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Psychiatry > Psychopharamcology > Flashcards

Psychopharamcology Flashcards

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1
Q

What is the action of serotonin?

A

Stabilises mood, feelings of well being and happiness, enables brain cells and other nervous system cells to communicate with each other
Helps with sleeping, eating, and digestion

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2
Q

What is the action of NA?

A

Increases arousal and alertness

Enhances formation and retrieval of memory and focusses attention, increases restlessness and anxiety

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3
Q

What is the action of dopamine?

A

Released when brain is expecting a reward and associated with reward

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4
Q

Why are MAO inhibitors rarely used?

A

Due to S/E

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5
Q

What is the mechanism of action of MAO inhibitors?

A

MAO enzyme works in gut to aid tyramine breakdown and down and works in brain to remove NA, serotonin and dopamine
Inhibitors prevent MAO working and so prevent the removal of NA, serotonin and dopamine from the brain

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6
Q

What are the S/E are MAO inhibitors?

A

Cheese effect - lack of breakdown of tyramine rich foods such as aged cheese, beer, dried meats, red wine - leads to migraines and life threatening BP spikes
Drug interactions - nasal decongestants, salbutamol and many more

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7
Q

Give 2 examples of MAO inhibitors

A

Isocarboxazid

Phenelzine

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8
Q

How do TCAs work?

A

Blocks 5-HT and NA transporters therefore blocking reuptake of serotonin and NA in presynaptic terminals therefore increasing mood and focus
Non-specific

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9
Q

Why are TCAs often not used?

A

S/E

Worse in an overdose

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10
Q

Give 2 examples of TCAs

A

Amitriptyline
Clopipramine
Nortriptyline

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11
Q

What are the S/E of TCAs?

A

Anticholinergic effects - can’t pee, can’t see, can’t spit, can’t shit
Alpha-1 adrenergic antagonism
- Antihistaminergic (H1) - sedation, weight gain
Overdose, seizures (lowers seizure threshold)
More likely to have a cardiac arrest

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12
Q

Give 2 examples of SSRIs

A

Citalopram
Fluoxetine
Sertraline

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13
Q

Why are SSRIs preferential?

A

Fairly safe in overdose

Fewer S/E

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14
Q

How do SSRIs work?

A

Blocks serotonin reuptake

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15
Q

What are SSRIs used for?

A 
Depression
GAD
PTSD
Eating disorders
OCD
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16
Q

What are the S/E of SSRIs?

A

Nausea, headache, GI upset (5-HT3)
Agitation, akathisia, anxiety, sexual dysfunction, insomnia (5-HT2)
S/E tend to wear off after a few weeks

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17
Q

Give 2 examples of SNRIs

A

Duloxetine

Venlafaxine

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18
Q

Give 2 examples of antipsychotics

A

Risperidone
Olanzapine
Clozapine

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19
Q

How do antipsychotics work?

A

Inhibit dopaminergic neurotransmission (D2)
Block D2 receptors in the meso-limbic system - reduces positive symptoms of psychosis BUT they feel less pleasure and have less ability to feel pleasure (meso-limibic system is activated by drugs
Block D2 receptors in the meso-cortical pathway - decreases the negative symptoms of psychosis - more control over emotions

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20
Q

What are the S/E of antipsychotics and why do they occur?

A

Also block D2 receptors in nigrostriatal pathway leading to a reduction in movement
Motor - acute dystonia, akathisia, tardive dyskinesia
Hyperprolactinaemia - infertility, irregular/no periods, galactorrhoea, pain in breasts, loss of libido, increased risk of ovarian and breast cancer
Metabolic - increased appetite and weight gain
Hypertriglyceridaemia
Lower seizure threshold
Postural hypotension

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21
Q

What is the first line treatment for depression?

A

SSRIs

SNRIs second line

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22
Q

How does mirtazapine work?

Study These Flashcards
A

Antagonist effects on central presynaptic alpha-2 adrenergic receptors causing an increased release of serotonin and noradrenaline

23
Q

Why is mirtazapine given to older adults?

Study These Flashcards
A

Fewer drug interactions

24
Q

What is the S/E of mirtazapine?

