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Psycho-Pharmacology Flashcards

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1
Q

How long do antidepressants take to kick in?

A

3-4 weeks

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2
Q

How long do anti-psychotics take to kick in?

A

up to 6 weeks

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3
Q

Indications for antidepressants

A 
Unipolar and bipolar depression 
organic mood disorders
schizoaffective disorder
anxiety disorders including OCD
Panic
social phobia 
PTSD
premenstrual dysphoric disorder
impulsivity associated with personality disorders
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4
Q

How long would you try an antidepressant for if no improvement is seen and you switch to another antidepressant or augment with another agent?

A

At least two months

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5
Q

4 types of antidepressant drugs

A

Tricyclics (TCA)
Monoamine Oxidase Inhibitor (MOIs)
Selective Serotonin Reuptake Inhibitors (SSRIs)
Serotonin/Noradrenaline Reuptake Inhibitors (SNRIs)
Novel antidepressants

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6
Q

Side effects of TCAs

A 
VERY HIGH SIDE EFFECT PROFILE 
antihistaminic
anticholinergic 
antiadrenergic 
QT lengthening
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7
Q

How much of TCA would it take for an overdose?

A

LETHAL in overdose

even a one week supply can be lethal

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8
Q

Side effects of tertiary TCAs

A

antihistaminic (sedation and weight gain)
Anticholintergic (dry mouth, dry eyes, constipation, memory deficits and potentially delirium)
antiadrenergic (orthostatic hypotension, sedation, sexual dysfunction)

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9
Q

What do tertiary TCAs predominately act on?

A

Serotonin Receptors

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10
Q

Examples of tertiary TCAs

A

Imipramine
Amytriptyline
Doxepin
Clomipramine

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11
Q

Side effects of secondary TCAs

A

Same as TCAs but generally less severe

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12
Q

Examples of secondary TCAs

A

Desipramine

Noritriptyline

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13
Q

What would be used to treat depression

A

Start with SSRI then switch

to SNRI

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14
Q

What are monoamine oxidase inhibitors (MAOIs) very effective for?

A

Depression

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15
Q

Side effects of MAOIs

A 
orthrostatic hypotension 
weight gain 
dry mouth 
sedation 
Sexual dysfunction 
sleep disturbance
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16
Q

What reaction can occur with MAOIS?

A

Cheese reaction - hypertensive crisis when MAIOs are taken with tyramine rich foods or symphatomimetics

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17
Q

What syndrome can develop if MAOIs are taken with meds that increase serotonin or have sympahtetomimetic actions?

A

Serotonin syndrome

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18
Q

What do SSRIs do?

A

Block the presynaptic serotonin reuptake

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19
Q

What does SSRI treat?

A

Both depressive and anxiety symptoms

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20
Q

Side effects of SSRI

A 
GI upset
Sexual dysfunction (30+)
anxiety 
restlessness 
nervousness 
insomnia 
fatigue or sedation 
dizziness
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21
Q

How toxic are SSRIs?

A

Pretty untoxic

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22
Q

Stopping SSRIs can give what?

A

A discontinuation syndrome with agitation, nausea, disequilibrium and dysphoria - but only lasts 1 week

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23
Q

3 examples of SSRIs

A

Paroxetine
Sertraline
Fluoxetine (Prozac)

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24
Q

What do SNRIs do?

A

Inhibit both serotonin and noradrenergic reuptake like TCAs but without antihistamine, antiadrenic or anticholingergic side effects

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25
What are SNRIs used for?
Depression Anxiety Neuropathic pain
26
Examples of SNRIs
Venlafaxine | Duloxetine
27
Examples of novel antidepressants
Mirtazapine | Burproprion
28
How to treat if treatment resistance
Combination of antidepressants e.g. SSRI or SNRI with Mirtazepine Adjunctive treatment with lithium Adjunctive treatment with atypical antipsychotic e.g. quetiapine ECT
29
How to treat depression
Start with SSRI | then if need to switch to SNRI
30
What is treatment prophylaxis?
Once better, keep on medication for a period of time so do not become unwell again
31
Treatment prophylaxis for a first episode
Keep on current dosage for 6 months - 1 year once better
32
Treatment prophylaxis for second episode
Keep on current doseage for 2 years
33
Treatment prophylaxis for third episode
Keep on current doseage for however long it takes e.g. possibly 3 years
34
Indications for mood stabilisers
Bipolar Cyclothymia Schizoaffective
35
Classes of mood stabilisers
Lithium Anticonvulsants Antipsychotics
36
What is the only medication to reduce the suicide rate
lithium
37
Factors predicting a positive response to lithium
Prior long term response Family member with good response Classic pure mania Mania is followed by depression
38
Before start lithium, what do you do?
U and Es TSH Pregnancy test
39
Who is not meant to use lithium?
Women of childbearing age
40
Side effects of lithium
``` GI distress - reduced appetite - nausea vomiting - diarrhoea Thyroid abnormalities Non significant leucocytosis Polyuria/polydipsia secondary to ADH antagonism Hair loss acne reduces seizure threshold cognitive slowing intention tremor ```
41
Examples of anticonvulsants
Valproic acid Carbamazepine Lamotrigine
42
Valproic acid has a positive response in....
Rapid cycling patients (F>M) Comorbid substance issues Mixed patients Paitents with co morbid anxiety disorders
43
Valproic acid vs Lithium
valproic acid as effective as lithium in mania prophylaxis valproic acid is not as effective as lithium in depression prophylaxis better tolerated than lithium
44
Before starting valproic acid, what needs to be done?
Pregnancy test Baseline LFTs FBC start folic acid supplement in women
45
Side effects of valproic acid
``` Thrombocytopenia and platelet dysfunction Nausea Vomiting Weight gain Sedation tremor increased risk of neural tube defect hair loss ```
46
What is carbamazepine first line for?
Acute mania | mania prophylaxis
47
Who is indicated for carbamazepine?
Rapid cyclers | Mixed patients
48
What should be done before carbamazepine is started?
LFTs FBC ECG
49
Side effects of carbamazepine
``` rash - MOST COMMON nausea, vomiting, diarrhoea sedation, dizziness, ataxia, confusion AV conduction delays Water retention resulting in hyponatraemia DRUG DRUG INTERACTIONS ```
50
Side effects of Lamotrigine
``` nausea vomiting sedation dizziness ataxia confusion steven johnstones syndrome Toxic epidermal necrolysis ```
51
Indications for antipyschotics
Schizophrenia Schizoaffective disorder Bipolar disorder (when psychotic symptoms and/or mood stabilisation) Psychotic depression augmenting agents in treatment with resistant anxiety disorders
52
What is the typical antipsychotic do?
D2 dopamine receptor antagonists
53
Examples of antipsychotics
``` Risperidone Olanzapine Quetiapine Aripiprazole Clozapine ```
54
S/Es of olanzapine
``` Weight gain Hypertriglyceraemia Hypercholesteraemia Hyperglycaemia Hyperprolactinaemia Abnormal LFTs ```
55
S/Es of clozapine
Agranulocytosis (required bloods every 6 months) Seizures Sedation Weight gain Abnormal LFTs Hypertriglycaemia,glycermia,cholesteraemia
56
What is clozapine reserved for?
Treatment resistant patients (due to side effect profile)
57
S/Es of antipsychotics
Tardive dyskinesia - involuntary muscle movements Neuroleptic malignant syndrome Extrapyramidal S/Es
58
Presentation of neuroepileptic malignant syndrome
``` Severe muscle rigidity Fever Altered mental status Autonomic instability Elevated WBC Elevated LFTs and CPK ```
59
Examples of extrapyramidal S/Es of antipsychotics
Acute dystonia Parkinson syndrome Akathisia
60
What are anxiolytics used to treat?
``` Panic disorder Generalised anxiety Substance related disorders and their withdrawal Insomnias Parasomnias ```
61
Example of an anxiolytic
Buspirone
62
What are benzodiazepines used to treat?
Insomnia Parasomnias Anxiety CNS depressant withdrawal protocols
63
S/Es of benzodiazepines
``` Somnolence Cognitive deficits Amnesia Disinhibition Tolerance DEPENDENCE ```
64
Definition of somnolence
Strong desire for sleep, and sleeping for long periods when do so

Psychiatry (18 decks)

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