CNS

Question 1

side effects of lithium?

Answer 1

fine tremor, acneiform eruptions

Question 2

signs of lithium toxicity?

Answer 2

vomiting and diarrhoea, coarse tremor, CNS disturbances…. Need to get levels done if they have these symptoms

Question 3

monitoring for sodium valporate?

Answer 3

Baseline and regular BMI, FBC, LFTs – after 6 months, then annually

Question 4

examples of SSRIs

Answer 4

Sertraline, Citalopram, Fluoxetine, Escitalopram, Paroxetine, Fluvoxamine

Question 5

side effects SSRIs

Answer 5

Initial agitation, anxiety
– need to warn a patient of this so they aren’t surprised if this does happen
GI side effects, hyponatraemia (low sodium, especially in the elderly)
Bleeding risk
– avoid using with NSAIDS/anticoagulants  GI bleeds, may need omeprazole if wanting to give SSRI and aspirin
Effect of platelts
QT prolongation
Fewer concerns about sedation, overdose risk, cardiac problems
Advise to take in morning or it may disrupt your sleep
Sexual dysfunction
May be difficult to tell you about and could cause them to stop

Question 6

examples of SNRIs?

Answer 6

Venlafaxine, Duloxetine

Question 7

when should you NOT use SNRIs?

Answer 7

hypertension

Question 8

side effects of mirtazapine?

Answer 8

Sedation – this might help if the patient is not sleeping very well
, weight gain – might help if patient is easting very well
Blood disorders – very rarely see it

Question 9

examples of tricyclics?

Answer 9

Amitriptyline, Clomipramine, Nortriptyline, Lofepramine, Dosulepin

Question 10

side effects of tricyclics?

Answer 10

Antimuscarinic side effects
Constipation, urine retention, blood pressure, hypotension, sedation, falls, blurred vision (elderly AVOID)
Cardiotoxicity – don’t use post MI

Question 11

examples of MOAs?

Answer 11

Phenelzine, Tranylcypromine, Isocarboxazid

Question 12

what can not be taken with MOAs?

Answer 12

If you eat cheese, marmite or alcohol
Monoamine oxidase is needed to break down tyramine, when you inhibit this it means you build them up to toxic levels and this may cause bleeds on brain.

Question 13

examples of 1st gen / typical APs?

Answer 13

: sulpiride, flupenthixol, haloperidol, chlorpromazine, zuclopenthixol, trifluoperazine, perphenazine

Question 14

examples of 2nd gen / atypical APs?

Answer 14

amisulpride, quetiapine, risperidone, olanzapine, clozapine, aripiprazole, paliperidone, lurasidone, asenapine

Question 15

side effects of 1st gen / typical APs?

Answer 15

extra-pyramidal side effects (EPSEs) and hyperprolactinaemia

Question 16

side effects for 2nd gen / atypical APs?

Answer 16

Metabolic side effects

- weight gian

Question 17

other side effects of all APs?

Answer 17

• QT prolongation
  Sedation

Anticholinergic effects, particularly clozapine and some typicals

Lowering seizure threshold

Neutropenia

Hyponatremia

Photosensitivity, especially chlorpromazine (use sunscreen)

Postural hypotension and tachycardia

Neuroleptic malignant syndrome – rare but could be fatal

Question 18

monitoring for APS?

Answer 18

Weight 
Waist circumference 
Pulse and BP
Fasting BMs and HbA1c 
Lipids 
Prolactin levels 
Assessment of movement disorders, adherence nutrition and exercise
An ECG at baseline (only if specified in SmPC, personal history of CVD, inpatient admission or physical examination reveals CV risk factor (e.g. HTN))

Question 19

what is the 1st line for mild - mod dementia?

Answer 19

AChE inhibitors rivastigmine, galantamine and donepezil recommended for mild-moderate AD
Use drug with lowest acquisition cost, but can also consider ADR profile, adherence, interactions and co-morbidities

Question 20

when would you use NMDA antagonist used?

Answer 20

NMDA antagonist memantine recommended as monotherapy for SEVERE AD