23+24) Drugs in Psychiatric Disease

Question 1

What can predispose to psychiatric disorders?

Answer 1

Genetic vulnerability
Life events
Personality, coping skills
Environmental influences

Question 2

What are the core symptoms of depression?

Answer 2

Low mood, anhedonia, decreased energy

Question 3

Give examples of SSRIs:

Answer 3

Fluoxetine, citalopram, paroxetine, sertraline

Question 4

What are some side effects of SSRIs?

Answer 4

Anorexia, nausea, diarrhoea, precipitation of mania, suicidal thoughts

Question 5

What is an important side effect of citalopram?

Answer 5

Prolongs QT interval

Question 6

Give examples of tricyclic antidepressants:

Answer 6

Amitryptyline, clomipramine

Question 7

What are some side effects of tricyclic antidepressants?

Answer 7

Sedation, lower seizure threshold
Tachycardia, postural hypotension
Constipation, reduction in glandular secretion

Question 8

Give examples of SNRIs:

Answer 8

Venlafaxine, duloxetine

Question 9

What are some side effects of SNRIs?

Answer 9

Sleep disturbance, increased BP, dry mouth, hyponatremia (also SEs of SSRIs)

Question 10

What are some symptoms of schizophrenia?

Answer 10

Hallucinations, delusions, thought disorder, behavioural changes, lack of insight

Question 11

What is a hallucination?

Answer 11

Perception in the absence of an external stimulus

Question 12

What is a delusion?

Answer 12

Fixed false belief out of keeping with someone’s culture or relgion

Question 13

What are some risk factors/predispositions for schizophrenia?

Answer 13

Genetics
Environment
Cannibis

Question 14

What is the function of the mesolimbic dopamine pathway?

Answer 14

Emotional response and behaviour

Question 15

What is the function of the mesocortical dopamine pathway?

Answer 15

Arousal and mood

Question 16

What is the function of the nigrostriatal dopamine pathway?

Answer 16

Production of movement

Question 17

What are the effects of antipsychotics?

Answer 17

Block D2 receptors, reducing psychotic symptoms by effects on mesolimbic pathway

Question 18

What are typical anti-psychotics?

Answer 18

Older, with increased D2 anatagonism so extra-pyramidal side effects and dyskinesia

Question 19

What are atypical anti-psychotics?

Answer 19

Modern, cause less EPSE

Question 20

What are the side effects of atypical anti-psychotics?

Answer 20

Weight gain, increase prolactin (risperidone), sedation

Neutropenia (clozapine)

Question 21

What are the side effects of typical anti-psychotics?

Answer 21

Parkinsonism, acute dystonia, akathasia, tardive dyskinesia
Postural hypotension, weight gain, prolactinemia
Neuroleptic malignant syndrome

Question 22

What is neuroleptic malignant syndrome?

Answer 22

Reaction to anti-psychotics

Severe rigidity, hyperthermia, tachycardia

Question 23

What are the symptoms of anxiety?

Answer 23

Light-headedness, shortness of breath, flushes, palpitations, nausea

Question 24

How can anxiety be treated?

Answer 24

CBT, antidepressants, anxiolytics, antipsychotics

Question 25

Describe tolerance and dependence in benzodiazepines:

Answer 25

Tolerance - need to increase the dose for the same effect | Dependence - withdrawal effects on discontinuation

Question 26

What are the side effects of benzodiazepines?

Answer 26

Drowsiness, Dizziness, psychomotor impairment, dry mouth, blurred vision

Question 27

Describe potential toxicity caused by benzodiazepines:

Answer 27

Cleft lip and palate in pregnancy | If late in pregnancy - resp depression and feeding difficulties in baby

Question 28

What can overdose on benzodiazepines cause?

Answer 28

Respiratory depression

Question 29

How can benzodiazepine overdose be reversed?

Answer 29

IV flumazenil

Question 30

What are the symptoms of bipolar disorder?

Answer 30

Overactive, poor concentration, poor sleep, poor judgement, increased interest in sex, psychosis

Question 31

Give examples of mood stabilisers:

Answer 31

``` Lithium Sodium valproate Carbamazepine Lamotrigine Anti-psychotics ```

Question 32

Describe lithium's mechanism of action:

Answer 32

Increases serotonin | Attentuate effects of certain neurotransmitters on their receptors

Question 33

How should lithium be monitored?

Answer 33

Renal and thyroid function every 6 months | Lithium blood levels weekly until stable conc. then 3 monthly (12 hours after dose)

Question 34

What are the indications for starting a patient on lithium?

Answer 34

Prophylaxis of mania and depression | Reduces suicidality

Question 35

What are the side effects of lithium?

Answer 35

Memory problems, thirst, tremor, weight gain, hypothyroidism, hair loss

Question 36

What medications can be used in dementia?

Answer 36

ACh-esterase inhibitors | NMDA agonist

Question 37

What are some side effects of ACh-esterase inhibitors?

Answer 37

N&V, fatigue, insomnia, bradycardia, worsening COPD, gastric ulcers

Question 38

What are some side effects of memantine?

Answer 38

Hypertension, dyspnoea, headache, dizziness, drowsiness