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Module 308 > Pharmacology for Psychiatry > Flashcards

Pharmacology for Psychiatry Flashcards

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1
Q

Do antidepressants work?

A

Yes

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2
Q

If patient isnt responding to antidepressants…

  • review …
  • review …
  • consider …. strategies
  • address … …
A
  • review compliance
  • review diagnosis
  • consider alternative strategies
  • address perpetuating factors
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3
Q

If patient isnt responding to antidepressants…

  • review …
  • review …
  • consider …. strategies
  • address … …
A
  • review compliance
  • review diagnosis
  • consider alternative strategies
  • address perpetuating factors
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4
Q

Common SSRIS? (5)

A
  • Fluoxetine
  • Paroxetine
  • Sertraline
  • Citalopram
  • Escitalopram
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5
Q

Indications for SSRIs

A
  • Depression
  • Anxiety Disorders
  • Panic Disorder
  • OCD
  • PTSD
  • Other
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6
Q

SSRIS - similarities between them

  • Indications
  • Mechanism of …
  • Delayed peak action (..-.. days)
  • Efficacy
  • Relative safety in …
  • Advisability of … course (e.g. … months in major depression)
  • Interactions
A
  • Indications
  • Mechanism of action
  • Delayed peak action (10-14 days)
  • Efficacy
  • Relative safety in overdose
  • Advisability of prolonged course (e.g. 6 months in major depression)
  • Interactions
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7
Q

SSRIS - similarities between them

  • I…
  • Mechanism of action
  • … … action (10-14 days)
  • E…
  • Relative … in …
  • Advisability of prolonged course (e.g. 6 months in major depression)
  • I…
A
  • Indications
  • Mechanism of action
  • Delayed peak action (10-14 days)
  • Efficacy
  • Relative safety in overdose
  • Advisability of prolonged course (e.g. 6 months in major depression)
  • Interactions
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8
Q

SSRIS - differences between them

  • Half-life - … shortest (20 hours), … is longest (2-4 days - but active metabolite 14 day half-life)
  • Propensity to cause … syndrome if stopped
  • Side-effect profiles: fluoxetine causes … most commonly
  • Individual differences - people are different
A
  • Half-life - paroxetine shortest (20 hours), fluoxetine is longest (2-4 days - but active metabolite 14 day half-life)
  • Propensity to cause discontinuation syndrome if stopped
  • Side-effect profiles: fluoxetine causes agitation most commonly
  • Individual differences - people are different
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9
Q

SSRIS - differences between them

  • Half-life - paroxetine shortest (… hours), fluoxetine is longest (2-4 days - but active metabolite … day half-life)
  • Propensity to cause … … if stopped
  • Side-effect profiles: …. causes agitation most commonly
  • Individual differences - people are different
A
  • Half-life - paroxetine shortest (20 hours), fluoxetine is longest (2-4 days - but active metabolite 14 day half-life)
  • Propensity to cause discontinuation syndrome if stopped
  • Side-effect profiles: fluoxetine causes agitation most commonly
  • Individual differences - people are different
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10
Q

SSRI discontinuation syndrome

  • Occurs on … of SSRI especially when abrupt
  • Symptoms - agitation and …, dizziness, balance problems, nausea, diarrhoea, …-like symptoms
  • Commonest with …
  • Treat by - reassurance and …, reintroduction of drug + … withdrawal, consider alternative antidepressant or anxiolytic
A
  • Occurs on cessation of SSRI especially when abrupt
  • Symptoms - agitation and anxiety, dizziness, balance problems, nausea, diarrhoea, flu-like symptoms
  • Commonest with paroxetine
  • Treat by - reassurance and monitoring, reintroduction of drug + tapered withdrawal, consider alternative antidepressant or anxiolytic
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11
Q

Mirtazapine

  • What type of antidepressant?
  • Acts on what receptors?
A
  • NaSSA - Noradrenergic and Specific Serotonergic Antidepressant
  • Acts at alpha 2 receptors (antagonist) “cuts the brake cable” on serotonin and nordrenaline release
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12
Q

Tricylic Antidepressants

  • Many compounds since 1950s
  • Main ones in current use:
    • A…
    • Imipramine
    • L…
    • Dothiepin
  • Indications similar to SSRIs although not as widely used outside of depression
    • Efficacy in major depression … to SSRIs
    • Rarely used first-line nowadays due to … effects and … risk
A
  • Many compounds since 1950s
  • Main ones in current use:
    • Amitriptyline
    • Imipramine
    • Lofepramine
    • Dothiepin
  • Indications similar to SSRIs although not as widely used outside of depression
    • Efficacy in major depression similar to SSRIs
    • Rarely used first-line nowadays due to adverse effects and overdose risk
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13
Q

Tricylic Antidepressants

  • Many compounds since 1950s
  • Main ones in current use:
    • Amitriptyline
    • …
    • Lofepramine
    • …
  • Indications similar to SSRIs although not as widely used outside of …
    • Efficacy in major depression similar to SSRIs
    • Rarely used first-line nowadays due to adverse effects and overdose risk
A
  • Many compounds since 1950s
  • Main ones in current use:
    • Amitriptyline
    • Imipramine
    • Lofepramine
    • Dothiepin
  • Indications similar to SSRIs although not as widely used outside of depression
    • Efficacy in major depression similar to SSRIs
    • Rarely used first-line nowadays due to adverse effects and overdose risk
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14
Q

Tricyclic Antidepressants

  • Mechanism of action:
    • Bind to … and … reuptake inhibitors
      • Increase monoamine levels in synaptic cleft
    • Pronounced … (antimuscarinic) effects
    • Specific affinities vary widely between different compounds
      • This means that TCA properties are variable
      • This may be clinically relevant e.g. if … effects are desirable (e.g. amitriptyline, dothiepin)
A
  • Mechanism of action:
    • Bind to NA and 5HT reuptake inhibitors
      • Increase monoamine levels in synaptic cleft
    • Pronounced anticholinergic (antimuscarinic) effects
    • Specific affinities vary widely between different compounds
      • This means that TCA properties are variable
      • This may be clinically relevant e.g. if sedative effects are desirable (e.g. amitriptyline, dothiepin)
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15
Q

Tricylic Antidepressants - Adverse Effects

  • Anticholinergic effects:
    • … mouth, c…, u… retention, c… effects
  • Other adverse effects - … effects (agitation, nightmares), Sexual dysfunction (e.g. erectile dysfunction), akathisia, muscle twitches, cardiac arrhythmias
A
  • Anticholinergic effects:
    • Dry mouth, constipation, urinary retention, cognitive effects
  • Other adverse effects - psychotropic effects (agitation, nightmares), Sexual dysfunction (e.g. erectile dysfunction), akathisia, muscle twitches, cardiac arrhythmias
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16
Q

Tricylic Antidepressants - Adverse Effects

  • … effects:
    • Dry mouth, constipation, urinary retention, cognitive effects
  • Other adverse effects - psychotropic effects (…, nightmares), Sexual dysfunction (e.g. … …), akathisia, … twitches, cardiac …
A
  • Anticholinergic effects:
    • Dry mouth, constipation, urinary retention, cognitive effects
  • Other adverse effects - psychotropic effects (agitation, nightmares), Sexual dysfunction (e.g. erectile dysfunction), akathisia, muscle twitches, cardiac arrhythmias
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17
Q

Tricylic Antidepressants - Overdose

  • Neurological and cardiovascular effects:
    • …, tachycardia and other …, hypotension, mydriasis - seizures, coma, … arrest
    • Studies in 1000s suggested … deaths per 100,000 prescriptions, and that TCAs involved in around a third of all fatal overdoses
A
  • Neurological and cardiovascular effects:
    • Confusion, tachycardia and other arrythmias, hypotension, mydriasis - seizures, coma, cardiorespiratory arrest
    • Studies in 1000s suggested 5 deaths per 100,000 prescriptions, and that TCAs involved in around a third of all fatal overdoses
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18
Q

