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MO1 > mental health update > Flashcards

mental health update Flashcards

1
Q

what are the different types of antipsychotic medication?

A

typicals and atypicals

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2
Q

what are the characteristics of atypical antipsychotic medication?

A

metabolic effects
anticholinergic
QT prolongation
lowered seizure threshold
antiadrenergic
NMS
sedation

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3
Q

what are the characteristics of typicals antipsychotic medication?

A

EPSE
anticholinergic
QT prolongation
lower seizure threshold
antiadrenergic
NMS
sedation

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4
Q

what should you monitor before initiating therapy?

A
  • Weight
  • Waist circumference
  • Pulse and BP
  • Fasting blood glucose, glycosylated haemoglobin
  • Blood lipid profile
  • Prolactin levels
  • Movement disorders
  • Nutritional status, diet and level of physical activity
  • ECG
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5
Q

what should you monitor during antipsychotic therapy?

A
  • Response to treatment,
    changes in symptoms and
    behaviour
  • Side effects of treatment
  • Weight
  • Adherence
  • Overall physical health
    – Cardiovascular
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6
Q

what is GASS?

A

The Glasgow Antipsychotic Side-effect Scale
(GASS) is an easy to use self-reporting
questionnaire aimed at identifying the side
effects of antipsychotic medication. It consists
of 22 questions with points assigned based on
answers given by the patient.

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7
Q

what is NMS?

A

Neuroleptic malignant syndrome is a life-threatening, neurological disorder most often caused by an adverse reaction to neuroleptic or antipsychotic drugs. Symptoms include:
High fever
Sweating
Unstable blood pressure
Stupor
Muscular rigidity
Autonomic dysfunction

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8
Q

when does NMS usually develop?

A

In most cases, the disorder develops within the first two weeks of treatment with the drug; however, the disorder may develop at any time during the therapy period. The syndrome can also occur in people taking anti-Parkinsonism drugs

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9
Q

when is clozapine given?

A

Schizophrenia in patients unresponsive to, or
intolerant of, conventional antipsychotic drugs

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10
Q

when must clozapine be re-titrated?

A

If a patient misses 48 hours or more of
clozapine doses the clozapine must be
discontinued and slowly re-titrated

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11
Q

what is a fatal risk of clozapine?

A

Potentially fatal risk of intestinal obstruction,
faecal impaction, and paralytic ileus
Neutropenia and potentially fatal
agranulocytosis reported

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12
Q

because of the toxicity surrounding clozapine- what should be monitored?

A

blood concentration of clozapine for toxicity in certain clinical situations such as when:
* a patient stops smoking or switches to an e-cigarette;
* concomitant medicines may interact to increase blood clozapine levels;
* a patient has pneumonia or other serious infection;
* reduced clozapine metabolism is suspected;
* toxicity is suspected.
Clozapine blood concentration monitoring should be carried out in addition to
the required blood tests to manage the risk of agranulocytosis

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13
Q

what are the key adverse effects of SSRIs?

A

insomnia/ anxiety/ agitation
GI bleed
sexual dysfunction
serotonin syndrome
suicidal thoughts
‘FINISH’ withdrawl
physiological symptoms

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14
Q

what are the key adverse effects of antidepressants?

A

anti-histamine
anti-andrergic
anti-cholinergic
cardiac

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15
Q

what are the key adverse effects of MAOIs?

A

hypertensive crisis
postural hypotension
anti-cholinergic
serotonin syndrome
hepatoxicity (phenelzine)
weight gain

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16
Q

what does FINISH mean?

A

FINISH: remembering the discontinuation
syndrome. Flu-like symptoms, Insomnia,
Nausea, Imbalance, Sensory disturbances, and
Hyperarousal (anxiety/agitation)

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17
Q

what are the key adverse effects of venlafaxine?

A

cardiac effects
blood dyscrasias/ bleed risk
SIADH
suicidal behaviour
withdrawal syndrome

18
Q

what are the key adverse effects with reboxetine?

A

cardiac effects
hyponatraemia
hypokalaemia on prolonged Tx
suicidal behaviour
urinary retention
impaired vision (caution in glaucoma)

19
Q

what are the key adverse effects of moclobemide?

A

lower risk of hypertensive crisis
troublesome interactions
hyponatraemia

20
Q

what are the key adverse effects of mirtazipine?

A

not many anti-muscarinic effects
sedating
BLOOD DISORDERS
withdrawal syndrome
weight gail
psychotic symptoms

21
Q

what are the common adverse effects of antidepressants (general)?

A
  • Potential for an initial increase in agitation,
    anxiety on starting tx
  • Hyponatraemia (see next slide)
  • Sexual dysfunction
  • Withdrawal effects
  • Bleeding risk
22
Q

what antidepressants can cause hyponatraemia?

