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Misc. Notes Year 3 > Psychiatry Drugs > Flashcards

Psychiatry Drugs Flashcards

(77 cards)

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1
Q

How long do anti-depressants typically take to work

A

4-6 weeks

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2
Q

How is non-response to an anti-depressant defined

A

No response or inadequate response after six weeks at the maximum BNF dose or highest tolerated dose

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3
Q

How long should you continue treatment after full resolution of symptoms after a first episode

A

6-12 months

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4
Q

How long should you continue treatment after full resolution of symptoms after a second episode

A

12-24 months

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5
Q

How long should you continue treatment after full resolution of symptoms after a third recurrence

A

Continue indefinitely if willing

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6
Q

What is the mainstay of treatment for Bipolar Disorder

A

Mood stabiliser (lithium) + anti-convulsant + anti-psychotic

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7
Q

What should you never give on its own for someone with Bipolar disorder and why not

A

Anti-depressant should not be given without a mood stabiliser
Can set patient to rapid cycling bipolar

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8
Q

What does SSRI stand for

A

Selective Serotonin Reuptake Inhibitor

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9
Q

Give 3 examples of SSRI’s

A

Citalopram, Fluoxetine, Sertraline

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10
Q

What is the first line drug treatment for major depressive disorder

A

SSRI’s

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11
Q

What side effect can SSRIs cause in elderly patients

A

Hyponatraemia

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12
Q

What side effect can SSRIs cause in under 25’s

A

Transient increase in self-harm / suicidal ideation

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13
Q

What time of day should SSRIs be taken

A

In the morning

to avoid insomnia

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14
Q

Name some general SSRI side effects

A

GI upset, anxiety, agitation, insomnia, sexual dysfunction

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15
Q

What is there an increased risk of, if SSRIs are taken with NSAIDS

A

GI bleeding

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16
Q

Which SSRI is safest in a patient with cardiac problems

A

Sertraline

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17
Q

Which SSRI is safest in a patient with epilepsy

A

Citalopram

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18
Q

What is the mechanism of action of SSRIs

A

Selectively inhibit reuptake of serotonin (5-HT) from the synaptic cleft

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19
Q

What class of drug is Amitriptyline

A

Tricyclic Antidepressant

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20
Q

Name 3 tricyclic antidepressants (not amitriptyline)

A

Imipramine
Clomipramine
Dosulepin

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21
Q

Why are tricyclic antidepressants not the first line for depression despite being as effective as SSRIs

A

Cardiac side effects

Dangerous in overdose

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22
Q

What effect do tricyclics have on weight

A

Weight gain

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23
Q

What time of day should tricyclics be taken

A

At night due to sedation side effect

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24
Q

Name some anticholinergic effects and which anti-depressant drug class can cause these

