Psychiatric drugs

Question 1

Mechanism of action of SSRIs

Answer 1

Inhibit the uptake of serotonin by neurones. So increasing the duration its in the synaptic cleft.

Improves mood and physical symptoms.

Question 2

SSRIs are first line for?

Answer 2

Moderate / severe depression

Question 3

Cautions for SSRIs (2)

Answer 3

Epilepsy

Peptic ulcer disease

Question 4

Why should SSRIs be used with caution in the young?

Answer 4

Can be associated with increased risk of self harm / suicidal thoughts.

Question 5

2 contraindications for SSRIs?

Answer 5

Bipolar disorder

Mania phase

Question 6

6 SE of SSRIs

Answer 6

GI upset - N&V and diarrhoea

Decreased appetite

Weight gain / loss

Hyponatraemia esp. in the elderly.

Rarely increase in suicidal thoughts and behaviours

Sexual dysfunction

Question 7

3 common SSRIs

Answer 7

Citalopram
Sertraline
Fluoxetine

Question 8

SSRIs interact specifically with?

Answer 8

MOIs

Question 9

SSRIs should be used in caution …..(4)

Answer 9

Epilepsy (lowers the seizure threshold)
Young patient
Peptic ulcer disease
Hepatic impairment

Question 10

Normal starting does for SSRI

Answer 10

20mg tablet OD

Question 11

How long do SSRIs take to start working?

Answer 11

few weeks

Question 12

How long should SSRIs be taken for as a minimum?

Answer 12

6 months once symptoms improve

Question 13

What happens if you stop SSRIs suddenly?

Answer 13

GI upset
flu like withdrawl symptoms
Sleeplessness

Question 14

Antipsychotics mainly target which symptoms of psychosis?

Answer 14

+ve

Question 15

What is the mechanism of action of antipsychotics?

Answer 15

Antagnoise D2 receptors

Question 16

Difference between first and second generation antipsychotics

Answer 16

improved efficiency in treatment resistant schizophrenia

Works against -ve symptoms more

Lower risk of extra-pyramidal SE

Question 17

What are patients especially at risk of with second generation APs?

Answer 17

Metabolic syndrome - weight gain, DM and lipid changes

Question 18

What happens as a result of APs targeting the nigrostriatal pathway?

Answer 18

Extrapyramidal SE

• Parkinsonian symptoms
• Actue dystonia
• Akathisia
• Neuroleptic malignant syndrome

Question 19

What hormones does dopamine inhibit the release of?

Answer 19

Prolactin

Question 20

Hyperprolactinaemia symptoms produced by APs (3)

Answer 20

Galatorrhoea
Amenotrhea
Sexual dysfunction

Question 21

Anticholinergic SE caused by APs (4)

Answer 21

Dry mouth
Constipation
Urinary retention
Blurred vision

Question 22

Why can APs cause arrhythmias?

Answer 22

Prolong the QT interval

Question 23

What causes postrural hypotension in APs?

Answer 23

Alpha adrenergic receptor blockade

Question 24

Histamine blockade in APs lead to?

Answer 24

Sedation and weight gain

Question 25

Caution for AP

Answer 25

CV disease

Question 26

3 serious SE of clozapine

Answer 26

Agranulocytosis Myositis Cardiomyopathy

Question 27

2 contraindications of APs

Answer 27

Severe HD | History of neutropenia

Question 28

2 uses of APs in psychosis

Answer 28

Acute and prophylactically

Question 29

2 possible methods of administration of APs

Answer 29

Daily oral treatment Slow release IM injections

Question 30

What time is it best to take APs?

Answer 30

bedtime

Question 31

What should be done on patients on APs each year?

Answer 31

Annual health screen

Question 32

Mechanism of action of tricyclic AD?

Answer 32

inhibit uptake of serotonin and noradrenaline at the synapse.

Question 33

Tricyclic AD second line for?

Answer 33

Moderate / severe AD

Question 34

4 types of receptors blocked by tricyclic AD?

Answer 34

H1 Alpha Muscarinic Dopamine

Question 35

4 symptoms of blocking antimuscarinic receptors -

Answer 35

Dry mouth Urinary retenion Constipation Blurred vision

Question 36

Blockade of H1 receptors in Tricyclic AD leads to -

Answer 36

Sedation

Question 37

Tricyclic AD blocking alpha receptors leads to -

Answer 37

postural hypotension

Question 38

What problems can Tricyclic AD cause on the heart?

Answer 38

Arrhythmia's and ECG changes

Question 39

How may tricyclic AD cause changes to the brain? (3)

Answer 39

Convulsions Hallucinations Mania

Question 40

Blocking of dopamine receptors causes what in tricylic AD?

Answer 40

Sexual dysfunction | Breast changes

Question 41

What should tricyclic AD not be prescribed with?

Answer 41

MOI | s

Question 42

Two preparations of tricyclic AD -

Answer 42

Tablet / oral solution

Question 43

How long do tricyclic AD take to work?

Answer 43

2 weeks

Question 44

How long should patients take tricyclic AD?

Answer 44

at least 6m after symptoms improve

Question 45

Sudden withdrawl of tricyclic AD can lead to? (4)

Answer 45

GI upset Influenza symptoms Neuro symptoms and Sleep disturbance

Question 46

Clozapine monitoring

Answer 46

every week for 18 weeks then every 2 weeks then @ at a year - monthly