Psychiatry

Question 1

Divalproex side effects

Answer 1

V - vomiting, nausea, diarrhoea

A - Ataxia | Anorexia

L - Liver toxic

P - Pancreatitis | Plt decrease, WCC decrease | PCOS

R - Retention of Weight & Water

O - Oedema

A - Alopecia

T - Teratogenic (NTD) | Tremors

E - Enzyme Inhibition

Question 2

Valproic acid drug interactions

Answer 2

Increased VPA levels:

ASA
Cimetidine
Erythromycin

Decreased VPA levels:

Lamotrigine
Carbamazepine

Question 3

Valproic acid monitoring

Answer 3

• White cell count
• Platelets
• Liver function tests
• Weight - BMI, WC

Question 4

Depression

Natural Health Product as first line monotherapy

Answer 4

St John’s Wart

Question 5

Depression

Natural Health Product as second line monotherapy

Answer 5

Omega-3-fatty acids

S-adenosylmethionine (SAM-e)

Question 6

Depression

Natural Health Products as supplements to SSRI

Answer 6

L - Methylfolate

Omega-3-fatty acids

Question 7

Depression

Natural Health Products

Answer 7

SOLS

S - St John’s Wart
O - Omega-3fatty acids
L - L-methylfolate
S - S-adenosylmethionine (SAM-e)

Question 8

Insomnia

Natural health products

Answer 8

• Valerian
• Melatonin
• L-tryptophan
• Chamomile

Question 9

Insomnia

Pharmacological treatment in pregnancy and breastfeeding

Answer 9

Benzodiazepine like receptor agonist

Zopiclone 3,75mg PO Nocte

Advice:

• Intermittent use
• Wait >12h before operating heavy machinery or driving

Question 10

Zopiclone

Side effects

Answer 10

Dry mouth 
Decreased alertness next day 
Global amnesia 
Increased fall risk 
Residual sedation

Question 11

Psychotic patient
Long standing hx without treatment
2 x suicide attempts
Obese

1. Long term treatment class, medication, dose, route
2. Medication instructions
3. Duration of treatment

Answer 11

1. Second generation antipsychotic
   Ziprasidone 80mg per os
2. Take treatment with meal of at least 500 calories
3. 5 years