Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Phase 3A > Psychiatry pharmacology > Flashcards

Psychiatry pharmacology Flashcards

(97 cards)

Start Studying
1
Q

HYPNOTICS - Z DRUGS

Name 2 examples

A

zopiclone

zolpidem

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

HYPNOTICS - Z DRUGS

What are the indications and the MOA of these drugs

A

Short term tx of insomnia that is distressing - Max 4 weeks

Facilitate and enhance binding of GABA to GABA receptor - GABA agonist
Opens chloride channels making cells more resisitant to depolarisation
Similar effect to BDZs but different strucutually - Act on alpha-2 subunit of the receptor

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

HYPNOTICS - Z DRUGS

What are the adverse effects and cations for these drugs

A 
daytiem sleepiness 
rebound insomnia 
headache 
confusion 
nightmares

Elderly - increased risk of falls
Don’t drive
Don’t operate complex/heavy machinery

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

BENZODIAZEPINES

What is the MOA?

A

Enhance effect of inhibitory GABA by increasing frequency of Cl- channels + flow of Cl- ions causing hyperpolarisation of membrane + so prevention of further excitation

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

BENZODIAZEPINES

Wha are some inidcations for BDZs use?

A 
Anticonvulsant - seizures 
Alcohol withdrawal 
sedation 
axiolytic 
muscle relaxant
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

BENZODIAZEPINES

What are some adverse effects of BDZs?

A

Dose dependant drowsiness
tolerance
confusion
dizziness

Monitor fro resp depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

BENZODIAZEPINES

Name some examples and how long should they be prescribed for?

A

Diazepam - longer duration
Lorazepam
Temazepam - shorter duration
Chlordiazepoxide

2-4 weeks due to risks of tolerance and dependence

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

BENZODIAZEPINES

What drugs can BDZs interact with?

A

Anti-hypertensives - Enhanced hypotensive effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

BENZODIAZEPINES
How do you manage a BDZ overdose?
What is the risk of this?

A

IV Flumazenil

Danger of inducing status epilpeticus or death

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

BENZODIAZEPINES

What is BDZs withdrawal syndrome, how does it occur and present?

A

BDZs withdrawa too quickly
Occurs 3 weeks after stopping long-acting drug

Insomnia 
irritability 
anxiety 
tremor 
loss of appetite 
seizures 
perspiration
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

BENZODIAZEPINES

What are some cautions for BDZs usage?

A

Elderly - Increased falls risk

Patients with liver disease - Risk of precipitating HE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

ANTI-DEPRESSANTS
What moniroing is required for patinets starting on anti-depressants?
When can an anti-depressant be stopped?

A

Monitored twice weekly to ensure dose is working and patient is stable

Weekly if <30 due to increased suicide risk

Carried on for 6m followinf sx resolution to reduce risk of relapse

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

ANTI-DEPRESSANTS

How should anti-depressants be stopped?

A

Gradual dose reduction over 4 weeks

Suddenly stopping can cause withdrawal effects:
Rebound depression 
pain 
diarrhoea 
vomiting 
sweating 
restlesness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

ANTI-DEPRESSANTS

What is the MOA for SSRIs?

A

Preferentially inhibit neuronal reuptak eof serotonin from synaptic cleft by inhibiting reuptake transporter on th epost synaptic membrane

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

ANTI-DEPRESSANTS

Name some examples of SSRIs?

A 
sertraline 
citalopram 
fluoxetine 
Paroxetine 
citalopram
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

ANTI-DEPRESSANTS

Name some adverse effects of SSRIs

A 
8 S'
Size - weight gain 
Sick - nausea / vomiting
Serotonin syndrome 
Seizure - Lower threshold 
Stomach upset - abdo pain / constipation / diarrhoea 
Stress - anxiety 
Suicidal thoughts 
Sexual difficulty - Impotence 
Sleep difficulty 
Sodium low - Hyponatraemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

ANTI-DEPRESSANTS

What is one important adverse effect of citalopram?

A

Prolongs QTc interval - Dose dependent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

ANTI-DEPRESSANTS

What are some cautions for SSRIs?

A

Increase in suicidal thoughts
May precipitate manic phase in bipolar
Epilpesy patients
Patients wit PUD

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

ANTI-DEPRESSANTS

What are the risks of SSRIs in preganncy?

A

1st trimester - Risk of Congenital heart defects

3rd trimester - Risk of persistent pulmonary HTN of newborn

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

ANTI-DEPRESSANTS

What is the influence of paroxetine in pregnancy?

A

Increased risk of congenital malformations - particualry in 1st trimester

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

ANTI-DEPRESSANTS

Why are SSRIs preffered over TCAs?

A

Fewer adverse side effects

Less dangerous on overdose

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

ANTI-DEPRESSANTS

Name some SSRIs interactions

A
  • Warfarin / Heparin
  • Triptans (Can cause SS)
  • Aspirin + NSAIDs (Add PPI due to risk of GI bleed)
  • Antipsychotics (QT prolongation)
  • MAOI (Both increase syanptic serotonin levels –>SS) Have to wait 2weeks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

ANTI-DEPRESSANTS
What is the mechanism of action of SNRIs?
Give some examples

A

Prevents reuptake + subsequent degradation of serotonin AND noradrenaline from synaptic cleft by inhibiting reuptake transporters on post-synaptic membrane

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

ANTI-DEPRESSANTS

Name some adverse effects of SNRIs?

