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Part II ISQ Club - Pharmacology

70 posts in this topic

Part II ISQs on one topic will be posted twice a week on Monday and Thursday. You are encouraged to post a reply in the thread, stating whether you think an ISQ is true or false and why (eg. a short explanation, with reference to the textbook you used). Please only deal with one ISQ in each post and include the question as the first line of your post.

In a few days this ISQ Club thread will be moved to the Question Bank board. If you submit an answer, your status will be changed to 'Question Bank member' and you will be able to see the Question Bank board. Please allow up to 48 hours for this change to happen.

1. The dexamethasone suppression test is a reliable test for depression in the elderly

2. Depression may present with similar features to hyperthyroidism

3. Melatonin has a significant side effect profile

4. The QT interval normally up to 400mV/sec

5. Neuroleptic malignant syndrome can be treated with calcium channel blockers and dopamine agonists

6. Sildenafil citrate acts on cGMP

7. Acamprosate blocks glutamate

8. Memantine blocks NMDA receptors.

9. Naltrexone is useful for managing self harm in LD

10. Heroin is more potent at m receptor than cocaine

11. Naloxone helps with opiate withdrawal

12. Lofexidine is an a2 agonist.

13. Alcohol flush can occur with metronidazole

14. Dependence should be treated with longer acting benzodiazepines

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Acamprosate blocks glutamate true

from Companion [page353]

it is a GABA agonist and glutamate antagonist used in alcohol problems.

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Lofexidine is alpha2 agonist True

Companion[p 358]

It is a alpha2 adrenergic agonists[like clonidine] used in symptomatin treatment of opiate withdrawal.

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metronidazole may cause alcohol flushing T.

drugs which induce alcohol flushing are

disulfiram

chlorpropamide

calcium carbamide

phentolamine

metronidazole

cephalosporins

alcohol may cause flushing while mushrooms are consumed.

ref:http//dermnetnz.org/vascular/flushing.html

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1. The dexamethasone suppression test is a reliable test for depression in the elderly

False

50% non-responders in depression

Also abnormal DST in mania, chr schizophrenia and dementia.

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2. Depression may present with similar features to hyperthyroidism

True?

Presentation with psychiatric sx common – anxiety, irritability, emotional lability, difficulty concentrating.

Diff diagnosis – anxiety disorder

Ref – shorter OTP pg 489

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3. Melatonin has a significant side effect profile

False

Not licensed but supposedly quite safe?

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4. The QT interval normally up to 400mV/sec

Normal QTc interval is 350 – 430 ms. (making sense of the ECG by Houghton & Gray)

I'm not sure about the 'mV/sec'

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5. Neuroleptic malignant syndrome can be treated with calcium channel blockers and dopamine agonists

False

Dantrolene & Dopamine agonists have been found useful.

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6. Sildenafil citrate acts on cGMP

False

Sildenafil is a high affinity selective Phosphodiesterase type 5 inhibitor i.e inhibits breakdown of cGMP

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7. Acamprosate blocks glutamate

True

Stimulates GABA inhibitory transmission and decreases excitatory effect of Glutamate

Shorter OTP pg 556

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8. Memantine blocks NMDA receptors.

True

Manchester course, Is NICE appraising it?

BNF: Memantine is a NMDA-receptor antagonist that affects glutamate transmission; it is licensed for treating moderate to severe Alzheimer's disease.

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False

Medications given to treat NMS include:

Benzodiazepines. lorazepam

Dopamine agonists. dopamine agonists such as bromocriptine or amantadine. Newer drugs such as ropinorole and pramipexole may also be useful. Dopaminergic drugs, however, can worsen psychosis and cause hypotension and emesis.

Dantrolene but since Dantrolene can impair respiratory and hepatic function and should not be combined with calcium channel blockers.

ECT has also been used for refractory NMS patients.

Ref:http://www.currentpsychiatry.com/2003_12/1203_nms.asp

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9. Naltrexone is useful for managing self harm in LD

True

Some recent studies suggest that the opiate antagonists, naloxone and naltrexone may attenuate the frequency or severity of self- injurious behavior.

