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Pharma ESA4 > Psychiatric Disease > Flashcards

Psychiatric Disease Flashcards

(57 cards)

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1
Q

What are the general actions of CNS drugs?

A

Agonists/antagonists of neurotransmitter receptors

Inhibitors of regulatory enzymes

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2
Q

What are the key transmission/modulatory CNS pathways?

A 
Noradrenaline
Dopamine
Serotonin
GABA
Acetylcholine
Glutamate
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3
Q

What factors can affect psychiatric disorders?

A 
Genetic vulnerability
Life events
Individual personality
Coping skills/social support
Environmental influences (viruses, toxins, drugs, health)
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4
Q

What are the secondary symptoms of depression?

A 
Decreased appetite
Sleep disturbance
Hopelessness
Poor concentration
Irritability
Self harm/suicidal ideas or acts
Reduced libido
May have psychotic symptoms
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5
Q

Why are monoamine oxidase inhibitors (MAOIs) not often given? (MAOIs inhibit destruction of neurotransmitters)

A

Dietary restrictions (tyramine, found in a lot of foods), which if broken can manifest as severe hypertension with a risk of death.

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6
Q

What are the three theories of depression cause?

A 
Monoamine hypothesis (deficit of serotonin/noradrenaline)
Neurotransmitter receptor hypothesis (malformations of receptor shape for neurotransmission)
Monoamine hypothesis of gene expression (deficiency in molecular functioning)
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7
Q

What are SSRIs used to treat?

A

Moderate to severe depression (first line)

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8
Q

Which SSRIs are given?

A

Fluoxetine
Citalopram (most selective)
Paroxetine (most potent)
Sertraline

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9
Q

Should SSRIs be given alone?

A

No - Psychiatric therapy in conjunction for max effectiveness (eg: CBT)

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10
Q

What are the pharmokinetic features of SSRIs?

A

Almost totally absorbed from the gut
Long elimination half-life lives (dose once daily)
Metabolised in liver

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11
Q

What are the side effects of SSRIs?

A

(common)
Anorexia, nausea, diarrhoea
(Rare)
Precipitation of mania, increased suicidal ideation, tremor, extrapyramidal syndromes
Reasonably safe in overdose if taken alone

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12
Q

What are TCAs?

A

Tricyclic antidepressants
(Not first line)
Amitriptyline, imipramine, clomipramine, lofepramine

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13
Q

What are the effects of TCAs?

A

Inhibition of noradrenaline uptake (↑ transmission)
Muscarinic cholinoceptor blockade (↓ transmission)
Alpha 1 adrenoreceptor blockade (suppresses transmission)

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14
Q

What are the pharmokinetics of TCAs?

A

As SSRIs

Lipid soluble

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15
Q

What are the side effects of TCAs?

A

Sedation, impairment of psychomotor performance, low seizure threshold
Reduction in glandular secretions, eye accomodation block
Tachycardia, postural hypertension, ↓myocardial contractility
Constipation
MORE dangerous in overdose

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16
Q

What are SNRIs?

A

Serotonin and noradrenaline uptake inhibitors
(Second/third line)
Eg: venlafaxine and duloxetine
Can be anxiolytic at high doses

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17
Q

What are the side effects of SNRIs?

A

As with SSRIs
Sleep disturbance, ↑BP, dry mouth, hyponatremia
Short half life, thus potential for withdrawal on discontinuation

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18
Q

What are the symptoms of schizophrenia?

A 
Disturbance of thinking
Hallucinations
Delusions
Unusual speech-thought disorder
Behavioural changes
Lack of insight
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19
Q

What is the dopamine theory of schizophrenia?

A

Excess dopaminergic pathway stimulation in schizophrenia
(Dopamine antagonists are best schizophrenia treatment, BUT other methods (eg amphetamine) only cause positive symptoms, not negative, and dopamine antagonists don’t treat negative symptoms)

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20
Q

What are the main dopaminergic pathways?

A

Mesolimbic ()
Mesocortical ()
Nigrostriatal
Tuberoinfundibular

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21
Q

What does the mesolimbic pathway handle?

A

Emotional response and behaviour

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22
Q

What does the mesocortical pathway handle?

A

Arousal and mood

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23
Q

What are the effects of blocking D2 receptors?

Study These Flashcards
A

Mesolimbic: ↓ positive psychotic symptoms
Mesocortical: ↑ negative and cognitive psychotic symptoms
Nigrostriatal: tardive dyskinesia, extrapyramidal side effects
Tuberoinfundibular: hyperprolactinaemia (lactation, infertility, sexual dysfunction)

24
Q

Is schizophrenia associated with increased 5HT function?

