BB2 Drugs Flashcards
State the class of drugs that selegiline belongs to [1]
MOA inhibitor
Name the 7 treatments for addiction [7]
‘Detoxification’
Aversion therapies (Antabuse – disulfiram, acute hang-over after ingesting alcohol via acetaldehyde)
Motivational therapies (groups, AA)
Cognitive-behavioural treatments (coping skills)
Drug substitutes (methadone, NRT)
Treatments for withdrawal relief (clonidine), antagonists (naltrexone), partial agonists (varenicline) etc.
Psychedelics (LSD, Psilocybin) – promise in alcoholism
Name two future pyschedelic drugs that could be used for treatment for addiciton? [2]
Not on drug list
LSD, Psilocybin
Describe how antabuse - disulfiram works to stop
(on the drugs list)
inhibits the enzyme acetaldehyde dehydrogenase, causing many of the effects of a hangover to be felt immediately following alcohol consumption
Which drug is methadone a substitute for? [1]
Heroin
How does Varenicline work to treat nicotine addiction? [1]
Not on drug list
is a selective partial agonist that stimulates the a4b2 nicotine cholinergic receptor
Name a drug used to provide withdrawal relief and its MoA [2]
Not on drug list
Clonidine
Alpha2 agonist used to treat hypertension and addiction
Name a drug that causes patients to temporarily leave vegetative state [1]
Zolpidem
Zolpidem is a drug that causes patients to temporarily leave vegetative state. What is its MoA?
GABA-A antagonist
GABA-A agonist
NMDA Glutamate antagonist
NMDA Glutamate agonist
AMPA Glutamate antagonist
Zolpidem is a drug that causes patients to temporarily leave vegetative state. What is its MoA?
GABA-A antagonist
GABA-A agonist
NMDA Glutamate antagonist
NMDA Glutamate agonist
AMPA Glutamate antagonist
Amantadine helps patients recover from TBI. What is its mechanism of action?
GABA-A antagonist
GABA-A agonist
NMDA Glutamate antagonist
NMDA Glutamate agonist
AMPA Glutamate antagonist
Amantadine helps patients recover from TBI. What is its mechanism of action?
GABA-A antagonist
GABA-A agonist
NMDA Glutamate antagonist AND blocks dopamine reuptake
NMDA Glutamate agonist
AMPA Glutamate antagonist
PVS treatment
Name a drug and describe MoA that may help to recover [3]
Amantadine
* NMDA receptor antagonist and block dopaminergic reuptake
* Improves functional recovery rate
PVS treatment
What is the hypothesis for zolpidem treatment?
Loss of active inhibition from striatum allows GPi to tonically inhibit thalamus and pedunculopontine nucleus, so thalamocortical overactivity
Future treatment for PVS? [1]
Vagal nerve stimulation:
Treatment strategies in AD
Name the drug class [1] and 3 drug examples you prescribe for mild - moderate AD? [3]
Name the drug class [1] and 3 drug examples you prescribe for severe AD? [1]
Mild-Moderate AD:
* Acetylcholinesterase inhibitors(e.g. donepezil, galantamine and rivastigmine)
Severe AD:
* NMDA receptor antagonists (e.g. memantine)
Which of the following treatments for AD is a NMDA glutamate receptor agonist?
memantine
donepezil
galantamine
rivastigmine
Which of the following treatments for AD is a NMDA glutamate receptor agonist?
memantine
donepezil
galantamine
rivastigmine
Which of the following is used for patients with severe AD?
memantine
donepezil
galantamine
rivastigmine
Which of the following is used for patients with severe AD?
memantine
donepezil
galantamine
rivastigmine
donepezil, galantamine & rivastigmine all belong to which drug class? [1]
Acetylcholinesterase inhibitor
rivastigmine is used to treat which pathology?
Parkinsons Disease
Alzeimers Disease
Huntingdons Disease
Epilepsy
rivastigmine is used to treat which pathology?
Parkinsons Disease
Alzeimers Disease
Huntingdons Disease
Epilepsy
Name two drugs used for seizure prophylaxis [2]
Phenytoin
Levetiracetam
How could you manage severe ICP:
Acutely [2]
Long term [1]
Short term:
* mannitol
* hypertonic saline
(shift of water from extravascular space to intravascular space across the BBB-controversy which therapy is better.)
Long term:
* extraventricular drain/ external ventricular drain (EVD) or ventriculostomy
Management of epilepsy:
Name 3 drugs target the inactive (intermediate) state of Na channels
Phenytoin
Carbamazepine
Sodium valproate
Phentoin is an anti-seizure drug that targets which channel?
GABA-A
NMDA Glutamate
AMPA Glutamate
Na+
CA2+
Phentoin is an anti-seizure drug that targets which channel?
GABA-A
NMDA Glutamate
AMPA Glutamate
Na+
CA2+
Which of the following should not be used to treat an absence seizure as they may exacerbate it?
Sodium valproate
Lamotrigine
Phenytoin
Pregabalin
Ethosuximide
Which of the following should not be used to treat an absence seizure as they may exacerbate it?
Sodium valproate
Lamotrigine
Phenytoin
Pregabalin
Ethosuximide
Which of the following exhibits zero order kinetics?
Sodium valproate
Lamotrigine
Phenytoin
Pregabalin
Ethosuximide
Which of the following exhibits zero order kinetics?
Sodium valproate
Lamotrigine
Phenytoin
Pregabalin
Ethosuximide
Name three calcium channels that are used as anti-epileptic drugs [3]
Ethosuximide
Gabapentin (in the PBL)
pregabalin (in the PBL)
Q
AEDs
What type of drug class does phenobarbitone and stiripentol belong to? [1]
What is MoA? [1]
phenobarbitone and stiripentol:
Drug class: Barbiturates: GABAA receptor positive allosteric modulators
. Phenobarbitone (leads to microsomal enzyme induction)
Enhances the duration of GABA channel opening. (more GABA; causes more inhibition
Which drug inhibits GABA metabolism? [1]
Vigabatrin
Which drug class increases the frequency of the opening of GABA channels?
Benzodiazepines
Barbiturates
Sulfonamides
GABA agonists
Which drug class increases the frequency of the opening of GABA channels?
Benzodiazepines
Barbiturates
Sulfonamides
GABA agonists
Which drug class increases the duration of the opening of GABA channels?
Benzodiazepines
Barbiturates
Sulfonamides
GABA agonists
Which drug class increases the duration of the opening of GABA channels?
Benzodiazepines
Barbiturates
Sulfonamides
GABA agonists
Which of the following inhibits GABA transaminase to prevent GABA breakdown
Vigabatrin
Levetiracetam
Phenobarbitone
Tiagabine
Which of the following inhibits GABA transaminase to prevent GABA breakdown
Vigabatrin
Levetiracetam
Phenobarbitone
Tiagabine
AEDs
Which of the following targets GAT-1 transporter to inhibit GABA reuptake
Vigabatrin
Levetiracetam
Phenobarbitone
Tiagabine
Which of the following targets GAT-1 transporter to inhibit GABA reuptake
Vigabatrin
Levetiracetam
Phenobarbitone
Tiagabine
Status elipeticus is a medical emergency. Name two drugs used to treat this conditon [2]
Lorezepam (IV)
Diazepam (IV)
Alternatives to AEDs
Name 3 surgical procedures that could be used to treat epilepsy [3]
Lobe resection
Corpus callasotomy (reduces propogation of seizures from one cerebral hemisphere to the next)
Functional hemispherectomy
Alternatives to AEDs
Name a type of diet that could help epilepsy [1]
Name a drug class for a potential new AED [1]
Keto diet
Cannabidiol
Which of the following type of channel does pregabalin target?
Ca2+
GABA
Na+
Glutamate
Which of the following type of channel does pregabalin target?
Ca2+
GABA
Na+
Glutamate
Name a drug that predominately blocks Na+ channels, but also acts on Ca2+ channels [ and causes the presynaptic inhibition of glutamate release.
Lamotrigine
(hint: tri gated?)
