mental health

Question 1

amitriptyline

Answer 1

tricyclic antidepressants

Question 2

mode of action of amitriptyline/trycyclics

Answer 2

inhibit neurona reuptake of serotonin and noradrenaline = more for neurotransmission

also block a wide aray of receptors which accounts for the side effects

Question 3

inidcations for tricyclics

Answer 3

second line treatment from moderate to sevre depresion where SSRIs are ineffective

as treatment for enuropathic pain - not licenced

Question 4

contraindications for tricyclics

Answer 4

those at risk of adverse effects - elderly CVS disease, epilepsy, constipation, prostatic hypettrophy, raised intraocular pressure

Question 5

side effects of tricyclics

Answer 5

blockade of antimuscarinic receptors = dry mouth, constipation, urinary retneiton and blurred vision

sedation and hypotension

arrhythmias and ECG changes

convulsion, hallucinations, mania

breast changes, sexual dysfunction

sudden withdrawal can cause GI upset, nerological and influenza like symptoms

Question 6

interactions of tricyclics

Answer 6

monoamine oxidase inhibitors - together preciptate hypertention and hyperthermia or serotonin syndrome

Question 7

citalopram

Answer 7

SSRI

selective serotonin reuptake inhibitor

Question 8

mode of action of citalopram/SSRI

Answer 8

inhibit neuronal reuptake of serotonin = increased availability for neurotransmission

improve mood and pysical symptoms of depression

Question 9

indications for SSRIs

Answer 9

first line treamtne tfor mod-severe depression + mild if psychological treatment fails

panic disorder

obsessive compulsive disorder

Question 10

contraindications for SSRIs

Answer 10

those at risk of epilepsy and peptic ulcer disease

poor efficacy in yong

hepatic impairment

Question 11

side effects of SSRIs

Answer 11

GI upset, apetite and weight disturbance

hyponatraemia

suicidal thoughts and behaviour

siezurs, bleeding

serotonin syndrome (hyperactivity, altered mental state and neuromuscular excitation)

withdrawal - GI upset, nuerological and flu like symptoms + sleep disturbance

Question 12

interactions of SSRIs

Answer 12

monoamine oxidase inhibitors
can precipitate serotonin syndrome

gastric protection with those taking aspririn or NSAIDs

Question 13

diazepam

Answer 13

benzodiazepines

Question 14

mode of action of diazepam/benzodiazepines

Answer 14

faciliate and enhance binding of GABA to GABAa receptors - depressant effect on syndaptic transmission

Question 15

indications for diazepam/benzodiazepines

Answer 15

first line treamte n tof seizures and status epilepticus

first line treatment of alcohol withdrawal reactions

sedation for interventional procedures if GA is unessary

short term treamtne tof severe, disabling or distressing anxiety

Question 16

contraindicaitons of diazepam/benzodiazepines

Answer 16

elderly more suspectible to side effects

respiratory impairment or neuromuscular disease

liver failure

Question 17

side effects of benzodiazepines

Answer 17

drowsiness, sedation and coma

overdose - airway obstruction

withdrawal reaction like alcohol

Question 18

interactions of benzodiazepines

Answer 18

cytochrome P450 inhibitors increase effects as this is the enzyme used for elimination

Question 19

donepezil

Answer 19

acetylcholinesterase inhibitors

Question 20

mode if action of donepezil/acetylcholinesterase inhbitors

Answer 20

reversible cholinesterase inhibitor, icnreases the amount of acetylcholine in brain = reduce symptoms of dementia

Question 21

inidcations for acetylcholinesterase inhibitors

Answer 21

mild to moderate dementia in alzheimers disease

Question 22

contraindications for acetylcholinesterase inhibitors

Answer 22

sick sinus rhythm syndrome
supraventricular conduction abdnormalities
susecptibility to peptic ulcers
asthma
COPD

Question 23

side effects of acetylcholinesterase inhibitors

Answer 23

nausea
vomiting
anorexia
diarhrhoea
fatigue
insomnia
headache
dizziness
syncope
abnormal dreams

Question 24

interactions of acetylcholinesterase inhiitors

Answer 24

ambenomium

parasympathomimetics antagnoised by antimuscarinics