Psych

Question 1

What are the common adrenergic receptor effects?

Answer 1

Sweating 
Tremor 
Headaches
Nausea
Dizziness

Question 2

What are the common acetycholin receptor effects?

Answer 2

Dry mouth 
Urinary retention 
Dry skin 
Thirst 
Hot and flushed

Question 3

What are the common histaine effects?

Answer 3

Dizziness
Drowiness
Dizziness
N and V

Question 4

What are the common side effects of serotonin?

Answer 4

Restlessness, agitation on initiation 
Nausea 
GI disturbance 
Headache 
Weight changes 
Sexual dysfunction 
Less common- bleeding and suicidal ideation

Question 5

What is the safest SSRI in heart disease?

Answer 5

Sertraline

Question 6

What is the caution with citalopram?

Answer 6

QTc prolongation
Do an ECG before and after
Do not use with other meds that cause QTc prolongation!

Question 7

When is fluoxetine given and when do you have to be careful with its use?

Answer 7

It is given as first line to children

You have to be careful when switching to other SSRIs because it can cause serotonin syndrome

Question 8

What SSRI can you experience discontinuation syndrome with?

Answer 8

Paroxetine

Question 9

What are the two types of NSRIs?

Answer 9

Duloxetine and venlaxafine (co not use in heat disease, can also cause hypertension)

Question 10

What are the major side effects of mitazapine?

Answer 10

Weight gain and sedation (act on histamine receptors too)

Question 11

What is the downside of TCAs?

Answer 11

They can be fatal in overdose, they can cause QTc prolongation and arrythmias

Question 12

What are the dangers of MAOIs?

Answer 12

Have lots of interactions with other drugs

Can cause a thyramine reaction and lead to a hypertensive crisis

Question 13

What is discontinuation syndrome?

Answer 13

Non life threatening!
Sweating, shakes, agitation, insomnia, headaches, irritability, nausea

Paroxetine and venlaxafine= trickiest to stop
Can do alternative days of taking, snap tablets in half

Question 14

What is serotonin syndrome?

Answer 14

Essentially you get too much of serotonin
It is a very vague presentation

Can cause…
Cognitive 
Headaches
Agitation
Hypomania
Confusions
Coma

Autonomic 
Shivering 
Sweating 
Hyperthermia 
Tachy 
Nausea
Diarrhoea

Somatic
Myoclonus
Hyper reflexia
Tremor

Treatment is usually fluids and monitoring

Question 15

How do antipsychotics work?

Answer 15

They reduce the level of dopamine avtivity at the D2 receptors

Question 16

What are the target pathways for antipsychotics and what pathways are also affected by mistake?

Answer 16

Target pathways= mesocortical and mesolimbin

But unwanted pathways which are also affected include nigrostriatal (movement) and tuberoinfundibular (hyothalamic pituitary adrenal axis)

Question 17

What are the potential side effects for antipsychotics?

Answer 17

All antipsychotics have the potential for sedation, extrapyramidal side effects and weight gain

All antipsychotics can cause acute dystonia, incling oculogyric crisis (eyes point involuntary upwards)

Question 18

What are the typical vs atypical antipsychotics?

Answer 18

Typical= haloperidol, chlorpromazine

Atypical= clozapine, onlanzapine, risperidoe, quietiapine, amisulpride, apiprazole

Question 19

What are the typical antipsychotics more likely to cause?

Answer 19

Extra pyramidal side effects- bradykinesia, muscle stiffness and tremor, tardive dyskinesia (involuntary chewing/movement of jaw), akathisia
Dizziness
Sexual dysfunction

Question 20

What are atypical antipsychotics more likely to cause

Answer 20

Weight gain
Dyslipidsemia
Diabetes

Question 21

What is the serious risk with clozapine?

Answer 21

Should be used in schizophrenia after two orher antipsychotics have nor worked

The significant problem is that is a serious potential for agranulocytosis (severe leukopaenia) therefore close monitoring of FBC- weekly for first 18 weeks then fortnightly, then monthly

Question 22

Other than agranulocytosis, what is one of the reasons patients can die on clozapine?

Answer 22

Clozapine has a significant potential for GI hypomobility which causes constipation and a potentially fatal bowel obstruction

Question 23

Side effects of clozapine?

Answer 23

Constipation
Agranulocytosis
Hypersalivation
Urinary incontinence

Question 24

What is neuroleptic malignant syndrome?

