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Make a Medic Finals Deck > PSA Specialties- Psych > Flashcards

PSA Specialties- Psych Flashcards

1
Q

1st line drug depression

A

SSRIs:
Citalopram + Fluoxetine preferred
Sertraline useful post=MI
Fluoxetine for <16s

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2
Q

Most common SE of SSRIs

A

GI Sx
(+increased risk of bleeding, prescribe PPI if use of NSAID)

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3
Q

Most important counselling point for SSRIs

A

Be vigilant for increased anxiety, suicidal ideation, DSH + agitation after starting a SSRI

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4
Q

Which SSRI is associated with dose dependent prolongation of QT interval? What is the maximum daily dose?

A

Citalopram (+escitalopram)
Max: 40mg (20 for >65s/ hepatic Impairment)

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5
Q

Name 2 drugs that increase risk of serotonin syndrome in patents taking SSRIs

A

Triptans
Monoamine oxidase inhibitors

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6
Q

Which SSRI has increased risk of congenital malformation in pregnancy?

A

Paroxetine

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7
Q

When should SSRIs be reviewed?

A

<25y: 1w after initiation
>25y: 2w after initiation
Continue for at least 6 months after remission

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8
Q

First line drug for generalised anxiety disorder

A

Sertraline

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9
Q

First line drug for panic disorder

A

SSRIs

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10
Q

How should SSRIs be stopped?

A

Gradually reduce over 4w
Not necessary with fluoxetine

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11
Q

7 discontinuation symptoms of SSRIs

A

Increased mood change
Restlessness
Difficulty sleeping
Unsteadiness
Sweating
GI Sx: pain, cramping, D+V
Paraesthesia

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12
Q

Therapeutic range of lithium. At what concentrations does toxicity typically occur?

A

0.4-1.0 mmol/L
Toxicity: >1.5mmol/L

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13
Q

Excretion of Lithium

A

Long plasma half-life
Primarily excreted by kidneys

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14
Q

3 precipitants to lithium toxicity

A

dehydration
renal failure
drugs

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15
Q

4 drugs that can precipitate lithium toxicity

A

Diuretics (esp. thiazides)
ACE inhibitors/ ARBs
NSAIDs
Metronidazole.

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16
Q

6 features of Lithium toxicity

A

Coarse tremor (a fine tremor is seen in therapeutic levels)
Hyperreflexia
Acute confusion
Polyuria
Seizure
Coma

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17
Q

Management of Lithium toxicity

A

Mild-mod: volume resus with normal saline
Severe: Haemodialysis

+/- Sodium bicarbonate (limited evidence)- increases alkalinity of urine, promotes lithium excretion

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18
Q
A
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19
Q

10 Adverse effects of Lithium use

A

N+V
Diarrhoea
Fine tremor
Nephrotoxicity: polyuria, secondary to nephrogenic DI
Thyroid enlargement, may lead to hypothyroidism
ECG: T wave flattening/ inversion
Weight gain
Idiopathic intracranial HTN
Leucocytosis
Hyperparathyroidism + hypercalcaemia

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20
Q

What is Lithium most commonly used for?

A

Mood stabilising in bipolar disorder

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21
Q

When should samples be taken to measure Lithium level?

A

12h post-dose

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22
Q

Describe monitoring requirements for lithium

A

Weekly + after each dose change until concentrations are stable
Once established, lithium blood level should ‘normally’ be checked every 3 months
Thyroid + renal function: every 6 months

23
Q

2 examples of typical antipsychotics

A

Haloperidol
Chlorpromazine

24
Q

3 examples of atypical antipsychotics

A

Clozapine
Risperidone
Olanzapine

25
Q

List 4 extrapyramidal side effects associated with typical antipsychotics

A

Parkinsonism
Acute dystonia (Torticollis, Oculogyric crisis)
Akathisia (restlessness)
Tardive dyskinesia

26
Q

List 4 antimuscarinic side effects associated with antipsychotics

A

Dry mouth
Blurred vision
Urinary retention
Constipation

27
Q

Which class of antipsychotics has greater association with hyperprolactinaemia? What is a possible complication of this?

A

Typical
Galactorrhoea

28
Q

List 3 antipsychotics that rarely cause hyperprolactinaemia

A

Aripiprazole
Clozapine
Quetiapine

29
Q

Management of acute dystonia caused by antipsychotics

A

Procyclidine

30
Q

Which antipsychotic is particularly associated with prolonged QT?

A

Haloperidol

31
Q

Which class of antipsychotics has greater association to reduced seizure threshold?

A

Atypical

32
Q

4 features of neuroleptic malignant syndrome

A

Pyrexia
Muscle rigidity
Autonomic lability: HTN, tachycardia + tachypnoea
Agitated delirium with confusion

33
Q

Investigations for neuroleptic malignant syndrome

A

High CK
AKI (secondary to rhabdomyolysis) in severe cases
+/- leukocytosis

34
Q

Management of neuroleptic malignant syndrome

A

STOP antipsychotic
Transferr to a medical ward
IV fluids to prevent renal failure

Dantrolene
or
Bromocriptine

35
Q

For what period should benzodiazepines be prescribed for?

A

2-4w
Patients commonly develop a tolerance + dependence

36
Q

What may happen if a patient withdraws too quickly from benzos?

A

Benzodiazepine withdrawal syndrome
very similar to alcohol withdrawal syndrome
may occur up to 3w after stopping a long-acting drug

37
Q

List 9 features of benzodiazepine withdrawal syndrome

A

Insomnia
Irritability
Anxiety
Tremor
Loss of appetite
Tinnitus
Perspiration
Perceptual disturbances
Seizures

38
Q

Describe monitoring of FBC, U&Es, LFTs when on antipsychotics

A

at the start of therapy
Annually
cCozapine requires much more frequent monitoring of FBC (initially weekly)

39
Q

Describe monitoring of lipids and weight on antipsychotics

A

at the start of therapy
at 3 months
Annually

40
Q

Name 2 antipsychotics that commonly cause weight gain

A

Clozapine
Olanzapine

41
Q

Describe monitoring of fasting blood glucose and prolactin on antipsychotics

A

at the start of therapy
at 6 months
Annually

42
Q

Describe monitoring of BP on antipsychotics

A

Baseline
Frequently during dose titration

43
Q

Describe ECG monitoring on antipsychotics

A

Baseline

44
Q

Describe cardiovascular risk assessment on antipsychotics

A

Annually

45
Q

Why is frequent FBC monitoring essential during treatment with Clozapine?

A

Significant risk of Agranulocytosis

46
Q

When is clozapine indicated?

A

If schizophrenia is not controlled despite the sequential use of >,2 antipsychotics (one of which should be a 2nd-gen antipsychotic), each for at least 6–8w

47
Q

List 6 adverse effects of Clozapine

A

Agranulocytosis (1%)
Neutropaenia (3%)
Reduced seizure threshold
Constipation
Myocarditis: baseline ECG should be taken before starting Tx
Hypersalivation

48
Q

Describe the effect of smoking on Clozapine concentration

A

Smoking (inc. cannabis) reduces amount of clozapine
High dose of Clozapine required if smokes

49
Q

Describe initial management of delirium

A

Tx of underlying cause
Modification of the environment

50
Q

What is the first line sedative used in delirium?

A

Haloperidol 0.5mg

51
Q

How should delirium in Parkinson’s patients be managed?

A

AVOID antipsychotics (worsen Sx)
If urgent Tx required: Quetiapine/ Clozapine

52
Q

When should Mirtazapine be taken?

A

Evening
as can be sedative

53
Q

2 side effects of Mirtazapine

A

Increased appetite
Sedation

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