Podcast
Questions and Answers
For a patient not responsive to antidepressants in Bipolar I disorder, what pharmacological intervention is typically needed?
For a patient not responsive to antidepressants in Bipolar I disorder, what pharmacological intervention is typically needed?
- Trial of a different class of antidepressant
- Initiation of an anxiolytic drug
- Adjustment of antidepressant dosage
- Addition of a mood stabilizer (correct)
What is a critical consideration when prescribing atypical antipsychotics to diabetic patients?
What is a critical consideration when prescribing atypical antipsychotics to diabetic patients?
- There is no direct interaction between these medications and diabetes
- Diabetic patients are less sensitive to the effects of these drugs
- Atypical antipsychotics can increase the risk of hyperglycemia (correct)
- These medications always improve glycemic control
Which factor is least important when determining the target symptoms of an antidepressant
Which factor is least important when determining the target symptoms of an antidepressant
- The patient's specific symptoms
- The patient's preferred brand of medication (correct)
- Patient drug information for other medical conditions
- Past responses to psychotropic medications
What is the most important consideration when side effects emerge while treating a patient with antidepressants?
What is the most important consideration when side effects emerge while treating a patient with antidepressants?
Which statement correctly describes the mechanism of action of antidepressants related to monoamines?
Which statement correctly describes the mechanism of action of antidepressants related to monoamines?
A patient is prescribed an antidepressant that increases neurogenesis. Where does the antidepressant primarily exert this effect?
A patient is prescribed an antidepressant that increases neurogenesis. Where does the antidepressant primarily exert this effect?
Which statement accurately compares the use of tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) in contemporary psychiatric practice?
Which statement accurately compares the use of tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) in contemporary psychiatric practice?
Which of the following side effects is most associated with tricyclic antidepressants and requires careful monitoring?
Which of the following side effects is most associated with tricyclic antidepressants and requires careful monitoring?
Why should serotonin and noradrenaline reuptake inhibitors (SNRIs) be used with caution in patients with pre-existing hypertension?
Why should serotonin and noradrenaline reuptake inhibitors (SNRIs) be used with caution in patients with pre-existing hypertension?
Which factor should be considered when choosing between different types of antidepressants?
Which factor should be considered when choosing between different types of antidepressants?
What is the primary goal of prescribing antipsychotic medications?
What is the primary goal of prescribing antipsychotic medications?
Which of the listed dopamine pathways is most associated with the positive symptoms of schizophrenia, such as hallucinations and delusions?
Which of the listed dopamine pathways is most associated with the positive symptoms of schizophrenia, such as hallucinations and delusions?
A 45-year-old patient with schizophrenia is experiencing significant negative symptoms. Which dopamine pathway is most likely implicated in these symptoms?
A 45-year-old patient with schizophrenia is experiencing significant negative symptoms. Which dopamine pathway is most likely implicated in these symptoms?
What is a significant difference between typical and atypical antipsychotics regarding their mechanisms of action?
What is a significant difference between typical and atypical antipsychotics regarding their mechanisms of action?
Which class of antipsychotics is more likely to cause extrapyramidal symptoms (EPS) such as parkinsonism and tardive dyskinesia?
Which class of antipsychotics is more likely to cause extrapyramidal symptoms (EPS) such as parkinsonism and tardive dyskinesia?
What is a primary concern when considering the use of clozapine, an atypical antipsychotic?
What is a primary concern when considering the use of clozapine, an atypical antipsychotic?
Regarding efficacy, how do typical and atypical antipsychotics compare in treating schizophrenia?
Regarding efficacy, how do typical and atypical antipsychotics compare in treating schizophrenia?
A patient on a typical antipsychotic develops akathisia. They are having significant difficulty remaining still. Which of the following strategies is most appropriate?
A patient on a typical antipsychotic develops akathisia. They are having significant difficulty remaining still. Which of the following strategies is most appropriate?
What is the primary role of mood stabilizers in treating bipolar disorder?
What is the primary role of mood stabilizers in treating bipolar disorder?
What is the most important monitoring requirement for patients taking lithium?
What is the most important monitoring requirement for patients taking lithium?
Which of the following statements best describes the mechanism of action of valproic acid in treating bipolar disorder?
Which of the following statements best describes the mechanism of action of valproic acid in treating bipolar disorder?
What is a significant advantage of using lamotrigine in the treatment of bipolar disorder compared to other mood stabilizers?
What is a significant advantage of using lamotrigine in the treatment of bipolar disorder compared to other mood stabilizers?
In cases where a rapid cycling presentation is observed, which mood stabilizers should be considered?
In cases where a rapid cycling presentation is observed, which mood stabilizers should be considered?
What is a common side effect associated with lithium that requires monitoring?
What is a common side effect associated with lithium that requires monitoring?
