Mental health

Question 1

Amitriptyline, imipramine & nortriptyline

Answer 1

TCAs

Question 2

Cautions for TCAs

Answer 2

Pregnancy- cat c
Hepatic- halve dose
Elderly- increased rick of falls
Children- specialist use only

Question 3

Citalopram, fluoxetine, sertraline

Answer 3

SSRIs

Question 4

Cautions for SSRIs

Answer 4

Pregnancy- cat C/ paroxetine is cat D
Hepatic- reduce in impairment
Elderly- avoid in high risk of bleeding
Children- specialist advice and only fluoxetine

Question 5

Venlafaxine, desvenlafaxine, duloxetine

Answer 5

SNRIs (serotonin and noradrenaline reuptake inhibitors)

Question 6

Cautions for SNRIs

Answer 6

Elderly- avoid in high risk of bleeding
Pregnancy- cat c
Hepatically- reduce in impairment

Question 7

phenelzine & tranylcypromine

Answer 7

non-selective monoamine oxidase inhibitor (last line)

Question 8

Cautions for non-selective MAOIs

Answer 8

Elderly- caution due to hypotension and CVD risk, start halved
Pregnancy/BF- no data, see specialist
Hepatic- avoid in liver disease
Not for use in CHD, epilepsy, diabetes, angina

Question 9

First line pharmacological treatment for bipolar

Answer 9

quetiapine (antipsychotic)

Question 10

First line prophylaxis of bipolar

Answer 10

lithium

Question 11

Cautions for lithium

Answer 11

Elderly- renal function and hyponatremia risk/reduce dose
Pregnancy- avoid
BF- specialist
Not to be used in renal impairment, uncontrolled hypo/hyperthyroidism

Question 12

Treatment of anxiety disorders (last line/short term)

Answer 12

benzodiazepines

Question 13

Cautions for benzos

Answer 13

Elderly- short term only/reduced dose
Children- avoid
Pregnancy- avoid in 3rd trimester
BF- monitor for sedation
Hepatic- avoid in severe impairments/short acting in mild
Renal- lower initial dose
High risk of abuse

Question 14

Pharmacological treatment for OCD

Answer 14

SSRIs and TCAs (higher dose for OCD than depression)

Question 15

Last line treatments for true insomnia

Answer 15

Benzodiazepines, zolpidem & melatonin