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Flashcards in CNS Deck (67):
1

According to the Maudsley guidelines, how long does it take before antidepressants exert their effects?

1-2weeks

2

What are the risk factors for antidepressant-induced hyponatraemia?

Old age
Female sex
Low body weight
Low baseline sodium concentration
Some drug treatments (e.g. diuretics, NSAIDs, carbamazepine, chemotherapy)
Reduced renal function
Medical co-morbidity (e.g. hypothyroidism, diabetes, COPD, hypertension, head injury, CVA, various cancers)
Warm weather (summer)

3

What are the five steps to better wellbeing?

Connect
Be active
Keep learning
Give
Take notice

4

What is the aetiology of depression?

Genetics
Environment
Biochemistry
Endocrine factors
Physical illness
ADRs

5

What are the two core screening questions used for depression?

During the last month have you often been bothered by feeling down, depressed or hopeless?

Do you have little interest or pleasure in doing things?

6

What are the typical symptoms of depression?

Fatigue/loss of energy
Worthlessness/excessive or inappropriate guilt
Recurrent thoughts of death, suicidal thoughts, or actual suicide attempts
Diminished ability to think/concentrate or indecisiveness
Psychomotor agitation or retardation
Insomnia/hypersomnias
Significant appetite and/or weight loss

7

Define subthreshold depression

Where there is more than 2 but less than 5 symptoms of depression

8

Define persistent subthreshold depression

Dysthymia, patient has had at least 2 years of depressed mood on more days than not and has at least 2 but less then 5 symptoms

9

Define mild depression

Few, if any, symptoms in excess of the five required to make the diagnosis, and only minor functional impairment

10

Define moderate depression

Symptoms or functional impairment between mild and severe. Some symptoms would be expected to be marked

11

Define severe depression

Several symptoms in excess of those required to make the diagnosis. Some symptoms would be expected to be severe and markedly interfere with functioning

12

Give an example of a tricyclics antidepressant

Amitriptyline

13

What are the main ADRs associated with TCAs?

Sedation, postural hypotension, tachycardia/arrhythmia, dry mouth, blurred vision, constipation, urinary retention

14

What are the major interactions associated with TCAs?

SSRIs (except citalopram), phenothiazines, cimetidine, alcohol, antimuscarinics, antipsychotics, MAOIs

15

Give an example of an SSRI

Citalopram

16

What are the main ADRs associated with SSRIs?

Nausea, vomiting, dyspepsia, abdominal pain, diarrhoea, rash, sweating, agitation, anxiety, headache, insomnia, tremor, sexual dysfunction, hyponatraemia, cutaneous bleeding disorders

17

What SSRIs are used in panic disorder?

Citalopram, escitalopram, paroxetine

18

What SSRIs are used in agoraphobia?

Citalopram, escitalopram, paroxetine

19

What SSRIs are used in social anxiety?

Escitalopram and paroxetine

20

What SSRIs are used in GAD?

Escitalopram and paroxetine

21

What SSRIs are used in OCD?

Escitalopram, fluoxetine, fluvoxamine, sertralineline

22

What interactions are associated with SSRIs?

MAOIs, lithium

23

What cautions surround the use of SSRIs?

Patients under 18
Epilepsy

24

What are the contraindications for the use of SSRIs?

Mania

25

What cautions surround the use of TCAs?

Depression associated with suicidal thoughts
Epilepsy

26

Give an example of an SNRI

Venlafaxine, duloxetine

27

What ADRs are associated with SNRIs?

Nausea, HTN, serotonin syndrome

28

What cautions surround the use of SNRIs?

Epilepsy
HTN
MI

29

What interactions are associated with SNRIs?

MAOIs

30

What class of drug is mirtazapine?

Presynaptic alpha-2 adrenoceptor blocker

31

What ADRs are associated with mirtazapine?

Drowsiness
Weight gain
Fatigue
Tremor
Dizziness

32

What class of drug is trazodone?

Serotonin receptor blocker

33

What ADRs are associated with MAOIs?

Dose-related postural hypotension

34

What interactions are associated with non-selective MAOIs?

Amine-containing drugs including sympathomimetics and tyramine

35

What ADRs are associated with reversible MAOIs?

Sleep disturbance
Agitation
Confusion
GI upset
Dizziness
Headache

36

What are the symptoms of serotonin syndrome?

Confusion
Hypomania
Agitation
Twitching
Tremor
Hyperthermia
Sweating
Shivering
Diarrhoea
HTN
CV collapse

37

What drugs cause serotonin syndrome?

SSRIs
Serotonin precursors (tryptophan)
Serotonin agonists (triptans, buspirone, LSD)
Serotonin releasing agents (ecstasy, amphetamines)
MAOIs
Chlorphenamine
Pethidine
Cocaine
Tramadol
Levodopa
Bromocriptine
Lithium
St John’s wort

38

How does hypertensive crisis occur?

