Mental Health

Question 1

Example of tricyclics

Answer 1

amitriptyline

Question 2

how does amitriptyline work

Answer 2

• inhibits reuptake of serotonin and noradrenaline from the synaptic cleft
• also blocks other receptors such as dopamine, histamine, muscarinic…etc.,

Question 3

when is amitriptyline used?

Answer 3

• moderate-severe depression (when SSRIs are contraindicated / ineffective)
• neuropathic pain (at a lower dose as this is off-licence)

Question 4

side effects of amitriptyline

Answer 4

hypotension, arrhythmias, sedation

more serious: convulsions, mania, hallucinations

Question 5

when is amitriptyline contraindicated

Answer 5

• cardiac conditions, elderly, increased risk of epilepsy, glaucoma, constipation, prostatic hypertrophy

Question 6

possible interactions with amitriptyline

Answer 6

mono-amine oxidase inhibitors

Question 7

what is an SSRI

Answer 7

selective serotonin re-uptake inhibitor

Question 8

example of SSRI

Answer 8

citalopram

Question 9

how do SSRIs work

Answer 9

inhibit neuronal re-uptake of serotonin from the synaptic cleft - increasing serotonin availability for neurotransmission

Question 10

when are SSRIs used

Answer 10

• depression
• OCD
• panic disorders

Question 11

contraindications for SSRIs

Answer 11

• young people be cautious (risk of increased thoughts of self harm / suicide)
• epilepsy
• hepatic impairment (be cautious)

Question 12

side effects of citalopram

Answer 12

GI disturbance, seizures, self harm and suicidal thoughts, increased risk of bleeding, hyponatraemia

Question 13

possible interactions of citalopram

Answer 13

mono-amine oxidase inhibitors

Question 14

difference between SSRIs and tricyclic antidepressants

Answer 14

• Tricyclic: also inhibits re-uptake of noradrenaline

- Tricyclic also blocks other receptors (increasing adverse effects)

Question 15

examples of benzodiazepines

Answer 15

diazepam, lorazepam, temazepam

Question 16

how do benzodiazepines work

Answer 16

• facilitate and enhance binding of GABA to GABAa receptors
• GABA is an inhibitory neurotransmitter which binds to the GABA chloride channel, allowing Cl- to enter the cell
• Cl- allows the cell to become more resistant to depolarisation
• overall, it gives a depressant effect on synaptic transmission

Question 17

when are benzodiazepines used?

Answer 17

• first line treatment for seizures and static epilepticus
• alcohol withdrawal reactions
• sedatives
• anxiety and insomnia as short term relief (sleeping tablets)

Question 18

when are benzodiazepines contraindicated?

Answer 18

• increased effect on elderly
• severe renal impairment
• severe neuromuscular disease
• liver failure

Question 19

side effects of benzodiazepines

Answer 19

drowsiness, sedation, coma, airway obstruction which could lead to death, dependence and withdrawal symptoms

Question 20

interactions of benzodiazepines

Answer 20

be cautious giving them with other sedately drugs

Question 21

example of acetylcholinesterase inhibitors

Answer 21

donepezil, rivastigmine, galantamine

Question 22

how do acetylcholinesterase inhibitors work

Answer 22

• inhibit acetylcholinesterase enzymes which breakdown acetylcholine
• this increases availability of acetylcholine which decreases the rate of cognitive decline as it is involved in functions such as learning and memory

Question 23

when are acetylcholinesterase inhibitors used?

Answer 23

• alzheimers disease / dementia

- sometimes in dementia of Parkinson’s dosease

Question 24

contraindications for acetylcholinesterase inhibitors

Answer 24

increases effects of: asthma, COPD, PUD

do not use if: heart block, sick sinus syndrome

Question 25

side effects for acetylcholinesterase inhibitors

Answer 25

Nausea and vomiting, diarrhoea, altered / aggressive behaviour, COPD and asthma exacerbations, serious effects include bradycardia, heart block, peptic ulcers, bleeds

Question 26

possible interactions of acetylcholinesterase inhibitors

Answer 26

• if on NSAIDs, increased risk of PUB

- if on beta blockers, increased risk of bradycardia