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ART_MRCPSYCH_B_MENTOR > Meds_Guidlines_3 > Flashcards

Meds_Guidlines_3 Flashcards

1
Q

What is next step in a stable bipolar patient on lithium who develops episodes of hypomania?

A

Continue with lithium and:

Add olanzapine —>NICE

Add mood stabilizer (valproate)—>Maudsley

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2
Q

A med that should be avoided in bipolar when compliance is assumed to be erratic

A

Lithium (narrow therapeutic index)

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3
Q

Tappering period for lithium in bipolar

A

1 month

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4
Q

It is indicated when quick action is required in acute mania

A

Valproic acid
Risperidone
Olan
(NICE)

(Lithium =for longer term )

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5
Q

it is used primarily in maintenance phase of bipolar & to prevent depression episodes

A

Lamotrigine

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6
Q

If a bipolar patient on low dose of Valproate still had low mood, what should you do?

A

Check adherence
Increase the dosage
consider side effects

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7
Q

When can you add lamotrigine to valproate in bipolar?

A

If low mood was present despite optimised dose of valproate

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8
Q

1st line Rx in long-term bipolar treatment in adults

A

Lithium

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9
Q

What should be monitored in lithium therapy

A

Renal
Thyroid

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10
Q

What does NICE suggest if lithium failed in prophylaxis treatment of bipolar?

A

-Consider Olan monoRx
-Asenapine

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11
Q

Adults with bipolar presented with moderate depression

A

NICE: olanzapine + fluoxetine

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12
Q

Gold standard Rx in Bipolar maintenance Rx (both hix of depression and mania)

A

Lithium monotherapy

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13
Q

Licensed medication to augment lithium therapy in biplar patients with manic episode

A

Olanzapine

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14
Q

An option to augment carbamazepine with in a bipolar case with manic episode

A

Quetiapine

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15
Q

Best action in a previously stable patient on below max dose of aripiprazole who presents with mania?

A

Increase the dose of aripiprazole

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16
Q

best agent for augmenting mood stablizers (lithium and valproate combination) at their max dose when stable mood is not yet achieved

A

Quetiapine

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17
Q

An option in long term bipolar prophylaxis Rx when lithium (needle phobia) and valproate (childbearing age) are not suitable

A

Olanzapine

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18
Q

A preferred treatment for pregnant lady with mixed affective state?

A

Haloperidol ( an antipsychotic)

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19
Q

Bipolar lady get pregnant while on antipsychotics and you know she will relapse if stopped medication

A

Continue the antipsychotics and monitor regularly

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20
Q

If a bipolar patient on valproate and a reliable contraception end up getting pregnant…what should be done

A

Stop valproate and switch to a anti psychotic for prophylaxis

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21
Q

A stable bipolar patient on long term lithium gets pregnant…what’s next?

A

Stop lithium over 4 weeks and offer an antipsychotic

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22
Q

If pregnant bipolar lady insisted to stay on lithium what should be done?

A

respect her dicision.
Just give her all info you have about tetragenic effects…
monitor her every month till 36 week, the weekly till end.
lithium drops during pregnancy so keep in in the therapeutic index

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23
Q

If pregnant bipolar lady insisted to stay on lithium what should be done?

A

respect her dicision.
Just give her all info you have about tetragenic effects…
monitor her every month till 36 week, the weekly till end.
lithium drops during pregnancy so keep in in the therapeutic index

24
Q

Mild depression in bipolar pregnant women with no Rx can be helped with

A

Guided self help

25
Q

A heroin addict wants to quit but not with methadon and buprenorphine… he wants something not addictive

A

Lofexidine (alleviates withdrawal symptoms)

26
Q

The hormone that offers theoretical Rx for bulimea

A

Cholecystokinin

27
Q

Induces vomiting in bulimia

A

Ipecac

28
Q

Side effects of ipecac in bulimia

A

Cardiomayopathy

29
Q

Responsible for psychoactive effect of cannabis

A

Tetrahydrocannabinol

30
Q

1st line Rx for catatonia

A

lorazepam (NICE)

31
Q

Best medication with strong evidence to reduce violence in schizophrenia

A

Clozapine

32
Q

Risk factor for agranulocytosis in clozapine use

A

Being asian
older age

33
Q

Risk percenrage for neutropenia in clozapine use

A

3%

34
Q

Risk percenrage for agranulocytosis in clozapine use

A

1%

35
Q

Sialorhoea proportion in clozapine use

A

30%

36
Q

What medication is suggested as evidence based agent for augmentation in clozapine resistant schizophrenia?

A

Lamotrigine (no response to clozapine)
Sodium Valproate (if partially responded to clozapie)
Amisulpride
Omega 3 triglyceride (neuroprotective &antiinflammatory)

37
Q

Monitoring protocol in clozapine

A

Weekly for 18 weeks
then
monthly lifelong
(agranulocytosis)

38
Q

In a schizophrenia case who has not responded to two antipsychotics what is next?

A

Clozapine

39
Q

What side effect in clozapine treatment is dose dependent?

A

Constipation
Sialorrhoea
Sedation

40
Q

In a excessively sedated psychotic patient whose plasma level of clozapine is higher than 1000 μg/L with normal ECG, what should you do?

A

Add anticonvulsant (to reduce risk of siezure) and simultaneously reduce clozapine level to below 1000 μg/L.

Discontinue the anticonvulsant once the reduction achieved

41
Q

do all clozapine induced myocarditis present with chest pain?

A

nope

only 25% do.

42
Q

Presenting features in clozapine induced myocarditis

A

Abnormal ECG 90%
Dyspnoea 90%
Palpitation 70%
elevated cardiac markers 70%
influenza like illness 50%
tackycardia 40%
leucocytosis 35%
chest pain 25%

43
Q

Percentage of treatment resistant schizophrenia

A

30%

44
Q

If a patient on clozapine shows a plazma level of 1.1 mg/L with no side effects what should be done

A

dose for the effect is👌
thought plama level is a bit high 🥶 so monitor routinely
Add an anticonvulsant to reduce risk of siezure

45
Q

What is the average ratio of clozapine to norclozapine

A

1.3 (0.5-2.5)

46
Q

Why is clozapine / norclozapine ratio is clinically useful?

A

To understand pharmavokinetic and compliance

47
Q

What does 🚬 does to clozapine?

A

Reduces its level in plasma

48
Q

Least likely dose dependent side effect of clozapine

A

Agranulocytosis

49
Q

A patient on clozapine is presented with fever, tired and unwell, what is the test you need to perform?

A

Full blood count for signs of agranulocytosis or neutropenia

50
Q

What condition can cholinergic effects of clozapine exacerbate and therefore be used with caution?

A

Susceptibility to angle-closure gaucoa

51
Q

What condition can cholinergic effects of clozapine exacerbate and therefore be used with caution?

A

Susceptibility to angle-closure gaucoa

52
Q

Safe meds to be used for mania in breastfeeding mothers?

A

Quetiapine
Olanzapine

53
Q

PMDD 1st line of treatment

A

SSRIS (NICE) like fluoxetine

54
Q

A med that if combined with Oral contraceptives can help with MPDD

A

drospirenone (synthetic progesterone)

55
Q

What dose Drospirenone COCs help patients with?

A

Oedema (spironolactone like effects)
psychological

ART_MRCPSYCH_B_MENTOR (38 decks)

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