Psychiatry

Question 1

acetylcholinesterase inhbiitors are indicated for which conditions?

Answer 1

Alzheimers disease

Dementia in Parkinsons disease

Question 2

what is the MoA of acetylcholinesterase inhibors (donepezil, rivastigmine) in alzhemiers and parkinsons dementia?

Answer 2

increases availabilty of acetylcholine for neurotransmission improving cognitive function and reducing rate of decline

Question 3

what are some side effects of acetylcholinesterase inhibotors?

Answer 3

N&V, diarrhoea

bradycardia and heart block

Question 4

acetylcholinesterase inhibitors should be used in caution in which pt groups?

Answer 4

asthma

COPD

risk of peptic ulcers

heart block

Question 5

examples of acetylcholinesterase inhibitors?

Answer 5

donepezil

rivastigmine

Question 6

what drug interactions are important to consider when prescribing acetylcholinesterase inhibitors?

Answer 6

B blockers- bradycardia/ heart block

NSAIDs- peptic ulcers

Question 7

how can explain acetylcholinesterase inhibitord to teh patient?

Answer 7

treatment improves memory and brain function and may slow rate of decline

Question 8

should acetylcholinesterase inhibotrs be monitored?

Answer 8

review at 2-4 weeks for adverse effects

repeat cognitive assessment at 3 months to assess efficacy

Question 9

why are some patients advised to take donepezil in the mornign rather than the usual bed time dose?

Answer 9

can cause vivid dreams which could be problematic for pts

Question 10

when are SSRIs indicated for use?

Answer 10

depression

panic disorder

OCD

Question 11

name some SSRIs?

Answer 11

citalopram

fluoextine

sertraline

escitalopram

Question 12

what is the MoA of SSRIs?

Answer 12

inhibit neuronal reuptake of 5-HT from synaptic cleft

Question 13

which SSRI can prolong the QT interval?

Answer 13

citalopram

Question 14

what is the triad in serotonin syndrome?

Answer 14

autonomic hyperactivity, altered mental state, neuromuscular excitation

Question 15

how are SSRIs metabolised?

Answer 15

metabolised by liver

Question 16

SSRIs should not be given alongside which other drugs?

Answer 16

monoamine oxidase inhibitors as may precipitate serotonin syndrome

drugs that prolong the QT interval i.e. antipsychotics

Question 17

how long should patients carry on with SSRI treatment?

Answer 17

at least 6 months even after feeling better from depression

Question 18

SSRIs should be stopped over how long?

Answer 18

4 weeks

Question 19

when are tricyclics indicated?

Answer 19

second line in dperession (SSRIs ineffective)

neuropathic pain

Question 20

what is the MoA of tricyclic antdepressants?

Answer 20

inhibit neuronal reuptake of 5-HT and noradrenaline from synaptic cleft

Question 21

side effects of tricyclic antodepressants?

Answer 21

blockade of antimuscarins receptors cause dry mouth, constipation, retention and blurred vision

Question 22

tricyclic antidepressants should not be given alongside which other drugs?

Answer 22

monoamine oxidase inhibitors as both inc 5-HT and noradrenaline

Question 23

examples of tricyclic antidepressants?

Answer 23

amitriptyline

lofepramine

Question 24

what is the MoA of antidepressants venlafaxine and mirtazapine?

Answer 24

venlafaxine is an SNRI

mirtazapine is an antagonist of inhibitory pre-synaptic a2-receptors

both inc availability of monoamines for transmission

Question 25

indications for venlafaxine?

Answer 25

depression (SSRIs inneffective) generalised anxiety disorder

Question 26

when during the day should mirtazapine be taken?

Answer 26

at night to beneift from sedative effects

Question 27

how are the sedative effects of mirtazapine affected by the dose?

Answer 27

sedative effects less severe at higher doses

Question 28

are first or second generation antipsychotics typical?

Answer 28

first generation = typical second generation = atypical

Question 29

name some first gen (typical) antipsychotics?

Answer 29

haloperidol, chlorpromazine, prochlorperazine

Question 30

indications for first gen (typical) antipsychotics?

Answer 30

psychomotor agitation causing dangerous/ violent behaviour schizophrenia bipolar disorder

Question 31

MoA of antipsychotics?

