BB2 Drugs Flashcards
1
Q
State the class of drugs that selegiline belongs to [1]
A
MOA inhibitor
2
Q
Name the 7 treatments for addiction [7]
A
‘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
3
Q
Name two future pyschedelic drugs that could be used for treatment for addiciton? [2]
Not on drug list
A
LSD, Psilocybin
4
Q
Describe how antabuse - disulfiram works to stop
(on the drugs list)
A
inhibits the enzyme acetaldehyde dehydrogenase, causing many of the effects of a hangover to be felt immediately following alcohol consumption
5
Q
Which drug is methadone a substitute for? [1]
A
Heroin
6
Q
How does Varenicline work to treat nicotine addiction? [1]
Not on drug list
A
is a selective partial agonist that stimulates the a4b2 nicotine cholinergic receptor
7
Q
Name a drug used to provide withdrawal relief and its MoA [2]
Not on drug list
A
Clonidine
Alpha2 agonist used to treat hypertension and addiction
8
Q
Name a drug that causes patients to temporarily leave vegetative state [1]
A
Zolpidem
9
Q
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
A
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
10
Q
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
A
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
11
Q
PVS treatment
Name a drug and describe MoA that may help to recover [3]
A
Amantadine
* NMDA receptor antagonist and block dopaminergic reuptake
* Improves functional recovery rate
12
Q
PVS treatment
What is the hypothesis for zolpidem treatment?
A
Loss of active inhibition from striatum allows GPi to tonically inhibit thalamus and pedunculopontine nucleus, so thalamocortical overactivity
13
Q
Future treatment for PVS? [1]
A
Vagal nerve stimulation:
14
Q
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]
A
Mild-Moderate AD:
* Acetylcholinesterase inhibitors(e.g. donepezil, galantamine and rivastigmine)
Severe AD:
* NMDA receptor antagonists (e.g. memantine)
15
Q
Which of the following treatments for AD is a NMDA glutamate receptor agonist?
memantine
donepezil
galantamine
rivastigmine
A
Which of the following treatments for AD is a NMDA glutamate receptor agonist?
memantine
donepezil
galantamine
rivastigmine
16
Q
Which of the following is used for patients with severe AD?
memantine
donepezil
galantamine
rivastigmine
A
Which of the following is used for patients with severe AD?
memantine
donepezil
galantamine
rivastigmine
17
Q
donepezil, galantamine & rivastigmine all belong to which drug class? [1]
A
Acetylcholinesterase inhibitor
18
Q
rivastigmine is used to treat which pathology?
Parkinsons Disease
Alzeimers Disease
Huntingdons Disease
Epilepsy
A
rivastigmine is used to treat which pathology?
Parkinsons Disease
Alzeimers Disease
Huntingdons Disease
Epilepsy
19
Q
Name two drugs used for seizure prophylaxis [2]
A
Phenytoin
Levetiracetam
20
Q
How could you manage severe ICP:
Acutely [2]
Long term [1]
A
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
21
Q
Management of epilepsy:
Name 3 drugs target the inactive (intermediate) state of Na channels
A
Phenytoin
Carbamazepine
Sodium valproate
22
Q
Phentoin is an anti-seizure drug that targets which channel?
GABA-A
NMDA Glutamate
AMPA Glutamate
Na+
CA2+
A
Phentoin is an anti-seizure drug that targets which channel?
GABA-A
NMDA Glutamate
AMPA Glutamate
Na+
CA2+
23
Q
Which of the following should not be used to treat an absence seizure as they may exacerbate it?
Sodium valproate
Lamotrigine
Phenytoin
Pregabalin
Ethosuximide
A
Which of the following should not be used to treat an absence seizure as they may exacerbate it?
Sodium valproate
Lamotrigine
Phenytoin
Pregabalin
Ethosuximide
24
Q
Which of the following exhibits zero order kinetics?
Sodium valproate
Lamotrigine
Phenytoin
Pregabalin
Ethosuximide
A
Which of the following exhibits zero order kinetics?
