Psychiatry Flashcards
Examples of typical (1st gen) anti-psychotics? (4)
Chlorpromazine
Haloperidol
Fluphenazine (depot)
Clopenthixol
Examples of atypical (2nd gen) anti-psychotics? (7)
Risperidone
Clozapine
Aripiprazole
Olanzapine
Quetiapine
Zotepine
Sertindole
Wrote all, as in exam its always the one you don’t know that pops up
Mx of Psychosis?
- 2nd gen antipsychotic
- 1st or 2nd gen antipsychotic
- Clozapine
Side effect of 1st gen antipsychotics?
Extra-pyramidal s/e
Side effect of 2nd gen anti-psychotic?
Weight gain, sedation
What are the extra-pyramidal side effects? (4)
Dystonia (fixed muscle posture / spasms)
Akathisia (motor restlessness)
Parkinsonism
Tardive kinesia
What is tardive kinesia?
Involuntary repetitive oro-facial movements
- Lip smacking
- Blinking
- Pouting
Mx for extra-pyramidal side effects?
Change anti-psychotic
Procyclidine (lowers acetylcholine)
Mx of neuroleptic malignant syndrome?
Bromocriptine + Dantrolene
+ stop anti-psychotic
Mania vs hypomania?
Abnormally elevated or irritable mood for a week = mania
for 4 days = hypomania
Triad of serotonin syndrome?
Autonomic instability - hypertension, tachycardia, hyperthermia
Neuromuscular instability - tremor, hyperreflexia, myoclonus
Mental state changes - delirium, confusion
SSRI examples?
Citalopram
Fluoxetine
Sertraline
Paroxetine
Four features of PTSD?
- Re-experiencing
- Avoidance
- Hyperarousal (enhanced startle reaction)
- Negative alteration in mood and thinking
PTSD mx?
Options:
- Trauma-focused CBT
- EMDR
- Drugs
1. SSRI or venlafaxine
2. Anti-psychotics
Acute stress reaction mx?
Individual CBT or group-CBT within 1 month of traumatic event
What is the time-frame of acute stress reaction?
Within one month
GAD drug mx?
- SSRI
- Pregablin if can’t tolerate SSRI or SNRI
What are the three main phobias?
Social phobia - fear of socialising
Agoraphobia - fear of going outside
Specific phobia - marked and persistent fear which is excessive and irrational
Mx of OCD?
- CBT
- SSRI
- alternative SSRI or clomipramine
- Either:
- add anti-psychotic
- SSRI + clomipramine
- SSRI + buspirone
Mx of body dysmorphic disorder?
Fluoxetine
Dx of OCD?
Obsessions and compulsions are time-consuming (>1h a day) or cause significant distress or significant impairment
What is the thought disorder - circumstantiality?
Inability to answer a question without giving excessive, unnecessary detail.
However, this differs from tangentiality in that the person does eventually return to the original point.
What is the thought disorder - Tangentiality?
Wandering from a topic without returning to it
What is a Neologism?
New word formation - might include combining of two words
What are clang associations?
When ideas are related to each other because they sound similar or rhyme
What is word salad?
Completely incoherent speech where real words are strung together into nonsense sentences
What is Knight’s move thinking?
Feature of schizophrenia
Severe type of loosening of associations, where there are unexpected and illogical leaps from one idea to another
What is flights of idea?
Feature of mania
Leaps from one topic to another but with discernible links between them
What is echolalia?
Repetition of someone else’s speech, including the question that was asked
Mx of akathisia?
Either:
- Propanolol
- Small dose clonazepam
- Cyproheptadine
Mx of dystonia?
Oral, IM or OV procyclidine (anti-cholinergic)
S/e of anti-psychotics?
SIADH
Hyperprolactinaemia
Postural hypotension
Reduced seizure threshold
Anti-cholinergic side effects - dry mouth, blurred vision, urinary retention, constipation
Metabolic syndrome
Examples of SNRI?
Venlafaxine
Duoloxetine
Mirtazapine drug class
Alpha2-adrenoceptor antagonist
This increases NA transmission by blocking negative feedback on alpha 2 receptors.
What needs monitored on mirtazepine?
FBC - associated with blood dyscrasia
Tricyclic anti-depressant drugs?
Sedative: Amitryptiline, clomipramine, dosulepin
Less sedative: Imipramine, lofepramine and nortriptyline
S/e of TCAs?
Antimuscarinic - dry mouth, urinary retention, blurry vision, constipation
Anti-histaminic - weight gain, sedation
Alpha1 adrenergic action - dizziness, orthostatic hypotension
Blockage of voltage-sensitive sodium channels - coma, seizure, arrhythmias, cardiac arrest (prolonged QTc)
When are TCAs contra-inidcated?
Arrhythmias, recent MI, heart block
Mania, hypomania
Acute porphyria
Monoamine oxidase inhibitor examples?
Phenelzine
Selegiline
Tranylcypromine
Isocarboxazid
Reversible MOAI - moclobemide
S/e of MOAi?
Hypertensive reaction /crisis caused by tyramine foods
- Cheese, yeast extracts
- Phenylephrine
Postural hypotension
When are MOAi contraindicated?
Delerium
Pheochromocytoma
Hyperthyroidism
CVD and CNS disease
Antidepressant in young people?
Fluoxetine
How long to trial antidepressants for?
Patients with two prior episodes and functional impairment should be treated for at least 2 years.
Electrode placement in ECT?
Bilateral (bitemporal or bifrontal) and right unilateral (RUL)
When ECT?
Acute treatment of moderate to severe depression, mania or catatonia in patients who have failed in responding to other treatments
Mx of alcohol intoxication?
Supportive with airway protection
Intramuscular thiamine, followed by glucose treatment
Mx of alcohol withdrawal?
Benzodiazepine - Chlordiazepoxide, lorazepam or diazepam
Benzos contra-indicated -> Carbamazepine
Mx of alcohol withdrawal with liver impairment?
Lorazepam, oxazepam and temazepam - no phase 1 metabolism (CYP450)
Mx of alcohol dependance
Disulfarim - aldehdye dehydrogenase inhibitor, adverse s/e on drinking alcohol
Acamprosate - NMDAr antagonist, reduces cravings
Naltrexone - opiate antagonist, reduces cravings
Mx of opioid dependance?
- Methadone
- Buprenorphine
- Lofexidine
Mx of nicotine dependance?
- Nicotine replacement therapy
- Varenicline
- Bupropion
Mx of alzheimers?
Mild-moderate: Cholinesterase inhibitors
- Donepezil, rivastigmine, galantamine
Moderate-severe: NMDA receptor blocking
- Memantine
Contra-indications to cholinesterase inhibitors?
Cardiac: Bradycardia (<50), LBBB.
Peptic ulcer disease
Medications: anticholinergic medications
Contra-indications to memantine?
Creatine clearance <30
S/e of stimulants (methylphenidate)? (7)
Decreased appetite
Sleep disturbance.
Stomach upset
Headache
Irritability
Growth suppression
Cardiovascular effects
What must be monitored for patients on stimulants?
Height and weight
HR & BP
Rating scaled (parent & teacher) - monitor medication response
ADHD mx?
- Stimulants - methylphenidate, bisphentin, concerta, vyvanse
- Atomoxetine (NRI)
S/e of carbamazepine and lamotrigine in pregnancy?
Carbamazepine - Neural tube defects
Lamotrigine - oral cleft
S/e of benzodiazepine in pregnancy?
Cleft palate
Floppy baby syndrome