MAOIs reduce breakdown of NA in adrenergic nerve ending
=> large stores that can be released into synaptic cleft in response to a neuronal discharge or an indirectly acting amine

39

What are the symptoms of hypertensive crisis?

HTN
Headache
Hyperpyrexia
Cardiac arrhythmias

40

How is hypertensive crisis managed?

Alpha-blockade with phentolamine

41

Describe the aetiology of anxiety

Stress
Genetics
Drugs
Withdrawal
Metabolic disturbances
Temporal lobe lesions
Rare hormone-secreting tumours e.g. phaeochromocytoma

42

What are the clinical features of anxiety?

Apprehension and fear
Somatic symptoms: palpitations, chest pain, SOB, dizziness, loss of libido, headaches, tremor

43

Describe the mechanism of action of benzodiazepines

Selective agonist on GABAa receptors, enhance responses to GABA by facilitating the opening of GABA-activated chloride channels, inhibit neuronal excitability

44

What ADRs are associated with benzodiazepines?

Respiratory distress and arrest
Sedation/drowsiness
Ataxia
Confusion and amnesia
Tolerance and dependence

45

What cautions surround the use of benzodiazepines?

Liver disease
Avoid alcohol
Avoid in pregnancy

46

What are the contraindications for the use of benzodiazepines?

Respiratory depression
Myasthenia gravis

47

What interactions are associated with benzodiazepines?

CNS depressants
Erythromycin, ketoconazole, fluconazole

48

What advice can be provided for benzodiazepine withdrawal?

Avoid prolonged treatment (<4w)
Gradual withdrawal over 4-8 weeks is desirable
Switch to a longer acting benzo
Dose reduction 2mg diazepam equivalents every 2w

49

What are the effects of benzodiazepine toxicity?

Excessive sedation, respiratory depression, coma

50

What is the treatment for benzodiazepine toxicity?

Romazicon (flumazenil) 0.2mg over 30s, wait 30s, 0.3mg over 30s, then 0.5mg every 60s up to a maximum of 3mg

51

What class of drug is buspirone?

5HT1a partial agonist

52

What ADRs are associated with buspirone?

Nausea
Dizziness
Headache
Restlessness

53

What ADRs are associated with z-drugs?

Drowsiness
Headache
Weakness
Dizziness

54

What cautions surround the use of z-drugs?

Confusion
Dependence

55

What are the contraindications for the use of z-drugs?

Respiratory insufficiency
Sleep apnoea
Myasthenia gravis

56

What are the symptoms of Alzheimer’s disease?

Memory loss
Language difficulties
Problems with visuospatial skills
Difficulties with organisational skills
Difficulties with orientation
Confusion
Hallucinations
Delusions

57

What are the symptoms of vascular dementia?

Apraxia
Slurred speech
Dizziness
Inability to recognise familiar objects

58

What are the symptoms of DLB?

Confusion
Attention deficits
Problems with executive functions
Visuospatial disturbances
Hallucinations
Repeated falls
Syncope
Transient, unexplained loss of consciousness
Severe autonomic dysfunction
Non-visual hallucinations
Depression
REMS disorders

59

What are the symptoms of behavioural variant frontotemporal dementia?

Loss of inhibitions
Loss of motivation
Loss of sympathy or empathy
Craving sweet or fatty foods
Develop compulsions
Difficulty planning, organising or making decisions
Lack of insight into their symptoms

60

What are the symptoms of progressive non-fluent aphasia?

Slow, hesitant speech
Difficulties with grammar
Difficulties understanding complete sentences

61

What are the symptoms of semantic dementia?

Asking the meaning of familiar words
Difficulty finding the right word or use of generalised words
Difficulty recognising familiar people or common objects

62

What class of drug is rivastigmine, donepezil and galantamine?

Acetylcholinesterase inhibitor

63

How do acetylcholinesterase (AChE) inhibitors work?

Block breakdown of acetylcholine, compensating for the loss of cholinergic neurones

64

What ADRs are associated with AChEIs?

Miosis
Nausea
Vomiting
Bronchoconstriction
Salivation
Sweating
Urinary incontinence
Alertness
Agitation
Hallucination
Dizziness
Insomnia
Seizures
Bradycardia
SA and AV block
Pain
Headache
Muscle cramps

65

What class of drug is memantine?

Glutamate receptor antagonist

66

What ADRs are associated with memantine?

Constipation
HTN
Dizziness
Tiredness
Headache
Vomiting
Hallucinations
Confusion
Seizures

67

What antipsychotic is licensed in treatment of BPSD?

Risperidone