Sign in to follow this  
Followers 0
Gurpal

Part II ISQ Club - Pharmacology

70 posts in this topic

Q2 Depression may present with similar features to hyperthyroidism. T

Apathetic hyperthyroidism though rare may present with weight loss and apathy, usually in middle aged or the elderly .

Folks and petrie (1982) describe a woman of 23 with hyperthyroidism presenting with depression,insomnia and early morning waking.

Organic psychiatry,2nd ed W A Lishman pg 431

Share this post


Link to post
Share on other sites

Q6 Sildenafil citrate acts on cGMP. T

Sildenafill prolongs cGMP(vasodilator) activity, enhancing the erectile response to sexual stimulation.[For you guys information] Peak plasma concentration occur 30-120min after oral dose and are delayed by food.

A Textbook of cliinical pharmacology . James M Ritter

4th edition

pg 461-462,

Share this post


Link to post
Share on other sites

6.Sildenafil citrate acts on cGMP TRUE

Sildenafil (Viagra) Is used for the treatment of erectile dysfunction.It inhibits conversion of cGMP to guanosine monophosphate in the corpus cavernosa and thereby increases the available concentration of cGMP.

Share this post


Link to post
Share on other sites

2. Dear Paddy

I would be careful to mark ' Depression may present with similar features as Hyperthyroidism'as True.

Does the Lishman actually say the above??

This MCQ has been going around for quite some time and most of the people say, ITS FALSE !

Share this post


Link to post
Share on other sites

Sanj25828 - know what you mean but it is a 'may' question, which is usually true. Also, think its fairly well recognised that hyperthyroidism, especially in the elderly can be masked and confused with depression. I have lecture notes from Roger Howell of the Maudsley Hospital from MRCPsych course which say that depression is not usually sustained or severe in hyperthyroidism. In the elderly though can get 'apathetic detachment' which is an 'important differential diagnosis of dementia and depression'

He also suggests all female patients with affective disorder are screened for hyperthyroidism.

Don't know if he writes the questions but wouldn't be too surprised! It's always difficult to know how far to analyse these questions - could be wrong.

Share this post


Link to post
Share on other sites

1. False - DST is not reliable in any patient, elderly or otherwise, as it can be non-supressed in other conditions.

Share this post


Link to post
Share on other sites

2. True - While usually presenting with depressive symptoms in hypothyroidism, it MAY be the case in hyperthyroidism also.

Share this post


Link to post
Share on other sites

3. False - Melatonin is an OTC drug with minimal side-effects.

Share this post


Link to post
Share on other sites

4. False - QTc is up to 440 ms for men; 470 ms for women.

Maudsley Prescribing Guidelines, 7th Edition (p.75)

Share this post


Link to post
Share on other sites

5. False - while bromocriptine is a dopamine agonist used empirically in the treatment of NMS, Dantroline is not a Calcium channel blocker (it acts in a different manner).

Manchester Course

Share this post


Link to post
Share on other sites

6. True - Sildenafil is a potent inhibitor of PDE type 5 and prevents the breakdown of cGMP, which is the intracellular meesenger that brings about smooth muscle relaxation.

Companion to Psychiatric Studies (p.759)

Share this post


Link to post
Share on other sites

7. True - Acamprosate is a GABA agonist and glutamate antagonist.

Companion to Psychiatric Studies (p.375)

Share this post


Link to post
Share on other sites

8. True - Memantine is an NMDA receptor antagonist which blocks excitotoxic glutamate activity.

Companion to Psychiatric Studies (p.636)

Share this post


Link to post
Share on other sites

9. True - The only use mentioned in the BNF for Naltrexone is as an adjunct to prevent relapse in detoxified formerly opioid-dependent patients. However, naltrexone is likely to reduce impulsivity and references above suggest this effect is present in DSH in patients with LD.

Share this post


Link to post
Share on other sites

10. True - Heroin acts at the m receptor whereas Cocaine's action is limited to dopamine receptors.

Share this post


Link to post
Share on other sites

11. False - Naloxone results in very rapid opioid withdrawal and so is only used in overdose.

BNF

Share this post


Link to post
Share on other sites

12. True - Lofexidine is an a2 agonist used for the alleviation of symptoms of opioid withdrawal.

BNF

Share this post


Link to post
Share on other sites

13. True - Metronidazole does cause disulfiram-type reaction with alcohol.

Share this post


Link to post
Share on other sites

14. True - BDZ dependence is better managed with long-acting preparations (same principle as Methadone use - less fluctuation).

Share this post


Link to post
Share on other sites

5. NMS can be treated with Ca channel blockers and dopamine agonists - TRUE

Nifedipine is unlicensed for NMS but has possible efficacy

Bromocriptine is unlicensed but has some efficacy

(Bazire, Psychotropic drug directory 2003/4 page 113)

Share this post


Link to post
Share on other sites

A question that comes up a lot, but should be answered by carefully reading the question:

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

FALSE

Not calcium CHANNEL blocker. If it had said 'calcium Blocker' then TRUE. It was in Manchester course last weekend. :lol:

2. Depression may present with similar features to hyperthyroidism

I would have to agree with TRUE for 2 reasons. Firstly, it really says so in LISHman, and secondly, because it is a MAY question.

MAY questions should usually be guessed as TRUE.

Share this post


Link to post
Share on other sites

Thanks salsababe - think I'll go with the Manchester Course answer then 8). Like timtam says, it is in the Bazire book as'possibly effective' but probably too small print and just trying to catch us out on the channel thing. b*****s! ::)

Share this post


Link to post
Share on other sites

Just to add to question number 8 'Memantine is NMDA antagonist'. it is true. other NMDA antagonists are Ketamine, Amantadin....

Share this post


Link to post
Share on other sites

thts right, nifedipine has been used in NMS

do a pubmed search and you will find '3' ancient articles

the royal college are seriously taking the piss aren't they!

Share this post


Link to post
Share on other sites
Sign in to follow this  
Followers 0