Set 2 Flashcards by Lucy M

Which antidepressant has lowest risk of sexual side effects?
- mirtazapine
- sertraline
- venlafaxine
- trazadone
- agomelatine

agomelatine

an atypical antidepressant used for major depressive disorder, working as a melatonin agonist (MT1/MT2) and serotonin 5-HT2C antagonist

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Huntington’s disease is progressive neurodegenerative disorder characterised by:
- CAG >35 expansion
- CAG < 35 expansion

CAG >35 expansion

located on the first exon of the HD gene

varies from 6-37 repeats of CAG on unaffected individuals, and 30-180 on affected individuals

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Gene most strongly implicated in ADHD
- dopamine 1 receptor gene
- dopamine 2 receptor gene
- dopamine 3 receptor gene
- dopamine 4 receptor gene
- dopamine 5 receptor gene

dopamine 4 receptor gene

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Frontotemporal dementia: what chromosome impacted?
- 19
- 17
- 5
- 7
- 22

(chromosome 17q21)

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Which is highest known genetic risk factor for schizophrenia (other than having monoxygotic twin sibling with the same illness)
- 19 q11.2
- 25 q11.2
- 5q 11.2
- 22 q 11.2
- 14q 11.2

22q11.2

22q11.2 deletion syndrome (velo-cardio-facial syndrome) have 30% chance of schizophrenia

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Mutations in progranulin cause:
- CJD
- Parkinsons
- FTD
- CADASIL
- Lewy Body dementia

FTD –> dementia (autosomal dominant type)

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CADASIL is a mutation in what gene
- COMT
- Dysbindin
- Parkin
- Notch3
- LRRK2

Notch3

subcortical small vessel disease

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Which structure involved in Wernickes encephalopathy?
- prefrontal cortex
- basal ganglia
- mamillary bodies
- hippocampus
- amygdala

mamillary bodies
(also thalamic nuclei, and walls of third ventricle)

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Cranial nerves

I - olfactory
II - optic
III occulomotor
IV trochlear
V trigeminal
VI abducens
VII facial
VIII vestibulocochlear
IX glossopharygeal
X vagus
VI accessory
XII hypoglossal

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nerve supply of superior oblique muscle
- trochlear
- oculomotor
- facial
- trigeminal
- abducent

trochlear (CN IV)

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A 56yo man with personality changes, anxiety, depression, confusion, memory loss. He has impaired coordinatin and began to experience falls There was suspicion of vCJD. What signs seen on MRI (accurate diagnostic sign)
- hypothalamus hyperintensity
- pineal gland sign
- frontal lobe atrophy
- pulvinar sign
- cereballar hypointensity

pulvinar sign

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Pregabalin: which receptor does it work on?
- acetylcholine
- serotonin
- GABA
- glutamate
- noradrenaline

GABA

pregabalin is a GABA analogue

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Benzos enhance effects of what neurotransmitter
- GABA
- dopamine
- norepinephrine
- serotonin
- acetyl choline

AGABA

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Angledust (phencyclidine AKA PCP) causes amnesia due to action on what recetpro
- acetyl choline
- serotonin
- dopamine
- glutamate
- noradernaline

glutamate

it acts as antagonist at ionotropic glutamate receptors e.g. NMDA

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Phencyclidine (PCPC) acts on what receptor to produce Sx of schizophrnia
- NMDA receptor
- AMPA
- Kainte
- dopamine receptor
- serotonin receptor

NMDA receptor
(blocks NMDA)

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What is NOT true RE D2 receptors?
- affect adenylyl cyclase activity
- they are excitatory
- consititue pre and post synaptic receptors
- G protein coupled
- act via tuberoinfundibular pathway

they are NOT excitatory!

they are
- pre and post synaptic
- inhibit adenylyl cyclase activity
act via tuberoinfundibular pathways (inhibiti prolactin)

antipsychotics remove inhibitory control of dopamine, as block D2 receptors in tuberinfundibular tract —> HYPERPROLACTINAEMIA

