UNIVERSITY OF EAST ANGLIA School of Pharmacy Main Series UG Examination 2012-2013 CLINICAL THERAPEUTICS 7: PSYCHIATRY PHA-MHBY Time allowed: 2 hours Part ONE Answer ALL questions. Write the correct answer CLEARLY in the answer grid provided. Part TWO Answer TWO (2) of the THREE (3) questions. Use a SEPARATE answer book for EACH question in Part TWO. All questions have equal weighting. Answer all parts of each of the individual questions you select. This paper consists of 11 pages in total Dictionaries are not permitted in this examination. Notes are not permitted in this examination. Do not turn over until you are told to do so by the Invigilator. Do not take this question paper out of the examinations room. (PHA-MHBY) Module Contact: Dr Anja Mueller, PHA Copyright of the University of East Anglia Version 1
2 PART ONE TYPE 1 MCQs For each of the following questions there is ONE (1) correct answer only. 1. Which ONE of the following is the most prevalent? A) Generalised anxiety disorder B) Depression C) Mixed anxiety and depression D) Obsessive compulsive disorder E) Phobia 2. Which ONE of the following is an agonist at GABA-B receptors? A) Diazepam B) Glycine C) Aspartate D) Glutamate E) NMDA 3. Which ONE of the following is the main stimulatory neurotransmitter in the CNS? A) Glutamate B) GABA C) Glycine D) Aspartate E) Glutamine 4. Which ONE of the following types of receptor are Xanthines antagonists at? A) Dopamine B) Adenosine C) Caffeine D) Noradrenaline E) Serotonin
3 5. A regular patient of yours says she is not sleeping well. On further questioning you establish that she fears losing control, and feels tense and has difficulty concentrating. She feels like this on most days and worries about everything. Which ONE of the following is the most likely cause? A) Panic disorder B) Obsessive compulsive disorder C) Generalised anxiety disorder D) Depression E) Agrophobia 6. Which ONE of the following is the only licensed antihistamine used for the short term treatment of anxiety? A) Cinnarazine B) Chlorpheniramine C) Cyclizine D) Hydroxyzine E) Cetrizine 7. Which ONE of the following drugs only acts at the 1 subunit of the GABA-A receptors and only has a hypnotic effect? A) Diazepam B) Nitrazepam C) Zolpidem D) Temazepam E) Lorazepam 8. Which ONE of the following is a NEGATIVE symptom of schizophrenia? A) Auditory hallucinations B) Delusions C) Anhedonia (loss of interest in pleasure) D) Catatonic behaviour E) Thought disorder TURN OVER
4 9. Which ONE of the following best describes when clozapine should be used for the treatment of schizophrenia? A) It is first line treatment B) It should never be used C) It should only be used in combination with a newer generation antipsychotic D) The patient should have not responded to at least two antipsychotic drugs on previous occasions E) It should be chosen according to patient preference and side effects 10. Which ONE of the following side effects will NOT occur as a result of the antagonism of dopamine D 2 receptors? A) Gynaecomastia B) Galactorrhoea C) Sexual dysfunction D) Nausea and vomiting E) Menstrual disturbances 11. Which ONE of the following would be the time period after which you would consider a switch of an antidepressant if no response was observed at a therapeutic dose? A) 1 week B) 2 weeks C) 4 weeks D) 6 weeks E) 8 weeks 12. Which ONE of the following antidepressants does not cause hyponatraemia? A) Paroxetine B) Sertraline C) Mirtazapine D) Amitriptyline E) Citalopram
5 13. Which ONE of the following drugs displays the highest risk of switching a patient with bipolar disorder into hypomania? A) Paroxetine B) Mirtazapine C) Bupropion D) Amitriptyline E) Citalopram 14. Which ONE of the following antiepileptic drugs is a hepatic enzyme inhibitor? A) Carbamazepine B) Phenobarbital C) Valproate D) Phenytoin E) Gabapentin 15. Which ONE of the following statements is INCORRECT with respect to ADHD? A) Giving children stimulants is more likely to make them abuse drugs later in life B) There is a possibility that some naughty children are being treated when it s just their personality C) Methylphenidate is first line treatment D) It commonly persists into adult life E) Adults will often abuse amphetamines to feel normal or concentrate, rather than feel high 16. Which ONE of the following is NOT true regarding cocaine? A) It blocks the neuronal uptake of monoamine neurotransmitters B) It blocks potassium channels and causes vasodilation C) It acts as a local anaesthetic D) It has a major effect in enhancing dopaminergic transmission E) In 1903 cocaine was removed from Coca-Cola 17. Which ONE of the following is the lowest that would be a potentially lethal blood level of alcohol, equivalent to over 6 times the drink drive limit? A) 0.05% v/v B) 0.1% v/v C) 0.5% v/v D) 1% v/v E) 5% v/v TURN OVER
6 18. Which ONE of the following age groups are most at risk of developing an eating disorder? A) 5-14 years B) 15-24 years C) 25-34 years D) 35-54 years E) Over 55 years 19. Which ONE of the following symptoms of Behavioural and Psychological Symptoms of Dementia (BPSD) may respond to drug treatment? A) Wandering B) Hiding C) Inappropriate undressing D) Physical or verbal aggression E) Vocalisation 20. Which ONE of the following is a symptom of mania and hypomania? A) Hypersomnia B) Loss of interest or pleasure (anhedonia) C) Loss of libido D) Flight of ideas E) Low appetite 21. Which ONE of the following is CORRECT regarding the use of an atypical (2 nd generation), rather than a typical (1 st generation), antipsychotic to treat schizophrenia? A) Atypicals produce a lower incidence of extrapyramidal side effects B) Atypicals raise prolactin levels C) Atypicals are effective in treating positive symptoms D) Atypicals cause less sedation E) Atypicals are cheaper 22. Which ONE of the following statements about anti-seizure drugs is FALSE? A) Ureide is a common motif for many anti-seizure drugs B) Phenytoin is a hydantoin C) Phenytoin binds to and stabilises the active state of sodium channels D) Phenytoin is metabolised via hydroxylation and glucuronidation E) Fosphenytoin is a phosphate pro-drug of phenytoin
