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Finals HH > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

Examples of typical (1st gen) anti-psychotics? (4)

A

Chlorpromazine
Haloperidol
Fluphenazine (depot)
Clopenthixol

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2
Q

Examples of atypical (2nd gen) anti-psychotics? (7)

A

Risperidone
Clozapine
Aripiprazole
Olanzapine
Quetiapine
Zotepine
Sertindole

Wrote all, as in exam its always the one you don’t know that pops up

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3
Q

Mx of Psychosis?

A
  1. 2nd gen antipsychotic
  2. 1st or 2nd gen antipsychotic
  3. Clozapine
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4
Q

Side effect of 1st gen antipsychotics?

A

Extra-pyramidal s/e

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5
Q

Side effect of 2nd gen anti-psychotic?

A

Weight gain, sedation

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6
Q

What are the extra-pyramidal side effects? (4)

A

Dystonia (fixed muscle posture / spasms)

Akathisia (motor restlessness)

Parkinsonism

Tardive kinesia

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7
Q

What is tardive kinesia?

A

Involuntary repetitive oro-facial movements
- Lip smacking
- Blinking
- Pouting

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8
Q

Mx for extra-pyramidal side effects?

A

Change anti-psychotic

Procyclidine (lowers acetylcholine)

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9
Q

Mx of neuroleptic malignant syndrome?

A

Bromocriptine + Dantrolene

+ stop anti-psychotic

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10
Q

Mania vs hypomania?

A

Abnormally elevated or irritable mood for a week = mania

for 4 days = hypomania

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11
Q

Triad of serotonin syndrome?

A

Autonomic instability - hypertension, tachycardia, hyperthermia

Neuromuscular instability - tremor, hyperreflexia, myoclonus

Mental state changes - delirium, confusion

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12
Q

SSRI examples?

A

Citalopram
Fluoxetine
Sertraline
Paroxetine

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13
Q

Four features of PTSD?

A
  • Re-experiencing
  • Avoidance
  • Hyperarousal (enhanced startle reaction)
  • Negative alteration in mood and thinking
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14
Q

PTSD mx?

A

Options:
- Trauma-focused CBT
- EMDR
- Drugs
1. SSRI or venlafaxine
2. Anti-psychotics

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15
Q

Acute stress reaction mx?

A

Individual CBT or group-CBT within 1 month of traumatic event

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16
Q

What is the time-frame of acute stress reaction?

A

Within one month

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17
Q

GAD drug mx?

A
  1. SSRI
  2. Pregablin if can’t tolerate SSRI or SNRI
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18
Q

What are the three main phobias?

A

Social phobia - fear of socialising
Agoraphobia - fear of going outside
Specific phobia - marked and persistent fear which is excessive and irrational

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19
Q

Mx of OCD?

A
  1. CBT
  2. SSRI
  3. alternative SSRI or clomipramine
  4. Either:
    - add anti-psychotic
    - SSRI + clomipramine
    - SSRI + buspirone
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20
Q

Mx of body dysmorphic disorder?

A

Fluoxetine

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21
Q

Dx of OCD?

A

Obsessions and compulsions are time-consuming (>1h a day) or cause significant distress or significant impairment

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22
Q

What is the thought disorder - circumstantiality?

A

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.

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23
Q

What is the thought disorder - Tangentiality?

A

Wandering from a topic without returning to it

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24
Q

What is a Neologism?

A

New word formation - might include combining of two words

25
Q

What are clang associations?

A

When ideas are related to each other because they sound similar or rhyme

26
Q

What is word salad?

A

Completely incoherent speech where real words are strung together into nonsense sentences

27
Q

What is Knight’s move thinking?

A

Feature of schizophrenia

Severe type of loosening of associations, where there are unexpected and illogical leaps from one idea to another

28
Q

What is flights of idea?

A

Feature of mania

Leaps from one topic to another but with discernible links between them

29
Q

What is echolalia?

A

Repetition of someone else’s speech, including the question that was asked

30
Q

Mx of akathisia?

A

Either:
- Propanolol
- Small dose clonazepam
- Cyproheptadine

31
Q

Mx of dystonia?