What is the primary mechanism of action of benzodiazepines in treating anxiety?
What is the primary mechanism of action of benzodiazepines in treating anxiety?
For which condition are anxiolytic drugs not ideal?
For which condition are anxiolytic drugs not ideal?
Which of the following considerations is most pertinent when prescribing benzodiazepines for anxiety?
Which of the following considerations is most pertinent when prescribing benzodiazepines for anxiety?
A patient has been taking lorazepam daily for several months to manage anxiety, and now wishes to discontinue it. What is the most important consideration in safely stopping the medication?
A patient has been taking lorazepam daily for several months to manage anxiety, and now wishes to discontinue it. What is the most important consideration in safely stopping the medication?
What is a potential risk that should be discussed with patients before initiating treatment with benzodiazepines?
What is a potential risk that should be discussed with patients before initiating treatment with benzodiazepines?
What is the mechanism of action of the drug buspirone?
What is the mechanism of action of the drug buspirone?
A patient is being prescribed sertraline. Which classification does this drug fall under?
A patient is being prescribed sertraline. Which classification does this drug fall under?
A patient is being prescribed venlafaxine. Which classification does this drug fall under?
A patient is being prescribed venlafaxine. Which classification does this drug fall under?
What is the MOA of Trazodone?
What is the MOA of Trazodone?
Which is a common example of a Monoamine Oxidase Inhibitor (MAO)?
Which is a common example of a Monoamine Oxidase Inhibitor (MAO)?
Which of the options is typically used in medication to treat schizophrenia?
Which of the options is typically used in medication to treat schizophrenia?
A patient is on Clozapine, what needs to be regularly checked?
A patient is on Clozapine, what needs to be regularly checked?
What are the different drug classifications of anxiety medications?
What are the different drug classifications of anxiety medications?
Which of the options is an example of a Benzodiazepine?
Which of the options is an example of a Benzodiazepine?
What is the primary reason for using caution when prescribing serotonin and noradrenaline reuptake inhibitors (SNRIs)?
What is the primary reason for using caution when prescribing serotonin and noradrenaline reuptake inhibitors (SNRIs)?
A patient on a typical antipsychotic presents with parkinsonism, akathisia and tardive dyskinesia. Which of the following best explains the side effects?
A patient on a typical antipsychotic presents with parkinsonism, akathisia and tardive dyskinesia. Which of the following best explains the side effects?
A patient with no prior history of psychosis presents with initial signs of agitation, delusions and disorganized thinking. Which dopamine pathway is most likely involved?
A patient with no prior history of psychosis presents with initial signs of agitation, delusions and disorganized thinking. Which dopamine pathway is most likely involved?
What is a potential long-term risk associated with the chronic use of benzodiazepines?
What is a potential long-term risk associated with the chronic use of benzodiazepines?
When initiating antidepressant treatment, what should be done regarding the dosage, according to the lecture's principles?
When initiating antidepressant treatment, what should be done regarding the dosage, according to the lecture's principles?
A patient with Bipolar I disorder, who is also diabetic, requires a mood stabilizer. Which mood stabilizer would require caution?
A patient with Bipolar I disorder, who is also diabetic, requires a mood stabilizer. Which mood stabilizer would require caution?
Which side effect necessitates regular monitoring with lithium treatment?
Which side effect necessitates regular monitoring with lithium treatment?
What is the primary risk associated with rapid discontinuation of benzodiazepines following extended use?
What is the primary risk associated with rapid discontinuation of benzodiazepines following extended use?
Which of the following mechanisms of action describes valproic acid?
Which of the following mechanisms of action describes valproic acid?
What is a notable benefit of using lamotrigine for bipolar disorder compared to other mood stabilizers?
What is a notable benefit of using lamotrigine for bipolar disorder compared to other mood stabilizers?
Flashcards
General Principles
General Principles
Addresses general principles in psychiatric pharmacological therapies.
Antidepressants
Antidepressants
Medications used to treat depression and related mood disorders.
Antipsychotic Drugs
Antipsychotic Drugs
Drugs used to manage psychotic symptoms in disorders like schizophrenia.
Mood Stabilizers
Mood Stabilizers
Signup and view all the flashcards
Anxiolytic Drugs
Anxiolytic Drugs
Signup and view all the flashcards
Differential Diagnosis
Differential Diagnosis
Signup and view all the flashcards
Target Symptoms
Target Symptoms
Signup and view all the flashcards
Monoamine Deficiency
Monoamine Deficiency
Signup and view all the flashcards
Antidepressant mechanism
Antidepressant mechanism
Signup and view all the flashcards
Antidepressants uses
Antidepressants uses
Signup and view all the flashcards
Mianserine, Mirtazapine
Mianserine, Mirtazapine
Signup and view all the flashcards
SSRIs
SSRIs
Signup and view all the flashcards
Clozapine
Clozapine
Signup and view all the flashcards
Mood stablizers
Mood stablizers
Signup and view all the flashcards
Anxiolytic
Anxiolytic
Signup and view all the flashcards
Study Notes
- Pharmacological Therapies in Psychiatry involves the use of medication to treat psychiatric disorders
General Principles
- Accurate history taking is essential for making a diagnosis
- Differential diagnoses should be reviewed, and other medical conditions like hypothyroidism should be excluded
- Comorbid medical disorders should be recognised
- Target symptoms need to be determined when choosing an antidepressant
- Patient drug information should be considered, especially other medical conditions, e.g., Carbamazepine
- The response to past psychotropics of the patient and their family needs to be reviewed
- Monotherapy is preferable
- The optimal dose for the appropriate duration needs to be administered
- A history of alcohol or substance use/abuse should be taken
- Side effects, such as weight gain, also need to be considered
- The available forms of the drug, such as oral, IV, IM, or depot, should be considered, as well as potential compliance problems
- Informing the patient and caregiver about the treatment is important
- Patients should be informed about potential side effects and when a response to the treatment is expected
Classification of Psychopharmacological Drugs
- The main classes are antidepressants, antipsychotic drugs, mood stabilizers, and anxiolytic drugs
Antidepressants
- Used in the treatment of major depression and other psychiatric disorders
- Also useful for anxiety disorders, obsessive-compulsive disorder, post-traumatic stress disorders, headaches (migraine), dysmenorrhea, and neuropathic pain
- Depression results from a deficiency of monoamines such as serotonin, dopamine, and norepinephrine
Mechanism of Action of Antidepressants
- Antidepressants increase monoamines, BDNF, and neurogenesis in the hippocampus
- Antidepressants decrease corticotropin-releasing hormone (CRH)
- Antidepressants cause methylation of DNA (epigenetic factors)
Types of Antidepressants
- Tricyclic Antidepressants (TCAs): Imipramine, Amitriptyline, Clomipramine, Opipramole are examples
- Selective Serotonin Reuptake Inhibitors (SSRIs): Fluoxetine, Sertraline, Paroxetine, Fluvoxamine, Citalopram, and Escitalopram are examples
- Serotonin and Noradrenaline Reuptake Inhibitors (SNRIs): Venlafaxine, Duloxetine, and Milnacipran are examples
- Serotonin Modulators: Tianeptine, Trazodone, Vortioxetine are examples
- Noradrenaline Reuptake Inhibitors: Maprotiline (non-selective) and Reboxetine (selective) are examples
- Dopamine and Noradrenaline Reuptake Inhibitors: Bupropion is an example
- Noradrenaline and Selective Serotonergic Antidepressants: Mianserine, Mirtazapine are examples
- Monoamine Oxidase Inhibitors (MAO): Moclobemide is an example
- Melatonin Analogues: Agomelatine is an example
Tricyclic Antidepressants (TCAs)
- Older class of antidepressants with problematic side effects
- These include Imipramine, amitriptyline, clomipramine, and opipramole
- Side effects are problematic, and their usage is now decreased
Tricyclic Antidepressants - Side Effects
- Anticholinergic effects: dry mouth, blurred vision, cognitive deficits, tachycardia, constipation, and urinary retention
- Antihistaminic effects: sedation and weight gain
- Cardiac effects: orthostatic hypotension and rhythm problems
- Sexual effects: erectile dysfunction and problems with ejaculation and orgasm
- Other effects: allergic skin reactions, hair loss, tremor and epileptic seizures
Selective Serotonin Reuptake Inhibitors (SSRIs)
- Commonly prescribed antidepressants with more tolerable side effects
- Their usage is easier with once-a-day dosing, e.g., fluoxetine, sertraline, paroxetine, fluvoxamine, citalopram, escitalopram
- Side effects include nausea, vomiting, diarrhea, stimulation and sleep disorder, weight gain or loss, sexual side effects, sedation, neurological effects (headache, akathisia, tremor, dystonia), vivid dreams, and skin rashes
Serotonin and Noradrenaline Reuptake Inhibitors (SNRIs)
- Include Venlafaxine, Duloxetine, and Milnacipran
- Dual action: increase both serotonin and noradrenaline
- This type is more effective than SSRIs
