Mental Health Flashcards by Polina Ingulova

Apart from low WBC and neutrophils, what else can give RED result in Clozapine blood monitoring?

Low platelets

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When is Clozapine lvl taken post dose?

12 hours post dose (trough lvls)

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What class of drug is procyclidine and what is it used for?

Antimuscarinic; EPSs

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Which receptors do benzodiazepines act on?

GABAa receptors agonists (allosteric modulation)

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Diazepam - Lorazepam - Clonazepam dose conversions

5mg Diazepam - 0.5mg Lorazepam - 0.25mg Clonazepam

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Clozapine monitoring intervals

Weekly for 18 weeks; Every 2 weeks from week 19 to week 52; Monthly afterwards

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What is necrotic skin reaction called?

Stevens-Johnson syndrome

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What should never be done with Lamotrigine regimen?

Speed up titration

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Why does aripiprazole have the least side-effects?

It`s a partial D2 agonist

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What checks need to be done before starting Lithium?

BMI, ECG, thyroid, parathyroid, kidneys

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Target Lithium lvls

0.4 - 1

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When to take Lithium lvls?

12 hours post dose, 1 week after initiation

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Can Lithium be sedating?

Yes

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Lithium side-effects

Stomach upsets (at the start of the treatment), shaky hands, metallic taste, weight gain, swelling of ankles

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Signs of Lithium toxicity

Severe tremor, confusion, dizziness, blurred vision, stomach aches with nausea or diarrhoea, slurred speech, muscle weakness, muscle twitches

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Which 2 antipsychotics have the safest profile in terms of QT prolongation and cardiac risks?

Aripiprazole and Flupenthixol

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Name antipsychotics with mood-stabilizing properties? (5)

Risperidone, paliperidone, olanzapine, quetiapine, aripiprazole

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Which antipsychotic is used to treat psychotic depression?

Quetiapine

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Why does quetiapine, olanzapine and clozapine cause postural hypotension?

They act on a-adrenoceptors

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Why does Clozapine cause constipation?

Acts on M1 receptors

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What is special about Quetiapine`s action on receptors?

Dissociates fast from the receptor complex, so no EPS even though has affinity for D2 receptors

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Name antipsychotics for acute psychosis (3)

Risperidone, Olanzapine, Haloperidol

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What class is Mirtazapine

Tetracyclic antidepressant

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Symptoms of hyperprolactinaemia

Gynecomastia, Galactorrhoea, Erectile dysfuntion, irregular periods

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Medication to treat hyperprolactinaemia (2)

Bromocriptine and cabergoline

Alzheimers Dementia treatments

Mild-moderate: galanthamine, rivastigmine, donepezil Severe: Memantine

Lewy body dementia treatment

Mild-moderate: rivastigmine or donepezil Memantine only if the others failed

Side-effects of Galanthamine

GI - take with food | Rash - discontinue as potentially SJS

What is the know paradoxical effect of benzodiazepines

Hostility and aggression

When is buspirone used

Short-term management of anxiety

How are benzodiazepines metabolized?

By liver

Which benzodiazepines are preferred in liver impairment?

Short-acting

ADHD 1st line management

Lisdexamphetamine or Methylphenidate - try either one for 6 weeks, switch to the other if ineffective

What is atomoxetine used for

last line in ADHD

What side-effects do ADHD medication have in common

Mental health side-effects

Contraindications of Methyphenidate

CVD, HF, psychosis

In which disease is Lithium contraindicated

Addison's

What adjustments does Lithium require in pregnancy and why

Dose to be increased in 2nd and 3rd trimester due to increased volume of distribution

Which antidepressant is the safest in MI and unstable angina

Sertraline

What electrolyte does all antidepressants derange

Sodium - hyponatraemia

Serotonin syndrome symptoms

Muscle rigidity, tremor, myoclonus Hyperthermia, BP changes, tachycardia Confusion, agitation, mania

Examples of sedative tricyclics (4)

Amitriptyline, Clomipramine, Dosulepin, Trazodone

Examples of less sedative tricyclics (2)

Nortriptyline, Imipramine

Examples of MAOis

Phenelzne, Moclobemide, Isocarboxazid

What is a serious side-effect of Atomoxetine

Liver toxicity

Symptoms of SSRI withdrawal

Electric shock feeling, GI disturbances, headache, flu-like symptoms

Which antidepressant is associated with most withdrawal

Venlafaxine

When is Venlafaxine contraindicated

Arrhythmias, uncontrolled HTN

Cautions for Mirtazapine

CVD, diabetes, epilepsy Can also cause blood disorders

How to distinguish NMS from Serotonin Syndrome?

In NMS - CK will be elevated

Which class of anti-psychotics is more effective for negative symptoms?

SGAs

What can Chlorpromazine cause

SLE - protect skin from light

Which anti-psychotic is licensed for PD?

Clozapine

What side effect does Clozapine have on heart?

Can cause myocerditis/cardiomyopathy - discontinue

What special parameter to monitor for Quetiapine and why

Weight gain - increases appetite

Parkinsons Disease management

If patient`s quality of life is affected: Co-caredopa/Co-beneldopa If quality of life isn`t affected: Levodopa 1st line Or D-receptor agonists (non-ergot derived) MAOI-Bs

Dopamine receptor agonists examples (3)

Rotigotine, ropinirole, pramipexole

MAOI-B examples (2)

Rasagiline, Selegiline

Which major side-effects are all PD meds associated with (3)?

Impulse control disorders, Psychiatric symptoms, Sudden onset of sleep

Which drug is associated with most end of dose deterioration?

Levodopa

What can happen if PD drugs stopped abruptly?

NMS | Akinesia

Ergot-derived D-receptor agonists examples (3)

Bromocriptine, cabergoline, pergolide

Antiemetic of choice in Parkinsons?

Domperidone

When is Metoclopramide contraindicated?

GI disorders, PD

Where does Domperidone act?

Chemoreceptor trigger factor

When is Domperidone contraindicated?

Cardiac disease

Anti-emetic of choice in pregnancy & 2nd line options

Promethazine - 1st line Metoclopramide & Prochlorperazine - 2nd line

Options for motion sickness

Hyoscine - 1st line Promethazine, Cyclizine, Cinnarizine

What SE is Ondansetron associated with?

QT prolongation

Buprenorphine action on opioid receptors

Both agonist and antagonist

What happens if you give buprenorphine to somebody who is already on opioids

It can trigger withdrawal

What happens with opioids in renal impairment

Accumulation - avoid or adjust the dose

Side-effect of SC opioid injection

Severe itching

What can IV fentanyl cause

Muscle rigidity

Which antiemetics to give in nausea in migraine?

Domperidone, metoclopramide

When are triptans contraindicated?

Unstable HTN, previous cardiac event

Medications of choice in neuropathic pain (3)

Amitriptyline, Pregabalin, Gabapentin

Drug of choice in post-herpetic neuralgia

Topical Capsaicin

Drug of choice in trigeminal neuralgia

Carbamazepine

Symptoms of benzos withdrawal

Toxic psychosis, convulsions, delirium tremens

In which benzos withdrawal is more common

Short-acting benzos

Examples of long-acting benzos (2) and short-acting benzos (2)

Diazepam, Chlordiazepoxide Lorazepam, Oxazepam

What can Methadone exacerbate?

Asthma

When is Disulfuram contraindicated

CVD

When to immediately discontinue Disulfiram

If liver toxicity develops