AEDs
Focal Seizures Treatment:
First line: [] or []
Second line: [] or []
First line: carbamazepine or lamotrigine
Second line: sodium valproate or levetiracetam
Management of tonic-clonic seizures is with:
First line: []
Second line: [] or []
Management of tonic-clonic seizures is with:
First line: sodium valproate
Second line: lamotrigine or carbamazepine
Which drugs are used for absence seizures? [2]
ethosuximide, sodium valproate
Myoclonic seizures:
First line: [1]
Other options: [3]
First line: sodium valproate
Other options: lamotrigine, levetiracetam or topiramate
Describe the MoA of sodium channel active drugs like phenytoin and carbamazepine [1]
Stabilises Na+ channels inactivated state to decrease excitability
Primary headaches
Treatment of tension-type headaches [2]
- Take painkillers for symptoms
- Find root causes and treat
Name acute [2] and prophylactic [1] treatment for cluster headaches
Acute:
* oxygen (15L/min 100% through non-rebreather mask – acts as vasoconstrictor);
* -triptans
Prophylactic
* : has to be quick. High dose of verapamil
Where do acute [1] and chronic [1] treatments for migraines target?
Acute:
Acute medication given for migraine primarily acts peripherally, at the trigeminal ganglion
Preventive medication for migraine acts more centrally (i.e. the trigeminal nucleus caudalis)
What drug classes are used to acutely treat migraine? [3]
Triptans: (5HT1D/B agonists)
* Vasoconstrictive Agents
Ditans (5HT1F agonists)
* Neurally Active Anti-Migraine Agent
Gepants: small molecule CGRP receptor antagonists
Name first line treatment for migraine? [1]
Sumatriptan
Describe MoA of triptans [1]
Where are 3 possible sites of action? [3]
Triptans:
* 5-HT1D/B agonists.
* 3 possible sites of action: 1. cranial vasoconstriction, 2. peripheral neuronal inhibition and 3. inhibition of transmission through second order neurones of the trigeminal ganglion.
SCN9A codes for which of the following
TRPM8
TRPV1
ASICS
Nav1.7
SCN9A codes for which of the following
TRPM8
TRPV1
ASICS
Nav1.7
Antiplatelet therapy for stroke? [3]
Aspirin
Aspirin & Clopidogrel
Aspirin and Dipyridamole
What type of family of antidepressants are clomipramine, imipramine, desipramine, amitriptyline, nortriptyline and protriptyline? [1]
TRICYCLIC ANTIDEPRESSANTS (TCAs)
Describe the MoA of TCAs [2]
- Inhibit reuptake of amines on the presynaptic terminal, so 5HT or NA cannot be taken back into neuron
Important AEs of TCAs? [4]
- Dangerous (cardiotoxic) in overdose
- Anti-cholinergic: dry mouth; blurred vision, constipation, urinary retention, aggravation of narrow angle glaucoma, fatigue, postural hypotension, dizziness, loss of libido, arrhythmias
- Antihistaminic: sedation, weight gain.
- Block alpha 1 adrenoreceptors: orthostatic hypotension - blood pressure drops on standing, cardiac effects
As a result aren’t the first choice!
Phenelzine, tranylcypromine belong to which drug class? [1]
MONOAMINE OXIDASE INHIBITORS
Describe the MoA of monoamine oxidase inhibitors such Phenelzine, tranylcypromine [1]
Which type of food interact with MOIs? [1]
Irreversible inhibition of the enzyme monoamine oxidase [1]
Interactions with tyramine-containing food (mature cheese, pickled fish and meat, red wine, beer, broad bean pods, yeast extract)- restrictions continue at least 2 weeks after discontinuation
Why do you have to wait approx. 2 weeks if you want to change treatment away from MAOIs? [1]
The drugs bind irreversibly: wait for at least 50% of enzymes have been replaced to change treatment
What type of drug class are citalopram, fluoxetine, paroxetine sertraline? [1]
SELECTIVE SEROTONIN REUPTAKE INHIBITORS
Which is the most selective SSRI?
citalopram
sertraline
fluoxetine
paroxetine
Which is the most selective SSRI?
citalopram
sertraline
fluoxetine
paroxetine
Moclobemide belongs to which drug class? [1]
REVERSIBLE MONOAMINE OXIDASE INHIBITOR
Which is the safest monoamine oxidisase inhibitor?
Moclobemide
Phenelzine
Tranylcypromine
Which is the safest monoamine oxidisase inhibitor?
Moclobemide (reversible MOAIs)
Phenelzine (irreversible MOAIs)
Tranylcypromine (irreversible MOAIs)
Anti-depressants
Describe MoA of Agomelatine [2]
Why is this potentially a really good drug? [2]
MoA:
* Agonist at melatonin MT1 & MT2 receptors: important for sleep control
* Antagonist of 5-HT2 receptors
Benefits of Agomelatine:
* improves sleep quality
* less sexual dysfunction than SSRIs;
* anxiolytic effects
* no ‘discontinuation syndrome’
The treatment with the SNRI [] reduces the increased Default Mode Network
connectivity seen in depression
The treatment with the SNRI duloxetine reduces the increased Default Mode Network connectivity seen in depression
How long do antidepressant drugs take to cause action in the body?
Although the level of drug increases in plasma soon after the patient starts taking the medication, there is a delayed onset of action of 1-2 weeks
What changes to drug treatment may trigger antidepressant drug discontinuation syndrome? [3]
What are the symptoms?
A condition that can occur after:
- a decrease in the dose of drug taken
- an interruption of treatment
- abrupt cessation of treatment
Insomnia
Anxiety
Nausea
Headaches
Electric shock sensations
Agitation
Mood swings
Diarrhoea/abdominal cramps
What drug do you give to manage bipolar disorder? [1]
What needs to be considered about this when adminsitering? [1]
Lithium
Narrow therapeutic margin
Which organs need to be monitored when giving lithium for bipolar disorder? [2]
Renal and thyroid function must be checked before treatment (and then at regular intervals during maintenance treatment)
Apart from inhibiting the reuptake of amines, which other receptors do TCAs bind to? [3]
Why is this problematic? [1]
Bind to:
* H1 receptors
* muscarinic receptors
* α1 and α2 adrenoceptors
Causes wide ranging side effects
Look up which TCAs need to know
Which is the first line drug choice for treating depression
TCAs
SNRIs
MAOIs
SSRIs
Which is the first line drug choice for treating depression
TCAs
SNRIs
MAOIs
SSRIs
Which class of drugs can you not use / creates lots of AEs if they eat food like red wine, cheese or mature cheese?
TCAs
SNRIs
MAOIs
SSRIs
Which class of drugs can you not use / creates lots of AEs if they eat food like red wine, cheese or mature cheese?
TCAs
SNRIs
MAOIs
SSRIs
What is the benefit of using SSRIs (citalopram, fluoxetine, paroxetine) with regards to AEs [3]
No anticholinergic activity
No cardiotoxic effects
Safe in overdose
AEs of SSRIs?
· Nausea vomiting
· Dry mouth
· Headache
· Asthenia
· Dizziness
· Anorexia
· Weight loss
· Nervousness
· Tremor
· Convulsions
· Sexual dysfunction
Which of the following is a reversible MAOI?
phenelzine
moclobemide
tranylcypromine
agomelatine
Which of the following is a reversible MAOI?
phenelzine
moclobemide
tranylcypromine
agomelatine
What are the different targets for reverible MAOIs compared to irreversible MOAIs? [2]
Describe the benefits of reversible MAOIs compared to irreversible MAOs [2]
Drug targets:
* Reversible MAOI targets: MOA-A
* Irreversible MAOI targets: MAOA versus MAOB
Differences:
* Reversible is safer than irreversible MAOIs
* Can switch drug classes quicker
Which of the following has the quickest onset?
TCAs
SNRIs
MAOIs
SSRIs
Which of the following has the quickest onset?
TCAs
SNRIs : duloxetine and venlafaxine
MAOIs
SSRIs
Which of the following drug class cause discontinuation syndrome
TCAs
SNRIs
MAOIs
SSRIs
Which of the following drug class cause discontinuation syndrome
TCAs
SNRIs
MAOIs
SSRIs
Depression drugs
Name a noradrenaline reuptake inhibitor used for depression treatment [1]
Reboxetine
Which of the following is noradrenaline reuptake inhibitor?
