Anxiolytics, Hypnotics, Mood Stabilisers, Dementia Drugs, and ADD and ADHD Drugs

Question 1

What classes of drugs can be used to treat anxiety?

Answer 1

Beta-blockers

Benzodiazepines

Pregabalin

Antidepressants

Question 2

How do beta-blockers work?

Answer 2

Reduce the autonomic nervous system activation by acting as adrenaline/noradrenaline antagonists

Question 3

What beta-blockers is most commonly used in psychiatry?

Answer 3

Propranolol

Question 4

What condition are beta-blockers contraindicated in?

Answer 4

Asthma

Question 5

When do beta-blockers have limited effectiveness?

Answer 5

In enduring anxiety disorders

Question 6

What is the most typically used benzodiazepines?

Answer 6

Diazepam

Lorazepam

Question 7

What kind of half-life does diazepam have?

Answer 7

Long half-life

Question 8

What kind of half-life does lorazepam have?

Answer 8

Short half-life

Question 9

What receptors do benzodiazepines bind to?

Answer 9

GABA receptors

Question 10

What effect do benzodiazepines have on GABA receptors?

Answer 10

Act as agonists

Question 11

What is the result of GABA receptor agonism by benzodiazepines?

Answer 11

Reduced excitability of neurones

Question 12

What kind of neurotransmitter is GABA?

Answer 12

Inhibitory

Question 13

What do benzodiazepines have significant potential for?

Answer 13

Tolerance

Dependence

Misuse

Question 14

When prescribing benzodiazepines what precautions should be taken?

Answer 14

Use cautiously

Use for no more than 6 weeks

Question 15

What can benzodiazepines occasionally cause?

Answer 15

Paradoxical disinhibition

Question 16

What is paradoxical disinhibition?

Answer 16

A poorly understood state of acute excitement that occurs occasionally in benzodiazepine use

Question 17

Where does pregabalin bind?

Answer 17

Voltage-gated calcium channels in neurones

Question 18

What effect does pregabalin have?

Answer 18

Increases the extra-cellular amounts of enzyme responsible for synthesis of GABA and therefore increases GABA concentration in the brain

Question 19

What effect does pregabalin have on the brain?

Answer 19

Acts as a CNS depressant

Question 20

What other conditions is pregabalin indicated in?

Answer 20

Neuropathic pain

Epilepsy

Question 21

In what ways is pregabalin generally safer than benzodiazepines?

Answer 21

Less potential for misuse, dependence and tolerance

Question 22

Is pregabalin misused?

Answer 22

Yes

Question 23

For how long does the BNF recommend to sue pregabalin for?

Answer 23

Short term

Question 24

What side-effects can pregabalin have?

Answer 24

Sedation

Weight gain

Question 25

What are the most common and effective pharmacological agents used to treat anxiety?

Answer 25

Antidepressants

Question 26

What are the two types of hypnotics used?

Answer 26

Benzodiazepines Nonbenzodiazepines

Question 27

What are some benzodiazepines used as hypnotics?

Answer 27

Temazepam Lormatazepam Nitrazepam

Question 28

How do nonbenzodiazepines exert their effects?

Answer 28

In a similar way to benzodiazepines (positive allosteric modulator) but are structurally different

Question 29

What is another name for nonbenzodiazepines?

Answer 29

Z drugs

Question 30

What are two nonbenzodiazepines?

Answer 30

Zopiclone Zolpidem

Question 31

Which class of hypnotics are usually favoured?

Answer 31

Z-drugs

Question 32

What do both classes of hypnotics have significant potential for?

Answer 32

Misuse Dependence Rebound insomnia

Question 33

For how long should hypnotics be used?

Answer 33

Only two weeks and take only 5/7 days per week to reduce potential for tolerance

Question 34

What disorder are mood stabilisers used to treat?

Answer 34

Bipolar disorder

Question 35

What are the main classes of mood stabilisers?

Answer 35

Lithium Anticonvulsants Second generation (atypical) antipsychotics

Question 36

What is one of the most effective mood stabilisers?

Answer 36

Lithium

Question 37

What is the mechanism of action of lithium?

Answer 37

Unknown

Question 38

What sort of therapeutic window does lithium have?

Answer 38

Narrow

Question 39

How often should serum lithium levels be checked in a patient who is stable on lithium?

Answer 39

3 months

Question 40

How is lithium excreted?

Answer 40

Kidneys

Question 41

What does evidence show lithium reduces?

Answer 41

Risk of suicide

Question 42

What can lithium also be used for?

Answer 42

Augmenting antidepressants

Question 43

What are the side-effects of lithium use?

