Pharm-Psych

Question 1

Describe SSRIs in psychopharmacology.

Answer 1

SSRIs are a class of antidepressant medications including fluoxetine, sertraline, paroxetine, citalopram, and fluvoxamine commonly used for depression and anxiety.

Question 2

What are some common side effects of SSRIs?

Answer 2

Sexual side effects, GI distress, agitation, and insomnia are common side effects of SSRIs.

Question 3

How can serotonin syndrome be described?

Answer 3

Serotonin syndrome presents with confusion, agitation, dilated pupils, headache, changes in blood pressure and temperature, nausea, vomiting, diarrhea, rapid heart rate, muscle coordination issues, shivering, and heavy sweating.

Question 4

What is the management approach in an emergency for serotonin syndrome caused by SSRIs?

Answer 4

Management includes hospitalization, stopping the offending drugs, and providing symptomatic treatment such as benzodiazepines for agitation.

Question 5

Define the clinical picture associated with TCAs.

Answer 5

TCAs may cause anticholinergic effects like dry mouth, constipation, urinary retention, sedation, and diplopia, as well as hyperprolactinemia and sexual problems.

Question 6

How is toxicity from TCAs characterized?

Answer 6

Toxicity from TCAs can lead to seizures and arrhythmias, with ECG showing prolongation of QRS complex. Treatment involves IV NaHCO3.

Question 7

What is crucial to avoid when taking MAOIs?

Answer 7

Taking MAOIs with high-tyramine foods like cheese and red wine can lead to a hypertensive crisis.

Question 8

What is the most important thing to monitor in patients on MAOIs?

Answer 8

It is crucial to monitor tyramine-rich food intake in patients on MAOIs to prevent hypertensive crises.

Blood pressure

Question 9

Describe the indications for lithium use.

Answer 9

Acute mania and prophylaxis in bipolar disorders.

Question 10

What are some side effects of lithium?

Answer 10

Nephrogenic diabetes insipidus, thirst, polyuria, acne, hypothyroidism, weight gain, nausea, diarrhea, seizures, teratogenicity, tremor.

Question 11

What is the therapeutic window of lithium?

Answer 11

Narrow.
0.8 mmol/L to 1.4 mmol/L
Normal: review every 3 months

Question 12

What are some symptoms of lithium toxicity?

Answer 12

Ataxia, dysarthria, delirium, acute renal failure.

Question 13

How should lithium be managed in patients with impaired renal function?

Answer 13

It should be avoided.

Question 14

Describe the indications for carbamazepine use.

Answer 14

Second-line mood stabilizer, anticonvulsant, drug of choice for trigeminal neuralgia.

Question 15

What are some side effects of carbamazepine?

Answer 15

Skin rash, leukopenia.

Question 16

What are typical antipsychotics?

Answer 16

Haloperidol, droperidol, fluphenazine, thioridazine, chlorpromazine.

Question 17

What are the indications for typical antipsychotics?

Answer 17

Psychotic disorders, acute mania, Tourette’s syndrome.

Question 18

Describe the symptoms of neuroleptic malignant syndrome.

Answer 18

Fever, muscle rigidity, autonomic instability, impaired conscious level, elevated CK.

Question 19

How is neuroleptic malignant syndrome treated?

Answer 19

Stop medication, use dantrolene or bromocriptine.

Question 20

What is acute dystonia and how is it treated?

Answer 20

Involuntary muscle contraction or spasm, treated with benztropine or diphenhydramine.

Question 21

What is akathisia and how can it be managed?

Answer 21

Restlessness in the legs, continuous walking; manage by decreasing the dose or using beta-blockers, benzodiazepines, or anticholinergics.

Question 22

What is tardive dyskinesia?

Answer 22

Involuntary movements, especially of the tongue, which is irreversible.

Question 23

Describe the side effects of clozapine.

Answer 23

Weight gain, Type 2 DM, Agranulocytosis (requires CBC monitoring).

Question 24

What are the common side effects of olanzapine?

Answer 24

Marked sedation and weight gain.

Question 25

Define pseudoparkinsonism and provide examples of its symptoms.

Answer 25

Pseudoparkinsonism is a side effect of neuroleptic medications such as shuffling gait and rigidity.

Question 26

How can pseudoparkinsonism be managed when caused by neuroleptics?

Answer 26

It can be managed with anticholinergic medication (benztropine) or dopamine agonists (amantadine), along with decreasing the dose of the neuroleptic or discontinuing it if tolerated.

