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Psychiatry > Psychiatric Treatments > Flashcards

Psychiatric Treatments Flashcards

1
Q

Name 3 atypical antipsychotics

A

Olanzapine
Risperidone
Quetiapine

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2
Q

Name 3 typical antipsychotics

A

Haloperidol

Sulpiride

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3
Q

How is clozapine monitored?

A

Weekly for first 18/52
Then fortnightly for 1 year
Then monthly

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4
Q

What is a specific side effect of clozapine?

A

Hypersalivation (wake up with pillow soaked)

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5
Q

Why do patients on clozapine have to gave frequent bloods?

A

To check their WCC

Clozapine can cause agranulocytosis and neutropenia

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5
Q

What are some differences between atypical and typical antipsychotics?

A

Typicals are more likely to cause EPSEs and hyperprolactinaemia

Atypicals are more likely to cause metabolic side effects e.g. weight gain, dyslipidaemia, diabetes
Atypicals also exert a serotoninergic effect, thought to reduce negative symptoms

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6
Q

What are some EPSEs of antipsychotics?

A

Parkinsonism: tremor, bradykinesia, rigidity
Dystonia
Tardive dyskinesia
Akathisia

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7
Q

How do antipsychotics generally work?

A

Inhibiting dopamine activity, by blocking mainly D2 receptor

Target the mesocortical and mesolimbic pathway, unwanted pathways are nigostriatal and tuberoinfundibular

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8
Q

What is a life threatening reaction to antipsychotics called?

A

Neuroleptic malignant syndrome

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9
Q

What are some symptoms of neuroleptic malignant syndrome?

A

Fever
Muscle rigidity
Altered mental state e.g. confusion, LOC
Autonomic instability e.g. tachycardia, sweating, tremor, fluctuating BP

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10
Q

How often is lithium monitored in a patient?

A

12 hours post first dose
Then weekly until stable for 4/52
Then every 3/12

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11
Q

Which mood stabiliser is safe to give to a woman of child bearing age/ in pregnancy?

A

Lamotrigine

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12
Q

What are some side effects of lithium?

A 
Teratogenic 
Renal failure
Metallic taste
Hypothyroidism 
GI upset
Weight gain
Polydipsia and polyuria
Convulsions
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13
Q

When would a mood stabiliser be prescribed?

A

To prevent depression or mania in bipolar or schizoaffective disorder

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14
Q

What are some examples of SSRIs?

A

Sertraline
Fluoxetine
Citalopram
Paroxetine

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15
Q

What is ECT used for?

A

Severe depression

Occasionally used for schizophrenia, good for catatonic type

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16
Q

What are some examples of SSRIs?

A

Fluoxetine
Sertraline
Citalopram
Paroxetine

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17
Q

Which SSRI is safest in people under age 18?

A

Fluoxetine

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18
Q

What are some ADRs of SSRIs?

A 
GI upset
Nausea
Weight changes
Headache
Sexual dysfunction
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19
Q

What are some examples of mood stabilisers?

A

Lithium
Sodium valproate
Carbamazepine
Lamotrigine

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20
Q

What marker is often raised in neuroleptic malignant syndrome?

A

Creatine kinase

21
Q

What are some appropriate investigations to do before prescribing an antipsychotic and why?

A

ECG, as they can lead to prolonged QTc which can lead to torsades de pointes
Baseline BMI, waist circumference, blood glucose and lipids (due to metabolic and anti histamine side effects)

22
Q

What regular blood tests are needed for a patient taking lithium carbonate?

A

U&Es as lithium is nephrotoxic
Lithium levels (as it has a narrow therapeutic index)
TFTs as lithium can damage thyroid and cause hypothyroidism

23
Q

What is the only absolute contraindication for ECT?

A

RICP

24
Q

Which antidepressant is safest post-MI?

A

Sertraline

25
Q

Why are SSRIs 1st line antidepressants?

A

Low side effect profile

Safe in overdose

26
Q

In an OSCE, when asked for management, how should this be presented?

A

BIOPSYCHOSOCIAL MODEL

27
Q

How should neuroleptic malignant syndrome be treated?

A

Stop the antipsychotic
IV Fluids
Dantrolene (can decrease release of calcium from the sarcoplasmic reticulum)

28
Q

How do antipsychotics affect prolactin?

A

Antipsychotics antagonise dopamine
Dopamine inhibits prolactin (tubero-infundibular)
Hence antipsychotics raise plasma prolactin

Hence side effect e.g. galactorrhea

29
Q

How long should a px continue their antidepressants for once their depression has remitted?

A

Continue for at least 6 month after first episode of depression

After a second episode, continue for 2 years

30
Q

Which drug is first line for ADHD?

A

Methylphenidate

31
Q

What is ECT?

A

Put patient under general anaesthesia (and give a muscle relaxant)
Place electrodes on head and send an electric current though the brain to induce a tonic clonic seizure

32
Q

When is ECT indicated?

A

In severe depression, uncontrolled mania or catatonia

33
Q

Which antidepressants are safest in OD?

A

SSRIs

34
Q

What are some side effects of SSRIs?

A 
Stomach upset
Sexual dysfunction
Serotonin syndrome
Suicidal thoughts
Sex drive decrease
Sleep disturbance 
QTc elongation
Sodium low so seizure threshold lowered in epilepsy
35
Q

What are some examples of SNRIs?

A

Venlafaxine

Duloxetine

36
Q

What are some examples of TCAs?

A

Amitriptyline

Clomipramine

37
Q

When are TCAs used?

A

For patients unresponsive to SSRIs

Can be used in neuropathic pain

38
Q

How does mirtazapine act?

A

5HT2 and 5HT3 antagonist
Also has strong histamine activity so causes sedation
Also causes weight gain

39
Q

What are some examples of hypnotics?

A

Benzodiazepines
Zopiclone
Zaleplon
Zolpidem

40
Q

Which class of antidepressants have most marked sleep disturbance?

A

SNRIs

41
Q

What is oculogyric crisis?

A

When the eyes are held in upward deviation

Type of dystonic reaction to dopamine antagonists (eg haloperidol, metoclopramide)

42
Q

What is bromocriptine an example of?

A

Dopamine agonist
Can use in Parkinson’s
Reduces muscle rigidity but can cause impulse control disorders

43
Q

What is an example of a COMT inhibitor?

A

Entacapone

44
Q

What drug can be used to help control EPSEs and how does this work?

A

Procyclidine

It is an anti muscarinic so blocks cholinergic receptors to hell tremor and rigidity

45
Q

What side effects are more common with atypical antipsychotics?

A

Hyperglycaemia
Weight gain
Sedation
QTc prolongation
Hyperprolactinaemia (so infertility, galactorrhea)
Hypotension
(So monitor BP, weight, glucose, lipids, ECG)

46
Q

What can be seen on bloods in neuroleptic malignant syndrome?

A

Raised CK

Raised WCC

47
Q

What could precipitate lithium toxicity?

A

Dehydration, renal failure, diuretics, ACEi, NSAIDs

48
Q

How could lithium toxicity be treated?

A

Volume resuscitation with IV fluids

If severe, haemodialysis

49
Q

What are some features of lithium toxicity?

A

Coarse tremor (fine tremor seen at therapeutic levels)
Seizures
Acute confusion
Hyperreflexia

Psychiatry (12 decks)

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