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GPhC Exam > CNS: Mental Health Disorders > Flashcards

CNS: Mental Health Disorders Flashcards

1
Q

What are some psychological symptoms of anxiety? (5)

A 
Restlessness
Worry
Fear
Difficulty concentrating
Irritability
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2
Q

What are some physical symptoms of anxiety? (5)

A 
Heart palpitations
Shortness of breath
Excessive sweating
Insomnia
Trembling/shaking
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3
Q

What two drugs are recommended for acute anxiety?

A

Benzodiazepines

Buspirone

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4
Q

What is the mechanism of action of busprione?

A

It is a 5HT-1A agonist

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5
Q

What can be given for the management of chronic anxiety (lasting > 4 weeks)?

A

Antidepressants; combined with a benzodiazepine if the antidepressant takes too long to produce an effect

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6
Q

What are the first-line drug classes for generalised anxiety disorder (GAD)?

A

SSRIs and SNRIs

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7
Q

What are some examples of SSRIs?

A 
Sertraline
Paroxetine
Citalopram
Escitalopram
Fluoxetine
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8
Q

Which SSRI can be used for moderate to severe depression in children?

A

Fluoxetine (licensed in children aged 7 and up)

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9
Q

What can be used in GAD if first-line treatment options are ineffective/not tolerated?

A

Pregabalin

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10
Q

What is the first-line treatment for panic disorder?

A

SSRIs

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11
Q

What can be used for second-line treatment of panic disorder? (2)

A

Clomipramine

Imipramine

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12
Q

What drug class be used as first-line therapy for OCD, PTSD and social anxiety disorder?

A

SSRIs

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13
Q

What drug be used as second-line therapy for OCD?

A

Clomipramine

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14
Q

What drug be used as second-line therapy for social anxiety disorder?

A

Moclobemide

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15
Q

What is one of the main uses of benzodiazepines?

A

Short-term relief of severe anxiety that causes unacceptable distress

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16
Q

Which three benzodiazepines are short-acting?

A

Lorazepam
Oxazepam
Temazepam

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17
Q

What are some examples of long-acting benzodiazepines?

A

Clonazepam
Chlordiazepoxide
Diazepam

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18
Q

What is the mechanism of action of benzodiazepines?

A

Binds allosterically to GABA-A receptors, which enhances the effect of GABA → increased levels of Cl- into the neuron (inhibitory effect)

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19
Q

What is an important caution of all benzodiazepines?

A

Paradoxical increase in hostility and aggression

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20
Q

What are some side effects of benzodiazepine overdose? (6)

A

Drowsiness
Dysarthria (speech difficulties)
Ataxia (impaired coordination)
Nystagmus (uncontrollable movement of the eyes)
(Sometimes) respiratory depression and coma

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21
Q

What dispensary warning label should be present on all benzodiazepines?

A

“This medicine may make you sleepy. If this happens, do not drive or use tools or machines. Do not drink alcohol.”

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22
Q

Why should benzodiazepines only be used short term? (2)

A

Risk of tolerance and dependence

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23
Q

What should be offered to patients with GAD before drug treatment?

A

Psychological treatment

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24
Q

What are symptoms of benzodiazepine withdrawal?

A 
Anxiety
Insomnia
Weight loss/loss of appetite
Tremors
Sweating
Tinnitus
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25
Q

When can benzodiazepine withdrawal occur?

A

Within a day of stopping a short-acting benzodiazepine

Within 3 weeks of stopping a long-acting benzodiazepine

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26
Q

How should a benzodiazepine be withdrawn in patients who were using it long term? (3)

A
  1. Gradually (over 1 week) convert to equivalent dose of diazepam ON
  2. Reduce diazepam by 1-2 mg every 2-4 weeks
  3. Reduce further, then stop
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27
Q

What are some important benzodiazepine drug interactions? (2)

A

Increased sedation and and CNS depressant effects when taken with other sedatives e.g. alcohol, opioids, antihistamines, antidepressants, antipsychotics, barbiturates, Z-drugs

Increased plasma conc. when taken with CYP inhibitors e.g. amiodarone, diltiazem, macrolides, fluconazole

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28
Q

What risk is associated with short-acting benzodiazepines?

A

Greater risk of withdrawal symptoms

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29
Q

What two benzodiazepines are very occasionally used for the control of panic attacks?

A

IV diazepam and IV lorazepam

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30
Q

What is ADHD?

A

Attention Deficit Hyperactivity Disorder; characterised by hyperactivity, impulsivity and inattention

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31
Q

What is the first-line drug management for ADHD?

A

Methylphenidate or lisdexamfetamine

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32
Q

What is the second-line drug management for ADHD?

A

Atomoxetine

33
Q

How long should ADHD medicines be trialed for before trying an alternative?

A

6 weeks

34
Q

What is the mechanism of action of methylphenidate?

A

Dopamine and noradrenaline reuptake inhibitor

35
Q

What are some side effects of methylphenidate? (4)

A

Loss in appetite/weight
Increased heart rate/blood pressure
Tourette’s syndrome
Growth restriction (in children)

36
Q

What needs to be monitored in patients taking methylphenidate and lisdexamfetamine and atomoxetine? (6)

A 
Pulse
Blood pressure
Height
Weight
Appetite
Psychiatric symptoms
37
Q

What is important to remember when dispensing methylphenidate?

A

Modified release preparations should be prescribed by brand

38
Q

What is the mechanism of action of lisdexamfetamine?

A

Promotes the release of dopamine and noradrenaline from the presynaptic neuron

39
Q

What are some side-effects of lisdexamfetamine? (4)

A

Loss in appetite; anorexia
Increased heart rate/blood pressure
Tourette’s syndrome
Growth restriction (in children)

40
Q

What are some signs of a lisdexamfetamine overdose?

