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2020 phase 3a newer > psych > Flashcards

psych Flashcards

1
Q

aside from lithium,

what is first line treatment of bipolar depressive episode

A

lamotrigine

antidepressants

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2
Q

aside from lithium,

what is first line treatment of bipolar manic episode

A

antipsychotic - risperidone or olanzipine

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3
Q

what are some second line treatments of bipolar?

A 
valproate
carbemazipine
oxcarbmazepine
topiramite
gabapentin
phenytoin
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4
Q

if bipolar resistant to depression

A

ECT

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5
Q

what is lithium mechanism of action

A

inhibits dopamine neurotransmission

promotes GABAergic (inhibitory transmission)

downregulates NMDA (excitatory)

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6
Q

what monitoring required in lithium?

A 
serum lithium 
U&Es 
eGFR
BMI
thyroid
CALCIUM
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7
Q

what are the side effects of lithium?

A

LITHIUM CON

Leukocytosis
Increased weight
Tremor
Hypothyroid
Insipidus (diabetes)
Urine output
Mums beware (teratogenic)

Cardiac - Long QT
Oedema
Nephro/neurotoxicity

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8
Q

what are the first rank symptoms of schizo?

A 
delusional perception
auditory hallucinations (3rd person!)
thought alienation
passivity phenomena
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9
Q

what are the second rank symptoms of schizo?

A
  • delusions (grandiose)
  • 2nd person auditory
  • thought disorder
  • catatonia
  • negative symptoms
    • blunted affect
    • apathy
    • alogia
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10
Q

what dopaminergic pathways involved in schizo and

A

nigrostriatal - normal
tuberoinfundibilar - normal
mesocortical - low
mesolimbic - hyperactive

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11
Q

which pathways do typical antipsychotics affect?

A

mesolimbic
tuberoinfundibular
nigrostriatal
CHOLINERGIC

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12
Q 
what class is haloperidol
risperidone
promazine
flupentixol
chlorpromezine
A

typical

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13
Q

where do atypical antipsychotics work?

A

mesolimbic

serotonin

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14
Q

where does aripiprizole work?

A

mesolimibic - agonist and antagonist

serotonin

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15
Q

where does clozapine work?

A

mesolimbic

serotonin

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16
Q

EPSEs

A

tardive dyskinesia
parkinsonism
akathisia
acute dystonia

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17
Q

what are the serotonergic side effects that you get from

A

diabetes
hyperlipidaemia
weight gain

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18
Q

What are the effects of tuberinfindibular?

A

galactorrhoea
gynaecomastia
infertility

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19
Q

what are the side effects of aripiprizile?

A

as it is a dopamine agonist, can cause compulsive behaviours

  • gambling
  • risky behaviour
  • withdrawal if aripiprizole stopped
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20
Q

clozapine side effects?

A

agranulocysosis and constipation

used to treat negative symptoms

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21
Q

what are anticholinergic side effects

A 
dry mouth
constipation
urine retention
hypotension
long QT
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22
Q

how is neuroleptic malignant syndrome managed?

A 
abcde
stop causative drug
iv benzos for agitation
cooling, antipyretics
treat rhabdomhyolysis
bromocriptine and amantadine used as muscle relaxants
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23
Q

what are the signs of bulimia?

A

dental erosion
parotid hypertrophy
russels sign
arrhythmia

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24
Q

what are the signs of anorexia?

A 
lanugo hair
telogen effluvion
carotenderma
dry skin cracked nails
proximal muscle weakness
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25
Q

what is refeeding syndrome characterised by?

A 
hypophosphataemia
hypomagnesemia
hypokalaemia
thiamine deficiency
salt + water retention
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26
Q

how does refeeding present?

A 
arrhythmias
gi disturbance
weakness
sob
delirium
seizures 
nystagmus
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27
Q

how is refeeding prevented?

A

monitor electrolytes
thiamine supplementation
slow refeeding

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28
Q

what investigation for personality disorder?

A

mmpi
minnesota
eysenck personality questionnaire

29
Q

how are alcohol units calculated?

A

percentage * vol in L

30
Q

can you prescribe SSRIs with MAOIs?

A

no, serotonin syndrome

phenelzine

31
Q

what is the effect of SSRIs on natraemia?

