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cardiovascular system 1 > CNS 3 > Flashcards

CNS 3 Flashcards

1
Q

What is the first line tx for ADHD

A

Methylphenidate or Lisdexamphetamine

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2
Q

State what drug to offer patients that cannot use Methylphenidate or Lisdex

A

Atomoxetine

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3
Q

State when atomoxetine may be used as first line tx?

A

For drug misuse patients

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4
Q

What are methylphenidate counselling advice

A

Affects driving, effects increased by alcohol

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5
Q

Side effects of atomoxetine

A

Monitor for agitation, irritability, suicidal thoughts, self harming, unusual changes in initial months of tx or after dose change

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6
Q

What is bipolar Disorder?

A

Serious chronic condition where there is a period of depression and periods if Mania or hypomania

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7
Q

Symptoms of mania

A

Patients in Mania will have 3 or 4 of the following
Grand ideas about self
Increase energy or less sleep
More talkative than usual
Full of new ideas and plans, unreliastic plan
Irritation or agitation
Want to do lots of pleasurable things

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8
Q

Medication use to manage bipolar

A

Bz
Antisychotics
Carbamezepine
Valproate
Lithium

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9
Q

Facts about Mania and hypomania drugs

A

They are used to control acute attacks and to prevent recurrent episodes of Mania or hypomania

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10
Q

Duration of tx for bipolar

A

Continue long term tx of bipolar for at 2 years from the last manic episode and up to five years if patient has a risk factor for relapse

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11
Q

When to give Antidepressants in bipolar patients

A

Give it for depression

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12
Q

Antidepressants in bipolar should be avoided in the following conditions

A

Rapid cycling bipolar disorder
Recent hx of hypomania
Rapid mood fluctuations

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13
Q

When is Bz used in bipolar disorder?

A

Eg Lorazepam
For agitation or behavioural disturbance
Avoid long term use as it may cause dependence

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14
Q

State examples of antipsychotics used mania and hypomania

A

Olanzepine, Quetiapine or risperidone

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15
Q

State what other drug to add to Antisychotics if response is inadequate

A

Add Lithium ir valproate

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16
Q

Facts about discontinuing Antipsychotics

A

Reduce it gradually over 4weeks if pt is continuing with other anti manic drugs

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17
Q

Do you give Antidepressants in mania or hypomania?

A

No

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18
Q

Reduce the dose of antipsychotics over how long if pt is stopping anti manic drugs or if there is a hx of relapse in mania

A

3 months

19
Q

What’s the indication of Carbamezepine

A

For prophylaxis of bipolar disorder (manic depressive disorder)
Use in pt with rapid cycling manic depressive illness (4 or More effective episodes/year

20
Q

State the indication of valproate

A

It is used to tx and prophylaxis of manic episodes of bipolar

21
Q

Indication of Lithium salt

A

Used in prophylaxis for and tx of mania , hypomania and depression in bipolar disorder

22
Q

The two forms of Lithium have different bioavailabilty. True or false?

A

True
Eg lithium citrate and carbonate

23
Q

When does full prophylactic effect of Lithium occur after initiation of therapy?

A

6-12 months

24
Q

List some Contraindications with Lithium

A

Dehydration
Low sodium diets (Increase lithium conc)
Untreated hypothyroidism (lithium affects T4 production sodium can cause hypothyroidism)
Significant renal impairment
Cardiac disease
Addison’s disease

25
Q

What are the cautions with Lithium

A

Avoid abrupt withdrawal
Diuretic tx (increases risk of toxicity) eg loops, ace inhibitors

QT interval elongation
Review dose in Diarrhoea, elderly, vomiting, surgery and intercurrent infection)
LTM use has been associated with thyroid disorders and mild cognitive and memory impairment

26
Q

Monitoring in lithium for long term use

A

Monitor Thyroid function every 6months
Assess need for continuity regularly and maintain patients after 3-5 years on lithium only if benefits persists

27
Q

Side effects of Lithium

A

Arrhythmia
Lowers seizure threshold
Tremor
QT interval elongation
Electrolytes imbalance
Renal dysfunction(polydipsia, polyuria)
Skin reactions
Vision disorder
Cardiomyopathy and AV block
GI disturbance
Drowsiness, unsteadiness and confusion fatigue hair loss and weight gain
Intracranial HTN
Leukocytes
Movement disorders

28
Q

Signs of Lithium OD

A

GI ( Nausea and Vomiting)
Visual disturbance
Polyuria, muscle weakness
Fine tremor
CNS disturbance
Cardiac Arrhythmia
AV block
Renal failure
Seizure
Coma and death

29
Q

What’s the mnemonic for lithium side effects?

A

LITHIUMS
Levels
Increased urination
Thirst, tremor and teratogenicity
Hypothyroidism
Interaction ( NSaids, ARBS/ DIURETICSS/ ANTACIDS
UPSET STOMACH
MUSCLE WEAKNESS
SKIN EFFECTS ( ACNE, PSORIASIS)

30
Q

Is lithium safe in Breastfeeding?

A

Avoid, present in milk and risk of toxicity in infants

31
Q

What stage of pregnancy should lithium be avoided?

A

First trimester ( risk of teratogenicity including cardiac abnormality)

32
Q

Lithium dose is increased during what stage of pregnancy ?

A

2nd and 3rd trimester but kn delivery, return abruptly to normal

33
Q

State what monitoring is required for pregnant pt on lithium

A

Monitor serum concentration closely during pregnancy as there is risk of toxicity in neonates

34
Q

What is the therapeutic range of Lithium

A

0.4- 1( lower ange for elderly pt and maintenance dose)

0.8-1 mmol/L( mania and pt who previously relapsed

35
Q

Monitoring requirements for Lithium

A

Take blood samples every 12 hours after dose initiation to achieve a serum concentration of 0.4-1 mmol/L
Weekly routine serum- lithium conc after initiation and every 3months when dose is stable

36
Q

State what to assess before initiation of Lithium

A

Cardiac, thyroid, renal function, BMI, FBC and electrolytes

37
Q

Lithium tx cessation

A

Abrupt discontinuation increase risk of relapse
Reduce gradually over a period of about 4weeks - 3months
In lithium discontinuation abruptly, consider changing therapy to an atypical antipsychotics or valproate

38
Q

What is the pt and carer advice for lithium

A

Report sides and symptoms of Lithium toxicity
Renal dysfunction
Hypothyroidism- weight gain
Maintain adequate fluid intake
Avoid dietary changes which reduce or increase sodium intake
Give tx pack
Persistent headache and visual disturbance
Maintain same brand of Lithium

39
Q

Which drug increases lithium concentration

A

Something that reduces sodium will increase Lithium
Ace Inhibit/ARBs
Diuretics/ loop/thiazide
NSAIDs
Metronidazole
Amiodarone
Tetracycline

40
Q

State mnemonic for drugs that increase Lithium conc

A

LAND on the MAT

41
Q

Which drugs decreases lithium conc

A

Sodium containing antacids and soluble/effervescent analgesics(high salt)
Urinary alkalinizing agents for cystitis
Theophylline
Osmotic and carbonic anhydrase inhibitor diuretics

42
Q

Drugs which increase neurotoxicity with lithium

A

Carbamezepine
Antipsychotics
SsRs
Tristan
CCB eg verapemil
Drugs that cause hypokaelamia prolonged QT interval with Lithium eg diuretic, corticosteroids, B agonist.

43
Q

Drugs which increase serotonin syndrome with lithium

A

Citalopram
Monoamine oxidase inhibitors
Tramadol
St John’s wort
Sumatriptans

44
Q
A

cardiovascular system 1 (41 decks)

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