Tricylic Antidepressants - Overdose

  • Neurological and cardiovascular effects:
    • Confusion, t.. and other arrythmias, …, mydriasis - seizures, c…, cardiorespiratory arrest
    • Studies in 1000s suggested 5 deaths per 100,000 prescriptions, and that TCAs involved in around a … of all fatal overdoses
A
  • Neurological and cardiovascular effects:
    • Confusion, tachycardia and other arrythmias, hypotension, mydriasis - seizures, coma, cardiorespiratory arrest
    • Studies in 1000s suggested 5 deaths per 100,000 prescriptions, and that TCAs involved in around a third of all fatal overdoses
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19
Q

TCA overdose deaths …./10^6 scripts

A

TCA overdose deaths 34.14/10^6 scripts

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20
Q

SSRIS overdose deaths …./10^6 scripts

A

SSRIS overdose deaths 2.02/10^6 scripts

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21
Q

Consistent finding that … are much more dangerous in overdose

A

Consistent finding that TCAs are much more dangerous in overdose

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22
Q

Venlafaxine

  • S…RI (serotonin and … reuptake inhibitor)
  • Not a TCA or SSRI- chemically distinct
  • Appears to have … pronounced dose-response effect than other antidepressants
  • Some evidence that it is particularly effective for mixed anxiety and depression
  • Side effects: headache, nausea, hypertension, discontinuation syndrome
A
  • SNRI (serotonin and noradrenaline reuptake inhibitor)
  • Not a TCA or SSRI- chemically distinct
  • Appears to have more pronounced dose-response effect than other antidepressants
  • Some evidence that it is particularly effective for mixed anxiety and depression
  • Side effects: headache, nausea, hypertension, discontinuation syndrome
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23
Q

Venlafaxine

  • S…RI (serotonin and … reuptake inhibitor)
  • Not a TCA or SSRI- chemically distinct
  • Appears to have … pronounced dose-response effect than other antidepressants
  • Some evidence that it is particularly effective for … … and depression
  • Side effects: headache, nausea, hypertension, …. syndrome
A
  • SNRI (serotonin and noradrenaline reuptake inhibitor)
  • Not a TCA or SSRI- chemically distinct
  • Appears to have more pronounced dose-response effect than other antidepressants
  • Some evidence that it is particularly effective for mixed anxiety and depression
  • Side effects: headache, nausea, hypertension, discontinuation syndrome
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24
Q