Sodium valproate
Lamotrigine
Phenytoin
Pregabalin
Ethosuximide
25
Name three calcium channels that are used as anti-epileptic drugs [3]
**Ethosuximide**
**Gabapentin** (in the PBL)
**pregabalin** (in the PBL)
26
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
27
Which drug inhibits GABA metabolism? [1]
Vigabatrin
28
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
29
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
30
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
31
# 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**
32
Status elipeticus is a medical emergency. Name two drugs used to treat this conditon [2]
Lorezepam (IV)
Diazepam (IV)
33
# 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**
34
# 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
35
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
36
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?)
37
# AEDs
Focal Seizures Treatment:
First line: [] or []
Second line: [] or []
First line: **carbamazepine** or **lamotrigine**
Second line: **sodium valproate** or **levetiracetam**
38
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**
39
Which drugs are used for absence seizures? [2]
**ethosuximide**, **sodium valproate**
40
Myoclonic seizures:
First line: [1]
Other options: [3]
First line: **sodium valproate**
Other options: **lamotrigine, levetiracetam or topiramate**
41
Describe the MoA of sodium channel active drugs like phenytoin and carbamazepine [1]
**Stabilises Na+ channels inactivated state** to **decrease excitability**
42
# Primary headaches
Treatment of tension-type headaches [2]
- Take painkillers for symptoms
- Find root causes and treat
43
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**
44
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)
45
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
46
Name first line treatment for migraine? [1]
Sumatriptan
47
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**.
48
SCN9A codes for which of the following
TRPM8
TRPV1
ASICS
Nav1.7
SCN9A codes for which of the following
TRPM8
TRPV1
ASICS
**Nav1.7**
49
Antiplatelet therapy for stroke? [3]
Aspirin
Aspirin & Clopidogrel
Aspirin and Dipyridamole
50
What type of family of antidepressants are clomipramine, imipramine, desipramine, amitriptyline, nortriptyline and protriptyline? [1]
**TRICYCLIC ANTIDEPRESSANTS (TCAs)**
51
Describe the MoA of TCAs [2]
- **Inhibit** **reuptake** of **amines** on the **presynaptic terminal**, so **5HT** or **NA** cannot be taken back into neuron
52
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!
53
Phenelzine, tranylcypromine belong to which drug class? [1]
MONOAMINE OXIDASE INHIBITORS
54
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
55
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
56
What type of drug class are citalopram, fluoxetine, paroxetine sertraline? [1]
SELECTIVE SEROTONIN REUPTAKE INHIBITORS
57
Which is the most selective SSRI?
citalopram
sertraline
fluoxetine
paroxetine
Which is the most selective SSRI?
**citalopram**
sertraline
fluoxetine
paroxetine
58
Moclobemide belongs to which drug class? [1]
**REVERSIBLE** MONOAMINE OXIDASE INHIBITOR
59
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)
60
# 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**’
61
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
62
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**
63
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
64
What drug do you give to manage bipolar disorder? [1]
What needs to be considered about this when adminsitering? [1]
**Lithium**
**Narrow therapeutic margin**
65
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)
66
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
67
Look up which TCAs need to know
68
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
69
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
70
What is the benefit of using SSRIs (citalopram, fluoxetine, paroxetine) with regards to AEs [3]
No anticholinergic activity
No cardiotoxic effects
Safe in overdose
71
AEs of SSRIs?
· Nausea vomiting
· Dry mouth
· Headache
· Asthenia
· Dizziness
· Anorexia
· Weight loss
· Nervousness
· Tremor
· Convulsions
· Sexual dysfunction
72
Which of the following is a reversible MAOI?
phenelzine
moclobemide
tranylcypromine
agomelatine
Which of the following is a reversible MAOI?
phenelzine
**moclobemide**
tranylcypromine
agomelatine
73
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**
74
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
75
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**
76
# Depression drugs
Name a noradrenaline reuptake inhibitor used for depression treatment [1]
Reboxetine
77
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
78
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
79
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**
80
# Depression Drugs
Name a serotonergic antagonist and reuptake inhibito (SARI) [1]
**Trazodone**
81
# Depression drugs
Name a noradrenergic and specific serotonergic antidepressant (NaSSA) [1]
Mirtazapine
82
83
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
84
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
85
Apart from lithium, name two other drugs used as mood stabilisers [2]
Carbamazepine, sodium valproate
86
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**
87
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
88
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”.
