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Psychopharmacology Flashcards

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1
Q

What are common effects of adrenergic/noradrenergic receptor?

A

Sweating, tremor, headaches, nausea, dizziness

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2
Q

What are common muscarinic receptor effects?

A

Dry mouth, urinary infrequency, thirst, flushed and dry skin

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3
Q

what are common histamine receptor effects?

A

Drowsiness, dry mouth, dizziness, N+V

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4
Q

How do SSRIs work?

A

They increase amount of serotonin in synapse by preventing its reuptake, this leads to a down regulation of serotonin receptors on post synaptic membrane

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5
Q

What are common side effects of SSRIs?

A

Restlessness and agitation on initiation
Nausea, GI disturbance, headache
Weight changes
Sexual dysfunction

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6
Q

what are some less common side effects of SSRIs?

A

Bleeding (due to serotonin receptors on platelets) and suicidal ideation (gives more energy to potentially carry out suicidal thoughts) affects younger patients more

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7
Q

Which SSRI is safest in cardiac disease?

A

Sertraline

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8
Q

Which SSRI has the greatest effect on QTc prolongation?

A

Citalopram

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9
Q

Which SSRI has a particularly long half life and which has a particularly short half life?

A

Long- fluoxetine
Short- paroxetine

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10
Q

Which SSRI has greatest risk of serotonin syndrome when stopping or switching from it to another?

A

Fluoxetine

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11
Q

Which SSRI is most at risk of discontinuation syndrome?

A

Paroxetine

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12
Q

How do SNRIs differ from SSRIs?

A

They also bind to noradrenaline reuptake receptors as well as serotonin ones

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13
Q

What are the side effects of SNRIs?

A

Similar to SSRI side effects but greater potential for sedation, nausea and sexual dysfunction

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14
Q

What are some examples of SNRIs?

A

Duloxetine and venlofaxine

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15
Q

Does the sedation effect of mirtazapine decrease if you decrease the dose?

A

No the effect is as strong on histamine receptors with low and high doses

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16
Q

What are the two main side effects of mirtazapine?

A

Weight gain and sedation

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17
Q

What are examples of tricyclic antidepressants?

A

Lofepramine, nortriptyline, amitriptyline

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18
Q

How dangerous are overdoses with tricyclic antidepressants?

A

They can be fatal as they cause QTc prolongation and arrhythmias

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19
Q

Which antidepressants can also be used for neuropathic pain?

A

Tricyclic antidepressants and SNRIs (duloxetine and venlofaxine)

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20
Q

Which receptors do monoamine oxidase inhibitors type A and type B work on?

A

A- serotonin, B- dopamine

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21
Q

What is atypical depression? Which antidepressant group is possibly more effective for this?

A

Depression with increased sleep and appetite
Monoamine oxidase inhibitors

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22
Q

MAOIs can have a reaction with amino acid leading to a hypertensive crisis? What is this found in?

A

Tyramine
Found in pickled meats, wine and cheese

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23
Q

How long of a washout period is needed after stopping/ switching to another antidepressant from MAOIs?

A

6 weeks

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24
Q

Which antidepressant had evidence for improvement of difficult to treat cognitive symptoms?

A

Vortioxetine

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25
What things can you consider when choosing an antidepressant to use?
If patient has used a certain type before? How effective was this? Was it tolerated? Are there particular symptoms that want addressing (e.g weight loss, insomnia, neuropathic pain) What patient wants/thinks will be most effective (placebo effect)
26
Which antidepressant is generally used first line?
SSRI
27
How long should you trial an antidepressant before determining if it having an effect or not?
4 weeks
28
I’d an antidepressant has absolutely no benefit at a typical dose, is it worth increasing the dose?
No Would only increase if there was a partial benefit seen
29
What condition tends to require high doses of antidepressants to treat?
OCD
30
What symptoms are characteristic of discontinuation syndrome?
Sweating, shakes, agitation, insomnia, headaches, irritability, nausea+vomiting, paraesthesia, clonus
31
Why do paroxetine and venlofaxine have a greater risk of discontinuation syndrome?
They have short half lives so there is more leaving the body at a quicker rate when they stop being taken
32
Switching to which antidepressant can help discontinuation syndrome?
Fluoxetine as it has a very long half life
33
What are the symptoms of serotonin syndrome?
Cognitive- headaches, agitation, hypomania, confusion, coma Autonomic- shivering, sweating, hyperthermia, tachycardia, nausea and diarrhoea Somatic- myoclonus, hyper-reflexia, tremor
34
How do we treat serotonin syndrome?
Fluids and monitoring
35
How do all antipsychotic work?
Reduce the level of dopamine activity at D2 receptors
36
Which dopaminergic pathways are targeted for psychological effects?
Mesocortical and mesolimbic
37
All anti-psychotics have the potential to cause what side effects?
Sedation, extra-pyramidal signs and weight gain Acute dystonia (e.g oculogyric crisis)
38
What are some differences between typical and atypical anti-psychotics?
Typical more likely to cause extrapyramidal side effects, dizziness and sexual dysfunction Atypical more likely to cause weight gain, dyslipidaemia and diabetes
39
What investigations are carried out in the monitoring of anti-psychotics? And why are they done?
FBC- risk of bone marrow suppression Lipids- risk of dyslipidaemia HbA1c- risk of diabetes ECG- risk for QTc prolongation Weight and blood pressure- signs of metabolic syndrome
40
How often is monitoring undertaken for antipsychotics?
At three months then yearly. Ideally weekly weight recording taken
41
What is neuroleptic malignant syndrome?
A rare life-threatening reaction to antipsychotics
42
What are the symptoms of neuroleptic malignant syndrome?
Fever, confusion, muscle rigidity, sweating autonomic stability
43
How is NMS distinguished from serotonin syndrome?
CK will be very elevated in NMS but may be slight raised or normal in SS Fluctuating BP and HR seen in NMS but not in SS
44
How is neuroleptic malignant syndrome treated?
Stop antipsychotics, give benzos for acute behavioural disturbance, fluid resuscitation, reduce temp Treat rhabomyolysis- fluids and sodium bicarbonate Relax muscles- lorazepam or dantrolene
45
How do we treat the extra-pyramidal side effects of anti-psychotics?
Anticholinergics like procyclidine (also benzatropine and trihexphenidyl)
46
How do we treat acute dystopias cause by anti-psychotics?
Administer IM or IV anticholinergics
47
What does oculogyric crisis look like?
Neck arched and eyes rolled back
48
Although clozapine is an effective anti-psychotic, what are some of its negative side effects?
Hyper salivation, urinary incontinence. Potential for agranulocytosis and gastrointestinal hypomobility (may lead to fatal bowel obstruction)
49
How we do we treat agranulocytosis from clozapine use?
Stop clozapine Stop other bone marrow suppressing drugs Lithium and granulomata colony-stimulating factor can help in arise levels Contact haematology
50
What types of drugs are used to treat anxiety?
Beta blockers, benzodiazepines, pregabalin and antidepressants
51
What condition is propanolol famously contraindicated in?
Asthma
52
How to beta blockers like propanolol help anxiety?
By reducing autonomic nervous system activation. Bio-psycho- feedback reduced anxious thoughts stemming from anxiety symptoms
53
What are some considerations with benzodiazepine use for anxiety?
Significant potential for tolerance and dependence and therefore misuse so used cautiously and not Ivan for more than six weeks
54
What are examples of hypnotics (sleeping tablets)?
Benzodiazepines: temazepam, lormatazepam, nitrazepam Non-Benzos: zopiclone, zolpidem
55
Mood stabilisers used to treat bipolar disorder come from which three drug groups?
Lithium Anticonvulsants (e.g sodium valproate) Atypical antipsychotics (quetiapine)
56
Does lithium have a wide or narrow therapeutic window?
Narrow
57
Which organ handles all the metabolism and excretion of lithium?
The kidneys
58
How often does lithium need monitoring after being started?
Weekly after dose change until level stable then 3 monthly
59
How does evidence suggest that lithium affects suicide risk?
Reduces suicide and self harm
60
What are the side effects of lithium?
Metallic taste in mouth/dry mouth, fine tremor, polydipsia and polyuria, weight gain and GI disturbance
61
What are some potential longer term effects of lithium?
Hypothyroidism, renal impairment
62
What are symptoms of lithium toxicity?
Confusion, coarse tremor, nausea and vomiting, ataxia and seizures
63
What can increase lithium levels?
Dehydration (encourage pts to drink lots when hot) Other medications: NSAIDS, loop diuretics, ACE inhibitors
64
What are the most common anticonvulsants used in bipolar as mood stabilisers?
Sodium valproate, lamotrigine, carbamazepine
65
What drugs are used in ADD and ADHD?
Methylphenidate (CNS stimulant) Atomoxetine (noradrenaline re-uptake inhibitor)
66
Why would we not give methylphenidate to a patients with previous drug problems?
Stimulants like this have potential for misuse and dependency
67
Why is there a decreased risk of dependency with atomoxetine compared to methylphenidate?
The increase in dopamine with atomoxetine takes several weeks to reach effect
68
Why do we measure childrens height that are on CNS stimulants?
They may have the potential to stunt growth
69
What are common side effects of tricyclic antidepressants?
Antagonism of histamine receptors: Drowsiness Antagonism of muscarinic receptors: dry mouth, blurred vision, constipation, urinary retention Anatagnism of adrenergic receptors: postural hypotension Lengthening of QT interval

Psychiatry (8 decks)

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