Psychopharm

Question 1

As per ccsmh guidelines for dep, what are the antidepressants that are least likely to cause hyponatremia

Answer 1

TCA
Buproprion
Mirtazapine

Question 2

How to minimize DDIs

Answer 2

-obtain list of rx and OTC, herbal
-patient education
-ensure one pharmacy
-update family doc
-choose something with least side effects
-choose something that plays well with others
-start low, go slow
-med recon

Question 3

As per textbook, order or worst to best for QTC prolongation

Answer 3

Ziprasidone>quetiapine>risperidone>olanzapine>haldol

Question 4

Advantages for using atypical over typical

Answer 4

More robust evidence base
Less Parkinsonism
Less TD
Lower risk of NMS
Less PRL increase
Potential antidepressant effects

Question 5

Adverse effects that are less common with arypicals in elderly

Answer 5

Metabolic: weight gain, hyperglycaemia/diabetes, hyperlipidemia

Acute dystonic reactions

Question 6

Practical suggestions for improving medication compliance

Answer 6

Think person, prescriber and health care factors

-write things down, psychoeducation
-blister packs, easy to open containers, in plain sight
-reminders from family/supervision from local health
-simplify the regimen
-make sure meds covered

Question 7

As per old guidelines, what are RF for developing CKD in someone using Li

Answer 7

-how long you’ve used it
-higher li levels
-multiple li doses per day
-concurrent meds (NSAIDs, ace,arb, diuretic)
-Comorbid illneses (HTN, DM, CAD)
-lithium tox

Question 8

Cardiac safety of AchI and management strategies

Answer 8

Heart block, bradycardia, syncope

Ecgs not predictive of adverse events and no high risk groups to target screening

See guidelines in questions 2.0

Question 9

Acute li tox signs

Answer 9

N/V
Coarse tremor
Dysarthria
Confusion
Lethargy

Moderate confusion agitation delirium, myoclonus