Duloxetine
Reboxetine
Mirtazapine
Tianeptine
Trazodone
Which of the following is noradrenaline reuptake inhibitor?
Duloxetine
Reboxetine
Mirtazapine
Tianeptine
Trazodone
Which of the following is noradrenergic and specific serotonergic antidepressants (NaSSA)?
Duloxetine
Reboxetine
Mirtazapine
Tianeptine
Trazodone
Which of the following is noradrenergic and specific serotonergic antidepressants?
Duloxetine
Reboxetine
Mirtazapine
Tianeptine
Trazodone
Which of the following is a serotonergic antagonist and reuptake inhibitor (SARI)?
Duloxetine
Reboxetine
Mirtazapine
Tianeptine
Trazodone
Which of the following is a serotonergic antagonist and reuptake inhibito (SARI)?
Duloxetine
Reboxetine
Mirtazapine
Tianeptine
Trazodone
Depression Drugs
Name a serotonergic antagonist and reuptake inhibito (SARI) [1]
Trazodone
Depression drugs
Name a noradrenergic and specific serotonergic antidepressant (NaSSA) [1]
Mirtazapine
Which of the following reduces the increased default mode network connectivity seen in depression?
Duloxetine
Reboxetine
Mirtazapine
Tianeptine
Trazodone
Which of the following reduces the increased default mode network connectivity seen in depression?
Duloxetine
Reboxetine
Mirtazapine
Tianeptine
Trazodone
Explain why there is a delayed action for anti-depressant drug action for TCAs [4]
The immediate increase in synaptic concentration of amines
may lead to activation of somatic neuronal autoreceptors
The activated autoreceptors decrease firing of the neurones
During the first weeks of treatment the autoreceptors desensitize
The neurones will return subsequently to the normal firing rate
The inhibition of reuptake continues and the level of amines
continues to be high, resulting in full efficacy
Apart from lithium, name two other drugs used as mood stabilisers [2]
Carbamazepine, sodium valproate
Name two risks of using antidepressant drugs used in bipolar disorder to treat periods of depression? [2]
can precipitate manic episodes or mixed
affective states
induce an increased frequency
in mood change cycles
Which drug class has the highest risk for mania if used to treat depression in bipolar patients?
TCAs
SNRIs
MAOIs
SSRIs
Which drug class has the highest risk for mania if used to treat depression in bipolar patients?
TCAs
SNRIs
MAOIs
SSRIs
Explain the three phases of antidepressant treatment [3]
Acute Treatment
- First 6-12 weeks of treatment; aims at remission (control of symptoms)
- Inadequate early response is associated with poor prognosis
Continuation Treatment
- for 6 months after full symptom control; to maintain remission status and prevent relapse
Maintenance Treatment
- Aims at prevention of recurrence of a further episode of depression.
- Indicated when higher risk of these recurrence; “maintenance dose”.
Name 4 non-pharmacological approaches for mood disorders
Electroconvulsive therapy (treatment-refractory severe depression with suicide risk)
Cognitive behavioural therapy (CBT) (can augment the effects of pharmacological treatment)
Vagal nerve stimulation (especially in chronic depression)
Deep brain stimulation (DBS); subcallosal cingulate white matter – Brodmann area 25)
Which area is the DBS target for treating depression? [1]
What the is the Broadmann area?
21
22
23
24
25
Which area is the DBS target for treating depression: subgenual cingulate cortex
What the is the Broadmann area?
21
22
23
24
25
Name two new therapeutic developments for depression [2]
What types of depression do they speficifically treat? [2]
What are their MoAs? [2]
Esketamine:
* NMDA glutamate receptor antagonist
* treatment-resistant depression
Brexanolone:
* progesterone-related compound, positive modulator of GABAA receptors
* approved for post-partum depression
Which of the following would be used to treat treatment resistant depression
Duloxetine
Esketamine
Mirtazapine
Brexanalone
Trazodone
Which of the following would be used to treat treatment resistant depression
Duloxetine
Esketamine
Mirtazapine
Brexanalone
Trazodone
Which of the following would be used to treat post-partum depression
Duloxetine
Esketamine
Mirtazapine
Brexanalone
Trazodone
Which of the following would be used to treat post-partum depression
Duloxetine
Esketamine
Mirtazapine
Brexanalone
Trazodone
Ketamine blocks NMDA glutamate receptors on GABA neurons.
Which receptors does this have an effect on and what is this response? [2]
Enhances transmission at the glutamatergic synapse: enhances signaling through AMPA glutamate receptors and also increases the level of brain-derived neurotrophic factor, BDNF
Which of the following class of drug causes this symptom?
TCAs
SNRIs
MAOIs
SSRIs
(orthostatic hypotension)
Which of the following class of drug causes this symptom?
TCAs: due to blocking of Block alpha 1 adrenoreceptors
SNRIs
MAOIs
SSRIs
TCAs are toxic to which part of the body? [1]
Cardiotoxic: Blockade of fast sodium channels in myocardial cells slows the action potential and provides a membrane stabilizing effect. The characteristic QRS prolongation seen in TCA overdose occurs secondary to prolongation of phase “0” of the myocardial action potential. T
Which of the following is the most cardiotoxic?
Amitriptyline
Nortriptyline
Citalopram
Sertraline
Fluoxetine
Which of the following is the most cardiotoxic?
Amitriptyline
Nortriptyline
Citalopram
Sertraline
Fluoxetine
Most common AE of SSRI? [3]
gastrointestinal symptoms are the most common side-effect:
30% schizophrenic patients do not respond to treatment. Which drug would you provied for those who have drug resistance? [1]
Clozapine
Name a risk of clozapine treatment [2]
agranulocytosis: increases chance of infection
Non-pharmacological approaches for SCH? [3]
- Cognitive Behavioural Therapy
- Cognitive remediation
- Family therapy
These do not replace the pharmacological treatment
The drugs used to treat schizophrenia are [] receptor antagonists [1]
They can be divided into typical and atypical drug treatments; what are the difference between them?
The drugs used to treat schizophrenia are D2 (dopamine) receptor antagonists
Typical:’ are older and cause generalised dopamine receptor blockade.
Atypical: are more selective in their dopamine blockade and also block serotonin 5-HT2 receptors.
Atypical antipsychotic drugs target which receptor/s
D1 receptors
D2 receptors
D1 & D2 receptors
D1 & 5-HT2 receptors
D2 & 5-HT2 receptors
Atypical antipsychotic drugs target which receptor/s
D1 receptors
D2 receptors
D1 & D2 receptors
D1 & 5-HT2 receptors
D2 & 5-HT2 receptors
Name 5 typical antipyschotics
chlorpromazine, thioridazine,
fluphenazine, haloperidol, flupenthixol
Describe the effect of typical anti-physchotics on positive and negative symptoms [1]
Improve positive symptoms
Little/no efficacy on negative symptoms
Clozapine blocks [] receptors with high affinity
Aripiprazole is a partial [] at presynaptic D2 receptors but an [] at D2 postsynaptic receptors
Clozapine blocks D4 receptors with high affinity
Aripiprazole is a partial agonist at presynaptic D2 receptors but an antagonist at D2 postsynaptic receptors
Name 4 atypical anti-psychotics used to treat SCH [4]
risperidone, olanzapine, clozapine, quetiapine, paliperidone, aripiprazole
Atypical anti-psychotics target which receptors? [2]
Antagonists at:
- D2 receptors
- 5-HT2A receptors
Name 3 extrapyramidal effects that occur due to antipsychotic drugs. [3]
Why do these occur? [1]
Extrapyramidal effects (EPS):
* acute dystonias
* parkinsonism
* tardive dyskinesia
Approx. 60% D2 receptor occupancy required for
antipsychotic efficacy; if >80% D2 receptors are blocked, then potential for EPS
Explain why antipsychotic drugs may cause sexual dysfunction, galactorrhoea or amenorrhoea?