Kaplan & sSaddock

Vol 2 page 2362

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No.10 Heroin is more potent at mu receptor than cocaine.

TRUE

Heroin acts on mu receptors and cocaine is a dopamine reuptake inhibitor.

(Stahl)

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11. Naloxone helps with opiate withdrawal - True

Opioid drug most often used to ameliorate the severity of withdrawl is oral mathadone.

In low-level to moderate dependence the withdrawl process can be accomplished within one or two days by giving repeated doses of naloxone to precipitate symptoms and ameliorating discomfort with diazepam or clonodine.

Kaplan & Saddock

Vol 1 page 855

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14. Dependence should be treated with longer acting benzodiazepines

True

Companion 6th edn

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depression may present with similar features to hyperthyroiidsm  F

hypothyroidism is assciated with depression

hyperthyroidism  mainly with anxiety symtoms??

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i think i have to agree with catpaw regarding depression and hyperthyroidism..i go for false as the answer too!

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Acamprosate act by stimulating GABA-ergic inhibitory transmission and antagonises excitatory aminoacids,particulary Glutamate.

Acamprosate is an anticraving agent.

Treatment with acamprosate should be initated ASAP after withdrawal period and once abstinance is acheived.

Treatment is recommended for 1yr.

Side effects tend to be mild and transient, generally Gastrointestinal in nature or a rash.

p-375,Use of Drugs in Psychiatry,Gaskell

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dependence should be treated with long acting benzos

i think its false since type of dependence is not specified i dont know what others think

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2. Depression may present with similar features to hyperthyroidism

From the Oxford textbook of Medicine...(sorry I can't give a better ref but this was taken from the on-line edn)

Occasionally there are paradoxial manifestations, such as the weight gain which can occur in up to 10 per cent of patients when the increase in appetite exceeds the effects of increased metabolism, and apathetic or masked thyrotoxicosis in the elderly which mimics depression.

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1. The dexamethasone suppression test is a reliable test for depression in the elderly

False - also non supression in ageing and dementia

Seminars in old age psych. gaskell, p109

2. Depression may present with similar features to hyperthyroidism

True

3. Melatonin has a significant side effect profile

False - it is available over the counter in the litigation friendly US after all

4.The QT interval normally up to 400mV/sec

False, figures seem to vary depending on the textbook but Maudsley guidelines say 440ms for men, 470ms for women

5. Neuroleptic malignant syndrome can be treated with calcium channel blockers and dopamine agonists

True - Oxford textbook of psychiatry, bromocriptine and dantrolene used (bromocriptine is a DA agonist and dantrolene blocks release of intracellular calcium)

6. Sildenafil citrate acts on cGMP

? True - if it increases quantity by preventing breakdown?

7. Acamprosate blocks glutamate

True. NMDA antagonist

8. Memantine blocks NMDA receptors

True - NMDA antagonist

9. Naltrexone is useful for managing self harm in LD

True

10. Heroin is more potent at m receptor than cocaine

true - mu is opiate receptor

11. Naloxone helps with opiate withdrawal

?True - used in 'ultrarapid detoxification' usually under anaesthesia but is a controversial treatment. Wording makes it difficult

Valmana, Anton Nonmethadone pharmacotherapies in opioid addiction. Current Opinion in Psychiatry. 12(3):307-310, May 1999.

12. Lofexidine is an a2 agonist.

True

13.Alcohol flush can occur with metronidazole

True

14. Dependence should be treated with longer acting benzodiazepines

True - short acting benzo's more likely to cause dependence

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11. naloxone helps with opiate withdrawl?

False

it is naltrexone which is used for rapid opioid detoxification and not nalaxone.

(Oxford P 569 )

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14. Dependance should be treated with long acting bezos?

True

I think it means Benzo dependance. As withdrawl is more severe from short acting benzos it is advisable to switch to long acting before attempting withdrawl.

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