25
What are the S/E of SSRIs?
Initially nausea, vomiting, anxiety, weight loss, diarrhoea, insomnia Sexual dysfunction may persist
26
What are the S/E of TCAs?
``` Postural hypotension Blurred vision Urinary retention Constipation Dry mouth Weight gain Drowsiness Confusion Agitation Adverse effects on cardiac function ```
27
What are the S/E of SNRIs?
Nausea, sexual dysfunction, headache, insomnia, anxiety and sweating Dose related increased in BP
28
What are the S/E of MAOIs?
Postural hypotension/dizziness Constipation Interactions with foods
29
What are the discontinuation symptoms of anti-depressants?
``` GI disturbances Headache Anxiety Dizziness Paraesthesia Electric shock sensation in head, neck and spine Tinnitus Sleep disturbances Fatigue Flu like symptoms Sweating ```
30
What are first generation anti-psychostics?
Typical | Purely block D2 and cause extra-pyramidal S/E causing movement disorders
31
What are second generation anti-psychotics?
Atypical | 5-HT2a occupancy too meaning you get some dopamine and extra-pyramidal S/E are reduced
32
Name a S/E of aripiprazole?
Get constant agitation | Unable to feel settled
33
What are the complications of anti-psychotic S/E?
Physical health complications - require full yearly health checks - ECG, weight, waist circumference Confound assessment of clinical condition Too much can make them seem psychotic Functional impairment - sedation levels Social stigma Negative attitudes towards treatment
34
Name 3 mood stabilisers
``` Lithium Olanzapine Lamotrigine Carbamazepine Sodium valproate ```
35
What does lithium work for?
Mania and depression but better for mania
36
What does olanzapine work for?
Mania/manic episodes
37
What does lamotrigine work for?
Bipolar if bipolar is mainly depressive episodes
38
What does carbamazepine work for?
Not NICE recommended Bipolar But only when bipolar is unresponsive to lithium
39
What does sodium valproate work for?
Mania and depression Not as good as lithium Better for mania
40
What are the S/E of lithium?
``` Fine tremor Sedation Lethary Impaired coordination Gastric disturbances Polyuria Weight gain Oedema Hypothyroidism ```
41
What are the S/E of valproate?
``` GI pain Drowsiness Tremor Ataxia Sedation Hair loss Increased appetite Weight gain Blood dyscrasias (low white cells, liver damamge) ```
42
What are the S/E of lamotrigine?
``` Headache Drowsiness Nausea Diarrhoea Ataxia Tremor Blurred vision Skin rash Blood disorders Liver failure ```
43
What are the S/E of carbamazepine?
``` Fatigue Nausea Blurred vision Ataxia Headache Drowsiness Rare - blood, liver, and skin disorders potentially serious in nature ```
44
What do you need to monitor with lithium and how long for?
Thyroid function - at start and every 6m Calcium - at start and every 6m Renal function - at start and every 6m Serum levels - 1 week after initiation, at every dose change, 3m once stable
45
What do you need to monitor with valproate and how long for?
Liver function - at start and during first 6m Serum levels - only if evidence of poor effectiveness or toxicity FBC - at start
46
What do you need to monitor with carbamazepine and how long for?
Liver function - at start and periodically Serum levels - only useful in verification of compliance FBC - at start and periodically
47
What does the mnemonic LITHIUM stand for?
L - levels 0.6-1.0 mmol/L, leukocytosis (older adults < 1.0) I - nephrogenic diabetes insipidus (v rare) T - tremors mild, coarse = toxicity H - hydration - dry mouth, diarrhoea, thirsty - must drink, NA restricted diet, no diuretics, and NSAIDs, regular renal function tests I - increased GI, skin, and memory problems U - under active thyroid M - metallic taste, mums beware - Ebsteins phenomena
48
What level does lithium need to be to be determined toxic?
> 1.5 mmol/L
49
What are the symptoms of lithium toxicity?
``` N&V Diarrhoea Confusion Excessive sleeping Seizures Myoclonic jerks Coarse tremor ```
50
What are the causes of lithium toxicity?
``` Fluid depletion Changes in salt level in diet Reduced renal function Certain medications (diuretics, NSAIDs, BP medication) Change in brand of lithium ```
51
How do you treat lithium toxicity?
Stop lithium Rehydrate Consider haemodialysis
52
What is the problem with valproate?
Highly teratogenic | High risk of developmental abnormalities
53
Who should you not prescribe valproate to?
Female patients of childbearing age unless only option
54
How do you look after young women on valproate?
Pregnancy prevention programme Irreversible/long term forms of contraception Require a checklist going through yearly

Psychiatry (15 decks)

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