Block dopamine receptors; causes a rise in prolactin
Which anti-psychotics can be adminstered by IM injections? [2]
fluphenazine decanoate
haloperidol decanoate
Describe the difference in AEs between atypicals and typical anti-pyschotics
Atypicals
* Less EPS
* Less cardiac toxicity (QT segment prolongation)
* Less hyperprolactinaemia
* Weight gain
* Hyperglycaemia, diabetes
* Insulin resistance
* Dyslipidaemia
* Cardiovascular disease
Typicals:
EPS (dystonia, parkinsonism…)
Tardive dyskinesia
Weight gain
QT interval prolongation
Sudden death
Hyperprolactinaemia
Describe the difference in AEs between atypicals and typical anti-pyschotics
Atypicals
* Less EPS
* Less cardiac toxicity (QT segment prolongation)
* Less hyperprolactinaemia
* Weight gain
* Hyperglycaemia, diabetes
* Insulin resistance
* Dyslipidaemia
* Cardiovascular disease
Typicals:
EPS (dystonia, parkinsonism…)
Tardive dyskinesia
Weight gain
QT interval prolongation
Sudden death
Hyperprolactinaemia
Explain what tardive dyskinesia is and the length of the AE [2]
Involuntary movements of the lips, jaw, face; grimacing, constant chewing, tongue thrusting; rapid involuntary limb movements
typical antipsychotics,
taken for longer than a few months/years
In some patients it may be possible to overcome it
Describe what neuroleptic malignant syndrome is a combination of [6]
Due to typical anti-psychotics
hyperpyrexia
muscle rigidity
tremor
confusion
autonomic instability
Explain what future SCH drug targers are [3]
The NMDA glutamate receptor:
- Decreased glutamatergic transmission in SCH- hypoglutamatergic state in cortex
- May be possible to potentiate activity of glutamatergic receptors in future
5- Acute management of TBI (Severe TBI)
Which drugs can you use to start seizure prophylaxis? [2]
Which drugs can you use to induce coma? [2]
A
Start on seizure prophylaxis: phenytoin/levetiracetam
Sedation/Induce coma with propofol or benzodiazepines
Treatment strategies in AD
Name the drug class [1] and 3 drug examples you prescribe for mild - moderate AD? [3]
Name the drug class [1] and 3 drug examples you prescribe for severe AD? [1]
Mild-Moderate AD:
* Acetylcholinesterase inhibitors(e.g. donepezil, galantamine and rivastigmine)
Severe AD:
* NMDA receptor antagonists (e.g. memantine)
Which of the following is first line of treatment for absence seizure?
Sodium valproate
Lamotrigine
Phenytoin
Pregabalin
Ethosuximide
Which of the following is first line of treatment for absence seizure?
Sodium valproate
Lamotrigine
Phenytoin
Pregabalin
Ethosuximide
What is the MoA of baclofen? [1]
What type of pathologies is it used to treat? [2]
GABA receptor agonists
It’s used to relieve muscle spasms, cramping or tightness caused by conditions such as MS, cerebral palsy
Which is the first line treatment for trigeminal neuraglia? [1]
Carbamazepine
Asides from morphine, name four other opioids prescribed [4]
Herion: high solubility compared to morphine
Dextromoramide: potent but limited prescription
Methadone: large half-life - so used for long dosing.
Meptazinol: Mu-1 produces less respiratory depression than morphine
Name some inhaled anaesthetics [2] and IV anaesthetics [2]
Inhaled: [end with -ane]
Halothane
Enflurane
Isoflurane
Nitrous oxide
Intravenous anaesthetics:
Propofol
Thiopental
Etomidate
Ketamine
Midazolam
What are the first three firstline drug classes recommended for neuropathic pain? [3]
SNRIs (duloxetine)
tricyclic antidepressants (amitrypyline)
calcium channel blockers (gabapentin, pregabalin)
Treatment for trigeminal neuralgia? [5]
carbamazepine (sodium channel blocker): 1st line
baclofen (GABAB agonist): 1st line if unresponsive
phenytoin (sodium channel blocker)
valproate (sodium channel blocker and other targets)
clonazepam (benzodiazepine)
Name a tricyclic antidepressant that is used to treaet neuropathic and cancer pain [1]
Amitriptyline
Baclofen is an agonist to which of the following
Ca2+
AMPA glutamate receptor
Amines
GABA
NMDA Glutamate receptor
Baclofen is an agonist to which of the following
Ca2+
AMPA glutamate receptor
Amines
GABA
NMDA Glutamate receptor
Celecoxib is a selective COX-2 inhibitor, but has a significant risk of what? [1]
significant risk of cardiovascular events
Explain the mechanism of action of tricylic anti-depressants [2]
Tricylic antidepressants inhibit the reuptake of amines (dopamine, norepinephrine, adrenaline, noradrenaline histamine, and serotonin) and also block sodium and calcium channels
Name a drug used to treat migraines [1]
Describe its MoA [1]
Sumatriptan: vasoconstriction of cerebral arteries reducing inflammatory response and trigeminal activation
Describe MoA of ketamine [1]
NMDA glutamate receptor antagonist
What is the MoA of baclofen? [1]
What type of pathologies is it used to treat? [2]
GABA receptor agonists
It’s used to relieve muscle spasms, cramping or tightness caused by conditions such as MS, cerebral palsy
Describe the MoA of tramadol & tapentadol [2]
Opioid receptor agonist AND amine reuptake inhibition
Local anaesthetics
Name 3 examples [3]
MoA? [1]
lignocaine, bupivacaine, prilocaine (all end in -caine)
Block Na channels
Which drug acts as a general anaesthetic AND acts as an analgesic? [1]
ketamine
5- Acute management of TBI (Severe TBI - ICP)
How could you manage severe ICP:
Acutely [2]
Long term [1]
Short term:
* mannitol
* hypertonic saline
(shift of water from extravascular space to intravascular space across the BBB-controversy which therapy is better.)
Long term:
* extraventricular drain/ external ventricular drain (EVD) or ventriculostomy
Which type of seizure would you not give phenytoin or carbamazepine in order to prevent worsening of symptoms
Focal seizure
Absence seizure
Generalised Tonic-Clonic Seizures
Atonic Seizures
Myoclonic Seizures
Which type of seizure would you not give phenytoin or carbamazepine in order to prevent worsening of symptoms
Focal seizure
Absence seizure
Generalised Tonic-Clonic Seizures
Atonic Seizures
Myoclonic Seizures
Which type of seizure would you give carbamazepine or lamotrigine as first line treatment?
Focal seizure
Absence seizure
Generalised Tonic-Clonic Seizures
Atonic Seizures
Myoclonic Seizures
Which type of seizure would you give carbamazepine or lamotrigine as first line treatment?
Focal seizure
Absence seizure
Generalised Tonic-Clonic Seizures
Atonic Seizures
Myoclonic Seizures
Which type of seizure would you give sodium valproate as first line treatment?
Focal seizure
Absence seizure
Generalised Tonic-Clonic Seizures
Atonic Seizures
Myoclonic Seizures
Which type of seizure would you give sodium valproate as first line treatment?
Focal seizure
Absence seizure
Generalised Tonic-Clonic Seizures
Atonic Seizures
Myoclonic Seizures
Which type of seizure would you give sodium valproate or ethosuximide as first line treatment?
Focal seizure
Absence seizure
Generalised Tonic-Clonic Seizures
Atonic Seizures
Myoclonic Seizures
Which type of seizure would you give sodium valproate or ethosuximide as first line treatment?
