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Psych. Pharmacology

Indications, mechanisms & side effects/interactions of drugs used in psychiatry

Define psychotropic. Mind-altering.
List the main classes of drugs used in psychiatry. Antidepressants. Mood stabilizers. Antipsychotics. Anxiolytics & hypnotics.
List the classes of antidepressants. Tricyclics, SSRIs, SNRIs, MAOIs, RIMAs, NaSSAs, NARIs, SARIs & misc. others.
A good first line antidepressant. An SSRI e.g. fluoxetine, sertraline etc.
SSRI side effects. GI upset, agitation, loss of appetite, insomnia, sweating, sexual dysfunction.
A contraindication of virtually all antidepressants. Mania.
Class and mechanism of mirtazapine. Noradrenergic and specific serotonergic antidepressant (NaSSA). Inhibition of presynaptic adrenergic receptors. ?Stimulation of postsynaptic serotonin receptors.
Mirtazapine side effects. Increased appetite, weight gain, sedation, headache, dry mouth, postural hypotension, tremor, dizziness, peripheral oedema.
Tricyclic side effects. Sympathetic (constipation, dry mouth etc.), postural hypotension etc., weight gain, sedation, cardiotoxicity.
List TCAs. Amitriptyline, clomipramine, imipramine, lofepramine.
Contraindications of TCAs. Recent MI, cardiac disease, arrhythmias, severe liver disease, mania, significant suicide risk.
Class and mechanism of trazodone. Antagonist of serotonin 2A R, but inhibits re-uptake.
What is the "cheese reaction"? A hypertensive crisis caused by ingesting tyramine-rich foods causing a release of noradrenaline when on MAOIs.
List tyramine-rich foods. Some cheeses, chianti, beer, pickled herring, game, yeast extract in Marmite / Vegemite etc. some legumes.
Drugs interacting with MAOIs. SSRIs (serotonin syndrome), opiates (serotonin syndrome; some SSRI activity), OTC decongestants, amphetamines, cocaine, adrenaline.
Contraindications of MAOIs. Phaeochromocytoma, cerebrovascular disease, liver disease, mania.
Which SSRI has the longest half life? Fluoxetine (therefore does not need tapering).
Which antidepressants are used in a lower dose for neuropathic pain? TCAs especially amitriptyline.
Drugs companies covered up the increased suicide risk in young people when taking which drug? Paroxetine, an SSRI.
Duloxetine, an SSRI, is also used in which condition? Bladder instability.
Class and mechanism of venlafaxine. SNRI, inhibits re-uptake of noradrenaline and serotonin.
Class and mechanism of phenelzine. MAOI, inhibits presynaptic degradation of amine neurotransmitters.
What are the principle symptoms of serotonin syndrome? Neuromuscular abnormalities, reduced consciousness and autonomic instability.
Class and mechanism of moclobemide. RIMA, reversably inhibits monoamine oxidase A.
Which class of antidepressants are associated with cardiotoxicity? TCAs.
Describe the classes of mood-stabilizer. Lithium and anti-epileptics.
Indications of lithium. Acute mania, prophylaxis in bipolar disorder, augmentation in major depression, various other adjuncts.
What are the therapeutic levels of lithium? 0.5 - 1.0 mmol/L. (Some clinicians say 0.4 - 0.8).
Lithium toxicity generally occurs above what level? 1.5 mmol/L
How is lithium eliminated by the body? Almost entirely renally excreted.
Symptoms of lithium toxicity. GI upset, coarse tremor, altered consciousness, double vision etc.
Lithium side effects (short term). Polydipsia, weight gain, oedema, skin disease, renal impairment, ECG abnormalities, memory problems etc. Lithium is highly teratogenic.
Lithium side effects (long term). Hypothyroidism, hyperparathyroidism (and elevated Ca++).
1.8 mmol/L of Li+ is: A toxic level, prescribe fluids and stop Li+ for a day or two.
2.5 mmol/L of Li+ is: Dangerously toxic, urgent dialysis required.
