Psychiatry Flashcards
Safest SSRI for cardiac issues?
Sertraline
Safest SSRI for epilepsy but associated with long QTC?
Citalopram
SSRI voided when using Tamoxifen & due to anticholinergic effects & intense discontinuation syndrome?
Paroxetine
Examples of SNRIs?
Venlafaxine & Duloxetine
Which alpha receptor does Mirtazepine block?
alpha 2
What is a rare side effect of Mirtazepine?
Blood dycaryosis
Which antidepressant is first line if the patient has isnomnia & poor appetite?
Mirtazepine
Which antidepressant class precipitates a “cheese reaction” or Hypertensive crisis & why?
MAO inhibitors (Phenelzine, Moclobemide) as accumulation of tyramine causes norepinephrine accumulation.
How do you manage a “cheese reaction” or Hypertensive crisis? What causes this?
Phentolamine infusion
MAO inhibitors
How do you manage neuroleptic malignant syndrome?
Bromocriptine (dopamine agonist reverses effects of antipsychotics - they work by inhibiting dopamine)
plus Diazepam
What drugs cause neuroleptic malignant syndrome?
Antipsychotics (Chlorpromazine, Quietiapine)
Levodopa
Benzodiazepenes (Haloperidol)
Metclopramide (prokinetic - also exacerbates parkinson’s)
Which antidepressant is known for causing overflow incontinence
Amytriptilline due to anticholinergic effects
Which class of antidepressant is cardiotoxic in overdose & should be avoided in those with suicidal intent?
Tricyclics
What are the main side effects of atypical antipsychotics
- Motor: Parkinsonism, Acute dystonia, Akathisia & Tardive dyskinesia (extrapyramidal effects)
- Venous/cardiac: Increase risk of stroke/VTE in elderly, Qtc prolongation
- Metabolic syndrome (hyperlipidaemia, hyperprolactinaemia Etc.)
- Weight gain & sedation
What do the terms Acute dystonia, Akathisia & Tardive dyskinesia mean? Which class causes them?
Acute dystonia is sustained muscle contraction
Akathisia is severe restlessness
Tardive dyskinesia is involuntary choreoathetoid movements
Antipsychotics
What is the first line recommendation for schizophrenia?
Olanzapine
When is Clozapine used in the management of schizophrenia?
If the patient is resistant to at least two other anti-psychotics for at least 6-8weeks
If Clozapine has been missed for >/48hours it must be titrated upwards from the starting dose (12.5mg) T/F?
True, can be titrated faster than in a clozapine niave patient, however
Smoking cessation increases levels of Clozapine in the body T/F?
True
Why is a baseline ECG required before starting Clozapine?
Assess risk of developing Myocarditis (adverse effect of C.)
What symptoms MUST patients report during Clozapine use?
Infection (agranulocytosis)
Constipation
Fast heart beat (myocarditis)
Aside myocarditis & agranulocytosis, what other significant side effects does Clozapine have?
Reduces seizure threshold
Huge weight gain & highly sedative
Hypersalivayion
What is the first line maintenace therapy for bipolar?
Lithium
If Lithium can’t be used, what are the options for maintenace therapy in bipolar?
Sodium valproate - but avoid in women of child-bearing age
Antipsychotics - but avoid in endocrine problems & obesity
Lamotrigine
Manging an acute manic episode?
- Discontinue antidepressants
- Control symptoms - benzodiazepenes
- Atypical antipsychotic - olanzapine, quietiapine, resperidone
Managing an acute depressive episode in bipolar?
- Must use antidepressants WITH an antipsychotic - olanzapine & fluoxetine.
- Can use quietiapine alone.
Side effects of Lithium?
Endocrine: Hypothyroidism, thyroid enlargement, HYPERparathyroidism, hypercalcaemia
Renal: nephrotoxicity
Leucocytosis, weight gain, idiopathic intracranial hypertension.
GI: nausea, vomiting, diarrhoea
How does lithium affect ECG findings?
T wave flattening or inversion
What is an acute dystonic reaction & how is it managed?
Muscle spasms lasting hours - days
Prochlorperazine or Procyclidine
