CNS

Question 1

Benzodiazepines (Lorazepam, Diazepam): Indications

Answer 1

Seizures and Status Epilectus
Symptomatic Management of Alcohol Withdrawal
SHORT term treatment of anxiety

Question 2

Benzodiazepines (Lorazepam, Diazepam): Mechanism of Action

Answer 2

They enhance the binding of GABA to GABA receptors. These are Cl- channels so are inhibitory so has a widespread depressant effect

Question 3

Benzodiazepines (Lorazepam, Diazepam): ADRs

Answer 3

Predictable! Drowsiness, sedation, coma

OD can cause respiratory depression and death

Question 4

Benzodiazepines (Lorazepam, Diazepam): Warnings and Interactions

Answer 4

Caution in elderly as they are more sensitive
Avoid in respiratory depression and hepatic failure

Their effect are additive with opioids and alcohol. They depend of CYP450 metabolism for excretion

Question 5

Benzodiazepines (Lorazepam, Diazepam): Prescription

Answer 5

Monitoring is based on signs and symptoms

Question 6

Antipsychotics, 1st gen, typical (Haloperidol, chlorpromazine): Indications

Answer 6

Urgent management of psychomotor agitation
Schizophrenia
Bipolar disorder (particularly in acute setting)
N&V in pallition

Question 7

Antipsychotics, 1st gen, typical (Haloperidol, chlorpromazine): Mechanism of Action

Answer 7

Block post-synaptic D2 receptors
Act on the 3 main dopaminergic pathways: mesolimbi, nigrostriatial, tuberohypophyseal
Also block D2 receptors in CTZ

Question 8

Antipsychotics, 1st gen, typical (Haloperidol, chlorpromazine): ADRs

Answer 8

Mainly because of blockade of nigrostriatial pathway: parkinsonian movements, restlessness, muscle spasms
Also drowsiness and hypotension

Question 9

Antipsychotics, 1st gen, typical (Haloperidol, chlorpromazine): Warnings and Interactions

Answer 9

Avoid in parkinsons!
There is an extensive list of interactions
Should not be combined with D2 blocking anti-emetics or QT prolonging drugs e.g. amiodarone/macrolides

Question 10

Antipsychotics, 2nd gen, atypical (Clozapine, Olanzapine): Indications

Answer 10

Urgent treatment of psychomotor agitation
Schizophrenia, especially when 1st gen drugs cannot be used due to side effects
Bipolar

Question 11

Antipsychotics, 2nd gen, atypical (Clozapine, Olanzapine): Mechanism of Action

Answer 11

Block post-synaptic D2 receptors
Act on the 3 main dopaminergic pathways: mesolimbi, nigrostriatial, tuberohypophyseal
Have fewer extrapyramidal side effects than 1st gen, possible because of some binding to other receptor types e.g. 5-HT

Question 12

Antipsychotics, 2nd gen, atypical (Clozapine, Olanzapine): ADRs

Answer 12

Fewer extrapyramidal effects (spasm, restlessness, parkisonian movements)
More metabolic effects: weight gain, DM
Sedation, prolonged QT interval

Question 13

Antipsychotics, 2nd gen, atypical (Clozapine, Olanzapine): Warnings and Interactions

Answer 13

Caution in heart disease

Should not be combined with D2 blocking anti-emetics or QT prolonging drugs e.g. amiodarone/macrolides

Question 14

Antidepressants, SSRI (citalopram, fluoxetine): Indications

Answer 14

Moderate to severe depression
Mild depression if psychological treatments have failed
Anxiety

Question 15

Antidepressants, SSRI (citalopram, fluoxetine): Mechanism of Action

Answer 15

Inhibit reuptake of 5-HT at synaptic cleft. Thus increases its availability of synaptic transmission. We reckon this is how they work…

Question 16

Antidepressants, SSRI (citalopram, fluoxetine): ADRs

Answer 16

GI upset, appetite and weight disturbance, suicidal thoughts

Question 17

Antidepressants, SSRI (citalopram, fluoxetine): Warnings and Interactions

Answer 17

They prolong the QT interaval
Metabolised by liver so caution in hepatic impairment
Poor efficacy and lots of suicidal thoughts when used in young people

MAOIs + SSRI = serotonin syndrome
Other drugs that prolong the QT interval

Question 18

Antidepressants, SSRI (citalopram, fluoxetine): Prescription

Answer 18

Treatment tends to be long term and shouldn’t be suddenly stopped due to withdrawal symptoms
Patients would be reviewed 1-2 weeks after starting therapy

Question 19

Antiemetics, D2 antagonists (metoclopramide): Indications

Answer 19

N&V treatment and prophylaxis, particularly die to reduced gut motility

Question 20

Antiemetics, D2 antagonists (metoclopramide): Mechanism of Actions

Answer 20

They block D2 receptors in the CTZ and increase gut motility

Question 21

Antiemetics, D2 antagonists (metoclopramide): ADRs

Answer 21

Predictable due to D2 antagonism: spasm, parkinsonian movements, restlessness

Question 22

Antiemetics, D2 antagonists (metoclopramide): Warnings and Interactions

Answer 22

Avoid in children and young adults
Avoid with anti-psychotics, due to increased side effects (as they are both blocking D2)
Avoid with dopaminergic agents in parkinson, as you’ll spoil any benefit