Many drugs interacting with lithium: Alter renal function, e.g. ACEis, NSAIDs, diuretics esp. thiazides.
The most common cause of lithium toxicity is. Iatrogenic - junior Drs Px NSAIDs etc.
Is all lithium carbonate the same? No, should be prescribed with a specific brand name (like insulin preparations).
Contraindications of lithium. Pregnancy and breastfeeding, renal impairment, thyroid disease, heart disease, degenerative neurological diseases.
Signs of lithium toxicity. Vomiting, apathy, coarse tremor, ataxia, weakness, nystagmus, dysarthria, reduced consciousness, hyperreflexia, oliguria, hypotension, convulsions, coma and death.
Lamotrigine is associated with which serious side effect? Stevens-Johnson syndrome (rashes, ulceration of mucous membranes)
Valproate, carbamazepine and lamotrigine are. Mood-stabilizers.
Main classification of antipsychotics. Typical and atypical. (Clozapine is the only true atypical).
What is the mechanism of (almost all) antipsychotics? D2R blockade, both for intended and side effects.
Side effects of antipsychotics. Increased negative and cognitive symptoms, extrapyramidal side effects, hyperprolactinaemia, anticholinergic, antiadrenergic etc. Arrythmias.
Long term monitoring of what condition is recommended for patients on antipsychotics? Metabolic syndrome.
List antipsychotics that can be Px IM. Haloperidol, flupentixol, zuclopenthixol, risperidone.
Clozapine is associated with which serious side effects? Agranulocytosis, myocarditis and cardiomyopathy, toxic megacolon.
Which blood test should be regularly undertaken in patients on clozapine? FBCs to screen for agranulocytosis. (And fasting lipids and glucose)
List the extrapyramidal side effects. Parkinsonism, acute dystonia, akathisia, tardive dyskinesia.
Antipsychotics are occasionally prescribed to patients with delirium. Are they helpful in DT? No; they lower the seizure threshold.
Which drugs is it illegal to prescribe to patients with dementia in America? Antipsychotics, as increase cerebrovascular risk and were used as "chemical cosh".
A hypnotic drug: Induces sleep (dose dependent).
An anxiolytic drug: Reduces anxiety (dose dependent).
Unlike many other drugs used in psychiatry, hypnotics/anxiolytics are Addictive (tolerance, dependence and withdrawal).
Indications for the use of benzodiazepines. Insomnia, anxiety disorders, alcohol withdrawal, akathisia, sedation in acute mania or psychosis etc.
Zopiclone etc. may be used in: Insomnia.
What is the mechanism of action of benzodiazepines? Potentiating GABA (by increasing the affinity of the receptor for its ligand)
Side effects of benzodiazepines. Dependence, sedation, respiratory depression.
Aside from benzodiazepines, which drugs may impair your ability to drive due to sedation? Tricyclic antidepressants, most antipsychotics (not aripiprazole), sedating antihistamines, opiates.
Treatment regimen for alcohol withdrawal: Reducing regimen of benzodiazepines (commonly chlordiazepoxide, QDS + prn)
Autonomic symptoms of anxiety may be treated by: beta-blockers, which have the advantage that they're not addictive.
How does acamprosate work in alcohol addiction? Reduces cravings.
How does disulfiram work in alcohol addiction? Prevents metabolism of acetaldehyde, causing unpleasant symptoms after drinking. People still drink on this, which can be dangerous.
Class and mechanism of naltrexone: Opioid receptor antagonist - use in opiate addiction as it lessens pleasureable effects.
Which benzodiazepines have a long half-life (many days)? Diazepam and chlordiazepoxide.
Many drugs used in the treatment of dementia: Increase the synaptic availability of ACh by inhibiting its breakdown by AChE.
How does memantine work in the treatment of dementia? NMDAR modulator.
Created by: s0911751



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