

Start Studying
1
Q

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

A

Delay of typically 3-6 weeks before symptoms improve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

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

A

Trial of 2 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

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

A

6 months-year

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

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

A

2 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

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

A

Lifelong

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Give example of tertiary TCA

A

Amitriptyline

Imipramine

Doxepin

Clomipramine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Give example of secondary TCA

A

Notrtriptyline

Desipramine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Give example of MAOI

A

Phenelzine

Rasagiline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How does discontinuation syndrome present?

A

Agitation

Nausea

Sweating

Difficulty sleeping

Diarrhoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Give examples of SSRIs

A

Paroxetine

Sertraline

Fluoxetine

Citlopram

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Give example of SNRI

A

Duloxetine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Give pros of Sertraline

A

Short half life with lower build-up of metabolites

Less sedating when compared to paroxetine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Give example of a novel antidepressant

A

Buproprion

Mirtazapine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Give side effects of Mirtazapine

A

Increases serum cholesterol

Sedating/Drowsiness

Weight gain/increased appetite

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the SSRI of choice in children and adolescents?

A

Fluoxetine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What is the SSRI of choice post MI or unstable angina?
Sertraline
26
What is the most common side effect of SSRIs?
GI symptoms
27
What should be prescribed if a patient is taking an SSRI and NSAID?
PPI for GI protection
28
Give specific side effects of Citalopram?
QT prolongation Sedation
29
What medications can cause adverse drug reactions with SSRIs?
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
How long should SSRIs be reduced to avoid discontinuation syndrome?
4 weeks
31
Which SSRI has an increased risk of discontinuation syndrome?
Paroxetine
32
How do SSRIs affect pregnancy?
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
What medication is known to reduce suicide rate?
Lithium
34
Give side effects of lithium?
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
How does lithium toxicity present?
Coarse tremor, fine tremor is seen in therapeutic levels) Hyperreflexia Acute confusion Polyuria Seizure Coma Ataxia Blurred vision Tinnitus
36
What can precipitate lithium toxicity?
Dehydration Renal failure Drugs * Diuretics, especially thiazides * ACEI and ARBS * NSAIDs * Metronidazole
37
What monitoring is involved in lithium prescribing?
Baseline U&E and TSH before initiation Pregnancy test
38
How does lithium affect pregnancy?
Associated with Epstein's anomaly in first trimester
39
When after last dose should lithium levels be checked?
Check 8-12 hours after last dose
40
Give example of a typical antipsychotic
Haloperidol Pimozide
41
Give examples of atypical antipsychotics
Risperidone Olanzapine Quetiapine Clozapine
42
What is the last resort antipsychotic?
Clozapine Offered if patient has not responded adequately to at least 2 anti-psychotics
43
Give side effects of antipsychotics
Neuroleptic Malignant Syndrome (NMS) Extrapyramidal side effects (EPS) Metabolic Syndrome Hyperprolactinaemia Hypertriglyceridemia Hypercholesterolemia
44
What are the extrapyramidal side effects?
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
How does metabolic syndrome present?
Weight gain DM, elevated blood sugars Abnormal LFTs Dyslipidemia
46
Give side effects of clozapine specifically?
Agranulocytosis Myocarditis Hypersalivation Weight gain Sedation Seizures Idiopathic hypothermia Constipation/intestinal obstruction
47
What do you do if clozapine doses have been missed for more than 48 hours?
Dose needs to be re-started again slowly
48
What is there an increased risk of when prescribing atypical antipsychotics in the elderly?
Stroke and VTE
49
What should be considered in psychotic patients with non-compliance?
Once monthly IM antipsychotic depot injection
50
How should patient's medication be adjusted before recieving electroconvulsion therapy?
Reduced but not stopped
51
What can hyperprolactinaemia cause?
Galactorrhea Menstrual irregularities Sexual dysfunction Osteoporosis Increased risk breast cancer
52
What side effect does clozapine NOT cause?
Tardive dyskineisa
53
What birth deformity can valproic acid cause?
Spina bifida
54
What is used to treat acute dystonia?
Procyclidine (anti muscarinic agent)
55
What is the mechanism of action of Olanzapine?
Mainly works via blockade of dopamine receptors, but also serotonin receptors
56
How does neuroleptic malignant syndrome present?
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
What investigations are used in neuroleptic malignant syndrome diagnosis?
\>CK AKI * Secondary to rhabdomyolysis \>WCC Deranged LFT
58
How is neuroleptic malignant syndrome managed?
Stop antipsychotic IV fluids to prevent renal failure Dantrolene Bromocriptine
59
What antipsychotic should be used in dementia patients?
Typical such as haloperidol Atypical antipsychotics should be avoided due to increased risk of cerebrovascular events
60
What is an appropriate therapeutic range for lithium?
0.4-1.0 mmol/l
61
What is the anti-psychotic of choice in pregnancy?
Olanzapine
62
How often should lithium levels be monitored?
Initially, check levels at 1 week, once stable monitor at 3 months and TSH/creatinine at 6 months
63
Which atypical antipsychotic is not associated with weight gain or prolactin elevation?
Aripiprazole
64
What is the mechanism of action of benzodiazepines?
enhance the effect of GABA, the main inhibitory neurotransmitter
65
Give side effects of benzodiazepines
Somnolence Cognitive deficits/memory loss Disinhibition Dependence Respiratory depression
66
What is used to treat tardive dyskinesia?
Tetrabenazine
67
What electrolyte abnormality is associated with SSRIs?
Hyponatraemia
68
What is the difference between typical and atypical antipsychotics?
Typical anti-psychotics are more effective, however atypical have less side effects
69
What is used to manage the Parkinsonism of extrapyramidal side effects?
Procyclidine
70
What is the most likely antipsychotic to cause neuroleptic malignant syndrome?
Haloperidol
71
What can cause a rise in Clozapine levels?
Smoking
72
What monitoring tests should be done for patients on antipsychotics?
FBC U&E LFT Lipids Weight Glucose Prolactin BP ECG

Psychiatry (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions