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CNS Flashcards

1
Q

According to the Maudsley guidelines, how long does it take before antidepressants exert their effects?

A

1-2weeks

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2
Q

What are the risk factors for antidepressant-induced hyponatraemia?

A 
Old age
Female sex
Low body weight
Low baseline sodium concentration 
Some drug treatments (e.g. diuretics, NSAIDs, carbamazepine, chemotherapy)
Reduced renal function 
Medical co-morbidity (e.g. hypothyroidism, diabetes, COPD, hypertension, head injury, CVA, various cancers)
Warm weather (summer)
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3
Q

What are the five steps to better wellbeing?

A 
Connect
Be active
Keep learning
Give
Take notice
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4
Q

What is the aetiology of depression?

A 
Genetics
Environment
Biochemistry
Endocrine factors
Physical illness
ADRs
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5
Q

What are the two core screening questions used for depression?

A

During the last month have you often been bothered by feeling down, depressed or hopeless?

Do you have little interest or pleasure in doing things?

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6
Q

What are the typical symptoms of depression?

A

Fatigue/loss of energy
Worthlessness/excessive or inappropriate guilt
Recurrent thoughts of death, suicidal thoughts, or actual suicide attempts
Diminished ability to think/concentrate or indecisiveness
Psychomotor agitation or retardation
Insomnia/hypersomnias
Significant appetite and/or weight loss

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7
Q

Define subthreshold depression

A

Where there is more than 2 but less than 5 symptoms of depression

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8
Q

Define persistent subthreshold depression

A

Dysthymia, patient has had at least 2 years of depressed mood on more days than not and has at least 2 but less then 5 symptoms

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9
Q

Define mild depression

A

Few, if any, symptoms in excess of the five required to make the diagnosis, and only minor functional impairment

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10
Q

Define moderate depression

A

Symptoms or functional impairment between mild and severe. Some symptoms would be expected to be marked

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11
Q

Define severe depression

A

Several symptoms in excess of those required to make the diagnosis. Some symptoms would be expected to be severe and markedly interfere with functioning

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12
Q

Give an example of a tricyclics antidepressant

A

Amitriptyline

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13
Q

What are the main ADRs associated with TCAs?

A

Sedation, postural hypotension, tachycardia/arrhythmia, dry mouth, blurred vision, constipation, urinary retention

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14
Q

What are the major interactions associated with TCAs?

A

SSRIs (except citalopram), phenothiazines, cimetidine, alcohol, antimuscarinics, antipsychotics, MAOIs

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15
Q

Give an example of an SSRI

A

Citalopram

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16
Q

What are the main ADRs associated with SSRIs?

A

Nausea, vomiting, dyspepsia, abdominal pain, diarrhoea, rash, sweating, agitation, anxiety, headache, insomnia, tremor, sexual dysfunction, hyponatraemia, cutaneous bleeding disorders

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17
Q

What SSRIs are used in panic disorder?

A

Citalopram, escitalopram, paroxetine

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18
Q

What SSRIs are used in agoraphobia?

A

Citalopram, escitalopram, paroxetine

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19
Q

What SSRIs are used in social anxiety?

A

Escitalopram and paroxetine

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20
Q

What SSRIs are used in GAD?

A

Escitalopram and paroxetine

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21
Q

What SSRIs are used in OCD?

A

Escitalopram, fluoxetine, fluvoxamine, sertralineline

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22
Q

What interactions are associated with SSRIs?

A

MAOIs, lithium

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23
Q

What cautions surround the use of SSRIs?

A

Patients under 18

Epilepsy

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24
Q

What are the contraindications for the use of SSRIs?

