Psychopharmacology Flashcards
(76 cards)
1
Q
Give 4 conditions that are treated with antipsychotics
A
- schizophrenia
- delirium in dementia
- mania
- psychosis
2
Q
What is the mechanism of action of typical antipsychotics
A
Dopamine D2 receptor antagonists, blocking dopaminergic transmission in:
* mesolimbic and mesocortical regions - antipsychotic effects
* nigrostriatal regions - motor side effects
3
Q
Give 4 extrapyramidal side effects of typical antipsychotics
A
- Parkinsonism
- acute dystonia
- akathisia - restlessness
- Tardive dyskinesia - abnormal movements, particularly affecting the face
4
Q
What is acute dystonia
A
sustained muscle contraction (e.g. torticollis, oculogyric crisis)
5
Q
What is tardive dyskinesia
A
- abnormal, involuntary movements
- mc is chewing and pouting jaw
6
Q
When does tardive dyskinesia usually present in relation to antipsychotics
A
presents after taking typical antipsychotics for a long time
7
Q
What causes extrapyramidal effects from typical antipsychotics
A
these result if the blockade of dopamine receptors in the nigrostriatal pathways exceed 80%
8
Q
Give 3 examples of typical antipsychotics
A
- haloperidol
- chlorpromazine
- Prochlorperazine
9
Q
What is the mechanism of action of atypical antipsychotics
A
antagonist to:
* D1 and/or 2 receptors
* 5HT2 receptor - prevent reuptake of serotonin
* histamine 1 receptor
* alpha 1 adrenoreceptor
10
Q
Give 3 examples of atypical antipsychotics
A
- risperidone
- olanzapine
- quetiapine
- aripiprazole
- clozapine
11
Q
Give 6 side effects of antipsychotics
A
- anticholinergic effects
- weight gain (atypical)
- drowsiness and cognitive impairment
- raised prolactin
- Impaired glucose tolerance -> diabetes (typical)
- reduced seizure threshold
- prolonged QT interval
12
Q
Give 2 potential risks of antipsychotic medications in elderly patients?
A
- increased risk of stroke
- increased risk of venous thromboembolism
13
Q
Which antipsychotic should be considered in patients struggling with symptoms of raised prolactin
A
aripiprazole
14
Q
When is clozapine most commonly used
A
treatment resistant schizophrenia - when 2 or more antipsychotics have not worked after 6-8w each
15
Q
Why is clozapine not first line with other atypical antipsychotics and how is it monitored
A
- lots of adverse effects so requires close monitoring
- Clozapine monitoring system - advice on drug dosage depending on blood results
- only consultant psychiatrists can prescribe
16
Q
Give 5 adverse effects of clozapine
A
- Myocarditis
- Agranulocytosis / neutropenia
- Reduced seizure threshold
- Constipation
- Hypersalivation
17
Q
What effect does smoking have on clozapine
A
- Dose adjustment of clozapine might be necessary if smoking is started or stopped during treatment
- smoking cessation can cause a rise in clozapine blood levels
18
Q
What is neuroleptic malignant syndrome
A
- rare, potentially life threatening reaction that can occur in response to taking antipsychotics
- occurs within hours to days of starting an antipsychotic
19
Q
Give 4 key features of neuroleptic malignant syndrome
A
- Rigidity
- Delirium/ altered consciousness
- Fluctuating bp and tachycardia
- hyperthermia/ pyrexia
20
Q
Give 3 investigation findings indicative of neuroleptic malignant syndrome
A
- Raised creatine kinase
- Deranged U&Es: AKI secondary to rhabdomyolysis
- leukocytosis
21
Q
How is neuroleptic malignant syndrome managed
A
- stopping the causative medication
- IV fluids and cooling methods
- benzodiazepines for agitation
- dopamine agonist (bromocriptine)
- dantrolene
22
Q
Give 5 examples of selective serotonin reuptake inhibitors (SSRIs)
A
- sertraline
- citalopram
- escitalopram
- fluoxetine
- paroxetine
23
Q
Give 4 conditions that are treated with SSRIs
A
- depression
- anxiety
- OCD
- bulimia
24
Q
Describe the mechanism of action for SSRIs
A
inhibit the reuptake of serotonin from presynaptic serotonin pumps
25
What is the first line SSRI in children and adolescents
fluoxetine
26
Which 2 SSRIs are most likely to lead to QT prolongation
* citalopram
* escitalopram
27
What is the SSRI of choice post myocardial infarction
sertraline
28
Which SSRI has an increased risk of congenital malformations, particularly in the first trimester
paroxetine
29
Give 5 side effects of SSRIs
* GI symptoms - N+V
* hyponatraemia
* increased suicidality
* sexual dysfunction
* anxiety/ agitation
30
Why should co-prescribing NSAIDs/ aspirin with SSRIs be avoided and how is this risk minimised?
* Increased risk of GI bleeding
* co-prescribe PPi
31
What 4 drugs should be avoided when taking SSRIs due to the increased risk of serotonin syndrome
* triptans
* monoamine oxidase inhibitors
* tramadol
* St John's Wort (often taken over the counter for depression)
32
Name 2 recreational drugs that can cause serotonin syndrome
* ecstasy
* amphetamines
33
How soon should a patient be reviewed after starting antidepressant therapy?
Normally after 2 weeks. For patients under 25 years or at increased risk of suicide, they should be reviewed after 1 week.
34
How long should a patient continue antidepressant therapy after achieving remission?
At least 6 months to reduce the risk of relapse
35
How should the dose of an SSRI be reduced when stopping treatment?
