Psychopharmacology Flashcards
(74 cards)
1
Q
Amisulpride - class
A
- Benzamide
2
Q
Aripiprazole - class
A
- Arylpiperidylindole
3
Q
Asenapine
A
- Acute mania in bipolar I, sublingual
- High affinity for 5-HT, alpha-adrenoreceptors, D1-4 and H1/H2.
- Less efficacious than risperidone or olanzapine
- Higher EPSEs than most atypicals, unlikely to raise prolactin, less weight gain
4
Q
Clozapine - class
A
- Dibenzodiazepine
5
Q
Lurasidone - mechanism and side effects
A
- Antagonist at alpha-receptors, D1/2 and 5-HT
- EPSEs likely, less weight gain and QTc
6
Q
Olanzapine - class and mechanism
A
- Thienobenzadiazepine
- Broad receptor antagonism
7
Q
Paliperidone
A
- Main hepatic metabolite of risperidone, lower bioavailability (twice dose)
- Useful in hepatic failure, renally excreted
- Higher EPSEs and prolactin; mod weight gain, no QTc changes.
8
Q
Quetiapine - class and mechanism
A
- Dibenzothiazepine
- Broad receptor antagonism
9
Q
Risperidone - class
A
- Benzoxazole
10
Q
Sertindole - side effects
A
- Strict ECG monitoring due to QTc prolongation
- Nasal congestion, decreased ejaculatory volume, postural hypotension
- Occasionally raised LFTs
11
Q
Thioridizine - class
A
- Piperidine
12
Q
Trifluoperazine - class
A
- Piperizine
13
Q
Haloperidol - class
A
- Butyrophenone
14
Q
Flupenthixol - class and use
A
- Thioxanthene
- Depressed patients
15
Q
Chlorpromazine - class
A
- Aliphatic phenothiazine
16
Q
Bupropion - mechanism
A
Norepinephrine-dopamine re-uptake inhibitor and nicotinic acetylcholine receptor antagonist
17
Q
SSRIs - metabolism and side effects
A
- Hepatically metabolised
- GI upset, sedation, dizziness, sexual dysfunction, SIADH, bleeding (platelets), convulsions, agitation
18
Q
Venlafaxine - mechanism and side-effects
A
- 5-HT and NARI
- Hypertension, seizures, dry mouth, urinary retention, sweating
19
Q
Trazodone - mechanism
A
- Weak 5-HT reuptake inhibition
- 5-HT2 antagonist, therefore lower sexual dysfunction than SSRIs
20
Q
Modafinil
A
Psychostimulant used in narcolepsy, obstructive sleep apnoea, chronic shift work, adjunct in depression
Similar to amphetamines, but without dependence or tendency to precipitate psychosis
21
Q
Mirtazapine - mechanism
A
- Alpha adrenergic, 5-HT and H1 antagonist
22
Q
TCAs - mechanism and metabolism
A
- 5-HT reuptake inhibition and/or NA reuptake inhibition
- Hepatically metabolised
- alcohol potentiates
23
Q
Moclobemide
A
Reversible MAOI with short half-life
24
Q
Contraindications to MAOIs
A
Cardiovascular or cerebrovascular disease Phaeochromocytoma Hyperthyroidism Hepatic disease Delirium
25
Side-effects of MAOIs
peripheral oedema, postural hypotension, nausea, sweating, tremor, insomnia
26
Causes of hypertensive crisis with MAOIs
Tyramine containing foods and phenylephrine
Treated with phentolamine, phenoxybenzamine or chlorpromazine
27
Side-effects of TCAs
Anticholinergic - dry mouth, blurred vision, constipation, retention
Antihistaminergic - sedation, weight gain
Alpha-adrenoceptor - postural hypotension
Cardiotoxicity - QTc, arrhythmias, ST-elevation
Neurotoxicity - delirium, movement disorders, seizures, coma
28
Mirtazapine - side-effcts
sedation, weight gain, abnormal dreams and blood dyscrasia
29
Trazodone - side-effects
GI upset, sedation, hypotension, priapism
30
Agomelatine - mechanism and monitoring
- Agonist at melatonin MT receptors
- Antagonist at 5-HT2C receptors
- LFT monitoring required
31
Symptoms of antidepressant discontinuation syndrome
sleep disturbance, increased dreams, GI disturbance, mood disturbance, EPSE, lethargy, headache
32
Symptoms of serotonin syndrome
confusion, myoclonic jerks, hyperreflexia, pyrexia, sweating, autonomic instability, GI symptoms, mood changes
33
Steady state of Lithium
5-7 days
34
Consider bipolar maintenance treatment after...
