Psych

Question 1

What are the indicators of first generation antipsychotics and some examples?

Answer 1

psychomotor agitation, nausea and vomiting
schizophrenia, bipolar
haloperidol, chlopromazapine, prochlorperazine

Question 2

What is the mechanism of action for haloperidol?

Answer 2

block post-synaptic D2 receptors

Question 3

What are some adverse affects of haloperidol?

Answer 3

extrapyramidal
acute dystonic reactions - parkinsonian movements, akathisia
neuroleptic malignant syndrome - rigidity, confusion
drowsy, hypotension, QT prolongation, erectile dysfunciton

Question 4

What are some warnings of haloperidol?

Answer 4

elderly, dementia, PD

Question 5

What are important interactions of haloperidol?

Answer 5

drugs that prolong QT e.g. amiodarone

Question 6

Name some acetylcholinesterase inhibitors and how they work

Answer 6

donepezil, rivastigmine

increase the availability of acetylcholine which improves cognitive function and slows rate of cognitive decline

Question 7

What is the indication for acetylcholinesaterase inhibitors?

Answer 7

alzheimer’s disease and dementia in PD

Question 8

What are some adverse effects of acetylcholinesterase inhibitors?

Answer 8

nausea, diarrhoea, vomiting
asthma and COPD can worsen symptoms
peptic ulcers, bleeding, bradycardia, heart block
hallucinations, aggressive behaviour
extrapyramidal symptoms, neuroleptic malignant syndrome

Question 9

What are some warnings with acetylcholinesterase inhibitors?

Answer 9

asthma, COPD
peptic ulcer
heart block
PD disease

Question 10

What are some important interactions with acetylcholinesterase inhibitors?

Answer 10

NSAIDs, corticosteroids can increase risk of peptic ulcers

antipsychotics can worsen risk of neuroleptic malignant syndrome

Question 11

What are the indications of amitriptyline?

Answer 11

second line depression treatment?

Question 12

What is the mechanism of action of amitriptyline?

Answer 12

inhibits neuronal reuptake of 5-HT and noradrenaline

Question 13

What are some adverse reactions of amitriptyline?

Answer 13

antimuscarinic - dry mouth, constipation, urinary retention, hypotension
arrhthymias
convulsions, hallucinations 
breast changes, sexual dysfunction 
extrapyramidal symptoms 
overdose, withdrawal

Question 14

What are some warnings of amitriptyline?

Answer 14

elderly patients, epilepsy, CVS prostatic hypertrophy, glaucoma, constipation

Question 15

What are some interactions of amitriptyline?

Answer 15

monoamine oxidase inhibitors

can augment antimuscarinic, sedative or hypotension

Question 16

What are examples of SSRIs and how does it work?

Answer 16

citalopram, fluoxetine, sertraline, escitalopram

inhibits neuronal reuptake of 5-HT

Question 17

What are indications of SSRIs?

Answer 17

depression
panic disorder
OCD

Question 18

What are important adverse reactions of SSRIs?

Answer 18

GI upset, appetite, hypersensitivity 
hyponatraemia 
suicidal thoughts and behaviour 
lower seizure threshold 
prolong QT
increase risk of bleeding 
serotonin syndrome 
sudden withdrawal

Question 19

What are warnings of SSRs?

Answer 19

epilepsy
peptic ulcer disease
young people
hepatic impairment

Question 20

What are interactions with SSRIs?

Answer 20

monoamine oxidase inhibitors 
serotonergic drugs 
gastroprotection with SSRIs
drugs that prolong QT 
bleeding risk with anticoagulants

Question 21

What are indications of venlafaxine and mirtazapine?

Answer 21

depression, GAD

Question 22

What are mechanism of action of venlafaxine and mirtazapine?

Answer 22

increase availability of monoamines for neurotransmission

Question 23

What are adverse efects of venlafaxine and mirtazapine?

Answer 23

GI upset, neuro effects 
hyponatraemia, serotonin syndrome 
suicide 
long QT
sudden drug withdrawal

Question 24

What are warnings of venlafaxine and mirtazapine?

Answer 24

elderly
hepatic or renal impairment
arrhythmias

Question 25

What are important interactions of venlafaxine and mirtazapine?

Answer 25

serotonin syndrome

Question 26

What is necessary with lithium prescribing?

Answer 26

keep same brand

Question 27

What needs monitoring if prescribed lithium?

Answer 27

``` thyroid and renal function BMI calcium - do at baseline and every 6 months serum lithium concentration - every 3 months ```

Question 28

What are some examples of second generation antipsychotics, what are they used for and how do they work?

Answer 28

quetiapine, olanzapine, risperidone, clozapine to treat psychomotor agitation, schizoprenia, bipolar blocks post-synaptic dopamine D2 receptors

Question 29

What are some important adverse effects of second generation antipsychotics?

Answer 29

``` sedation extrapyramidal effects metabolic disturbance -weight gain prolong QT breast symptoms, sexua dysfunction clozapine - reduces neutrophils, myocarditis ```

Question 30

What are some warnings and interactions of second generation antipsychotics?

Answer 30

cardiovascular disease, neutropenia | don't prescribe with other drugs that block dopamine or prolong QT interval

Question 31

What are some examples of benzodiazepines and what are they used for?

Answer 31

diazepam, tamazepam, lorazepam, chlordiazepoxide, midazolam | first line seizures, alcohol withdrawal, sedation, anxiety and insomnia

Question 32

What are some adverse reactions of benzos?

Answer 32

drowsy, sedation, coma, overdose, airway obstruction, death, dependence and withdrawal

Question 33

What are some warnings and interactions of benzos?

Answer 33

caution in elderly avoid in respiratory impairment, NM disease, liver failure don't give with other sedating drugs need CYP to be elimnated