Psychotropic Drugs

Question 1

What are the common adverse effects of antidepressants?

Answer 1

GIT symptoms, sedation, dizziness, weight gain, sexual dysfunction, headaches, insomnia, anxiety

Question 2

What are the adverse effects of clozapine?

Answer 2

Specific: agranulocytosis, myocarditis
General: weight gain, sedation, EPSE, tardive dyskinesia, prolactinaemia

Question 3

What are the adverse effects of benzodiazepines?

Answer 3

Sedation, poor coordination, decreased libido, hypotension, suppressed breathing, memory loss, tolerance, dependence, addiction

Question 4

What are the features of neuroleptic malignant syndrome and how is it treated?

Answer 4

F - Fever
A - Autonomic Dysfunction
R - Rigidity
M - Mental State Change
Treatment: cessation of antipsychotics +/- admission to ICU

Question 5

What are the features of serotonin syndrome and how is it treated?

Answer 5

Cognitive: confusion, hypomania, hallucinations
Autonomic: hyperthermia, sweating/shivering, increased HR, dilated pupils, dry mouth
Neuromuscular: tremor, hypertonia, hyperreflexia, ataxia, seizures

Question 6

Which commonly used atypical antipsychotic is associated with high rates of hyperprolactinaemia?

Answer 6

Risperidone, Paliperidone

Question 7

Which commonly used atypical antipsychotic is unlikely to cause weight gain?

Answer 7

Aripiprazole

Question 8

Which commonly used atypical antipsychotics are associated with a high risk of weight gain?

Answer 8

Olanzapine + Clozapine

Question 9

Which commonly used atypical antipsychotics are non-sedating?

Answer 9

Aripiprazole

Risperidone

Question 10

What is the difference between MOAIs used in Parkinson’s Disease and those used to treat depression?

Answer 10

MOAI Type B (e.g. selegeline) used in PD to increased DA levels
Nonselective MAOI used in depression to increase DA and serotonin (e.g. tranylcypromine)

Question 11

Which medication is used to treat serotonin syndrome?

Answer 11

Cyproheptadine (serotonin antagonist)

Question 12

What are EPSEs?

Answer 12

A - Akasthesia (restlesssness)
A - Acute dystonias
P - Parkinsonism (tremor, rigidity, bradykinesia, apathy)
T - Tardive dyskinesia

Question 13

How can akasthesia be treated?

Answer 13

Benzodiazepine, beta-blocker
Reduce dose
Change agent

Question 14

How can antipsychotic-induced Parkinsonism be treated?

Answer 14

Benztropine (anticholinergic)
Amantadine (MAOI-A + NMDA blocker)
Reduce dose
Change agent

Question 15

How do serotonin syndrome and NMS present differently?

Answer 15

SS (<24 hours): dilated pupils, hyperreflexia, myoclonus, tremor, hyperactive bowel sounds
NMS (days-weeks): hyporeflexia, rigidity (sluggish)

Question 16

What is the treatment for alcohol withdrawal?

Answer 16

Diazepam

Question 17

Which benzodiazepine can be given to treat acute aggression or anxiety?

Answer 17

Lorazepam (oxazepam if hepatic impairment present)

Question 18

Which benzodiazepine can be used for chemical restraint?

Answer 18

Midazolam

Question 19

Which benzodiazepam can be used to aid sleep?

Answer 19

Tamazepam

Question 20

What medications can be used to treat Alzheimer’s Disease?

Answer 20

Cholinesterase Inhibitors (donepezil, galantine, rivastigmine) for MMSE >10
NMDA Antagonists (memantine) for MMSE 10-14

Question 21

What are the adverse effects of lithium?

Answer 21

L - Leg swelling (secondary to renal problems)
I - Indigestion / GI complaints
T - Tremor, toxicity, thirst
H - Hypothyroidism
I - Interactions (diuretics, NSAIDs, ACEI, ARB)
U - Urinary excess (polyuria)
M - Metallic taste, mums-to-be (teratogenic)

Question 22

What are the clinical features of lithium toxicity?

Answer 22

(similar to alcohol intoxication)
F - Fatigue
A - Ataxia
S - Slurred speech
T - Tremor, thirst
C - Confusion
N - Nausea + vomiting
S - Seizurea

Question 23

What medications can be used as an adjunct in alcohol dependence?

Answer 23

Naltrexone: opioid receptor antagonist
Acamprosate (campral): NMDA blocker, GABA A antagonist
Disulfiram (antabuse): inhibits acetaldehyde dehydrogenase

Question 24

What medications can be given to reduce nicotine dependence?

Answer 24

• Nicotine replacement therapy
• Verenicline (champix): blocks nicotine receptors
• Bupropion
• TCAs (nortryptiline)

Question 25

What are the physical effects of cocaine intoxication?

Answer 25

Fever (up to 41 degrees)
Dilated pupils
Tachycardia and hypertension
Agitation and aggression
Muscle twitches and tremors
Muscle rigidity and hyperreflexia
Cardiac arrhythmias

Question 26

Which antidepressants may also improve insomnia?

Answer 26

Mirtazepine
Venlafaxine
Clomipramine (TCA)