Nervous System Overview Flashcards
What is a side effect of first generation antipsychotic and give examples
Weight gain and anti-cholinergic effects are more pronounced in first gen antipsychotic or atypical antipsychotic.
Atypical antipsychotic.
Which TWO are not a side effect of atypical antipsychotic
(a) blurred vision
(b) diarrhoea
(c) tachycardia
(d) alertness
(e) urinary retention
(b)
(d)
Main action of histamine.
•Contract smooth muscle
•Dilate capillaries
•Secretion of gastric acid
•Promotes awakeness
Fill table of histamine.
H1 antagonist adverse effect
Tremor
Blurred vision
GI upset
Dry mouth
Tachycardia
H2 Antagonist adverse effects
Fatigue
Constipation
Drowsiness
Adverse effects of Antagonising D1/2 receptors.
D1 receptor inhibition
Increased extrapyramidal side effects, nigrostrial pathway in where D2 receptors are involved: Acute dystonia+tardive dyskinesia.
What are the positive effects of antagonising D1/2 receptor.
Decrease in positive symptoms by inhibiting D1 receptors implicated mesolimbic system.
Which neurotransmitters are thought to be involved in depression?
Noradrenaline and Serotonin.
What are the core symptoms of depression.
Anergia
Anhedonia.
Persistent low mood.
What are the physical symptoms of depression.
Sleep disturbance
Appetite alteration
Self harm
How long do antidepressants take to work?
Antidepressants show effects during weeks 1-2 (however full response will be gradual over several weeks and months). 4-6 weeks.
Nausea
Dry mouth
GI upset: Constipation/Diarrhoea.
Nausea
Dry mouth
GI upset: Constipation/Diarrhoea.
What would you monitor in an elderly patient taking a tricyclic antidepressant?
New onset Confusion
Drowsiness
Blood pressure/ECG
Treatment pathway for antidepressants.
Picking the terms below, pick what terms describes the the statement well.
(a) efficacy
(b) acceptability
(c) Cost-effectiveness
- Reboxetine is not be picked as first line.
- Setraline is better than escitalopram.
- Setraline selected over fluoxetine.
- Setraline selected over mirtazepine.
- (a) + (b)
- (c)
- (a) Setraline, escitalopram, venlafaxine, mirtazepine, were more efficacious than duloxetine, fluoxetine, fluvoxamine, paroxetine and reboxetine.
4.(b) Setraline is more acceptable than mirtazepine and venlafaxine.
What are the symptoms of antidepressant discontinuation (FINISH)
F: Flu-like symptoms
I: Insomnia
N: Nausea
I: Instability
S: Sensory disturbances
H: Hyper arousal
Which one is not symptom of antidepressant discontinuation
(a) Flu-like
(b) Electric shock sensation
(c) Hyper arousal
(d) diarrhoea
(e) instability
(d) diarrhoea
Which ONE is NOT true about antidepressant.
(a) Mild depression is treated with SSRis first
(b) Antidepressants have an immediate onset of action but takes weeks for full effect to be seen.
(c) Counselling is part of successful treatment of someone with mild depression
(d)Combination CBT and antidepressant is used in more severe depression
(a) Mild depression is worked out with non-pharmacological methods first…
Select the best option for the scenarios below.
(a) Mirtazepine
(b) Venlafaxine
(c) Lithium
(d) Seteraline
(e) Fluoxetine
- A 45 year old patient is currently on SSRI and is not showing signs of improvement. Which agent would you give.
- A 60 year old patient is initiated on mirtazepine but cannot tolerate it due to dizziness. Which agent would you give.
- Patient stepped on venlafaxine and treatment has been unsuccessful after 2 months.
- (a) Mirtazepine
- (b) Venlafaxine
- (d) +(a) Seteraline and Mirtazepine.
Which side effect is LIKELY with haloperidol
(a) Galactorrhea
(b) Weight gain
(c) hypotension
(d) agranulocytosis
(a) It has D2 antagonism work thus tuberoinfundibular and nigrostriatal pathway is significantly affected.
Which side effect is NOT likely with clozapine.
(a) dose related EPS
(b) Sedation
(c) QTc prolongation
(d) weight gain
(A)
Which side effect is MORE likely with olanzapine
(a) QTc prolongation
(b) weight gain
(c) hypotension
(d) agranulocytosis
(b)
Define dystonia
Sustained muscle contraction e.g. oculogyric crisis
How do you manage: a. Dystonia b. Pseudo-Parkinsonism c. Akathisia d. Tardive dyskinesia
What is the plasma level aimed for with clozapine
0.35-0.5 mg/L
Major metabolism route for clozapine
CYP1A2
What are the four important side effects associated with clozapine
Constipation
Myocarditis
Seizures
Pneumonia
Which EFFECT listed below increases the risk of lithium toxicity
(A) hypernatremia
(B) Addison’s disease
(C) Hyperkalemia
(D) SGLT2 inhibitor
(B) Addison’s diseases: lack of adrenal or cortex hormones leading to thirst/dehydration state.
Which EFFECT listed below decrease lithium levels
(A) hypernatremia
(B) Addison’s disease
(C) Hyperkalemia
(D) SGLT2 inhibitor
(D) SGLT2 inhibitor
First line for bipolar depression
- Fluoxetine +olanzapine or quetiapine
What is the mainstay treatment for bipolar disorder.
Antipsychotics and mood stabilisers.
Using these options
(a) Efficacy
(b) safety
(c) acceptability
Describe the sentences below for treatment of acute bipolar (mania):
1. Risperidone, haloperidol and olanzapine is used over other antipsychotic….
2. Olanzapine is preferred over lithium.
- (B) Shows better efficacy
- (B) and (C) Shows better efficacy and acceptability
Overall what antipsychotic are show good efficacy when treating acute bipolar disorder (mania).
Risperidone, haloperidol and olanzapine.
What are the two agents that are licensed for acute mania.
Lithium and Valproate.
True or False: Sodium valproate is licensed for treatment of bipolar disorder.
False, Sodium valproate is unlicensed in treatment of bipolar disorder.
What is the treatment of choice for bipolar DEPRESSION.
Fluoxetine + olanzapine or quetiapine
