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Rabiah's 3a > Psych > Flashcards

Psych Flashcards

1
Q

mech of action for alcohol withdrawal

A

decreased GABA and increased NMDA glutamate transmission

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2
Q

When do symptoms start with alcohol withdrawal? What symptoms are they

A

6-12 hrs later, tremor, sweating, tachy, sweaty

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3
Q

Peak incidence of seizures how many hours after alcohol withdrawal

A

36 hrs

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4
Q

Peak incidence of delirium tremens how many hours after alcohol withdrawal

and what does it pres with

A

72 hrs

coarse tremor, confusion, delusions, auditory and visual hallucinations, fever, tachy

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5
Q

how to treat delirium tremens after alcohol withdrawal

A

IV pabrinex and high dose benzo

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6
Q

first line tx alcohol withdrawal

A

long acting benzos (tapering dose chlordiazepoxide or diazepam)

lorazepam if pt has hep failure

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7
Q

tx after 6 months of established withdrawal from alcohol

A

disulfiram - once daily as deterrent to stop relapse, causes unpleasant symptoms if alcohol consumed

acamprosate - three times daily, ‘anti-craving’ med

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8
Q

what is somatisation disorder

A

multiple physical symptoms present for >2 yrs, pt refuses to accept reassurance or neg test results

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9
Q

section 2: reason for admission? who?

A

assessment (max 28 days)

not renewable

instigated by relative or AHMP
2xRMP

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10
Q

section 3: reason for admission? who?

A

treatment (<6 months)

renewable

instigated by relative or AHMP
2xRMP

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11
Q

section 4: reason for admission? who?

A

emergency assessment

1x RMP

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12
Q

section 5(2): reason for admission? who?

A

pt already in-patient ward (<72 hrs)

1x RMP

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13
Q

section 5(4): reason for admission? who?

A

pt requiring tx for mental disorder (<6 hrs)

senior nurse

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14
Q

warrant 135 meaning

A

police can enter house with force needed

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15
Q

warrant 136 meaning

A

police can take you somewhere safe and detain you for 24 hrs

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16
Q

section 17?

A

pt can request to leave the hosp for a fixed period of time, this can be revoked at any time

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17
Q

how long does perinatal mental health cover

A

first 12 months after birth

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18
Q

how long does postnatal mental health cover

A

first 6 weeks after birth

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19
Q

what class drug is trazadone

A

TCA

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20
Q

what class drug is imipramine

A

TCA

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21
Q

what class drug is nortriptyline

A

TCA

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22
Q

what class drug is amitryp

A

TCA

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23
Q

SE of dosulepin

A

TCA : SEs can include drowsiness, dry mouth, blurred vision, constipation, overflow incontinence, postural hypo, lengthened QT

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24
Q

SE lofepramine

A

TCA : SEs can include drowsiness, dry mouth, blurred vision, constipation, overflow incontinence, postural hypo, lengthened QT

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25
Q

SE amitryp

A

TCA : SEs can include drowsiness, dry mouth, blurred vision, constipation, overflow incontinence, postural hypo, lengthened QT

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26
Q

TCA mech of action

A

Inhibition of reuptake of serotonin and noradrenaline

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27
Q

benzos mech of action

A

Enhance effect of inhibitory neurotransmitter gamma-aminobutyric acid (GABA) by increasing frequency of chloride channels

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28
Q

name some benzos

A

lorazepam, clonazepam, alprazolam, diazepam, chlordiazepoxide

29
Q

SE of benzos during preg?

A

cleft palate
floppy baby syndrome

30
Q

name some SSRIs

A

fluoxetine, paroxetine, sertraline

citalopram, escitalopram

can’t find purple socks

31
Q

Fluoxetine SEs

A

drug interactions
GI upset (prescribe PPI if pt on nsaids)
serotonin syndrome
anxiety and agitation

32
Q

Citalopram SEs

A

prolongs QT interval (torsades de points)
Max dose 40mg adults, 20mg >65 yrs or hep impairment
Avoid if pt is on warfarin, aspirin, triptans, MAOIs - serotonin syndrome
give PPI if pt on nsaids
anxiety and agitation

33
Q

serotonin syndrome pres

A

confusion, agitation, tremors, shivering, hyperreflexia

34
Q

serotonin syndrome tx

A

activated charcoal
benzos for agitation
cooling blanket

35
Q

after starting SSRIs, when should a doctor review

A

2 weeks

1 week if <25 yrs or risk of suicide

36
Q

When stopping, reduce SSRI over how long

A

4 weeks

37
Q

What happens with SSRI during preg

A
  • 1st trimester small increased risk congenital heart defects
  • Use in 3rd persistent pulmonary htn in new-born
  • Esp avoid paroxetine for congenital malformations in first trimester

Case by case basis

38
Q

MAOIs examples

A

phenelzine
isocarboxazid
tranlycypromine
selegeline

PITS

39
Q

avoid what food with MAOIs

A

high tyramine - cheese, cured/smoked meats, pickled/fermented, sauces, soybeans, dried fruits, alcohol, marmite - causes hypertensive crisis

40
Q

name typical antipsychotics

A

halperidol
chlorpromazine
fluphenazine
perphenazine
thioridazine
etc -azine

41
Q

name atypical antipsychotics

A

risperidone
paliperidone
ziprasidone
olanzapine
quetiapine
clozapine
(-idone, -apine)

done with the alpine

42
Q

typical antipsychotics mech of action

A

dopamine D2 receptor antagonists, blocking dopaminergic transmission in mesolimbic pathways

43
Q

haloperidol SEs

A

EPSEs
- Parkinsonism
- o Acute dystonia (sustained muscle contraction, e.g. torticollis, oculogyric crisis), stop AP, manage w IM/IV procyclidine!
o Akathisia (severe restlessness), managed w propranolol
o Tardive dyskinesia (e.g. abnormal or involuntary chewing and pouting of jaw, smacking lips, difficulty swallowing, excessive blinking, after taking antipsychotics for a long time (tardive like tardy)), managed w tetrabenzine

prolonged QT interval

44
Q

what is acute dystonia and tx?

