Mental Health

Question 1

What drug class is Amitriptyline?

Answer 1

Tricyclic Antidepressant (TCAs)

Question 2

What are TCAs indicated for?

Answer 2

Moderate to severe depression (second line)
Neuropathic pain (not licensed)

Question 3

How do TCAs work?

Answer 3

Inhibit neuronal reuptake of serotonin and noradrenaline from synaptic cleft
Increase availability for neurotransmission
Block a wide array of receptors (muscarinic, histamine, adrenergic and dopamine) - wide range of side effects

Question 4

What are the side effects of TCAs?

Answer 4

Sedation
Hypotension
Arrhythmias
ECG changes
Convulsions
Hallucinations
Mania
Breast changes
Extrapyramidal symptoms (rare)

Question 5

What are the contraindications of TCAs?

Answer 5

Elderly
CVD
Epilepsy
BPH
Raised Intraocular pressure

Question 6

Important drug interactions of TCAs?

Answer 6

Monoamine oxidase inhibitors - do same thing - can cause hypertension and hyperthermia or serotonin

Question 7

What drug class is Citalopram?

Answer 7

SSRI

Question 8

What are SSRIs indicated for?

Answer 8

First line for moderate to sever depression
Can be for mild as well
Panic disorder
OCD

Question 9

How do SSRIs work?

Answer 9

Inhibit neuronal reuptake of serotonin

Question 10

What are the side effects of SSRIs?

Answer 10

GI
Appetite loss
Weight disturbance (loss or gain)
Hyponatraemia
Suicidal thoughts and behaviour can increase
Lower seizure threshold
Prolong QT interval
Can get withdrawal symptoms if sudden removal

Question 11

What are the contraindications of SSRIs?

Answer 11

Epilepsy
Peptic Ulcer Disease
Young people

Question 12

Important drug interactions of SSRIs?

Answer 12

Monoamine oxidase inhibitors

Antipsychotics that increase the QT interval

Question 13

What drug class is Diazepam?

Answer 13

Benzodiazepine

Question 14

What are Benzodiazepines indicated for?

Answer 14

Management of seizures and status epilepticus (1st line)
Alcohol withdrawal reactions (1st line)
Sedation for interventional procedures 
Short term for severe anxiety
Short term for severe insomnia

Question 15

How do Benzodiazepines work?

Answer 15

Targets GABA
Benzos facilitate and enhance binding of GABA to receptor
This depresses synpatic transmission

Question 16

What are the side effects of Benzodiazepines?

Answer 16

Drowsiness
Sedation
Loss of airway reflexes in overdose
Can become dependant
Abrupt cessation of treatment (alcohol withdrawal esque symptoms)

Question 17

What are the contraindications of Benzodiazepines?

Answer 17

Elderly
Respiratory impairment
Neuromuscular disease
Liver failure

Question 18

Important drug interactions of Benzodiazepines?

Answer 18

P450 inhibitors stop elimination

Benzo have additive effects to other sedating drugs - opiods and alcohol

Question 19

What drug class is Donepezil?

Answer 19

Acetylcholinesterase Inhibitor

Question 20

What are Acetylcholinesterase Inhibitors indicated for?

Answer 20

Treating dementia symptoms in mild to moderate Alzheimers

memory loss and behavioural changes

Question 21

How do Acetylcholinesterase Inhibitors work?

Answer 21

Increase levels of ACh in brain
Slows destruction of ACh
By blocking cholinesterase

Question 22

What are the side effects of Acetylcholinesterase Inhibitors?

Answer 22

Hallucinations
Insomnia
Muscle cramps
Urinary incontinence
Rash
Peptic Ulcer Disease

Question 23

What are the contraindications of Acetylcholinesterase Inhibitors?

Answer 23

Peptic Ulcer disease
Asthma, COPD
Antipsychotic treatment
SVT conductions abnormalities

Question 24

Important drug interactions of Acetylcholinesterase Inhibitors?

Answer 24

Interferes with non-depolarising muscle relaxants