Duloxetine – also an SNRI – without concerns re …

A

Duloxetine – also an SNRI – without concerns re hypertension

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25
_MAOIs_ * Prevents action of ... ... * Thereby preventing 5-HT, DA and NA being broken down
* Prevents action of Monoamine Oxidase * Thereby preventing 5-HT, DA and NA being broken down
26
_MAOIs_ * Prevents action of Monoamine Oxidase * Thereby preventing 5-HT, DA and NA being broken down
* Prevents action of Monoamine Oxidase * Thereby preventing 5-HT, DA and NA being broken down
27
_MAOIs interactions_ * Foods * Which ones? * Most ..., red wine, ... production liver, broad bean pods, fermented sausages – salami etc. * T... * Hypertensive effect -\> HYPERTENSIVE CRISIS * Moclebamide is much lower risk
* Foods * Which ones? * Most cheeses, red wine, yeast production liver, broad bean pods, fermented sausages – salami etc. * TYRAMINE * Hypertensive effect -\> HYPERTENSIVE CRISIS * Moclebamide is much lower risk
28
_MAOI interactions cont_ * Drugs * ... syndrome * DO NOT COMBINE WITH SSRIs * Autonomic hyperactivity * Neuromuscular abnormality * Mental status changes * Adrenaline and noradrenaline * L-Dopa
* Drugs * Serotonin syndrome * DO NOT COMBINE WITH SSRIs * Autonomic hyperactivity * Neuromuscular abnormality * Mental status changes * Adrenaline and noradrenaline * L-Dopa
29
_Summary of actions - Antidepressants_
30
_Summary of actions - Antidepressants_
31
Depression - flow chart
32
_Antipsychotics_ * Licenced uses: * Psychotic illnesses * ... ... disorder * ... therapy for depressive episodes * Off-licence uses: * Anxiety disorders * ... disturbance in dementia and learning disability * ... disorder * ... disorder * PTSD * And many more…
* Licenced uses: * Psychotic illnesses * Bipolar affective disorder * Adjunctive therapy for depressive episodes * Off-licence uses: * Anxiety disorders * Behavioural disturbance in dementia and learning disability * Conduct disorder * Personality disorder * PTSD * And many more…
33
_Dopamine_ * What is it? * Monoamine neurotransmitter * Metabotropic, G-protein coupled receptors * Precursor = ... * What does dopamine do? * ... functions * Motor control * M.. * Reward * L... * Nausea
* What is it? * Monoamine neurotransmitter * Metabotropic, G-protein coupled receptors * Precursor = Tyrosine * What does dopamine do? * Executive functions * Motor control * Motivation * Reward * Lactation * Nausea
34
_Dopamine_ * What is it? * ... neurotransmitter * ..., G-protein coupled receptors * Precursor = Tyrosine * What does dopamine do? * Executive functions * Motor control * Motivation * R.. * Lactation * N...
* What is it? * Monoamine neurotransmitter * Metabotropic, G-protein coupled receptors * Precursor = Tyrosine * What does dopamine do? * Executive functions * Motor control * Motivation * Reward * Lactation * Nausea
35
_Dopamine pathways_
36
So what goes wrong in schizophrenia?
We know that “too much dopamine” can cause psychotic symptoms
37
_Typical Antipsychotics_
38
_Typical Antipsychotic Side Effects_ * Dopamine has inhibitory effect on ... release - reduced dopamine by D2 antipsychotics therefore cause ... * Too little dopamine effect in nigrostriatum causes ...
Dopamine has inhibitory effect on prolactin release - reduced dopamine by D2 antipsychotics therefore cause hyperprolactinaemia Too little dopamine effect in nigrostriatum causes EPSE
39
Neuroleptics or "typical antipsychotics" were introduced when? What is efficacy like? What side effects?
1950s various different classes of drug, all have roughly similar efficacy - neurological side effects include EPSEs - parkinsonism, akathisia, dystonia and tardive dyskinesia which develops in approx 5% of patients on long-term antipsychotic medication per year
40
_Other neurotransmitter systems and psychosis_ Serotonin hypothesis: some .... drugs (e.g. LSD) have structural resemblance to serotonin, some newer antipsychotic drugs (especially ...) act at serotonin receptors Glutamate hypothesis: ... - glutamate agonist that can produce schizophrenia like symptoms, some evidence of abnormal glutamate activity in schizophrenia
