Psychopharmacology

Question 1

Give 4 side effects of 1st gen anti-psychotic use?

Answer 1

Extrapyramidal SE
Postural hypotension
Galactorrhoea
Erectile dysfunction

Question 2

4 complications of anti-psychotic use?

Answer 2

Neuroleptic malignant syndrome
Acute dystonic reaction
Tardive dyskinesia
Akathisia

Question 3

3 common side effects with clozapine?

Answer 3

Agranulocytosis (most common)
Constipation
Hypersalivation

Question 4

4 side effects of 2nd gen anti-psychotic use?

Answer 4

Arrhythmias (QT interval prolongation)
Weight gain
Hyperglycemia
Dyslipidaemia

Question 5

Which group of patients should anti-psychotics be prescribed with caution in?

Answer 5

Elderly patients
Dementia patients
Patients with Parkinson’s disease

Note: STOPP-START criteria

Question 6

A 45-year old woman has recently started phenelzine. She is out for lunch with her friend who is a doctor. She asks her friend what she can eat from the menu.

A) Broccoli and stilton soup
B) Pickled herring on a bed of salad
C) Marmite and sesame toast
D) Smoked mackerel pate
E) Egg mayonnaise toastie

Answer 6

E) Egg mayonnaise toastie

Phenelzine is MAO-i, and you need to avoid cheese, red meat and wine. These react with MAO-i because of the presence of tyramine –> precipitates hypertensive crisis (headache, tremor, hypertension)

Question 7

A 29-year-old man is brought to the emergency department at 4 am after a night out. He is unable to give a clear history as his Glasgow coma scale is 12 and he is confused, but on examination you find he is pyrexic (39 °C), and on neurological examination you find he is hyperreflexic, with muscle rigidity, and his pupils are dilated.

A. Cocaine
B. Ecstasy
C. Heroin
D. Marijuana
E. Paracetamol

Answer 7

Ecstasy

This is serotonin syndrome

Question 8

Which antipsychotic has the highest risk of QT interval prolongation?

Answer 8

Haloperidol

Question 9

Which antipsychotic has the highest risk of hyperglycaemia?

Answer 9

Olanzapine

Question 10

Which antipsychotic has the lowest risk of tardive dyskinesia?

Answer 10

Clozapine

Question 11

Name 4 1st gen antipsychotics

Answer 11

Haloperidol
Zuclopenthixol
Clozapine
Chlorpromazine
Prochlorperazine

Question 12

Which antipsychotic is associated with the lowest chance of QT interval prolongation?

Answer 12

Aripiprazole

Question 13

Which antipsychotic is associated with the lowest chance of weight gain?

Answer 13

Aripiprazole

Question 14

Which antipsychotic is good to use in the dementia-related mood disturbance in the elderly?

Answer 14

Risperidone

Question 15

Give 4 side effects of SSRI use

Answer 15

Increased risk of GI bleed
Hyponatraemia
QT interval prolongation i.e citalopram
Loss of libido
Increased suicidal ideation (in younger men)

Question 16

Which SSRI is safe for breast feeding and in patients with previous history of MI?

Answer 16

Sertraline

Question 17

SSRI co-prescribed with warfarin/heparin, what should you do?

Answer 17

Change to mirtazapine

Question 18

SSRI co-prescribed with Aspirin, what should you do?

Answer 18

Discontinue or give gastroprotection

Question 19

MAO-i with cheese/red meat/wine, what is the resulting reaction cause?

Answer 19

Hypertensive crisis due to tyramine in cheese

Question 20

Which class of antidepressant is most likely to cause a manic switch?

Answer 20

TCAs

Question 21

Which antidepressant is good for sleep and appetite?

Answer 21

Mirtazapine

Question 22

Which antipsychotic has the highest risk of weight gain?

Answer 22

Olanzapine/Clozapine

Question 23

Which class of antidepressant is associated with increased risk of HTN?

Answer 23

SNRI i.e Venlafaxine

Question 24

What are anti-psychotics not encouraged to be used in the elderly with dementia?

Answer 24

Slightly increased risk of stroke and TIA

Question 25

Most SSRIs need cross-tapering to each other except one. What is that one SSRI that does not need cross tapering?

Answer 25

Fluoxetine (risk of serotonin syndrome)

Question 26

Which SSRI increases the risk of QT interval prolongation?

Answer 26

Citalopram

Question 27

What advice should you give to young men started on an SSRI?

Answer 27

Increased risk of suicidal thinking and self-harm in the first month after starting