psychopharmacology in psychiatry

Question 1

How long after prescribing antidepressants is an affect noticed

Answer 1

2-4 weeks

Question 2

What are antidepressants used for

Answer 2

Unipolar and bipolar depression, organic mood disorders, schizoaffective disorder, anxiety disorders including OCD, panic, social phobia, PTSD

Question 3

how do Selective serotonin reuptake inhibitors (SSRIs) work

Answer 3

Block the presynaptic serotonin reuptake

Question 5

What are the side effects of SSRIs

Answer 5

• GI upset
• sexual dysfunction
• anxiety
• restlessness
• nervousness
• insomnia
• fatigue
• sedation
• dizziness

Question 6

What is activation syndrome and what are the symptoms

Answer 6

starting SSRIs causing increased serotonin in the brain with the medication which can cause nausea, increased anxiety, panic and agitation - lasts 2-10 days

Question 7

What drug is used when trying to avoid discontinuation syndrome

Answer 7

Fluoxetine (Prozac) - due to long half life

Question 8

What are the cons of sertaline

Answer 8

GI adverse reactions and needs a full stomach for max absorption

Question 9

How do monoamine oxidase inhibitors (MAOIs) work

Answer 9

bind irreversibly to monoamine oxidase, preventing inactivation of amines such as norepinephrine, dopamine and serotonin leading to increased synaptic lebels

Question 10

What are the side effects for MAOIs

Answer 10

Orthostatic hypotension, weight gain, dry mouth, sedation, sexual dysfunction and sleep disturbance

Question 11

How does serotonin syndrome occur

Answer 11

MAOIs taken with serotonin increasing meds

Question 12

What are the symptoms of serotonin syndrome

Answer 12

Abdo pain
Diarrhoea
Irratibility
Sweats
Tachycardia
HTN
myoclonus

Question 14

How to avoid serotonin syndrome

Answer 14

Wait 2 weeks before switching from an SSRI to a MAOI - 5 weeks if fluoxetine

Question 16

How do Serotonin/Norepinephrine reuptake inhibitors work

Answer 16

Inhibit both serotonin and noradrenergic reuptake like the TCAS but without the antihistamine, antiadrenergic or anticholinergic side effects

Question 17

What needs to be done before prescribing lithium

Answer 17

Baseline U+Es and TSH
Pregnancy test as tetranogenic in first trimester

Question 18

What is the con with Mirtazapine

Answer 18

Associated with weight gain

Question 19

What can duloxetine help with

Answer 19

Neuropathic pain
Depression
Anxiety

Question 20

How is treatment resistant depression treated

Answer 20

1. Combination of antidepressant like an SSRI or SNRI with Mirtazepine
2. Adjunctive treatment with lithium
3. Adjuctive treatment with atypical antipsychotic - quetipaine, olanzapine or aripiprazole

Question 21

What is the treatment ladder for treatment resistant anxiety

Answer 21

1. High dose SSRI
2. Add on Mirtazapine with an SSRI or SNRI
3. Adjunctive treatment with atypical antipsychotic - quetipane, olanzapine
4. Adjuctive treatment with pregabalin or buspirone

Question 22

How long to continue treatment after first depressive or anxiety episode

Answer 22

6 months - 1 year prophylaxis

Question 23

How long to continue treatment after second depressive or anxiety episode

Answer 23

2 years prophylaxis

Question 24

How long to continue treatment after third depressive or anxiety episode

Answer 24

Life long prophylaxis

Question 25

What are examples of TCAs

Answer 25

Imipramine Amitriptyline Doxepin Clomipramine Desipramine nortriptyline

Question 26

What are mood stabilizers used for

Answer 26

Bipolar Cyclothymia Schizoaffective disorder

Question 27

What is the only drug that reduces suicide rate

Answer 27

Lithium

Question 28

What is lithium effective at treating

Answer 28

Prophylaxis of mania and depressive episodes

Question 29

What are the signs that lithium will be effective

Answer 29

Familt member used it with good response Classic pure mania Mania followed by depression