- It is a useful group in neuropathic pain
- Side effect profiles are similar to SSRIs
Antipsychotics
- Divided into typical (first generation) and atypical (second-generation) antipsychotics
Typical Antipsychotics
- Act via D2 receptor blockade but have extrapyramidal side effects and hyperprolactinemia
- Effective against positive symptoms
Atypical Antipsychotics
- Act via 5-HT2, D4, and weak D2 blockade
- Have a lower incidence of extrapyramidal symptoms and hyperprolactinemia
- Are effective against positive and negative symptoms
- Have more prominent metabolic side effects
Side effects: Typical vs. Atypical Antipsychotics
- No differences in terms of efficacy between typical and atypical antipsychotics
- The differences lie in SE profiles
- Typical antipsychotics have more EPS and endocrine side effects
- Atypical antipsychotics have fewer EPS and endocrine side effects but more metabolic side effects
Typical Antipsychotics - Side Effects
- Extrapyramidal side effects: Parkinsonism, akathisia, tardive dyskinesia, NMS
- Endocrine side effects: amenorrhea, galactorrhea, loss of libido
- Anticholinergic side effects: dry mouth, blurred vision, tachycardia, urinary retention, constipation, cognitive changes
- Antihistaminic side effects: Sedation and weight gain
- α-adrenergic blockage: orthostatic hypotension
- Lowered seizure threshold
- Sexual side effects: anorgasmia and erectile dysfunction
Mood Stabilizers
- Mood stabilizers help to reduce mood swings and prevent manic and depressive episodes
- Lithium
- Valproic Acid, Carbamazepine, and Lamotrigine are antiepileptic drugs
Lithium
- Exact mechanism of action is not known
- Has neuroprotective effects
- Modulates neurotransmitters by inhibiting dopamine neurotransmission, downregulating the NMDA receptor (subtype of glutamate-excitator), and activating GABA receptors (GABA-inhibitory)
- Inhibits intracellular proteins: PKC, GSK-3, IMPase, and IPPase
Lithium - Side Effects
- Gastrointestinal effects: nausea, vomiting, diarrhea, and loss of appetite
- Tremor
- Polydipsia, polyuria, and impaired renal functioning
- Hypothyroidism: mostly subclinical, with a 4 % clinical rate
- Parathyroid dysfunction: hypercalcemia
Antiepileptic Drugs
- They work by calming hyperactivity in the brain by modulating signal pathways
- Kindling hypothesis: repeated administration of a subconvulsive electrical stimulus results in progressive seizure activity, resulting in spontaneous seizures
Valproic Acid-Mechanism of Action
- Prolongs the recovery of voltage-sensitive Na channels
- It increases the level of GABA
- Blocks NMDA receptor-mediated excitation
Carbamazepine - Mechanism of Action
- Blocks voltage sensitive Na channels
- Reduces cell excitability
- Attenuates action/release of glutamate
Side Effects: Valproic Acid vs. Carbamazepine
- Valproic Acid: Abnormal LFT (liver function test), weight gain, pancreatitis, and thrombocytopenia
- Carbamazepine: Fatigue, blurred vision, diplopia, SIADH (syndrome of inappropriate antidiuretic hormone secretion), leukopenia, agranulocytosis, and skin rashes
Lamotrigine
- Different from other mood stabilizers, it is only effective in the prophylactic treatment of depressive episodes in bipolar disorder
- Must be titrated slowly
- Skin rashes and risk of Stevens-Johnson syndrome are potential risks.
Anxiolytic Drugs
- These are drugs used to treat anxiety
- Main classes: GABAergic, Serotonergic, and Noradrenergic anxiolytics
Types of Anxiolytic Drugs
- GABAergic anxiolytics: Benzodiazepines
- Serotonergic anxiolytics: 5-HT1a partial agonist, Buspirone
- Noradrenergic anxiolytics: α-2 agonist, Clonidine
Therapeutic Uses of Anxiolytic Drugs
- Relief of anxiety
- Control of alcohol withdrawal symptoms
- Control of convulsions
- Skeletal muscle relaxation
- Short-term sleep promotion
- Sedation
Benzodiazepines
- Increase the inhibitory neurotransmitter action of gamma-aminobutyric acid (GABA) in the CNS
- The benzodiazepine receptor is a subtype of the GABA-A receptor
- There is a risk of tolerance, dependency, and withdrawal symptoms with long-term usage
- Short-term usage is recommended
Selected Benzodiazepines
- Alprazolam: Effective dose of 0.5-4 mg; equivalent dose of 0.5 and half-life of 12 hours
- Clonazepam: Effective dose of 1-4 mg, equivalent dose of 0.25 and half life of 1-2 days
- Diazepam: Effective dose of 5-40mg, equivalent dose of 5 and half life of 2-4 days
- Lorazepam: Effective dose of 2-6mg, equivalent dose of 1 and half life of 12 hours
Benzodiazepines - Side Effects
- Sedation and impaired motor functions
- Dependency, withdrawal with long-term use
- This can include tachycardia, hypertension, muscle cramps, panic attacks, and memory problems
- Impairment in attention and memory
- Dysinhibition
- The use of these drugs is not recommended in patients with impulse control problems.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