2 illnesses in 2 years or
3 illnesses in 5 years or
1 severe illness
35
Lithium drug interactions
NSAIDs
Diuretics
ACE inhibitors
36
Serotonin receptor that is ligand gated
5-HT3
37
Serotonin receptors associated with nausea
5-HT3
38
Serotonin receptors associated with circadian rhythms
5-HT7
39
Serotonin receptor associated with insomnia, agitation and sexual dysfunction
5-HT2
40
Pregabalin
GABA analogue
High affinity for calcium channels
Eliminated unchanged by kidneys
41
Buspirone
5-HT1A Partial agonist
Short half life
Nausea, headache, dizziness, akithisia
42
Disulfiram
Bonds irreversibly to acetaldehyde dehydrogenase
43
Clozapine - efficacy
- Reduces positive SCZ Sx in 60% of resistant SCZ
44
Clozapine - side effects
- Sedation, postural hypotension, agranulocytosis, seizures, myocarditis, cardiomyopathy, hypersalivation
45
Clozapine - interactions
- Avoid carbamazepine, chloramphenicol,cytotoxics, benzodiazepines, depot antipsychotics
- SSRIs and valproate may increase levels
46
Amisulpride - mechanism
- Selective D2/D3 antagonism
| - 5-HT7 antagonism
47
Amisulpride - side effects
- Low EPSE and weight gain
| - prolactinaemia at higher doses
48
Aripiprazole - mechanism
- High affinity D2 partial agonist
| - High affinity 5-HT2A
49
Aripiprazole - side effects
- Low EPSE at all doses
- may decrease prolactin
- less weight gain than other antipsychotics
- no QTc changes
50
Olanzapine - pharmacokinetics and adverse effects
- Levels reduced by smoking
- Higher plasma levels in women for same dose
- Low EPSEs and prolactin; high sedation, weight gain, antimuscarinc SEs, glucose dysregulation.
51
Quetiapine - metabolite and side effects
- Key metabolite (norquetiapine) is NARI
| - Low EPSEs and prolactin; high dizziness, sedation, constipation
52
Risperidone - mechanism
- 5-HT2A/D2 antagonism
53
Risperidone - side effects
- Less DI Parkinsonism than typicals
| - Tachycardia, weight gain, hyperprolactinaemia
54
SSRI with lowest risk of interactions
Citalopram
55
SSRIs (2) with highest risk of interactions
Fluoxetine and paroxetine
56
Causes of tachycardia
```
Clozapine
TCAs
MAOIs
Antiparkinsonian
Antipsychotics (generally the older ones)
```
57
Causes of Torsades
Haloperidol
Thioridazine
Mesoridazine
Chlorpromazine
58
Causes of bradycardia
SSRIs
Lithium
Cholinesterase inhibitors
59
Causes of heart block
TCAs
60
Causes of ST segment changes
Thioridazine
| Chlorpromazine
61
Secondary amines
Desipramine
Nortriptyline
Protriptyline
Amoxapine
62
Zopiclone - class
cyclopyrrolone
63
Zopiclone - contraindications
unstable myasthenia gravis, respiratory failure, severe sleep apnoea syndrome, breastfeeding
64
Least likely to cause hyponatraemia
MAOIs, agomelatine
65
Antidepressants licensed in nocturnal enuresis (children)
Amitriptyline, Imipramine, Nortriptyline
66
Antidepressant licensed for phobias
Clomipramine
67
Antidepressant licensed for cataplexy
Clomipramine
68
Antidepressants licensed for panic disorder and agoraphobia
Citalopram, Escitalopram, Sertraline, Paroxetine, Venlafaxine
69
Antidepressants licensed for social anxiety
Escitalopram, Paroxetine, Sertraline, Moclobemide, Venlafaxine
70
Antidepressants licensed for general anxiety
Escitalopram, Paroxetine, Duloxetine, Venlafaxine
71
Antidepressants licensed for OCD
Escitalopram, Fluoxetine, Fluvoxamine, Paroxetine, Sertraline
72
Antidepressant licensed for bulimia
Fluoxetine
73
Antidepressant licensed for PTSD
Paroxetine, Sertraline
74
Antipsychotics least likely to cause hyperprolactinaemia
```
Clozapine
Aripiprazole
Quetiapine
Olanzapine
Ziprasidone
```
