Chapter 4 - Mental Health Flashcards Preview

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Flashcards in Chapter 4 - Mental Health Deck (158)
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1

Give examples of SSRIs

Sertraline
Citalopram
Escitalopram
Fluoxetine
Paroxetine

2

Give examples of SNRIs

Duloxetine
Venlafaxine

3

Give examples of TCAs

Sedating:
Amitriptyline
Doulepin
Trazadone
Clomipramine

Non-sedating
Nortriptyline
Imipramine
Lofepramine

4

Give an example of a 5HT1A receptor antagonist

Buspirone

5

What are some symptoms of anxiety?

Worry
Fear
Fatigue
Sleep disturbance
SOB
Trembling
Poor concentration
Irritability
Increased HR
Restlessness
Muscle tension

6

Give some examples of anxiety disorders

General anxiety disorder
OCD
PTSD
Social anxiety
Phobias
Panic disorder

7

Name some drugs/substances that can cause anxiety

Some antidepressants
Beta blockers
Corticosteroids
Salbutamol
Theophylline

Caffeine
Alcohol
Some herbal medicines e.g. St Johns Wort, ginseng, ma huang

8

What drugs are usually used for acute anxiety?

Buspirone
Benzodiazepines

9

What is first line for chronic anxiety?

Psychological interventions e.g. CBT

10

When is drug treatment offered in chronic anxiety?

Severe anxiety
Anxiety not responding to psychological interventions

11

What are the treatment options for generalised anxiety disorder?

First line - SSRI (sertraline, escitalopram, paroxetine)

Second line - SNRI (duloxetine, venlafaxine)

If these are contraindicated or not tolerated - pregabalin

12

When should drug treatment in anxiety be monitored?

Initially every 2-4 weeks for the first 3 months

Then every 3 months thereafter

13

Why is an additional risk associated with SSRIs and SNRIs in <30 year olds?

Increased risk of self harm and suicidal thoughts

14

When should benzodiazepines be issued for anxiety in primary care?

Short term during crises

15

When is buspirone indicated?

Short term use in anxiety

16

What MRHA advice is associated with benzodiazepines?

Use of benzodiazepines with opioids increase the risk of potentially fatal respiratory depression

17

What are the side effects of diazepam?

Sedation
Respiratory depression
Hypotension
Paradoxical side effects
Withdrawal syndrome, tolerance and dependence

18

What paradoxical side effects may be seen in diazepam?

Talkativeness
Excitability
Irritability
Aggression
Suicide ideation
Antisocial behaviour

19

What are the main interactions with diazepam?

Antihypertensives, vasodilators, diuretics - increased hypotensive effects

Alcohol and opioids - respiratory depression

CYP 450 inhibitors and inducers - affects serum concentrations

Phenytoin

20

Why shouldn’t benzodiazepines be used long term?

Risk of tolerance (reduced effectiveness)

Risk of dependence

21

What withdrawal symptoms are associated with benzodiazepines?

Rebound insomnia
Seizures
Hallucinations
Delerium
Anxiety

22

How are benzodiazepines withdrawn?

Convert to diazepam

Reduce gradually

23

What 3 behaviours is ADHD characterised by?

Hyperactivity
Impulsivity
Inattention

24

What non-drug treatments are available for ADHD?

Regular exercise
Balanced diet
Controlling environmental factors e.g. noise, distractions
Giving written rather than verbal requests
In school/work have shorter periods of focus and longer breaks
CBT

25

Who should initiate ADHD drug treatments?

Specialist

26

When can a GP be involved in the drug treatment of ADHD?

Once the dose has been stabilised by a specialist
The GP can then continue and monitor drug treatment
Under a shared care agreement

27

What are the first line drugs for ADHD and what do you do if one doesn’t work after a 6 week trial?

Methylphenidate
Lisdexamfetamine

After trialling one for 6 weeks, if there is no improvement try the other

28

What drug treatments are available for ADHD?

Methylphenidate
Lisdexamfetamine
Dexamfetamine (if lisdexamfetamine worked but isn’t tolerated)
Atomoxetine
Guanfacine (specialist)
Antipsychotics (specialist)

29

What are some advantages of m/r formulations over immediate release formulations in ADHD?

Longer duration of action
Improved adherence
Don’t need to take to work/school (reduced stigma, less storage and administration issues)
Reduced risk of drug diversion

30

When are immediate release preparations used alone in ADHD?

When flexible dosing is required e.g. when drugs are initiated and may need to be titrated often