Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 4 - Psychiatry > Session 11 - Pharmacology in Psychiatry > Flashcards

Session 11 - Pharmacology in Psychiatry Flashcards

1
Q

Common receptor effects of muscarinic (acetylcholine) receptors.

A
  • dry mouth
  • difficulty swallowing
  • thirst
  • difficulty urinating
  • urinary retention
  • hot and flushed skin
  • dry skin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Common receptor effects of histamine receptors.

A
  • dry mouth
  • drowsiness
  • dizziness
  • nausea and vomiting
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Common receptor effects of adrenergic / noradrenergic receptors.

A
  • sweating
  • tremor
  • headaches
  • nausea
  • dizziness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Generally, how long does it take for antidepressants to begin to work?

A

Two to three weeks.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Types of antidepressants.

A
  • SSRIs (most common)
  • SNRIs
  • Mirtazapine
  • Tricyclic antidepressants
  • MAOIs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

MOA of SSRIs.

A

Increase serotonin activity by reducing the presynaptic uptake of serotonin after release, therefore more serotonin sits in the synapse.

This leads to a down-regulation of post-synaptic receptors within 2-3 weeks.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Common side-effects of SSRIs.

A
  • restlessness and agitation on initiation
  • nausea
  • GI disturbance
  • headache
  • weight loss / gain
  • sexual dysfunction
  • bleeding
  • suicidal ideation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How can the specific side effects of SSRIs be managed?

a) restlessness and agitation on initiation

b) sexual dysfunction

c) bleeding

d) suicidal ideation

A

a) judicious use of benzodiazepines on initiation

b) prescribe viagra to help achieve erection

c) co-prescribe PPI if risk factors for bleeding

d) repeat consultation after 2-3 weeks to quantify suicide risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Dosage of Sertraline (SSRI).

A

50-200mgs

Safest in cardiac disease.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Dosage of Citalopram (SSRI).

A

20-40mgs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Dosage of Escitalopram (SSRI).

A

10-20mgs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Dosage of Fluoxetine (SSRI).

A

20-60mgs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Dosage of Paroxetine (SSRI).

A

20-60mgs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Why should an ECG be conducted when prescribing Citalopram or Escitalopram for a patient?

A

Risk of QTc prolongation and subsequent arrhythmias.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

MOA of SNRIs.

A

Increase serotonin and noradrenaline activity by reducing the presynaptic uptake of serotonin and noradrenaline after release, therefore more serotonin and noradrenaline sits in the synapse.

This leads to a down-regulation of post-synaptic receptors within 2-3 weeks.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Side effects of SNRIs.

A

Similar side effects to SSRIs, but greater potential for:
- sedation
- nausea
- sexual dysfunction
- weight gain

Other side effects are similar to SSRIs:
- restlessness and agitation on initiation
- GI disturbance
- headache
- bleeding
- suicidal ideation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Dosage of Duloxetine.

A

60-120mgs

Low dose range.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Dosage of Venlafaxine.

A

75-375mgs

Greater efficacy than Duloxetine and can go to a higher dose.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Monitoring required at higher Venlafaxine dosing.

A

Venlafaxine >225mgs cautioned in heart disease - monitor blood pressure.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

MOA of Mirtazapine.

A

Antagonises 5HT-2 and 5HT-3 receptors.

Agonises H1 receptors, causing sedation as side effect.

Side effects are used to a therapeutic advantage.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Side effects of Mirtazapine.

A
  • sedation
  • weight gain

Side effects are pronounced even at low doses, therefore a reduction in dose would not help relieve symptoms.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

MOA of tricyclics.

A

Agonise muscarinic and histaminergic receptors, causing sedation.

Can also be used to treat neuropathic pain.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Examples of tricyclics.

A

Newer tricyclics:
- lofepramine
- nortriptyline

tolerated better than older tricyclics:
- amitriptyline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Risk of tricyclics.

A

Can be fatal in overdose - cause QTc prolongation and arrhythmias.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

MOA of MAOIs.

A

Inhibit monoamine oxidase, having effects on serotonin, dopamine and adrenaline levels.

Some are irreversible (more dangerous), while some are reversible (less dangerous).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Interactions of MAOIs.

A

Potential for significant and dangerous interaction with other drugs.

