Therapeutics

Question 1

SSRI’s mechanism

Answer 1

increase serotonin activity by reducing pre-synaptic reuptake of serotonin after release
…so more serotonin…down regulation of post synaptic receptors

Question 2

SSRI’s s/e

Answer 2

agitation
nausea
GI disturbance
headache
weight change
sexual dysfunction
suicidal idealation - younger

Question 3

sertraline safest in

Answer 3

CVD

Question 4

citalopram s/e

Answer 4

QT prolong

Question 5

fluoxetine switching

Answer 5

risk of serotonin syndrome

Question 6

paroxetine stop

Answer 6

discontinuation syndrome

Question 7

SNRI mechanism

Answer 7

same as SSRI but bind to NA reuptake receptors as well

Question 8

SNRI s/e

Answer 8

sedation
nausea
sexual dysfunction

Question 9

mirtazapine mechanism

Answer 9

noradrenergic and specific serotonergic antidepressant - 5HT-2 and 5HT-3 antagonist and H1 activity

Question 10

mirtazepine

Answer 10

sedation (histamine)
weight gain

Question 11

TCA uses and examples

Answer 11

if not respond to SSRI’S
newer - lofepramine
older - amitriptyline

Question 12

TCA s/e

Answer 12

muscarinic and histaminic side effects
QT prolong and arrhythmias

Question 13

MAOI mechanism

Answer 13

MAOI-A - work on serotonin
MAOI-B - work on dopamine
…both can increase adrenaline

Question 14

MAOI types

Answer 14

irreversible (more dangerous) - phenelzine, isocarboxazid
reversible (less dangerous) - moclobamide, tranylcypromine

Question 15

MAOI cautions

Answer 15

potential for significant drug interactions
tyramine reaction leading to hypertensive crisis - avoid cheese, pickled meats, wine and other tyramine products
if changed to another antidepressant, need a washout period (up to 6 weeks)

Question 16

vortioxetine mechanism

Answer 16

serotonergic activity

Question 17

vortioxetine s/e

Answer 17

nausea

Question 18

when use mirtazapine not SSRI

Answer 18

if major weight loss or major sleep difficulty

Question 19

Anxiety and OCD dose changes

Answer 19

If no initial change, consider increasing

Question 20

Discontinuation syndrome

Answer 20

Sweating, shakes, agitation, insomnia, headaches, irritability, N+V
…worse if shorter half life (paroxetine and venlafaxine)

Question 21

Stop paroxetine and venlafaxine

Answer 21

Alternate days of taking or snap in half
Or switch to fluoxetine and then reduce

Question 22

Serotonin syndrome sx

Answer 22

Headaches, agitation, hypomania, coma, shiver, sweat, hyperthermia, tachycardia, N+V, myoclonus, hyperreflexia, tenor

Question 23

Serotonin syndrome tx

Answer 23

Fluids and monitor

Question 24

Antipsychotics mechanism

Answer 24

Reduce levels of dopamine activity at D2 receptors at mesocortical and Mesolimbic pathways

Question 25

Antipsychotics general s/e

Answer 25

Nigostriatal - movement Tuberoinfundibular - hypothalamic-pituitary-adrenal axis Sedation Extrapyramidal Weight gain Acute dystopia - ocuolgyric crisis

Question 26

Typical v atypical antipsychotics mechanism

Answer 26

Typical - muscarinic and hustaminic receptors Atypical - serotonergic

Question 27

Typical antipsychotics examples

Answer 27

Haloperidol Chlorpromazine

Question 28

Atypical antipsychotics examples

Answer 28

Clozapine Olanzapime Riperidone

Question 29

Anomaly atypical antipsychotic

Answer 29

Aripiprazole - D2 partial agonist not antagonist so fewer side effects

Question 30

Typical antipsychotics s/e

Answer 30

Extra pyramidal - bradykinesia, muscle stiffness, tremor, tardive dyskinesia, akathisia Dizziness Sexual dysfunction