A

sustained muscle contractions, e.g. torticollis, oculogyric crisis

IM/IV procyclidine

45
Q

what is akathisia and tx?

A

severe restlessness

propranolol

46
Q

what is tardive dyskinesia and tx?

A

abnormal or involuntary chewing and pouting of jaw, smacking lips, excessive blinking after taking APs for a long time (tardive like tardy)

tetrabenzine

47
Q

AP SEs

A

anti-muscarinic (dry mouth, blurred vision, urinary retention, constipation)
raised prolactin = galactorrhea (enlarged tender breasts and lactation)
impaired glucose tolerance (polydips and polyuria)

atypicals = reduced seizure threshold, weight gain

typical = EPSEs

48
Q

Clozapine SEs

A

agranulocytosis (decreased leukocytes)
ECG done before tx, continuous FBC monitoring
- weight gain
- excessive salivation
-neutropenia
-myocarditis/ arrthymias

clutz-apine

49
Q

olanzapine SEs

A

weight gain
gest diabetes
other SEs

50
Q

neuroleptic malignant syndrome pres

A

within hours or days of starting AP

fever, rigidity, altered mental status, tachy, hyperthermia, tremore, incontinence or retention (hot, sweaty, confused)

51
Q

neuroleptic malig syndrome blood results

A

raised urinary myoglobin
raised CK
raused WCC (leukocytosis)

52
Q

neuroleptic malig syndrome tx

A

decrease rigidity - dantrolene and bromocriptine
stop causative drugs
cooling blanket
IV fluids/ O2 as needed

53
Q

depression tx

A

less severe (PHQ-9<16) = healthy habits, follow up 2 weeks

more severe (PHQ-9>16) = CBT+SSRI

in children - refer CAMHS, 1st = CBT+fluoxetine 10mg
2nd = sertraline and citalopram

54
Q

indications for ECT

A

treatment resistant severe depression, manic episodes, moderate depression known to respond to ECT in past, life threatening catatonia

55
Q

contraindication to ECP

A

Raised ICP

56
Q

Suicide RF

A
  • Male
  • Hx of deliberate self harm
  • Alcohol or drug misues
  • Hx mental illness (depression, schizo)
  • Hx chronic disease
  • Advancing age
  • Unemployment
  • Being unmarried, divorced, widowed
57
Q

GAD differentials

A

hyperthyroid, cardiac disease and medication-induced anxiety, e.g. salbutamol, theophylline, corticosteroids, antidepressants, caffeine

58
Q

GAD tx

A
  • 1st Education and monitoring
  • 2nd Low-intensity psych interventions (self-help/ groups)
  • 3rd High intensity (CBT, etc,) or drugs – 1st = Sertraline (k Srivastav), then consider alternative SSRI or SNRI (duloxetine/ venlafaxine), then consider pregablin
  • 4th Highly specialist input
59
Q

PTSD tx

A
  • Watchful waiting if symptoms < 1 month
  • CBT or EMDR therapy if severe
  • Last line = drugs – 1. Venlafaxine (SNRI) (ven LA = when in LA, you will get PTSD), 2. Sertraline (SSRI), if severe 3. Risperidone
  • Remember bc in PTSD they are scared to face the fax (facts, venlafaxine)
60
Q

acute stress disorder tx

A

1st line = trauma focused CBT
Poss benzos for acute symptoms, e.g. agitation, sleep disturbance

61
Q

ADHD tx

A

10 week wait and wait period
if symptoms persist, refer to secondary care
drug therapy last resort, in those > 5 yrs

1st = methylphenidate on 6 week trial basis (monitor height and weight every 6 months)
2nd = lisdexamfetamine

perform baseline ECG before tx since both potentially cardio toxic

62
Q

methylphenidate SE

A

stunted growth due to appetite supressing effect

63
Q

bipolar tx

A

lithium

64
Q

lithium SE

A

should be measured one week after starting tx or dose change, usually monitored every 3 months by a blood test 12 hours post-dose – can induce a benign leucocytosis (high WBCs – just safety net), chronic lithium toxicity can result in hypothyroidism

65
Q

schizophrenia symptoms

A

Schneider’s first rank symptoms:
- Auditory hallucinations
- Thought disorders
- Passivity phenomena
- Delusion perceptions

66
Q

schizophrenia tx

A
  • Oral atypical antipsychotics and CBT 1st line
  • CVD risk modification
  • Clozapine used for tx resistant schizo
67
Q

OCD tx

A

mild = CBT+ERP
moderate = SSRI or higher intensity CBT

continue SSRI in higher dose and for 12 months compared to depression (6 months)

68
Q

hand sign in bulimia

A

Russell’s sign (calluses on knuckles/ back of hand)

69
Q

anorexia Gs and Cs

A

raised
growth hormone, glucose, salivary glands, cortisol, cholesterol, carotenaemia (yellow orange skin pigmentation, like a carrot)

Rabiah's 3a (4 decks)

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