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Cardiovascular System > Psychiatry and CV Disease > Flashcards

Psychiatry and CV Disease Flashcards

1
Q

__% of adults with mental disorders have medical conditions

__% of adults with medical conditions have mental disorders

A

68%; 29%

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2
Q

Are cardiac risk factors more increased in patients with diabetes AND depression or diabetes WITHOUT depression?

A

Diabetes AND depression

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3
Q

What physiologic risk factors are associated with depression?

A
  • 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
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4
Q

Is there a link between beta-blockers and depression?

A

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

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5
Q

What antipsychotic medication has increased levels in the blood when taken with Thiazide diuretics (antihypertensive)?

What is the mechanism?

A

Lithium

Due to thiazide action on distal tubule which causes a compensatory proximal tubular reabsorption of sodium and lithium

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6
Q

How do beta blockers and SSRIs interact when taken together?

A

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

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7
Q

How do Clonidine and mirtazapine interact when given together?

A
  • 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
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8
Q

What type of cardiomyopathy is brought on by sudden emotions or stress?

A

Takotsubo cardiomyopathy

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9
Q

What is the standardized mortality ratio for schizophrnics?

Natural causes:

Unnatural causes:

A

Natural causes: 2.41

Unnatural causes: 7.50

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10
Q

What is CATIE?

A

Clinical Antipsychotic Trials of Intervention Effectiveness

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11
Q

How much of an increaes in mortality following MI do schizophrenic patients have over normal patients?

A

34%

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12
Q

Why do schizophrenic patients have a higher risk of mortality even though they receive the same treament as non-schizophrenic patients?

A

THEY DO NOT RECIEVE THE SAME TREATMENT - often other illness are overlooked when treating schizophrenia

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13
Q

What history is often associated with increased risk for insulin resistance (The deadly quartet/GHO syndrome/syndrome X)?

A
  • Upper-Body Obesity
  • Glucose Intolerance
  • Hypertriglyceridemia
  • Hypertension
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14
Q

Patients with mental illness have ______ the rates of metabolic syndrome and obesity

A

double

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15
Q

What factors contribute to metabolic syndrome in the mentally ill?

A
  • Schizophrenia
  • Lifestyle
    • Sedentary
    • Poor food intake
    • Substance abuse
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16
Q

What anti-psychotic medication causes the most increased levels of metabolic syndrome?

A

Olanzapine

17
Q

What are demographic risk factors for antipsychotic induced weight gain?

A
  • Younger age
  • Lower initial BMI
  • fx of obesity
  • non-white ethnic background
  • Cannabis use
18
Q

Which antipsychotic causes the most weight gain after ten weeks of treatment? After 1 year?

A

Clozapine; Olanzapine

19
Q

Which antipsychotics are metabolically neutral?

A

Aripirazole and Ziprasidone

20
Q

What risk factors are increased in psychotic patients leading to increased CVD risk?

A

Smoking

Diabetes

Hypertension

Low HDL level

21
Q

What is a Framingham score and which population scores higher between the mentally ill and non-mentally ill?

A

algorithm used to estimate the 10-year cardiovascular risk of an individual

Increased score in mentally ill patients

22
Q

What screening checks are often not performed by psychiatrists leading to increased risk of CVD

A

BMI

Waist circumference

Weight

BP

Fasting glucose/lipids

23
Q

What strategies can be used to reduce modifiable risk factors?

A

Antipsychotic choice/change

Lifestyle modifications

Medication augmentation

24
Q

A normal QT is less than half the ____ _______

A

RR interval

25
Q

How do you measure QT using the tangent method?

A

Two steps (Lead II or V5)

  1. 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
  2. QTc is defined as QT/√RR interval between the measured and the preceding complex
26
Q

QTc prolongation invreases the risk of ____

A

TdP

27
Q

Normal QT for men?

Normal QT for women?

What is an abnormally high QT?

A

Men: <440

Women: < 450

Abnormally high: >500

28
Q

What are non modifiable risk factors for prolonged QT interval?

A
  • Genetic LQTS
  • Age > 65
  • Female Gender
  • Circadian Rhythm
  • CV Disease
29
Q

What are modifiable risk factors associated with QT prolongation?

A
  • Bradycardia
  • Electrolyte abnormalities
  • Pharmocologic (drug interactions)
30
Q

Charactersitics of torsades de pointes?

A
  • Polymorphic ventricular tachycardia
  • Ventricular rate: 160-240 bpm
  • Usually short lived and terminates spontaneously
31
Q

What SSRI is no longer used because of its QT prolongation side effects?

A

Citalopram

32
Q

What are the ABCs of treatment in poisoned patients?

How is a diagnosis made?

A

Airway, Breathing and Circulation

  • Diagnosis
    • History
    • Physical Examination
    • Toxidrome Recognition
    • Diagnostic Tests
33
Q

What are TCAs?

A

Tricyclic antidepressants

  • Amitryptyline
  • Nortriptyline
  • Chlorpromazine
  • Imipramine
  • Desipramine
  • Doxepin
34
Q

What are the pharmacologic affects of TCAs?

A
  • 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
35
Q

What are the signs on ECG that suggest TCA toxicity?

A
  • 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
36
Q

What is used to resolve cardiac symptoms associated with TCA toxicity?

A

Sodium bicarbonate

Cardiovascular System (35 decks)

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