passmed 16/03 Flashcards
serotonin syndrome
causes?
hypertension
Muscle rigidity
Pupillary dilatation
tachycardia
Confusion
Agitation
Loss of muscle coordination
Diarrhoea
Shivering
Fever
Seizures
side effects of antipsychotics
typical
D2 receptor antagonist
example?
extra pyramidal side effects
hyperprolactinaemia
haloperidol
chlorpromazine
EPSE - extra pyramidal side effects
parkinsonism
acute dystonia
akathisia
tardive dyskinesia
when does tradive dyskinesia occur?
another word for this
common after sustained anti psychotic use
choreoatheiod movement
example of acute dystonia
sustained muscle contractions
torticollis
oculogyric
why does galactorrhoea occur in anti psychotic use?
inhibition of dopaminergic tuberoinfundibular pathway
triad of neuroleptic malignant syndrome
fever
altered mental state
muscle rigidity
which antipsychotic reduces seizure threshold
clozapine
side effects of clozapine
neutropenia
agranulocytosis
reduced seizure theshold and
myocarditis
olanzapine associated with?
dyslipidaemia
weight gain
diabetes
sedation
notable side effect of quetiapine
postural hypotension
agranulocytosis
when neutrophil count is below 100 neutrophils
what is the screening test for OCD
Yale brown Obsessive compulsive scale
Y-BOCS
venlafaxine is a?
SNRI
is clozapine doses are missed how to take t again?
re-titrate and give slowly if missed over 48 hours
side effects can be worse after 48 hours
management of acute alcohol withdrawal
chlordiazepoxide / diazepam [long acting benzo]
bulimia nervosa
physical signs
metabolic alkalosis woith a low chloride
loss of HCL from stomach
hypokalaemia on ECG
palpitations
common features of ptsd?
re experiencing - flashbacks
avoidance - avoiding people / situations
hyperarousal : hypervigilence / sleep problems
management of tardive dyskinesia?
tetrabenazine
what effect does bulimia have on teeth?
short rounded teeth / erosion
korsakoff and wernicke what differentiates them?
anterograde amnesia
retrograde amnesia
confabulation
its a complication of wernicke but memory is also impacted
antipsychotics in elderly patients increase risk of ?
stroke and
vte
how can depression and dementia be differentiated?
rapid onset
and short history ois depression
alongside biological features
if patient cannot tolerate second line treatment for GAD what can you offer?
pregabalin
2nd line management of GAD
alternative SSRI (to sertraline)
or
Start SNRI ( duloxetine / venlafaxine)
sertraline can cause what kind of electrolyte imbalance
hyponatraemia
management of mania/hypomania in patients taking antidepressants
antidepressants can cause / trigger a manic episode
- stop antidepressant and start a second generation antipsychotic
what effect can lorazepam have on memory?
can cause anterograde amnesia
lithium ecg changes?
t wave inversion / flattening
how often should lithium levels be checked once dose is set?
3 monthly
anorexia nervosa G’s and C;s raised
growth hormone
glucose
salivary glands
cortisol
cholesterol
carotinemia
ECT is indicated when?
catatonia
prolonged / severe manic episode
severe depression that is life threatening
what effect can smoking cessation have on clozapine?
smoking cessation can cause a rise in clozapine levels
tar in cigarettes induce CYP450
increases clozapine metabolism so reduced levels
when smoking is ceased clozapine levels go up
SSRI discontinution syndrome
dizziness
electric shock sensations
anxiety
TRicyclic overdose
hypotension
drowsiness
seizures
opiate withdrawal
anxiety
sweating
gastrointestinal symptoms
alcohol withdrawal
anxiety
tremor
sweating
erotomania - de clerambault is a type of
delusional disorder
most important impairment of ECT?
memory loss
retrograde amnesia - prior to insult
immediate s/e of ECT
drowsy
confused
headache
nausea
aching muscles
loss of appetite
long term s/e of ECT
apathy
anhedonia
diff concentrating
loss of emotional responses
difficulty learning new information
absolute contraindictaion for ECT
raised ICP
when is ECt useful?
catatonia - severe depression refractory to medication
what is somatisation disorder?
excess distress due to symptoms w no identifiable cause
what is difference between illness anxiety disorder and somatisation
somatisation - symptoms physically present as opposed to a belief of underlying illness
tardive dyskinesia is defined as
late onset involuntary movements that typically affect orofacial muscles > grimacing, tongue protrusion and lip smacking
parkinsonism
why does it occur with antipsychotics?
resting tremor
bradykinesia
rigidity
postural instability
dopamine-blocking effects of the medication in basal ganglia
lithium toxicity manifets how long after?
6-18 months
it can cause hypothyroidism
capgras syndrome
irrational delusion of misidentification where patients believe that a relative or friend has been replaced by an identical impostor
TCA’s
amitriptyline
clomipramine
dosulepin
trazodone
how does mirtazapine work?
blocks alpha-adrenegric receptors
sedative
increases appetite
switching antidepressants
citalopram etc to another SSRI
first is withdrawn before alternative is started
fluoxetine
to another SSRI
withdraw then leave a gap of 4-7 days
as it has a long half life
SSRI to a tca
cross-taper
GAD mx second?
alternative SSRI / SNRI
PPI is indictaed when giving ssri
NSAID +SSRI - PPI
long term atypical antipsychotic use causes dysregulation of what?
glucose
diabetes
> polyuria / polydipsia
atypical antipsychotics effect on GI
antagonise acetylcholine M1 receptors
> constipation as action of ach is blocked
hoover sign?
differentiates organic - non organic
pressure felt in under the paralysed leg when lifting the non paralysed leg under pressure due to the contralateral hip extension
severe OCD
SSRI and CBT
z drugs
s/e
they act on the α2-subunit of the GABA receptor.
increase risk of falls
