Pharmacology

Question 1

What can anti-depressants be used to treat?

Answer 1

Moderate to severe depression
Anxiety disorders
Chronic pain

Question 2

How long should someone take anti-depressants for?

Answer 2

6 months after symptoms have subsided

Question 3

What is the action of tricyclics amine antidepressants?

Answer 3

Inhibit uptake of NA and 5HT

Question 4

Examples of some TCAs?

Answer 4

Amitryptiline
Nortriptyline
Imipramine
Dothiepin
Clomipramine
Lofepramine

Question 5

Which is the safest TCA?

Answer 5

Lofepramine

Question 6

Side effects of TCAs?

Answer 6

Anticholinergic:

• dry mouth
• blurred vision
• urinary retention
• constipation
• worsening glaucoma

Question 7

Side effects of SSRIs?

Answer 7

GI

• nausea
• anorexia
• diarrhoea

Sweating
Sexual dysfunction
Increased risk of bleeding

Question 8

Which TCA is considered the most dangerous in overdose?

Answer 8

Amitryptiline

Dothiepin

Question 9

Name some SSRIs

Answer 9

Sertraline
Fluoxetine
Paroxetine
Citalopram

Question 10

Name some SNRIs

Answer 10

Venlafaxine

Duloxetine

Question 11

When are SNRIs used?

Answer 11

Second line treatment for depression and anxiety (think of DOPA patient with GAD who had taken sertraline then venlafaxine!)

Question 12

Side effects of SNRIs?

Answer 12

Same as SSRIs plus

• sleep disturbance
• increased BP
• dry mouth
• hyponatraemia

Question 13

Side effects of mirtazapine?

Answer 13

Weight gain
Increased appetite 
Sedation 
Dry mouth
Confusion
Angle closure glaucoma

Question 14

Which antidepressant is the preferred one in someone who has had an MI?

Answer 14

Sertraline

Question 15

When is mirtazapine used?

Answer 15

Severe depression

PTSD

Question 16

Contraindications for mirtazapine?

Answer 16

Renal impairment
Pregnancy
Hepatic impairment
Jaundice

Question 17

Mechanism of action of mirtazapine?

Answer 17

A weak NA reuptake inhibitor
Antihistamine
Alpha 1+2 blocker

Question 18

What is serotonin syndrome and what are the signs/symptoms?

Answer 18

Too much serotonin from antidepressants

• restlessness
• excessive sweating
• tremor
• shivering
• myoclonus
• confusion
• convulsions
• death

Question 19

Mechanism of action of antipsychotics?

Answer 19

Dopamine antagonists - D2 and 5HT

Question 20

Name some typical antipsychotics

Answer 20

Haloperidol
Chlorpromazine
Sulpiride

Question 21

What are some extra-pyramidal side effects?

Answer 21

Parkinsonism

• tremor
• cogwheel rigidity
• bradykinesia

Akathisia (restlessness)

Dystonia

Tardive dyskinesia - permanent

Question 22

Name some atypical antipsychotics

Answer 22

Olanzapine 
Quetiapine 
Risperidone 
Aripiprazole
Clozapine

Question 23

Which antipsychotic is prolactin sparing?

Answer 23

Clozapine

Question 24

Why must clozapine levels be monitored?

Answer 24

Can cause agranulocytosis

Question 25

Side effects of atypical antipsychotics?

Answer 25

``` Weight gain (especially olanzapine) Hyper-prolactinaemia -amenorrhoea -galactorrhoea -gynaecomastia -sexual dysfunction -osteoporosis ``` Anti-adrenergic - sedation - postural hypotension Cardiac arrhythmias - prolonged QT interval EPSE

Question 26

What monitoring is needed for all antipsychotics?

Answer 26

Baseline and then regular - weight - BP - glucose - lipids

Question 27

Symptoms of neuroleptic malignant syndrome?

Answer 27

EPSE - muscle rigidity - akinetic mutism - stupor Autonomic dysfunction - hyperpyrexia - tachycardia - unstable BP - sweating - salivation - urinary incontinence Raised creatinine kinase - renal failure - pneumonia - thrombo-embolism