Psychiatry drugs

Question 1

Tx for acute mania? SEs?

Answer 1

for acute moderate/severe mania: olanzapine 10mg PO
SE: increased weight and increased glucose

or semisodium valproate (SE: hyperandrogenism in women)

Question 2

Prophylactic treatment for bipolar affective disorder?

Answer 2

Mood stabilizer for longer term control.

good compliance, U&E, ECG, and T4 normal - Lithium carbonate

Question 3

Lithium carbonate monitoring? SEs? Toxic signs?

Answer 3

Check Li+ levels weekly (~12h post-dose) until the dose has been constant for
4wks; then monthly for 6 months; then 3-monthly, if stable; more often if on
diuretic, NSAIDs, ACE-i (all  Li+) or on a low-salt diet or if pregnant

U&E + TSH 6-monthly

SE: hypothyroidism; nephrogenic diabetes insipidus, renal impairment

Toxic: reduced vision, D+V, low potassium, ataxia, tremor, dysarthria, coma.

Question 4

what drugs increase lithium levels in the blood?

Answer 4

diuretics, NSAIDs, ACE-i

low-salt diet, pregnancy

Question 5

What should you suspect if lithium levels are progressively rising?

Answer 5

progressive nephrotoxicity

Question 6

Drugs to reduce risk of suicide?

Answer 6

Lithium

If CI: olanzapine + fluoxetine
may be better than lamotrigine

Question 7

How to stop lithium and why?

Answer 7

gradual discontinuation over 2-4 wks

abrupt cessation –> abrupt mania in 50% of patients.

Question 8

Alternatives to lithium if it does not give good control?

Answer 8

Anticonvulsants: Semisodium valproate and carbamazepine

Antipsychotics: olanzapine

Question 9

What antidepressants should be used with lithium?

Answer 9

bupropion or venlafaxine

Monoamine oxidase inhibitors if anergic bipolar depression

also use of omega-3 oils

Question 10

How to manage violence as a result of psychiatric illness?

Answer 10

recognise early signs: tachypnoea, clenched fists, shouting,
chanting, restlessness, repetitive movements, pacing, gesticulations
Summon police if needed
calming and taking with patient
Get his or her consent for treatment (emergency
treatment can still be given to save life, or if serious deterioration)

Rapid tranquillisation - last resort:
oral Tx: if on regular antipsychotic - lorazepam or promethazine. If not on regular AP - olanzipine, quetiapine, risperidone or haloperidol)

repeat after 45-60mins.

If 2 doses fail or sooner if the patient is placing themselves or others at
signifi cant risk—consider IM treatment:
lorazepam, promethazine (useful in benzodiazepine-tolerant patient), olanzipine, aripiprazole, haloperidol

If immediate effect is needed - IV treatment (diazepam

Question 11

To manage violence as a result of psychiatric illness, substance misuse, personality disorder, or physical illness, why would you avoid using multiple antipsychotics?

Answer 11

Avoid QT prolongation