Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PAN > Medical Management of Psychiatric Conditions Lecture > Flashcards

Medical Management of Psychiatric Conditions Lecture Flashcards

1
Q

What is the other name for anti-psychotic medications?

A

Neuroleptics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the pathophysiological theory fo schizophrenia with reference to dopamine

A

In schizophrenia, the theory is that there is a functional excess of dopamine in mesolimbic areas.
There is increase dopamine presynaptic function in the nigrostriatal pathway.
Maybe there is an involvement with serotonin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the general mechanism of action of anti-psychotics

A

Antagonism of the D2 receptor - some atypicals also affect the serotonin receptors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the two classifications of anti-psychotic medication?

A

Typical - First Generation: Causes extrapyramidal side effects
Atypical - Second generation: Causes metabolic syndrome but does not cause extra-pyramidal effects.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Which types of anti-psychotics cause extra-pyramidal side effects?

A

Typical anti-psychotics/First Generation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Give three drug categories of anti-psychotics

A

Phenothiazines - Trifluoperazine (High potency)

Chlorpromazine (low potency)
Butyrophenones - Haloperidol (high potency)

Thioxanthenes - Flupentixol, zuclopenthixol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the advantages of typical anti-psychotics?

A
  • They are cheap
  • The medical profession has lots of experience with their use - there are side effects but we know what they are
  • They are injectable - Rapid tranquilisation because of acute disturbance, agitation/aggression. Long-acting depot - is a priority of treatment when there is a risk of covert non-adherence.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the side effects of typical anti-psychotics?

A

Can be subdivided into the effects of the medications:

  • Dopamine antagonists:
  • HP axis - Dopamine inhibits prolactin: blocks dopamine - this increases prolactin and causes galactorrhoea and impotence.
  • Nigrostriatal/Extrapyramidal side effects - Acute dystonia, Parkinsonism, Akathisia (restless legs), tardive dyskinesia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Treatment of Extra-pyramidal side effects of anti-psychotics

A
  • Stop or reduce anti-psychotics - do they still needs to be on these meds?
  • Switch to atypical anti-psychotics - if no? Add
  • Antimuscarinic (procyclicidine) most commonly used in psych and can be used IM for crises.
  • Anticholinergic e.g. benztropine, trihexyphenidyl
  • Akathisia - Beta-blockers (metoprolol, propranolol - these are better at centrally acting) can use benzos as cover during drug switch.
  • Tardive dyskinesia: STOP all anti-psychotics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the anti-cholinergic side effects of antipsychotics?

A 
Dry mouth
Dizziness
Contripation
Urinary Retention
Confusion
Headache
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the histaminergic side effects of anti-psychotics?

A

Sedation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the alpha-1 side effects of anti-psychotics?

A

Postural hypotension

Impotence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the non-categorised side effects of anti-psychotics?

A
  • Neuroleptic Malignant Syndrome - Rare, but a high mortality (1/3) - Rigidity, swinging autonomic nervous system, increased creatine kinase due to muscle breakdown. Management of this involves: In a general ward: hydration, temperature management, pulse and supportive care. Bromocriptine - dopamine agonist to increase dopamine again to reverse the effects of anti-psychotics.
  • Weight gain
  • Arrhythmia
  • Decrease seizure threshold
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Give a list of atypical antipsychotics

A 
Olanzapine
Amisulpride
Risperidone
Quetiapine
Aripiprazole
Clozapine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the advantages of atypical antipsychotics?

A

Advantages:

  • Better tolerated?
  • Less risk of tardive dyskinesia
  • At least as effective typicals
  • Some have an effect on negative symptoms such as clozipine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the disadvantages of atypical anti-psychotics?

A
  • They are expensive
  • They are new - staff have less experience as prescribers in these
  • Many only available orally - Olanzapine (short acting IM), Risperidone (long acting IM) - 40% OF DRUG BUDGET, Aripiprazole (short or LAI IM)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the side effects of atypical antipsychotics?

A
  • Extrapyramidal side effects especially at higher doses
  • Sedation
  • Weight gain
  • Decreased seizure threshold
  • Metabolic Syndrome

The atypicals that were tested in the trial, which meant that they were recommended by NICE - 16 week trials only and showed absence of extra-pyramidal side effects. However, longer trials show METABOLIC SYNDROME

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

When comparing 1st/2nd generation anti-psychotics, or typical/atypical anti-psychotics, which ones are preferred?

A

Current NICE guidelines:
1st + 2nd = equal benefit
Patient must decide which side effects they would rather cope with.
Monitor patients on 2nd generation anti-psychotics - Triglycerides, Blood Pressure, BMs
Due to 2nd generation anti-psychotics, there is a whole cohort of patients with poor adherence with early onset high triglycerides and high glucose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is clozapine?

What is it used for?

A

Anti-psychotic medication
Only drug effective in treatment resistant schizophrenia
May have effects on negative symptoms.

20
Q

What are the advantages of the anti-psychotic clozapine for schizophrenia?

A
  • Only drug effective in treatment resistant schizophrenia
  • Reduces suicide most effectively
  • May have effects on negative symptoms
21
Q

What are the side effects of clozapine?

A 
Sedation
Anti-cholinergic
Weight gain
Reduced seizure threshold
Hypersalivation - night drooling
Metabolic syndrome
AGRANULOCYTOSIS - decreased white cell count, which can lead to sepsis
22
Q

Describe Clozapine monitoring i) before starting

ii) after starting

A

i) Check full blood count
- HAS TO BE NORMAL
- Register patient/doctor/pharmacist (psychiatric pharmacist) with monitoring company
ii) Thereafter:
- FBC weekly for 18/52
- Fortnightly until 1 year
- 4/52 (monthly) as long as you are taking the drug
- The blood must remain NORMAL for the whole time

23
Q

Describe the traffic light system for CLOZAPINE patient monitoring.

