Psych drugs

Question 1

Function of benzodiazepine

Answer 1

1. Anxiolytic

2. Hypnotic agent

Question 2

Name 3 classes of benzodiazepine

Answer 2

1. Short acting: Midazolam
2. Intermediate acting: Lorazepam, alprazolam
3. Longer acting: Diazepam

Question 3

MOA of benzodiazepine (BZD)

Answer 3

1. bind to CNS BZD sites
2. potentiates GABA action on
3. GABA dependent binding
4. increase frequency chloride channels opening

note GABA is inhibitory neurotransmitter

Question 4

Route of administration of BZD

Answer 4

1. Oral fast onset 30mins-1hr

2. IV: midazolam, lorazepam, diazepam

Question 5

Adverse effects of BZD (7)

Answer 5

4 CNS + 1 CVS

1. Sedation
2. Increase drowsiness, reaction time + Decrease motor skill
3. Anterograde amnesia (forget after drug– esp in IV)
4. Decrease BP & respiration in predisposed pt (eg IHD)
5. Paradoxical effect of hallucination/excitement/violence (due to disinhibition by BZD where behaviour normally suppressed)
6. Floppy child syndrome: 3rd trimester (pls don’t give ans in elderly)
7. Tolerance & dependence, withdrawal

Question 6

What’s the characteristic of benzodiazepine induced sleep?

Answer 6

Reduced REM & deep stage 4 sleep

compared to natural sleep

Question 7

Will overdose BZD result in toxicity?

Answer 7

No, GABA dependent

Question 8

What’s insomnia?

Answer 8

1. difficulty falling asleep
2. maintaining sleep
3. early morning awakening

–> affects next day fn

Question 9

Causes of insomnia

Answer 9

Internal

1. anxiety
2. depression

External

1. drug induced -caffeine
2. drug withdrawal- eg. from alcohol/ sleeping pill

Question 10

What are the 2 Non-benzodiazepine hypnotics?

Answer 10

Zolpidem, zopiclone

Question 11

MOA of non BZD hypnotics

Answer 11

Act on BZD sites similar to BZD

Question 12

Adverse effects of non BZD hypnotics

Answer 12

1. withdrawal

2. abuse potential

Question 13

What’s depression?

Answer 13

1. symptoms persist for at least 2 weeks

2. severity of symptoms interfere w normal functioning

Question 14

What’s depression due to?

Answer 14

deficiency of monoamines (dopamine/serotonin/noradrenaline)

Question 15

What are the 4 drug classes of Antidepressants?

Answer 15

1. SSRI
2. TCA (more effect on NA> serotonin): amitriptyline, imipramine
3. SNRI
4. NaSSa

Question 16

How do SSRI work?

Answer 16

Block reuptake of monoamines in synaptic cleft back into pre-synpatic neuron

increase BDNF in post synaptic neuron

Question 17

Name the 4 SSRIs

Answer 17

1. Fluoxetine
2. Paroxetine
3. Sertraline
4. Escitalopram

Question 18

DDI of selective serotonin reuptake inhibitor

Answer 18

Inhibition CYP450 enzymes

fluoxetine> paroxetine > sertraline> escitalopram

** eg pt taking anti-hypertensives–> may become hypotensive low BP fainty giddy

Question 19

What are the SSRI adverse effects? (4)

Answer 19

1. Anxiety
2. Weight loss/gain
3. Headache, nausea
4. Sexuality dysfunction

no fatality in overdose

Question 20

What are the TCAs adverse effects? (4)

Answer 20

1. CNS: sedation & fatigue
2. CVS: tachycardia, arrhythmias, postural hypotension
3. Anticholinergic effect: glaucoma, blurred vision, urinary retention, constipation

Question 21

What happens if you take too much TCAs amitriptyline/imipramine?

Answer 21

Overdose fatality

Question 22

Weighing which antidepressant to give?

Answer 22

SSRI– non fatal on overdose
** given to pt w suicide tendencies

TCA– gold standard for severe depression (but CVS arrhythmia)

Atypical antidepressant Mirtazapine– sedating, gd for insomnia

Question 23

Adult neurogenesis in hippocampus/olfactory bulb is upregulated by?

Answer 23

1. exercise
2. enriched env
3. learning (hippocampal)
4. estrogen
5. AD

Question 24

Effect of AD drugs on hippocampus

Answer 24

1. increased BDNF in hippocampus

2. BDNF protects neurons from neurotoxic damange

Question 25

Adult neurogenesis is down-regulated by?

Answer 25

1. Stress 2. glucocorticoids 3. age 4. opiates 5. excitatory aa

Question 26

Psychosis is caused by? (hypothesis)

Answer 26

excess dopamine transmission (mscl system)

Question 27

Schizophrenia symptoms & duration (+ve & -ve symptoms)

Answer 27

++ve symptoms 1. delusion 2. hallucination - -ve symptoms 1. blunting of affect 2. poor [ ] > 6 months

Question 28

Name the 2 clasess of anti-psychotic drugs

Answer 28

1. Typical (first gen): low potency chlorpromazine, high potency haloperidol 2. Atypicals (second gen): ROQCA

Question 29

What's the difference b/n 1st & 2nd generation antipscyhotics?

Answer 29

typicals block more dopamine R than serotonin R

Question 30

MOA of antipsychotics

Answer 30

1. TYPICAL block D2 > 5-HT2 R + block D,M,H,AA 2. ATYPICAL 5HT2> D

Question 31

What is the Adverse effect of typical antipsychotic drugs?

Answer 31

Extra pyramidal side effects

Question 32

What does EPSE entail? (ADAPT from early to late onset symptoms)

Answer 32

``` Acute Dystonia Akathisia (cannot sit still) Parkinsonism Tardive dyskinesia ``` malignant syndrome (catatonia, myoglobinemia etc - can be fatal)

Question 33

What are the adverse effects of the atypical antipsychotic drugs?

Answer 33

Less EPSE but... 1. risperidone - epse dose dependent 2. clozapine- agranulocytosis 2% pt 3. olanzepine - sedation + weight gain 4. quetiapine - weight gain