Rarely prescribed.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What foods need to be avoided if prescribing MAOIs?

A

Avoid tyramine products:
- cheese
- pickled meats
- wine

Potential for tyramine reaction leading to hypertensive crisis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

MOA of Vortioxetine.

A

Differing effects on serotonergic activity according to receptor.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Side effects of Vortioxetine.

A

Generally well tolerated.

Most common side effect is nausea.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What factors influence antidepressant choice?

A
  • what has been used before?
  • what has been effective before?
  • what has been well tolerated before?
  • what does the patient want?
  • are there any particular symptoms or comorbidities you want to address?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

General antidepressant step-up.

A
  1. Sertraline
  2. Different SSRI
  3. SNRI / Mirtazapine

If SSRI causes major weight changes or sleep difficulty consider Mirtazipine; if comorbid neuropathic pain consider SNRI first line.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

When should you switch antidepressant medication?

A

Switch if no treatment effect within the first 4 weeks.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

When should you increase the dose of antidepressant medication?

A

If there has been partial benefit within the first 4 weeks.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is discontinuation syndrome?

A

For some people, the rapid exit of serotonin from the system can cause an unpleasant syndrome:
- sweating
- shaking
- agitation
- insomnia
- headaches
- irritability
- nausea and vomiting
- paraesthesia
- clonus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Is discontinuation syndrome life-threatening?

A

No - it is unpleasant but not life-threatening.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Which antidepressants are particularly associated with discontinuation syndrome?

A

Those with a short half life:
- Venlafaxine
- Paroxetine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

How can the risk of discontinuation syndrome be reduced?

A
  • alternate days of taking
  • snap tablets in half
  • switch to Fluoxetine* (long half life) then reduce

*Fluoxetine comes in liquid preparation so can make micro-adjustments in dose.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What is serotonin syndrome?

A

A potentially life-threatening side effect of antidepressants, characterised by excess serotonin.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Presentation of serotonin syndrome:

a) cognitive

b) autonomic

c) somatic

A

a) headaches; agitation; hypomania; confusions; coma

b) shivering; sweating; hyperthermia; tachycardia; nausea and diarrhoea

c) myoclonus; hyper-reflexia; tremor

Can cause seizures and sudden death.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Treatment of serotonin syndrome.

A

Supportive - fluids and monitoring.

41
Q

What are the four dopaminergic pathways in the brain?

A
  • mesocortical pathway
  • mesolimbic pathway
  • nigrostriatal pathway
  • tuberoinfundibular pathway
42
Q

MOA of antipsychotics.

A

Reduce level of dopamine activity at D2 receptors:
- target pathways are mesocortical and mesolimbic
- unwanted effects come from nigrostriatal and tuberoinfundibular

43
Q

Difference between typical and atypical antipsychotics.

A

Typical are older and more likely to cause extra-pyramidal side effects.

Typical tend to bind to more muscarinic and histaminic receptors.

Atypical tend to have more serotonergic activity.

44
Q

Examples of typical antipsychotics.

A
  • haloperidol
  • chlorpromazine
  • flupenthixol
45
Q

Examples of atypical antipsychotics.

A
  • clozapine
  • olanzapine
  • resperiodone
  • quetiapine
  • aripiprazole
46
Q

Side effects of all antipsychotics.

A
  • sedation
  • weight gain
  • QTc prolongation
47
Q

Side effects more associated with typical antipsychotics.

A
  • extra-pyramidal side effects (as stronger D2 antagonist)
  • dizziness
  • sexual dysfunction
48
Q

What are the extra-pyramidal side effects?

A

Side effects caused by impaired motor control, due to dysfunction of the basal ganglia secondary to dopamine dysregulation.

  • bradykinesia
  • muscle stiffness
  • tremor
  • tardive dyskinesia (chewing like a horse)
  • akathisia
49
Q

Side effects more associated with atypical antipsychotics.

A
  • weight gain
  • dyslipidaemia
  • diabetes
50
Q

Baseline monitoring of antipsychotics.

A
  • FBC (bone marrow suppression)
  • lipid profile (dyslipidaemia)
  • LFTs (steatohepatitis)
  • HbA1c (DM)
  • weight (weight gain)
  • ECG (QTc prolongation)
  • blood pressure and pulse (early sign of metabolic syndrome)
51
Q

Weekly monitoring of antipsychotics.

