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Psychiatry > Management of Mood Disorders > Flashcards

Management of Mood Disorders Flashcards

1
Q

What is the mode of action of lithium?

A

Blocks phosphatidylinositol pathway

Inhibits glycogen synthase kinase

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2
Q

Why must bloods be monitored when patient is on lithium?

A

lithium has a narrow therapeutic window

Can have very toxic side effects

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3
Q

List some of the toxic side effects of lithium

A 
Vomiting
Diarrhea
Ataxia
Course tremor
Drowsiness
Convulsions
Coma
Nephrotoxicity
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4
Q

List some of the common side effects of lithium:

A 
Dry mouth
Polydipsia and polyuria
Hypothyroidism
Weight gain 
Nephrogenic diabetes insipidus
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5
Q

What syndrome can develop as a side effect from Lamotrigine?

A

Stevens-Johnson Syndrome

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6
Q

When should you take lithium?

A

At night

Has sedatory side effects

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7
Q

What drugs interact with lithium?

A

ACE inhibitors
NSAIDs
ARBs
Diuretics - especially thiazides

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8
Q

What is lithium used to treat?

A

Bipolar disorder

Can be used as an add on in resistant depression

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9
Q

What investigations need to be done before prescribing lithium?

A

Us and Es
TFTs
ECG

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10
Q

When do check the lithium level in the blood?

A

12 hours after latest dose

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11
Q

What do you do if a patient on lithium develops hypothyroidism?

A

Add on levothyroxine

Tend not to stop lithium if possible

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12
Q

Describe the mechanism of action of sodium valproate:

A

Blocks voltage sensitive sodium channels and increases levels of GABA

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13
Q

What group of people do you avoid sodium valproate and why?

A

Women of childbearing age

Teratogenic

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14
Q

List some side effects of sodium valproate:

A 
Sedation
Tremor
Dizziness
GI upset
Tiredness
Weight gain
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15
Q

What is sodium valproate used to treat?

A

Epilepsy
Bipolar
Mania / Hypomania

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16
Q

What investigations should be done prior to starting sodium valproate?

A

Platelet count

LFTs

17
Q

What is lamotrigine used to treat?

A

Epilepsy

Prophylaxis of bipolar depression

18
Q

List some side effects of lamotrigine?

A 
Rash (10%)
GI upset
Insomnia
Dizziness
Ataxia
Tiredness
19
Q

How is lamotrigine given

A

Titrated dose slowly over first 6 weeks to reduce risk of SJS / rash.
Then twice daily dosing

20
Q

List some examples of atypical antipsychotics:

A 
Olanzipine 
Risperidone 
quetiapine, 
amisulpride, 
paliperidone, 
clozapine
21
Q

Which atypical antipsychotics are available as IM depots?

A

Olanzapine

Risperidone

22
Q

List some side effects of antipsychotics:

A 
Sedation / lethargy 
Weight gain
Constipation & urinary retention 
EPSE
QT prolongation
Venous thromboembolism
Neuroleptic malignant sydrome
23
Q

Which anti-psychotic has different side effects and what are they?

A 
Aripiprazole
Insomnia
GI upset
Agitation
Akathisia
Orthostatic hypotension
Headache
Constipation
24
Q

What investigations need to be done before prescribing an atypical anti-psychotic

A 
ECG
FBC
Us and Es
LFTs
BP 
Weight
Lipids
Blood glucose
25
Q

List some examples of typical antipsychotics:

A 
Haloperidol
Chlorpromazine
Flupentixol
Sulpiride
Zuclopentixol
26
Q

What is a typical antipsychotics main mechanism of action

A

Dopamine 2 receptor blockage

27
Q

List some side effects of typical antipsychotics

A 
EPSE
Sedation
Dizziness
QT prolongation
Neuroleptic malignant syndrome
28
Q

What are used more, typical or atypical anti-psychotics

A

Atypical

29
Q

What is the mechanism of action for atypical anti psychotics?

A

Dopamine antagonism and 5-HT antagonism

30
Q

When can clozapine be used in the treatment of schizophrenia?

A

When the patient has not responded to adequate therapy with at least two different anti-psychotic medications

31
Q

What can be offered alongside medication in the management of schizophrenia?

A

CBT

32
Q

Can ECT be used in the treatment of schizophrenia?

A

No

33
Q

What is a serious side effect of clozapine that must be monitored for?

A

Agranulocytosis

34
Q

What medications lower the seizure threshold?

A

Anti-psychotics

35
Q

Define torticollis:

A

“wry neck”

This is a dystonic condition defined by an abnormal, asymmetrical head or neck position

Psychiatry (15 decks)

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