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Phase 3A 'The List' conditions > Psychopharmacology > Flashcards

Psychopharmacology Flashcards

1
Q

Antidepressants indications for what? Selection based on? Delay of how many weeks after therapeutic dose is achieved before symptoms improve? If no improvement after at least 2 months and adequate dose, do what?

A

Depression, OCD, GAD, panic disorder
Past hx of response, SE profile and coexisting medical conditions
3-6 weeks
Switch to another antidepressant

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2
Q

Classification of antidepressants? E.g. of other antidepressants?

A

Tricyclics
MAOIs
SSRIs
Others= duloxetine, reboxetine, mianserin, mirtazapine, trazadone, venlafaxine

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3
Q

1st line tx of depression? Next steps?

A

SSRI e.g. sertraline
Another SSRI/ another class
Combine/ adjunctive agent- vitamins, thyroid hormone, antipsychotics

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4
Q

E.g. of tricyclics? Also what what? For OCD? Most and least toxic? Action? SEs?

A

Amitriptyline, imipramine, lofepramine, neuropathic pain
Clomipramine
Dothiepine
Lofepramine
Inhibit reuptake of serotonin and NAD
Based on receptor type:
Antihistaminic- sedation+ weight gain
Anticholinergic- dry mouth, eyes, constipation, urinary retention
Antiadrenergic- postural hypotension, sedation, sexual dysfunction
Prolonged QT int, ST depression–> yearly ECG recommended

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5
Q

E.g. MAOIs? MAOIs effective in what? Action? SEs?

A 
Phenelzine, tranylcypromine
Atypical depression (mood-reactivity, over-eating, over-sleeping)
Inhibits enzyme that degrades MA- dopamine, NA, AD, serotonin

Dangerous- hypertensive crisis (when taken with tyramine-rich foods/ sympathomimetics), serotonin syndrome, postural hypotension, weight gain, dry mouth, sedation, sexual dysfunction and sleep disturbance

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6
Q

When might serotonin syndrome occur? Symptoms? How avoided?

A

MAOI+ meds that increase serotonin/ have sympathomimetic actions (SSRI)
NM abnormalities, altered mental state, AN dysfunction- abdo pain, diarrhoea, sweats, tachycardia, nystagmus, myoclonus, irritability, delirium
Can lead to hyperpyrexia, CV shock+ death
Wait 2 weeks before switching from SSRI–> MAOI, fluoxetine (5 weeks)

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7
Q

E.g. of SSRIs? Younger people given what? Sertraline for who? Duloxetine prescribed in what also? Need to be on for how long? Action? SEs? Low risk of? First week, increased what? Recommend taking when?

A 
Fluoxetine, paroxetine, sertraline, fluvoxamine, citalopram, escitalopram
Fluoxetine 
Older people 
Non mental health issues 
6 months--> symptom resolution
Block presynaptic serotonin reuptake
GI upset, sexual dysfunction, anxiety
Cardiotoxicity
Suicidality/ unusual changes in behaviour
1st thing in the morning
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8
Q

E.g. of NaSSA? Action? Leads to what?

A

Mirtazapine
Blocks alpha receptors to increase monoamines
Weight gain and sedation/ drowsiness

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9
Q

E.g. of SNRIs? SEs? Venlafaxine can cause what? Action? NARI?

A 
Venlafaxine, duloxetine
Similar to SSRIs, also increased BP and HR
Discontinuation symptoms
Serotonin and NAD reuptake inhibitor
Robxetine- NAD reuptake inhibitor
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10
Q

Mood stabilisers long-term tx for what? If patient with bipolar I has had what? Or if patient with bipolar II has what?

A

Bipolar
2/more acute episodes
Significant functional impairment, risk of suicide/ frequent episodes

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11
Q

E.g. mood stabilisers? Lithium also for what? Choice based on? What is monitored carefully?

