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mental health disorders Flashcards

1
Q

which class of drugs are the most commonly used anxiolytics/hypnotics?

give a few examples

A

benzodiazepines

temazepam, diazepam, loprazolam, nitrazepam

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2
Q

when and for who are short acting hypnotics usually prescribed for?

A

people with short term insomnia [caused by emotions or illness]
the elderly
ppl who do not want to be sedated during the day

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3
Q

which hypnotics should be avoided in the elderly? and why?

A

z drugs [zolpidem and zopiclone]

benzodiazepines

bc can make them confused and increase risk of falls and injury

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4
Q

which hypnotics are normally used for dental pain?

A

diazepam or temazepam

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5
Q

are the Z drugs [zolpidem/zopiclone] short or long acting?

are they licensed for long term use?

A

short acting and not licensed for long term use

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6
Q

which hypnotic can be used for insomnia in the ELDERLY? and why?

A

clomethiazole [non benzodiazepine hypnotic]

bc doesnt cause hangover effects

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7
Q

which antihistamines are available otc for occasional insomnia?
what are the side effects?

A

promethazine hydrochloride

can cause drowsiness the nest day, headaches, psychomotor impairment and antimuscarinic effects

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8
Q

why is alcohol a poor hypnotic?

A

bc it is a diuretic so the constant urination affects sleep. it can also worsen sleep disorders

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9
Q

which drug is a pineal hormone and licensed for adults OVER 55 years for insomnia?

A

melatonin

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10
Q

how does buspirone work?

how long does response to treatment take?

A

acts as specific serotonin [5ht1a] receptors. used for insomnia

response to treatment can take up to 2 weeks

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11
Q

which insomnia should barbiturates be used in?

can they be used for the elderly?

A

severe insomnia in pt already taking barbiturates

no - avoid

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12
Q

give an example of a short and long acting barbiturates and their indications?

A

long acting: phenobarbital. uses are epilepsy

short acting: thiopental sodium used as an anaesthetic

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13
Q

what can help alleviate the PHYSICAL symptoms of anxiety eg tremor, palpitations?

A

beta blockers

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14
Q

how can you avoid a pt becoming dependant on benzodiazepines?

A

lowest dose for shortest period of time

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15
Q

list the names of the SHORT acting benzodiazepines

A

LLATOM

lormetazepam
loprazolam
alprazolam
temazepam
oxazepam
midazolam
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16
Q

in which pt are short acting benzodiazepines considered for insomnia?

A

elderly

ppl with liver impairment

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17
Q

give some examples of LONG ACTING benzodiazepines?

A

DCCN

diazepam
chlordiazepoxide
clobazam
nitrazepam

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18
Q

give an example of an intermediate acting benzo?

A

lorazepam

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19
Q

how can you withdraw benzodiazepines?

A

gradually reduce dose
for short acting benzos, tapering can take 2-4 weeks
for long acting benzos, tapering can take months or more

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20
Q

what can occur with abrupt withdrawal of benzodiazepines?

A

confusion, ataxia, toxic psychosis and convulsions

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21
Q

what is benzodiazepine withdrawal syndrome and what are some symptoms?

A

can develop when a pt is starting to be withdrawn from benzodiazepines.

symptoms include insomnia, anxiety, loss of appetite, tremor, tinnitus etc

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22
Q

when can benzo withdrawal syndrome occur for a pt taking a long acting benzo?
when can it occur for a pt taking a short acting benzo?

A

long: at any time up to 3 weeks of stopping
short: the next day from stopping

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23
Q

what is the protocol for withdrawal of LONG TERM benzos?

A

transfer pt to equivalent dose of diazepam taken preferably at night

reduce dose by 1-2mg every 2-4 weeks

if withdrawal symptoms occur maintain pt on that dose until symptoms lessen

reduce dose further [in smaller steps if needed] and then completely stop

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24
Q

what 2 drugs are normally used for panic attacks?

A

IV diazepam and IV lorazepam

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25
Q

what are some indications of benzos?

A 
epilepsy
severe insomnia
severe anxiety
muscle spasm
alcohol withdrawal
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26
Q

which type of benzos are recommended for elderly/hepatic impairment?
what do they carry a greater risk of?

A

short acting

greater risk of withdrawal symptoms

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27
Q

what are the cautions of benzodiazepines? [4]

A

avoid prolonged use
avoid abrupt withdrawal
ppl with history of drug/alcohol dependance
paradoxical effects

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28
Q

what are paradoxical effects of benzodiazepines and list some examples?

A

they are when benzos produce the opposite effects to what they are intended

increased anxiety, aggression, talkativeness

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29
Q

what are the side effects of benzodiazepines? [8]

A 
decreased alertness
anxiety
ataxia and confusion
dizziness and drowsiness
fatigue
GI disorders and sleep disorders
muscle weakness
hypotension
altered mood, tremor, suicidal thoughts
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30
Q

what are the 3 contraindications of benzos?

A
  • pulmonary insufficiency [lung problems bc can cause respiratory depression]
  • sleep apnoea
  • unstable myasthenia gravis [muscle weakness]
31
Q

what is the risk of benzos in pregnancy?

A

neonatal withdrawal symptoms

32
Q

when may you use benzos during pregnancy?

A

when there is a clear indication eg epilepsy

33
Q

are benzos safe in breastfeeding pt?

A

avoided if possible, as traces are found in breastmilk

34
Q

what is the pt and carer advice regarding benzodiazepines?

A
  • drowsiness can affect performance of skilled tasks

- effects enhanced by alcohol

35
Q

can benzos be given in hepatic impairment?
what is the risk?]
which benzos are preferred?
when must you avoid giving benzos?

A

if treatment is necessary, use short acting [LLATOM]

risk: benzos can precipitate coma esp long acting

AVOID in severe impairment

36
Q

what is ADHD?

A

attention deficit hyperactivity disorder

behavioural syndrome characterised by hyperactivity, impulsitivity and inattention

37
Q

what is the drug treatment of ADHD?

A
  • methylphenidate or lisdexamfetamine 1st line treatment

- atomoxetine or dexamfetamine alternative

38
Q

which drug is used 1st line for ADHD for ppl with drug misuse?

A

atomoxetine

39
Q

what are the side effects of atomoxetine? [6]

A
  • agitation
  • irritability
  • side effects
  • suicidal thoughts
  • self harming
  • unusual behaviour changes
40
Q

what is bipolar disorder and mania?

A

chronic condition where pt has lows [depression] and highs [mania]

41
Q

what are the symptoms of mania in bipolar disorder?

A

more talkative
have grand ideas abt themselves or unrealistic plans
increased energy
less sleep

42
Q

what is hypomania?

A

pt still on a high but not as much as mania

43
Q

what are the symptoms of depression in bipolar?

A 
low mood
loss of enjoyment
abnormal sadness
poor motivation
feeling guilty
poor concentration
sleeping problems
44
Q

what drugs can be used to manage bipolar?

A 
antipsychotics
benzos
lithium
valproate
carbamazepine
45
Q

how long for must you continue long term treatment of bipolar after a pt has a manic episode?

what if the pt has risk of factors for relapse?

A

2 years from last manic episode

5 years if pt has risk of factors for relapse

46
Q

when must you avoid giving antidepressants for bipolar disorder?

A

when pt has rapid cycling bipolar, recent history of hypomania or rapid mood fluctuations

47
Q

when are benzos used in bipolar disorder?

what must you avoid with benzos?

A

for agitation or behavioural disturbance

avoid long term use

48
Q

give examples of anti-psychotic drugs used in bipolar disorder?

what must be added to them if response to these drugs is inadequate?

A

olanazpine, quetiapine, risperidone

add lithium or valporate if response inadequate

49
Q

what should be done when discontinuing a pt from anti-psychotics?

A

reduce dose gradually over 4 weeks

50
Q

when is carbamazepine used in bipolar disorder

A

prophylaxis of bipolar disorder

51
Q

when are valproate considered in bipolar disorder?

A

for prophylaxis of bipolar and in pt with rapid cycling manic depressive illness

52
Q

what are the uses of lithium in bipolar?

A

prophylacis, treatment of mania and hypomania and depression in bipolar

53
Q

what are the 2 forms of lithium>?

are they bioequalivent?

A

lithium citrate and lithium carbonate

no

54
Q

what are the indications of lithium? [4]

A 
prophylaxis and treatment of:
mania
bipolar disorder
recurrent depression
aggressive or self harming behaviour
55
Q

what are the contraindications of lithium?

A
  • uncontrolled hypothyroidism [lithium can cause hypothyroidism]
  • low sodium salts [can increase lithium conc]
  • dehydration
  • significant renal impairment
  • cardiac disease
  • addisons disease
56
Q

what are the cautions of lithium? [4]

A
  • avoid abrupt withdrawal
  • diuretic treatment
  • QT interval prolongation
  • review doses in diarrhoea, elderly, vomiting, surgery, intercurrent infection
57
Q

what should be monitored with lithium?

A

thyroid function every 6 months

58
Q

when would you only maintain a pt on lithium for?

A

maintain pt after 3-5 years only if benefits persist

59
Q

what are the side effects of lithium?

A

LITHIUM

levels [therapeutic levels]
increased urination [renal dysfunction]
thirst, tremor, teratogenic
hypothyroidism
interactions [NSAIDs, ACEi, ARB, diuretics, antacids]
upset stomach [diarrhoea, N&V]
muscle weakness
skin effects [acne, psoriasis]

others:
CNS [drowsiness/confusion], electrolyte imbalance, cardiomyopathy, arrhythmia, lower seizure threshold, leucocytosis, memory loss, vision disorders, intracranial hypertension, QT interval prolongation!

60
Q

what are the signs of lithium overdose?

A

[baso the side effects]

heart block
arrythmia
renal failure
fine tremor
CNS disturbance
muscle weakness
coma and sudden death
GI disturbance
visual disturbance
61
Q

is lithium ok for breastfeeding pt?

A

avoid bc its present in the milk

62
Q

is lithium ok for pregnant women?
which trimesters are not suitable for lithium?
when would you need a dose increase of lithium during pregnancy?

A

avoid if possible esp in 1st trimester

dose increase in 3rd and 2nd trimester but return to normal on delivery

63
Q

what should be monitored before a patient is initiated on lithium?

A 
Full blood count
thyroid
renal
electrolytes
cardiac
64
Q

when would you need to monitor lithium blood concentrations in a pt?

A

every week after initiation and after every dose change until pt stable
then every 3 months

65
Q

what are the 2 therapeutic ranges of lithium serum concentration?

A
  1. 4-1mmol/L [lower range] for elderly pt and for maintenance
  2. 8-1mmol/L [upper range] for acute episodes of mania and for pt who previously relapsed
66
Q

how long should you withdraw lithium for?

A

over a period of 4 weeks to 3 months

67
Q

what is the pt and carer advice of lithium? [6]

A
  • report signs of lithium toxicity
  • report hypothyroidism, renal dysfunction
  • report benign intracranial hypertension [eg headache/visual disturbance]
  • maintain adequate fluid intake
  • avoid dietary changes that will reduce or increase sodium levels
  • give pt lithium treatment pack
68
Q

must lithium be brand specific?

A

yes

69
Q

which drugs INCREASE lithium concentration? [6]

A 
ace/arb
diuretics [loop/thiazide]
metronidazole
NSAIDs
amiodarone
tetracyclines
70
Q

which drugs DECREASE lithium concentration? [5]

A
  • sodium containing antacids [bc contain high salt]
  • carbonic anhydrase inhibitor diuretic [eg dorzalamide]
  • osmotic diuretic [eg mannitol]
  • theophylline
  • urinary alkalinising agents for cystitis
71
Q

which drugs INCREASE neurotoxicity with lithium? [5]

A
  • carbamazepine
  • antipsychotics
  • SSRIs
  • triptans
  • CCB
72
Q

how do most drugs prolong QT interval prolongation with lithium?

A

by causing hypokalaemia

73
Q

which drugs INCREASE RISK OF serotonin syndrome with lithium? [5]

A
  • SSRIs [eg citalopram]
  • monoamine oxidase inhibitors
  • tramadol
  • st johns wort
  • sumatriptan

CNS (11 decks)

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