Psych Written - Medications

Question 1

Amitriptyline side effects

Answer 1

Tricyclic antidepressant so Anticholinergic effects

• tachycardia
• dry mouth
• mydriasis
• urinary retention
• drowsiness
• blurred vision
• constipation
• lengthening of QT interval
• weight gain (anti-histaminic)

Question 2

Typical antipsychotic side effects

Answer 2

Extrapyramidal side-effects (EPSEs):

• Parkinsonism
• acute dystonia = sustained muscle contraction (e.g. torticollis, oculogyric crisis), Tx = procyclidine
• akathisia = severe restlessness
• tardive dyskinesia = late onset of abnormal/involuntary choreoathetoid movements, may be irreversible, e.g. chewing and pouting of jaw)

Other side-effects

• antimuscarinic: dry mouth, blurred vision, urinary retention, constipation
• sedation, weight gain
• raised prolactin
• impaired glucose tolerance
• neuroleptic malignant syndrome: pyrexia, muscle stiffness
• reduced seizure threshold
• prolonged QT interval (esp haloperidol)

In elderly: stroke + VTE

Question 3

Lithium side effects

Answer 3

Idiopathic intracranial HTN
Nausea, vomiting, diarrhoea
Fine tremor
Nephrotoxicity - nephrogenic DI
Thyroid enlargement - hypothyroidism, parathyroid dysfunction, high Ca2+
Weight gain
Leucocytosis

ECG - T wave flattening, inversion

Question 4

Lithium monitoring requirements

Answer 4

Measure levels 5-7 days after starting Tx (or a dose change)

Repeat weekly until appropriate levels reached (target = 0.6-1)

THEN every 3 months

NOTE: whenever checking levels, should be 12 hours post dose

Question 5

Worst antipsychotics for hyperprolactinaemia

Answer 5

1st gen (typicals)
Amisulpride
Risperidone

Question 6

Worst antipsychotics for sedation

Answer 6

Chlorpromazine
Clozapine
Olanzapine
Quetiapine

Question 7

Worst antipsychotics for metabolic SEs

Answer 7

2nd gen (atypicals)
Clozapine > Olanzapine > Risperidone > Quetiapine

Question 8

Worst antipsychotics for tardive dyskinesia

Answer 8

1st gen (typicals)

Question 9

Worst antipsychotics for akathisia

Answer 9

1st gen (typicals)

+ Aripiprazole

Question 10

Worst antipsychotic for Acute dystonia

Answer 10

1st gen (typicals)

+ Risperidone

Question 11

Worst antipsychotics for parkinsonism

Answer 11

1st gen (typicals)

Question 12

Worst antipsychotic for decreased seizure threshold

Answer 12

Clozapine

Question 13

Medical Tx of Alzheimer’s

Answer 13

Mild-most = ACh inhibitors - Donepezil, Galantamine, Rivastigmine

More severe = non-competitive NMDA (glutamate) receptor partial agonist - Memantine

Question 14

Medical Tx of Lewy Body Dementia

Answer 14

AChE inhibitors e.g. donepezil, rivastigmine

NOT antipsychotics - up to 50% have neuroleptic sensitivity –> potentially fatal SE

Question 15

Medical Tx of Vascular dementia

Answer 15

No direct Tx

Optimise vascular RF

If mixed type (vascular + Alzheimer’s) can give AChE inhibitor e.g. donepezil, rivastigmine, galantamine

Question 16

Medical Tx of ED

Answer 16

Nothing specifically licensed

Antidepressant if depression. anxiety

+ SSRI in BN - reduces bingeing & purging (enhances impulse control)

Question 17

Medications for Alcohol abstinence

Answer 17

Acamprosate - modulates glutamatergic system, increases abstinence

Disulfiram - inhibits liver enzyme that metabolises EtOH, gives unpleasant systemic reaction, can be dangerous?

Question 18

Tx of alcohol withdrawal

Answer 18

Reducing dose regimen of BDZ e.g. chlordiazepoxide

+ Parenteral thiamine - prevent Wernicke’s