Mental Health

Question 1

4 examples of TCAs

Answer 1

Amitriptyline
Lofepramine
Imipramine
Clomipramine

Question 2

Mechanism of TCAs

Answer 2

Inhibit neuronal reuptake of serotonin and adrenaline from the synaptic cleft

Block receptors including alpha 1/2, muscuranic, histamine, dopamine

Question 3

Indications for use of TCAs

Answer 3

Second line treatment for moderate to severe depression

Neuropathic pain

Question 4

CIs of TCAs

Answer 4

Elderly
CVD
Constipated
Prostatic hyperplasia
Epileptic

Question 5

Side effects of TCAs

Answer 5

TCAs

Tremor
Cardiovascular (arrhythmia)
Antimuscuranic (dry mouth, constipation, blurred vision, urinary retention)
Sedation and seizures

Question 6

Which drugs should TCAs not be prescribed with

Answer 6

Monoamine oxidase inhibitors

Question 7

What should a patient be told to avoid doing whilst taking TCAs

Answer 7

Not to stop suddenly

Not to take more than the stated dose

Question 8

Citalopram, fluoxetine and sertraline are examples of which drug class?

Answer 8

SSRIs

Question 9

Mechanism of SSRIs

Answer 9

Similar to TCAs but they DO NOT INHIBIT ADRENALINE REUPTAKE, only serotonin

Do not block as many other receptors unlike TCAs

Question 10

Indications for use of SSRIs

Answer 10

Moderate to severe Depression
Panic disorder
OCD

Question 11

CI of SSRIs

Answer 11

Prescribed with caution in those with with epilepsy or PUD

SSRIs have poor efficacy in young people and cause thoughts of self harm so should only be prescribed by a specialist

Dose reduction in hepatic impariment

Question 12

Side effects of SSRIs

Answer 12

GI upset
Appetite change + weight change 
Suicidal thoughts
Hyponatremia
Lowered seizure threshold
Syndrome of inappropriate ADH secretion

Question 13

What is serotonin syndrome?

Answer 13

A triad of autonomic hyperactivity, altered mental state and neuromuscular excitation

Question 14

What happens if SSRIs are suddenly withdrawn?

Answer 14

GI disturbance
Neurological and influenza like symptoms
Sleep disturbance

Question 15

Which drug should SSRIs not be prescribed with and why?

Answer 15

Monoxidase inhibitors. They both result in increased levels of serotonin in the synaptic cleft which can lead to serotonin syndrome (much like TCAs)

Any drug which prolongs the QT interval ie antipyschotics

Question 16

How long should patients be told to take SSRIs for after they start to feel better

Answer 16

6 months

Question 17

Examples of benzodiazepines include

Answer 17

Diazepam
Temazepam
Lorazepam
Midazolam
Chlordiazepoxide (the weird one that doesn't fit the -am rule)

Question 18

Mechanism of action of benzodiazepines

Answer 18

Facilitate the binding of GABA to GABA1 receptors which allows more chloride to flow into the cell, making it more resistant to depolarization

Question 19

Indications for use of benzodiazepines

Answer 19

1. Seizures and status epillepticus
2. Alcohol withdrawal reactions
3. Sedation for interventional procedures
4. SHORT TERM mx of anxiety
5. SHORT TERM mx of insomnia

Question 20

Contraindications of benzodiazepines

Answer 20

Caution in the elderly
AVOID in:
-resp. impairment
-neuromuscular disease
-liver failure (they precipitate hepatic encephalopathy)

Question 21

Side effects of benzodiazepines

Answer 21

Dose dependant drowsiness, sedation and coma
Loss of airway reflexes due to overdose can lead to death
Dependance can develop if used rptdly over weeks
Abrupt cessation = withdrawal symptoms

Question 22

Cytochrome p450 inhibitors may increase the effect of this class of mental health drug

Answer 22

Benzodiazpines

Question 23

Donepezil, galantamine and rivastigimine are examples of what type of drug?

Answer 23

ACh-esterase inhibitors

Question 24

How do ACh-esterase inhibitors work?

Answer 24

Reversible inhibition of ACh esterases which prevents the hydrolsysis of ACh and an increase of ACh in the cleft

Question 25

This drug type is used for mild-moderate dementia in Alzheimers

Answer 25

ACh-esterase inhibtor

Question 26

Side effects of ACh-esterase inhibitors

Answer 26

Basically every common side effect imaginable

Question 27

Mechanism of action of SNRI

Answer 27

interferes with uptake of neurotransmitters from the synaptic cleft

Question 28

Examples of SNRIs

Answer 28

Venlaflaxine, Reboxetine, duloxetine

Question 29

What can sudden withdrawal of an SNRI or NaSSA cause?

Answer 29

GI upset Neuro and flu like symptoms Sleep disturbance

Question 30

What are the side effects of SNRI and NaSSAs?

Answer 30

``` GI upset Dry mouth Nausea Change in wt Headache Abnormal dreams Insomnia Confusion Convulsions Serotonin syndrome Hyponatraemia Suicidal thoughts and behaviour ```

Question 31

Venlaflaxine has other side effects which are

Answer 31

Prolonged QT | Greater risk of withdrawal affects than others

Question 32

Contraindications to the use of SNRI and NaSSAs

Answer 32

Elderly | Hepatic/renal impairment

Question 33

What is carbamazepine used for?

Answer 33

Epilepsy: 1st choice Trigeminal neuralgia: 1st choice Bipolar disorder: prophylaxis in patients intolerant of other meds

Question 34

Anti epileptic hypersensitivity syndrome is contraindicated with what key mental health drug?

Answer 34

Carbamezapine

Question 35

Which kind of patients should be prescribed carbamazepine with caution

Answer 35

Hepatic disease Renal disease Cardiac disease

Question 36

What does carbamazepine do to p450 enzymes?

Answer 36

Induces them

Question 37

What can increase the serum level of carbamazepine?

Answer 37

CP450 inhibitors

Question 38

Side effects of carbamazepine

Answer 38

GI upset Neurological defects Oedema Hyponatraemia

Question 39

A patient diagnosed with bipolar disorder has presented with a milky maculopapular skin rash. What is causing this?

Answer 39

Carbamezapine hypersensitivity

Question 40

Can carbamezapine be prescribed in pregnancy?

Answer 40

Yes but it should be avoided as it is associated with NTDs, cardiac and urinary abnorms., and cleft palate

Question 41

MoA of carbamezapine

Answer 41

Inhibit neuronal sodium channels, stabilising resting membrane potentials and reducing neuronal excitability

Question 42

What are the types of mood stabilisers?

Answer 42

Sodium valproate Carbamazepaine Lithium