Psychopharmacology

Question 1

What are the barriers to adherence?

Answer 1

Side effects
Lack of insight
Not believing that drugs will work
Goes against their beliefs
Formulation or mode of administration
Fear of addiction
Fear of changing self

Question 2

What are the levels of insight?

Answer 2

Knowledge that there is something wrong
Knowledge of the nature and cause of the disorder
Knowledge that the treatment will help and willingness to help

Question 3

What are the considerations when prescribing medication?

Answer 3

Contraindications
Drug interactions
Effects on current conditions (epilepsy, Parkinson’s etc)
Pharmacokinetics (weight, ethnicity, endogenous enzymes)

Question 4

What are the first line medications for depression?

Answer 4

SSRIs

Question 5

What connections/parts of the brain might cognitive dysfunction in depression be related to?

Answer 5

Ventral tegmental area to the DLPFC (attention, working memory, decision making)

Question 6

What connections/parts of the brain might anhedonia in depression be related to?

Answer 6

Ventral tegmental area to nucleus accumbens (pleasure and reward)

Question 7

What connections/parts of the brain might cognitive dysfunction in depression be related to?

Answer 7

Ventral tegmental area to ventral PFC

Question 8

What connections/parts of the brain might depressed mood and suicidal ideation in depression be related to?

Answer 8

Raphe nucleus to ventral prefrontal cortex (serotonergic)

Question 9

What connections/parts of the brain might somatic symptoms (sleep and appetite) in depression be related to?

Answer 9

Raphe nucleus to hypothalamus (serotonergic)

Question 10

How would you dose someone over 75yo?

Answer 10

Half of standard adult dose

Question 11

How soon would it be expected to see side effects?

Answer 11

10-14 days

Question 12

How does half life length affect SSRI discontinuation syndrome?

Answer 12

Shorter half life increases risk

Question 13

How does half life length affect benzodiazepine addictiveness?

Answer 13

Shorter half life increases addiction risk

Question 14

What is a NaSSA (like mirtazapine?)

Answer 14

Noradrenergic and specific serotonergic antidepressant - block is receptors to increase noradrenaline and serotonin release

Question 15

What would be a somatic side effect of an SNRI?

Answer 15

Increased blood pressure from noradrenergic activity

Question 16

What is a short term first line for anxiety?

Answer 16

Benzodiazepines

Question 17

What are the issues with first generation antipsychotics?

Answer 17

They bind to dopamine receptors across pathways and for a long time, causing side effects such as apathy, anhedonia, extrapyramidal symptoms

Question 18

What pathways is dopamine implicated in?

Answer 18

Nigrostriatal - motor (EPS)
Mesocortical - cognition, socialisation
Mesolimbic- arousal, memory behaviour
Tuberoinfundibular - prolactin release

Question 19

What are examples of first generation antipsychotics?

Answer 19

Chlorpromazine, haloperidol

Question 20

What are examples of second generation (atypical) antipsychotics?

Answer 20

Olanzapine
Risperidone (dementia)
Quetiapine
Aripiprazole
Lurasidone

Question 21

What medication is used for treatment resistant psychosis?

Answer 21

Clozapine

Question 22

What are the risks of clozapine?

Answer 22

Increased risk of seizures
Agranulocytosis (<2%) which can be fatal
Monitoring by blood test is necessary

Question 23

How would you counter agranulocytosis from clozapine?

Answer 23

Growth colony stimulating factor (cancer treatment)

Question 24

How would you monitor someone on Olanzapine?

Answer 24

Glucose at baseline? One month, and 4-6 months. Lipids every quarter for one year, then yearly.

Question 25

How do you monitor patients on any antipsychotics?

Answer 25

Baseline FBC, urea and electrolytes, liver function, ECG, BP

Question 26

How would you monitor patients on Risperidone, Amisulpride, or Sulpiride?

Answer 26

Prolactin: baseline, 6 months, and annual