Focal seizure
Absence seizure
Generalised Tonic-Clonic Seizures
Atonic Seizures
Myoclonic Seizures
Which anti-epileptic treatment is teratogenic
Sodium Valproate
Ethosuximide
Lamotrigine
Levetiracetam
Lorazepam
Which anti-epileptic treatment is teratogenic
Sodium Valproate
Ethosuximide
Lamotrigine
Levetiracetam
Lorazepam
Which anti-epileptic treatment works by bind to synaptic vesicle protein SV2A causing a reduction in neurones
Sodium Valproate
Ethosuximide
Lamotrigine
Levetiracetam
Lorazepam
Which anti-epileptic treatment works by bind to synaptic vesicle protein SV2A causing a reduction in neurones
Sodium Valproate
Ethosuximide
Lamotrigine
Levetiracetam
Lorazepam
Which anti-epileptic treatment would be used to treat status epilepticus
Sodium Valproate
Ethosuximide
Lamotrigine
Levetiracetam
Lorazepam
Which anti-epileptic treatment would be used to treat status epilepticus
Sodium Valproate
Ethosuximide
Lamotrigine
Levetiracetam
Lorazepam & Diazepam
Which drug classes are current treatments for insomnia? [2]
Benzodiazepine - short acting
Z drugs
Name drugs & the drug class they belong to, to treat short term [2]& long term insomina [2]
Short-term use:
* lorazepam (benzo)
* temazepam (benzo)
Long-term use:
* eszopiclone (benzo)
* Zolpidem (Z-drug)
Name a drug that used for epilepsy that has recent use for insomnia [1]
Pregabalin
Name a drug that acts as a benzo antagonist and can be used to treat overdose? [1]
What is administration like? [1]
Flumazenil
Has a short half-life so need continous adminsitration needed
Which of the following has the shortest half life
temazepam
zolpidem
eszopiclone
lorazepam
Which of the following has the shortest half life
temazepam
zolpidem
eszopiclone
lorazepam
Name 5 classes of drugs that can act as anxiolytics [5]
SSRIs
SNRIs
Benzodiazepines
5-HT1A agonists
β-adrenoceptor antagonists
Name 3 benzodiazepines used as anxiolytics
clonazepam, alprazolam, lorazepam
Name two SNRIs and three SSRIs used as anxiolytics [3]
SSRIs
* fluoxetine, escitalopram, paroxetine
* can be used to treat panic and social phobias
SNRIs:
* venlafaxine, duloxetine
Name two 5HT-1A agonists and one B-adrenoreceptor antagonists used as anxiolytics [3]
5-HT1A agonists: buspirone ipsapirone
β-adrenoceptor antagonists: propranolol
You are a medical student based in general practice. A 38-year-old male with chronic back pain presents for a repeat prescription of his amitriptyline. What is the mechanism of action of this medication?
Inhibits monoamine reuptake on the presynaptic membrane
Inhibits monoamine reuptake on postsynaptic membrane
Agonist on monoamine receptors on postsynaptic membrane
Dopamine agonist
Antagonist on monoamine receptors on postsynaptic membrane
You are a medical student based in general practice. A 38-year-old male with chronic back pain presents for a repeat prescription of his amitriptyline. What is the mechanism of action of this medication?
Inhibits monoamine reuptake on the presynaptic membrane
Inhibits monoamine reuptake on postsynaptic membrane
Agonist on monoamine receptors on postsynaptic membrane
Dopamine agonist
Antagonist on monoamine receptors on postsynaptic membrane
A 35-year-old man attends the emergency department with his partner, who provides the history as the patient is currently unable to speak. He tells you that about 2 hours ago the muscles in the left side of the patient’s neck suddenly stiffened, meaning that his head is now fixed looking sideways. At the same time, the patient’s jaw also began clenching uncontrollably. His past medical history includes a fractured right femur in a car accident 8 years ago, and schizophrenia. On further questioning, the patient’s partner reveals that he started taking a new medication prescribed by the psychiatrist 5 days ago, but he cannot remember what it was called.
On examination, the patient appears distressed, although his observations are within normal limits and his neurological examination is normal apart from the increased tone of the muscles in the jaw and neck.
Which of the following medications would most likely have caused the patient’s symptoms?
Clozapine
Haloperidol
Olanzapine
Quetiapine
Sertraline
A 35-year-old man attends the emergency department with his partner, who provides the history as the patient is currently unable to speak. He tells you that about 2 hours ago the muscles in the left side of the patient’s neck suddenly stiffened, meaning that his head is now fixed looking sideways. At the same time, the patient’s jaw also began clenching uncontrollably. His past medical history includes a fractured right femur in a car accident 8 years ago, and schizophrenia. On further questioning, the patient’s partner reveals that he started taking a new medication prescribed by the psychiatrist 5 days ago, but he cannot remember what it was called.
On examination, the patient appears distressed, although his observations are within normal limits and his neurological examination is normal apart from the increased tone of the muscles in the jaw and neck.
Which of the following medications would most likely have caused the patient’s symptoms?
Clozapine
Haloperidol
Olanzapine
Quetiapine
Sertraline
Josephine is a 25-year-old female with schizophrenia for which she is taking treatment. Some of the possible side effects which can be caused by the medication used to treat her schizophrenia include parkinsonism, sustained muscle contractions and severe restlessness.
The mentioned side effects are most likely to occur with which of the following antipsychotic medications?
Aripiprazole
Haloperidol
Olanzapine
Quetiapine
Risperidone
Josephine is a 25-year-old female with schizophrenia for which she is taking treatment. Some of the possible side effects which can be caused by the medication used to treat her schizophrenia include parkinsonism, sustained muscle contractions and severe restlessness.
The mentioned side effects are most likely to occur with which of the following antipsychotic medications?
Aripiprazole
Haloperidol
Olanzapine
Quetiapine
Risperidone
A 23-year-old male is recently started on risperidone for schizophrenia. Shortly after starting the medication he notices that his breasts have enlarged and there is some discharge. He also admits to a reduced libido and erectile dysfunction.
He is diagnosed with hyperprolactinaemia secondary to anti-psychotic use.
Which dopaminergic pathway is inhibited to cause this presentation?
Nigro-striatal pathway
Tuberoinfundibular pathway
Mesolimbic pathway
Mesocortical pathway
Corticospinal tract
A 23-year-old male is recently started on risperidone for schizophrenia. Shortly after starting the medication he notices that his breasts have enlarged and there is some discharge. He also admits to a reduced libido and erectile dysfunction.
He is diagnosed with hyperprolactinaemia secondary to anti-psychotic use.
Which dopaminergic pathway is inhibited to cause this presentation?
Nigro-striatal pathway
Tuberoinfundibular pathway
Mesolimbic pathway
Mesocortical pathway
Corticospinal tract
A 68-year-old patient enters the clinic for follow up review after his recent total knee replacement. The surgery was successful with no complications. He complains of feeling groggy particularly in the mornings. You look to reducing or stopping some of the medications that were started during his hospital admission, one of which is zopiclone.
What is the most appropriate description of the mechanism of this drug?
A H1 receptor antagonist
A benzodiazepine hypnotic that stimulates GABA receptors
A benzodiazepine hypnotic that is a GABA antagonist
A non-benzodiazepine hypnotic that stimulates GABA receptors
A non-benzodiazepine hypnotic that is a GABA antagonist
A 68-year-old patient enters the clinic for follow up review after his recent total knee replacement. The surgery was successful with no complications. He complains of feeling groggy particularly in the mornings. You look to reducing or stopping some of the medications that were started during his hospital admission, one of which is zopiclone.
What is the most appropriate description of the mechanism of this drug?
A H1 receptor antagonist
A benzodiazepine hypnotic that stimulates GABA receptors
A benzodiazepine hypnotic that is a GABA antagonist
A non-benzodiazepine hypnotic that stimulates GABA receptors
A non-benzodiazepine hypnotic that is a GABA antagonist
A 27-year-old female is recently started on olanzapine following a diagnosis of schizophrenia. Shortly after the initiation of the drugs she becomes restless and her mother states that she seems to be staring blankly. On examination you note an upward deviation of both eyes.
What is the cause of this?
Brain tumour
Neuroleptic malignant syndrome
Oculogyric-crisis
Cranial nerve III palsy
Oculogyric-crisis
Oculogyric crisis is a dystonic reaction that occurs shortly after initiation of anti-psychotics, most commonly with the older typical anti-psychotics. Treatment involves drug cessation and anti-muscarinic administration.
An 84-year-old male is on your ward for community-acquired pneumonia. He was diagnosed with Parkinson’s 5 years ago. He is now getting very agitated on the ward. You notice his prescription chart where he is prescribed haloperidol for agitation. After being given this, his Parkinson’s symptoms dramatically worsen. What is the presumed method of action of haloperidol?
