Passmed Flashcards
What SSRI causes increased QT ? What anti-psych causes increased QT?
Citalopram
Haloperidol
What SSRI do you use for post-MI depression?
Sertraline
What antidepressant do you give children and adults first line?
Fluoxetine
What antidepressant can cause congenital malformations?
Paroxetine
What do you never give with SSRIs? Why?
MAOis - increased risk for serotonin syndrome
What is erotomania?
Delusion famous person loves them
How do you manage mania in primary care?
Refer urgently to CMHT
Examples of tarditive kinesia
Blink excessively, pout, chewing
Blood gases for bulimia
Hypochloremic metabolic alkalosis
Hypokalaemia as well
Metabolic side effects of antipsych
Dislipidaemia, glycemic, DM
Manage patients with poor compliance to oral anti-psych
Switch to once a month injections
Manage antidepressants before ECT
Reduce dose but don’t stop
Peak for seizures and delirium after alcohol withdrawal
36 hours
72 hours
How do you diagnose schizophrenia?
2 of: Delusions, hallucinations, disorganized speech, disorganized / catatonic behaviour, negative symptoms 1 has to be one of the first 3 Ongoing for 6+ months Not explained by any other condition
5 subtypes of schiz
- Paranoid (+ symptoms)
- Disorganized (hebenephric)
- Catatonic
- Undifferentiated
- Residual
What are features of paranoid schizophrenia?
Positive symptoms: delusions, hallucinations, thought disorder/disorganized speech
What are the features of disorganized schizophrenia?
Disorganized speech, behaviour, flat/inappropriate affect
What are the features of catatonic schizophrenia?
Immobile, maintained rigid posture, resist movement
Echolalia/praxis
Rocking, nail biting
3 spectrum schiz disorders
- Schizoaffective: schiz + bipolar
- Schizopheniform: shorter duration
- Schizotypal: impacted social/interpersonal skills, magical thinking, bizzare fantasies
Features of alcohol withdrawal by hour
6-12: anxiety, tremor, tachycardia, sweat
36: seizures
72: delirium, coarse tremor, tachycardia, hallucinations, fever
Acute management of alcohol withdrawal
BZD: chlordiazepoxide / diazepam (lorazepam if hepatic failure)
Maintaining alcohol abstinence treat
Disulfram: causes severe reaction if they drink - throw up!!
Acamprosate: reduces craving
Features of opioid misuse
Pinpoint pupils, needle marks, rhinorrhea, watering eyes, yawning
Opioid overdose treat
IV/IM naloxone
Manage opioid dependence with what drugs
- Methadone
2. Buprenorphine
How long do you monitor opioid dependence treatment
4 weeks in hospital or 12 weeks if in community
ECT is useful for
Severe depression
Absolute contraindication to ECT
ICP increased
Side effects of ECT
Headache, nausea, memory problems, cardiac arrhythmia
Othello’s syndrome
Partner is cheating no proof
What is Wernick’s encephalopathy?
Neuropsychiatric disorder caused by thiamine deficiency (B1)
Who gets Wernicke’s?
Alcoholics, extreme throw up, stomach cancer, dietary deficiency
Wernicke’s triad
- Opthalmoplegia/nystagmus
- Ataxia
- Confusion
2 other features of Wernicke’s
Petechial haemorrhages in brain
Peripheral sensory neuropathy
Tests for Wernicke’s
Decreased RBC transketolase
MRI
What is korsakoff’s ?
Wernicke’s +:
Anterograde amnesia
Retrograde amnesia
Confabulation
What is impaired in Wernicke’s / Korsakoff’s?
Medial thalamus and mammillary of hypothalamus
Treat akathisia
Propanolol
Treat acute dystonia
Procyclidine
Treat tar dive dyskinesia
Tetrabenazine
Severe OCD treat
SSRI and CBT
Lithium with increased WBC
Normal - leave it !
How long do you continue antidepressants for?
6 months
ECT is clinically indicated for who?
A catatonic patient with severe depression
TCAs cause _____ incontinence
Overflow
Having a high/low IQ is linked to a good prognosis for schizophrenia
High
AMTS for dementia has to be
8
Next steps when you suspect dementia
Blood tests to rule out B12 and folate and thyroid function
Urine dip
Referral to memory clinic
What ECG finding is more common in patients with severe anorexia?
Prolonged QT - due to hypokalaemia
Alzheimer’s post-mortem
Widespread cerebral atrophy
How long does it take for antidepressants to work?
2-4 weeks
What is the mechanism of action for atypical antipsychotics?
Inhibition of 5HT2 and D2 receptors
St. John’s wort on COCP
Reduces the effect due to enzyme induction
Which dopaminergic areas does haloperidol act on?
Mesolimbic and mesocortical
________ pathway is responsible for the positive symptoms of schizophrenia and the ________ pathway is responsible for the negative symptoms
Mesolimbic, mesocortical
Relative risk calculation
Experimental event rate/control event rate
Orthostatic hypotension is a side effect of which anti-psychotic drugs?
Typical
Single most important screening test before starting olanzapine
Blood glucose
Don’t use BZD in
Panic disorder
Don’t use propanolol in
Anxiety disorder
What drug reduces your seizure threshold?
Clozapine
Side effects of anti-psychotic medications
Sedation, weight gain, reduced seizure, increased QT, increased prolactin, impaired glucose, neuroleptic
SNRIs can cause what?
Hypertension
SSRIs side effect to look for
Hyponaturemia
Lithium measure when?
12 hours post dose
Weekly after starting or changing dose until levels are stable
Then 3 monthly
Patient comes in with dizziness, increased anxiety, and electric shocks
SSRI discontinuation
Can you stop SSRIs all at once?
No, need to over 4 week period
Patient comes in with elevated levels of clozapine, what can cause this?
Smoking cessation
Clozapine GI symptom
Chronic constipation
Flight of ideas is characteristic of
Mania
Lithium endocrine
Hyperparathyroid and hypothyroid
