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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
SE amitryp
TCA : SEs can include drowsiness, dry mouth, blurred vision, constipation, overflow incontinence, postural hypo, lengthened QT
26
TCA mech of action
Inhibition of reuptake of serotonin and noradrenaline
27
benzos mech of action
Enhance effect of inhibitory neurotransmitter gamma-aminobutyric acid (GABA) by increasing frequency of chloride channels
28
name some benzos
lorazepam, clonazepam, alprazolam, diazepam, chlordiazepoxide
29
SE of benzos during preg?
cleft palate floppy baby syndrome
30
name some SSRIs
fluoxetine, paroxetine, sertraline citalopram, escitalopram can't find purple socks
31
Fluoxetine SEs
drug interactions GI upset (prescribe PPI if pt on nsaids) serotonin syndrome anxiety and agitation
32
Citalopram SEs
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
serotonin syndrome pres
confusion, agitation, tremors, shivering, hyperreflexia
34
serotonin syndrome tx
activated charcoal benzos for agitation cooling blanket
35
after starting SSRIs, when should a doctor review
2 weeks 1 week if <25 yrs or risk of suicide
36
When stopping, reduce SSRI over how long
4 weeks
37
What happens with SSRI during preg
- 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
MAOIs examples
phenelzine isocarboxazid tranlycypromine selegeline PITS
39
avoid what food with MAOIs
high tyramine - cheese, cured/smoked meats, pickled/fermented, sauces, soybeans, dried fruits, alcohol, marmite - causes hypertensive crisis
40
name typical antipsychotics
halperidol chlorpromazine fluphenazine perphenazine thioridazine etc -azine
41
name atypical antipsychotics
risperidone paliperidone ziprasidone olanzapine quetiapine clozapine (-idone, -apine) done with the alpine
42
typical antipsychotics mech of action
dopamine D2 receptor antagonists, blocking dopaminergic transmission in mesolimbic pathways
43
haloperidol SEs
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
what is acute dystonia and tx?
sustained muscle contractions, e.g. torticollis, oculogyric crisis IM/IV procyclidine
45
what is akathisia and tx?
severe restlessness propranolol
46
what is tardive dyskinesia and tx?
abnormal or involuntary chewing and pouting of jaw, smacking lips, excessive blinking after taking APs for a long time (tardive like tardy) tetrabenzine
47
AP SEs
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
Clozapine SEs
agranulocytosis (decreased leukocytes) ECG done before tx, continuous FBC monitoring - weight gain - excessive salivation -neutropenia -myocarditis/ arrthymias clutz-apine
49
olanzapine SEs
weight gain gest diabetes other SEs
50
neuroleptic malignant syndrome pres
within hours or days of starting AP fever, rigidity, altered mental status, tachy, hyperthermia, tremore, incontinence or retention (hot, sweaty, confused)
51
neuroleptic malig syndrome blood results
raised urinary myoglobin raised CK raused WCC (leukocytosis)
52
neuroleptic malig syndrome tx
decrease rigidity - dantrolene and bromocriptine stop causative drugs cooling blanket IV fluids/ O2 as needed
53
depression tx
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
indications for ECT
treatment resistant severe depression, manic episodes, moderate depression known to respond to ECT in past, life threatening catatonia
55
contraindication to ECP
Raised ICP
56
Suicide RF
- 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
GAD differentials
hyperthyroid, cardiac disease and medication-induced anxiety, e.g. salbutamol, theophylline, corticosteroids, antidepressants, caffeine
58
GAD tx
- 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
PTSD tx
- 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
acute stress disorder tx
1st line = trauma focused CBT Poss benzos for acute symptoms, e.g. agitation, sleep disturbance
61
ADHD tx
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
methylphenidate SE
stunted growth due to appetite supressing effect
63
bipolar tx
lithium
64
lithium SE
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
schizophrenia symptoms
Schneider’s first rank symptoms: - Auditory hallucinations - Thought disorders - Passivity phenomena - Delusion perceptions
66
schizophrenia tx
- Oral atypical antipsychotics and CBT 1st line - CVD risk modification - Clozapine used for tx resistant schizo
67
OCD tx
mild = CBT+ERP moderate = SSRI or higher intensity CBT continue SSRI in higher dose and for 12 months compared to depression (6 months)
68
hand sign in bulimia
Russell’s sign (calluses on knuckles/ back of hand)
69
anorexia Gs and Cs
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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