Pharmacology

Question 1

give an example of an irriversible and reversible monoamine oxidase inhibitor

Answer 1

phenelzine and moclobemide respectively

Question 2

what is the main side effect of MAO inhibitors

Answer 2

cheese reaction- hypertensive crisis

Question 3

give and example of a tricyclic antidepressant

Answer 3

amitriptyline, imipramine, lofepramine

Question 4

what is the mechanism of action of a tricyclic antidepressant

Answer 4

block the reuptake of monoamines such as noradrenaline and 5-HT/serotonin

Question 5

under which conditions should imipramine be avoided

Answer 5

if the patient has cardiac conditions

Question 6

giva an example of SSRI

Answer 6

fluoxitine, citalopram, sertraline

Question 7

what is the mechanism of action of SSRI

Answer 7

block reuptake of serotonin

Question 8

what are the side effects of SSRI

Answer 8

vivid dreams, nausea, sweating, sexual dysfunction and hyponatraemia (in the elderly)

Question 9

give an example of SNRI

Answer 9

venlafaxine and duloxetine

Question 10

what is the mechanism of mirtazapine

Answer 10

block of alpha 2, 5-HT2 and 3

Question 11

give an example of a dopamine uptake inhibitor

Answer 11

bupropion

Question 12

what special precautions are taken with lithium

Answer 12

12hr post dose blood levels due to narrow theraputic index

Question 13

what is the mechanism of action of lithium

Answer 13

block second messenger system or inhibit glycogen synthase kinase 3beta or modulate NO signalling

Question 14

what are the toxic effects of lithium

Answer 14

vomiting, diarrhoea, ataxia, altered consiousness

Question 15

give and example of anticonvulsant (mood stabalisers)

Answer 15

carbamazepine, lamotrigine

Question 16

side effects of valproate

Answer 16

teratogenicity

Question 17

lamotrigine side effects

Answer 17

small risk of Stevens-Johnson syndrome

Question 18

what are side effects shared by valproate and carbamazepine

Answer 18

ataxia, drowsiness, CV affects and induced liver enzymes

Question 19

give examples of antipsychotics

Answer 19

aripiprazole, olanzipine

Question 20

what is a risk of olanzipine use

Answer 20

higher risk of metabolic syndrome

Question 21

what are the side effects of aripiprazole

Answer 21

extrapyramidal- motor

Question 22

which classes of drugs can be used to treat anxiety

Answer 22

benzodiazepines, pregabalin, antidepressants, buspirone

Question 23

what is the mechanism of action of benzodiazepines

Answer 23

enhance the activity of the neurotransmitter GABA, particuarly affecting the amygdala

Question 24

give an example of a benzodiazepine used for rapid tranquilisation

Answer 24

lorazepam

Question 25

what are the pharmacological effects of benzodiazepines

Answer 25

reduced anxiety and aggression hypnosis and sedation muscle relaxation anticonvulsant effects

Question 26

what are the 2 biggest side effects or problems with benzodiazepines

Answer 26

can cause anterograde amnesia | withdrawal and additction upon long term usage

Question 27

what are the clinical uses of benzodiazepines

Answer 27

acute treatment of extreme anxiety and mania | rapid tranqulisation, status epilepticus

Question 28

how do you withdraw a patient from benzodiazepines

Answer 28

transfer to equvalent dose of diazepam/chlordiazepoxide | reduce dose 2-3 weeks by 2-2.5mg

Question 29

treatment pathway for anxiety (pharmacologically)

Answer 29

SSRI first then tricyclics (imipramine) then venalfaxine (also very useful in GAD)

Question 30

what is the management pathway for GAD (generalised anxiety disorder)

Answer 30

``` 1st- psychoeducation 2nd- self help and social groups 3rd- CBT or SSRI 4th- SNRI 5th- pregabalin ```

Question 31

what are some of the clinical uses of SSRIs

Answer 31

panic disorder, PTSD, OCD and phobias

Question 32

what is the management of panic disorder

Answer 32

1st- self help 2nd-CBT or SSRI if longstanding symptoms 3rd-tricyclics (clomipramine, imipramine) continue treatment for 6 months

Question 33

what is the management of OCD

Answer 33

1st- CBT or self help 2nd- more intense psychological intervention or SSRI (sertrline, citalopram) 3rd- consider increase in dose after 4-6 weeks 4th- SSRI plus CBT and ERP 5th- clomipramine

Question 34

what is the management of PTSD

Answer 34

``` 1st- watchful waiting for 4 weeks 2nd- within 3 months of trauma then CBT after 3 months of trauma then forcused CBT or EMRD 4th- mirtazepine ```

Question 35

what is the management of social anxiety

Answer 35

``` 1st- CBT 2nd- SSRI reviewed at 12 weeks 3rd- SSRI plus CBT 4th- alternative SSRI (fluoxitine or paroxetine) 5th- MAOI (moclobemide) ```