ILA 5 Flashcards Preview

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Flashcards in ILA 5 Deck (33)
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1
Q

What drugs can cause low mood?

A

CCBs, steroids, antipsychotics, buproprion, champix, levodopa, OCP, beta blockers, anticonvulsants…

2
Q

What are 2 smoking cessation drugs?

A

Bupropion and verenicline

3
Q

What are the differentials for low mood?

A
Depression
Dementia
Secondary to drugs (e.g. steroids)
Mental health: schizophrenia, BPAD, anxiety, eating dirsoder
substance misuse
Anaemia
PD
Cushing's
...
4
Q

Give some RFs for depression

A
Substance misuse
chronic illness
Existing psyhciatric disorder
Hx of depression
Victim of abuse
...
5
Q

Give some RFs for suicide

A
Male
Single/divorced/widowed
Hx of suicide or self-harm
Age 40-60
Unemploued
Psychiatric mental health problem
Chronic illness
Living alone
Substance misuse...
6
Q

What is the treatment for sub threshold or mild depression?

A

Low intensity psychological therapies:

  • Individualised guided self-help
  • computer CBT
  • Group CBT
7
Q

In mild-moderate depression which fails low intensity psychological therapies, what can be used?

A

Antidepressant OR high intensity psychological therapy

E.G. CBT, interpersonal therapy, behavioural couple therapy [if relationship problems]

8
Q

In moderate-severe depression what can be offered?

A

COMBO: Antidepressant AND high intensity psychological therapy

9
Q

Give some examples of low intensity psychological therapies

A
  • Individualised guided self-help
  • computer CBT
  • Group CBT
10
Q

Give some examples of high intensity psychological therapies

A

CBT, interpersonal therapy, behavioural couple therapy [if relationship problems]

11
Q

If pt’s decline intervention what can be offered?

A

Counselling

12
Q

How do pt’s access low-intend. psych therapy

A

IAPT: improving access to psychological therapy

13
Q

Who should be involved in the management if there is a suicide risk?

A

Crisis team

14
Q

How long should antidepressants be used after symptoms have stopped? why?

A

6mths - prevent relapse

15
Q

What are the screening tools for depression?

A

PHQ-9

HAD scale (hospital anxiety and depression scale)

16
Q

What warrants the use of PHQ-9?

A

+ve screening questions:

  • ‘in last month hopeless, down, depressed?’
  • ‘In last month little interest or pleasure in doing things?’
17
Q

What is the PHQ-9 useful for?

A

Severity of depression

18
Q

Give 2 alcohol screening questionairres?

A

CAGE

AUDIT (alcohol use disorders identification test)

19
Q

If AUDIT suggests alcohol dependence, what can be used to assess the severity of alcohol dependence?

A

SADQ-C

20
Q

What indicates ECT in depression?

A

1st line if psychotic severe depression
If all treatments fail for moderate-severe depression
Emergency: risk to pt (e.g. not eating, suicide…)

21
Q

What affect do TCAs/SSRIs/SNRIs have on an ECG?

A

Prolong QT interval

22
Q

What drug should you avoid if someone is on SSRIs? why?

A

MAO inhibitors (causes serotonin syndrome)

23
Q

What type of MAO-inhibitors are there? What are they used in?

A

MAO-A (depression)

MAO-B (PD)

24
Q

Give an example of an MAO-A inhibitor?

A

Isocarboxazid

25
Q

Give an example of a SNRI?

A

Venlafaxine

26
Q

What drugs might cause serotonin syndrome in combination with MAO-inhibitors?

A

SSRIs and TCAs

27
Q

What drugs might cause hypertensive crisis in combination with MAO-inhibitors?

A

sympathetogics (E.g. adrenaline, NAd…)

28
Q

Give a drug that can be used to treat serotonin syndrome?

A

Cyproheptadine or chlorpromazine (both serotonin antagonists)

29
Q

What drug can be used to treat neuroleptic malignant syndrome?

A

Dantrolene (muscle relaxant)

Bromocriptine (dopamine agonist)

30
Q

What is the difference between serotonin syndrome and NMS in terms of onset?

A

NMS - gradual onset

SS - acute onset

31
Q

How do patients access psychological therapies?

A

IAPT (improving access to psychological therapies)

32
Q

What are the 3 broad symptoms experienced in serotonin syndrome?

A

Autonomic hyperactivity

Altered mental status

Neuromuscular excitation (e.g. myoclonus)

33
Q

What causes hypertensive crisis with MAO-I’s?

A

Sympathetogenics (NAd)

and tyramine containing substances (e.g. cheese and red wine)