Question | Answer |
Define psychotropic. | Mind-altering. |
List the main classes of drugs used in psychiatry. | Antidepressants.
Mood stabilizers.
Antipsychotics.
Anxiolytics & hypnotics. |
List the classes of antidepressants. | Tricyclics, SSRIs, SNRIs, MAOIs, RIMAs, NaSSAs, NARIs, SARIs & misc. others. |
A good first line antidepressant. | An SSRI e.g. fluoxetine, sertraline etc. |
SSRI side effects. | GI upset, agitation, loss of appetite, insomnia, sweating, sexual dysfunction. |
A contraindication of virtually all antidepressants. | Mania. |
Class and mechanism of mirtazapine. | Noradrenergic and specific serotonergic antidepressant (NaSSA). Inhibition of presynaptic adrenergic receptors. ?Stimulation of postsynaptic serotonin receptors. |
Mirtazapine side effects. | Increased appetite, weight gain, sedation, headache, dry mouth, postural hypotension, tremor, dizziness, peripheral oedema. |
Tricyclic side effects. | Sympathetic (constipation, dry mouth etc.), postural hypotension etc., weight gain, sedation, cardiotoxicity. |
List TCAs. | Amitriptyline, clomipramine, imipramine, lofepramine. |
Contraindications of TCAs. | Recent MI, cardiac disease, arrhythmias, severe liver disease, mania, significant suicide risk. |
Class and mechanism of trazodone. | Antagonist of serotonin 2A R, but inhibits re-uptake. |
What is the "cheese reaction"? | A hypertensive crisis caused by ingesting tyramine-rich foods causing a release of noradrenaline when on MAOIs. |
List tyramine-rich foods. | Some cheeses, chianti, beer, pickled herring, game, yeast extract in Marmite / Vegemite etc. some legumes. |
Drugs interacting with MAOIs. | SSRIs (serotonin syndrome), opiates (serotonin syndrome; some SSRI activity), OTC decongestants, amphetamines, cocaine, adrenaline. |
Contraindications of MAOIs. | Phaeochromocytoma, cerebrovascular disease, liver disease, mania. |
Which SSRI has the longest half life? | Fluoxetine (therefore does not need tapering). |
Which antidepressants are used in a lower dose for neuropathic pain? | TCAs especially amitriptyline. |
Drugs companies covered up the increased suicide risk in young people when taking which drug? | Paroxetine, an SSRI. |
Duloxetine, an SSRI, is also used in which condition? | Bladder instability. |
Class and mechanism of venlafaxine. | SNRI, inhibits re-uptake of noradrenaline and serotonin. |
Class and mechanism of phenelzine. | MAOI, inhibits presynaptic degradation of amine neurotransmitters. |
What are the principle symptoms of serotonin syndrome? | Neuromuscular abnormalities, reduced consciousness and autonomic instability. |
Class and mechanism of moclobemide. | RIMA, reversably inhibits monoamine oxidase A. |
Which class of antidepressants are associated with cardiotoxicity? | TCAs. |
Describe the classes of mood-stabilizer. | Lithium and anti-epileptics. |
Indications of lithium. | Acute mania, prophylaxis in bipolar disorder, augmentation in major depression, various other adjuncts. |
What are the therapeutic levels of lithium? | 0.5 - 1.0 mmol/L. (Some clinicians say 0.4 - 0.8). |
Lithium toxicity generally occurs above what level? | 1.5 mmol/L |
How is lithium eliminated by the body? | Almost entirely renally excreted. |
Symptoms of lithium toxicity. | GI upset, coarse tremor, altered consciousness, double vision etc. |
Lithium side effects (short term). | Polydipsia, weight gain, oedema, skin disease, renal impairment, ECG abnormalities, memory problems etc. Lithium is highly teratogenic. |
Lithium side effects (long term). | Hypothyroidism, hyperparathyroidism (and elevated Ca++). |
1.8 mmol/L of Li+ is: | A toxic level, prescribe fluids and stop Li+ for a day or two. |
2.5 mmol/L of Li+ is: | Dangerously toxic, urgent dialysis required. |
Many drugs interacting with lithium: | Alter renal function, e.g. ACEis, NSAIDs, diuretics esp. thiazides. |
