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Psychiatry > Psychopharmacology > Flashcards

Psychopharmacology Flashcards

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1
Q

Choice of agent and dosage?

A

Acceptable side effect profile

Lowest effective dose

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2
Q

Important to remember in psychopharmacology?

A

Delayed response of many drugs

Drug-drug interactions

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3
Q

Indications for an antidepressant?

A

Unipolar and bipolar depression
Organic mood disorders
Schizoaffective disorder
Anxiety disorders

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4
Q

Typical antidepressant delay?

A

3-6 weeks

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5
Q

When would you choose another antidepressant or augment with another agent?

A

If no improvement after at least 2 months at an adequate dose

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6
Q

Classifications of antidepressants?

A 
Tricyclics (TCAs)
MAOIs (Monoamine Oxidase Inhibitors)
SSRIs
SNRIs (Serotonin/ Noradrenaline Reuptake Inhibitors) 
Novel antidepressants
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7
Q

Why are tricyclic antidepressants generally not used?

A

Very effective but poor side effect profile (antihistaminic, anticholinergic, antiadrenergic)
Lethal in overdose
Can cause QT lengthening

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8
Q

Antihistaminic side effects?

A

Sedation

Weight gain

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9
Q

Anticholinergic side effects?

A 
Dry mouth
Dry eyes
Constipation
Memory deficit
(potentially delerium)
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10
Q

Antiadrenergic side effects?

A

Orthostatic hypotension
Sedation
Sexual dysfunction

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11
Q

Examples of a tertiary TCA?

A

Amitriptyline
Clomipramine
Doxepin

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12
Q

MAOI method of action and example?

A

Bind to monoamine oxidase, preventing inactivation of amines (norepinephrine, dopamine and serotonin)
Phenelzine

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13
Q

Side effects of MAOIs?

A 
Orthostatic hypotension
Weight gain
Dry mouth
Sedation
Sexual dysfunction
Sleep disturbance
Cheese reaction
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14
Q

Cheese reaction?

A

Hypertensive crisis when taken with tyramine rich foods

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15
Q

Potential uses of MAOIs?

A

Treatment resistant depession

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16
Q

Why would you need to wait if switching from an SSRI to a MAOI?

A

Wait at least 2 weeks to avoid serotonin syndrome

5 weeks if fluoxetine

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17
Q

Most common side effect of SSRIs?

A 
GI upset
Sexual dysfunction
Anxiety
Restlessness
Nervousness
Insomnia
Fatigue or sedation
Dizziness
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18
Q

SSRI examples?

A 
SFCP
Sertraline
Fluoxetine
Citalopram
Paroxetine
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19
Q

Benefits of sertraline?

A

Weak P450 interactions
Short half life
Less sedating

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20
Q

Disadvantages of sertraline?

A

Max absorption requires a full stomach

Increased number of GI adverse drug reactions

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21
Q

Benefits of fluoxetine?

A

Long half life

Initially activating

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22
Q

Disadvantages of fluoxetine?

A

Long half life and metabolite build up
P450 interactions
More likely to induce mania

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23
Q

How do SNRIs work?

A

Inhibit both serotonin and noradrenaline reuptake like TCAs but without the same side effects

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24
Q

Uses for SNRIs?

A

Depression
Anxiety
(possibly neuropathic pain)