A

Wakefulness, hyperactivity and paranoia

followed by exhaustion, convulsions, hyperthermia and coma

41
Q

What is the mechanism of action of atomoxetine?

A

Noradrenaline reuptake inhibitor

42
Q

What are some side effects of atomoxetine? What should patients be made aware of?

A

QT prolongation (avoid other drugs that do this)
Suicidal ideation - patients should report any suicidal thoughts/self harm
Hepatotoxicity - patients should report signs of liver damage

43
Q

What is bipolar disorder?

A

A long-term mental illness characterised by extreme depressed and elated moods

44
Q

What are the two types of episodes experienced in bipolar?

A

Depression and mania

45
Q

What is mania?

A

Abnormal and persistent [physical and mental] hyperactivity

46
Q

What is hypomania?

A

A milder form of mania

47
Q

What is the aim of antimanic treatment? (2)

A

To manage an acute episode

To prevent the reoccurrence of further episodes

48
Q

When treating co-existing bipolar disorder, when should antidepressants be avoided? (3)

A

In patients with:
Rapid-cycling bipolar disorder
Recent history of mania/hypomania
Rapid mood fluctuations

49
Q

What can be used to treat acute episodes of mania?

A

Antipsychotics, e.g. risperidone, olanzapine, quetiapine

50
Q

What can be used in the initial stages of treatment of mania [for behavioural disturbance and agitation]?

A

Short-term benzodiazepines e.g. lorazepam

51
Q

When treating acute manic episodes, what can be added to antipsychotics if the response is inadequate? (2)

A

Lithium or sodium valproate

52
Q

What can be used for the initial treatment of severe, acute mania?

A

An antipsychotic AND lithium or valproate

53
Q

What can be used long-term to prevent the reoccurrence of mania? (2)

A

Olanzapine, if a previous episode was responsive to it;

+/- lithium or sodium valproate if they have frequent relapses/severe impairment

54
Q

What is asenapine?

A

A second-generation antipsychotic used for treatment of moderate to severe manic episodes

55
Q

How long should the withdrawal period of antipsychotics be if the patient is taking other antimanics?

A

4 weeks

56
Q

How long should the withdrawal period of antipsychotics be if the patient is NOT taking other antimanics?

A

3 months

57
Q

What is carbamazepine licensed for in the management of bipolar disorder?

A

Preventing the reoccurrence of acute episodes in patients who are unresponsive to lithium therapy

58
Q

When can valproate be used for the treatment of manic episodes associated with bipolar disorder? (2)

A

As monotherapy when lithium is contraindicated or not tolerated
As adjunct therapy when lithium alone is ineffective

59
Q

What does the MHRA advise re: valproate in women?

A

It should not be used in women of childbearing potential, unless:
There are no alternative options
Conditions of the Pregnancy Prevention Programme are met

60
Q

What can be changed if a patient on valproate for bipolar experiences frequent relapse or functional impairment? (2)

A

Lithium OR olanzapine can replace valproate as monotherapy; or can be added to the valproate

61
Q

What can be added as adjunct therapy when increasing the dose of valproate is not sufficient in managing an acute manic episode?

A

An antipsychotic e.g. risperidone, olanzapine, quetiapine

62
Q

How long might it take for the prophylactic effect of lithium to occur after initiating treatment?

A

6-12 months

63
Q

What is lithium indicated for? (3)

A

Prophylaxis and treatment of bipolar disorder
Resistant depression
Aggressive/self-harming behaviour

64
Q

What are some symptoms of depression? (6)

A 
Apathy
Low-self esteem
Suicidal thoughts
Low energy
Changes in weight/appetite
Insomnia
65
Q

What drug class is first-line for treating depression?

A

SSRIs (selective serotonin reuptake inhibitors)

e.g. citalopram, escitalopram, fluoxetine, sertraline, paroxetine

66
Q

Why are SSRIs favoured over other classes for the treatment of depression? (4)

A

Better tolerated

Safer in overdose

67
Q

Which antidepressant is safe to use in patients with unstable angina or who have had a recent MI?

A

Sertraline

68
Q

What are some examples of tricyclic antidepressants (TCAs)?

A 
Amitriptyline
Clomipramine
Dosulepin
Imipramine
Lofepramine
Nortriptyline
69
Q

Why are TCAs less likely to be used to treat depression? (4)

A 
More toxic in overdose
More likely to be discontinued due to side-effects
More sedating (than SSRIs)
More antimuscarinic/cardiotoxic side-effects (than SSRIs)
70
Q

Why are monoamine oxidase inhibitors (MAOIs) rarely used to treat depression?

A

They have many drug- and food-drug interactions

71
Q

What is an example of a reversible MOAI?

A

Moclobemide (short-acting and does not require a washout period)

72
Q

What is a washout period?

A

The length of time between stopping one drug and starting another one for the same indication; usually to make sure drugs with long half-lives are fully cleared from the body before initiating new treatment

73
Q

How long do SSRIs take to work?

A

2 weeks

74
Q

How should SSRIs be monitored for efficacy after initiating?

A

Review every 1-2 weeks after starting treatment

Wait at least 4 weeks (6 weeks in elderly) before deeming ineffective

75
Q

How long should treatment of depression using SSRIs last?

A

At least 6 months (12 months in elderly)

76
Q

How long should treatment of anxiety using SSRIs last?

A

At least 12 months (higher risk of relapse)

77
Q

How long should treatment of recurrent depression using SSRIs last?

A

At least 2 years

78
Q

What steps can be taken if a patient’s depression fails to respond to SSRI treatment? (2)

A

Increase dose; or

Switch to a new SSRI or mirtazapine

79
Q

What second-line drugs are can be used if SSRIs are ineffective?

A

Lofepramine […]

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