Pharmacology

Question 1

What are some examples of SSRIs? (3)

Answer 1

Sertraline
Fluoxetine - for under 18s
Citalopram
Paroxetine
Escitalopram

Question 2

What is the mechanism of action of SSRIs?

Answer 2

Inhibit reuptake of serotonin from presynaptic serotonin pumps

Question 3

SE of SSRIs?

Answer 3

GI bleeding
Anxiety/agitation
Insomnia
Inc. risk suicidal ideation in young people
Dec. libido

Question 4

SSRI discontinuation sx?

Hint - mnemonic FINISH

Answer 4

Flu-like sx (e.g. lethargy)
Insomnia
N + V
Imbalance
Sensory disturbances (paraesthesia)
Hyperarousal (anxiety, agitation, etc)

Question 5

What are SSRIs used to treat?

Answer 5

Depression
Anxiety
OCD
Bulimia Nervosa

Question 6

What is a CI for citalopram use?

Answer 6

Can lead to QT interval prolongation and torsades de pointes

Question 7

What are some examples of SNRIs?

Answer 7

Venlafaxine
Duloxetine

Question 8

Mechanism of action of SNRIs?

Answer 8

Presynaptic blockade of both noradrenaline and serotonin reuptake pumps

Question 9

SE of SNRIs?

Answer 9

Dizziness
Dry mouth
Constipation
Hot flushes

Question 10

What are SNRIs used for?

Answer 10

Depression
Anxiety

Question 11

What is an example of tricyclic antidepressants?

Answer 11

Amitriptyline

Question 12

CI for TCA?

Answer 12

IHD
Arrhythmias
Severe liver disease
Overdose risk!!

Question 13

SE of TCA?

Hint - Triple A

Answer 13

1. Anticholinergic effects (muscarinic receptor block) - dry mouth, constipation, blurred vision, urinary retention
2. Antiadrenergic effects - postural hypotension
3. Antihistaminergic effects - sedation + wgt gain
4. Possible cardiac effects - prolonged QT, heart block, arrhythmias

Question 14

What is TCA used for treatment?

Answer 14

• Neuropathic pain and prophylaxis of migraines
• Depression
• Anxiety
• OCD
• Chronic pain (much lower dose)

Question 15

What is the target lithium plasma level for a patient taking it for the first time?

Answer 15

0.6 - 0.8 mmol/L

Question 16

What drug does lithium mainly interact with?

Answer 16

NSAIDs

Question 17

How often should lithium levels be monitored for in the following:
1. Just started on lithium
2. Dose change
3. 1st year of taking lithium
4. After 1st year

Answer 17

1. 1 week after starting
2. Weekly until stable
3. Every 3 mths
4. Every 6 mths (unless at risk)

Question 18

Can lithium be taken during pregnancy and breastfeeding?

Answer 18

• In pregnancy - avoid, teratogenic
• In breastfeeding - risk of infant toxicity so avoid

Use olanzapine in pregnancy

Question 19

SE of lithium?

Answer 19

• GI disturbance (N+V, Diarrhoea)
• Wgt gain
• Odema
• Fine tremor
• Polyuria and polydipsia

Question 20

Sx of lithium toxicity?

Answer 20

• Blurred vision
• Seizure
• Coarse tremor
• Ataxia
• Confusion and coma
• ECG changes - QT prolongation

Question 21

What are some examples of benzodiazepines?

Answer 21

• Lorazepam - short acting
• Diazepam - long acting
• Midazolam
• Chlordiazepoxide

Question 22

What cdtns are benzodiazepines used to treat?

Answer 22

Anxiety
Mania
Psychosis
Alcohol withdrawal
Acute agitation/aggression