A

Mania

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25
What cautions surround the use of TCAs?
Depression associated with suicidal thoughts | Epilepsy
26
Give an example of an SNRI
Venlafaxine, duloxetine
27
What ADRs are associated with SNRIs?
Nausea, HTN, serotonin syndrome
28
What cautions surround the use of SNRIs?
Epilepsy HTN MI
29
What interactions are associated with SNRIs?
MAOIs
30
What class of drug is mirtazapine?
Presynaptic alpha-2 adrenoceptor blocker
31
What ADRs are associated with mirtazapine?
``` Drowsiness Weight gain Fatigue Tremor Dizziness ```
32
What class of drug is trazodone?
Serotonin receptor blocker
33
What ADRs are associated with MAOIs?
Dose-related postural hypotension
34
What interactions are associated with non-selective MAOIs?
Amine-containing drugs including sympathomimetics and tyramine
35
What ADRs are associated with reversible MAOIs?
``` Sleep disturbance Agitation Confusion GI upset Dizziness Headache ```
36
What are the symptoms of serotonin syndrome?
``` Confusion Hypomania Agitation Twitching Tremor Hyperthermia Sweating Shivering Diarrhoea HTN CV collapse ```
37
What drugs cause serotonin syndrome?
``` SSRIs Serotonin precursors (tryptophan) Serotonin agonists (triptans, buspirone, LSD) Serotonin releasing agents (ecstasy, amphetamines) MAOIs Chlorphenamine Pethidine Cocaine Tramadol Levodopa Bromocriptine Lithium St John’s wort ```
38
How does hypertensive crisis occur?
MAOIs reduce breakdown of NA in adrenergic nerve ending => large stores that can be released into synaptic cleft in response to a neuronal discharge or an indirectly acting amine
39
What are the symptoms of hypertensive crisis?
HTN Headache Hyperpyrexia Cardiac arrhythmias
40
How is hypertensive crisis managed?
Alpha-blockade with phentolamine
41
Describe the aetiology of anxiety
``` Stress Genetics Drugs Withdrawal Metabolic disturbances Temporal lobe lesions Rare hormone-secreting tumours e.g. phaeochromocytoma ```
42
What are the clinical features of anxiety?
Apprehension and fear | Somatic symptoms: palpitations, chest pain, SOB, dizziness, loss of libido, headaches, tremor
43
Describe the mechanism of action of benzodiazepines
Selective agonist on GABAa receptors, enhance responses to GABA by facilitating the opening of GABA-activated chloride channels, inhibit neuronal excitability
44
What ADRs are associated with benzodiazepines?
``` Respiratory distress and arrest Sedation/drowsiness Ataxia Confusion and amnesia Tolerance and dependence ```
45
What cautions surround the use of benzodiazepines?
Liver disease Avoid alcohol Avoid in pregnancy
46
What are the contraindications for the use of benzodiazepines?
Respiratory depression | Myasthenia gravis
47
What interactions are associated with benzodiazepines?
CNS depressants | Erythromycin, ketoconazole, fluconazole
48
What advice can be provided for benzodiazepine withdrawal?
Avoid prolonged treatment (<4w) Gradual withdrawal over 4-8 weeks is desirable Switch to a longer acting benzo Dose reduction 2mg diazepam equivalents every 2w
49
What are the effects of benzodiazepine toxicity?
Excessive sedation, respiratory depression, coma
50
What is the treatment for benzodiazepine toxicity?
Romazicon (flumazenil) 0.2mg over 30s, wait 30s, 0.3mg over 30s, then 0.5mg every 60s up to a maximum of 3mg
51
What class of drug is buspirone?
5HT1a partial agonist
52
What ADRs are associated with buspirone?
Nausea Dizziness Headache Restlessness
53
What ADRs are associated with z-drugs?
Drowsiness Headache Weakness Dizziness
54
What cautions surround the use of z-drugs?
Confusion | Dependence
55
What are the contraindications for the use of z-drugs?
Respiratory insufficiency Sleep apnoea Myasthenia gravis
56
What are the symptoms of Alzheimer’s disease?
``` Memory loss Language difficulties Problems with visuospatial skills Difficulties with organisational skills Difficulties with orientation Confusion Hallucinations Delusions ```
57
What are the symptoms of vascular dementia?
Apraxia Slurred speech Dizziness Inability to recognise familiar objects
58
What are the symptoms of DLB?
``` Confusion Attention deficits Problems with executive functions Visuospatial disturbances Hallucinations Repeated falls Syncope Transient, unexplained loss of consciousness Severe autonomic dysfunction Non-visual hallucinations Depression REMS disorders ```
59
What are the symptoms of behavioural variant frontotemporal dementia?
``` Loss of inhibitions Loss of motivation Loss of sympathy or empathy Craving sweet or fatty foods Develop compulsions Difficulty planning, organising or making decisions Lack of insight into their symptoms ```
60
What are the symptoms of progressive non-fluent aphasia?
Slow, hesitant speech Difficulties with grammar Difficulties understanding complete sentences
61
What are the symptoms of semantic dementia?
Asking the meaning of familiar words Difficulty finding the right word or use of generalised words Difficulty recognising familiar people or common objects
62
What class of drug is rivastigmine, donepezil and galantamine?
Acetylcholinesterase inhibitor
63
How do acetylcholinesterase (AChE) inhibitors work?
Block breakdown of acetylcholine, compensating for the loss of cholinergic neurones
64
What ADRs are associated with AChEIs?
``` Miosis Nausea Vomiting Bronchoconstriction Salivation Sweating Urinary incontinence Alertness Agitation Hallucination Dizziness Insomnia Seizures Bradycardia SA and AV block Pain Headache Muscle cramps ```
65
What class of drug is memantine?
Glutamate receptor antagonist
66
What ADRs are associated with memantine?
``` Constipation HTN Dizziness Tiredness Headache Vomiting Hallucinations Confusion Seizures ```
67
What antipsychotic is licensed in treatment of BPSD?
Risperidone

Stage 3 Block 2 (8 decks)

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