Question 27

Do olanzapine and risperidone have different side effect profiles?

Answer 27

Yes, olanzapine is associated with weight gain and sedation, while risperidone can cause insomnia, weight gain, acne, and rash.

Question 28

Describe the indications for Electroconvulsive Therapy (ECT).

Answer 28

Indications include severe cases of mental illness with no response to medical treatment, suicidal patients with contraindications to medical treatment, and postpartum psychosis.

Question 29

What is the value of ECT in treatment?

Answer 29

ECT provides an immediate response in severe cases, making it very important in certain situations.

Question 30

How can akathesia caused by marijuana be managed?

Answer 30

The first step in management is to stop marijuana usage.

Question 31

What is the significance of obtaining consent from the mental health tribunal for ECT?

Answer 31

It is very important to obtain consent from the mental health tribunal before proceeding with ECT.

Question 32

Compare olanzapine and risperidone in the treatment of psychosis.

Answer 32

Both olanzapine and risperidone can be used for psychosis, but olanzapine is preferred due to having fewer side effects.

Question 33

What is the first-line therapy for schizophrenia according to the content?

Answer 33

Olanzapine is considered the first-line therapy for schizophrenia.

According to the RACGP guidelines, the first-line therapy for schizophrenia typically includes antipsychotic medications. Here are the recommended treatments:

1. Second-Generation Antipsychotics (SGAs): These are preferred due to their lower risk of extrapyramidal side effects compared to first-generation antipsychotics. Examples include:
   
   • Risperidone
   • Olanzapine
   • Quetiapine
   • Aripiprazole
   • Clozapine (often reserved for treatment-resistant cases due to its side effect profile)

2. First-Generation Antipsychotics (FGAs): These may be considered if SGAs are not effective or not tolerated. Examples include:
   
   • Haloperidol
   • Chlorpromazine
   • Fluphenazine

• Psychosocial interventions: Cognitive-behavioral therapy (CBT), social skills training, supported employment, and family interventions.
• Other medications: Antidepressants or mood stabilizers may be added if there are co-occurring mood disorders or persistent depressive symptoms.

• Clozapine: This is often considered for patients who do not respond adequately to other antipsychotics.

Regular monitoring and review of medication efficacy and side effects are essential components of managing schizophrenia.

Question 34

Which antipsychotic is known for causing palpitations?

Answer 34

Clozapine is the most common antipsychotic to cause palpitations.

Question 35

What should be monitored in patients on antipsychotic medications?

Answer 35

Blood sugar and lipid profile should be monitored in patients on antipsychotic medications.

Question 36

Define synergistic effect in the context of Donepezil and SSRIs.

Answer 36

Synergistic effect refers to an enhanced effect when Donepezil and SSRIs are used together.

Question 37

What is the first step in managing psychosis and marijuana use?

Answer 37

The first step is to stop marijuana usage.

Question 38

Describe the initial steps when a homeless psychotic patient is brought to the police.

Answer 38

First step involves obtaining collateral history from the police. If agitated, administer antipsychotic medication and consider admission. If not agitated, still consider admission to a psychiatric unit.

Question 39

Define the differential diagnosis of sudden withdrawal manifestations in teenagers.

Answer 39

1. Drug abuse, which needs to be excluded first. 2. Depression, associated with decreased appetite, energy, sleep disturbances, and suicidal thoughts. 3. Prodrome of schizophrenia, associated with delusions and hallucinations.

Question 40

How do you manage delusions with pregnancy using medication?

Answer 40

Olanzapine is used for delusions related to pregnancy.

Question 41

What is the recommended action if a mother complains about her son’s behavior?

Answer 41

The first step is to conduct an interview with the son. 🍀🍀

Question 42

Do you know the current treatment of choice for an agitated person based on their condition?

Answer 42

For a psychotic patient, delirious patient, postoperative patient: antipsychotic medications are preferred. For amphetamine toxicity: benzodiazepines. For alcoholics: diazepam. For alcoholic with liver impairment: lorazepam. For mentally retarded children: risperidone.

Question 43

Describe overvalued ideas in the context of psychiatric terms.

Answer 43

Overvalued ideas are unreasonable, strongly held beliefs or ideas that are acceptable to the patient but beyond the bounds of reason.

Question 44

What are obsessions in psychiatric terms?

Answer 44

Obsessions are persistent, unwanted, and intrusive ideas, thoughts, impulses, or images.

Question 45

How should urgent surgery be approached in a patient with dementia?

Answer 45

The first step is to ask for advanced directives.