Wk 28 - Mental health update

Question 1

What are the adverse effects of atypical antipsychotics?

Answer 1

• Metabolic effects: inc glucose
• Anticholinergic
• QT prolongation
• Lowered seizure threshold
• Antiadrenergic
• NMS
• Sedation

Question 2

What are the monitoring requirements needed before starting antipsychotics?

Answer 2

• Weight + Waist circumference
• Pulse + BP
• Blood glucose
• Prolactin
• Movement disorders
• Diet
• ECG

Question 3

What is GASS?

Answer 3

Glasgow antipsychotic side effects scale - 22 questions

Question 4

What are the symptoms of NMS + when does it occur?

Answer 4

First 2 wks of treatment:

• High fever
• Sweating
• Unstable BP
• Muscular rigidity

Question 5

When would you use clozapine + what are the s/e?

Answer 5

• Schizo if intolerant to conventional antipsychotics
• Misses 48hrs: discontinue + re-titrate
• Intestinal obs, faecal impaction, paralytic ileus
• Neutropenia + agranulocytosis

Question 6

When would monitor clozapine blood conc?

Answer 6

• Stops smoking/switches to e-cig
• Concomitant med interact to inc blood clozapine
• Pneumonia or serious infection
• Red clozapine metabolism
• Toxicity suspected

Question 7

What are the key adverse effects of SSRIs?

Answer 7

• Insomnia
• GI bleed + postpartum haemorrhage
• Sex dys
• Serotonin syndrome
• Suicidal thoughts
• FINISH w/drawals
• Fractures

Question 8

What are the key adverse effects of TCAs?

Answer 8

• Anti-histamine
• Anti-adrenergic
• Anti-cholinergic
• Cardiac
• Fractures

Question 9

What are the key adverse effects of MAOIs?

Answer 9

• Hypertensive crisis: food w/ high tyramine
• Postural hypo
• Anti-cholinergic
• Serotonin syndrome
• Hepatotoxicity
• Weight gain

Question 10

What are the symptoms of FINISH?

Answer 10

Discontinuation syndrome:

• Flu
• Insomnia
• Nausea
• Sensory disturbance
• Anxiety/agitation

Question 11

What are the adverse effects of venlafaxine?

Answer 11

• Cardiac effects
• Blood dyscrasias
• W/drawal syndrome

Question 12

What are the adverse effects of reboxetine?

Answer 12

• Cardiac effects
• Hyponatraemia
• Suicidal
• Impaired vision

Question 13

What are the adverse effects of mirtazapine?

Answer 13

• Blood disorders
• Weight gain
• W/drawal syndrome

Question 14

What are the general adverse effects of antidepressants?

Answer 14

• Hyponatremia
• Sexual dysfunction
• W/drawal effects
• Bleed risk

Question 15

What has the highest risk of causing hyponatremia + what are the symptoms?

Answer 15

• SSRI in elderly
• Dizzy, confused, muscle cramp, seizure
• W/in 30 days of starting
• Identified: stop + sodium normalise 1-2 wks
• Urgent care if <125
• Once normalised change

Question 16

How do SSRIs/SNRIs cause a bleed risk?

Answer 16

Red serotonin uptake by platelets, red ability to aggregate inc haemorrhage + GI bleed

Question 17

What increases the risk of bleeds when taking SSRIs/SNRIs?

Answer 17

• Elderly
• Peptic ulcer
• Excess alcohol
• NSAIDs, antiplatelet, corticosteroid + warfarin

Question 18

When would you avoid Citalopram + escitalopram?

Answer 18

• Congenital long QT syndrome
• Pre-exisiting QT prolongation
• Meds that prolong QT

Question 19

Before starting citalopram or escitalopram, what needs to be monitored?

Answer 19

• ECG if cardiac disease
• Electrolyte disturbance corrected

Question 20

What are the doses of citalopram + escitalopram?

Answer 20

Cit:

• 40mg adults
• 20mg >65
• 20mg hepatic impairment

Esc:

• 10mg >65

Red further in first 2 wks of mod hepatic impairment or poor CYP2C19 metabolisers

Question 21

What are the symptoms of serotonin syndrome?

Answer 21

• Agitation, confusion, delirium
• Shivering
• Hyperreflexia
• Inc temp
• Vital signs abnormal
• Encephalopathy
• Restlessness
• Sweating

Question 22

What increases the risk of serotonin syndrome?

Answer 22

• Tramadol + triptans
• Selegiline

Question 23

Which antidepressants have the highest risk of OD?

Answer 23

TCA + venlafaxine

Question 24

How would you stop an antidepressant?

Answer 24

• Red dose over 4 wks
• Longer if paroxetine + venlafaxine bc short HL
• Not required for fluoxetine bc long HL

Question 25

What is a reversible MAOI with fewer side effects?

Answer 25

Moclobemide

Question 26

What are the monitoring requirements of lithium?

Answer 26

• Serum electrolytes
• eGFR
• Body weight
• Thyroid function
• Calcium levels
• Every 3-6 months, every 5-7 days if dose change, 12 hrs post dose

Question 27

What are the side effects of lithium?

Answer 27

• Fine tremor
• Sedation
• Impaired coordination
• GI disturbance

Question 28

What are the longer term effects of lithium?

Answer 28

• Weight change
• Thyroid disorders
• Hyperparathyroidism
• Renal impairment

Question 29

What are the signs of lithium toxicity?

Answer 29

• Lack of appetite
• Blurred vision
• Tremor
• Drowsiness

> 2mmol

• Muscle twitch
• Convulsion

Question 30

Which drugs interact with lithium?

Answer 30

• Diuretics
• NSAIDs
• ACEi
• Antidepressants (serotonin syndrome)
• Carbamazepine
• Haloperidol

Question 31

What are the counselling points for lithium?

Answer 31

• Adequate fluid intake
• Avoid dietary changes
• Regular blood tests
• Childbearing use contraception
• S/e: dry mouth, metallic taste, thirsty, weight gain

Question 32

What would you look out for when taking donepezil?

Answer 32

• Bradycardia
• Anti-muscarinic drugs

Question 33

When is galantamine CI + when would you reduce the dose?

Answer 33

• CI: severe renal impairment
• Red: hepatic impairment
• Rare: stevens johnson