A

Most antidepressants can cause but SSRIs are highest risk
* More common in elderly

23
Q

what are the symptoms of hyponatraemia?

A

dizziness, drowsiness, confusion, nausea, muscle cramps, or seizures

24
Q

when does hyponatraemia with antidepressants usually occur?

A

normally within 30 days of starting

25
Q

what should you do if hyponatraemia with antidepressants occurs?

A

If identified stop antidepressant & sodium levels should normalise within 1-2 weeks
* Urgent care if severe (Na < 125mmol/L)
* Withdrawal symptoms may occur (less likely at beginning of treatment)
* Once sodium normalised, choose different antidepressant (try different class)

26
Q

why do SSRIs/ SNRIS cause a bleed risk?

A

By reducing the uptake of serotonin by platelets, SSRIs reduce the ability of platelets to aggregate and thereby increase the risk of
haemorrhage, particularly gastrointestinal bleeding

27
Q

what factors increase the risk of bleeding with SSRIs/ SNRIs?

A

– Elderly
– Patients with a history of peptic ulcers
– Excessive use of alcohol
– Co-administration with other drugs associated with the risk of bleeding
* NSAIDs, antiplatelet drugs, corticosteroids, and warfarin

28
Q

what are the risk reduction measures that can be done reduce SSRI bleed risk?

A

– Avoid SSRIs/ SNRIs if possible if at increased risk
– Avoid concomitant drugs which increase bleeding risk
– If no suitable alternative can be found, consider gastroprotection
– NICE suggests gastroprotection in older people who are taking NSAID/aspirin

29
Q

what are some cautions and contraindications with antidepressants?

A

– Antidepressants can cause QT prolongation, risk varies with each antidepressant
– Thorough medical history, laboratory monitoring, and a baseline electrocardiogram (ECG) necessary to identify patients at risk for QT prolongation before starting an antidepressant that may prolong QT
interval.

30
Q

what are some risk factors that can prolong QT interval?

A

cardiac conditions- bradycardia, MI, HF
electrolyte disturbances- hypokalemia, hypomg, hypocalcemia
female
genetic predispositions
65+
congenital long QT syndrome

31
Q

what drug safety update is associated with citalopram and escitalopram? when should you avoid it?

A

dose-dependent QT interval
prolongation. Avoid use in;
– congenital long QT syndrome
– known pre-existing QT interval prolongation
– or in combination with other medicines that prolong the QT interval

32
Q

what should be done prior to starting citalopram and escitalopram?

A

ECG measurements for patients with cardiac disease
* Electrolyte disturbances should be corrected before starting treatment

33
Q

what are the max doses for citalopram and escitalopram?

A

Citalopram maximum daily dose:
– 40 mg for adults
– 20 mg for patients older than 65 years
– 20 mg for those with hepatic impairment
* Escitalopram maximum daily dose:
– older than 65 years is now reduced to 10 mg/day

34
Q

when are further dose reductions required for citalopram/escitalopram?

A
  • Further dose reductions in the first two weeks of treatment is recommended in patients with mild or moderate hepatic impairment or in poor metabolisers of CYP2C19
  • Remember importance of drug interactions
  • Take care with patients prescribed CYP2C19
    inhibitors - for example omeprazole (NICE 2011
    recommend gastroprotection with SSRI in patients at risk of bleeding disorder)
35
Q

what is a person at increased risk of with antidepressants> TCAs and SSRIs?

A

fracture risk- use of TCAs and SSRIs

36
Q

when is someone at risk of postpartum haemorrhage?

A

SSRI/SNRI antidepressant
medicines: small increased risk of postpartum
haemorrhage when used in the month before
delivery (January 2021)

37
Q

what are the symptoms of serotonin syndrome?

A

Characterized by altered mental status, neuromuscular hyperactivity, and
autonomic instability
Symptoms include agitation, confusion, delirium, and hallucinations
profound shivering, tremor, teeth grinding, myoclonus, and hyperreflexia
– Tachycardia, fever, and hypertension or hypotension
– Flushing, diarrhoea, and vomiting are also common

38
Q

what increases the risk of serotonin syndrome?

A

Concomitant use of antidepressants with other serotonergic drugs (tramadol, triptans) or dopaminergic drugs (selegiline) can increase the risk

39
Q

when do you have to consider safety in overdose with antidepressants?

A

Tricyclic antidepressants (TCAs) and venlafaxine very harmful in cases of overdose

40
Q

how should you withdraw antidepressants?

A
  • When stopping an antidepressant, gradually
    reduce the dose, normally over a 4-week
    period, although some people may require
    longer periods, particularly with drugs with a
    shorter half-life (such as paroxetine and
    venlafaxine).
  • This is not required with fluoxetine because of
    its long half-life

MO1 (50 decks)

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