The dose should be gradually reduced over a 4-week period
* except fluoxetine; this should be tapered over the course of 6-12 weeks
36
Why should antidepressants not be stopped suddenly?
Antidepressants should not be stopped suddenly to minimise discontinuation symptoms
37
Give 5 symptoms of discontinuation syndrome
* increased mood change
* unsteadiness/ dizziness
* paraesthesia, electric shock sensations
* restlessness and sweating
* insomnia/ Vivid dreams
* GI: pain, cramps, D+V
38
Which SSRI has a higher incidence of discontinuation symptoms. Give one side effect of this drug
paroxetine
weight gain
39
Give 2 conditions that are treated with Serotonin and noradrenaline reuptake inhibitor (SNRI's)
Depression and anxiety
40
Give 2 examples of Serotonin and noradrenaline reuptake inhibitor (SNRI's)
* venlafaxine
* duloxetine
41
Describe the mechanism of action of Serotonin and noradrenaline reuptake inhibitor (SNRI's)
work by blocking the reuptake of serotonin and noradrenaline by the presynaptic membrane
42
Give 3 side effects of Serotonin and noradrenaline reuptake inhibitor (SNRI's)
* hot flush
* constipation
* dizziness
* dry mouth
43
What drug class is mirtazapine
Noradrenergic and specific serotonergic antidepressant
44
Describe the mechanism of action of mirtazapine
presynaptic alpha2-adrenoreceptor antagonist which increases central noradrenaline and serotonin
45
Give 2 side effects of mirtazapine
* sedation
* increased appetite - weight gain
* postural hypotension
46
Give 2 examples of tricyclic antidepressants (TCAs)
* amitriptyline
* clomipramine
47
Describe the mechanism of action of TCAs
They block the reuptake of serotonin and noradrenaline by the presynaptic membrane. They also have additional actions, including blocking acetylcholine and histamine receptors
48
Give 3 conditions that are treated with TCAs
* depression
* anxiety
* chronic pain (much lower dose)
49
When are TCAs contraindicated
* IHD
* arrhythmias
* severe liver disease
* overdose risk
50
Give 4 antimuscarinic side effects of TCAs
* dry mouth
* constipation
* urinary retention
* blurred vision
51
Give 2 antiadrenergic side effects of TCAs
* dizziness and palpitations
* postural hypotension
52
Give 2 antihistaminergic side effects of TCAs
* weight gain
* sedation (drowsy)
53
Give 4 cardiac side effects of TCAs
* prolonged QT
* bundle branch block
* arrhythmias
* palpitations
54
Give 2 conditions that are treated with lithium
* mania
* treatment-resistant depression
55
How is lithium monitored
monitoring is essential due to narrow therapeutic index
* when checking lithium levels, the sample should be taken 12 hours post-dose
* weekly blood tests until stable levels then 3 monthly
* after a change in dose, lithium levels should be taken a week later and weekly until the levels are stable.
* thyroid and renal function should be checked every 6 months
56
What is the ideal serum lithium range when treating bipolar disorder
0.4 -1.0 mmol/L
57
Give some adverse effects of lithium
* fine tremor
* nephrotoxicity - polyuria secondary to nephrogenic diabetes insipidus
* weight gain
* hypothyroidism
* nausea/vomiting, diarrhoea
* hyperparathyroidism and resultant hypercalcaemia
* leucocytosis
58
Give 4 things that may precipitate lithium toxicity
* dehydration
* renal failure
* drugs: diuretics (thiazides), ACEi, metronidazole, NSAIDs
59
Give 5 features of lithium toxicity
* coarse tremor
* hyperreflexia
* acute confusion
* polyuria
* seizure
* coma
60
How is lithium toxicity managed
* IV fluids with isotonic saline
* haemodialysis may be needed in severe toxicity
61
Why is lithium avoided in pregnancy
teratogenic - causes ebstein's anomaly (malformation of tricuspid valve)
62
Describe the mechanism of monoamine oxidase inhibitors
* inhibit monoamine oxidase A and B
* leads to accumulation of amine neurotransmitters (noradrenaline, serotonin etc)
63
What are MAOIs used to treat
atypical/ Tx resistant depression
64
Give 2 examples of Non-selective monoamine oxidase inhibitors
* phenelzine
* tranylcypromine
65
Give 3 side effects of monoamine oxidase inhibitors
* hypertensive reactions with tyramine containing foods - eg cheese, broad beans, marmite
* anticholinergic effects - constipation, dry mouth, confusion
* suicidal behaviours - overdose
66
What are Z drugs used for
initiating sleep
67
Describe the mechanism of Z drugs
stimulate GABA receptor by binding to the alpha 2 subunit
68
Give 2 examples of Z drugs
* zopiclone
* zaleplon
69
Give 3 side effects of Z drugs
* increase risk of falls in elderly
* can become dependent
* dry mouth/ bitter taste
70
Describe the mechanism of benzodiazepines
enhance the effects of GABA by increasing the frequency of chloride channels
71
Give 3 examples of benzodiazepines
* lorazepam (short acting)
* diazepam (long acting)
* chlordiazepoxide
72
What are benzodiazepines used to treat
* alcohol withdrawal
* mania
* psychosis
* acute agitation/ aggression
73
Give 3 side effects of benzodiazepines
* can be addictive long term
* resp depression
* CNS depressant - decreased alertness, drowsiness etc
74
When are benzodiazepines contraindicated
* neuromuscular resp weakness (eg myasthenia gravis)
* respiratory disease
75
Give 5 features of benzodiazepine withdrawal
* insomnia
* loss of appetite
* perspiration
* irritability
* tremors
* seizures
76
How is a benzodiazepine overdose treated
flumazenil
