BNPH700 Mental health

Question 1

What are the clinical indications for benzodiazepine (anxiolytics) use

Answer 1

Severe anxiety, agitation, insomnia, alcohol withdrawal, muscle spasm, treatment for seizures.

Question 2

Mechanism of action for anxiolytics

Answer 2

Act by facilitating the binding of the inhibitory neurotransmitter GABA at various GABA receptors throughout the CNS - resulting in anxiolytic, sedative, muscle relaxant and antiepileptic effects.

Question 3

What are some benzodiazepine drugs called

Answer 3

Diazepam, Clonazepam, Midazolam, lorazepam.

Question 4

Common symptoms of benzodiazepine withdrawal

Answer 4

Common - Anxiety, insomnia, gastric problems, tremors, agitation, fearfulness and muscle spasms
Less common - Sweating, depersonalisation, derealisation, suicidal behaviours, seizures, hypersensitivity to stimuli.

Question 5

How do antipsychotics work?

Answer 5

Do not really know how but the main theory focuses on the neurotransmitter dopamine and blocking the D2 receptor

Question 6

Name some antipsychotics

Answer 6

Haloperidol, Zuclopenthixol, Flupenthixol, Chlorpromazine.

Question 7

Side effects of antipsychotics

Answer 7

Blurred vision, confusion, agitation, drowsiness, dry mouth, difficulty urinating, constipation, hallucinations

Question 8

What are extrapyramidal symptoms?

Answer 8

Tremor, rigidity, difficulty in swallowing, sustained muscular conditions that produce abnormal postures (Dystonia) Akathisia (agitation like jogging, walking on the spot) Tardive dyskinesia (Involuntary movements of orofacial, linb and truncal regions)

Question 9

Name some Atypical antipsychotics

Answer 9

Olanzapine, Clozapine, Risperidone, Quetiapine

Question 10

Side effects of atypical antipsychotics

Answer 10

Weight gain, drowsiness, constipation, dizziness, hypersalivation, sexual dysfunction, postural hypotension

Question 11

What medication can cause life threatening symptoms, what are those symptoms? And what must a patient have done?

Answer 11

Clozapine - Causes neutropenia or agranulocytosis. Low white blood cells or neutrophil count. Patient needs weekly blood tests for 18 weeks then 4 weekly there after
Symptoms - Fever, rigor, sore throat, any signs of infection or cognitive changes

Question 12

What is Neuroleptic Malignant Syndrome? and what doe sit cause the body to do?

Answer 12

Dopamine receptor block in the corpus striatum, resulting in spasticity of skeletal muscles (leading to excessive heat generation) and impaired thermoregulation

Question 13

Signs and symptoms of Neuroleptic Malignant Syndrome (NMS)? And treatment to stop it?

Answer 13

F - fever
E - encephalopathy
V - vitals stable
E - elevated enzymes (CPK)
R - rigidity of muscles

Stop medication, cooling, hydration, use benzodiazepines/dantrolene to relax muscles

Question 14

Examples of SSRI

Answer 14

Citalopram, Escitalopram, Paroxetine, Fluoxetine, Sertraline

Question 15

Mechanism of action for SSRI

Answer 15

SSRI’s block the reuptake of serotonin leading to increased neurotransmitter levels in the synaptic cleft and increased stimulation of the postsynaptic cleft

Question 16

Side effects of SSRI’s

Answer 16

Common - Insomnia, sexual dysfunction, nausea, vomiting, headache, anxiety, diarrhea, tremor, emotional dulling,

Question 17

Serotonin syndrome symptoms

Answer 17

Increased heart rate, fever, sweating, dilated pupils, tremor, hyperreflexia, hyperactive bowel sounds, high blood pressure, confusion, agitation, hypervigilance, temperature.

Question 18

What is the mechanism of action of tricyclic antidepressants?

Answer 18

They block reuptake of norepinephrine and serotonin leading to increased neurotransmitter levels in the synaptic cleft and increased stimulation of the postsynaptic receptors.

Question 19

Example medications for tricyclic antidepressnats

Answer 19

Amitriptyline, Nortriptyline, Imipramine, Clomipramine.

Question 20

Side effects of tricyclic antidepressants

Answer 20

Dry mouth, blurred vision, constipation, urinary retention, drowsiness, weight gain, headache, nausea, palpitations, postural hypotension, sexual dysfunction, sweating

Question 21

Mechanism of action for monoamine oxidase inhibators

Answer 21

MAOI’s inhibit MAO, an enzyme in the nerves that breaks down norepinephrine, dopamine and serotonin. Allows neurotransmitters to accumulate in the synaptic cleft, causing increased stimulation of the postsynaptic receptors

Question 22

Example of MAOI medication

Answer 22

Tranylcypromine

Question 23

What food to avoid when taking MAOI’s?

Answer 23

Avoid foods high in tyramine such as hard cheese, meat and fish that are not fresh, salami, dried meats, soy sauce, tofu, home brew beer, yeast extracts and fermented food, as it activates norepinephrine receptors when in excess

Question 24

Example of mood stabiliser medication

Answer 24

Lithium

Question 25

Effect of lithium

Answer 25

Prevents and treats manic and depressive disorders.

Question 26

Mechanism of action of lithium

Answer 26

Acts on sodium channels to stabilise serotonin neurons however largely unknown

Question 27

Side effects of lithium

Answer 27

Tremor, stomach upset, polyuria, polydipsia, weight gain, oedema, hypothyroidism.

Question 28

Patient education for lithium

Answer 28

Take with food
Maintain hydration
3 monthly plasma level checks

Question 29

Mechanism of action for anticonvulsants

Answer 29

Stabilise nerve membranes throughout CNS, thereby reducing excitability and hyperexcitability

Question 30

What is the use of sodium valproate

Answer 30

To manage bipolar and schizophrenia

Question 30

Common side effects of sodium valproate

Answer 30

gastric irritation, nausea, increased appetite, and weight gain, teratogenic

Question 31

Patient education for someone taking sodium valporate

Answer 31

Take with food

Question 32

Common side effects of lamotrigine

Answer 32

Nausea, ataxia, drowsiness, headache, dizziness, rash, blurred vision, diplopia, confusion, insomnia, irritability, agitation, aggression

Question 33

Medications that are used for anticonvulsants

Answer 33

Sodium valproate, lamotrigine, carbamazepine

Question 34

What is the treatment pathway for manic episode

Answer 34

Ask what has worked in the past
Generally use an antipsychotic, +/- valproate, if less severe use lithium

Question 35

What is the treatment pathway for depressive episode

Answer 35

Quetiapine
Fluoxetine / olanzapine
Lithium
? Lamotrigine
? Antidepressants

Question 36

Name some non-benzodiazepine medications

Answer 36

SSRI’s, Buspirone (moderates serotonin receptors) & Propanalol (beta blocker)