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25
Examples of SNRIs?
Venlafaxine | Duloxetine
26
Examples of novel antidepressants?
Mirtazapine | Buproprion
27
Indications for mood stabilisers?
Bipolar Cyclothymia Schizoaffective disorder
28
Classes of mood stabilisers?
Lithium Anticonvulsants Antipsychotics
29
Only drug to reduce suicide rate?
Lithium
30
Factors predicting a positive response to lithium?
Prior long-term response or family member with a good response Classic pure mania Mania is followed by depression
31
What needs to be done before starting lithium?
Baseline EUC and TFT | rule out pregnancy
32
Goal therapeutic range for lithium?
0.6-1.2
33
What monitoring is needed on lithium treatment?
EUC and TFT monitoring (6 months) | Drug level monitoring (3 months)
34
Most common side effects of lithium?
``` GI distress Thyroid abnormalities Polyuria/polydipsia (ADH antagonism) Reduces seizure threshold, cognitive slowing, intention tremor Non significant leukocytosis Hair loss Acne ```
35
Mild lithium toxicity?
1.5 - 2.0 | Vomiting, diarrhoea, dizziness, slurred speech
36
Moderate lithium toxicity?
2.0 - 2.5 | Nausea, vomiting, anorexia, blurred vision, clonic limb movements, convulsions, delerium
37
Severe lithium toxicity?
>2.5 | Generalised convulsions, oliguria, renal failure
38
Example of anticonvulsants?
Valproic acid (Valproate) Carbamazepine Lamotrigine
39
Is valproate as effective as lithium?
For mania prophylaxis, but not as effective in depression prophylaxis
40
What needs to be done before starting valproate?
Baseline LFT, FBC and pregnancy test (folic acid supplementation in women)
41
Therapeutic range for valproate?
50-125 micrograms/ml
42
Side effects of valproate?
``` Thrombocytopenia Nausea/vomiting and weight gain Sedation, tremor Hair loss Increased risk of neural tube defect ```
43
Indications for carbamazepine?
First line for acute mania and mania prophylaxis | 'Rapid cyclers'
44
Monitoring for carbamazepine?
LFT, FBC and an ECG | Check dose after 1 month, induces own metabolism
45
Carbamazepine side effects?
``` Rash Nausea/vomiting Sedation AV conduction delays Aplastic anaemia Water retention (vasopressin like effect) Multiple drug interactions ```
46
Lamotrigine side effects?
Nausea/vomiting Sedation, dizziness Severe: Stevens Johnson's Syndrome
47
Indications for antipsychotics?
Schizophrenia Schizoaffective disorder Bipolar disorder (for mood stabilisation and/or psychotic features) Psychotic depression Augmenting agent in treatment resistant anxiety disorders
48
Dopamaine pathways?
Mesocortical Mesolimbic Nigrostriatal Tuberoinfundibular
49
Typical antipsychotics? (Drug names)
D2 dopamine receptor antagonists Haloperidol Fluphenazine Chlorpromazine
50
Side effects of typical antipsychotics?
``` Extrapyramidal side effects Tremor Slurred speech Akathisia Dystonia Paranoia ```
51
Atypical antipsychotics? (Drug names)
Aripiprazole Risperidone Olanzapine Quetiapine
52
Side effects of risperidone?
Sexual dysfunction Most likely to induce hyperprolactinemia Weight gain Sedation
53
Side effects of olanzapine?
Weight gain | May cause hypertriglyceridemia, hypercholesterolemia, hyperglycemia
54
Side effects of quetiapine?
Most likely to cause orthostatic hypotension | Weight gain but not as bad as olanzapine
55
Antipsychotic not associated with weight gain?
Aripiprazole
56
Efficacy of antipsychotics?
1/3 good response 1/3 average response 1/3 no response
57
Treatment resistant?
Clozapine, only drug shown to be beneficial in treatment resistance
58
Efficacy of clozapine?
Same rule of thirds 1/3 do well 1/3 reasonable 1/3 non responders
59
Why is clozapine not a first line drug?
Because of side effects
60
Side effects of clozapine?
Agranulocytosis Increased risk of seizures Associated the most with weight gain, sedation and abnormal LFTs
61
If clozapine is not effective?
- Add another antipsychotic to clozapine - Add lithium/anticonvulsant - ECT
62
Adverse effects of antipsychotics?
Tardive dyskinesia (TD) Neuroleptic Malignant syndrome (NMS) Extrapyramidal side effects (EPS)
63
Agents for extrapyramidal side effects?
Anticholinergics (benztropine) Dopamine facilitators (amantadine) Beta-blockers (propranolol)
64
Anxiolytic?
Buspirone
65
Anxiety disorder treatment?
Anxiolytic in combination with an SSRI or SNRI
66
Indications for benzodiazepines?
Insomnia Parasomnias Anxiety disorders
67
Side effects of benzodiazepines?
``` Somnolence Cognitive deficits Amnesia Disinhibition Tolerance DEPENDENCE ```

Psychiatry (12 decks)

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