Psychopharmacology

Question 1

Question 1
List at least two classes of antidepressants and provide one example for each class (2 marks)

Answer 1

TCAs -Amitriptyline, Nortriptyline, Imipramine
SSRIs - Citalopram, Fluoxetine, Sertraline

Question 2

Question 2

Describe two common contraindications for the use of Tricyclic Antidepressants (TCAs) (2 marks)
Answer

Answer 2

Suicidal ideation due to the risk of cardiac toxicity in overdose.
Recent myocardial infarction due to the risk of arrhythmias.

Question 3

What is the minimum number of symptoms required to diagnose a Major Depressive Episode (MDE) according to DSM-5? (1 mark)

Answer 3

Answer
5

Question 4

Question 4
Name four symptoms of Major Depressive Episode as per DSM-5 criteria (0.5x4 = 2 marks)

Answer 4

Worthlessness, Loss of interest, Fatigue, Suicidal ideation

Question 5

Mood stabilizers questions (7 marks)

A 35-year-old male patient with a history of bipolar mood disorder type 1 is currently prescribed lithium as a mood stabilizer. He presents to the clinic complaining of nausea, tremors, and confusion. On further questioning, he mentions that he recently started taking ibuprofen regularly for joint pain.
Questions:
1. Explain the possible cause of the patient’s symptoms (2 marks).
2. What are the clinical signs and symptoms of lithium toxicity? (2 marks)

Answer 5

Answers

1. The patient’s symptoms could be due to lithium toxicity. Ibuprofen, a nonsteroidal anti-inflammatory drug (NSAID), can reduce the clearance of lithium by affecting kidney function, leading to increased lithium levels and potential toxicity.
2. Clinical signs and symptoms of lithium toxicity: nausea, vomiting, diarrhea, tremors, confusion, ataxia, and in severe cases, seizures, arrhythmias, or coma.

Question 6

3. Name one natural mineral used as a mood stabilizer (1mark)

Answer 6

Lithium

Question 7

Give two examples of an anticonvulsant used as a mood stabilizer (0.5x2 = 1 mark)

Answer 7

Lamotrigene
Sodium valproate

Question 8

Name two psychiatric disorder for which mood stabilizers are indicated (0.5 x2 = 1 mark)

Answer 8

Bipolar type 1 or type 2
Schizoaffective
Borderline personality disorder

Question 9

What extrapyramidal signs should you be aware of when using neuroleptics? [1½ marks]

Answer 9

Akathisia, Dystonia & Parkinsonism

Question 10

Name 2 side effects of using atypical antipsychotics [1 mark]

Answer 10

Impaired glucose tolerance
· Dyslipidemia
· Prolonged QT interval
· Sexual Dysfunction
· Sedation
· Agranulocytosis (clozapine)

Question 11

An adult patient was on Haloperidol but has experienced EPSEs, as the doctor on duty you are required to change the patient to another medication.
Name the medication and your stat dose [1½ marks]

Answer 11

If extrapyramidal side effects: switch to risperidone rather than adding an anticholinergic medicine:
Risperidone, oral (Doctor prescribed).
o Initial dose: 2 mg daily.
o Increase to 4 mg daily, if poor response after 4 weeks.

Question 12

Name the two main categories of antipsychotic drugs (0.5 x2 = 1 mark)

Answer 12

Typical antipsychotics (first generation)
Atypical antipsychotics (second generation)

Question 13

What is one benefit of atypical antipsychotics over typical antipsychotics? ( 1 mark)
Answer

Answer 13

Decreasing chances of EPSE (extrapyramidal side effects)