89
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)
90
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**
91
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**
92
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
93
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
94
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**
95
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
96
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
97
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
98
Most common AE of SSRI? [3]
**gastrointestinal symptoms** are the most common side-effect:
99
30% schizophrenic patients do not respond to treatment. Which drug would you provied for those who have drug resistance? [1]
**Clozapine**
100
Name a risk of clozapine treatment [2]
agranulocytosis: increases chance of infection
101
Non-pharmacological approaches for SCH? [3]
* Cognitive Behavioural Therapy
* Cognitive remediation
* Family therapy
**These do not replace the pharmacological treatment**
102
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**.
103
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**
104
Name 5 typical antipyschotics
**chlorpromazine**, thioridazine,
fluphenazine, **haloperidol**, flupenthixol
105
Describe the effect of typical anti-physchotics on positive and negative symptoms [1]
**Improve positive** symptoms
Little/no efficacy on **negative symptoms**
106
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**
107
Name 4 atypical anti-psychotics used to treat SCH [4]
**risperidone**, **olanzapine**, **clozapine**, quetiapine, paliperidone, **aripiprazole**
108
Atypical anti-psychotics target which receptors? [2]
Antagonists at:
* D2 receptors
* 5-HT2A receptors
109
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**
110
Explain why antipsychotic drugs may cause sexual dysfunction, galactorrhoea or amenorrhoea?
Block dopamine receptors; causes a rise in prolactin
111
Which anti-psychotics can be adminstered by IM injections? [2]
**fluphenazine** decanoate
**haloperidol** decanoate
112
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
113
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
114
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
115
Describe what neuroleptic malignant syndrome is a combination of [6]
Due to typical anti-psychotics
hyperpyrexia
muscle rigidity
tremor
confusion
autonomic instability
116
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
117
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**
118
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)
119
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**
120
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**
121
Which is the first line treatment for trigeminal neuraglia? [1]
Carbamazepine
122
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
123
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
124
What are the first three firstline drug classes recommended for neuropathic pain? [3]
**SNRIs** (duloxetine)
**tricyclic antidepressants** (amitrypyline)
**calcium channel blockers** (gabapentin, pregabalin)
125
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)
126
Name a tricyclic antidepressant that is used to treaet neuropathic and cancer pain [1]
Amitriptyline
127
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
128
Celecoxib is a selective COX-2 inhibitor, but has a significant risk of what? [1]
significant risk of **cardiovascular** events
129
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**
130
Name a drug used to treat migraines [1]
Describe its MoA [1]
**Sumatriptan**: vasoconstriction of cerebral arteries reducing inflammatory response and trigeminal activation
131
Describe MoA of ketamine [1]
NMDA glutamate receptor antagonist
132
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
133
Describe the MoA of tramadol & tapentadol [2]
Opioid receptor agonist AND amine reuptake inhibition
134
# Local anaesthetics
Name 3 examples [3]
MoA? [1]
**lignocaine, bupivacaine, prilocaine** (all end in -caine)
**Block Na channels**
135
Which drug acts as a general anaesthetic AND acts as an analgesic? [1]
**ketamine**
136
# 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**
137
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
138
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
139
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
140
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
141
Which anti-epileptic treatment is teratogenic
Sodium Valproate
Ethosuximide
Lamotrigine
Levetiracetam
Lorazepam
Which anti-epileptic treatment is teratogenic
**Sodium Valproate**
Ethosuximide
Lamotrigine
Levetiracetam
Lorazepam
142
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
143
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**
144
Which drug classes are current treatments for insomnia? [2]
**Benzodiazepine** - short acting
**Z drugs**
145
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)
146
Name a drug that used for epilepsy that has recent use for insomnia [1]
**Pregabalin**
147
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
148
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
149
Name 5 classes of drugs that can act as anxiolytics [5]
**SSRIs**
**SNRIs**
**Benzodiazepines**
**5-HT1A agonists**
**β-adrenoceptor antagonists**
150
Name 3 benzodiazepines used as anxiolytics
clonazepam, alprazolam, lorazepam
151
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
152
Name two 5HT-1A agonists and one B-adrenoreceptor antagonists used as anxiolytics [3]
5-HT1A agonists: **buspirone** ipsapirone
β-adrenoceptor antagonists: **propranolol**
153
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
154
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
155
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
156
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
157
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
158
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.
