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GPhC Exam > CNS: Mental Health Disorders > Flashcards

CNS: Mental Health Disorders Flashcards

1
Q

What are some psychological symptoms of anxiety? (5)

A 
Restlessness
Worry
Fear
Difficulty concentrating
Irritability
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2
Q

What are some physical symptoms of anxiety? (5)

A 
Heart palpitations
Shortness of breath
Excessive sweating
Insomnia
Trembling/shaking
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3
Q

What two drugs are recommended for acute anxiety?

A

Benzodiazepines

Buspirone

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4
Q

What is the mechanism of action of busprione?

A

It is a 5HT-1A agonist

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5
Q

What can be given for the management of chronic anxiety (lasting > 4 weeks)?

A

Antidepressants; combined with a benzodiazepine if the antidepressant takes too long to produce an effect

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6
Q

What are the first-line drug classes for generalised anxiety disorder (GAD)?

A

SSRIs and SNRIs

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7
Q

What are some examples of SSRIs?

A 
Sertraline
Paroxetine
Citalopram
Escitalopram
Fluoxetine
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8
Q

Which SSRI can be used for moderate to severe depression in children?

A

Fluoxetine (licensed in children aged 7 and up)

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9
Q

What can be used in GAD if first-line treatment options are ineffective/not tolerated?

A

Pregabalin

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10
Q

What is the first-line treatment for panic disorder?

A

SSRIs

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11
Q

What can be used for second-line treatment of panic disorder? (2)

A

Clomipramine

Imipramine

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12
Q

What drug class be used as first-line therapy for OCD, PTSD and social anxiety disorder?

A

SSRIs

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13
Q

What drug be used as second-line therapy for OCD?

A

Clomipramine

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14
Q

What drug be used as second-line therapy for social anxiety disorder?

A

Moclobemide

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15
Q

What is one of the main uses of benzodiazepines?

A

Short-term relief of severe anxiety that causes unacceptable distress

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16
Q

Which three benzodiazepines are short-acting?

A

Lorazepam
Oxazepam
Temazepam

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17
Q

What are some examples of long-acting benzodiazepines?

A

Clonazepam
Chlordiazepoxide
Diazepam

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18
Q

What is the mechanism of action of benzodiazepines?

A

Binds allosterically to GABA-A receptors, which enhances the effect of GABA → increased levels of Cl- into the neuron (inhibitory effect)

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19
Q

What is an important caution of all benzodiazepines?

A

Paradoxical increase in hostility and aggression

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20
Q

What are some side effects of benzodiazepine overdose? (6)

A

Drowsiness
Dysarthria (speech difficulties)
Ataxia (impaired coordination)
Nystagmus (uncontrollable movement of the eyes)
(Sometimes) respiratory depression and coma

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21
Q

What dispensary warning label should be present on all benzodiazepines?

A

“This medicine may make you sleepy. If this happens, do not drive or use tools or machines. Do not drink alcohol.”

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22
Q

Why should benzodiazepines only be used short term? (2)

A

Risk of tolerance and dependence

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23
Q

What should be offered to patients with GAD before drug treatment?

A

Psychological treatment

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24
Q

What are symptoms of benzodiazepine withdrawal?