Answer 31

block post-synpatic dopamine D2 receptors all have some sedative effect

Question 32

important adverse effects of first gen (typical) antipsychotics?

Answer 32

**extrapyramidal effects**: acute dystonia, akathisia, tardive dyskinesia **drowsiness** **hypotension** **prolonged QT interval** **erectile dysfunction**

Question 33

important adverse effects of second gen (atypical) antipsychotics?

Answer 33

**extrapyradimal effects**: more common w first gen **prolonged QT interval**

Question 34

what are extrapyramidal effects?

Answer 34

'drug induced movement disorders' acute dystonia, akathasia (restlessness), tardive dyskinesia

Question 35

what rare but serious side effect can occur with antipsychotic use?

Answer 35

Neuroleptic malignant syndrome rigidity, confusion, autonomic dysregulation, pyexia

Question 36

which pt population are particulary sensitive to antipsychotics?

Answer 36

elderly- start with lower dose

Question 37

who should not take antipsychotics?

Answer 37

**dementia**- inc risk of stroke and death **parkinsons**- extrapyradimal effects cardiovascular disease- interacts with drugs prolong QT interval

Question 38

which first gen (typical) antipsychotic is a popular choice for managing acute violent behaviour?

Answer 38

haloperidol

Question 39

oral antipsychotics are best taken at which time?

Answer 39

bed time

Question 40

which antipsychotic requires regular blood test monitoring?

Answer 40

**Clozapine**- risk of agranulocytosis (neutrophil deficiency)

Question 41

name some second gen (atypical) antipsychotics?

Answer 41

quetiapine, olanzapine, risperidone, clozapine

Question 42

when are benzodiazepines indicated?

Answer 42

management of alchol withdrawal sedation short term treatment of severe, distressing anxiety

Question 43

list some benzodiazepines?

Answer 43

diazepam, lorazepam, temazepam, chordiazepoxide, midazolam

Question 44

MoA of benzodiazepines?

Answer 44

**facilitate and enhance binding of GABA to the GABA_A receptor** opens chloride channel making cell more resistant to depolarisation

Question 45

why are benzos useful in alcohol withdrawal?

Answer 45

alcohol acts on GABA_A receptor so chronic alcohol use causes tolerance- abrupt cessation provokes the excitatiry state of alcohol withdrawal benzos can be withdrawn in a gradual and controlled way

Question 46

important adverse effects of benzos?

Answer 46

drowsiness, sedation, dependence can develop abrupt cessation can cause withdrawal reaction similar to alcohol

Question 47

benzos should be used with caution in which patient groups?

Answer 47

elderly, repiratory impairment, neuromuscular disease, liver disease

Question 48

which benzodiazepine is best for sedation in the short term?

Answer 48

midazolam

Question 49

what psychiatric illness is lamotrogine indicated for?

Answer 49

**bipolar depression**, not mania or hypomania

Question 50

lamotrogine binds to which channels?

Answer 50

Na⁺ channels interfering with Na influx

Question 51

common adverse effects of lamotrogine?

Answer 51

**headache, drowsiness, irritability, blurred vision, GI upset** can develop skin rash which may be sign of severe hypersensitivity reaction

Question 52

is lamotrogine safe during pregnancy?

Answer 52

yes- no evidence to suggest inc risk of congenital abnormnality but should be discussed with pt

Question 53

lamotrogine is metabolised by the ?

Answer 53

liver: hepatic glucuronidation may need to reduce dose in heptic impairment

Question 54

which drugs interact with lamotrogine by inducing glucuronidation?

Answer 54

carbamazepine, oestrogens, rifampicin, protease inhibitors all can cause lamotrogine levels to fall

Question 55

why is lamotrogine unique with its use in bipolar disease?

Answer 55

treats depressive symtpoms without increasinf risk of switch to mania

Question 56

indications for naloxone?

Answer 56

treatment of **opiod toxicity** | (respiratory depression)

Question 57

MoA of Naloxone?

Answer 57

binds to opiod receptors acting as competitive antagonist if an opiod is present naloxone displaces it from its receptors and reverses its effects

Question 58

psychiatric indication for sodium valproate?

Answer 58

bipolar disorder- acute manic episodes and prophylaxis of recurrence

Question 59

which pt population should sodium valproate be avoided in?

Answer 59

**women of child bearing age** avoid in hepatic and severe renal impairment