A

Lithium, carbamazepine, sodium valproate, lamotrigine
Atypical- quetiapine, olanzapine, aripiprazole
Tx resistant depression
Previous txs, relative risk, manic vs depressive relapse, physical RFs- renal disease, obesity, diabetes
Preference and history of adherence

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12
Q

Response to lithium monotherapy how long? Often administered how? Effective against what? Compliant patients show a reduction in what? Combined with antipsychotic in the tx of what? Single dose associated with what?

A

6-10 days
In combination with antipsychotic for faster symptom relief
Manic, depressive, mixed relapse and suicidal behaviours
Suicidal behaviour
Mania–> acute symptom relief
Higher peaks in lithium levels–> SEs and deeper troughs–> higher likelihood of breakthrough symptoms

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13
Q

After starting lithium, should be checked after how long, then how often? In elderly/ impaired renal function patients, after how many days?

A

7 days
7 days after every dose change until desired level reached
10-12 days, time to steady-state increases

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14
Q

SEs of lithium? Organs needing monitoring? Severe toxicity leads to what? Therapeutic level? Toxicity symptoms? What level is an emergency?

A

Diarrhoea, frequent urination, hair loss, increased thirst, nausea, swelling, tremor, weight gain
Kidneys, parathyroid, thyroid- tests before tx
Encephalopathy, arrhythmias
0.8-1mmol/L
Tremor, nausea, diarrhoea, blurry vision–> unsteady, slurred speech, muscle twitches, weakness, confusion
2.0mmol/L–> delirium, arrhythmias

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15
Q

Interactions of lithium? Blood levels when? Mineral checked yearly? Kidney function and thyroid tests?

A

ARBs, ACEis, diuretics, NSAIDs
5 days after dosage change, new meds impacting lithium levels added/ discontinued
Calcium–> hypoparathyroidism
Beginning of tx, regularly during, if any symptoms become evident
Frequently and at least every 6 months

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16
Q

What is common co-morbid symptom with many psych illnesses? What is generally short-term tx until underlying better treated? E.g.?

A

Anxiety
Anxiolytics
Benzodiazepine- diazepam, lorazepam
Hypnotic- temazepam, zopiclone

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17
Q

Psychostimulants work how? E.g.? Indication? SEs?

A

Increase release and block reuptake of dopamine and NAD
Methylphenidate, modafinil, atomoxetine
ADHD, narcolepsy
Restlessness, insomnia, poor appetite, dizziness, tremor, palpitations, cardiac arrhythmias

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18
Q

Antipsychotics tx for what? To reduce what symptoms?

A

Schizophrenia, acute mania symptoms, psychotic symptoms, schizoaffective disorder, mood stabilisation, delirium, psychotic depression
Hallucinations, delusions, agitation, psychomotor excitement

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19
Q

Mode of action of antipsychotics?

A

DA theory of schizophrenia- overstimulation of postsynaptic D2 receptor in limbic system
Reformulation of DA theory- overactivity of mesolimbic dopaminergic activity in the frontal cortex–> -ve symptoms and cognitive impairment

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20
Q

1st generation/ typical APs against what? Atypical/ 2nd generation?

A

+ve symptoms, block D2 receptor/ EPSE
H1 and M1 receptor/ sedation+ anticholinergic effect

+ve and -ve symptoms, reduce D2 receptor potency
High affinity D3, D4 and 5HT
Less EPSE and hyperprolactinaemia

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21
Q

E.g. typical APs? Atypical? Clozapine for what?

A

Chorpromazine, haloperidol

Risperidone- depot, paliperidone= metabolite of risperidone
Olanzapine
Quetiapine
Aripiprazole
Clozapine- tablet–> tx resistant schizophrenia

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22
Q

Antidopaminergic SEs of APs? Antiadrenergic?

A

Acute dystonia, akathisia, Parkinsonism, tardive dyskinesia

Sedation, postural hypotension, inhibition of ejaculation

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23
Q

Anticholinergic SEs of APs? Other effects?