A

Oral, IM or OV procyclidine (anti-cholinergic)

32
Q

S/e of anti-psychotics?

A

SIADH
Hyperprolactinaemia
Postural hypotension
Reduced seizure threshold
Anti-cholinergic side effects - dry mouth, blurred vision, urinary retention, constipation
Metabolic syndrome

33
Q

Examples of SNRI?

A

Venlafaxine
Duoloxetine

34
Q

Mirtazapine drug class

A

Alpha2-adrenoceptor antagonist

This increases NA transmission by blocking negative feedback on alpha 2 receptors.

35
Q

What needs monitored on mirtazepine?

A

FBC - associated with blood dyscrasia

36
Q

Tricyclic anti-depressant drugs?

A

Sedative: Amitryptiline, clomipramine, dosulepin

Less sedative: Imipramine, lofepramine and nortriptyline

37
Q

S/e of TCAs?

A

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)

38
Q

When are TCAs contra-inidcated?

A

Arrhythmias, recent MI, heart block
Mania, hypomania
Acute porphyria

39
Q

Monoamine oxidase inhibitor examples?

A

Phenelzine
Selegiline
Tranylcypromine
Isocarboxazid

Reversible MOAI - moclobemide

40
Q

S/e of MOAi?

A

Hypertensive reaction /crisis caused by tyramine foods
- Cheese, yeast extracts
- Phenylephrine

Postural hypotension

41
Q

When are MOAi contraindicated?

A

Delerium
Pheochromocytoma
Hyperthyroidism
CVD and CNS disease

42
Q

Antidepressant in young people?

A

Fluoxetine

43
Q

How long to trial antidepressants for?

A

Patients with two prior episodes and functional impairment should be treated for at least 2 years.

44
Q

Electrode placement in ECT?

A

Bilateral (bitemporal or bifrontal) and right unilateral (RUL)

45
Q

When ECT?

A

Acute treatment of moderate to severe depression, mania or catatonia in patients who have failed in responding to other treatments

46
Q

Mx of alcohol intoxication?

A

Supportive with airway protection

Intramuscular thiamine, followed by glucose treatment

47
Q

Mx of alcohol withdrawal?

A

Benzodiazepine - Chlordiazepoxide, lorazepam or diazepam

Benzos contra-indicated -> Carbamazepine

48
Q

Mx of alcohol withdrawal with liver impairment?

A

Lorazepam, oxazepam and temazepam - no phase 1 metabolism (CYP450)

49
Q

Mx of alcohol dependance

A

Disulfarim - aldehdye dehydrogenase inhibitor, adverse s/e on drinking alcohol

Acamprosate - NMDAr antagonist, reduces cravings

Naltrexone - opiate antagonist, reduces cravings

50
Q

Mx of opioid dependance?

A
  • Methadone
  • Buprenorphine
  • Lofexidine
51
Q

Mx of nicotine dependance?

A
  • Nicotine replacement therapy
  • Varenicline
  • Bupropion
52
Q

Mx of alzheimers?

A

Mild-moderate: Cholinesterase inhibitors
- Donepezil, rivastigmine, galantamine

Moderate-severe: NMDA receptor blocking
- Memantine

53
Q

Contra-indications to cholinesterase inhibitors?

A

Cardiac: Bradycardia (<50), LBBB.
Peptic ulcer disease
Medications: anticholinergic medications

54
Q

Contra-indications to memantine?

A

Creatine clearance <30

55
Q

S/e of stimulants (methylphenidate)? (7)

A

Decreased appetite
Sleep disturbance.
Stomach upset
Headache
Irritability
Growth suppression
Cardiovascular effects

56
Q

What must be monitored for patients on stimulants?

A

Height and weight
HR & BP
Rating scaled (parent & teacher) - monitor medication response

57
Q

ADHD mx?

A
  1. Stimulants - methylphenidate, bisphentin, concerta, vyvanse
  2. Atomoxetine (NRI)
58
Q

S/e of carbamazepine and lamotrigine in pregnancy?

A

Carbamazepine - Neural tube defects
Lamotrigine - oral cleft

59
Q

S/e of benzodiazepine in pregnancy?

A

Cleft palate
Floppy baby syndrome

Finals HH (21 decks)

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