Psychopharmacology

Question 1

what the delay before therapeutic dose is achieved to improve symptoms?

Answer 1

typically 3-6 weeks

Question 2

whats the problem with TCAs?

Answer 2

lethal in overdose

Question 3

how long should you wait before saying no improvement?

Answer 3

2 months

Question 4

what can TCAs cause?

Answer 4

QT lengthening

Question 5

how do MAOIs work?

Answer 5

bind irreversibly to monoamine oxidase preventing inactivation of amines such as norepinephrine leading to increased synaptic levels

Question 6

MAOIs side effects? (4)

Answer 6

orthostatic HT
weight gain
dry mouth
sedation

Question 7

what do you need to be careful with in MAOIs?

Answer 7

hypertensive crisis can develop when taken with tyramine-rich foods or sympathomimetics

Question 8

how long do you need to wait when switching from SSRIs to MAOIs?

Answer 8

2 weeks

5 weeks for fluoxetine

Question 9

SSRI most common side effects? (2)

Answer 9

GI upset

sexual dysfunction

Question 10

Sertraline facts?

Answer 10

short half life with low build up of metabolites
max absorption requires a full stomach
safe for overdose

Question 11

Best thing about fluoxetine?

Answer 11

long half-life so decreased chance of discontinuation syndromes in patients with non-compliance

increased energy

Question 12

disadvantages with fluoxetine?

Answer 12

active metabolite may build up

not good for polypharmacy patients

Question 13

what is lithium effective in?

Answer 13

long-term prophylaxis of both mania and depressive episodes

Question 14

what can lithium do in pregnancy?

Answer 14

Ebstein’s anomaly

Question 15

blood level goal?

Answer 15

0.6 - 1.2

Question 16

lithium side-effects? (5)

Answer 16

GI distress
hypothyroidism
acne
hair loss
tremor

Question 17

1.5-2.0 lithium toxicity symptoms?

Answer 17

vomiting, diarrhoea, ataxia, dizziness

Question 18

2.0-2.5 lithium toxicity symptoms?

Answer 18

clonic limb movements, convulsions, syncope

Question 19

above 2.5 lithium toxicity symptoms?

Answer 19

generalised convulsions

renal failure

Question 20

what are the 2 main anti-convulsants?

Answer 20

Valproic acid

Carbamazepine

Question 21

Valproic acid disadvantage?

Answer 21

not effective in depression

Question 22

Valproic acid target level?

Answer 22

50-125

Question 23

Carbamazepine is first line agent for what?

Answer 23

acute mania and mania prophylaxis

Question 24

Carbamazepine target levels?

Answer 24

4 - 12

Question 25

Carbamazepine side-effects?

Answer 25

rash | AV conduction delays

Question 26

difference between typical and atypical anti-psychotics?

Answer 26

Typical block D2 dopamine receptors where as Atypical are more serotonin-dopamine 2 antagonists

Question 27

why are atypicals considered atypical?

Answer 27

as they affect dopamine and serotonin

Question 28

what are the advantages of atypical?

Answer 28

dont tend to get the extra-pyramidal side-effects

Question 29

what is the main disadvantage of atypical?

Answer 29

cause weight gain more

Question 30

what is Risperidone the most likely to induce?

Answer 30

hyperprolactinaemia

Question 31

what are the side-effects of Olanzapine?

Answer 31

hypertriglyceridemia hypercholesterolaemia weight gain

Question 32

when is clozapine used?

Answer 32

if 2 antipsychotics with limited response

Question 33

major life-threatening side effect with clozapine?

Answer 33

agranulocytosis

Question 34

examples of EPSEs? (4)

Answer 34

parkinsonism akathisia acute dystonia tardive dyskinesia (involuntary muscle movements)

Question 35

agents for EPSEs?

Answer 35

anticholinergics | BB