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1
Q

Recommended weekly alcohol

A

14 units
at least 2 alcohol-free days per week
no bingeing

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2
Q

Describe the risks of alcohol

A

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

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3
Q

How is acute dystonia different from tardive dyskinesia?

A

dystonia: sustained muscular contractions or spasms

dyskinesia are movements, like grimacing, protruding tongue

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4
Q

Risk assessment should include which considerations

A

Self
Others
Children
Property

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5
Q

What is the common action of antidepressants?

A

elevate monoamine NT in the synaptic cleft

most block NA and serotonin reuptake

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6
Q

Example of TCA

A

amitriptyline

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7
Q

Indications for TCAs

A 
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

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8
Q

MoA for TCAs

Side-effects

Contraindications

A

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
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9
Q

Examples SSRI

A

sertraline
citalopram
fluoxetine

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10
Q

Indications for SSRIs

A

Depression
Anxiety
OCD
Bulimia (fluoxetine)

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11
Q

MoA for SSRIs

Side-effects

Contraindications

A

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

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12
Q

Example of SNRI.

What does it stand for?

A

Venlafaxine

Serotonin-noradrenalin reuptake inhibitor

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13
Q

Examples of MAOI

A

Phenelzine

Isocarboxazid

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14
Q

Indications for MAOIs

A

Depression
Anxiety
Eating disorders
Others: chronic pain, Parkinson’s, migraine prophylaxis, TB

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15
Q

MoA for MAOIs

Side-effects

Contraindications

A

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

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16
Q

What is RIMA?

A

Reversible inhibition of monoamine oxidase A

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17
Q 
When might mirtazapine be prescribed?
What class of drug is it?
A

Depression, where sedation and increased appetite are desired.

NaSSA (noradrenergic and specific serotonergic antidepressant)

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18
Q

Which foods and drugs to be avoided on MAOIs?

A

Tyramine-rich foods (cheese, pickled/ smoked fish, liver, beer)

Drugs (adrenaline, NA, amphetamines, cocaine, ephedrine/ pseudoephedrine (decongestants), L-dopa, dopamine)
Even LA containing adrenaline

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19
Q

Symptoms of serotonin syndrome

A

neuromuscular abnormalities, altered consciousness, autonomic instability

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20
Q

How to avoid serotonin syndrome

A

At least 2 weeks between MAOI and starting other antidepressant

Opiates when on MAOI

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21
Q

Symptoms of discontinuation syndrome

A

GI upset, agitation/ insomnia, dizziness, headache, tremor

SSRIs worse culprits
should be tapered down

fluoxetine OK

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22
Q

Examples of mood stabilisers

Which are acute mania?

A

lithium, valproate, carbamazepine, lamotrigine

acute: lith, v
prophylaxis: all

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23
Q

How might clearance of lithium be decreased?

A

almost entirely excreted by kidneys
so renal failure, dehydration, older adults
avoid diuretics (esp thiazides), NSAIDs, ACEi

