OPIC

Question 1

What is the most likely cause of death in homeless?

Answer 1

1. Drug poisening
2. Suicide

Question 2

Patient presents with fall +
- resting tremor
- unsteady and slow gait
- anosmia
- postural drop
- MMSE 26/30

Answer 2

Parkinson’s disease

Question 3

Donepezil contraindications

Answer 3

Contraindications: Bradycardia, heart block, recurrent unexplained syncope

Cautions: asthma, COPD, Sick sinus syndrome, conduction abnormalities

Medications: concurrent treatment with drugs that reduce heart rate

Question 4

SE Donepezil and ECG abnormality caused

Answer 4

• Headaches
• N+V
• Diarrhoea
  -reduced appetite
• dizziness/drowsiness
  -Muscle cramps

ECG - Bradycardia

Question 5

When do we give donepezil and memantine?

Answer 5

Mild-mod Alzheimer’s: Anticholinesterases if no contra
Mod-severe Alzheimer’s: Anticholinesterase +/- memantine or memantine monotherapy

Question 6

memantine contra

Answer 6

epilepsy
history of convulsions

Question 7

SE memantine

Answer 7

Dizziness/drowsiness
Balance affected
Headaches
SOB
Constipation
severe bradycardia

Question 8

Before prescribing donepezil what test would you do in clinic ?

Answer 8

Pulse - as can cause bradycardia

Question 9

Typical antipsychotics names

Answer 9

Haloperidol, chlorpromazine

Question 10

Typical antipsychotics MOA

Answer 10

Dopamine D2 receptor antagonists, blocking dopaminergic transmission in the mesolimbic pathways

Question 11

Typical antipsychotics Side effects

Answer 11

Extrapyramidal side-effects:
akathisia-severe restlessness, cant sit still
Dystonia- muscles contract involuntarily
Parkinsonism- bradykinesia, resting tremor, muscle rigidity
tardive dyskinesia- choreoathetoid movements (chewing, pouting)

hyperprolactinaemia: gallactorrhoea, gynaecomastia

anti-cholinergic- dry mouth, hypersalivation, urinary retention, constipation

Arrythmias- QT prolongation (esp haloperidol)

Question 12

Haloperidol contraindications

Answer 12

• CNS depression/coma

cardiac
- congential long QT syndorme
- QTc prolongation
- torsade de pointes
- ventricular arrythmia

• Lewy body dementia
• parkinson’s

Question 13

What do antipsychotics increase the risk of IN ELDERLY?

Answer 13

stroke
VTE

Question 14

Atypical antipsychotics names and MOA

Answer 14

Clozapine
Risperidone
Olanzapine

Variety of receptors-D2, D3, D4, 5-HT therefore extrapyramidal side-effects and hyperprolactinaemia less common

Question 15

SE of atypical antipsychotics

Answer 15

• impaired glucose tolerance
  -reduced seizure threshold
• sedation, weight gain
• anticholinergic

Question 16

What is neuroleptic malignant syndrome

Answer 16

In pt taking antipsychotics- dopamine blockade= massive glutamate release =neurotoxicity + muscle damage
Occurs within hours to days of starting antipsychotics

Question 17

Symptoms of neuroleptic malignant syndrome?

Answer 17

pyrexia- high temp
muscle rigidity- increased tone
autonomic lability:- hypertension, tachycardia and tachypnoea
agitated delirium with confusion

Rasied CK and AKI can develop

Question 18

Management of Neuroleptic malignant syn

Answer 18

• stop antipsychotic
• PT transfer to medical ward
• IV fluid to prevent renal failure
  medication- dantrolene or bromocriptine

Question 19

If parkinsonism and cognitive symptoms occure at the same time which condition is it?

Answer 19

Lewy body dementia

Parkinsons disease- motot sym present 1 year before cognitive

Question 20

Agitation in lewy body dementia treat with:

Answer 20

Diazepam
not haloperidol due to extrapyramidal symtoms!

Question 21

What is transient global amnesia?

Answer 21

sudden, temporary loss of short term memory and not being able to form new memories

Question 22

how to manage TGA?

Answer 22

explain diagnosis, reassure, discharge