A

Dry mouth, reduce sweating, urinary retention, constipation, blurred vision
Arrhythmias, metabolic syndrome- dyslipidaemia amenorrhoea, galactorrhoea, hypothermia

24
Q

Symptoms of tardive dyskinesia? Tx?

A

Involuntary, repetitive purposeless movements, most common= perioral movements- tongue, lips and jaw
Increased by stress
Review hx, identify cause, reduce agent, change to atypical if possible

25
Q

Akathisia caused by what? Feeling of what? Tx?

A 
APs, ADs, anxiolytics
Inner restlessness-LL, trunk
Movement, pacing and restless 
High dose of high potency antipsychotics
Reduce dose if possible, propanolol, benzodiazepines
26
Q

Symptoms of acute dystonic reaction? Onset? Affects? Lasts? Tx?

A 
Sustained painful muscular spasm, twisted abnormal postures
Within 48 hours- 5 days
Neck, tongue, jaw
Minutes-hours
Anticholinergic agent- IM injection
27
Q

Symptoms of neuroleptic malignant syndrome? Tx?

A

Severe muscule rigidity, fever, altered mental state, AN instability, elevated WBC, CPK and LFTs
Diazepam- muscle stiffness
Dantrolen- malignant hyperthermia
Bromocryptine- dopamine agonist

28
Q

Why do we need the MHA?

A

Patients with mental disorder may lose insight and refuse to be assessed/ treatment: psychosis
May lose capacity to make judgement for tx: dementia
May be at risk- to themselves/ others

29
Q

Informal admission have same rights and freedoms as who? Civil sections of MHA? Forensic sections?

A

Any other hospital patients
Section 2,3,4 and 5
Section 37, 41- committed criminal offence

30
Q

How many needed for MHA assessment?

A

3- 2 doctors, 1 psychiatrist 3 years training–> section 12 approved, 1 AMHP

31
Q

Conditions for detention under MHA?

A

Suffering from mental disorder
Detained in interests of patients own health/ safety or other persons
Nature/ degree warrants the detention of the patient in a hospital- informal/ community assessment not appropriate

32
Q

When is informal admission not appropriate? E.g. of risk to self/ others?

A

Refuse admission and/ or tx
Does not have capacity to consent for admission and/or tx
Self-harm/ suicide, self-neglect, further deterioration, vulnerability/ exploitation
Aggression, neglect of minor e.g. children

33
Q

3 important sections?

A

Section 2- assessment
Section 3- admission for tx
Section 5(2)- doctor’s holding power for detention of patients who are already voluntary patients in hospital

34
Q

Duration of section 2? Cannot be what? If continued detention needed, what used? Conditions for detention? What can be given?

A

28 days
Renewed or extended
Section 3
Suffering from a mental disorder that warrants detention for assessment
Interests of his own health/ safety/ protection of other persons
Informal admission= not appropriate
Treatment- during/ following the assessment

35
Q

Aim of section 3? Duration? May be what?

A

To detain someone in hospital for tx
Up to 6 months initially
Renewed for a further 6 months and then for a year at a time

36
Q

Aim of section 5(2)? Can be/ can’t be what ward? Duration? Can’t be what? If continued detention required, then what used? Who is required? Tx given?

A

Detain a person who is a voluntary patient in hospital
Psych/ non-psych ward (except A&E)
Up to 72 hours
Renewed/ extended
Section 2 or section 3
Doctors in the team on on-call doctors nominated deputy- nominated by one in charged of tx
No- except in emergency under common law

37
Q

A person is regarded as being unable to make a decision if, at the time the decision needs to be made, he/ she fails:

A

To understand the information
Retain the information
Use/ weigh the information
Communicate the decision

38
Q

Assessment of capacity is what and what? Section 5(4) who’s holding power? Up to how long?

A

Time and decision specific

Nurses’- 6 hours

39
Q

Starting a psych interview?

A

Intro, explain purpose, confirm name+ DOB and address, preferred name, mode of referral

40
Q

HPC for psych hx?