7 23. Which ONE of the following statements is FALSE? A) Chlorpromazine is a gamma aminobutyric acid mimic B) Chlorpromazine is a phenothiazine antipsychotic C) Chlorpromazine is a dopamine mimic D) Chlorpromazine is not an acetylcholinesterase inhibitor E) Chlorpromazine was accidently discovered during the search for novel antihistamine drugs 24. Which ONE of the following statements about the antipsychotic drug haloperidol and its analogues is FALSE? A) The decanoate derivative is a pro-drug that can be injected every 4 to 6 weeks B) Haloperidol is a butyrophenone derivative C) The hydrochloride salts of these compounds are inactive D) For an active analogue, the aromatic ring is usually substituted with fluorine but may also carry a methoxy group E) The starting point in the development of haloperidol was the analgesic pethidine END OF TYPE 1 MCQs TURN OVER
8 TYPE 2 MCQs Decide which of the responses to the following questions is (are) correct: Then choose: Answer: A) If i, ii and iii are correct B) If i and ii only are correct C) If ii and iii only are correct D) If i only is correct E) If iii only is correct 25. Miss Partridge suffers from epilepsy, and says that the doctor has agreed to change her medication from valproate to lamotrigine because she has put on a lot of weight and her hair seems to be falling out. He wants to initiate her immediately on 200 mg BD. What is your advice to the doctor? i) Start with a lower dose of lamotrigine ii) Gradually reduce the dose of valproate iii) Stop the valproate immediately the lamotrigine is started 26. Miss Partridge now has a boy friend and proudly presents you with a prescription for the combined oral contraceptive pill (COC). i) Lamotrigine reduces the efficacy of the COC ii) She will need to tricycle and take at least 50 micrograms of oestrogen iii) The COC can decrease blood levels of lamotrigine so its dose may have to be adjusted 27. Miss Partridge is now married and is now Mrs Pear-Tree. She now wants to become pregnant, and has stopped her COC. She is worried about the effects of her medication and condition on the fetous. i) You advise her to start taking folic acid 5mg OD ii) You advise her to stop her lamotrigine immediately iii) You advise her most women have an increased rate of seizures during pregnancy and she will need additional AED s 28. Mrs Pear-Tree gives birth to a healthy baby boy, she is now worried about breast feeding. i) She can breast feed ii) She must not breast feed iii) She should stop her lamotrigine until the baby is weaned. END OF TYPE 2 MCQs
9 TYPE 3 MCQs Directions: The following questions consist of a statement in the left-hand column followed by a second statement in the right-hand column. Decide whether the first statement is TRUE or FALSE. Decide whether the second statement is TRUE or FALSE. Then choose: A) If both statements are TRUE and the second statement is a correct explanation of the first statement B) If both statements are TRUE but the second statement is NOT a correct explanation of the first statement C) If the first statement is TRUE but the second statement is FALSE D) If the first statement is FALSE but the second statement is TRUE E) If both statements are FALSE 29. First Statement Second Statement Some patients starting Wait at least ONE week before to take SSRIs may considering a change of therapy experience benefits after a few days treatment 30. First Statement Second Statement Giving children stimulants for ADHD is less likely to make them abuse drugs later in life There is a strong statistically significant association between stimulant treatment use between 6 and 17 years, and decreased alcohol, drug or nicotine use in adult life END OF PART ONE TURN OVER
10 PART TWO 31. Professor David Nutt was forced to resign from his role as chairman of the Advisory Council on the Misuse of Drugs in 2007. He produced a league table of drugs on which prescribed benzodiazepines were ranked as the United Kingdom's 7th most dangerous drug above such drugs as tobacco, cannabis, LSD and ecstasy. Critically discuss the benefits and hazards associated with the use of benzodiazepines to treat named psychiatric conditions. Make reference to their mechanism of action, safety profile, therapeutic uses, efficacy and published guidelines. [100%] 32. Answer ALL parts (a), (b), (c) and (d). Lithium is often called the Gold Standard with regard to the treatment of Bipolar Affective Disorder (BAD). a) Discuss the diagnosis of BAD, and why it is important to treat this condition. [20%] b) Discuss the specific indications and the benefits of treatment with lithium. [30%] c) What are the main side effects, cautions and contra-indications of lithium and what monitoring is required? [30%] d) Discuss, with reference to other drugs used to treat BAD, whether lithium is indeed the Gold Standard? [20%]
11 33. Answer ALL parts (a), (b), and (c). "Roses are red, violets are blue, I am a schizophrenic and so am I." a) Outline the signs and symptoms of schizophrenia, and discuss if the sentiments in the rhyme have any justification. [20%] b) With reference to the dopamine hypothesis discuss the pathophysiology of the disease and how this relates to the pharmacology of anti-psychotic drugs. [40%] c) Discuss the side effects commonly associated with the first (typical) and second (atypical) generation of antipsychotic drugs, and how these would influence patient choice. [40%] END OF PAPER