A 
Similar to SSRIs
Size - weight gain 
Sick - nausea / vomiting
Serotonin syndrome 
Seizure - Lower threshold 
Stomach upset - abdo pain / constipation / diarrhoea 
Stress - anxiety 
Suicidal thoughts 
Sexual difficulty - Impotence 
Sleep difficulty
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
ANTI-DEPRESSANTS What is the mechanism of action of monoamine oxidase inhibitors (MAOI)? Give some examples.
Inhibits monoamine oxidase enzyme which reduces breakdown of adrenaline, noradrenaline + serotonin so increases level Isocarboxazid Phenelzine Selegiline
26
ANTI-DEPRESSANTS | What is different about selegiline in comparison to other MAIOs?
Selegiline is selective MAO-B inhibitor which also increases dopamine
27
ANTI-DEPRESSANTS | What are some adverse effects to MAOIs?
``` sexual dysfunction hypotension weight gain dry mouth dizziness migraines ```
28
ANTI-DEPRESSANTS | What is the link between tyramine and MAOIs?
MAO breaks down tyramine (cheese, cured/smoked meet, alcohol) MAO-I= increased tyramine Tyramine mimics noradrenaline= hypertensive crisis ->headache, increased HR, palpitations, chest pain, N/V, anxiety
29
ANTI-DEPRESSANTS | What foods increase the risk of a hypertensive crisis from MAOIs?
High tyramine foods - aged cheese - cured meats - broad beans - wine - marmite
30
ANTI-DEPRESSANTS What is the mechanism of action of tricyclic antidepressants (TCAs)? Give some examples
Inhibit neuronal reuptake of serotonin (5-HT) and noradrenaline from the synaptic cleft, thereby increasing their availability for neurotransmission. Tricyclic antidepressants also block a wide array of receptors, including muscarinic, histamine (H1), α-adrenergic (α1 and α2) and dopamine (D2) receptors. Amitryptiline Dosilepin
31
ANTI-DEPRESSANTS | What are the side effects of TCAs?
``` Anticholinergic - think/see/pee/spit blurred vision urinalry retention constipation dry mouth confusion ``` Anti-adrenergic Postural hypotension impotence ``` Other Arrthymias Cardiotoxicity seizures weight gain ```
32
ANTI-DEPRESSANTS | What cautions are there for TCAs?
Caution in CVD - Avoid following MI Cardiotoxicity in overdose - caution in suicidal patients (QTc prolongation)
33
ANTI-DEPRESSANTS In terms of TCA overdose... i) mild-moderate Sx? ii) severe Sx? iii) ECG signs? iv) management?
i) Dilated pupils, dry mouth, urinary retention, increased tendon reflexes + extensor plantars ii) Fits, coma, cardiac arrhythmias > arrest iii) Sinus tachy, wide QRS, prolonged QT interval iv) Sodium bicarbonate
34
ANTI-DEPRESSANTS What is the mechanism of action of mirtazapine? What are some side effects?
Blocks alpha-2 adrenergic receptors > increased release of neurotransmitters - Increased appetite + weight gain - Sedation / Drowsy - increased triglyceride levels
35
MOOD STABALISERS | Name some examples
Lithium sodium valporate Carbamazepine Lamogitrine
36
MOOD STABALISERS | What is lithium's MOA and what is the target range for blood levels?
Lithium inhibits cAMP production which inhibits monamines Narrow theraputic range (0.4 - 1.0 mmol/L)
37
MOOD STABALISERS | What are the adverse effects of lithium at a theraputic dose?
``` fine tremor dry mouth GI disturbance - Increased GI motility Hypothyroidism Increased thirst Increased urination Hypothyroidism Drowsiness weight gain ```
38
MOOD STABALISERS | What is the presentation of lithium toxicity?
``` Tremor (COARSE) Oliguric (renal failure) ataXia  Increased reflexes Convulsions - seizures Coma Consciousness reduced ``` Nausea muscle weakness Dysarthria Nystagmus
39
MOOD STABALISERS | What must be checked prior to initiating Lithium?
``` Renal function - eGFR FBC U+E TFTs BMI ECG ```
40
MOOD STABALISERS | What drugs dos lithium interact with?
NSAIDs ACEi ARBs Diuretics - Increase lithium levels due to dehydration
41
MOOD STABALISERS | What regualr monitoring is required for lithium?
Weekly serum lithium levels after initiation and dose changes until stable - Every 3m for a year - Every 6m
42
MOOD STABALISERS | How long should a lithium blood sample be taken after dose?
12 hours
43
MOOD STABALISERS | What bloods must be checked every 6m on lithium?
TFTs U+Es eGFR
44
MOOD STABILISERS | What might carbamazepine and lamotrigine interfere with?
Contraceptive pill
45
DRUG INTERACTIONS | what are CYP450 Inducers and name some examples
Reduce the concetration of drugs metabolised by CYP450 system ``` CRAPS Carbamazepine Rifampicin Barbituates Phenytoin St Johns wort ```
46
DRUG INTERACTIONS | what are CYP450 Inhibtirors
Increase the concetration of drugs metabolised by CYP450 system
47
DRUG INTERACTIONS | What is the mneumonic for CYP450 inhibtiors
Some certain silly compounds annoyingly inhibit enzymes Grrrrr
48
DRUG INTERACTIONS | Name some examples of CYP450 inhibitors
``` sodium valporate ciprofloxacin sulphonamide cimetidine / omeprazole antifungals / amiodarone isoniazid erythromycin / clarithromycin grapfruit juice ```
49
DRUG INTERACTIONS | Name some examples of drugs which interact with CYP450 inhibitors / inducers
``` Warfarin COCP Theophyline corticosteroids tricyclics statins ```
50
ANTI-PSYCHOTICS What are the 2 types of anti-psychotics? Give some examples
Typicals/1st gen - Haloperidol / chlorpromazine Atypicals / 2nd gen - Olanzapine / Risperidone (d) / Clozapine / Aripripazole (d) / Quetiapine
51
MOOD STABALISERS | What are the indications for mood stabalisers usage?
Prophylaxis for bipolar acute treatemnt of mania augmentation of antidepressants in resistant depression schizoaffective disorder
52
ANTI-PSYCHOTICS | Inidcations for typical anti-psychotic use?
1. Psychomotor agitation 2. Schizophrenia when metabollic side effects of atypicals are likely to be problematic 3. Bipolar - acute mania
53
ANTI-PSYCHOTICS | What is the MOA for typical anti-psychotics?
Antipsychotic drugs block post-synaptic dopamine D2 receptors in the mesolimbic pathway
54
ANTI-PSYCHOTICS | What is the theraputic range that once exceeded results in unwanted extra-pyramidal side effects?
Effects occur if blockade of dopamine receptors exceeds 65-80%
55
ANTI-PSYCHOTICS What pathway do anti-psychotics act on to... i) have anti-psychotic effects ii) cause side effects
i) Mesolimbic (Reduces +ve sx) ii) Nigrostriatal -Parkinsoism Tuberoinfundibular - Prolactin
56
ANTI-PSYCHOTICS | What is the MOA for atypical anti-psychotics?
Antagonists at dopamine D2 receptors but more selective in dopamine blockade + so block serotonin 5-HT2a
57
ANTI-PSYCHOTICS | What is the benefit of atypical anti-psychotics and what is this due to?
More useful in treating -ve Sx of schizophrenia, resistant schizophrenia + less likely to cause EPSEs - Higher affinity for other receptors - Looser binding to D2 receptors
58
ANTI-PSYCHOTICS | What anti-psychotic has a reduced side effect profile
Aripripazole - partial agonist
59
ANTI-PSYCHOTICS What is the most crucial adverse effect of clozapine? What is the most common adverse effect? What other adverse effects may it have?
Severe life-threatening agranulocytosis - Constipation (big issue in elderly) - Reduced seizure threshold, hypersalivation (Rx hyoscine hydrobromide), myocarditis
60
ANTI-PSYCHOTICS | What lifestyle factors should a pateint taking clozapine report?
Smoking cessation - rise in clozapine elvels | Alcohol cessation - reduction in clozapine levels
61
ANTI-PSYCHOTICS | How many days must be missed of clozapine levels for re-titration to start?
2 days
62
ANTI-PSYCHOTICS | What is the blood regimine required for clozapine?
FBC weekly 18 weeks 2-weekly for a year then monthly 
63
ANTI-PSYCHOTICS | What are the 5 broad categories of SEs caused by anti-psychotics?
Extra-pyramidal side effects (EPSEs) - Hyperprolactinaemia - Metabolic - Anticholinergic - Neurological
64
ANTI-PSYCHOTICS | What are the EPSEs?
Acute dystonic reaction - Parkinsonism - Akathisia - Tardive dyskinesia
65
ANTI-PSYCHOTICS How does Parkinsonism present? How is it managed?
Bradykinesia, rigid, resting pill-rolling tremor + postural instability - Reduce dose or switch to atypical anti-psychotic - Procyclidine
66
ANTI-PSYCHOTICS How does akathisia present? What is a risk of this? How is it managed?
- Motor restlessness, typically lower legs (can't sit still) - Massive RF for suicide in young men with schizophrenia - Reduce dose, introduce beta-blocker (propranolol)
67
ANTI-PSYCHOTICS How does tardive dyskinesia present? When does it present? How is it managed?
- Purposeless involuntary movements (chewing, lip smacking, blinking, tongue protrusion) - After months-years of Tx - Prevention crucial, switch to atypical anti-psychotic, tetrabenazine (dopamine agonist) used if mod–severe but unlikely to completely resolve
68
ANTI-PSYCHOTICS | What are the SEs from hyperprolactinaemia?
- Sexual dysfunction (+ anti-adrenergic) - Osteoporosis risk - Amenorrhoea - Galactorrhoea, gynaecomastia + hypogonadism in men