A 
Tricyclic antidepressants can cause: 
Blurred vision
Dry mouth
Constipation
Urinary retention
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25
What kind of drug is Mirtazapine
Noradrenergic and Specific Serotonergic Antidepressant (NaSSA)
26
When could Mirtazapine be used 1st line in depression
May be used first line if the patient has insomnia and/or poor appetite
27
What is a characteristic side effect of Mirtazapine
Increase in appetite
28
When should Mirtazapine be taken
Night time due to sedation effect
29
Which anti-depressant can cause GI upset when taken with alcohol
Mirtazapine
30
What does SNRI stand for
Serotonin Noradrenaline Reuptake Inhibitor
31
How do SNRIs work
Block the reuptake of monoamines (noradrenaline and 5-HT) into presynaptic terminals
32
Name 2 SNRIs
Duloxetine | Venlafaxine
33
Which drug combination can be very very effective in treating depression which hasn't responded to SSRI's
Mirtazapine + Venlafaxine | "california rocket fuel"
34
Which SNRI can also be used to treat neuropathic pain and bladder instability
Duloxetine
35
What time of day should SNRIs be taken
Morning to avoid insomnia side effect
36
What are the side effects of SNRIs
Similar to SSRIs: | GI upset, anxiety, agitation, insomnia, sexual dysfunction
37
What does MAOI stand for
Monoamine oxidase inhibitor
38
How do MAOIs work
Inhibitors of MAO-A and B -> decreased breakdown of the monoamine neurotransmitters (norepinephrine, serotonin, dopamine) leading to increased levels in the synapse
39
What are the differences between reversible and irreversible MAOIs
Reversible MAOIs are typically less effective but also have fewer side effects
40
Name a reversible MAOI
Moclobemide
41
Name an irreversible MAOI
Phenelzine
42
What are some minor side effects of MAOIs
Postural Hypotension Insomnia Peripheral oedema
43
What is the major side effect of MAOIs (concerning diet)
Hypertensive crisis
44
Which amine can cause a hypertensive crisis as a side effect of MAOIs
Tyramine
45
How does a hypertensive crisis occur when a patient is on an MAOI
Tyramine is a potent releaser of norepinephrine -> elevated BP. Normally MAO-A breaks down norepinephrine. If MAO-A is inhibited and a high-tyramine meal is taken, norepinephrine can accumulate and cause a hypertensive crisis
46
What are some symptoms of a hypertensive crisis
Headache, shortness of breath, nosebleed, anxiety. Can lead to arrhythmias, stroke, seizures, death
47
What sort of foods have a high tyramine content
Red meats, cheese, wine
48
How is hypertensive crisis treated
Phentolamine infusion (alpha-adrenergic antagonist)
49
What is Trazodone
Serotonin 2 antagonist/reuptake inhibitors (SARI)
50
When would Trazodone be used
Often used when sedation is needed and/or to augment other antidepressants
51
When should Trazodone be taken
Should be taken at night due to sedation
52
What are some side effects of Trazodone
GI upset, dizziness, sedation, tiredness, headache
53
What is the most effective treatment for Bipolar disorder
Lithium carbonate
54
What is the mode of action of Lithium (don't bother about this too much)
May block phosphatidylinositol pathway (second messenger system) or inhibit Glycogen Synthase Kinase 3β
55
Why must 12-hour post-dose blood levels be measured when a patient is on lithium
Because of lithium's narrow therapeutic index
56
What are some side effects of Lithium
``` Dry mouth / strange taste Polydipsia & polyuria Tremor Hypothyroidism Weight gain ```
57
Which endocrine condition can lithium cause as a side effect
Nephrogenic diabetes insipidus
58
When should lithium be taken
At night due to sedation
59
What are some toxic effects of lithium
``` Vomiting Diarrhoea Ataxia / coarse tremor Drowsiness Convulsions Coma ```
60
What is the treatment of lithium toxicity
Stop lithium IV fluids Monitor renal function
61
What kind of drug is Sodium Valproate
Anti-convulsant
62
How does sodium valproate work
Blocks voltage sensitive sodium channels, increases levels of GABA
63
What are some side effects of sodium valproate
sedation, tremor, dizziness, GI upset, tiredness, weight gain. Rarely hepatotoxicity, pancreatitis, increase in suicidal behaviour
64
Why should sodium valproate not be given to women of childbearing age
Teratogenic
65
Name an anticonvulsant apart from sodium valproate
Lamotrigine
66
How does Lamotrigine work
Blocks voltage sensitive sodium channels
67
What are some common side effects of Lamotrigine
GI upset, insomnia, sedation (not common), dizziness, ataxia, tiredness
68
What is a potentially fatal side effect of Lamotrigine
Stevens-Johnson syndrome
69
Name 2 typical antipsychotics
Haloperidol | Chlorpromazine
70
Name 2 atypical antipsychotics
Quetiapine | Olanzapine
71
How do antipsychotics work
Block D2 receptors
72
What are the possible drug treatments for Generalised Anxiety Disorder (GAD)
SSRI/SNRI Pregabalin Benzodiazepines (short term only)
73
What are the possible drug treatments for Panic Disorder
SSRI/SNRI Tricyclic Benzodiazepines (short term only)
74
Which tricyclic antidepressant can be used to treat Obsessive Compulsive Disorder
Clomipramine
75
Which receptor do benzodiazepines act on
GABA-A
76
Which substances also act on the GABA-A receptor
Alcohol | Barbituates
77
Which ion channel is the GABA-A receptor linked to
Chloride ion (allows influx when stimulated)

Misc. Notes Year 3 (25 decks)

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