Psychiatry Flashcards
What will the vitals look like in a benzo overdose?
Normal or hypotensive
Antidote to benzo overdose and mechanism of action
Flumazenil- GABA-A partial agonist and competitive inhibitor to displace benzo
Antidote to opioid overdose
Naloxone
Antidote to aspirin overdose
Sodium bicarbonate
Antidote to ethylene glycol overdose
Fomepizol
What are the four key features of methanol poisoning
CNS depression
Blurred vision or blindness
Anion gap acidosis
Elevated osmolar gap
What is the treatment of mild methanol poisoning? Symptomatic? Very severe?
Mild – IV fomepizole
Blindness or acidosis – IV sodium bicarb, fomepizole or ethanol, IV folinic acid
Severe – dialysis
How do you differentiate between ethanol, methanol and ethylene glycol poisoning?
Ethanol – increased serum levels
Methanol – normal ethanol levels but visual sx
Ethylene glycol – normal ethanol levels but calcium oxalate crystals in urine
Photophobia, anion gap acidosis, calcium oxalate crystals in urine
Ethylene glycol poisoning
Abdominal pain, N/V, diarrhea, hematemesis, metabolic acidosis
Iron toxicity
Tinnitus, tachypnea, metabolic acidosis, respiratory alkalosis
Salicylate overdose
Miosis, diarrhea, urination, salivation, elevated troponins, hypomag
Organophosphate poisoning
What are some suicide risk factors
Organized plan Male sex Older age Depressed Single Previous attempt Alcohol abuse Lack of social support Chronic illness
What overdose results in tinnitus
Aspirin
What is the mechanism of action of quetiapine? What are the side effects?
Atypical antipsychotic - antagonist to dopamine, serotonin, NE
Causes sedation, weight gain, constipation, headache
How are typical and atypical antipsychotic different in their effectiveness in treating schizophrenia?
Typical antipsychotics are primarily dopamine blockade and reduce positive symptoms but do not affect negative symptoms, whereas atypicals can affect serotonin and NE and can help positive and negative symptoms
What causes the tardive dyskinesia seen in patients on typical antipsychotics?
Blockade of D2 receptors
Name 5 typical antipsychotics
Haloperidol Chlorpromazine Fluphenazine Perphenazine Thioridazine
What is the mechanism of action of typical and atypical antipsychotics?
Typical – block D2 receptors
Atypical – block D2, serotonin, Alpha1, H1 receptors
Which atypical antipsychotic is associated with hyperprolactinemia?
Risperidone
What is the most dreaded side effect of risperidone?
Hyperprolactinemia
What is the mechanism of action and side effects of mirtazapine?
Alpha1 and 5HT2 blocker (antidepressant)
Sedation, weight gain
What is the mechanism of action of TCAs?
Inhibition of serotonin and NE reuptake
What are the 3 severe side effects of TCAs?
3 Cs– convulsions, coma, cardiotoxicity
What are 3 side efffects to lithium?
Tremor
Hypothyroidism
Nephrogenic DI
What are the 3 high potency typical antipsychotics
Trifluoperazine
Fluphenazine
Haloperidol
What are 2 low potency typical antipsychotics?
Chlorpromazine
Thioridazine
What are the main differences in side effects between high and low potency typical antipsychotics?
High – mainly EPS side effects
Low – less EPS, more anticholinergic, antihistamine, Alpha1 effects
What are 3 effects of hyperprolactinemia on antipsychotics?
Galactorrhea
Oligomenorrhea
Gynecomastia
What is the progression of EPS symptoms experienced with typical antipsychotics?
ADAPT: acute dystonia (hrs-days) –> akathisia, Parkinsonism (days-mo) –> tardive dyskinesia (mo-yrs)
What is the treatment of EPS symptoms on antipsychotics?
Benztropine
Benzos
B-blockers for akathisia
What are the signs and symptoms of neuroleptic malignant syndrome?
Malignant FEVER – Myoglobinuria, Fever, Encephalopathy, unstable Vitals, inc Enzymes (CK), muscle Rigidity
What is the treatment of neuroleptic malignant syndrome?
Dantrolene
Bromocriptine (D2 agonist)
What is the mechanism of action of aripiprazole?
Partial D2 agonist and antagonist
What are 6 conditions typical antipsychotics are used for?
Delirium Psychosis Bipolar disorder Schizophrenia OCD Tourette's
Which atypical antipsychotic has evidence of reducing suicidal behavior?
Clozapine
What are 7 conditions that atypical antipsychotics are used for?
Schizophrenia Bipolar OCD Tourette's Anxiety disorders Depression Mania
Which has more anticholinergic side effects, typical or atypical antipsychotics
Typical
What are the 2 severe side effects of clozapine?
Agranulocytosis
Seizures
Benztropine
Anticholinergic drug used to treat Parkinson’s disease ad acute dystonia
What are the sx of anticholinergic overdose?
Difficulty focusing eyes, flushing, inability to sweat, hyperthermia, Urinary retention, constipation, confusion
What are the sx of organophosphate poisoning
Excess cholinergic activity causing urination, salivation, defecation, lacrimation, n/v, diarrhea, wheezing, miosis, blurry vision, bradycardia, HoTN, seizures
How do organophosphates cause toxicity?
They irreversibly inhibit acetylcholinesterase therefore blocking metabolism of ACh and causing increased activity
What are the steps to treat organophosphate poisoning?
- Remove clothes and wash patient
- Administer atropine (competitive inhibitor)
- Administer pralidoxime (reactives AChE)
- If seizures, give benzo
What are the sx of Serotonin syndrome?
Fever, myoclonus, hyperreflexia, muscle rigidity, tremor, diaphoresis, hyperthermia, diarrhea, AMS
What lab test can be ordered to confirm the diagnosis of Serotonin syndrome?
CK
What is the treatment of Serotonin Syndrome?
- Benzos – muscle relaxant, control seizures
- O2 and IVF
- Cyproheptadine – block serotonin
- Anti-hypertensives like b-blocker or nitroprusside
