Wk 28 - Mental health update Flashcards
What are the adverse effects of atypical antipsychotics?
- Metabolic effects: inc glucose
- Anticholinergic
- QT prolongation
- Lowered seizure threshold
- Antiadrenergic
- NMS
- Sedation
What are the monitoring requirements needed before starting antipsychotics?
- Weight + Waist circumference
- Pulse + BP
- Blood glucose
- Prolactin
- Movement disorders
- Diet
- ECG
What is GASS?
Glasgow antipsychotic side effects scale - 22 questions
What are the symptoms of NMS + when does it occur?
First 2 wks of treatment:
- High fever
- Sweating
- Unstable BP
- Muscular rigidity
When would you use clozapine + what are the s/e?
- Schizo if intolerant to conventional antipsychotics
- Misses 48hrs: discontinue + re-titrate
- Intestinal obs, faecal impaction, paralytic ileus
- Neutropenia + agranulocytosis
When would monitor clozapine blood conc?
- Stops smoking/switches to e-cig
- Concomitant med interact to inc blood clozapine
- Pneumonia or serious infection
- Red clozapine metabolism
- Toxicity suspected
What are the key adverse effects of SSRIs?
- Insomnia
- GI bleed + postpartum haemorrhage
- Sex dys
- Serotonin syndrome
- Suicidal thoughts
- FINISH w/drawals
- Fractures
What are the key adverse effects of TCAs?
- Anti-histamine
- Anti-adrenergic
- Anti-cholinergic
- Cardiac
- Fractures
What are the key adverse effects of MAOIs?
- Hypertensive crisis: food w/ high tyramine
- Postural hypo
- Anti-cholinergic
- Serotonin syndrome
- Hepatotoxicity
- Weight gain
What are the symptoms of FINISH?
Discontinuation syndrome:
- Flu
- Insomnia
- Nausea
- Sensory disturbance
- Anxiety/agitation
What are the adverse effects of venlafaxine?
- Cardiac effects
- Blood dyscrasias
- W/drawal syndrome
What are the adverse effects of reboxetine?
- Cardiac effects
- Hyponatraemia
- Suicidal
- Impaired vision
What are the adverse effects of mirtazapine?
- Blood disorders
- Weight gain
- W/drawal syndrome
What are the general adverse effects of antidepressants?
- Hyponatremia
- Sexual dysfunction
- W/drawal effects
- Bleed risk
What has the highest risk of causing hyponatremia + what are the symptoms?
- 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
How do SSRIs/SNRIs cause a bleed risk?
Red serotonin uptake by platelets, red ability to aggregate inc haemorrhage + GI bleed
What increases the risk of bleeds when taking SSRIs/SNRIs?
- Elderly
- Peptic ulcer
- Excess alcohol
- NSAIDs, antiplatelet, corticosteroid + warfarin
When would you avoid Citalopram + escitalopram?
- Congenital long QT syndrome
- Pre-exisiting QT prolongation
- Meds that prolong QT
Before starting citalopram or escitalopram, what needs to be monitored?
- ECG if cardiac disease
- Electrolyte disturbance corrected
What are the doses of citalopram + escitalopram?
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
What are the symptoms of serotonin syndrome?
- Agitation, confusion, delirium
- Shivering
- Hyperreflexia
- Inc temp
- Vital signs abnormal
- Encephalopathy
- Restlessness
- Sweating
What increases the risk of serotonin syndrome?
- Tramadol + triptans
- Selegiline
Which antidepressants have the highest risk of OD?
TCA + venlafaxine
How would you stop an antidepressant?
- Red dose over 4 wks
- Longer if paroxetine + venlafaxine bc short HL
- Not required for fluoxetine bc long HL
What is a reversible MAOI with fewer side effects?
Moclobemide
What are the monitoring requirements of lithium?
- Serum electrolytes
- eGFR
- Body weight
- Thyroid function
- Calcium levels
- Every 3-6 months, every 5-7 days if dose change, 12 hrs post dose
What are the side effects of lithium?
- Fine tremor
- Sedation
- Impaired coordination
- GI disturbance
What are the longer term effects of lithium?
- Weight change
- Thyroid disorders
- Hyperparathyroidism
- Renal impairment
What are the signs of lithium toxicity?
- Lack of appetite
- Blurred vision
- Tremor
- Drowsiness
> 2mmol
- Muscle twitch
- Convulsion
Which drugs interact with lithium?
- Diuretics
- NSAIDs
- ACEi
- Antidepressants (serotonin syndrome)
- Carbamazepine
- Haloperidol
What are the counselling points for lithium?
- Adequate fluid intake
- Avoid dietary changes
- Regular blood tests
- Childbearing use contraception
- S/e: dry mouth, metallic taste, thirsty, weight gain
What would you look out for when taking donepezil?
- Bradycardia
- Anti-muscarinic drugs
When is galantamine CI + when would you reduce the dose?
- CI: severe renal impairment
- Red: hepatic impairment
- Rare: stevens johnson