A

Weekly monitoring of weight to prevent weight gain.

52
Q

Monitoring of antipsychotics at 3 months.

A
  • FBC (bone marrow suppression)
  • lipid profile (dyslipidaemia)
  • LFTs (steatohepatitis)
  • HbA1c (DM)
  • weight (weight gain)
  • ECG (QTc prolongation)
  • blood pressure and pulse (early sign of metabolic syndrome)
53
Q

Monitoring of antipsychotics at 1 year.

A
  • FBC (bone marrow suppression)
  • lipid profile (dyslipidaemia)
  • LFTs (steatohepatitis)
  • HbA1c (DM)
  • weight (weight gain)
  • ECG (QTc prolongation)
  • blood pressure and pulse (early sign of metabolic syndrome)
54
Q

What is neuroleptic malignant syndrome?

A

A rare, life-threatening reaction to antipsychotics due to:
- rhabdomyolysis
- renal failure
- seizures

55
Q

Risk factors for neuroleptic malignant syndrome.

A
  • typical antipsychotics
  • antipsychotic naive
  • high doses
  • young men
56
Q

How can neuroleptic malignant syndrome be differentiated from serotonin syndrome via investigation?

A

Neuroleptic malignant syndrome causes rhabdomyolysis, therefore CK will be raised.

57
Q

Presentation of neuroleptic malignant syndrome.

a) cognitive

b) autonomic

c) somatic

A

a) headaches; agitation; hypomania; confusions; coma

b) shivering; sweating; hyperthermia; tachycardia; nausea and diarrhoea

c) myoclonus; hyper-reflexia; tremor

Can cause seizures and sudden death.

58
Q

Treatment of neuroleptic malignant syndrome.

A
  1. Stop antipsychotic
  2. Emergency referral to A&E
  3. Fluid resuscitation
  4. Reduce temperature (cooling blankets)
  5. Benzodiazepine for acute behavioural disturbance

Give fluids and sodium bicarbonate to alkalise the urine in rhabdomyolysis.

Give dantrolene or lorazepam to relax muscles.

59
Q

How can extra-pyramidal side effects (EPSEs) be treated?

A

Low ratio of dopamine:acetylcholine in nigrostriatal pathway leads to extrapyramidal side effects.

By reducing acetylcholine, the ratio of doapmine:acetylcholine increases and EPSEs are reduced.

60
Q

Examples of medication used to treat EPSEs.

A

Acetycholine receptor antagonists.

Procyclidine most commonly used drug; potential for misuse as causes a ‘high’.

61
Q

What are acute dystonias?

A

Sustained, painful muscular spasms, producing abnormal postures.

Associated with typical antipsychotic use.

62
Q

How long after initiating antipsychotics do acute dystonias present?

A

Around half in the first 48 hours.

90% within the first 5 days.

63
Q

Management of acute dystonias.

A
  • stop antipsychotic
  • IM or IV anticholinergic (procyclidine)
  • continue for 1-2 days after dystonia and consider long-term prophylactic
64
Q

MOA of Clozapine.

A

Atypical antipsychotic.

D2 antagonist; 5HT-2 antagonist.

65
Q

Indication of Clozapine prescription.

A

Should be used in schizophrenia after two other antipsychotics have not been effective.

66
Q

Side effects of Clozapine.

A

Agranulocytosis, plus:

Autonomic side effects:
- constipation
- fatal bowel obstruction
- hypersalivation
- urinary incontinence

Dose titrated slowly upward over two weeks, with vital signs and FBCs monitored closely.

67
Q

Monitoring when on Clozapine.

A

FBC monitoring to assess for agranulocytosis.

Weekly for first 18 weeks; fortnightly up to 52 weeks; monthly thereafter.

68
Q

Treatment of agranulocytosis.

A
  • stop Clozapine (and other bone marrow suppressants e.g. sodium valporate)
  • avoid other antipsychotics
  • consider broad spectrum abx prescription
  • contact consultant Haematologist as an emergency

Lithium and G-CSF can be used to increase WCC and neutrophil count, under specialist instruction.

69
Q

Which antipsychotic has the least potential for bone marrow suppression?

A

Aripiprazole - used as antipsychotic if agranulocytosis occurs.