159
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**
160
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.
161
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
162
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
163
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
164
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
165
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
166
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**
167
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**
168
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
169
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
170
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**
171
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
172
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**
173
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**
174
Phenelzine belongs to which drug class
SNRI
SSRI
MOA (reversible)
TCA
MOA (irreversible)
Phenelzine belongs to which drug class
**MOAI (irreversible)**
175
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)**
176
Eating a food like cheese contains tyramine, which inhibits which of the following
Phenelzine
177
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)
178
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)
179
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
180
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
181
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)
182
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
183
GI side effects are most common to which drug class
SNRI
SSRI
MOA (reversible)
TCA
MOA (irreversible)
**SSRI**
184
Which drugs would you prescribe for treatment resistant:
- Schizophrenia [1]
- Depression [1]
Schizophrenia: **Clozapine**
Depression: **Esketamine**
185
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**
186
Haloperidol is a typical anti-pyschotic used in SCH. Name one more [1]
**chlorpromazine**, thioridazine,
fluphenazine, , flupenthixol
187
Which of the following causes an increase in photosensitivity?
thioridazine
flupenthixol
chlorpromazine
fluphenazine
haloperidol
thioridazine
flupenthixol
**chlorpromazine**
fluphenazine
haloperidol
188
Olanzapine is a atypical antipsychotic. State which disease that prescribing this drug can cause [1]
**Diabetes** ( & metabolic syndrome)
189
Which of the following has the potential to cause neuroleptic malignant syndrome
190
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)
191
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)**
192
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.
193
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
194
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
195
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**
196
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**
197
1. A
2. B
3. C
4. D
5. E
**2. B**
198
1. Caudate nucleus
2. Thalamus
3. Putamen
4. Insula
5. Fornix
6. Corpus callosum
**1. Caudate nucleus**
199
1. Frontal eye field
2. Parahippocampus
3. Insula
4. Supplementary motor cortex
5. Cingulate cortex
6. Prefrontal cortex
**6. Prefrontal cortex**
200
1. Pia mater
2. Arachnoid mater
3. Arachnoid granulation
4. Dural mater
5. Periostium
6. Dural sinus
**2. Arachnoid mater**
201
Identify structure 21.
1. Amygdala
2. Caudate nucleus
3. Dentate gyrus
4. Insula
5. Hippocampus
6. Mammillary body
7. Subiculum
8. Uncus
Identify structure 21.
**1. Amygdala**
202
The vascular injury shown here is
1. Extradural
2. Subdural
3. Subarachnoid
4. Diffuse axonal injury
5. Contusion
The vascular injury shown here is
1. Extradural
2. Subdural
3. Subarachnoid
4. Diffuse axonal injury
**5. Contusion**
203
1. Uncal herniation
2. Tonsillar herniation
3. Sub-falcine herniation
4. Hydrocephalus
5. Mass effect
**1. Uncal herniation**
204
1. Uncal herniation
2. Tonsillar herniation
3. Sub-falcine herniation
4. Hydrocephalus
5. Mass effect
**1. Uncal herniation**
205
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.
