PT SAFETY IN MENTAL HEALTH Flashcards
switching/cross titration
occurs when no response seen or intolerable side effects
discontinuation (withdrawal) effects
electric shocks
flu like symptoms
disturbed sleep
GI issues
ataxia/sensory vasomotor
serotonin syndrome
caused by too much serotonin in the synapses of the brain
likely during augmentation, or when treating resistant depression
3 main symptoms of serotonin syndrome
neuromuscular hyperactivity/abnormality (tremor, clonus, rigidity)
autonomic dysfunction/instability (tachycardia, hyperthermia, cold sweats)
altered mental state (agitation, confusion)
drugs that increase likeliness of developing serotonin syndrome
triptans
synthetic cannabinoids
tramadol
hallucinogens
safety issues with lithium
- lithium has a narrow therapeutic index, with a high potential for toxicity and therefore careful monitoring is required
- can interchange with sodium and potassium levels in the body, if dehydrated then lithium ions can get reabsorbed instead of the sodium (toxicity)
NSAIDs and lithium
NSAIDs reduce the renal excretion of lithium via their action on renal prostaglandins, resulting in increased plasma lithium levels
safety issues with antipsychotics
- metabolic syndrome
- thromboemoblism
- myocarditis/cardiomyopathy
- QTC elongation (arrhythmias, sudden death)
- higher risk of seizures
- neuroleptic malignant syndrome
high dose antipsychotic therapy (HDAT)
defined as either a total daily dose of a single antipsychotic which exceeds the max limit stated in the BNF or a total daily dose of two ore more antipsychotics which exceed the BNF max
when/why does HDAT happen?
- acute psychotic episode (switching)
- relapse prevention/poor concordance
- acute disturbance/emergency tranquillisation
- treatment resistance/refractory
why are some patients on both the depot and oral
poor concordance
ensures some of the drug is taken
monitoring parameters in antipsychotics
baseline tests and every 3 months
- ECG
- pulse/HR
- BP
- Temp.
- FBC
- LFTs/U and Es
- electrolytes associated with homeostasis (Ca, Mg etc.)
dangerous side effects of clozapine
agranulocytosis
neutropenia
when to prescribe clozapine
trial of 2 other antipsychotics for 6-8 weeks before clozapine
clozapine dispensing arrangements
- pt must have valid blood test before supply
- NO BLOOD = NO DRUG
- regular monitoring of WBCs, esp. neutrophils
- neutrophil count coded red, amber and green
- medication supplied when green, discontinue on red
- more likely to be neutropenic at the beginning of treatment
clozapine blood testing intervals
0-18 weeks = weekly bloods
next 18 weeks = fortnightly
thereafter = monthly
titrating clozapine
gradual titration of dose starting from 25mg daily up to 900mg (max), however break in treatment >48 hours, must re-titrate from starting dose (25mg)
clozapine specific safety issues
- red/amber result (no supply)
- management of leukopenia/agranulocytosis
- missed doses (>48 hrs)
- CYP induction/inhibition
- co-prescribing (esp. other neutropenic drugs)
- other medicines via GP10 Rx or depot (diff. supply routes)
how to withdraw or stop BZs
need to convert BZ dose to ‘diazepam dose equivalents’
gradual reduction by 1/8th or 1/6th of total daily dose every fortnight - over 6 months (depending on symptoms)
inappropriate use of psychotropic drugs
- incorrect diagnosis/co-morbidity of personality disorder
- to provide relief or sedation in heightened state
- high doses/combination therapy (adverse effects)
- patient group/status (elderly, pregnant/breast feeding)
