Pharmacology

Question 1

What is the first line treatment for anxiety?

Answer 1

Psychological approaches: relaxation, mindfulness, CBT techniques

Question 2

What pharmacological agents are indicated for acute severe anxiety?

Answer 2

Anxiolytics: benzodiazepines (ST), Buspirone, SSRIs

Question 3

Non-anxiolytics that have anxiolytic properties:

Answer 3

Antidepressants
Antipsychotics
Beta-adrenergic antagonists (ST action)
Pregabalin

Question 4

Agents used to control somatic symptoms of anxiety?

Answer 4

Beta-adrenergic agonists (albuterol, levalbuterol)

Question 5

Examples of benzodiazepines include:

Answer 5

Short acting (<12 hours): lorazepam, temazepam, oxazepam, triazolam
Long acting (>24 hours): diazepam, nitrazepam, flurazepam, chlordiazepoxide, clobazam, clorazepate, alprazolam
LA likely to cause dependence

Question 6

Side effects of benzodiazepines

Answer 6

headache
drowsiness
ataxia
aggression (reduced inhibitions)
paradoxical disinhibition

Question 7

Examples of neuroleptics include:

Answer 7

Haloperidol
Chlopromazine
Clozapine
Risperidone
Olanzapine

Question 8

Examples of atypical antipsychotics include:

Answer 8

Clozapine
Risperidone
Olanzapine
Aripiprazole

Question 9

Examples of typical antipsychotics include:

Answer 9

Haloperidol
Chlopromazine

Question 10

Side effects of antipsychotics:

Answer 10

antimuscarinic: dry mouth, blurred vision, urinary retention, constipation
sedation, weight gain
raised prolactin > galactorrhea
impaired glucose tolerance
neuroleptic malignant syndrome
reduced seizure threshold (greater with atypicals)
prolonged QT interval (particularly haloperidol)

Question 11

What are the features of neuroleptic malignant syndrome?

Answer 11

hyperthermia
fluctuating level of consciousness
muscle rigidity
autonomic dysfunction (fever, tachycardia, labile BP, sweating)

Question 12

What are the extra-pyramidal side effects associated with antipsychotics?

Answer 12

Parkinsonism
acute dystonia / sustained muscle contraction (e.g. torticollis, oculogyric crisis) - can be managed with procyclidine
akathisia (severe restlessness)
tardive dyskinesia (involuntary movement of facial muscles)

Question 13

What are the risks of prescribing antipsychotics to elderly patients?

Answer 13

Increased risk of stroke
Increased risk of VTE

Question 14

What is the management of neuroleptic malignant syndrome?

Answer 14

Stop antipsychotics (dopamine antagonists) / consider dopamine agonist
Rehydration + cooling
Treatment of AKI, rhabdomyolysis, hyperkalemia
Benzodiazepines (sedation)

Question 15

What class of drugs are antipsychotics?

Answer 15

AKA Neuroleptic drugs
dopamine antagonists

Question 16

What monitoring is required for the prescription of antipsychotics?

Answer 16

ECG (yearly)
Prolactin (baseline, 6 months, yearly)
Blood lipids (baseline > every 3 months > yearly)
Weight (baseline > weekly / monthly > every 3 months)
Fasting blood glucose (baseline > every 4-6 months > yearly)

Question 17

What tests should be undertaken at baseline before initiation of clozapine and why?

Answer 17

FBC: neutrophils + granulocytes
Clozapine > neutropenia + agranulocytosis (potentially life-threatening)

Question 18

What are the common side effects of clozapine?

Answer 18

Agitation; amenorrhoea; arrhythmias; constipation; dizziness; drowsiness; dry mouth; erectile dysfunction; fatigue; galactorrhoea; gynaecomastia; hyperglycaemia; hyperprolactinaemia; hypotension (dose-related); insomnia; leucopenia; movement disorders; muscle rigidity; neutropenia; parkinsonism; postural hypotension (dose-related); QT interval prolongation; rash; seizure; tremor; urinary retention; vomiting; weight increased