Pharmacological Therapies

Question 1

what are anti-depressants used for ?

Answer 1

unipolar and bipolar depression
mood disorders
schizophrenia
anxiety

Question 2

what time period is there a delay of after starting anti-depressants ?

Answer 2

2-4weeks

Question 3

what time period after no improvement of symptoms is an anti depressant changed ?

Answer 3

2 months

Question 4

what is the response rate of anti-depressants ?

Answer 4

70%

Question 5

what is the response rate for placebos for depression?

Answer 5

40%

Question 6

how long after a depressive episode should someone treated?

Answer 6

6months to a year after the first episode

2 years after the second episode

life long after 3 episode

Question 7

what % of patients relapse after 6 months of prophylaxis?

Answer 7

20%

Question 8

what % of patients relapse after none of prophylaxis?

Answer 8

80%

Question 9

state the 5 classifications of antidepressants ?

Answer 9

tricyclics (TCAs)
monoamine oxidase inhibitors (MAOIs)
selective serotonin repute inhibitors (SSRIs)
serotonin/noradrenaline repute inhibitors (SNRIs)
novel antidepressants

Question 10

what changes to ECG can TCAs cause?

Answer 10

long QT

Question 11

are TCAs easy or hard to overdose?

Answer 11

easy

Question 12

what are some side effects of TCAs?

Answer 12

low BP, constipation, blurred vision

Question 13

do secondary or tertiary TCAs have more side effects?

Answer 13

tertiary

Question 14

state some examples of tertiary TCAs?

Answer 14

amitriptyline

clomipramine

Question 15

what is the main function of secondary TCAs?

Answer 15

primarily block noradrenaline since they are a similar structure

Question 16

state some examples of secondary TCAs?

Answer 16

despiramine

nortriptyline

Question 17

what is the function of MAOIs?

Answer 17

they bind to monoamine oxidase thus preventing the breakdown of monoamine neurotransmitters and thereby increasing their availability

Question 18

what conditions are MAOIs used for?

Answer 18

parkinsons

resistant depression

Question 19

what are some side effects of MAOIs?

Answer 19

orthostatic hypertension 
weight gain 
dry mouth 
sedation 
sexual dysfunction 
sleep disturbance

Question 20

what diet change is required for use of MAOIs?

Answer 20

reduction of tyramine rich foods

Question 21

why do patients on MAOIs need a reduction of tyramine rich foods?

Answer 21

causes hypertensive crisis

Question 22

what is the cheese reaction

Answer 22

when patients on MAOIs take tyrosine rich foods

and since MAO is inhibited, the amines can enter the tissues and cause a hypertensive response

Question 23

on what medication can serotonin syndrome occur?

Answer 23

MAOIs

Question 24

give some symptom of serotonin syndrome?

Answer 24

abdo pain
myoclonus 
irritability 
tachycardia 
HTN
delirium

Question 25

how long is required to wait when switching from a SSRI to a MAOI?

Answer 25

2 weeks

Question 26

what is the function of SSRIs?

Answer 26

block the presynaptic serotonin reuptake

Question 27

what conditions are SSRIs used to treat?

Answer 27

anxiety and depression

Question 28

state some side affects of SSRIs?

Answer 28

``` GI upset sexual dysfunction anxiety restlessness nervousness ```

Question 29

what can occur if SSRIs are stopped suddenly?

Answer 29

discontinuation syndrome

Question 30

what chemical is increased in the body by SSRIs?

Answer 30

serotonin

Question 31

what medication should be started if discontinuation syndrome occurs?

Answer 31

fluoxetine

Question 32

state some names of SSRIs

Answer 32

sertraline fluoxetine citalopram

Question 33

what is the function of SNRIs?

Answer 33

Inhibit both serotonin and noradrenergic reuptake

Question 34

give two names of SNRIs?

Answer 34

duloxetine | venlafaxine

Question 35

give two names of novel antidepressants

Answer 35

mirtazapine | bupropion

Question 36

are sertraline and citalopram sedating?

Answer 36

no

Question 37

a patient with depression, hyperphagia, psychomotor retardation and hypersomnolence (sleeping too much) should be started on what type of medication?

Answer 37

SSRIs

Question 38

can TCAs help with pain

Answer 38

yes neuropathic pain

Question 39

what does IPT stand for?

Answer 39

interpersonal therapy

Question 40

what options are there for treatment resistance for depression?

Answer 40

combination of anti-depressants adjunctive Tx of lithium adjunctive Tx of atypical anti-psychotic ECT

Question 41

what conditions is the medication mood stabilisers used for?

Answer 41

bipolar schizoaffective cyclothymia - mild, moods swing between short periods of mild depression and hypomania

Question 42

what are the three classes of mood stabilisers ?

Answer 42

lithium anticonvulsants antipsychotics

Question 43

what is the only medication to reduce the suicide rate?

Answer 43

lithium

Question 44

what condition is lithium used for?

Answer 44

bipolar

Question 45

what abnormality can be caused by lithium during pregnancy?

Answer 45

Ebsteins anomaly - congenital heart defect, the septal and posterior leaflets of the tricuspid valve are displaced towards the apex of the right ventricle of the heart.

Question 46

what serum levels need to be checked after lithium has been started ?

Answer 46

TSH and creatinine

Question 47

what is the blood serum level goal for lithium ?

Answer 47

0.6 and 1.2

Question 48

what is the most common side effect of lithium ?

Answer 48

GI symptoms - appetite - nausea/vomiting - diarrhoea hypothyroid hair loss

Question 49

what is the treatment for a lithium overdose?

Answer 49

stop lithium and increase fluids

Question 50

what are the symptoms of severe lithium toxicity ?

Answer 50

generalised convulsions oliguria renal failure

Question 51

what are the symptoms of mild lithium toxicity ?

Answer 51

``` vomiting diarrhoea ataxia dizziness slurred speech ```

Question 52

what is valproic acid used for?