Serotonin hypothesis: some hallucinogenic drugs (e.g. LSD) have structural resemblance to serotonin, some newer antipsychotic drugs (especially clozapine) act at serotonin receptors Glutamate hypothesis: PCP - glutamate agonist that can produce schizophrenia like symptome, some evidence of abnormal glutamate activity in schizophrenia
41
.... .... develops in approx 5% of patients on long-term antipsychotic medication per year (typical antipsychotics)
tardive dyskinesia which develops in approx 5% of patients on long-term antipsychotic medication per year
42
Examples of typical antipsychotics: * Butyrophenones: **H...** * Phenothiazines: **C...**, Trifluoperazine, Fluphenazine * Thioxanthines: Flupenthixol * Differ mainly in terms of side effect profiled, degree of sedation and preparations available (e.g. depot forms)
* Butyrophenones: **Haloperidol** * Phenothiazines: **Chlorpromazine**, Trifluoperazine, Fluphenazine * Thioxanthines: Flupenthixol * Differ mainly in terms of side effect profiled, degree of sedation and preparations available (e.g. depot forms)
43
_Atypical antipsychotics_ * Newer drugs with less propensity to cause ... - they still can and do cause them * Different mechanism of action - generally not as specific for .... receptors, also act on serotonin (...) system * Not neccessarily any more effective than older "typicals" * Examples: R..., olanzapine, Q..., aripiprazole * Neurological side effects less common/severe than with typicals * Problems with weight gain and 'metabolic syndrome' (new-onset diabetes), particularly with olanzapine
* Newer drugs with less propensity to cause EPS - they still can and do cause them * Different mechanism of action - generally not as specific for D2 receptors, also act on serotonin (5HT) system * Not neccessarily any more effective than older "typicals" * Examples: risperidone, olanzapine, quetiapine, aripiprazole * Neurological side effects less common/severe than with typicals * Problems with weight gain and 'metabolic syndrome' (new-onset diabetes), particularly with olanzapine
44
_Atypical antipsychotics_ * ... drugs with less propensity to cause EPS - they still can and do cause them * Different mechanism of action - generally not as specific for D2 receptors, also act on serotonin (5HT) system * Not neccessarily any more effective than older "typicals" * Examples: risperidone, ..., quetiapine, ... * Neurological side effects ... common/severe than with typicals * Problems with ... ... and '... syndrome' (new-onset diabetes), particularly with ...
* Newer drugs with less propensity to cause EPS - they still can and do cause them * Different mechanism of action - generally not as specific for D2 receptors, also act on serotonin (5HT) system * Not neccessarily any more effective than older "typicals" * Examples: risperidone, olanzapine, quetiapine, aripiprazole * Neurological side effects less common/severe than with typicals * Problems with weight gain and 'metabolic syndrome' (new-onset diabetes), particularly with olanzapine
45
_Thinking about side effects - down to receptors_ * Occur because - side effect of the direct action of the drug (antipsychotics and ...) * but also happen due to other receptors affected by the drug (antipsychotics and ..., muscarinic, alpha 1 & 2 receptors)
* Occur because - side effect of the direct action of the drug (antipsychotics and dopamine) * but also happen due to other receptors affected by the drug (antipsychotics and histamine, muscarinic, alpha 1 & 2 receptors)
46
_Dopamine receptor blockade side effects_ * .... side effects * Parkinsonism * Dystonias * Tardive .... * ....
* Extrapyramidal side effects * Parkinsonism * Dystonias * Tardive Dyskinesia * Hyperprolactinaemia
47
_Muscarinic (cholinergic) receptor side effects_ * C..., dyspepsia, .... vission, dry eyes, T..., somnolence, impaired memory and cognition, D...
Constipation, dyspepsia, blurred vission, dry eyes, tachycardia, somnolence, impaired memory and cognition, dizziness
48
_Alpha adrenergic receptor side effects_ * Orthostatic ..., vertigo, p..., .... dysfunction
* Orthostatic hypotension, vertigo, palpitations, sexual dysfunction
49