Question 31

Atypical antipsychotics s/e

Answer 31

Weight gain Dyslipidaemia and diabetes

Question 32

Antipsychotic generally monitoring

Answer 32

FBC, LIPID, LFT, HBA1C, WEIGHT, ECG, BP, PULSE,

Question 33

Neuroleptic malignant syndrome what and risks

Answer 33

Life threatening reaction to antipsychotics - fever, confusion, muscle rigidity, sweating, autonomic instability Risk of death due to rhabdomyolysis, renal failure, seizures

Question 34

Neuroleptic malignant syndrome risk factors

Answer 34

High potency dopamine antagonist ie typical ones, high doses, young men

Question 35

Neuroleptic malignant syndrome tx

Answer 35

EMERGENCY stop antipsychotics Give benzo acutely due to behaviour change Fluid resuscitation Reduce temp Oxygen Fluids and sodium bicarbonate Relax muscles with Dantrolene or lorazepam

Question 36

Extra pyramidal and acute dystonia treatment

Answer 36

Too much acetylcholine in relation to dopamine….reduce by antagonising with procyclidine

Question 37

Most efficacious antipsychotic

Answer 37

Clozapine D2 antagonist, 5HT2 antagonist Used after trying two other ones

Question 38

Clozapine s/e

Answer 38

Leukopenia Constipation and fatal bowel obstruction Hypersalivation Urinary incontinence

Question 39

Clozapine agranulocytosis tx

Answer 39

Stop any myelosuppresive drugs Avoid antipsychotics for a couple of weeks Consultant haematologist Avoid infection Lithium or G-CSF

Question 40

Beta blocker mechanism

Answer 40

Reducing autonomic activity

Question 41

Beta blockers c/i

Answer 41

Asthma

Question 42

Benzodiazepines mechanism

Answer 42

Bind to GABA receptors to potentiate effects of GABA and reduce excitability of neurones

Question 43

Benzo how long use

Answer 43

Tolerance, dependence Misuse <6 weeks

Question 44

Pregablin mechanism

Answer 44

Binds ro voltage gated calcium channels on neurones reducing neuronal activity

Question 45

Pregablin indications

Answer 45

Anxiety Neuropathic pain Epilepsy

Question 46

Pregablin s/e

Answer 46

Sedation Weight gain

Question 47

Hypnotics types

Answer 47

Benzodiazepines - temazepam, lormatazepam Non Benzo - zopiclone < 2 weeks

Question 48

Mood stabilisers indications

Answer 48

Bipolar

Question 49

Lithium mechanism

Answer 49

Lowers noradrenaline release and increase serotonin synthesis

Question 50

Lithium monitoring

Answer 50

Regular serum lithium levels - narrow gap between effective and toxic dose

Question 51

Lithium other indications

Answer 51

Self harm Augment antidepressant

Question 52

Lithium s/e

Answer 52

GI disturbance, metallic taste, dry mouth, fine tremor, polydipsia, polyuria, weight gain

Question 53

Lithium long term effects

Answer 53

Hypothyroidism Renal impairment

Question 54

Lithium toxicity

Answer 54

Confusion, coarse tremor, NAND V, ataxia, seizures Tx with stop lithium and supportive fluids

Question 55

Lithium interactions

Answer 55

NSAIDS loop diuretics ACEi

Question 56

1st line tx for bipolar

Answer 56

Quetiapine Second generation antipsychotics in bipolar

Question 57

Anticonvulsants in bipolar examples

Answer 57

Sodium valproate Carbamazepine Lamotrigine

Question 58

Anticonvulsants s/e

Answer 58

Sedation Weight gain Thrombocytopenia

Question 59

Drugs for ADD and ADHD

Answer 59

Methylphenidate - CNS stimulants Atomoxetine - NA re uptake inhibitor

Question 60

antipsychotics in elderly pts

Answer 60

increased risk of stroke and VTE

Question 61

mirtazapine

Answer 61

blocks alpha 2 adrenergic receptors - increases release of neurotransmitters fewer side effects - sedation and increased appetitie

Question 62

SSRI +NSAID

Answer 62

require PPI

Question 63

citalopram

Answer 63

QT prolongation

Question 64

SSRI interactions

Answer 64

warfarin heparin NSAIDS aspirin tritptans