Psychiatry

Question 0

SSRIs pharmacokinetics

Answer 0

Almost completely absorbed from gut
Metabolised in liver
Long T1/2 so once daily

Question 1

SSRIs uses

Answer 1

First line for moderate to severe depression

Question 2

SSRIs ADRs

Answer 2

Anorexia, nausea and diarrhoea 
Mania
Suicidal ideation
Tremor
Extrapyramidal syndromes 
Reasonably safe in overdose

Question 3

Fluoxetine

Answer 3

Prozac

SSRI

Question 4

Citalopram

Answer 4

SSRI
Most selective
Anxiolytic effect but can cause more sedation

Question 5

Paroxetine

Answer 5

Most potent

SSRI

Question 6

Sertraline

Answer 6

SSRI

Question 7

Tricyclics

Answer 7

First generation antidepressants

Still used but not first or second line

Question 8

Tricyclics mechanism

Answer 8

Inhibit NA reuptake
Muscarinic receptor blockade
Alpha 1 adrenoceptor blockade

Question 9

Tricyclics pharmacokinetics

Answer 9

Lipid soluble
Absorbed from gut
Long half life
Liver metabolism

Question 10

Tricyclics ADRs

Answer 10

Sedation
Psychomotor performance impairment
Lowered seizure threshold 
Reduced glandular secretion
Eye accommodation block 
Tachycardia
Postural hypotension
Impaired myocardial contractility
Overdose leads to cardiac death 
Constipation

Question 11

SNRIs

Answer 11

SSRIs with the property of Na uptake inhibitors grafted on

Question 12

Amitryptiline

Answer 12

Tricyclic

Question 13

Imipramine

Answer 13

Tricyclic

Question 14

Clomipramine

Answer 14

Tricyclic

Question 15

Lofrepramine

Answer 15

Tricyclic

Question 16

Venlafaxine

Answer 16

SNRI

Question 17

Duloxetine

Answer 17

SNRI

Urinary incontinence

Question 18

SNRIs pharmacokinetics

Answer 18

Short half life - may have withdrawal syndrome

Question 19

Olanzapine

Answer 19

Atypical antipsychotic

Question 20

Risperidone

Answer 20

Atypical antipsychotic

Question 21

Quetiapine

Answer 21

Atypical antipsychotic

Question 22

Clozapine

Answer 22

Atypical antipsychotic

ADR: agranulocytosis

Question 23

Atypical antipsychotics actions

Answer 23

Sedation within hours
Tranquilisation within hours
Antipsychotic takes several days to weeks
Negative symptom improved within weeks

Question 24

Atypical antipsychotic ADRs

Answer 24

``` Sedation Extrapyramidal Weight gain (Olanzapine) Increased prolactin (Risperidone) Long QT syndrome ```

Question 25

Typical antipsychotic actions

Answer 25

Dopamine receptor blockade Anticholinergic Alpha blockade Antihistamine

Question 26

Haloperidol

Answer 26

Typical antipsychotic | Safe in emergencies

Question 27

Chlorpromazine

Answer 27

Typical antipsychotic

Question 28

Typical antipsychotic ADRs

Answer 28

``` Extra pyramidal More sedation CNS depression Weight gain Prolactin Pigmentation Long QT Postural hypotension Neuroleptic malignant syndrome ```

Question 29

Anxiety management

Answer 29

``` CBT is first line SSRIs or SNRIs Anxiolytics Occaisionally antipsychotics Not benzodiazepines unless need to sedate in emergency ```

Question 30

Benzodiazepine action

Answer 30

Enhance GABA mediated inhibition

Question 31

Mood stabilisers

Answer 31

``` Lithium Sodium valproate Carbamazepine Lamotrigine Antipsychotics ```

Question 32

Lithium pharmacology

Answer 32

Renal excretion Slow release preparation given once daily Levels need monitoring Monitor kidney and thyroid function

Question 33

Lithium uses

Answer 33

Prophylaxis of mania and depression in bipolar Augmentation of antidepressants in unipolar Reduces suicidality Best evidence of all mood stabilisers

Question 34

Lithium ADRs

Answer 34

``` Memory problems Thirst Tremor Drowsiness Weight gain Kidneys Thyroid Hair loss Rash ```

Question 35

Lithium toxicity

Answer 35

``` Narrow therapeutic window Tremor, dysarthria, agitation Give anticonvulsants and fluids Vomiting, diarrhoea Long term use can effect kidney and thyroid function ```