_Clozapine_ * Reserved for ...-resistant cases * ... effective antipsychotic * Problems with ... side-effects (in 1-3%) necessitate blood test monitoring * Acts on range of neurotransmitter systems (including D4 receptors and serotonin system) * ... propensity to cause EPS * Hypersalivation and hypotension may occur
* Reserved for treatment-resistant cases * Most effective antipsychotic * Problems with haematological side-effects (in 1-3%) necessitate blood test monitoring * Acts on range of neurotransmitter systems (including D4 receptors and serotonin system) * Low propensity to cause EPS * Hypersalivation and hypotension may occur
50
_Clozapine_ * Reserved for treatment-resistant cases * Most effective antipsychotic * Problems with haematological side-effects (in ...-...%) necessitate blood test monitoring * Acts on range of neurotransmitter systems (including D4 receptors and serotonin system) * Low propensity to cause ... * ... and ... may occur
* Reserved for treatment-resistant cases * Most effective antipsychotic * Problems with haematological side-effects (in 1-3%) necessitate blood test monitoring * Acts on range of neurotransmitter systems (including D4 receptors and serotonin system) * Low propensity to cause EPS * Hypersalivation and hypotension may occur
51
Clozapine - can't forget ...
constipation! can be fatal - toxic megacolon
52
_Rapid transquillisation_ * For acute agitation/aggression where risk of harm to self or others * oral first * IM * Antipsychotics - ... or olanzapine * Benzodiazepines - ... or midazolam * Check local protocols - treat underlying cause
* For acute agitation/aggression where risk of harm to self or others * oral first * IM * Antipsychotics - haloperidol or olanzapine * Benzodiazepines - lorazepam or midazolam * Check local protocols - treat underlying cause
53
_Rapid transquillisation_ * For acute .../... where risk of harm to ... or ... * oral first * IM * Antipsychotics - haloperidol or olanzapine * Benzodiazepines - lorazepam or midazolam * Check local protocols - treat underlying cause
* For acute agitation/aggression where risk of harm to self or others * oral first * IM * Antipsychotics - haloperidol or olanzapine * Benzodiazepines - lorazepam or midazolam * Check local protocols - treat underlying cause
54
_Mood stabilisers_
* Lithium * Valproate * Carbamazepine * Lamotrigine * Other anticonvulsants e.g. gabapentin
55
_Lithium_ * Certain mode of action * Second messenger - inhibition of ... * Regulation of gene expression - protein ... C
* Certain mode of action * Second messenger - inhibition of inositol * Regulation of gene expression - protein kinase C *
56
Lithium - short term side effects
polydipsia and polyuria, nausea, fine tremor, loose stools
57
Lithium - long term side effects
renal impairment, hypothyroidism, weight gain, acne
58
_Lithium toxicity_ * ... ... index - 0.4-1.2mmol/L * Coarse ..., nausea and ...., ataxia and .... signs, confusion * Precipitants: - dehydration (e.g. in ...), drug interactions-thiazides, NSAIDs, deteriorating renal function
* Narrow therapeutic index - 0.4-1.2mmol/L * Coarse tremor, nausea and vomiting, ataxia and cerebellar signs, confusion * Precipitants: - dehydration (e.g. in diarrhoea), drug interactions-thiazides, NSAIDs, deteriorating renal function
59
_Lithium toxicity_ * Narrow therapeutic index - 0.4-1.2mmol/L * Coarse tremor, nausea and vomiting, .... and cerebellar signs, .... * Precipitants: - .... (e.g. in diarrhoea), drug interactions-thiazides, NSAIDs, .... renal function
* Narrow therapeutic index - 0.4-1.2mmol/L * Coarse tremor, nausea and vomiting, ataxia and cerebellar signs, confusion * Precipitants: - dehydration (e.g. in diarrhoea), drug interactions-thiazides, NSAIDs, deteriorating renal function
60
_Valproate_ * Effect on ... of Ca and Na channels * ... inhibitory GABA * ... excitatory glutamate * Effective in ... mania, not effective in ... phase * ease of use * improved tolerability * weight gain * teratogenic - plus developmental disorders
* Effect on inhibition of Ca and Na channels * Enhances inhibitory GABA * Reduces excitatory glutamate * Effective in acute mania, not effective in depressive phase * ease of use * improved tolerability * weight gain * teratogenic - plus developmental disorders
