Questions Flashcards
What are the 4 signs of neuroleptic malignant syndrome?
Rigidity (lead pipe type)
Hyperthermia >38 degrees
Reduced consciousness
Autonomic instability - labile BP, tachycardia, tremor, excessive sweating
What is the mechanism behind neuroleptic malignant syndrome?
It is loss blockage of dopaminergic receptors in the hypothalamus
What are some of the risk factors for developing neuroleptic malignant syndrome?
High dose or rapid initiation of neuroleptics
Abruptly stopping neuroleptics
Previous episode of NMS
Dehydration
What investigations would suggest Neuroleptic malignant syndrome?
Leucocytosis on FBC
Increased creatine kinase and metabolic disturbance from AKI
Hypocalcaemia
LFTs - elevated ALT
What is the treatment of neuroleptic malignant syndrome?
Antipsychotic must be withdrawn immediately
IV fluids and antipyretics
Bromocriptine (dopamine agonist)
Dantrolene can be used to reduce muscle spasm
ECT activates dopaminergic system
What are the complications of neuroleptic malignant syndrome?
Cardiac arrest
Seizures
AKI
What is serotonin syndrome?
This is symptoms caused by increased 5-HT activity in the brain, usually caused by interactions between drugs e.g. SSRI and MAOI
What are the symptoms of serotonin syndrome?
Confusion
Myolonic jerks
Hyperreflexia
Mania
What is the treatment of serotonin syndrome?
Stop offending drug
Supportive treatment
What drugs cause serotonin syndrome?
SSRI
MAOI
SNRI
St johns wort
What is an acute dystonia?
This is a sudden muscle contraction that is sustained and results in abnormal positioning, often painful
What are some examples of acute dystonias?
Oculogyric crisis
Torticollis (neck)
Facial grimacing
What is the cause of acute dystonias?
usually caused by antipsychotics
What is the treatment of an acute dystonic reaction?
Immediately discontinue the antipsychotic and consider using a different one
use anticholinergic (Procyclidine) with massage of muscle
Prescribe procyclide on a PRN basis
Monitor over 24 hours
How often do you need to measure lithium levels?
Every 5 days until stable and then 3 monthly
What are the main tests that need monitoring on lithium?
TFTs and U and E
What are the common lithium side effects?
Polydipsia Polyuria Weakness Lack of coordination Dry mouth Weight gain
What is the level of lithium that is toxic?
Above 1.3mmol/L
What are the symptoms of lithium toxicity?
Diarrhoea Vomiting Coarse tremor Drowsiness Convulsions
What is the management of lithium toxicity?
Stop immediately
Perform urgent lithium level and U and E
IV fluids
Dialysis may be required if lithium level is greater than 3.0
What congenital abnormalities do lithium cause?
Ebstein’s anomaly
What blood test should be monitored for sodium valproate and how often?
Should monitor LFTs before and 3-6 months after starting as severe liver injury can occur in rare cases
What blood test should be monitored for sodium valproate and how often?
Should monitor LFTs before and 3-6 months after starting as severe liver injury can occur in rare cases
How often is ECT usually done?
Usually twice weekly
What are the indications for ECT?
Moderate to severe depression
Catatonia
Mania if patients have not responded to other treatments
What are the common side effects of ECT?
Adverse effects of anaesthesia
Headache
Nausea
Cognitive impairment
What are the serious side effects of ECT?
Acute confusion immediately following treatment
Anterograde amnesia
Retrograde amnesia
What are the absolute contraindications to ECT?
Raised intracranial pressure
Recent cerebrovascular event
Unstable cascular aneurysm
Recent MI with unstable rhythm
What is the mechanism behind alcohol withdrawl?
There is constant GABA replacement by the alcohol so when you stop drinking there is no inhibitory neurotransmission
What scale is commonly used to assess alchol withdawl?
Clinical institute withdrawl assessment of alcohol scale (CIWA)
What is the treatment of alcohol withdrawl?
Chlordiazepoxide to increase GABA function
THiamine and vitamins to reduce chance of developing Wernicke’s encephalopathy
What are the features of delerium tremens and how do you treat it?
Coarse tremor, hallucinations, tachycardia, seizures
Chlordiazepoxide
When does delerium tremens occur after stopping alcohol?
It is typically 48-72 hours after stopping
What are the features of alcohol dependence syndrome?
Craving Loss of control Restricted regime Physical dependence Tolerance
What is the treatment of alcohol dependence?
Chlordiazepoxide for withdrawl symptoms
disulfram: promotes abstinence - alcohol intake causes severe reaction due to inhibition of acetaldehyde dehydrogenase. Patients should be aware that even small amounts of alcohol (e.g. In perfumes, foods, mouthwashes) can produce severe symptoms.
What are the symptoms of opiod withdrawl?
Dirrhoea, insomnia, restlessness
How should opioid withdrawl be treated?
Clinical opioid withdrawl scale (COWS) SUbstitute therapy (methadone) Smptomatic treatment (GI disturbance)