A

hyponatraemia?

32
Q

what are the core features of depression?

A
  1. low mood
  2. anhedonia
  3. anergia
33
Q

how is bipolar diagnosed?

A

at least 2 disturbances in mood

at least 1 manic/hypomanic

34
Q

how would alzheimer’s look postmortem?

A

widespread cerebral atrophy

35
Q

what does refeeding syndrome affect?

A

potassium
magnesium
phosphate

36
Q

how to calm a patient with PD or LBD>

A

im lorazepam

avoid haloperidol/olanzipine

37
Q

what are the features of aspirin overdose?

A

respiratory alkalosis due to hyperventilation
then progresses to metabolic acidosis

patients have
tinnitus
vomiting
dehydration

38
Q

how is aspirin od managed?

A

iv rehydration
activated charcoal
urinary alkalisation!!!
dialysis if severe poisoning

39
Q

how would opiate od present?

A

pinpoint pupils
hypoventilation - resp acidosis
reduced gcs

pupils dilate in withdrawal

40
Q

which ecg abnormality in anorexia?

A

qt prolongation (electrolyte disturbance/weight loss)

41
Q

which type of amnesia more common following ect?

A

retrograde amnesia (remembering events prior to insult

42
Q

what is anterograde amnesia?

A

can’t form new memories

43
Q

what are the side effects of donepezil?

A 
diarrhoea 
n,v
bradycardia
hypersalivation
urinary incontinence
44
Q

what is the effect of anorexia on wbc count?

A

low

45
Q

patient with palpitations and feeling on edge all the time

sometimes exercise induced. what investigation?

A

48 hour holter monitor ecg

46
Q

what is transient global amnesia

A

temporary but total disruption of amnesia
perseveration
preserved functioning?

47
Q

what are the symptoms of heroin withdrawal?

A 
sweating 
watering eyes
rhinorrhea 
yawning
GI upset
anxiety and irritability
48
Q

which ssri in breastfeeding?

A

sertraline and paroxetine

49
Q

first line managament of schizophrenia?

A

risperidone

50
Q

beta amyloid plaques and neurofibrillary tangles with hyperphosphorylated tau proteins. what?

A

alzheimers

51
Q

how to distinguish bulimia from anorexia?

A

bulimia has normal bmi

binge eating and purging is also in anorexia

52
Q

how do antipsychotics work?

A

dopamine receptor antagonism

53
Q

if patient is intolerant of methylphenidate, what to do?

A

switch to atomoxetine

facial tics are a side effect of methylphenidate

54
Q

how is severe alzheimer’s treated?

A

memantine

55
Q

what is a side effect of memantine?

A 
constipation
impaired balance
dizziness
drowsiness
dyspnoea
hallucination
vomiting
56
Q

which type of diuretic associated with lithium toxicity?

A

thiazide

bendroflumethiazide

57
Q

what is a mild depressive episode ?

A

two core + 2 additional features

58
Q

how to differentiate borderline and impulse eupd?

A

borderline = uncertainty with self-image, intense relationships, try to avoid abandonment

impulsive = outbursts, unstable mood

59
Q

which medications avoided in depression?

A

tca = overdose is bad

60
Q

what is hypnogogic?

A

as you fall asleep

61
Q

what is hypnopompic?

A

as you wake up

pompous, high head, wake up

62
Q

give examples of dopamine agonists?

A

ropinirole

63
Q

what causes serotonin syndrome

A 
tramadol
phenelzine
st johns wort
ecstasy
amphetamines
64
Q

how is serotonin syndrome treated?

A 
iv fluids
benzodiazepines
serotonin antagonists:
- cyproheptidine 
-
65
Q

how is neuroleptic malignant syndrome treated?

A

iv fluids
dantrolene
bromocriptine (dopamine agonist)

66
Q

how are epses treated?

A

procyclidine

67
Q

how is tardive dyskinesia treated?

A

tetrabenazine

68
Q

which antipsychotic LEAST associated with prolactinaemia

A

aripiprizole

69
Q

pt on lithium has constipation. what

A

hypercalcaemia due to hyperparathyroidism

Bisphosphonates for hypercalcaemia?

2020 phase 3a newer (11 decks)

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