Answer 43

GI disturbance Metallic taste in mouth Dry mouth Fine tremor Polydipsia and polyuria Weight gain

Question 44

What are the long term effects of lithium use?

Answer 44

Hypothyroidism (usually reversible) Renal impairment (usually only occurs at above therapeutic doses)

Question 45

What tests must be conducted annually in patients on lithium?

Answer 45

U&E’s TFT’s

Question 46

What can lithium toxicity cause?

Answer 46

Death Confusion Coarse tremor N&V Ataxia Seizures

Question 47

What can increase the potential for lithium toxicity?

Answer 47

Dehydration

Question 48

What advice should patients on lithium be given to avoid toxicity?

Answer 48

Drink lots of water Avoid hot climates

Question 49

What drugs can lithium interact with?

Answer 49

NSAIDs Loop diuretics ACE inhibitors

Question 50

What atypical antipsychotic is first line treatment for bipolar?

Answer 50

Quetiapine

Question 51

What are the most commonly used anticonvulsants used to treat bipolar disorder?

Answer 51

Sodium valproate Carbamazepine Lamotrigine Pregabalin

Question 52

When should sodium valproate be avoided?

Answer 52

In women of child bearing age due to teratogenicity

Question 53

What does lamotrigine have the potential to cause?

Answer 53

Stevens Johnson Syndrome

Question 54

What do most anticonvulsants have the potential to cause?

Answer 54

Thrombocytopenia

Question 55

What are the side-effects of anticonvulsants?

Answer 55

Sedation Weight gain

Question 56

What do dementia drugs do?

Answer 56

Treat cognitive and emotional symptoms Don’t prolong life or slow changes

Question 57

What are the two classes of dementia drugs?

Answer 57

Acetylcholinesterase inhibitors Memantine

Question 58

What are acetylcholinesterase inhibitors also known as?

Answer 58

Cholinesterase inhibitors

Question 59

How do cholinesterase inhibitors work?

Answer 59

They inhibit the breakdown of acetylcholine and therefore increase the levels of acetylcholine in the brain

Question 60

What is Alzheimer’s associated with?

Answer 60

Lower levels of activity in the cholinergic system

Question 61

What symptom are cholinesterase inhibitors particularly used to treat?

Answer 61

Apathy

Question 62

What severity of dementia are cholinesterase inhibitors indicated in?

Answer 62

Mild to moderate

Question 63

What are the side-effects of cholinesterase inhibitors?

Answer 63

Nausea Diarrhoea Vomiting Insomnia Muscle cramps Anorexia

Question 64

What is usually performed before commencing treatment with cholinesterase inhibitors?

Answer 64

ECG

Question 65

What should be checked at every appointment with a patient on a cholinesterase inhibitor?

Answer 65

Pulse check

Question 66

What are some cholinesterase inhibitors?

Answer 66

Donepezil Galantamine Rivastigmine

Question 67

What are the advantage of rivastigmine?

Answer 67

Can be given as a patch to increase adherence Less GI side effects

Question 68

What sort of drug is memantine?

Answer 68

A glutamate (NMDA) receptor antagonist

Question 69

What is the effect of memantine?

Answer 69

Lower neuronal excitability

Question 70

What condition is memantine indicated in?

Answer 70

Moderate to severe Alzheimer’s disease

Question 71

What is memantine used to treat most in Alzheimer’s disease?

Answer 71

Agitated patients/challenging behaviour

Question 72

How should memantine be initiated?

Answer 72

Slowly

Question 73

What are the side-effects of memantine?

Answer 73

Headaches Drowsiness Insomnia Nausea

Question 74

What type of drugs are most commonly used in ADHD?

Answer 74

CNS stimulants

Question 75

Which CNS stimulants are used in ADHD treatment?

Answer 75

Methylphenidate Dextroamphetamine

Question 76

Which CNS stimulant is most commonly prescribed in ADHD?

Answer 76

Methylphenidate

Question 77

What sort of release is used?

Answer 77

Combination of immediate and sustained in the same tablet

Question 78

What stimulants have the potential for?

Answer 78

Misuse Dependency

Question 79

What should be monitored in CNS stimulant use?

Answer 79

Weight and height (in children) Pulse

Question 80

What other drug is used to treat ADHD?

Answer 80

Atomoxetine

Question 81

What sort of drug is atomoxetine?

Answer 81

Noradrenaline re-uptake inhibitor

Question 82

When is atomoxetine used to treat ADHD?

Answer 82

When patients are unable to tolerate stimulants or in previous drug dependency