06/02/2015 Flashcards
What are the commonly used antipsychotics?
Atypicals: first line as fewer movement SE. Olanzapine and Quitiapine often used. Risperidone good for elderly, as less sedating.
Typical: haloperidol. Now used more for acute sedation (5mg) but is still a regular oral medication in those who have failed atypicals.
Atypical: clozapine. Good for psychosis that has resisted other treatment. Needs careful monitoring as can cause agranulocytosis of white cells.
What are the main SE of antipsychotics?
Weight gain Sexual dysfunction (erection and ejaculation) Gynaecomastia and galactorrhoea Amenorrhea in women Hyperglycaemia and sometimes diabetes Tachycardia and Arrhythmias Long QT interval with haloperidol Movement disorders; acute dystonia ( face/neck/body spasm), akathisia (restlessness), tardive dyskinesia (chorea), parkinsonianism. Neuroleptic malignant syndrome (rare)
How do you treat movement symptoms caused by antipsychotics?
Procyclidine is an Antimuscarinic that can help with the parkinsonianism and dystonia, but not the tardive dyskinesia (which may get worse on this medication)
Orphenadrine and trihexyphenidyl are similar.
Example dose: 10mg procyclidine tds. Build up to this.
If a dystonia is resistant to Antimuscarinics, IV diazepam can be used if dystonia is life threatening.
Example dose: 5-10mg IV into a large vein. Slow IV injection. Rate no more than 5mg/minute.
What is the definition of enuresis and how common is it?
What are the potential causes of different kinds of enuresis?
Enuresis is bedwetting at night (nocturnal enuresis). If there is wetting during the day it is known as diurnal enuresis.
If bedwetting continues in girls over 5 or boys over 6, then enuresis can be diagnosed.
It’s pretty common, 15% of 5 year olds, 5% of 10 year olds and 1% 16 year olds will wet the bed once a week or more.
Enuresis can be primary (when they have never had full bladder control) or secondary (when there was full bladder control, but they start wetting again)
Secondary enuresis is more likely to have an organic or psychological cause, such as UTI, spina bifida, diabetes mellitus, diabetes insipidus, abuse, behavioural problems.
Diurnal enuresis is usually caused be detrusor instability.
How do you treat the different kinds of enuresis?
Simple Primary enuresis: drink the right amount during the day but restrict drinking for the last hour before bed and void bladder just before bed. Give a drinking/voiding chart so that the child can record these activities, and be rewarded for them. Can also reward for helping change the sheets.
Lifting at night can help the child become dry sooner.
After 6 months in primary care without improvement, the child may be referred. An alarm system may be used. This is first line and the most effective long term treatment for nocturnal enuresis. It helps to train the brain to associate a full bladder and urination with the need to wake up, as bedwetting may be caused by a tendency to stay asleep even when the bladder is full.
Desmopressin can be used for short term dryness (eg for a sleepover to avoid embarrassment) or can be used longer term in more resistant cases.
