Psych Passmed Flashcards
What acute dystonia?
sustained muscle contraction (e.g. torticollis, oculogyric crisis)
What drug is used to manage Acute dystonia secondary to antipsychotics?
Procyclidine - is an anticholinergic = helps decrease muscle stiffness, sweating + the production of saliva, and helps improve walking ability in people with Parkinson’s disease
What is tardive dyskinesia?
a side-effect of antipsychotics after being on the drug for several years.
How do you manage Tardive Dyskinesis?
Tetrabenazine
Symptoms of Tardive Dyskinesia?
lip-smacking, difficulty swallowing and excessive blinking
Which SSRI is a good choice for young adults?
Fluoxetine
When prescribing citalopram which drug should be avoided?
Rasagiline (MAOi)
What is serotonin syndrome?
present with fever, confusion, seizures, renal and hepatic impairment, arrhythmia, increased muscle tone, and hypersecretion of sweat
Typical Anti-psychotics
D2 Receptor Antagonist, blocking dopaminergic transmission in the mesolimbic pathways.
Examples of Atypical Anti-psychotic?
Clozapine
Risperidone
Olanzapine
Examples of Typical Anti-psychotic?
Haloperidol
Chlopromazine
Atypical Anti-psychotic?
Act on a variety of receptors (D2, D3, D4, 5-HT)
Mechanism of Alcohol Withdrawal?
decreased inhibitory GABA and increased NMDA glutamate transmission
When do symptoms of Alcohol start?
6-12 hours: tremor, sweating, tachycardia, anxiety
When do seizures occur after alcool withdrawal?
36 hrs
When do incidences of delirium tremens occur?
48-72 hours
coarse tremor, confusion, delusions, auditory and visual hallucinations, fever, tachycardia
What is the 1st line for Acute Mania/depression in Bipolar Disorder?
Atypical Anti-psychotic e.g. Olanzapine / Quetiapine
MoA of anticonvulsants ?
Block overactive pathways (reduce hyperactivity in the brain)
Possible MoA: increased GABA neurotransmission (GABA is an inhibitory neurotransmitter)
What are SE of Lithium ?
Dry mouth Strange taste (metallic) Tremor Polyuria Weight gain Hypothyroidism Renal impairment = dehydration + hyponatremia
Adverse Effects of Atypical antipsychotics?
Weight gain, metabolic dysregulation (Olanzapine)
Agranulocytosis (Clozapine)
Hyperprolactinaemia (Risperidone + Amisulpride)
Which atypical Anti-psychotic has a good side-effect profile for prolactin elevation ?
Aripiprazole
Anti-depressants that block a2 adrenergic receptors?
Mirtazapine
Side Effects of Mirtazapine?
Increase appetite + sedation
Mirtazapine is useful for who?
For elderly people: suffering from insomnia + poor appetite
SE of TCA?
Anticholinergic side effects: dry mouth, blurred vision and urinary retention.
Antihistaminic side effects: weight gain
Role of Mesolimbic?
Acts on nucleus accumbens (NA) to mediate pleasure /motivation.
Overactive in schizophrenia due to too much dopamine => causes +VE symptoms.
Role of Mesocortical?
Underactive in schizophrenia due to reduced dopamine => causes negative symptoms.
Role of Nigrostratal?
Affected by antipsychotics => extra-pyramidal side effects.
Transient increase in suicidal ideation especially in <25yrs
SSRIs
When should you stop SSRI?
Gradually reducing dose over 4 weeks
SSRIs in pregnancy?
A small increase in congenital heart defects in 1st trimester.
Small risk of persistent pulmonary hypertension of the newborn in the 3rd trimester.
Paroxetine ++ bad for this.
TCA examples?
Imipramine, Amitriptyline, Clomipramine
SE of TCAs?
Anticholinergic (Drowsiness, dry mouth, blurred vision, constipation, urinary retention)
QT prolongation
Orthostatic Hypotension
Cardiotoxic in overdose
What is Wernicke?
acute thiamine deficiency (ataxia, nystagmus, confusion)
What is korsakoff?
chronic thiamine deficiency (dementia, confabulation)
Opioid toxicity reversal?
IV Naloxone
SE of paroxetine / SSRI?
gastrointestinal symptoms (Diarrhoea), restlessness, mood changes and insomnia.
Avoidant personality disorder?
Fearful of criticism, being unliked, rejection and ridicule
What is Neuroleptic malignant syndrome?
Presents w/ muscular rigidity, fever, altered mental status, and autonomic dysfunction (such as tachycardia and hypertension)
Management of alcohol withdrawal?
First-line: long-acting benzodiazepines e.g. chlordiazepoxide or diazepam. Lorazepam may be preferable in patients with hepatic failure.
What is a hoover sign?
clinical tool to differentiate organic from non-organic leg paresis.
What is Bulimia nervosa acid-base + electrolyte imbalance?
Associated w/ metabolic alkalosis, hypokalemia + hypochloraemia.
Tuberoinfundibular pathway?
dopaminergic pathway emanating from the hypothalamus to the median eminence.
Nigrostraital pathway ?
involves in the pathophysiology of parkinson’s
Common features of PTSD
Flashbacks, nightmares
Avoidance
Hyperarousal
Believe that your movement / sensations are controlled by external force
Passivity
Which anti-psychotic drug cause hperprolactinaemia?
Risperidone
Which Anti-psychotic drugs is assoc. w/ seizures?
Clozapine reduces seizure threshold, making seizures more likely
What is akathisia?
Motor restlessness + need to be in constant movement due to long-standing use of Anti-psych drugs.
Ris factor for GAD?
Aged 35 - 54
Being divorced or separated
Living alone
Being a lone parent
Comparing dementia and delirium?
Delirium = sudden and Dementia = gradual decline. Dementia = pt are alert, orientated, normal behaviour, no halucination and deliriase pts are the opposit.
What is the management of dilirium?
First line Haliperidol
Sendond line lorazepam