Question 30

What is the goal blood level of lithium during lithium treatment

Answer 30

0.6 - 1.2

Question 32

What are the side effects of lithium

Answer 32

- GI distress such as diarrhoea and reduced appetite - Thyroid abnormalities - Polyuria/polydypsia - Hair loss - Acne - Cognitive slowing - Intention tremor

Question 33

What is seen when lithium levels reach 1.5-2 - mild lithium toxicity

Answer 33

- vomiting - Diarrhoea - ataxia - dizziness - slurred speech - nystagmus

Question 34

What is seen in moderate lithium toxicity - 2-2.5

Answer 34

Nausea vomiting anorexia blurred vision chronic limb movements convuslions delireum

Question 35

What is seen in severe lithium toxicity >2.5

Answer 35

Generalised convulsions Oliguria Renal failure

Question 36

What is valproic acid effective for

Answer 36

Mania prophylaxis but not depression prophylaxis

Question 37

When should valproic acid be avoided

Answer 37

Woman of child bearing age due to neural tube defects which can occur

Question 38

What are the side effects of valproic acid

Answer 38

Thrombocytopenia and platelet dysfunction Nausea, vomiting, weight gain Sedation, tremor Hair loss

Question 40

What is the first line agent for acute mania and mania prophylaxis

Answer 40

Carbamazepine

Question 41

What are the side effects of carbamazepine

Answer 41

Rash - most common Nausea, vomiting, diarrhea Sedation, dizziness, ataxia, confusion AV conduction delays Aplastic anemia and agranulocytosis (<0.002%) Water retention due to vasopressin-like effect which can result in hyponatremia Drug-drug interactions!

Question 42

Why is lamotrigine titrated very slowly

Answer 42

If given high dose at once, can cause Steven Johnsons syndrome - if any rash develops ithe lamotrigine is stopped immediately

Question 43

What are the side effects of lamotrigine

Answer 43

Nausea vomiting sedation dizziness ataxia confusion Steven Johnson syndrome

Question 44

What can happen to the LFTs due to anticonvulsants

Answer 44

increase - not worrying unless it more than triples

Question 45

What are antipsychotics used for

Answer 45

Schizophrenia Schizoaffective disorder Bipolar Mood stabilisation Psychotic depression

Question 46

What can reduced dopamine cause

Answer 46

Parkinsonian movements such as rigidity, bradykinesia and tremors

Question 47

What are typical antipsychotics

Answer 47

D2 dopamine receptor antagonistics

Question 48

What are the side effects of antipsychotics

Answer 48

Tardive Dyskinesia (TD)-involuntary muscle movements that may not resolve with drug discontinuation- risk approx. 5% per year Neuroleptic Malignant Syndrome (NMS): Characterized by severe muscle rigidity, fever, altered mental status, autonomic instability, elevated WBC, CPK and lfts. Potentially fatal. Extrapyramidal side effects (EPS): Acute dystonia, Parkinson syndrome, Akathisia be aware increased risk of suicide

Question 49

What should be given for the extrapyramidal side effects when using antipsychotics

Answer 49

- Anticholinergics - benztropine, trihexyphenidyl or procyclidine - Beta blockers like propanalol

Question 50

What do atypical antipsychotics do

Answer 50

Serotonin dopamine 2 antagonists

Question 52

What are the side effects of risperidone - atypical antipsychotic

Answer 52

Hyperprolactinemia Weight gain Sedation

Question 53

What is teh significant side effects of olanzapine

Answer 53

Atypical antipsychotic: Significant weight gain Hyperprolacinemia - less chance then risperidone Abnormal LFTs

Question 54

Define treatment resistant schizophrenia

Answer 54

Poor response to 2 first line antipsychotics at an adequate dose for 8 weeks

Question 55

What is given for treatment resistant schizophrenia

Answer 55

Clozapine

Question 56

What are the side effects of clozapine

Answer 56

Agranulocytosis Increased risk of seizures Sedation Weight gain Abnormal LFTS Increased risk of hypertriglyceridemia, hypercholesterolemia, hyperglycemia, including nonketotic hyperosmolar coma and death with and/or without weight gain Increased saliva production

Question 57

What is the most common psychotic symptom

Answer 57

Lack of insight