Psych Flashcards
Recommended weekly alcohol
14 units
at least 2 alcohol-free days per week
no bingeing
Describe the risks of alcohol
Alcohol affects every organ in the body.
When drunk, obviously affects…injuries, memory, social, work etc.
Long-term brain damage, depression, obesity, DM, heart disease, liver damage, infertility
Lots of cancers more common in drinkers
How is acute dystonia different from tardive dyskinesia?
dystonia: sustained muscular contractions or spasms
dyskinesia are movements, like grimacing, protruding tongue
Risk assessment should include which considerations
Self
Others
Children
Property
What is the common action of antidepressants?
elevate monoamine NT in the synaptic cleft
most block NA and serotonin reuptake
Example of TCA
amitriptyline
Indications for TCAs
Depression Anxiety disorders (inc OCD: clomipramine) Chronic pain Nocturnal eneuresis Narcolepsy
Good sedative. Often used as adjunct to those receiving a non-sedating antidepressant, eg SSRI
MoA for TCAs
Side-effects
Contraindications
Pre-synaptic blockade of both NA and serotonin reuptake pumps (and dopamine to a lesser extent)
Blockade of muscarinic, histamminergic and alpha–adrenergic receptors
Muscarinic side-effects: dry mouth, constipation, urinary retention, blurred vision
Alpha-adrenergic s/e: postural hypotension
Histminergic: weight gain, sedation
Cardiotoxic effects: QT prolongation, ST elevation, heart block, arrhythmias
CONTRAINDICATED IN: RECENT MI, ARRHYTHMIAS SEVERE LIVER DISEASE MANIA HIGH RISK OF OVERDOSE
Examples SSRI
sertraline
citalopram
fluoxetine
Indications for SSRIs
Depression
Anxiety
OCD
Bulimia (fluoxetine)
MoA for SSRIs
Side-effects
Contraindications
Selective presynaptic blockade of serotonin reuptake pumps
(low cardiotoxicity)
Alerting (can encourage agitation after initiation) GI upset at initiation Loss of appetite/ weight loss Insomnia Sweating Sexual dysfunction
No contraindications, really
Example of SNRI.
What does it stand for?
Venlafaxine
Serotonin-noradrenalin reuptake inhibitor
Examples of MAOI
Phenelzine
Isocarboxazid
Indications for MAOIs
Depression
Anxiety
Eating disorders
Others: chronic pain, Parkinson’s, migraine prophylaxis, TB
MoA for MAOIs
Side-effects
Contraindications
Non-selective and irreversible inhibition of monoamine oxidase A + B
Inhibition of A results in accumulation of NTs, impairing the metabolism of certain amines in drugs/ food
Amines may accumulate to dangerously high levels –> life-threatening hypertensive crisis (early warning is throbbing headache)
Contraindicated in phaechromocytoma, CVD, hepatic impairment, mania
What is RIMA?
Reversible inhibition of monoamine oxidase A
When might mirtazapine be prescribed? What class of drug is it?
Depression, where sedation and increased appetite are desired.
NaSSA (noradrenergic and specific serotonergic antidepressant)
Which foods and drugs to be avoided on MAOIs?
Tyramine-rich foods (cheese, pickled/ smoked fish, liver, beer)
Drugs (adrenaline, NA, amphetamines, cocaine, ephedrine/ pseudoephedrine (decongestants), L-dopa, dopamine)
Even LA containing adrenaline
Symptoms of serotonin syndrome
neuromuscular abnormalities, altered consciousness, autonomic instability
How to avoid serotonin syndrome
At least 2 weeks between MAOI and starting other antidepressant
Opiates when on MAOI
Symptoms of discontinuation syndrome
GI upset, agitation/ insomnia, dizziness, headache, tremor
SSRIs worse culprits
should be tapered down
fluoxetine OK
Examples of mood stabilisers
Which are acute mania?
lithium, valproate, carbamazepine, lamotrigine
acute: lith, v
prophylaxis: all
How might clearance of lithium be decreased?
almost entirely excreted by kidneys
so renal failure, dehydration, older adults
avoid diuretics (esp thiazides), NSAIDs, ACEi
v narrow therapeutic window
Signs of lithium toxicity
diarrhea vomiting stomach pains fatigue tremors uncontrollable movements muscle weakness drowsiness weakness
What must be tested prior to initiating lithium therapy?
FBC
U&Es
thyroid function (can cause hypothyroidism)
pregnancy test
ECG if cardiac risk factors (can cause T wave inversion/ flattening)
What is the general difference between first and second generation antipsychotics?
fewer EPSE (although clozapine only true atypical with diff receptor profile - all will produce EPSE at certain doses)
Examples of first gen and second gen antipsychotics
1st: chlorpromazine, haloperidol
2nd: clozapine, olanzapine, quetiapine, risperidone (can be given as depot)
Indications for anti-psychotics
Schiz, schizoaffective, delusional disorders
Depression or mania with psychotic symptoms
Psychoactive episodes secondary to medical conditions/ drugs
Delirium
Behavioural disturbance in dementia
Severe agitation, anxiety, violent/ impulsive disorders
Non-psych: motor tics, N&V (prochlorperazine)