A

Based on blood tests
RED - bloods are not normal at all - STOP IT BUT NEVER PRESCRIBE AGAIN
AMBER - Somewhere in the middle - blood tests are not normal but not too bad - need more testing required
GREEN - Normal - go ahead.

24
Q

What is the theory of Alzheimer’s Disease?

A
  • Substantial loss of cholinergic neurons
  • Increases in cholinergic function can improve symptoms
  • Acetylcholinesterases prevent ACh metabolism.
25
Q

What does Donepezil do in the treatment of Alzheimer’s?

A
  • Selective reversible AChE inhibitor
  • Only licensed for Alzheimer’s dementia and only in early disease - as you have many cholinergic neurones to stimulate.
  • Management - give Donezepil and trial and monitor.
26
Q

What is the effect of Donepezil?

A
  • Functional improvement (hard to measure) is more important than cognitive improvement
  • May slow or temporarily stop decline
  • Over time, there is still cognitive decline.
27
Q

What are the problems with the Alzheimer’s Donepezil?

A
  • Expensive
  • Not a cure
  • Questionable evidence
  • Rapid decline if stopped
28
Q

What are the four categories of alcohol dependence syndrome symptoms?

A

1) Simple withdrawal syndromes
2) Delirium Tremens - mortality 20%, acutely confused, shaking hallucinations
3) Withdrawal seizures - mortality
4) Wernicke-Korsakoff syndrome - Thiamine deficiency - leads to Wernicke’s encephalopathy if left untreated - leads to confusion, nystagmus, wide based gait. Not treated? - can lead to Korsakoff syndrome

29
Q

What management is needed for acute alcohol detoxification?

A

SEDATIVES - Chlordiazepoxide, Diazepam - prevent withdrawal symptoms, DTs, seizures. - start high and taper it down slowly (not more than 2 weeks)

VITAMIN B - Prevenst Wernicke-Korsakoff’s syndrome. Oral or parenteral thiamine - Pabrinex - why is thiamine needed? - Thiamine is required for a co-factor in Kreb cycle - alcohol for energy enters the cycle below where thiamine is required. People who drink a lot tend to have poor diets and alcohol prevents absorption of thiamine. Thiamine is needed if the patient stops alcohol as they start to take calories from food and then they need thiamine - low thiamine then goes to nil quickly.
Pabrinex - Prevents Wernicke-Korsakoff’s syndrome

30
Q

What are the drugs to promote abstinence from alcohol?

A

Disulfiram - aldehyde dehydrogenase inhibitor - unpleasant reaction if you drink - Good for people with willpower + willingness to change

Acamprosate - GABA analogue - helps to prevent cravings

Naltrexone - partial opiate antagonist - reduces craving - not used in the UK, only used in the US.

31
Q

What are the main steps of the NICE guidelines for PANIC AND ANXIETY disorders?

A

Need to remember that most anxiety and panic disorders are treated in primary care.

1) Recognition and Diagnosis
2) Treatment in primary care
3) Review and consider other treatments
4) Review and refer to specialist mental health services
5) Treatment in secondary care

32
Q

What are the preferred treatments for panic and anxiety?

A

These are preferred:

  • Psychological therapy
  • Pharmacological therapy
  • Self-help
33
Q

What treatments should you NOT use in the treatment of PANIC AND ANXIETY disorders?

A

Do not use BENZODIAZEPINES or ANTI-PSYCHOTICS

34
Q

What is the first line pharmacological therapy for PANIC DISORDER AND ANXIETY?

A

SSRIs - Sertraline

35
Q

When implementing SSRI treatment for PANIC AND ANXIETY disorder, when do the patients need review?

A 
Review:
2 weeks
4 weeks
6 weeks
12 weeks
36
Q

If there is no response to SSRI treatment, what is the second line treatment for PANIC and ANXIETY disorders?

A

Different SSRI OR tricyclic antidepressants - Imipramine, clomipramine

37
Q

Once symptoms for PANIC and ANXIETY disorder have stabilised, how long should you continue treatment?

A

6 months

38
Q

When considering treatment of PANIC and ANXIETY disorder with venlafaxine (<75mg), what does one need to check first?

A

BP needs to be controlled

Monitor BP and cardiac dysfunction

39
Q

What is the definition of generalised anxiety disorder?

A

Anxious most of the day every day for 6 months

40
Q

Which PANIC and ANXIETY disorders are treated with high dose SSRIs?

A

Obsessive Compulsive Disorder
Bulimia Nervosa
Post-traumatic stress disorder (+benzodiazepines at the time of trauma)

41
Q

What are the Z-hypnotics?

A

Zopiclone
Zolpidem
Zaleplon

42
Q

How do Z- hypnotics work?

A

They are short-acting benzodiazepine-like drugs

No hangover the next day

43
Q

What are Z-hypnotics indicated for?

A

Shift workers, struggling with shift patterns.
Short term reason for not sleeping
Good for intermittent use
More than a week in a row? - need a weekly consultant review

44
Q

Why are benzodiazepines contraindicated for over a 2-4 week period?

A

Dependence and tolerance

45
Q

Give 3 examples of benzodiazepines

A

Diazepam
Lorazepam
Chlordiazepoxide

PAN (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions