Sedatives, Anxiolytics, Anticonvulsants, and Psychotropic Pharmacology — WACS Viva & Clinical Scenarios (Pharmacology and Applied Pharmacology)

Exam-style sedatives, anxiolytics, anticonvulsants, and psychotropic pharmacology viva scenarios with examiner probes and model answers for ANAESTHESIA…

Scenarios covered

• SCENARIO 1: A 42-year-old man with a long-standing history of bipolar affective disorder managed on lithium carbonate and an irreversible non-selective monoamine oxidase inhibitor presents for emergency appendicectomy. He is tachycardic, anxious, and dehydrated. How do you prepare and conduct anaesthesia for this patient, detailing your choice of anaesthetic agents, muscle relaxants, analgesics, and perioperative vasopressors?
• SCENARIO 2: A 28-year-old primigravida at 34 weeks gestation with a known seizure disorder on chronic phenytoin therapy presents with prolonged generalized tonic-clonic seizures lasting over 25 minutes despite 10 mg intravenous diazepam. The obstetric team decides on an emergency caesarean delivery. What is your pharmacological strategy to abort the status epilepticus, manage airway control, and avoid lethal drug interactions and foetal compromise?
• SCENARIO 3: A 55-year-old male chronic alcohol-dependent patient sustains an open tibial fracture and undergoes internal fixation under subarachnoid block. On postoperative day two, he develops profound agitation, coarse tremors, autonomic instability (blood pressure 185/105 mmHg, heart rate 135 beats/min), and visual hallucinations. How do you pharmacologically manage this acute alcohol withdrawal syndrome and prevent progression to life-threatening delirium tremens in a low-resource high-dependency unit?
• SCENARIO 4: A 68-year-old woman undergoing day-case diagnostic hysteroscopy received 5 mg intravenous midazolam and 100 micrograms fentanyl. Postoperatively in the recovery room, she is unarousable with a respiratory rate of 6 breaths/min and an SpO₂ of 88% on room air. The junior resident administers 0.5 mg intravenous flumazenil as a rapid bolus. Critically evaluate this intervention, explain the clinical pharmacology of flumazenil, and outline your ongoing monitoring and management plan.