Psych

Question 1

What is the reversal agent for benzodiazepines?

Answer 1

Flumazenil

Question 2

What is the reversal agent for opioids?

Answer 2

Naloxone

Question 3

What is the calculation for units of alcohol?

Answer 3

Volume (L) x Percentage

Question 4

What are the 4 questions of the cage questionaire?

Answer 4

Have you ever felt like you should cut down?
Do you get annoyed when people comment on your drinking
Do you feel guilty about your drinking?
Have you ever had a morning eye-opener to get rid of your hangover?

Question 5

What effect does alcohol have on neurotransmitters?

Answer 5

It is a relaxant/ suppressant therefore enhances the inhibitory GABA

Question 6

What effect does chronic alcohol abuse have on the blood?

Answer 6

Anaemia, high MCV
Often mixed folate and B12 deficiency
Reduced platelet production

Question 7

Which nerve palsy is a consequence when people are drunk? What is the classic sign?

Answer 7

Radial nerve palsy

Typical sign is a drooping wrist

Question 8

What are the early symptoms of alcohol withdrawal? When do they occur?

Answer 8

Tremor
Nausea
Sweating
Agitation
Tachycardia
Raised BP

<24 hours

Question 9

What are the late symptoms of alcohol withdrawal? When do they occur/

Answer 9

Delusions
Confusions
Diarrhoea
Convulsions
Auditory hallucinations
After 48 hours= delirium tremens

Question 10

Which drug should be used to treat the symptoms of alcohol withdrawal?

Answer 10

Chlordiazepoxide

Question 11

What are the symptoms of delirium tremens?

Answer 11

Loads of sweating
Tremor
Visual hallucinations
Auditory hallucinations

Question 12

What is the management of delirium tremens?

Answer 12

Benzo for 10 days e.g. chlordiazepoxide or diazepam
Thiamine
Fluid replacement

Question 13

What is the consequence of thiamine deficiency?

Answer 13

Wernicke’s encephalopathy/ korsakov’s syndrome

Question 14

What is the triad of symptoms in wernicke’s?

Answer 14

Opthamoplegia and nystagmus (eye signs)
Confusion
Ataxia

Question 15

How does Korsakov’s present?

Answer 15

Anterograde memory disorder. Old memories can be accessed but new ones cannot be made

Peripheral neuropathy

Confabulation

Question 16

What is the management of wernicke’s?

Answer 16

Thiamine
Sedation
Fluids <3

Question 17

Which drug can be prescribed to put people off drinking by causing nasty side effects?

Answer 17

Disulfiram

Question 18

Which two medications should be prescribed for those who have achieved abstinence and wish to maintain it?

Answer 18

Acamprosate and disulfiram

Question 19

Which drug can be given to people still actively drinking to help them reduce?

Answer 19

Naltrexone. Works by reducing the positive effects of drinking

Question 20

What are the contraindications of naltrexone?

Answer 20

Liver failure and opioid abuse

Question 21

What are the contraindications to disulfiram?

Answer 21

Ischaemic heart failure
psychosis

Question 22

Which type of antipsychotics have fewer motor side effects?

Answer 22

Atypical

Question 23

Name a few typical (first generation) antipsychotics?

Answer 23

Chlorpromazine
Haloperidol
Fluphenazine

Question 24

Name a few atypical (second generation) antipsychotics?

Answer 24

Clozapine
Risperidone
Sertindole
Aripiprazole
Olanzapine
Quetiapine

Question 25

Which type of antipsychotic is more effective at combating the negative symptoms seen in schizophrenia?

Answer 25

Atypical

Question 26

What is the mechanism of action for antipsychotics?

Answer 26

Blockade of dopamine receptors (mostly D2 receptors) Also block neuroreceptors for other neurotransmitters including histamine, ach and serotonin

Question 27

What are the clinical effects of antipsychotics?

Answer 27

Depression of emotional responses Sedation Anti-emetic effect Anti-histamine effect

Question 28

How are antipsychotics eliminated?

Answer 28

Liver metabolism

Question 29

Why is the IM dose of antipsychotics significantly lower than the oral dose?

Answer 29

Due to first pass metabolism

Question 30

What are the extrapyramidal effects of antipsychotics?

Answer 30

Akathisia- restlessness Acute dystonia Parkinsonism Tardive dyskinesia

Question 31

What are the common side effects of atypical antipsychotics?

Answer 31

Weight gain Drowsiness Antimuscarinic effects (dry mouth, constipation, urinary retention) Postural hypotension Photosensitivity Prolonged QT

Question 32

What is the life threatening side effect of clozapine?

Answer 32

Agranulocytosis

Question 33

What is the presentation of neuroleptic malignant syndrome?

Answer 33

Can happen after starting antipsychotic, mechanism not fully known. Features are: Fever Rigidity Hypertension, tachycardia and sweating Agitated delirium with confusion Blood CK is really high

Question 34

What are the clinical features of GAD?

Answer 34

Persistent anxiety Apprehension Motor tension Increased sympathetic activity Hypervigilance Panic attacks

Question 35

What is the pathophysiology of GAD?

Answer 35

Overactivity of 5-HT neurons

Question 36

What us the management of GAD?

Answer 36

Lifestyle changes- avoid caffiene, alcohol, nicotine and try to exercise Breathing techniques, headspace etc CBT SSRIs Propanolol Benzos if severe for short term use only

Question 37

What are the 3 types of bipolar disorder?

Answer 37

Type 1= manic and depressive 1:1 Type 2= Depression is more dominant, 5:1 Rapid cycling= >4 episodes of mania and depression

Question 38

What is the definition of mania?

Answer 38

Elated mood lasting 1-2 weeks with psychotic symptoms

Question 39

What is the definition of hypomania?

Answer 39

Elevated mood with no psychotic symptoms, must last >4 days

Question 40

What are the features of mania?

Answer 40

Elevated mood grandiosity Delusions and hallucinations Auditory hallucinations (usually 2nd person) Pressured speech General increase in activity Increased feelings of self worth