206
1. Uncal herniation
2. Tonsillar herniation
3. Sub-falcine herniation
4. Hydrocephalus
5. Mass effect
**3. Sub-falcine herniation**
207
1. Uncal herniation
2. Tonsillar herniation
3. Sub-falcine herniation
4. Hydrocephalus
5. 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
208
1. Uncal herniation
2. Tonsillar herniation
3. Sub-falcine herniation
4. Hydrocephalus
5. Mass effect
1. Uncal herniation
209
1. Uncal herniation
2. Tonsillar herniation
3. Sub-falcine herniation
4. Hydrocephalus
5. Mass effect
**2. Tonsillar herniation**
210
Which type of haemorrhage is seen here
Epidural
Subdural
Subarachnoid
Intracerebral
Which type of haemorrhage is seen here
Epidural
**Subdural**
Subarachnoid
Intracerebral
211
Which type of haemorrhage is seen here
Epidural
Subdural
Subarachnoid
Intracerebral
**Epidural**
212
Which type of haemorrhage is seen here
Epidural
Subdural
Subarachnoid
Intracerebral
**Subarachnoid**
213
Which type of haemorrhage is seen here
Epidural
Subdural
Subarachnoid
Intracerebral
**Subarachnoid**
214
Which type of haemorrhage is seen here
Epidural
Subdural
Subarachnoid
Intracerebral
Which type of haemorrhage is seen here
Epidural
Subdural
**Subarachnoid**
Intracerebral
215
Which type of haemorrhage is seen here
Epidural
Subdural
Subarachnoid
Intracerebral
**Epidural**
216
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.
217
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
218
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
219
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
220
What is the main pharmocokinetic characteristic of phenytoin? [1]
| exam q
Dose-dependent kinetics
221
Describe the effect of tiagabine on GABAnergic transmission? [1]
| Exam Q
Blocks GABA uptake
222
Foetal malformations represent a main unwanted effect of an antiepileptic drug. Name this drug [1]
| Exam Q
Phenytoin
223
Which dopamine pathway is involved in reward and addiction? [1]
| Exam Q
Mesolimbic
224
Which part of the brain does MDMA alter in physiology to cause increased temperature? [1]
| Exam q
Hypothalamus
225
Name two opiates metabolised to morphine in the body? [2]
| Exam Q
Codiene; Heroin
226
[] is an effective pharmacotherapy to aid smoking cessation
| Exam Q
**Bupropion** is an effective pharmacotherapy to aid smoking cessation
227
Neuroleptic side effects of schizophrenic drugs arise from blockade of dopamine receptors in which striatum [1]
| Exam Q
Extrapyramidal symptoms
228
Risperidone blocks which 5-HT subtype? [1]
| Exam Q
5-HT2A
229
Which drug can be used to reuced nausea induced by L-DOPA [1]
| Exam Q
Carbidopa or benserazide
230
Which are the only neurons whose axons leave the cerebellar cortex? [1]
| Exam Q
Purkinje cells
231
Which part of the limbic system is the nuclei involved in reward circuits? [1]
Amygdala
Nucleus accumbens
Septal nuclei
Uncus
| Exam Q
**Septal nuclei**
232
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**
233
Which cortical region is thought to be most involved in affactive and emotional behaviour [1]
| Exam Q
Cingulate gyrus
234
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
235
**[]** cortex acts as an interface between hippocampus and cerebral cortex.
| Exam Q
**Entorhinal** cortex acts as an interface between hippocampus and cerebral cortex.
236
Which region contains dopamine axons projecting to the accumbens nucleus? [1]
| Exam Q
**VTA**
237
Chronic use of barbiturates will cause what physiological effect? [1]
| Exam Q
**Induction of liver microsomal enzymes**
238
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
239
Name a symptom that occurs due to Amitriptyline blocking muscarinic receptors [1]
| Exam q
dry mouth, constipation
240
Buspirone can be used to treat which disorder? [1]
| Exam Q
Anxiety
241
Name a risk associated with the use of irreversible MAOA inhibitors [1]
| Exam Q
Hepatoxicity
242
The cheese effect is due to the presence of which compound in certain food [1]
| Exam Q
Tyramine
243
Which anti-epileptic drugs are safe in pregnancy? [2]
Lamotrigine and levetiracetam