The most common cause of lithium toxicity is. | Iatrogenic - junior Drs Px NSAIDs etc. |
Is all lithium carbonate the same? | No, should be prescribed with a specific brand name (like insulin preparations). |
Contraindications of lithium. | Pregnancy and breastfeeding, renal impairment, thyroid disease, heart disease, degenerative neurological diseases. |
Signs of lithium toxicity. | Vomiting, apathy, coarse tremor, ataxia, weakness, nystagmus, dysarthria, reduced consciousness, hyperreflexia, oliguria, hypotension, convulsions, coma and death. |
Lamotrigine is associated with which serious side effect? | Stevens-Johnson syndrome (rashes, ulceration of mucous membranes) |
Valproate, carbamazepine and lamotrigine are. | Mood-stabilizers. |
Main classification of antipsychotics. | Typical and atypical. (Clozapine is the only true atypical). |
What is the mechanism of (almost all) antipsychotics? | D2R blockade, both for intended and side effects. |
Side effects of antipsychotics. | Increased negative and cognitive symptoms, extrapyramidal side effects, hyperprolactinaemia, anticholinergic, antiadrenergic etc. Arrythmias. |
Long term monitoring of what condition is recommended for patients on antipsychotics? | Metabolic syndrome. |
List antipsychotics that can be Px IM. | Haloperidol, flupentixol, zuclopenthixol, risperidone. |
Clozapine is associated with which serious side effects? | Agranulocytosis, myocarditis and cardiomyopathy, toxic megacolon. |
Which blood test should be regularly undertaken in patients on clozapine? | FBCs to screen for agranulocytosis. (And fasting lipids and glucose) |
List the extrapyramidal side effects. | Parkinsonism, acute dystonia, akathisia, tardive dyskinesia. |
Antipsychotics are occasionally prescribed to patients with delirium. Are they helpful in DT? | No; they lower the seizure threshold. |
Which drugs is it illegal to prescribe to patients with dementia in America? | Antipsychotics, as increase cerebrovascular risk and were used as "chemical cosh". |
A hypnotic drug: | Induces sleep (dose dependent). |
An anxiolytic drug: | Reduces anxiety (dose dependent). |
Unlike many other drugs used in psychiatry, hypnotics/anxiolytics are | Addictive (tolerance, dependence and withdrawal). |
Indications for the use of benzodiazepines. | Insomnia, anxiety disorders, alcohol withdrawal, akathisia, sedation in acute mania or psychosis etc. |
Zopiclone etc. may be used in: | Insomnia. |
What is the mechanism of action of benzodiazepines? | Potentiating GABA (by increasing the affinity of the receptor for its ligand) |
Side effects of benzodiazepines. | Dependence, sedation, respiratory depression. |
Aside from benzodiazepines, which drugs may impair your ability to drive due to sedation? | Tricyclic antidepressants, most antipsychotics (not aripiprazole), sedating antihistamines, opiates. |
Treatment regimen for alcohol withdrawal: | Reducing regimen of benzodiazepines (commonly chlordiazepoxide, QDS + prn) |
Autonomic symptoms of anxiety may be treated by: | beta-blockers, which have the advantage that they're not addictive. |
How does acamprosate work in alcohol addiction? | Reduces cravings. |
How does disulfiram work in alcohol addiction? | Prevents metabolism of acetaldehyde, causing unpleasant symptoms after drinking. People still drink on this, which can be dangerous. |
Class and mechanism of naltrexone: | Opioid receptor antagonist - use in opiate addiction as it lessens pleasureable effects. |
Which benzodiazepines have a long half-life (many days)? | Diazepam and chlordiazepoxide. |
Many drugs used in the treatment of dementia: | Increase the synaptic availability of ACh by inhibiting its breakdown by AChE. |
How does memantine work in the treatment of dementia? | NMDAR modulator. |