Pharmacology

Question 1

What type of drug can effectively diffuse across the BBB?

Answer 1

Lipophilic/hydrophobic

Question 2

Give an example of a lipophilic drug that is used for anxiety

Answer 2

Propranolol - more lipophilic than other beta blockers

Question 3

State the uses of antidepressant drugs

Answer 3

• moderate/severe depression
• dysthymia
• generalised anxiety disorder
• panic/OCD/PTSD
• bulimia nervosa
• neuropathic pain
• premenstrual dysphoric disorder

Question 4

Name three classes of antidepressants

Answer 4

Monoamine oxidase inhibitor
Monoamine reuptake inhibitor
Atypical drugs (post synaptic)

Question 5

Name three monoamines

Answer 5

• dopamine
• noradrenaline
• 5 HT/serotonin

Question 6

Where is serotonin produced?

Answer 6

Raphe nucleus

Question 7

Where are most serotonin neurons located?

Answer 7

Rostral nucleus but has multiple cortical projections to areas involving mood, sleep, feeding, behaviour and sensory perception

Question 8

Other than serotonin production what is the raphe nucleus also involved in?

Answer 8

Analgesia

Question 9

Where is noradrenaline produced?

Answer 9

Locus coeruleus with projections to areas of arousal and emotion

Question 10

What is the function of MAO?

Answer 10

Converts monoamines into metabolites

Question 11

How do monoamine oxidase inhibitors work?

Answer 11

Prevent the conversion of neurotransmitter to metabolite

Question 12

Give two examples of MAOi

Answer 12

Phenelzine (irreversible)

Moclobemide (reversible)

Question 13

What are the side effects of MAOi?

Answer 13

Cheese reaction 
Decreased metabolism of other drugs 
Insomnia 
Postural hypotension 
Peripheral oedema

Question 14

Describe the cheese reaction

Answer 14

Hypertensive crisis, inhibition of MAO in the gut prevents breakdown of dietary tyramine - tyramine causes vasoconstriction and malignant hypertension

Question 15

How do tricyclic antidepressants work?

Answer 15

Block uptake of amines by competition of nerve terminals - non-specific inhibition of noradrenaline and 5HT uptake

Question 16

Give examples of tricyclic antidepressants

Answer 16

Imipramine
Dosulepin
Amitriptyline
Lofepramine

Question 17

What are the side effects of tricyclic antidepressants?

Answer 17

Anticholinergic syndrome, sedation, weight gain, constipation, cardiotoxic in overdose and cardiovascular effects of increased noradrenaline

Question 18

How to SSRIs work?

Answer 18

Inhibit re-uptake of 5HT from the synaptic cleft

Question 19

Give examples of SSRIs

Answer 19

Fluoxetine, citalopram, sertraline

Question 20

What are the side effects of SSRIs?

Answer 20

Nausea, headache, worsened anxiety, <25 year olds risk of increased self harm and suicidal ideation, sweating/vivid dreams, sexual dysfunction, hyponatraemia (elderly)

Question 21

How do monoamine reuptake inhibitors work?

Answer 21

Block the reuptake of monoamines - noradrenaline and 5HT into presynaptic terminals

Question 22

Give examples of monoamine reuptake inhibitors

Answer 22

Duloxetine and Venlafaxine

Question 23

What are the side effects of monoamine reuptake inhibitors?

Answer 23

Similar to SSRI but lack of major receptor blocking actions so a more limited range of side effect than tricyclics

Question 24

Name two types of atypical antidepressant

Answer 24

• Mirtazapine (mixed receptor effects)

- Dopamine uptake inhibitor (Bupropion)

Question 25

When can mirtazapine be used?

Answer 25

With SSRI to block serotenergic side effects

Question 26

What are the side effects of mirtazapine

Answer 26

Weight gain and sedation

Question 27

How is lithium given to a patient?

Answer 27

As a salt usually lithium carbonate

Question 28

How does lithium work?

Answer 28

- blocks phosphatidylinostol pathway - inhibits glycogen synthase kinase 3beta - modulates NO signalling

Question 29

What is the issue with lithium?

Answer 29

Requires close monitoring as it has a narrow therapeutic index - 12 hour post dose bloods (0.4-1mmol/l target)

Question 30

What are the side effects of lithium?

Answer 30

Dry mouth, diabetes insipidus, polydipsia/uria, hypothyroid, reduced renal function, weight gain

Question 31

Why must dehydration be avoided in patients who take lithium?

Answer 31

Renal tubules cannot differentiate between sodium and lithium ions, in dehydration more sodium is resorbed so more lithium is resorbed

Question 32

Describe the toxic effects of lithium

Answer 32

- Vomiting - Ataxia/tremor - Drowsiness - Convulsion - Coma - Diarrhoea

Question 33

What anticonvulsants can be used long term in bipolar?

Answer 33

Valproic acid, lamotrigine, carbamazepine - sodium channel blockers

Question 34

When must valproic acid not be used?

Answer 34

Pregnancy - neural tube defect

Question 35

What is a rare side effect of lamotrigine?

Answer 35

Steven Johnson Syndrome

Question 36

What are the side effects of valproate and carbamazepine?

Answer 36

Ataxia, drowsiness, induction of liver enzymes

Question 37

Which antipsychotics can be used in bipolar?

Answer 37

Quetiapine, Aripiprazole, Olanzapine, lurasidone - act as dopamine and 5HT antagonists

Question 38

Which antipsychotics can be used in bipolar?

Answer 38

Quetiapine, Aripiprazole, Olanzapine, lurasidone, risperidone - act as dopamine and 5HT antagonists