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which is highly selective dopamien antagonist
- haloperidol
- sulpride
- olanzapine
- chlorpromazine
- clozapine

sulpride

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methylphenidate in ADHD: how does it work
- catecholamine reuptake inhiition
- norepinephrine dopamine reuptake inbiitor
- dopamine agonist
- serotonin reuptake inhibitor
- Sigma 1 antagonist

norepinephrine dopamien reuptake inhibitor

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Parkinsons disease: whcih genes
- dysbindin
- presenilin-2
- alpha synuclein
- neuroregulin
- amyloid precursor protein

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alpha synuclein

also
- parkin
- leucine rich repeat kinase 2
- PTEN-induced putative kinase (PINK1)

Name of phenomenon:
womna spreading lies to other parents about her ex husband. She is happy when ex husband excluded from letting him see the kids and she tells you this proves shes a better parent. these fale accounse coincide with his new relationship.

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psueodologica fantastica
(seen in Munchausen)

PTSD sleep findings
- decreased NREM stage 1
- increased frequenct of rapid eye movements in REM
- longer sleep time
- decreased sleep latency
- longer duration NREM stage 2

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increased frequency rapid eye movements in REM

also
increased NREM stage 1, decreased slow wave sleep, increased rapid eye smovements per minute

GAD (anxiety): which treatment is licensed:
- aripiprazole
- topiramate
- gabapentin
- pregabalin
- lamotrigine

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pregabalin

(comparable to benzos in RCTs)

If patient develops hyponatraemia on SSRI, which is a good switch?
- citalopram
- mirtazapine
- moclobemide
- paroxetine
- amitriptyliina

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MOA (moclobemide)

or noradrenercie e.g. nortriptyline and lofepramine

Olanzapine travels well into fat tissues because of
- renally excreted
- protein bound
- lipophilic
- metabolised in phase I oxidative metabolism
- induces cytochrme BYP450

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lipophilic

Stopping smoking: will this increase or decrease clozapine levels?

INCREASE

The serotonergic receptor with auto-regulatory function in synaptosomes (5-HT terminal) is: - 5-AT1A - 5-HT2A - 5-HT2B - 5-HT1B - 5-HT1D

5-HT1B these regular 5-HT reuptake and modulate 5-HT release and synthesis

'Sawtooth wave pattern' in EEG is seen in which phase of sleep - NREM Stage 1 - NREM Stage 2 - NREM Stage 3 - NREM Stage 4 - REM Stage

REM

What type of EEG changes are routinely seen in Delirium Tremens - low voltage fast activity - focal delta activity - diffuse slowing of the background rhythm - increase triphasic waves - generalised periodic 1-2Hz sharp waves

low voltage fast activity

33yo woman taking paroxetine for a few months. She develops pins and needles and shock like senseatons in legs. what is the diagnosis? - neuroleptic malignant syndrome - dyskinesia - serotonin syndrome - antidespressant discontinuation syndrome - akithesia

antidespressant discontinuation syndrome onset usually 5 days from stopping but depends on half life (presonally I think stupid question becasue it doesn't say she stopped taking it) risk of discontinuation increased in those with short half-life e.g. parioxetine and venlafaxine

What should be avoided in organic disinhibiton? - trazadone - SSRI - sodium vaproate - olanzapine - benzodiazepines

benzodiazepines

Which is least likely to precipitate a manic switch in someone depressed with Bipolar Affective Disorder Type II? - sertraline - amitripyillin - buproprion - fluoxetine - venlafaxine

buproprion

What two illict drugs act as NMDA receptor antagonists?

