Phenelzine is used to treat social phobia in a 28yo. What do they need to be aware of:
- infrom team if new rash
- have at exactly same time each day
- avoid use of NSAIDS
- avoid fermented food and drinks
MOAI
(avoid foods high in tyramine incl alcohol, ages cheese)
excessive tyramine –> hypertensive crisis by releasing noradrenaline –> blood vessels contrict by activating alpha-1 adrenergic receptors
Which is a/w increased risk of clozapine induced constipation
- inpatient mental health treatment
- decreasing age
- diagnosis of schizophrenia
- smoking
- female gender
inpatient mental health treatment
Man with opiate dependance. He has tried a medication in past to cease use of opioids but it caused light-headedness and episodes of fainting. Which caused this?
- clonidine
- naltrexone
- lofexidine
- methadone
- buprenorphine
What is it’s mechanism of action?
Chloidine
(can –> hypotension and fainting)
it is a centrally acting alpha 2 agonist
Which 2 antidepressants are associated with weight gain?
- venlfaxine
- paroxetine
- amitriptyline
- sertraline
- bupropion
- fluoxetine
amitriptyline and paroxetine
(in contrast fluoxetine and bupropion –> weight loss)
Which causes weight gain
- methyphenidate
- vortioxetine
- pregabalin
- agomelatine
- modafini
pregabalin
Which psychotropic drugs are the following associated with
- renal impairment
- polycystic ovarian syndrome
- SJS
- hypothyroidism
- renal impairment/ hypothyroid= lithium
- PCOS = valproate
- SJS = lamotrigine
Which describes how benzo work
- GABA-B positive allosteric modulator
- GABA-A positive allosteric modulator
- GABA-A antagonist
- GABA-B agonist
- GABA-A agonit
GABA-A allosteric modulator
they increase efficiency of natural brain chemical GABA to decrease excitability of neurons.
increases the total conduciton of chloride ions across the nuronal celll membrane when GABA is already bound to its receptor. The increased chloride ion influc hyperpolarizes the nruones membrane potential. As a result the difference ebtween resting potential and threshold potential is increased and firing less likely
Lithium: what ECG change NOT seen
- PR prolonged
- higher QT dispersion ratio
- T wave flattening
- Wolff Parkinson White
- Sinus node dysfunction
WPW syndrome
(all the rest associated with lithium)
WPW is a congeital condition involving abnormal condution between the atria and ventricles, which can provide a pathway for re-entrant tachycardiac circuit, in associated with SVT
post haloperidol depot a patient is troubled by stiffness when moving and slowed physical reactions.
what is the diagnosis?
what is treatment
- propanolol
- procyclidine
- valbenazine
- topiramate
- diazepam
EPSE
procyclindine is used to treat
Valbenazine = used to treat tardive diskinesia
How does Carbidopa work
- prevents breakdown of dopamine in CNS
- dopamine partial agonist
- dopamine antagonist
- increases metabolism of L-dopa
- inihits DOPA decarboxylast
inhibits DOPA dcarboxylase
L-dopa acts as precursoe of dopamine and can cross blood-brain barrier
CArbidopa inhibits DOPA decarboxylase which metabolises L-dopa into dopaine –> increases amound of L DOPA –> more crosses CNS and then becomes dopamine
Carbidopa doesn’t cross BBB and so doesn tinterfere with L dopa metaboism in CNS
Which neurotransmitter is used by the neurons in the locus coeruleus
- glutamate
- GABA
- dopamine
- serotonin
- noradrenaline
noradrenaline
Valproate and lamotrigine: how do they interact
valproate inhibits clearance of lamotrigine by ~30%
How do these drugs affect one another
- tramadol and amitriptaline
- clozapine and lithuum
- citalopram and aspirin
- tramadol and amitriptaline
increases risk of seizure - clozapine and lithum – neurotoxicity even with theraprutic serum concentrations
- citaopram inhibits serotonin reutake –> more serontonin in periphery –> iparied ability of platelets to store serotonin which they use in their aggregation –> risk of bleeding
GHB acts on:
- COMT
- GABA-A
- GABA-B
GABA-B
GHB also known as 4-hydroxybutanoic acid. it is a precursoe to GABA, glutamate and glycine
How does cocaine work
- sodium channel blockade
- increased conc glutamate
- inhibition of dopamine reuptake
- reduced availability of dopamine
inihibiton of dopamine reuptake
dopamine subtype D1
Which is correct medicine with MoA?
- methadone- partial optioid agonist
- buprenorphine- pure optiod agonist
- naltrexone- partial opioid agonist
- methadone- pure opioid agonist
- buprenorphine-pure opioid antagonist
methadone- pure opioid agonist
buprenorphine- partial optioid agonist
naltrexone - competative opioid antagonist
SSRI and platelets how do they work
inhibit transporter for uptake of serotonin into platelets
Atomoxetine is used in ADHD. How does it work
- GABA antagonist
- serotonin reuptake inhibitor
- glutamate agonist
- noradrenaline reuptake inhibitor
- dopamine reuptake inhibitor
noradrenaline reuptake inhibitor
methylphenidate is a dopamine reuptake inhibitor
Hypnotics: which has shortest HL
- zaleplon
- diazepam
- temazepam
- zopiclone
- zolpiden
zalepon (~1hr)
Others:
ZALEPlon= 1hr
Zolpidem 2.4hr
zopiclone 5hr
Benzos:
temazepam 10hr
diazepam 100hr
Which has “waves” of withdrawal
- vortioxetine
- venlafaxine
- mirtazapine
- sertraline
- fluoxetine
venlafaxine
a/w severe withdrawal
short half life (~5hr)
Which has shortest HL
- paroxetine
- fluoxetine
- fluvoxamine
- escitalopram
- sertraline
fluvoxamine
SHORTEST
fluvoxamine (17-22hr)
sertraline (22-36hr)
paroxetine (24hr)
escitalopram (30hr)
fluoxetine (4-6days)
for comparison venlafaxine is 5hr
Which tests fronal lobe
- Bender-Gestalt test
- adult reading test
- dot cancellation test
- Wisconsin card sorting test
- Ravens progressive matrices
Wisconsin card sorting test
Test for visual attention and task switching:
- Boston Naming test
- Trail Making test
- Tower of London test
- Rey-Osterrieth comlex figure
- Stroop task
trail making test
“Trail Making = Connect the dots to test attention and flexibility”
Part A = numbers only → attention & speed
Part B = numbers + letters → executive function & set-shifting