Stimulates dopamine receptors
Decreased dopamine stores
Inhibits monoamine oxidase
Blocks serotonin receptors
Blocks dopamine receptors
An 84-year-old male is on your ward for community-acquired pneumonia. He was diagnosed with Parkinson’s 5 years ago. He is now getting very agitated on the ward. You notice his prescription chart where he is prescribed haloperidol for agitation. After being given this, his Parkinson’s symptoms dramatically worsen. What is the presumed method of action of haloperidol?
Stimulates dopamine receptors
Decreased dopamine stores
Inhibits monoamine oxidase
Blocks serotonin receptors
Blocks dopamine receptors
A 61-year-old male with a long history of schizophrenia is seen in the clinic. He appears to be grimacing and exhibits rapid darting movements of his tongue. What is the mechanism of action of the medication that has most likely given rise to his symptoms?
Antagonism of dopamine receptors at the chemoreceptor trigger zone
Degeneration of dopaminergic neurones in the substantia nigra
Long term dopamine receptor blockade causing hypersensitivity of dopamine receptors in the nigrostriatal pathway
Abrupt withdrawal of dopaminergic agent
Inhibition of peripheral conversion of L-DOPA into dopamine
Long term dopamine receptor blockade causing hypersensitivity of dopamine receptors in the nigrostriatal pathway
The scenario describes the features of tardive dyskinesia. This can result from long-term use of antipsychotic drugs, which is likely in this patient due to his long history of mental illness. It is suggested that blockade of the dopamine receptor promotes hypersensitivity of the D2 receptor in the nigrostriatal pathway, thus giving rise to excessive movements.
A 78-year-old patient is being seen by a physiotherapist (PT) when he suddenly becomes very agitated and attempts to hit the PT with his zimmer frame. Soon after, the doctor on the ward arrives and administers a dose of lorazepam.
Which one of the following adverse effects may be seen in this patient following the administration of lorazepam?
Tremor
Respiratory depression
Seizures
Anxiety
Perspiration
A 78-year-old patient is being seen by a physiotherapist (PT) when he suddenly becomes very agitated and attempts to hit the PT with his zimmer frame. Soon after, the doctor on the ward arrives and administers a dose of lorazepam.
Which one of the following adverse effects may be seen in this patient following the administration of lorazepam?
Tremor
Respiratory depression
Seizures
Anxiety
Perspiration
A 28-year-old patient with schizophrenia presents to the general practice. On two occasions he has noticed discharge on his shirt, when inspecting he noticed a milky fluid was coming from his nipples. He remembers the psychiatrist mentioning something similar to this could occur with his medication.
Which of the following is the most likely cause of his discharge?
Clozapine
Risperidone
Fluoxetine
Olanzapine
Quetiapine
A 28-year-old patient with schizophrenia presents to the general practice. On two occasions he has noticed discharge on his shirt, when inspecting he noticed a milky fluid was coming from his nipples. He remembers the psychiatrist mentioning something similar to this could occur with his medication.
Which of the following is the most likely cause of his discharge?
Clozapine
Risperidone
Fluoxetine
Olanzapine
Quetiapine
A 60-year-old gentleman is undergoing an upper gastrointestinal endoscopy for investigation for his dysphagia. He is sedated with midazolam, a benzodiazepine, which acts by enhancing activity at the GABA receptor, one of the body’s inhibitory receptors. What ion flows through the GABA receptor?
Sodium
Chloride
Bicarbonate
Potassium
Calcium
A 60-year-old gentleman is undergoing an upper gastrointestinal endoscopy for investigation for his dysphagia. He is sedated with midazolam, a benzodiazepine, which acts by enhancing activity at the GABA receptor, one of the body’s inhibitory receptors. What ion flows through the GABA receptor?
Sodium
Chloride
Bicarbonate
Potassium
Calcium
Which of the following side-effects are more common with clozapine than conventional anti-psychotics?
Neuroleptic malignant syndrome
Tardive dyskinesia
Agranulocytosis
Akathisia
Torticollis
Which of the following side-effects are more common with clozapine than conventional anti-psychotics?
Neuroleptic malignant syndrome
Tardive dyskinesia
Agranulocytosis
Akathisia
Torticollis
A 66-year-old man is taken to theatre as an emergency due to suspected ruptured abdominal aortic aneurysm. As he has not been fasted prior to surgery the anaesthetists decide to perform rapid sequence intubation. The induction agent used is thiopental sodium, a barbiturate.
What is the mechanism of action of this drug?
Blocks acetylcholine release at the neuromuscular junction
Blocks voltage-gated sodium channels
Glutamate receptor antagonist
Increase duration of chloride channel opening
Serotonin-norepinephrine reuptake inhibitor
A 66-year-old man is taken to theatre as an emergency due to suspected ruptured abdominal aortic aneurysm. As he has not been fasted prior to surgery the anaesthetists decide to perform rapid sequence intubation. The induction agent used is thiopental sodium, a barbiturate.
What is the mechanism of action of this drug?
Blocks acetylcholine release at the neuromuscular junction
Blocks voltage-gated sodium channels
Glutamate receptor antagonist
Increase duration of chloride channel opening
Serotonin-norepinephrine reuptake inhibitor
A 27-year-old female is seen in the epilepsy clinic for follow-up since switching from lamotrigine to carbamazepine for generalised tonic-clonic seizures.
What is the mechanism of action of her new drug?
Binds to sodium channels to increase their refractory period
Binds to sodium channels to decrease their refractory period
Binds to potassium channels to block potassium efflux
Binds to potassium channels to promote potassium efflux
Binds to GABAA receptors allosterically to hyperpolarize neuronal cell membranes
Binds to sodium channels to increase their refractory period
A 17-year-old boy has been in status epilepticus for 45 minutes. He is given intravenous lorazepam boluses before being commenced on a phenytoin infusion. He resumes consciousness and his seizures stop. How does phenytoin act as an emergency treatment for epilepsy?
Blocks voltage-gated sodium channels
Blocks voltage-gated potassium channels
Blocks voltage-gated calcium channels
Enhances voltage-gated sodium channels
Enhances voltage-gated calcium channels
Blocks voltage-gated sodium channels
A 26-year-old woman comes to the emergency department with a suspected heroin overdose.
She has a GCS of 9, only opening her eyes to trapezial squeeze, her speech was not coherent and consisted of inappropriate words. As part of her assessment, the doctor does an arterial blood gas.
What arterial blood gas results would you expect to see in this scenario?
Normal arterial blood gas
Partially compensated respiratory acidosis
Partially compensated respiratory alkalosis
Uncompensated respiratory acidosis
Uncompensated respiratory alkalosis
Uncompensated respiratory acidosis
A 23-year-old rugby player is being discharged from the hospital after sustaining a shoulder injury during a match. He was reviewed by orthopaedics and has been advised to take regular codeine whilst the injury is still painful, engage in physiotherapy, and attend a follow-up appointment.
The patient has some concerns as he is aware that codeine is an opioid medication.
What side effect is likely to continue to affect the patient, even with long-term use?
Constipation
Dry mouth
Peptic ulceration
Respiratory depression
Sedation
Constipation All side effects of opioids tend to abate with long-term use, except for constipation
A 45-year-old woman with multiple sclerosis is commenced by your consultant on baclofen for management of muscle spams.
What is the mechanism of action of this medication?
Dopamine antagonist
GABA receptor agonist
Muscarinic receptor agonist
NMDA receptor antagonist
Serotonin–norepinephrine reuptake inhibitor (SNRI)
GABA receptor agonist
A 45-year-old woman presents with pain associated with muscle spasticity in the context of relapsing-remitting multiple sclerosis. Baclofen is initiated with the aim of reducing spasticity.
What is the mechanism of action of this medication?