Ketamine and phenycyclidine

How do SSRIs increase risk of GI bleeding

inhibit serotonin transporter which is responsbile for serotonin uptake into platelets --> deplete platelet of serotonin --> reduced ability to clot

acute confusional state, fever, rasied BP, excessive sweating, blateral clonus. Diagnosis? - serotonin syndrome - antidepressant discontinuation syndrome - hyponatraemia - neuroleptic malignant syndrome - mchausen syndrome

serotonin syndrome

What blood test needed before starting Agolematine for depressive disorder? - liver function test - ECG - U&E - FBC - TFTs What is the mechanism?

liver function test (before starting and at 3,6,12, and 24 week intervals) A melatonin receptor agonist and a selective serotonin-receptor antagonist

55yo woman behaving psychotically after a medication stopped following DVT. Which medication was stopped? - eostrogen - thyroxine - testosterone - progesterone - androgen

estrogen HRT estrogen is a powerful psychoactive hormone

New antidepressant starting + dinner party + suddenly feels unwell with facial flushing, high BP. What was started? - sertraline - fluoxetine - agomelatine - mirtazapine - tranylcypromine

tranylcypromine (MOAI)

What pharmokinetic change occurs in pregnant: - increased renal elimination - reduced rate of metabolism - increased plasma protein binding - reduced volume of distribution

increased renal eliminaition also - gastric emptying and small intestine motility reduced (due to increased progesterone) - increased water --> hydrophilic drughs distribute more - albumin decresaes due to haemodilution --> less binding - some enzymes P450 induced by oestrogen/ proesterone - renal filtration increases by 50%

whhich is an aspect of pharmokinetics - storage release - neurotramsitter synthesis - reuptake - absorption - neurotransmitter storate

absorption (and distribution, metabolism, and elimination) ADME

What is free recall in memory tests?

retrieval of information without the help of cues

Memory test: asked t0o remeber one list, then given another to remember, then asked what was on the first list - immediate free recal - delayed free recall - working memory - semantic memory - iconic memory

delayed free recall

What is advised when switching: trazodone to mirtazapine - cross taper with caution - withdraw and wait 2 weeks - withdraw and wait 5-6 weeks - stop and start other drug immediately - half dose, start new drug, then slow withdrawal

cross taper with caution trazaone= SARI (serotonin antagonist and reuptake inhibitor) Withdraw and wait 2 or 5-6 weeks: This is typically reserved for switching to/from MAOIs (Monoamine Oxidase Inhibitors) to avoid Serotonin Syndrome. Since neither trazodone nor mirtazapine are MAOIs, such a long "washout" period is unnecessary and leaves the patient's depression untreated for too long. Stop and start immediately: This carries a high risk of discontinuation syndrome from the trazodone. It is generally only done when switching between drugs in the exact same class with similar half-lives (e.g., certain SSRIs). Half dose, start new drug, then slow withdrawal: While this is a form of cross-tapering, it isn't the standard clinical phrasing. A standard cross-taper usually involves a more granular, step-wise reduction of the first drug rather than a single "half dose" jump.

What is advised when switching: phenelzine to sertraline - cross taper with caution - withdraw and wait 2 weeks - withdraw and wait 5-6 weeks - stop and start other drug immediately - half dose, starrt new drug, then slow withdrawal

withdraw and wait 2 weeks

What is advised when switching: fluoxetine to tranylcypromine - cross taper with caution - withdraw and wait 2 weeks - withdraw and wait 5-6 weeks - stop and start other drug immediately - half dose, starrt new drug, then slow withdrawal

withdraw and wait 5-6 weeks

What is advised when switching: - cross taper with caution - withdraw and wait 2 weeks - withdraw and wait 5-6 weeks - stop and start other drug immediately - half dose, starrt new drug, then slow withdrawal

What is advised when switching: fluoxetine to duloxetine - cross taper with caution - withdraw and wait 2 weeks - withdraw and wait 5-6 weeks - stop and start other drug immediately - half dose, starrt new drug, then slow withdrawal

stop and start other drug immediately

What is advised when switching: amitriptyline to citalopram - cross taper with caution - withdraw and wait 2 weeks - withdraw and wait 5-6 weeks - stop and start other drug immediately - half dose, starrt new drug, then slow withdrawal

half dose and start new drug, the slow withdrawal

Set 2 Flashcards

(47 cards)