Psychiatry and CV Disease Flashcards
__% of adults with mental disorders have medical conditions
__% of adults with medical conditions have mental disorders
68%; 29%
Are cardiac risk factors more increased in patients with diabetes AND depression or diabetes WITHOUT depression?
Diabetes AND depression
What physiologic risk factors are associated with depression?
- Autonomic nervous system dysfunction (heart rate variability is lost in depressed patients)
- Inflammation/Platelet reactivity (Decrease in serotonin causes platelets to be sticky)
- HPA axis dysregulation
Is there a link between beta-blockers and depression?
Systematic studies have failed to find a increase in rates of depression associated with beta blockers
Beta Blockers DO cause drowsiness, fatigue, lethargy, and sleep disorders
What antipsychotic medication has increased levels in the blood when taken with Thiazide diuretics (antihypertensive)?
What is the mechanism?
Lithium
Due to thiazide action on distal tubule which causes a compensatory proximal tubular reabsorption of sodium and lithium
How do beta blockers and SSRIs interact when taken together?
Metoprolol is extensively metabolized via 2D6 which is inhibited by Paroxetine
This leads to a 2x increase in both maximum plasma concentration of metoprolol and terminal elimination half life → Decrease in exercise HR and SBP
How do Clonidine and mirtazapine interact when given together?
- Clonidine (antihypertensive effect) acts as an agonist to the alpha 2 receptors
- Mirtazapine acts as an antagonist to the alpha 2 receptors
- High doses of mirtazapine displace clonidine leading to loss of antihypertensive effect
What type of cardiomyopathy is brought on by sudden emotions or stress?
Takotsubo cardiomyopathy
What is the standardized mortality ratio for schizophrnics?
Natural causes:
Unnatural causes:
Natural causes: 2.41
Unnatural causes: 7.50
What is CATIE?
Clinical Antipsychotic Trials of Intervention Effectiveness
How much of an increaes in mortality following MI do schizophrenic patients have over normal patients?
34%
Why do schizophrenic patients have a higher risk of mortality even though they receive the same treament as non-schizophrenic patients?
THEY DO NOT RECIEVE THE SAME TREATMENT - often other illness are overlooked when treating schizophrenia
What history is often associated with increased risk for insulin resistance (The deadly quartet/GHO syndrome/syndrome X)?
- Upper-Body Obesity
- Glucose Intolerance
- Hypertriglyceridemia
- Hypertension
Patients with mental illness have ______ the rates of metabolic syndrome and obesity
double
What factors contribute to metabolic syndrome in the mentally ill?
- Schizophrenia
- Lifestyle
- Sedentary
- Poor food intake
- Substance abuse
What anti-psychotic medication causes the most increased levels of metabolic syndrome?
Olanzapine
What are demographic risk factors for antipsychotic induced weight gain?
- Younger age
- Lower initial BMI
- fx of obesity
- non-white ethnic background
- Cannabis use
Which antipsychotic causes the most weight gain after ten weeks of treatment? After 1 year?
Clozapine; Olanzapine
Which antipsychotics are metabolically neutral?
Aripirazole and Ziprasidone
What risk factors are increased in psychotic patients leading to increased CVD risk?
Smoking
Diabetes
Hypertension
Low HDL level
What is a Framingham score and which population scores higher between the mentally ill and non-mentally ill?
algorithm used to estimate the 10-year cardiovascular risk of an individual
Increased score in mentally ill patients
What screening checks are often not performed by psychiatrists leading to increased risk of CVD
BMI
Waist circumference
Weight
BP
Fasting glucose/lipids
What strategies can be used to reduce modifiable risk factors?
Antipsychotic choice/change
Lifestyle modifications
Medication augmentation
A normal QT is less than half the ____ _______
RR interval
How do you measure QT using the tangent method?
Two steps (Lead II or V5)
- The end of the T wave is defined as the intersection of a tangent to the steepest slope of the T wave and the baseline
- QTc is defined as QT/√RR interval between the measured and the preceding complex
QTc prolongation invreases the risk of ____
TdP
Normal QT for men?
Normal QT for women?
What is an abnormally high QT?
Men: <440
Women: < 450
Abnormally high: >500
What are non modifiable risk factors for prolonged QT interval?
- Genetic LQTS
- Age > 65
- Female Gender
- Circadian Rhythm
- CV Disease
What are modifiable risk factors associated with QT prolongation?
- Bradycardia
- Electrolyte abnormalities
- Pharmocologic (drug interactions)
Charactersitics of torsades de pointes?
- Polymorphic ventricular tachycardia
- Ventricular rate: 160-240 bpm
- Usually short lived and terminates spontaneously
What SSRI is no longer used because of its QT prolongation side effects?
Citalopram
What are the ABCs of treatment in poisoned patients?
How is a diagnosis made?
Airway, Breathing and Circulation
- Diagnosis
- History
- Physical Examination
- Toxidrome Recognition
- Diagnostic Tests
What are TCAs?
Tricyclic antidepressants
- Amitryptyline
- Nortriptyline
- Chlorpromazine
- Imipramine
- Desipramine
- Doxepin
What are the pharmacologic affects of TCAs?
- Inhibition of NE and 5HT reuptake
- Antagonism of H1 receptors
- Blockade of cardiac fast Na channels (lead to prolonged QT)
- Antagonism of alpha 1 receptors
- Antagonism of m-Ach receptors
What are the signs on ECG that suggest TCA toxicity?
- Abnormal morphology of QRS
- QT and PR prolongation
- Right axis deviation
- AV or bundle branch blocks
- Abnormal size and ration or R and S waves in lead AVR
What is used to resolve cardiac symptoms associated with TCA toxicity?
Sodium bicarbonate