Gamma-aminobutyric acid (GABA) receptor agonist
Gamma-aminobutyric acid (GABA) receptor antagonist
N-methyl-D-aspartate receptor (NMDA) receptor agonist
N-methyl-D-aspartate receptor (NMDA) receptor antagonist
Muscarinic M3 receptor antagonist
Gamma-aminobutyric acid (GABA) receptor agonist
A 45-year-old man is admitted to the intensive care unit following a head injury. His history is significant for alcohol use disorder and 5 mg of diazepam is administered intravenously every 2 hours as ordered. After administering a dose, you observe the patient’s respiratory rate change from 20 breaths/min to 6 breaths/min. Which drug should be readily available to treat this complication?
A. Fentanyl
B. Fluorouracil
C. Naloxone
D. Flumazenil
A 45-year-old man is admitted to the intensive care unit following a head injury. His history is significant for alcohol use disorder and 5 mg of diazepam is administered intravenously every 2 hours as ordered. After administering a dose, you observe the patient’s respiratory rate change from 20 breaths/min to 6 breaths/min. Which drug should be readily available to treat this complication?
A. Fentanyl
B. Fluorouracil
C. Naloxone
D. Flumazenil
A 45-year-old man is admitted to the intensive care unit following a head injury. His history is significant for alcohol use disorder and 5 mg of diazepam is administered intravenously every 2 hours as ordered. After administering a dose, you observe the patient’s respiratory rate change from 20 breaths/min to 6 breaths/min. Which drug should be readily available to treat this complication?
A. Fentanyl
B. Fluorouracil
C. Naloxone
D. Flumazenil
A 45-year-old man is admitted to the intensive care unit following a head injury. His history is significant for alcohol use disorder and 5 mg of diazepam is administered intravenously every 2 hours as ordered. After administering a dose, you observe the patient’s respiratory rate change from 20 breaths/min to 6 breaths/min. Which drug should be readily available to treat this complication?
A. Fentanyl
B. Fluorouracil
C. Naloxone
D. Flumazenil
Phenelzine belongs to which drug class
SNRI
SSRI
MOA (reversible)
TCA
MOA (irreversible)
Phenelzine belongs to which drug class
MOAI (irreversible)
Tranylcypromine belongs to which drug class
SNRI
SSRI
MOA (reversible)
TCA
MOA (irreversible)
Tranylcypromine belongs to which drug class
SNRI
SSRI
MOA (reversible)
TCA
MOA (irreversible)
Eating a food like cheese contains tyramine, which inhibits which of the following
Phenelzine
Which of the following are antagonists to alpha 1 adrenoreceptors and create side effects like postural hypotension
SNRI
SSRI
MOA (reversible)
TCA
MOA (irreversible)
Which of the following are antagonists to alpha 1 adrenoreceptors and create side effects like postural hypotension
SNRI
SSRI
MOA (reversible)
TCA
MOA (irreversible)
Moclobemide belongs to which drug class?
SNRI
SSRI
MOA (reversible)
TCA
MOA (irreversible)
Moclobemide belongs to which drug class?
SNRI
SSRI
MOA (reversible)
TCA
MOA (irreversible)
Describe the mechanism of action of agomelatin
Binds to MT1 and MT2 receptors only
Binds to MT1 and MT2 receptors; 5HT agonist
Binds to MT1 and MT2 receptors; 5HT antagonist
5HT agonist
5HT antagonist
Describe the mechanism of action of agomelatin
Binds to MT1 and MT2 receptors only
Binds to MT1 and MT2 receptors; 5HT agonist
Binds to MT1 and MT2 receptors; 5HT antagonist
5HT agonist
5HT antagonist
Which combination of food and drug can result in an idiosyncratic reaction leading to hypertensive crises?
A. Ergotamine and cheese
B. Selegiline and beer
C. Phenelzine and red wine
D. Tranylcypromine and caffeine
Which combination of food and drug can result in an idiosyncratic reaction leading to hypertensive crises?
A. Ergotamine and cheese
B. Selegiline and beer
C. Phenelzine and red wine
D. Tranylcypromine and caffeine
Reboxetine is a drug used to treat depression that has the mechanism of action of which of the below?
noradrenaline reuptake inhibitor (NARI)
serotonergic reuptake inhibirot (SARI)
noradrenergic and specific serotonergic antidepressant (NaSSA)
Which of the following binds to Monoamine oxidase A to cause inhibition?
Tranylcypromine
Moclobemide
Phenelzine
Selegiline
Which of the following binds to Monoamine oxidase A to cause inhibition?
Tranylcypromine
Moclobemide - reversible inhibitor; others all bind to MOA-B
Phenelzine
Selegiline
GI side effects are most common to which drug class
SNRI
SSRI
MOA (reversible)
TCA
MOA (irreversible)
SSRI
Which drugs would you prescribe for treatment resistant:
- Schizophrenia [1]
- Depression [1]
Schizophrenia: Clozapine
Depression: Esketamine
Weight gain due to TCA use is due to antagonist effect at which receptor?
Alpha 1 adrenoreceptors
Alpha 2 adrenoreceptors
Muscarinic receptors
H1 receptors
Weight gain due to TCA use is due to antagonist effect at which receptor?
Alpha 1 adrenoreceptors
Alpha 2 adrenoreceptors
Muscarinic receptors
H1 receptors
Haloperidol is a typical anti-pyschotic used in SCH. Name one more [1]
chlorpromazine, thioridazine,
fluphenazine, , flupenthixol
Which of the following causes an increase in photosensitivity?
thioridazine
flupenthixol
chlorpromazine
fluphenazine
haloperidol
thioridazine
flupenthixol
chlorpromazine
fluphenazine
haloperidol
Olanzapine is a atypical antipsychotic. State which disease that prescribing this drug can cause [1]
Diabetes ( & metabolic syndrome)
Which of the following has the potential to cause neuroleptic malignant syndrome
Which is most toxic in an overdose?
SNRI
SSRI
MOA (reversible)
TCA
MOA (irreversible)
Which is most toxic in an overdose?
SNRI
SSRI
MOA (reversible)
TCA
MOA (irreversible)
A man with generalized anxiety disorder is started on buspirone therapy. This drug is thought to interact with which of the following neurotransmitters?
A. Acetylcholine
B. Gamma amino butyric acid
C. Norepinephrine
D. Serotonin (5-HT)
A man with generalized anxiety disorder is started on buspirone therapy. This drug is thought to interact with which of the following neurotransmitters?
A. Acetylcholine
B. Gamma amino butyric acid
C. Norepinephrine
D. Serotonin (5-HT)
A 45-year-old female with a past medical history of generalized anxiety disorder with panic attacks and opioid use disorder has been taking sertraline 200 mg daily for three months. She has panic attacks monthly. She treats it with alprazolam. She wants to start therapy with buspirone to further treat her generalized anxiety disorder. Which of the following has been shown to negatively impact the efficacy of buspirone therapy in patients with a generalized anxiety disorder?
A. Previous treatment with benzodiazepines
B. Use in patients with a history of substance use disorder
C. Using buspirone as monotherapy due to the side effects of selective serotonin reuptake inhibitor (SSRI) treatment
D. Using buspirone as an augmentation agent with an SSRI
A. Previous treatment with benzodiazepines
Buspirone is a serotonin 5-HT1A receptor partial agonist used to treat anxiety. Patients who have been on benzodiazepines in the past often do not find the medication useful.
Buspirone is an anti-anxiolytic that targets which receptor
5-HT1A
5-HT1B
5-HT2A
5-HT2B
5-HT2C
Buspirone is an anti-anxiolytic that targets which receptor
5-HT1A
5-HT1B
5-HT2A
5-HT2B
5-HT2C
A 19-year-old man is brought in by his family. They tell you he has become withdrawn and not left the house for several months and has been acting strangely. They think he is hearing voices and he often refuses to eat as he claims the food it is poisoned. Given the likely diagnosis, what would be the most appropriate first-line treatment?
Clozapine
Olanzapine
Sertraline
Sodium Valproate
Pregabalin
A 19-year-old man is brought in by his family. They tell you he has become withdrawn and not left the house for several months and has been acting strangely. They think he is hearing voices and he often refuses to eat as he claims the food it is poisoned. Given the likely diagnosis, what would be the most appropriate first-line treatment?