69
ANTI-PSYCHOTICS | What are the metabolic SEs?
Weight gain (esp. olanzapine) - Hyperlipidaemia, risk of stroke + VTE in elderly - T2DM risk + metabolic syndrome - Lipid changes
70
ANTI-PSYCHOTICS | What are the anticholinergic SEs?
``` Can't see, pee, spit, shit – - Blurred vision - Urinary retention - Dry mouth - Constipation + tachycardia ```
71
ANTI-PSYCHOTICS | What are the neurological SEs?
- Seizures (reduced threshold) - Postural hypotension (anti-adrenergic) - Sedation - Headaches
72
ANTI-PSYCHOTICS | What baseline investigations are done for people starting on anti-psychotics?
- FBC, U+Es, LFTs, lipids, BMI, fasting glucose, prolactin, BP, ECG (QTc prolongation) + smoking status (can reduce effects by enhancing metabolism so issues if suddenly stop)
73
ANTI-PSYCHOTICS | What regular investigations are done for people on anti-psychotics?
- Lipids + BMI at 3m - Fasting glucose + prolactin at 6m - Frequent BP during dose titration - FBC, U+Es, LFTs, lipids, BMI, fasting glucose, prolactin + CV risk yearly
74
ANTI-PSYCHOTICS | How do oral and IM doses of anti-psychotics differ?
IM dosage lower due to oral first pass metabolism IM dosage lasts up to 12 weeks
75
ANTI-PSYCHOTICS | What must be communicated to a patient on anti-psychotics?
Continue for up to 5 years after acute episode Taper down over 3+ weeks when discontinuing Best taken before bedtime
76
OLD AGE PSYCHIATRY | What are the risks for anti-psychotic use in the elderly?
stroke | VTE
77
OLD AGE PSYCHIATRY | Why are lower doses of BDZs required in the elderly?
Higher proportion of fat/water as you age impacts distributions of drugs Benzos – water soluble so hang around for longer --> Lower doses required
78
``` ANTI-PSYCHOTICS How long do these conditions take to develop? Acute dystonia akathisia parkinsism tardive dyskinesia ```
Hours = Acute dystonic reaction (muscle spasms) 4 weeks = Parkinsonism (tremor, bradykinesia) 6-60 days = Akasthesia (inner restlessness) Long term use = Tardive dyskinesia
79
ANTI-PSYCHOTICS | How do you prevent EPSE's?
Start dose low and slowly titrate up
80
ANTI-PSYCHOTICS | What safety netting advice is required for patient's on clozapine?
Any sign of infection go straight to A+E immedietly as high risk for sepsis - sore throat - fever - cough
81
MOOD STABALISERS | What is the management for lithium toxicity?
ABCDE Fluid resuscitation Haemodyalisis - if severe
82
ANTI-PSYCHOTICS | What must be tried prior to administering anti-psychotics for agitation?
De-escalation techniques - Quiet room - talk them down - turn on hearing aids
83
ANTI-DEPRESSANTS | What anti-depressant is safe for use with warfarin
Mirtazapine
84
ANTI-DEPRESSANTS | Are SSRIs CYP450 inducers or inhibitors
Inhibitors
85
SCHIZOPHRENIA treatment of EPSEs?
Procycladine Propanolol +/- cyproheptadine Tetrabenazine
86
SCHIZOPHRENIA What does dopamine inhibit and what is the clinical effects of inhibtion?
Prolactin = therefore dopamine antagonism increases prolactin Hyperprolactinaemia Side Effects: - Galactorrhoea - Amenorrhoea and infertility - Sexual dysfunction
87
SCHIZOPHRENIA What is Procycladine used for?
Treatment of the EPSE of Acute Dystonia/ Parkinsonism
88
SCHIZOPHRENIA What is propanalol/ cyproheptadine used for?
Treatment of the EPSE of Akathesia
89
SCHIZOPHRENIA What is Tetrabenazine used for?
Treatment of EPSE of Tardive Dyskinesia although its generally irreversible
90
SCHIZOPHRENIA Main dopamine and serotonin receptors?
D = D2 S = 5HT2a
91
SCHIZOPHRENIA Hyperprolactinaemia is a common SE of antipsychotics. What is it generally not seen in?
Aripiprazole Quetiapine Clozapine
92
PHARMACOLOGY | What is pharmacokinetics
``` The Body's effect on the drug ADME Absorption Distribution Metabolism Elimination ```
93
PHARMACOLOGY | What is pharmacodynamics
The drug's effect on the body - Receptor sensitivity - Receptor agonism / antagonism
94
Name some advice for sleep hygeine
1. Limit caffeine / alcohol 2. Less noise / lights / screen use 3. Regular pattern
95
ALZHEIMERS | Adverse effects of Acetylcholinesterase inhibitors
bradycardia diarrhoea headache
96
ALZHEIMERS | Adverse effects of NDMA receptor antagonists?
confusion hallucinations dizziness seizures
97
ANTI - EPILEPTICS | Name some adverse effects of lamotrigine
``` Steven johnson syndrome agitation agression arthralgia dizziness ```

Phase 3A (12 decks)

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