Drugs

Question 1

how long should antidepressants be trialed for?

Answer 1

4-6wks

Question 2

how do benzodiazepines work?

Answer 2

enhance the effect of GABA

Question 3

what do benzodiazepines cause?

Answer 3

sedation
anticonvulsant
anterograde amnesia

Question 4

are benzos safe in pregnancy? what risks?

Answer 4

no, cleft palate

floppy baby when breastfeeding

Question 5

examples of typical antipsychotics?

Answer 5

haloperidol

chlorpromazine

Question 6

how do typical antipsychotics work?

Answer 6

inhibit dopamine 2 receptors

Question 7

side effects of antipsychotics?

Answer 7

parkinsonism
akathisia
metabolic syndrome
sedation
increased PRL

Question 8

treatment for acute dystonia?

Answer 8

prochlorperazine

Question 9

eg of atypical antipsychotics?

Answer 9

clozapine
olanzapine
risperidone
aripiprazole
amisulapride

Question 10

what antipsychotic is less likely to cause extrapyramidal side effects?

Answer 10

atypical

Question 11

what antipsychotic has a higher risk of metabolic syndrome?

Answer 11

atypical (particularly clozapine)

Question 12

what other risks does clozapine have?

Answer 12

agranulocytosis
FBC measured regularly
myocarditis (taper off)

Question 13

what two atypical antipsychotics should be avoided in pregnancy?

Answer 13

clozapine

olanzapine

Question 14

what can anticonvulsants be used in?

Answer 14

bipolar

Question 15

what is valporate good for?

Answer 15

mania/hypomania

Question 16

what is lamotrigine good for?

Answer 16

bipolar depression

Question 17

side effects of lithium?

Answer 17

dry mouth
strange taste
polydipsia/uria
hypothyroid
reduced renal function
wt gain

Question 18

complication of lithium?

Answer 18

nephrogenic diabetes insipidus

Question 19

monitoring for lithium?

Answer 19

U+Es, ECG, TFTs at start
3 months - U+Es, Li level
6 months - TFTs

Question 20

is lithium safe in pregnancy?

Answer 20

no

Question 21

features of Li toxicity?

Answer 21

vomiting 
diarrhoea
ataxia
drowsy
convulsions
coma

Question 22

first line in depression? egs?

Answer 22

SSRIs
fluoxetine
citalopram
sertraline
paroxetine

Question 23

mechanism of SSRIs?

Answer 23

selectivity inhibits reuptake of 5-HT

Question 24

major complication of SSRIs?

Answer 24

increase in self harm/suicide in under 25yrs

Question 25

when should SSRIs be taken?

Answer 25

morning

Question 26

are SSRIs safe in overdose?

Answer 26

yes

Question 27

which SSRIs safe in pregnancy?

Answer 27

fluoxetine | sertraline

Question 28

egs of tricyclic antidepressants?

Answer 28

imipramine amitriptyline dosulepin

Question 29

mechanism of tricyclic?

Answer 29

blocks reuptake of NA and 5-HT into presynaptic terminals

Question 30

side effects of tricyclics?

Answer 30

``` sedation wt gain arrythmia/tachydardia/PHT blurred vision dry mouth urinary retention ```

Question 31

when should tricyclics be taken?

Answer 31

night

Question 32

what antidepressants should be avoided in those with a Hx of overdose?

Answer 32

tricyclics

Question 33

what antidepressants are safe in those with a Hx of overdose?

Answer 33

SSRIs

Question 34

what is used in Tx resistant depression? egs?

Answer 34

MOAIs moclobemide phenelzine isocarboxazid

Question 35

side effects of MOAIs?

Answer 35

``` insomnia PHt oedema jaundice makes other drugs more potent ```

Question 36

major complication of MOAIs?

Answer 36

hypertensive crisis

Question 37

how to avoid and Tx HT crisis?

Answer 37

avoid tyramine meals - cheese, alcohol, caffeine | Tx - phentolamine infusion

Question 38

what are another use of antidepressants? egs?

Answer 38

neuropathic pain duloxetine (SNRI) amitriptyline (tricyclic)

Question 39

egs of SNRIs?

Answer 39

venflaxine | duloxetine

Question 40

when should SNRIs be taken?

Answer 40

morning

Question 41

eg of NaSSA?

Answer 41

mirtazapine

Question 42

when should NaSSA be taken?

Answer 42

night

Question 43

side effects of NaSSA?

Answer 43

``` weight gain (due to appetite increase) sedation ```

Question 44

what can occur when alcohol and NaSSA are mixed?

Answer 44

GI upset

Question 45

eg of SARI?

Answer 45

trazodone

Question 46

when should SARI be taken?

Answer 46

night

Question 47

features of a hypertensive crisis?

Answer 47

headache SOB nosebleeds anxiety

Question 48

side effects of SSRIs?

Answer 48

``` nauseau headache sweating vivid dreams sexual dysfunction ```

Question 49

what anti depressants have discontinuation side effects?

Answer 49

SSRIs

Question 50

what fetal abnormality can lithium caused if used while pregnant?

Answer 50

ebstein's (heart defect)

Question 51

if used during pregnancy, what can olanzapine cause?

Answer 51

gestational diabetes

Question 52

how do atypical antipsychotics work?

Answer 52

dopamine and 5-HT antagonism

Question 53

how do MOAis work?

Answer 53

inhibitor MAO-A and B enzymes

Question 54

what antidepressant is best in CVS problems?

Answer 54

sertraline

Question 55

what antidepressant is best in epilepsy?

Answer 55

citalopram

Question 56

what is a cardiac side effect of one SSRI?

Answer 56

long QT with citalopram

Question 57

mechanism of SNRI?

Answer 57

block reuptake of NA and 5-HT into presynaptic terminals

Question 58

what is the only licensed antidepressant for under 18s?

Answer 58

fluoxetine

Question 59

if on an SSRI and NSAID, what must be given?

Answer 59

PPI

Question 60

if on SSRI, what drug should be avoided?

Answer 60

triptans

Question 61

if on warfarin/heparin, what drug should be recommended?

Answer 61

mirtazipine (NaSSA)

Question 62

what is Tx for neuroleptic malignant syndrome?

Answer 62

bromocriptine

Question 63

what is neuroleptic malignant syndrome?

Answer 63

reaction to antipsychotics

Question 64

who is good to use mirtazipine in?

Answer 64

lack of appetite | wt loss

Question 65

how do NaSSAs work?

Answer 65

Blocks a2, 5-HT2 & 5-HT3