Study These Flashcards
A

Yes - 5HT-2A antagonists are effective antipsychotics

5HT implicated in behaviours disturbed during schizophrenia (appetite, mood, attention, aggression, sexual drive)

25
Is schizophrenia associated with decreased cortical glutamate function?
Post mortems show ↑ cortical glutamate receptors and binding of receptor ligands in cortex, basal ganglia, and hippocampal formation. However, no current treatments targeting this system.
26
What are the actions of antipsychotics?
Sedation, tranquillisation (in hours) Antipsychotic (days to weeks) (Side effects - ↑ negative symptoms in weeks (unlikely in typical antipsychotics), extrapyramidal in hours to days (unlikely in atypical antipsychotics))
27
What are the benefits of atypical antipsychotics?
Less extrapyramidal side effects Different preparations - dissolvable Some only need one dose daily
28
Which atypical antipsychotics are usually given?
Risperidone Quetiapine Olanzapine
29
What are the side effects of atypical antipsychotics?
``` Sedation Can have extrapyramidal side effects at high doses Very drug to drug: Olanzapine - weight gain Risperidone - increased prolactin ```
30
What is clozapine?
The most effective antipsychotic, atypical. | However, severe side effects thus given as third line agent.
31
What are the side effects of clozapine?
``` Severe constipation Sedation Hypersalivation Extreme weight gain Neutropenia/agranulocytosis ```
32
What is haloperidol?
A typical antipsychotic Safe to give in emergencies (side effects well known) Sedating effect
33
What is the range of action of haloperidol?
Dopamine receptor blockade Anticholinergic effects Alpha-adrenergic blockade Antihistamine effects
34
What are the side effects of haloperidol?
``` Extrapyramidal: Parkinsonism, acute dystonia, akathisia, tardive dyskinesia Neuroleptic malignant syndrome: Severe rigidity, hyperthermia, ↑CPK, autonomic lability Postural hypertension Weight gain Pigmentation Hyperprolactinaemia ```
35
What are the toxic effects of haloperidol?
CNS depression Cardiac toxicity Risk of sudden death with high dose
36
What is anxiety?
Fear out of proportion to the situation Manifests in: avoidance, fear, light headedness, shortness of breath, hot and cold flush, nausea, palpitations, numbness, pins and needles
37
How is anxiety treated?
Non pharmacologically at first (CBT) Treat coexisting disorders Drugs - antidepressants, anxiolytics, very occasionally antipsychotics
38
What are the principle neurotransmitter systems involved with anxiety?
GABA Serotonin Noradrenaline
39
What are benzodiazepines? (Eh: diazepam, lorazepam)
Exerts effects through binding to high affinity BDZ receptor, which normally forms a GABA-BDZ complex. Full agonist at these receptor sites, enhancing GABA.
40
What issues are there with benzodiazepines?
Highly addictive (dependence leads to withdrawal) Negative side effects Reduced benefit over time (tolerance)
41
What are the pharmokinetics of benzodiazepines?
Readily bioavailable following oral administration Rapid acting: 30-90 minutes Highly lipid soluble, allowing for rapid CNS diffusion Renally excreted Long half life
42
What are the side effects of benzodiazepines?
Common: Drowsiness, dizziness, psychomotor impairment Occasional: Dry mouth, blurred vision, GI upset, ataxia, headache, ↓BP Rare: Amnesia, restlessness, rash
43
What is bipolar disorder?
A psychiatric disorder consisting of episodes of depression and hypomania/mania
44
Which drugs act as mood stabilisers?
``` Lithium Sodium valproate Carbamezepine Lamotrigine Antipsychotics ```
45
What is the action of lithium?
Unknown May compete with Mg/Ca ions in ion channels ↑5HT Attenuates effect of some neurotransmitters on their receptors
46
What are the pharmokinetics of lithium?
Renally excreted Slowly release preparations once daily Levels need to be monitored and taken 12 hours after last oral dose Check renal and thyroid function every 6 months and before starting
47
What are the uses of lithium?
Prophylaxis of mania and depression in bipolar disorder Augmentation of antidepressants in unipolar depression Reduces suicidality Best evidence as a mood stabiliser
48
What are the side effects of lithium?
``` (Hypothyroidism, hair loss, rashes) Memory problems (52%) Thirst (42%) Polyuria (38%) Tremor (34%) Drowsiness (24%) Weight gain (18%) ```
49
What are the toxic effects of lithium?
Monitor blood levels closely Vomiting, diarrhoea Coarse tremor, dysarthria Cognitive impairment, restlessness, agitation
50
Which antiepilieptics work as mood stabilisers?
Sodium valproate Lamotrigine Carbamezepine
51
What is the chief side effect of antiepilieptic mood stabilisers?
Teratogenic if taken during pregnancy
52
Which groups of drugs are used to treat dementia?
Acetylcholine cholinesterase inhibitors (Donepezil, galantamine, rivastigmine) NDMA antagonists (Memantine)
53
What are AChE-I drugs used to treat?
Mild to moderate dementia
54
What does ACh handle?
Arousal, memory, attention, mood
55
What are the side effects of AChE-Is?
Nausea, vomiting, diarrhoea, gastric/duodenal ulcers Fatigue, insomnia, headache Bradycardia Worsens COPD
56
What is memantine used to treat?
Moderate to severe dementia | NDMA receptor antagonist
57
What are the side effects of memantine?
Usually well tolerated | Hypertension, dyspnoea, headache, dizziness, drowsiness

Pharma ESA4 (8 decks)

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