A 
Anxiety
Insomnia
Weight loss/loss of appetite
Tremors
Sweating
Tinnitus
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25
When can benzodiazepine withdrawal occur?
Within a day of stopping a short-acting benzodiazepine | Within 3 weeks of stopping a long-acting benzodiazepine
26
How should a benzodiazepine be withdrawn in patients who were using it long term? (3)
1. Gradually (over 1 week) convert to equivalent dose of diazepam ON 2. Reduce diazepam by 1-2 mg every 2-4 weeks 3. Reduce further, then stop
27
What are some important benzodiazepine drug interactions? (2)
Increased sedation and and CNS depressant effects when taken with other sedatives e.g. alcohol, opioids, antihistamines, antidepressants, antipsychotics, barbiturates, Z-drugs Increased plasma conc. when taken with CYP inhibitors e.g. amiodarone, diltiazem, macrolides, fluconazole
28
What risk is associated with short-acting benzodiazepines?
Greater risk of withdrawal symptoms
29
What two benzodiazepines are very occasionally used for the control of panic attacks?
IV diazepam and IV lorazepam
30
What is ADHD?
Attention Deficit Hyperactivity Disorder; characterised by hyperactivity, impulsivity and inattention
31
What is the first-line drug management for ADHD?
Methylphenidate or lisdexamfetamine
32
What is the second-line drug management for ADHD?
Atomoxetine
33
How long should ADHD medicines be trialed for before trying an alternative?
6 weeks
34
What is the mechanism of action of methylphenidate?
Dopamine and noradrenaline reuptake inhibitor
35
What are some side effects of methylphenidate? (4)
Loss in appetite/weight Increased heart rate/blood pressure Tourette's syndrome Growth restriction (in children)
36
What needs to be monitored in patients taking methylphenidate and lisdexamfetamine and atomoxetine? (6)
``` Pulse Blood pressure Height Weight Appetite Psychiatric symptoms ```
37
What is important to remember when dispensing methylphenidate?
Modified release preparations should be prescribed by brand
38
What is the mechanism of action of lisdexamfetamine?
Promotes the release of dopamine and noradrenaline from the presynaptic neuron
39
What are some side-effects of lisdexamfetamine? (4)
Loss in appetite; anorexia Increased heart rate/blood pressure Tourette's syndrome Growth restriction (in children)
40
What are some signs of a lisdexamfetamine overdose?
Wakefulness, hyperactivity and paranoia | followed by exhaustion, convulsions, hyperthermia and coma
41
What is the mechanism of action of atomoxetine?
Noradrenaline reuptake inhibitor
42
What are some side effects of atomoxetine? What should patients be made aware of?
QT prolongation (avoid other drugs that do this) Suicidal ideation - patients should report any suicidal thoughts/self harm Hepatotoxicity - patients should report signs of liver damage
43
What is bipolar disorder?
A long-term mental illness characterised by extreme depressed and elated moods
44
What are the two types of episodes experienced in bipolar?
Depression and mania
45
What is mania?
Abnormal and persistent [physical and mental] hyperactivity
46
What is hypomania?
A milder form of mania
47
What is the aim of antimanic treatment? (2)
To manage an acute episode | To prevent the reoccurrence of further episodes
48
When treating co-existing bipolar disorder, when should antidepressants be avoided? (3)
In patients with: Rapid-cycling bipolar disorder Recent history of mania/hypomania Rapid mood fluctuations
49
What can be used to treat acute episodes of mania?
Antipsychotics, e.g. risperidone, olanzapine, quetiapine
50
What can be used in the initial stages of treatment of mania [for behavioural disturbance and agitation]?
Short-term benzodiazepines e.g. lorazepam
51
When treating acute manic episodes, what can be added to antipsychotics if the response is inadequate? (2)
Lithium or sodium valproate
52
What can be used for the initial treatment of severe, acute mania?
An antipsychotic AND lithium or valproate
53
What can be used long-term to prevent the reoccurrence of mania? (2)
Olanzapine, if a previous episode was responsive to it; | +/- lithium or sodium valproate if they have frequent relapses/severe impairment
54
What is asenapine?
A second-generation antipsychotic used for treatment of moderate to severe manic episodes
55
How long should the withdrawal period of antipsychotics be if the patient is taking other antimanics?
4 weeks
56
How long should the withdrawal period of antipsychotics be if the patient is NOT taking other antimanics?
3 months
57
What is carbamazepine licensed for in the management of bipolar disorder?
Preventing the reoccurrence of acute episodes in patients who are unresponsive to lithium therapy
58
When can valproate be used for the treatment of manic episodes associated with bipolar disorder? (2)
As monotherapy when lithium is contraindicated or not tolerated As adjunct therapy when lithium alone is ineffective
59
What does the MHRA advise re: valproate in women?
It should not be used in women of childbearing potential, unless: There are no alternative options Conditions of the Pregnancy Prevention Programme are met
60
What can be changed if a patient on valproate for bipolar experiences frequent relapse or functional impairment? (2)
Lithium OR olanzapine can replace valproate as monotherapy; or can be added to the valproate
61
What can be added as adjunct therapy when increasing the dose of valproate is not sufficient in managing an acute manic episode?
An antipsychotic e.g. risperidone, olanzapine, quetiapine
62
How long might it take for the prophylactic effect of lithium to occur after initiating treatment?
6-12 months
63
What is lithium indicated for? (3)
Prophylaxis and treatment of bipolar disorder Resistant depression Aggressive/self-harming behaviour
64
What are some symptoms of depression? (6)
``` Apathy Low-self esteem Suicidal thoughts Low energy Changes in weight/appetite Insomnia ```
65
What drug class is first-line for treating depression?
SSRIs (selective serotonin reuptake inhibitors) | e.g. citalopram, escitalopram, fluoxetine, sertraline, paroxetine
66
Why are SSRIs favoured over other classes for the treatment of depression? (4)
Better tolerated | Safer in overdose
67
Which antidepressant is safe to use in patients with unstable angina or who have had a recent MI?
Sertraline
68
What are some examples of tricyclic antidepressants (TCAs)?
``` Amitriptyline Clomipramine Dosulepin Imipramine Lofepramine Nortriptyline ```
69
Why are TCAs less likely to be used to treat depression? (4)
``` More toxic in overdose More likely to be discontinued due to side-effects More sedating (than SSRIs) More antimuscarinic/cardiotoxic side-effects (than SSRIs) ```
70
Why are monoamine oxidase inhibitors (MAOIs) rarely used to treat depression?
They have many drug- and food-drug interactions
71
What is an example of a reversible MOAI?
Moclobemide (short-acting and does not require a washout period)
72
What is a washout period?
The length of time between stopping one drug and starting another one for the same indication; usually to make sure drugs with long half-lives are fully cleared from the body before initiating new treatment
73
How long do SSRIs take to work?
2 weeks
74
How should SSRIs be monitored for efficacy after initiating?
Review every 1-2 weeks after starting treatment | Wait at least 4 weeks (6 weeks in elderly) before deeming ineffective
75
How long should treatment of depression using SSRIs last?
At least 6 months (12 months in elderly)
76
How long should treatment of anxiety using SSRIs last?
At least 12 months (higher risk of relapse)
77
How long should treatment of recurrent depression using SSRIs last?
At least 2 years
78
What steps can be taken if a patient's depression fails to respond to SSRI treatment? (2)
Increase dose; or | Switch to a new SSRI or mirtazapine
79
What second-line drugs are can be used if SSRIs are ineffective?
Lofepramine [...]

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