Answer 52

mania prophylaxis

Question 53

is lithium or valproic acid better tolerated

Answer 53

valproic acid

Question 54

what pregnancy defect can valproic acid cause?

Answer 54

neural tube defect

Question 55

what investigations need to be done before valproic acid is started ?

Answer 55

LFTs Pregnancy test FBC

Question 56

what are some side effects of valproic acid?

Answer 56

Thrombocytopenia and platelet dysfunction Nausea, vomiting, weight gain Sedation, tremor

Question 57

what is the first line agent for acute mania and mania prophylaxis ?

Answer 57

carbamazepine

Question 58

what investigations should be done before starting carbamazepine ?

Answer 58

ECG LFTs FBC

Question 59

what is the most common side effect of carbamazepine?

Answer 59

rash

Question 60

state some side effects of carbamazepine?

Answer 60

``` GI effects - nausea, vomiting, diarrhoea sedation dizziness aplastic anaemia agranulocytosis ```

Question 61

what anti-convulsant be used for neuropathic pain?

Answer 61

lamotrigine

Question 62

state some side effects of lamotrigine?

Answer 62

``` GI sedation dizziness ataxia confusion ```

Question 63

what two drugs increase the levels of lamotrigine?

Answer 63

sertraline | valproate

Question 64

what conditions should anti-psychotics be used for?

Answer 64

schizophrenia | bipolar for mood stabilisation

Question 65

what is the key pathway affecting in the brain in the Tx of schizophrenia?

Answer 65

dopamine

Question 66

what is first line for mania with no depression?

Answer 66

lithium

Question 67

what medication should be given for a rapid cycler of depression and mania with alcohol abuse?

Answer 67

depakote

Question 68

what part of the brain is responsible for negative symptoms ?

Answer 68

mesocortical

Question 69

what are the levels of dopamine like in the mesocortical part of the brain?

Answer 69

too little dopamine

Question 70

what part of the brain is responsible for positive symptoms ?

Answer 70

mesolimbic

Question 71

what are the levels of dopamine like in the mesolimbic part of the brain?

Answer 71

too much dopamine

Question 72

what part of the brain causes parkinsonian movements ?

Answer 72

nigrostriatal

Question 73

what levels of dopamine cause parkinsonian movements

Answer 73

dopamine hypoactivity

Question 74

what does dopamine do to the levels of prolactin?

Answer 74

inhibits release of prolactin

Question 75

if dopamine is blocked by medication, what happens to the levels of prolactin?

Answer 75

hyperprolactinaemia

Question 76

what are the symptoms of hyperprolatcineamia?

Answer 76

gynecomastia galactorrhea decreased libido menstrual dysfunction

Question 77

what type of dopamine receptor antagonists are antipsychotics typicals ?

Answer 77

D2

Question 78

what type of antagonist are atypical antipsychotics ?

Answer 78

serotonin dopamine 2 antagonists

Question 79

what side effects does risperidone cause?

Answer 79

extrapyramidal side effects | hyperprolactineamia

Question 80

what is the most likely atypical antipsychotic to cause orthostatic hypotension

Answer 80

quetiapine

Question 81

what side effect is associated with aripiprazole ?

Answer 81

akathisia

Question 82

what is the most likely atypical antipsychotic to cause weight gain, sedation and abnormal LFTs?

Answer 82

clozapine

Question 83

are all atypical antipsychotics the same effectiveness?

Answer 83

yes | - they just have different side effects

Question 84

what is the commonest psychotic symptom?

Answer 84

lack of insight

Question 85

what is the most common cause of release in psychotic illness?

Answer 85

non compliance

Question 86

what should be considered for a third episode of schizophrenia?

Answer 86

long acting IM medication

Question 87

what is Tardive Dyskinesia (TD)?

Answer 87

involuntary muscle movements that may not resolve with drug discontinuation

Question 88

what is Neuroleptic Malignant Syndrome (NMS)?

Answer 88

Characterized by severe muscle rigidity, fever, altered mental status, autonomic instability, elevated WBC, CPK and lfts. Potentially fatal.

Question 89

what four tests should be done before prescribing anti-psychotics?

Answer 89

Fasting lipid profile fasting blood sugar LFTs FBC

Question 90

what can akathisia increase the risk of ?

Answer 90

suicide

Question 91

what are anxiolytics used to treat?

Answer 91

panic disorder generalised anxiety disorder withdrawal

Question 92

give two examples of anxiolytics?

Answer 92

buspirone | benzodiazepines