A

Timeline, impairment- domestic/ social/ occupational, risk behaviours, suicide- risk assessment

41
Q

Past psych hx?

A

When first develop difficulties, come into contact with services, previous Ix, admissions, suicidal thoughts, self-harm, attempts

42
Q

Past medical hx? Medication?

A

Med/ surgical issues, previous admissions/ operations, head injury, epilepsy etc
Current- OTC, herbal preps, date of initiation, compliance, SEs, allergies, adverse effects

43
Q

Substance misuse hx?

A

Alcohol- CAGE, primacy, tolerance, withdrawal, relief

Drug hx, IV use, complications, previous tx, smoking- pack years

44
Q

Family hx?

A

Parents- marital status, ages, relationships

Siblings, children, family hx- issues, suicide, drinking/ psych

45
Q

Personal hx?

A

Gestation+ development, childhood, schooling, higher education, employment, psychosexual hx
Premorbid personality

46
Q

Forensic hx? Social hx?

A

Police issues

Accomodation, employment, finances, other people, social support, past times, ADLs, driving

47
Q

Physical health?

A 
Neuro exam
Blood tests
ECG
Urine drug screen 
Urine dipstick, CXR
48
Q

Factors when assessing risk?

A 
Previous violence
Relationship of violence--> mental state
Lack of supportive relationships
Poor concordance with tx, discontinuation/ disengagement
Impulsivity
Alcohol/ substance abuse
Early exposure--> violence
Triggers/ changes in behaviour/ mental state prior to previous violence
Recent stressors, losses/ threat of loss
Factors stopping violence
Family/ carers at risk, history of domestic violence
Lack of empathy
Violence--> personality factors
49
Q

Order for overdose/ suicidal attempt history?

A 
Intro
Name DOB
What led up to overdose 
What, how much 
Belief in lethality→ protective factors 
Who found them 
What happened after
Taken with anything
Happened before 
Leave note/ message/ letter
How do you feel now 
Factors leading to overdose 
Other symptoms- seeing/ hearing things, outside/ inside head, who are they, what are they saying, control of thoughts, delusions
Presenting complaints- mood, concentration, sleep, appetite
Social hx- drugs/ history, who at home, job, family/ friends, social support, ADLs, anyone to speak to 
Self-harm/ suicidal thoughts 
Physical health 
Scale of 1-10- do it again
Insight
Plans going out of here- who’s at home, safe at home?
Future plans
50
Q

What is CBT? Doesn’t focus much on what? Less concerned with what? Focus on what? Recognition that thoughts can affect what? Encourages what?

A 
The past
The relationship with the therapist
The practical effects of a problem 
How we feel 
Looking at different ways of thinking
51
Q

Structure of CBT? Outcome of CBT?

A

Usually on a one-to-one basis
Once-a-week for a few months= 8-12 sessions
Uses problem-solving
Patient will get homework to do

For particular aspects of depression
Can help to prevent relapse
Usual treatment often continues
Therapist undergoes supervision; still keeps confidentiality

52
Q

Mechanism of SSRIs? e.g.? Common SE?

A

Prevents serotonin reuptake
Sertraline, fluoxetine, escitalopram
GI upset, sexual problems

53
Q

Mechanism of SNRIs? e.g.? Common SE?

A

Prevents serotonin and NAD reuptake
Venlafaxine, duloxetine
GI upset

54
Q

Mechanism of NaSSA? e.g.? Common SE?

A

Blocks alpha receptors to increase monoamines
Mirtazapine
Drowsiness, weight gain

55
Q

Mechanism of tricyclics? e.g.? Common SE?

A

????
Amitriptyline
Anticholinergic effects

56
Q

What is ECT?

A

A treatment that involves sending an electric current through your brain, causing a brief surge of electrical activity within your brain

57
Q

When is ECT used?

A 
If you have:
severe/ life-threatening depression
moderate- severe depression- medication and talking therapies haven't helped
Catatonia
Severe/ long-lasting episode of mania

Phase 3A 'The List' conditions (8 decks)

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