What is the treatment?

Answer 24

Rare, life threatening reaction to antipsychotics
Fever, confusion, muscle rigidity, sweating, autonomic instability

Death is usually due to:
Rhabdomyolysis, renal failure, seizures

It usually happens in people that have never had antipsychotics before

Treatment involves emergency referral to A and E, stopping the antipsychotic, fluid rescucitation and reducing temperature

Question 25

What can be used to treat extra pyramidal side effects?

Answer 25

Anticholinergics (reduce acetylcholine) Procyclidine Benzatropine (parkinsons) Its not effective for tardive dyskinesia, if this is the only side effect a patient has got then dont give them procyclidine as it can make it worse!

Question 26

What are anxiolytics and give examples…

Answer 26

``` Drugs that reduce anxiety! Beta blockers (reducing ANS activation) Benzodiazepines Pregabalinn Antidepressants ```

Question 27

How do benzodiazepines work?

Answer 27

Examples are diazepam and lorazepam They work by binding to GABA receptors and therefore reduce the excitability of neurones They have a significant potential for tolerance and dependence They have a significant potential for mishse Use very cautiously for no more than 6 weeks

Question 28

What is pregabalin used for? How does it work? What side effects does it cause?

Answer 28

Anxiety, neuropathic pain, epilepsy Works by increasing GABA concentrations in the brain Causes sedation and weight gain

Question 29

What is lithium excreted by?

Answer 29

The kidneys

Question 30

Why does lithium have to be so regularly monitored?

Answer 30

It has a narrow therapeutic window (the gap between the effective dose and the toxic dose) so a requirement for regular serum lithium levels- 3 monthly once stable

Question 31

What are the side effects of lithium?

Answer 31

``` GI disturbance (especially on initiation) Metallic taste Dry mouth Fine tremor Polydypsia Polyuria Weight gain ``` Long term effects are; - hypothyrodism (usually reversible) - renal impairment (usually irreversible) Annual UEs and TFTs are needed

Question 32

What are the signs of lithium toxicity?

Answer 32

Confusion, coarse tremor, nause and vomiting, ataxia and seizures It is treated with supportive measures- dialysis if necessary The potential for toxicity increases w/ dehydration- advise to drink lots of water in hot climates

Question 33

What interactions can cause dangerously high levels of lithium?

Answer 33

NSAIDS, loop diuretics, ACE-I

Question 34

What do you use for long term mood stabilisers for bipolar affective disorders?

Answer 34

Can use lithium, quietiapine Can use anticonvulsants Sodium valproate (be wary in women of child bearing age due to teratogenicity, check LFTs before and soon after starting too) Carbamazepine Lamotrigine- potential for steven johnson syndrome Pregabalin Most anticonvulsants have the potential to cause thrombocytopenia so check FBC Side effects include weight gain and sedation

Question 35

What are the drugs use for the cognitive symptoms of dementia?

Answer 35

The drugs do not prolong life or slow down neurodegeneratibe changes, but they do improve cognitive and emotional/behavioural symptoms Acetylcholinesterase imhibitors (cholinesterase inhibitors) Memantine (NDMA agonist)

Question 36

What is the difference between acetylcholinesterase inhibitors and anticholinergics?

Answer 36

Anticholinergics cause a decrease in acetylcholine, acetylcholinesterase inhibitors cause an increase in acetylcholine (they prevent acetylcholine from breaking down).

Question 37

What are the side effects of cholinesterase inhibitors?

Answer 37

``` Nausea Diarrhoea Vomiting Insomnia Muscle cramps Anorexia ```

Question 38

What monitoring do you need with cholinesterase inhibitors? What are examples of cholinesterase inhibitors?

Answer 38

Pulse check at every appointment ECG before starting treatment Examples= donepezil, galantamine, rivastigmine (can be given as a patch, good for concordance and less GI side effects)

Question 39

What is memantine used for? How does it work? Side effects?

Answer 39

Glutamine (NDMA) receptor agonist- leading to lower neuronal excitability Used in moderate to severe Alzheimers Used most for agitated and challenging behaviour in alzheimers Generally well tolerated if initiated slowly No specific monitoring Side effects= headache, drowsiness, insomnia, nausea

Question 40

What are the drugs used in ADD and ADHD? | What needs to be monitored?

Answer 40

Methylphenidate | Weight, height, pulse