Only use if really needed.

70
Q

Medications used to treat anxiety.

A
  • SSRIs
  • beta blockers
  • benzodiazepines
  • pregabalin
71
Q

MOA of beta-blockers.

A

Reducing autonomic nervous system activation, having a bio-psychofeedback mechanism that dampens anxiousness.

72
Q

Contraindications of beta-blockers.

A

Asthma

73
Q

Most commonly used beta-blocker.

A

Propanolol

74
Q

Most commonly used benzodiazepines.

A
  • diazepam (long half-life)
  • lorazepam (short half-life)
75
Q

MOA of benzodiazepines.

A

Bind to GABA receptors to potentiate the effect of GABA, and therefore reduce the excitability of neurones.

(GABA is an inhibitory neurotransmitter).

76
Q

Cautions of benzodiazepines.

A
  • tolerance
  • dependence
  • misuse

Due to cautions, use for no more than 6 weeks.

77
Q

MOA of Pregabalin.

A

Binds to voltage-gated calcium channels on neurones, reducing neuronal activity.

78
Q

Indications of Pregabalin.

A
  • anxiety
  • neuropathic pain
  • epilepsy
79
Q

Side effects of Pregabalin.

A
  • sedation
  • weight gain

Less potential for misuse and dependence than benzodiazepines, but still misused.

80
Q

What are the classes of sleeping tablets?

A

Benzodiazepines: Temazepam, Lormatazepam, Nitrazepam.

Nonbenzodiazepines: Zopiclone, Zolpidem (Z-drugs).

Note Z-drugs are usually favoured.

81
Q

Prescription advise for sleeping tablets.

A
  • two weeks max
  • take for 5 out of 7 days each week
82
Q

What is used to treat bipolar disorder?

A

Mood stabilisers:
- lithium
- anticonvulsants
- atypical antipsychotics

83
Q

Monitoring of serum lithium levels.

A

Narrow therapeutic window:
- weekly serum lithium levels until stable
- 3 monthly lithium levels once stable

84
Q

What is the effect of Lithium use in depression?

A

Significant evidence that Lithium reduces suicide risk - and it has a license for reduction of self-harm.

Can also be used to augment antidepressants.

85
Q

Side effects of Lithium.

A
  • GI disturbance
  • metallic taste
  • dry mouth
  • fine tremor
  • polydipsia
  • polyuria
  • weight gain
86
Q

Long-term effects of Lithium, and extra monitoring therefore required.

A
  • hypothyroidism
  • renal impairment

Therefore annual U&Es and TFTs.

87
Q

Monitoring of LFTs when on Lithium.

A

Not required as Lithium completed excreted by the kidneys - has no effect on the liver at all.

88
Q

Presentation of Lithium toxicity.

A
  • confusion
  • coarse tremor
  • nausea and vomiting
  • ataxia
  • seizures
89
Q

Treatment of lithium toxicity.

A
  • stop lithium
  • IV fluids
  • dialysis if necessary
  • benzodiazepines for seizures
90
Q

Dangerous interactions with lithium.

A
  • NSAIDs
  • loop diuretics
  • ACE inhibitors
91
Q

First line treatment for bipolar disorder.

A

Atypical antipsychotic

Quetiapine.

92
Q

Most commonly used anticonvulsants in bipolar disorder.

A
  • Sodium valporate
  • Carbamazepine
  • Lamotrigine
93
Q

Cautions of Sodium Valporate.

A

Avoid in men and women of child bearing age due to teratogenicity - must stop >6 months before pregnancy.

Check LFTs before and soon after starting.

94
Q

Cautions of Lamotrigine.

A

Potential for Stevens Johnson syndrome:

Type IV hypersensitivity reaction, causing blistering of mucosal membranes.

95
Q

Why are FBCs monitored when taking anticonvulsants?

A

Potential for thrombocytopenia.

96
Q

Side effects of anticonvulsants.

A
  • sedation
  • weight gain
97
Q

Medication prescribed for ADHD.

A
  1. Methylphenidate
  2. Dextroamphetamine
  3. Atomoxetine
98
Q

Monitoring required when prescribing ADHD medications.

A

Monitor weight and height in children (stunted growth).

Monitor pulse in children.

Year 4 - Psychiatry (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions