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MED 5 > MH > Flashcards

MH Flashcards

1
Q

Pharmacology of Alcohol use disorder-NAD

A

Naltrexone
Acamprosate
Disulfiram

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2
Q

Drug and alcohol history- PCWHTA

Also, check their motivation to stop

A

Pattern

Control

Withdrawal

Persistence despite harm

Tolerance + Abstinence

Motivation to stop

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3
Q

Mood in MSE

-SOA

A

Subjective–> I feel like shit too
Objective–> Euthymic, dysthymic and maniac
Affect–> outward manifestation of mood

Is it congruent
Is it reactive
Is it labile

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4
Q

Substance dependence- two things you have to look for if they are dependent on a substance

A

Substance tolerance and withdrawal

A maladaptive change in behaviour, resulting from substance tolerance and substance withdrawal. Namely, the patient perceives a need for the substance to avoid unpleasurable feelings–> Monopolization, loss of control and social changes

Monopolization
Multiple hospitalizations
Loss of control of use
Symptoms of tolerance and withdrawal

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5
Q

Why is ETOH and benzo dangerous

A

Although the extent of respiratory depression differs from one benzodiazepine to another, severe, life-threatening episodes such as those seen in opioid intoxication are uncommon in benzodiazepine monotherapy. However, respiratory depression can be quite severe when benzodiazepines are combined with other respiratory depressants (e.g., alcohol).

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6
Q

The antidote for Benzo overdose

A

Antidote: flumazenil

Indications
Severe respiratory depression
Overdose in benzodiazepine-naive patients (e.g., accidental ingestion in children, periprocedural oversedation with benzodiazepines)
Routine use of flumazenil for benzodiazepine overdose is not recommended.

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7
Q

Why should you be cautious when using flumazenil in Benzo OD in a chronic benzo user

A

Can precipitate seizures

Most cases of benzodiazepine overdose occur in patients who are on chronic benzodiazepine therapy. Flumazenil can precipitate withdrawal symptoms and seizures in patients with benzodiazepine dependence.

Benzodiazepine overdose is very rarely life-threatening unless associated with the co-ingestion of alcohol, opioids, barbiturates, 1st generation antihistamines (e.g., diphenhydramine) or other respiratory or CNS depressants!

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8
Q

ECT electrode placement

A

Unilateral placement- all dependent on the tragus of the ear on non-dominant hemisphere, one goes to the temporal fossa and the other close to the vertex

Bitemporal- Placed on the temporal fossa

Bi-frontal- outer the canthus of the eye

LOOK AT THE PICTURE for electrode placement in ECT

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9
Q

What are the absolute contraindications and relative for ECT

A

No absolute contraindications.

Relative contraindications include:
Elevated intracranial pressure and space-occupying lesions in the brain
Recent myocardial infarction (within the last 3 months)
Severe arterial hypertension
Narcotic intolerance
Acute glaucoma
Changes in the cerebral arteries, e.g., aneurysm, angioma

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10
Q

Pregnancy and pacemakers contraindicated in ECT-True or false

A

False

Pregnancy and pacemakers are not a contraindication for ECT!

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11
Q

What are some side effects of ECT

  • common
  • uncommon
A
  1. Reversible memory loss: retrograde more often than anterograde amnesia
  2. Tension headache
  3. Nausea
  4. Transient muscle pain

Less common
Skin burns
Temporary, short-term functional disorders (such as amnesic aphasia)
Prolonged seizure

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12
Q

Delusion vs illusion vs hallucination

A

Delusion- fixed false belief
Illusion- Misintreparation of an external stimulus
Hallucination- Perception in the absence of an external stimulus

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13
Q

5A of schizophrenia- negative symptoms

A 
Anhedonia 
Affect(Flat)
Avolition 
Alogia- a poverty of speech
Attention(poor)
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14
Q

Positive, negative and cognitive symptoms of schizophrenia

A

Think of positive symptoms as things that are ADDED to normal behaviour

Think of negative symptoms as things that are SUBTRACTED or missing from normal behaviour

cognitive symptoms–> impairment in attention, executive function, and working memory

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15
Q

Three phases of schizophrenia

A

Prodromal

Psychotic

Residual

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16
Q

Which pathway responsible in schizophrenia

  • positive symptoms
  • negative symptoms
A

mesolimbic for +

Mesocortical for -

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17
Q

What happens in the blockage of

  • tuberoinfundibular
  • nigrostriatal
A

Tubo–> gynacomastia, galactorrhea, and menstrual irregularities

Nigrostriatal–> EPS–> tremor, slurred speech, akathisia, dystonia and other abnormal movements

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18
Q

What are the difference between delusional and schizophrenia

A

Schizophrenia

  1. Bizzare delusions
  2. Daily functioning impairment
  3. Must have 2 or more of the following
    - Delusions
    - Hallucinations
    - Disorganized speech
    - Disorganized behaviour
    - Negative symptoms

Delusional disorder

  1. Non-bizzare
  2. Not impaired
  3. Does not meet the schizophrenia criterion
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19
Q

Delusion

  • defintion
  • bizzare
  • non-bizzare
A

Delusions: fixed, false beliefs that are not amenable to reason, despite evidence to the contrary

Bizarre: impossibility of being true or not consistent with the patient’s social and cultural norms(having super-powers and all)

Non-bizarre: possibility of being true or consistent with the patient’s social and cultural norms(winning the lottery,when you haven’t)

May be grandiose , ideas of reference , paranoid, or erotomanic

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20
Q

Catatonia

  • definition
  • treatment
  • types
A

A behavioral syndrome characterized by abnormal movements and reactivity to the environment

Treatment- benzo and ECT

Retarded catatonia: immobility, posturing, negativism (resisting external commands), staring, mutism

Excited catatonia: excessive, purposeless movement in both the upper and lower limbs, restlessness, and impulsivity

Malignant catatonia: fever, autonomic instability (e.g., tachycardia, tachypnea, abnormal BP, and sweating), rigidity, and delirium (resembles neuroleptic malignant syndrome)

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21
Q

What will schizophrenia show with brain imaging

A

Brain imaging of schizophrenia patients often shows cortical atrophy and enlargement of the cerebral ventricles.

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22
Q

Psychotic symptoms lasting > 6 months

A

Schizophrenia

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23
Q

Psychotic symptoms lasting > 1 day but ≤ 1 month

Triggered by stressful situations

A

Brief psychotic disorder

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24
Q

Psychotic and residual symptoms lasting 1–6 months

A

Schizophreniform disorder

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25
Q

Schizoaffective disorder

A

Features of schizophrenia AND a major mood disorder (depression or bipolar disorder)

Remeber that it can happen with any MOOD DISORDER- EVEN BIPOLAR–> so you have maniac epsiode with it haha

Psychosis must have been present for at least 2 weeks in the absence of any mood disturbance.
Mood symptoms do not appear in the absence of psychosis

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26
Q

DDX for psychosis

A 
Psychosis secondary to GMC
Drug-induced psychosis 
Delirium/Dementia
Bipolar disorder, maniac/mixed episode
MDD with psychotic features
BPD
Schizo ones 
Delusional disorder
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27
Q

≥ 1 delusion with a duration of ≥ 1 month and no other psychotic symptoms
Functioning is not markedly impaired and behavior is not obviously bizarre or odd

A

Delusional disorder

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28
Q

Mood disorder with psychotic features

How is it different to schizoaffective disorder

A

Meets criteria for a mood disorder (e.g., depression or manic phase of bipolar mood disorder)
Psychotic features appear exclusively during manic or depressive episodes.
Mood symptoms may be present in the absence of psychosis.

Mood symptoms do not appear in the absence of psychosis - this is schizoaffective disorder

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29
Q

If delusions and hallucinations are not mood congruent it is

If delusions and hallucinations are mood congruent it is likely due to

A
  1. psychotic or schiz etc disorder

2. Mood disorders

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30
Q

Differences between mania vs hypomania

A

Mania

Lasts at least 7days
Causes severe impairment in social or occupational functioning
May necessitate hospitalization to prevent harm to self for others
May have psychotic features

Hypomania

  1. Lasts at least 4 days
  2. No impairment
  3. Does not require hospitalization
  4. No psychotic features
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31
Q

MDD and sleeping patterns

A

Two most common sleep disturbances are:

  1. Difficulty falling asleep
  2. Early morning awakening
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32
Q

What are the unique types and features of depressive disorder

A
  1. Melancholic
  2. Atypical
  3. Catatonic
  4. Psychotic
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33
Q

What if pregnant women comes in with maniac episode

A

ECT is the best treatment for a maniac woman in pregnancy. It provides a good alternative to antipsychotics and can be used with relative safety in all trimesters

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34
Q

Dysthymic disorder

A

Double depression

-Pt. with MDD with dysthymic disorder during residual periods

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35
Q

Adjustment disorder vs PSTD

and Define adjustment disorder

A

In adjustment disorder, the stressful event is not life-threatening(such as a divorce, death of a loved one, or loss of a job).

In PTSD it is

Adjustment disorder occurs when maladaptive behavioural or emotional symptoms develop after a stressful life event.

  • symptoms begin 3 months after the event
  • end within 6 months
  • cause significant impairment in daily functioning or relationships
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36
Q

Obsessions

A
  1. Recurrent and persistent intrusive thoughts or impulses

That cause marked anxiety

and are not simply excessive worries about real problems

  1. The person attempts to suppress the thoughts
  2. The person realises thoughts are products of his or her own mind
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37
Q

Compulsions

A
  1. Repetitive behaviours that the person feels driven to perform in response to an obsession
  2. The behaviours are aimed at reducing distress, but there is no realistic link between the behaviour and the distress
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38
Q

Intrusive thoughts, images, and urges that trigger repetitive, compulsive behaviour

Time-consuming (E.g., ≥ 1 hour/day), or result in significant distress/impairment (school, work)

A

Obsessive compulsive disorder

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39
Q

Excessive perfectionism and rigid control regarding real-life concerns

A

Obsessive-compulsive personality disorder

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40
Q

Recurrent thoughts revolve around real-life concerns, e.g., work, as opposed to the obsessions in OCD, which tend to be of an irrational nature.

A

GAD

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41
Q

Acute stress disorder vs PTSD

A

Acute stress disorder

  • the event occurred < 1 month ago
  • symptoms last < 1 month

PTSD

  • event occurred at any time in the past
  • symptoms lasts >1 month
42
Q

What 2 things should you rule out in any anxiety disorder

A
  1. Hyperthyroidism

2. Caffeine intake

43
Q

Major complaint: anxiety in response to unspecific events or themes (e.g., health, relationships)
Impaired memory, sleep disturbances, muscle tension, and/or fatigue
Impaired functioning
Lasts > 6 months

A

GAD

44
Q

EtOH withdrawal monitoring scale

A

CIWA-Ar

45
Q

Withdrawal from which 2 substances are lethal

A

Alcohol and benzo

In general, withdrawal from drugs that are sedating is life-threatening, while withdrawal from stimulants is not.

46
Q

Pharmacotherapy to promote alcohol cessation

A

Block positive effects of alcohol: Naltrexone (first-line agent), acamprosate, or topiramate.

Create a toxic reaction when alcohol is ingested: Disulfiram.

47
Q

Nose bleeding and history of drug use think

A

Cocaine

The complication of using cocaine–> Cocaine-induced vasospasm
↓ Reuptake of norepinephrine → ↑ α- and β1‑stimulation → vasoconstriction and vasospasm → myocardial infarction, cerebrovascular accident, or ischemic colitis

48
Q

Amphetamine use clinical features

A

↑ libido, constipation, tachycardia with arrhythmias, mydriasis, ↑ body temperature, ↑ perspiration, ↓ appetite, weight loss, grinding teeth

49
Q

What is the treatment of choice for opiate overdose

A

Naloxone

50
Q

Naloxone

A

immediate acute opioid antagonist–> used in Opioid OD

51
Q

Methadone

A

full opioid AGONIST–> used to wean off the opioid tolerance without going into withdrawal

Helps with weaning off

52
Q

Buprenorphine

A

partial opioid agonist –> opioid withdrawal in patients with opioid dependence

similar to methadone but partial

53
Q

Naltrexone

-what are the 2 uses

A

opioid antagonist –> used to help people maintain their opioid abstinence.

Keep them not going back to using opioids

2 uses->

  1. help people get off alcohol
  2. help people stay off opioids(heroin)
54
Q

Treat associated comorbidities of IV opioid addiction

A

HIV, hepatitis C, endocarditis

55
Q

Clinical features of opioid intoxication

A

Altered mental status
Bilateral miosis (pinpoint pupils)
Respiratory depression (decreased respiratory rate and tidal volume) and hemorrhagic lung edema
Seizures
Decreased bowel sounds
Decreased heart rate and blood pressure, hypothermia

56
Q

Naloxone vs naltrexone

A

Naloxone: rapid onset, short duration (1–2 hours) → preferred for treatment of acute opioid intoxication
Naltrexone: long duration (24–48 hours) → used for withdrawal treatment after acute detoxification

57
Q

What is suboxone

A

Combination drug Buprenorphine+naloxone

58
Q

Triad of an opioid overdose-RAM

A

Respiratory depression, ALOC and Miosis

Altered mental status, respiratory depression, and miosis are the classic triad of opioid intoxication! However, the absence of miosis does not rule out opioid intoxication!

59
Q

How do you monitor withdrawal from opioids

A

COWS- clinical opioid withdrawal scale–>

  1. SOWS- subjective opioid withdrawal scale
  2. OOWS- objective opioid withdrawal scale
60
Q

Drug history always ask- if they said they had used drugs in the past

A

When was the last time you took said drug? like how long has it been

61
Q

Can opioid withdrawal kill you

A

Opioid withdrawal causes severe discomfort, but is not life threatening!

62
Q

Treatment options for nictoine

A

Varenicline- Champix (alpha-4-beta-2 nACHR partial agonist): reduces positive symptoms and prevents withdrawal

Bupropion: reduces craving and withdrawal symptoms

Nicotine replacement therapy (inhaler, lozenges, transdermal patch, nasal spray, or gum)

63
Q

What are 2 typical symptoms of delirium

A

Visual hallucinations and short attention span

Impairment in recent memory is the most finding in delirium

64
Q

What is the workup for dementia

A
  1. FBC
  2. Electrolytes
  3. TFTs
  4. VDRL/RPR
  5. B12 and folate levels
  6. Brain CT and MRI
65
Q

Fact-Dementia due to Parkinson’s disease is exacerbated by antipsychotic medication

A

Visual hallucinations early in dementia suggest a diagnosis of dementia with Lewy bodies. DO NOT GIVE THESE patients antipsychotics

66
Q

EPS- grimacing and tongue protrusion

A

Tardive dyskinesia

67
Q

EPS- twisting and abnormal postures

A

Acute dystonia

68
Q

EPS-characterized by the inability to sit still

A

Akathisia

69
Q

EPS-characterized by a decrease or slow body movement

A

Bradykinesia

70
Q

Hypertensive crises with MAOI

A

Caused bt a build-up of stored catecholamines, MAOIs plus food with tyramine(red wine, cheese, chicken liver, cured meats) or plus sympathomimetics

71
Q

What is the black box warning with SSRIs

A

increased suicidal thinking and behaviour

72
Q

PTSD- which drug can help with nightmares

A

Nightmares: Prazosin is effective for improving sleep.

73
Q

Anorexia nervosa-AN- what are 2 management

A

1) Medical management- this is the 1st priority

2) Psychiatric management

74
Q

What is the mainstay treatment for TCA OD

A

IV sodium bicarbonate

75
Q

Major complications of TCAs- 3Cs

A

Cardiotoxicity
Convulsions
Coma

76
Q

What are the anti-HAM effects of typical antipsychotics

A

Caused by the action of
Histamine
Adrenegeric
Muscarinic

Anti-histamine–> results in sedation and weight gain

Anti-alpha Adrenergic–> results in orthostatic hypotension, cardiac abnormalities and sexual dysfunction

Anti-muscarinic–> anticholinergic effects: results in dry mouth, tachycardia, urinary retention, blurry vision, constipation, and precipitation of narrow-angle glaucoma

77
Q

Neuroleptic malignant syndrome-FALTERED

A 
Fever
Autonomic instability(tachycardia, labile hypertension and diaphoresis)
Leukocytosis 
Tremor
Elevated CPK
Rigidity--> lead pipe rigidity
Excessive rigidity
Delirium
78
Q

Atypical antipsychotic/SGA-increase in prolactin

A

Risperidione

79
Q

Atypical antipsychotic/SGA-sedation

A

Quetiapine

80
Q

Atypical antipsychotic/SGA-olanzapine

A

O-o–> weight gain

81
Q

Atypical antipsychotic/SGA-unqiue partial D2 agonism

A

Aripiprazole

82
Q

Atypical antipsychotic/SGA-Depo from

A

Paliperidone

83
Q

Lithium and suicide tendencies

A

Lithium is the only mood stabilizer shown to decrease suicidality

84
Q

Mnemonic for suicide risk assessment- modified SADPERSONS

–> how do you assess for
low
moderate
increased

A

S: Male sex → 1
A: Age 15-25 or 59+ years → 1
D: Depression or hopelessness → 2
P: Previous suicidal attempts or psychiatric care → 1
E: Excessive ethanol or drug use → 1
R: Rational thinking loss (psychotic or organic illness) → 2
S: Single, widowed or divorced → 1
O: Organized or serious attempt → 2
N: No social support → 1
S: Stated future intent (determined to repeat or ambivalent) → 2

0–5: Maybe safe to discharge (depending upon circumstances)
6-8: Probably requires psychiatric consultation
>8: Probably requires hospital admission

The 2 point ones are DR.SO

85
Q

Lithium toxicity- tell me the main points

A

May occur at any Li toxicity(>1.5)
Nausea, vomiting, slurred speech, ataxia and incoordination, myoclonus, hyperreflexia, seizures, delirium, coma and nephrogenic diabetes insipidus

Discontinue Li
Hydrate aggressively
Consider dialysis with acute kidney impairment

86
Q

Suicide risk assessment

A

KIR(pip)E

Kill
Ideation
R(risk)- PIP–> plan, intent and previous Hx
E-explore ideation

1) Ask every patient
2) Classify ideation–> passive and active
3) Assess risk- plan, intent and past attempts

87
Q

Mental health-admission blood(8)

A

1.UEC
2.LFT
3.CMP
4.TFT
5FBC
6.UDS
7.ECG
8.beta-HCG
9.Syphilis serology

88
Q

If you are starting a pt. an antipsychotic what are the levels in the body are you worried about

A
  1. Prolactin
  2. Fasting lipids
  3. B12
  4. Folate
  5. Vitamin D
89
Q

For Bipolar depression which medication should not be used alone

A

Do not use antidepressants alone in the treatment of bipolar depression.

90
Q

What is the treatment for bipolar depression-eTG

A

an antidepressant + a drug recommended for prophylaxis of bipolar disorder

OR

quetiapine

91
Q

After last dose when should lithium levels be checked

A

When monitored, the serum lithium concentration should be measured 8 to 12 hours after the last dose.

92
Q

What is the therapeutic level of lithium

A

The therapeutic range for lithium has previously been established at 0.6 - 1.2 mmol/L but recent studies have suggested a range of 0.6 - 1.0 mmol/L.

0.6-1 is a good answer

For most patients, the therapeutic serum lithium concentration for prophylaxis of bipolar disorder is 0.6 to 0.8 mmol/L

Some may need 0.8-1

YOU NEED TO PSYCHOEDUCATE them about the early warning signs of lithium toxicity

93
Q

At which level does lithium toxicity occur at

A

Toxicity usually occurs at concentrations more than 1.5 mmol/L, but may develop at lower concentrations,

94
Q

Which 4 drugs interact with Lithium

A

1) NSAIDs
2) Diuretics
3) ACEI

Other medications: tetracyclines, cyclosporine(immunosuppressant- similar to tacrolimus)

95
Q

The most common side effect of lithium

A

Fine tremor

96
Q

Nephrogenic diabetes insipidus with lithium, what is the treatment

A

Treatment: amiloride

97
Q

Which organ does lithium get excreted by

A

Kidneys

98
Q

LITHIUM mneomic

A

Leukocytosis
I–>inspidius–> polyuria, polydipsia, decrease GFR and AKI
T–> tremor and ataxia
H-Hypothyroidism
I- increase weight
U- underactive mind
M–> mother–> Tetratogenic–> tricuspid atresia

GIT–>Nausea, vomiting and diarrhea
Lithium induced arrhythmias
Lithium induced nephropathy

99
Q

What are some early/mild lithium toxicity signs

A

Gastrointestinal symptoms dominate in acute poisoning.

Nausea, vomiting 
Tremor 
Agitation 
Proximal weakness
Vision changes was a bit thing that the reg told us- double vision

Dehydrated

100
Q

Late signs of lithium toxicity

A

Altered mental status: confusion, delirium, somnolence, encephalopathy
Coarse tremor
Dysarthria
Disorientation

101
Q

VALRPOATE

A 
Vomiting and nausea
Anorexia
Liver toxicity(hepatically excreted)
Pancreatitis
Retention of weight
Odema
Alopecia
Teratogen, tremors
E
102
Q

CPL causes Steven-johnson syndrome

A

Carbamazepine
Phenytoin
Lamotrigine

MED 5 (23 decks)

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