v narrow therapeutic window

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24
Q

Signs of lithium toxicity

A 
diarrhea
vomiting
stomach pains
fatigue
tremors
uncontrollable movements
muscle weakness
drowsiness
weakness
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25
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)
26
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) ```
27
Examples of first gen and second gen antipsychotics
1st: chlorpromazine, haloperidol 2nd: clozapine, olanzapine, quetiapine, risperidone (can be given as depot)
28
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)
29
Why should caution be used in prescribing antipsychotics in alcohol withdrawal?
Lowers seizure threshold
30
MoA anti-psychotics
Blockade of dopamine receptors Most second-gen also block serotonin receptors Block other receptors too
31
Side-effects of anti-psychotics
EPSE: Parkinsonian symptoms, dyskinesias, neuroleptic malignant syndrome Hyperprolactinaemmia: galactorrhoea, amenorrhoea & infertility, sexual dysfunction Muscarinic blockade Alpha-adrenergic blockade Cardiac effects: prolongation of QT, arrhythmias Metabolic effects: risk of metabolic syndrome (esp second gen) Dermatological effects: photosensitivity, skin rashes (esp clozapine and blue/grey discolouration in sun) Lowering of seizure threshold, hepatotoxicity, cholestatic jaundice, pancytopenia, agranulocytosis
32
Examples of autonomic dysfunction
hyperthermia, sweating, tachycardia, unstable BP
33
Differences in causes of neuroleptic malignant syndrome and serotonin syndrome
SS: after 1-2 doses of serotonin meds (often SSRIs + MAOIs) NMS: within 4-11 days of initiating dopamine antagonist (antipsychotics, metaclopramide)
34
Differences in onset of NMS and serotonin syndrome. Mortality
NMS more insiduous, SS acute SS has low mortality, NMS 20% die if untreated
35
Treatment for neuroleptic malignant syndrome
Bromocriptine Dantrolene (for muscle spasmm) ECT
36
Treatment for serotonin syndrome
Cyproheptadine (serotonin antagonist)
37
Differences in neuromuscular abnormalities in NMS and SS
Reduced activity in NMS: severe leadpipe rigidity, bradyreflexia, stiff muscles may lead to dysphagia and dyspnoea Increased activity in SS: myoclonus, tremor, hyperreflexia, less severe rigidity
38
MoA of hypnotics and anxiolytics
GABA receptors | benzos + Z drugs
39
Meds used in alcohol dependence
acamprosate, disulfiram
40
When is ECT considered
Most effective treatment for severe depression poor fluid intake puerperal strong suicidal intent psychotic features/ stupor antidepressants ineffective/ not tolerated effective for establish mania (but may precipitate mania in pts with bipolar) certain schiz
41
how often is ECT needed
usually 2-3 times/week | 4-12 treatments
42
Depression lite
Dysthymia
43
How long should antidepressant be tried before deciding it doesn't work?
6-8 weeks
44
Bipolar lite
Cyclothymia
45
Two mine types of non-situational anxiety
GAD | Paroxysmal anxiety
46
Difference between schizoid and schizotypal personality disorders
Schizoid: cold, indifferent to people/ praise/ criticism Schizotypal: eccentric behaviour
47
Histrionic personality disorder
Dramatic, exaggerated expressions of emotion, attention-seeking, seductive etc.
48
Avoidant PD
hypersensitive to critical remarks/ rejection, fears of inadequacy
49
What is an adjustment disorder?
When symptoms are considered out of proportion to original stressor resolves ~6 months (otherwise consider other diagnosis)
50
What is an acute stress reaction?
Symptoms last up to 3 days - externally shut-down, if severe like a stupor
51
Anorexia definition
self-imposed weight 15% below expected (ie BMI 17.5 in adult)
52
PSYCHOSIS
mental state in which reality is grossly distorted
53
HALLUCINATION
perceptions in absence of external stimuli - little insight
54
Extracampine hallucinations
false perceptions outside limits of person's sensory field
55
Functional hallucination vs reflex hallucination
F: normal sensory stimulus needed to precipitate hallucination in same modality R: normal sensory simulus in one modality precipitates hallucinations in another
56
PSEUDOHALLUCINATION
hallucinations with insight arises from subjective inner space, not under conscious control eg PTSD flashbacks
57
DELUSION
Unshakable false belief not accepted by other members of pt's culture
58
Types of schizophrenia
Paranoid: dominated by presence of delusions and hallucinations (positive symptoms) - onset of illness later/ better prognosis Hebephrenic: delusions/ hallucinations are fleeting or not prominent - thought disorganisation, disturbed behaviour, flat affect - younger, worse prognosis Catatonic: rare Residual: 1 year predominantly chronic negative symptoms with at least 1 clear-cut psychotic episode
59
Age of onset schiz | incidence vs prevalence
M: 18-25 F: 25-35 men have higher incidence but prevalance about same (high male mortality)
60
high expressed emotion
family/ carers too involved affects schizophrenics - 35hrs +
61
How much pabrinex in DT
2 ampoules, BD | for 5 days
62
Difference in fatality: heroin withdrawal vs benzo withdrawal
heroin withdrawal not fatal | benzo is
63
Section 2 What is it? Duration?
``` Admission for assessment 28 days (can be transformed to s3) ```
64
Section 3 What is it? Duration?
``` admission for treatment 6 months (can be extended) ```
65
Section 4 What is it? Duration?
Emergency admission for assessment (Dr) | 72h (to allow s2/3)
66
Section 5(2)
Dr's holding power Detention of hosp in-patient 72h
67
Section 5(4)
Nurse's holding power | 6h
68
Section 17
Community treatment order
69
Section 135
Police can enter private premmises to remmove someone with suspected MH problem
70
Section 136
Police can remove someone from public space

Medicine (30 decks)

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