Psych

Question 1

SSRI interactions?

Answer 1

NSAIDs - PPI
Warfarin/heparin - consider mirtazapine
Triptans - serotonin

Question 2

Mania in bipolar treatment?

Answer 2

Consider olanzapine or haloperidol

Question 3

Monitoring of lithium?

Answer 3

Check weekly when starting/changing dose

Check 12 hours after last dose

Once stable check 3 monthly

TFT and renal function every 6 months

Question 4

First rank symptoms?

Answer 4

Auditory hallucinations

Thought insertion/blocking/broadcasting

Passivity phenomena

Delusions

Other features - lack of insight, neologisms, catatonia

Question 5

What receptor blockage causes weight gain?

Answer 5

5-HT2c

Most pronounced in clozapine and olanzapine

Question 6

4 dopamine pathways?

Answer 6

Mesolimbic - reward and aggression (positive schiz)

Mesocortical - emotions, executive functioning (negative schiz)

Nigrostriatal - substantia nigra to striatum - EPSE

Tubuloinfundibular - PRL

Question 7

SE clozapine?

Answer 7

Weight gain
Hypersalivaton
Myocarditis
Reduced seizure threshold
Agranulocytosis
Neutropaenia

Question 8

Initiation of clozapine?
Monitoring?
If 2 doses missed?
Smoking?

Answer 8

Initiation - baseline ECG and titrate dose

Regular FBC testing

Must re-titrate if 2 doses missed

Smoking reduces clozapine levels in blood

Question 9

SPECT in vascular dementia?

Answer 9

Reduced attenuation throughout brain

Question 10

SPECT in levy body?

Answer 10

low dopamine uptake in substantia nigra

Question 11

What types of dementia are cholinesterase inhibitors or memantine used in?

Answer 11

Alzheimers or Lewy body

Question 12

Drugs to avoid in levy body?

Answer 12

Antipsychotics

Question 13

Long-term drug management in panic disorder?

Answer 13

1. SSRI

If no improvement after 12 weeks:

2. Imipramine

Question 14

SSRI of choice in agoraphobia?

Answer 14

Fluoxetine

Question 15

Treatment of OCD:

Answer 15

1. CBT with exposure response prevention

2. SSRI + CBT (if functional impairment)

Question 16

Drugs used in PTSD?

Answer 16

Venlafaxine or sertraline

Question 17

Physiological abnormalities in anorexia?

Answer 17

• low K, thyroid and gonadotrophins

- high cortisol, aldosterone, glucose and carotin

Question 18

Timeline of alcohol withdrawal?

Management?

Answer 18

6-12 hours - tremor, swathing, tachycardia, anxiety

36 hours: seizure

48-72 hours: DT

Diazepam or chlordiazepoxide

Question 19

Drugs for alcohol withdrawal?

Answer 19

Disulfram - inhibits acetaldehyde dehydrogenase - makes you sick

Acamprosate - weak antagonist of NMDA, reduces cravings

Question 20

Only CI for ECT?

Answer 20

Raised ICP