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Psychiatry > Management > Flashcards

Management Flashcards

1
Q

What are the questions that need to be asked with non-response to pharmacological treatment?

A

OH-/illicit drug use
Are they taking it
Taking it correctly
Reasonable length of time, reasonable dose

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2
Q

What are the side effects of lithium?

A

Early: Dry mouth, metallic taste, N, polydipsia, fine tremor, polyuria, fatigue
Late: Diabetes insipidus, hypothyroid, arrhythmia, ataxia, weight gain, dysarthria

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3
Q

What are the signs & symptoms of Lithium toxicity?

A

Li levels >1.5

Early: Blurred vision, anorexia, N&V, diarrhoea, coarse tremor, ataxia, dysarthria, muscle weakness, polyuria,
Late: Confusion, renal failure, fits, coma, death, arrhythmia

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4
Q

What are the classes of antidepressants?

A

Monoamine re-uptake inhibitors
Receptor antagonists
Monoamine Oxidase Inhibitors

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5
Q

What are the different types of monoamine re-uptake inhibitors?

A 
Tricyclics: Amitriptyline
SSRIs: Citalopram, Fluoxetine
NorA re-uptake inhibitors: Reboxetine
SNRI: Venlafaxine
NorA & specific serotonin antidepressants: Mirtazapine
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6
Q

What are common SE of SSRIs?

A 
Headache
Weight gain
Drowsiness (take at night)
Nausea/ loss of appetite
Indigestion/diarrhoea/ constipation
Loss of libido/ erectile dysfunction
Dizziness/ dry mouth/ blurred vision/ sweatiness
Inc suicidal risk in first 2weeks of use
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7
Q

Why are MAOIs rarely used?

A

Poor tolerability
Interactions
Diet restrictions: Breakdown tyramine in the gut found in cheese, redline, Bovril & can lead to hypertensive crisis

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8
Q

What are the main SE which can occur with all antidepressants?

A

Suicidal ideas
Serotonin Syndrome
HypoN- SSRI worst

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9
Q

How long should antidepressants be used for?

A

6-9m post-recovery
Multiple episodes consider for 2years
Use: 4-6weeks before considering changing drug

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10
Q

What are the indications for prescribing Lithium?

A 
Mood stabiliser-Treatment & prophylaxis of:
Mania
Recurrent depression
Bipolar
Aggressive/ Self-mutilating behaviour
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11
Q

What are the baseline investigations that need to be done before starting Lithium?

A 
Physical
Weight
Bloods: U&E, TFT, Ca, FBC
ECG
Pregnancy test
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12
Q

What monitoring needs to be done for a patient on Lithium?

A

Lithium levels:
12hours after initial dose
7-10days initially then 3m when stable
Every 6m: Bloods: U&E, TFT, Ca, Weight, ECG

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13
Q

What are the causes of Lithium toxicity?

A

Drugs: NSAIDs, Diuretics, ACEi
Renal failure
UTI
Dehydration

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14
Q

How is Lithium toxicity managed?

A

STOP Li!
IV fluids
Start diuresis/dialysis

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15
Q

What are classed as low & high intensity interventions?

A

Low: Advice, CBT based self-help
High: CBT, IPT, Behavioural activation, couples therapy

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16
Q

What are the SE of Mirtazapine?

A

Sedative

Weight gain

17
Q

What needs to be checked when starting an SNRI?

A

Check BP
ECG
Contraindicated: CV issues

18
Q

What combination of antidepressants should NOT be taken together? Why?

A

SSRI + TCA/MAOI

Causes: Serotonin Syndrome

19
Q

What are the effects of antipsychotics (depending on receptor type)?

A

Anticholinergic: Dry mouth, blurred vision, constipation, urinary retention
Antiadrenergic: Postural hypoT, Sexual dysfunction
Antihistamine: Sedation, anti-emetic

20
Q

What investigations need to be done before starting an antipsychotic?

A

Bloods: FBC, U&E, LFT, RBS/HbA1c, Lipids & Cholesterol, Prolactin
Weight
BP & Pulse
ECG (Prolonged QTc which can lead to Torsade des Pointes)

21
Q

What are the SE of antipsychotics?

When do they occur?

A

1st gen: NEURO/MOTOR SE
D2 antagonists
Tardive dyskinesia, Tx= gradual dose reduction, benzos, tetrabenazine
Parkinsonism, Tx= anticholinergics (Procyclidine)
Acute dystonia, occur within 72hrs of Tx
Akathisia, occurs within 60d of Tx, Mx= Beta blockers & benzos
2nd gen: METABOLIC SE
5HT/D2 antagonists
Hyperglycaemia
Weight gain
Dyslipidaemia

22
Q

When should Clozapine be offered in Schizophrenia?

A

Illness not responded to Tx despite use of adequate doses of >2 different drugs
>1 drug should be a non-clozapine 2nd gen
Acts on D2 & D4 receptors & subtypes of serotonin receptor

23
Q

What are the SE of Clozapine?

A 
Agranulocytosis (REGULAR FBC)
Weight gain
Salivation
Sedation
Myocarditis
Paralytic ileus
Lower seizure threshold
24
Q

What drugs have an effect on the 5HT neurotransmitter?

A

LSD (hallucinations)

Clozapine

25
Q

What drugs have an effect on the Glutamate neurotransmitter?

A

Phencyclidine

26
Q

What are the risks of antipsychotic use in older people?

A 
Inc stroke risk
Inc CV risk
Parkinsonian SE
Falls
Additional deaths
27
Q

What are the SE of antipsychotics related to increased Prolactin?

A 
Asymptomatic
Amenorrhoea
Galactorrhoea
Gynaecomastia
Impotence
Weight gain
Osteoporosis
28
Q

What are the EPSE of antipsychotics?

A

Acute:
Parkinsonism: rigidity, bradykinesia, tremor
Acute dystonia: Trismus, tongue protrusion, spasmodic tortocollis, opisthotonus, oculogyric crisis, grimacing
Akathisia: restlessness, restless leg syndrome
Chronic:
Tardive dyskinesia: Chewing, sucking, grimacing, darting tongue
Choreoathetoid movements

29
Q

What should be done when starting/stopping someone on SSRIs?

A

Start: Initiate then review at 2weeks
If <30yo or suicide risk review at 1week
Stop: Reduce tablets over 4weeks unless Fluoxetine

30
Q

What are the contraindications of Lithium?

A

Addison’s
Cardiac insufficiency
Fhx/Phx: Brugada syndrome

31
Q

What drugs can interact with Lithium?

A 
Diuretics: Amiodarone, Bendroflumethiazide
ACEi
NSAIDs: Ibuprofen, Diclofenac
Carbamazepine
Chlorpromazine, Citalopram, Clopamide
Macrolides
32
Q

What is the mechanism of action of Lithium?

A

Widely distributed in the CNS
Interacts with a number of neurotransmitters and receptors
Decreasing norE release and inc serotonin synthesis

33
Q

What is the mechanism of action for SSRIs?

A

Selectively inhibiting the re-uptake of serotonin at 5HT receptors.

34
Q

What are the indications for SSRIs?

A 
Depression
Bulimia (Fluoxetine only)
OCD
Panic
PTSD (Sertraline)
35
Q

What are the contraindications of SSRIs?

A

Poorly controlled epilepsy

Mania/manic phase

36
Q

What drugs do SSRIs interact with?

A 
Diuretics
Chlorpromazine 
Macrolides
Haloperidol, Risperidone
Lithium

Psychiatry (19 decks)

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