61
_Valproate_ * Effect on inhibition of Ca and Na channels * Enhances inhibitory GABA * Reduces excitatory glutamate * Effective in acute mania, not effective in depressive phase * ease of use * improved ... * ... gain * ... - plus developmental disorders
* Effect on inhibition of Ca and Na channels * Enhances inhibitory GABA * Reduces excitatory glutamate * Effective in acute mania, not effective in depressive phase * ease of use * improved tolerability * weight gain * teratogenic - plus developmental disorders
62
_Carbamazepine_ * Antimanic but ... effective than lithium * major problems with drug ... * ... liver enzymes so ... levels of other agents * other agents in turn alter CBZ metabolism
* Antimanic but less effective than lithium * major problems with drug interactions * reduces liver enzymes so reducing levels of other agents * other agents in turn alter CBZ metabolism
63
_Benzodiazepines_ * Commonly used ones - diazepam, lorazepam, clonazepam, temazepam, clobazam (benzo derivative) * Differ mainly in potency, half-life duration of action (lorazepam ...-acting, clonazepam ...-acting)
* Commonly used ones - diazepam, lorazepam, clonazepam, temazepam, clobazam (benzo derivative) * Differ mainly in potency, half-life duration of action (lorazepam short-acting, clonazepam longer-acting)
64
_Benzodiazepines - uses in psychiatry_ * ..., anxiolytics, "... tranquillisers" - role in acute transquillisation, management of ... withdrawal, also ... (esp. clobazam) and muscle relaxant, bind to BZP site on GABA-A receptor, ... is main inhibitory neurotransmitter in CNS
* hypnotics, anxiolytics, "minor tranquillisers" - role in acute transquillisation, management of alcohol withdrawal, also anticonvulsant (esp. clobazam) and muscle relaxant, bind to BZP site on GABA-A receptor, GABA is main inhibitory neurotransmitter in CNS
65
_Dependency - benzos_ * ..., withdrawal - abrupt withdrawal can precipitate acute ..., rarely psychosis, ... * other withdrawal symptoms include ..., hyperacusis, dizziness and imbalance, tinnitus, ... * ... lengthy prescriptions * tapered withdrawal using 'diazepam equivalents' * but - there will be a very small subgroup of patients for whom long term treatment is ...
* Tolerance, withdrawal - abrupt withdrawal can precipitate acute delirium, rarely psychosis, convulsions * other withdrawal symptoms include nausea, hyperacusis, dizziness and imbalance, tinnitus, depersonalization * avoid lengthy prescriptions * tapered withdrawal using 'diazepam equivalents' * but - there will be a very small subgroup of patients for whom long term treatment is indicated
66
_Management of alcohol withdrawal_ * Reducing regimen of ... * ... supplementation - oral, IM/IV * Additional aids to maintain abstinence - ... reduces cravings, ... reduces cravings/enjoyment via opiod receptors, ... (antabuse) induces severe reaction if alcohol consumed
* Reducing regimen of benzodiazepines * Vitamin supplementation - oral, IM/IV * Additional aids to maintain abstinence - acamprosate reduces cravings, naltrexone reduces cravings/enjoyment via opiod receptors, disulfiram (antabuse) induces severe reaction if alcohol consumed
67
_Other anxiolytics_ * ... - binds to and modulates voltage-gated calcium channels in CNS, originally developed for use in neuropathic pain but has a growing use in anxiety and panic disorder, also in partial seizures, concerns re misuse * .... - partial agonist at 5HT-1a receptors, licensed for use in generalised anxiety disorder - doubts over efficacy
* Pregablin - binds to and modulates voltage-gated calcium channels in CNS, originally developed for use in neuropathic pain but has a growing use in anxiety and panic disorder, also in partial seizures, concerns re misuse * Buspirone - partial agonist at 5HT-1a receptors, licensed for use in generalised anxiety disorder - doubts over efficacy
68
Dont forget psychological and social interventions!
also effective, patient choice, side effects too!

Module 308 (17 decks)

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