Clozapine
Olanzapine
Sertraline
Sodium Valproate
Pregabalin
A 40-year-old mother of four children who is normally fit and well has been seeing you with low mood for 8 weeks. She has no suicidal ideation and there are no safeguarding concerns regarding her children.
She has tried a low-intensity psychosocial intervention but her symptoms are not improving and she now scores 12 on a PHQ-9 depression questionnaire suggesting that she has moderate depression. She is keen to try an antidepressant and she has no allergies or contraindications to taking medication.
Which medication is the best first line treatment for her?
Amitriptyline
Isocarboxazid
Mirtazapine
Sertraline
Venlafaxine
Sertraline
A patient with complex mental health problems who is on a variety of medications comes into the clinic complaining of weight gain. Which of the following medications is likely to be responsible for this side effect?
Olanzapine
Diazepam
Sodium Valproate
Tramadol
Citalopram
Olanzapine
- A
- B
- C
- D
- E
2. B
- Caudate nucleus
- Thalamus
- Putamen
- Insula
- Fornix
- Corpus callosum
1. Caudate nucleus
- Frontal eye field
- Parahippocampus
- Insula
- Supplementary motor cortex
- Cingulate cortex
- Prefrontal cortex
6. Prefrontal cortex
- Pia mater
- Arachnoid mater
- Arachnoid granulation
- Dural mater
- Periostium
- Dural sinus
2. Arachnoid mater
Identify structure 21.
- Amygdala
- Caudate nucleus
- Dentate gyrus
- Insula
- Hippocampus
- Mammillary body
- Subiculum
- Uncus
Identify structure 21.
1. Amygdala
The vascular injury shown here is
- Extradural
- Subdural
- Subarachnoid
- Diffuse axonal injury
- Contusion
The vascular injury shown here is
- Extradural
- Subdural
- Subarachnoid
- Diffuse axonal injury
5. Contusion
- Uncal herniation
- Tonsillar herniation
- Sub-falcine herniation
- Hydrocephalus
- Mass effect
1. Uncal herniation
- Uncal herniation
- Tonsillar herniation
- Sub-falcine herniation
- Hydrocephalus
- Mass effect
1. Uncal herniation
A baby dies and the post-mortum reveals this finding alongside a subdural haemorrhage. What is the most likely cause of death? [1]
Shaken baby syndrome
The SBS is characterized by a triad of encephalopathy, subdural hematomas and retinal hemorrhages.
- Uncal herniation
- Tonsillar herniation
- Sub-falcine herniation
- Hydrocephalus
- Mass effect
3. Sub-falcine herniation
- Uncal herniation
- Tonsillar herniation
- Sub-falcine herniation
- Hydrocephalus
- Mass effect
1. Uncal herniation
Increased intracranial pressure in a 58-year-old man with right
middle cerebral artery infarction causing marked bilateral uncal
herniation with notching (arrows). The notching is more prominent
on the right side
- Uncal herniation
- Tonsillar herniation
- Sub-falcine herniation
- Hydrocephalus
- Mass effect
- Uncal herniation
- Uncal herniation
- Tonsillar herniation
- Sub-falcine herniation
- Hydrocephalus
- Mass effect
2. Tonsillar herniation
Which type of haemorrhage is seen here
Epidural
Subdural
Subarachnoid
Intracerebral
Which type of haemorrhage is seen here
Epidural
Subdural
Subarachnoid
Intracerebral
Which type of haemorrhage is seen here
Epidural
Subdural
Subarachnoid
Intracerebral
Epidural
Which type of haemorrhage is seen here
Epidural
Subdural
Subarachnoid
Intracerebral
Subarachnoid
Which type of haemorrhage is seen here
Epidural
Subdural
Subarachnoid
Intracerebral
Subarachnoid
Which type of haemorrhage is seen here
Epidural
Subdural
Subarachnoid
Intracerebral
Which type of haemorrhage is seen here
Epidural
Subdural
Subarachnoid
Intracerebral
Which type of haemorrhage is seen here
Epidural
Subdural
Subarachnoid
Intracerebral
Epidural
D. The diagnosis is tuberculous meningitis with foci of caseating necrosis (Your Answer)
Feedback:
CORRECT! The gross picture shows inflammatory exudates in the subarachnoid space, as well as several foci of caseous necrosis over the cerebellar hemispheres. Microscopy shows necrotizing granulomatous inflammation. A ZN stain should be done to look for acid=fast bacilli.
What is a form of learning whereby behaviour is changed because of the consequences?
Classical conditioning
Aversion therapy
Operant condiitoning
Negative reinforcement
Attribution theory
Exam Q
What is a form of learning whereby behaviour is changed because of the consequences?
Classical conditioning
Aversion therapy
Operant condiitoning
Negative reinforcement
What is the name for when a hospital patient’s well-being is negatively affected by factors such as loss of identity and feelings of powerlessness [1]
Exam Q
Insitituitonal neurosis
Which of the following accompanies taking drugs to escape adverse withdrawal effects
Postive reinforcement
Negative reinforcement
Theory of reasoned action
Low self efficacy
Exam Q
Which of the following accompanies taking drugs to escape adverse withdrawal effects
Postive reinforcement
Negative reinforcement
Theory of reasoned action
Low self efficacy
What is the main pharmocokinetic characteristic of phenytoin? [1]
exam q
Dose-dependent kinetics
Describe the effect of tiagabine on GABAnergic transmission? [1]
Exam Q
Blocks GABA uptake
Foetal malformations represent a main unwanted effect of an antiepileptic drug. Name this drug [1]
Exam Q
Phenytoin
Which dopamine pathway is involved in reward and addiction? [1]
Exam Q
Mesolimbic
Which part of the brain does MDMA alter in physiology to cause increased temperature? [1]
Exam q
Hypothalamus
Name two opiates metabolised to morphine in the body? [2]
Exam Q
Codiene; Heroin
[] is an effective pharmacotherapy to aid smoking cessation
Exam Q
Bupropion is an effective pharmacotherapy to aid smoking cessation
Neuroleptic side effects of schizophrenic drugs arise from blockade of dopamine receptors in which striatum [1]
Exam Q
Extrapyramidal symptoms
Risperidone blocks which 5-HT subtype? [1]
Exam Q
5-HT2A
Which drug can be used to reuced nausea induced by L-DOPA [1]
Exam Q
Carbidopa or benserazide
Which are the only neurons whose axons leave the cerebellar cortex? [1]
Exam Q
Purkinje cells
Which part of the limbic system is the nuclei involved in reward circuits? [1]
Amygdala
Nucleus accumbens
Septal nuclei
Uncus
Exam Q
Septal nuclei
Which part of the limbic system is the thought to be the emetional content of experiences
Amygdala
Nucleus accumbens
Septal nuclei
Uncus
Exam Q
Amygdala
Which cortical region is thought to be most involved in affactive and emotional behaviour [1]
Exam Q
Cingulate gyrus
Deja-vu is associated with epilepsy in which brain region of the brain?
Frontal
Temporal
Occipital
Parietal
Exam Q
Deja-vu is associated with epilepsy in which brain region of the brain?
Frontal
Temporal
Occipital
Parietal
[] cortex acts as an interface between hippocampus and cerebral cortex.
Exam Q
Entorhinal cortex acts as an interface between hippocampus and cerebral cortex.
Which region contains dopamine axons projecting to the accumbens nucleus? [1]
Exam Q
VTA
Chronic use of barbiturates will cause what physiological effect? [1]
Exam Q
Induction of liver microsomal enzymes
Which of the following is an example of an SSRI
Paroxetine
Phenelzine
Phenytoin
Lithium
Exam Q
Which of the following is an example of an SSRI
Paroxetine
Phenelzine
Phenytoin
Lithium
Name a symptom that occurs due to Amitriptyline blocking muscarinic receptors [1]
Exam q
dry mouth, constipation
Buspirone can be used to treat which disorder? [1]
Exam Q
Anxiety
Name a risk associated with the use of irreversible MAOA inhibitors [1]
Exam Q
Hepatoxicity
The cheese effect is due to the presence of which compound in certain food [1]
Exam Q
Tyramine
Which anti-epileptic drugs are safe in pregnancy? [2]
Lamotrigine and levetiracetam
