Mental Health Update Flashcards by C L

What are the common s/e of atypical antipsychotics? (7)

Metabolic effects
Anticholinergic
QT prolongation
Lowered seizure threshold
Antiadrenergics
NMS
Sedation

How well did you know this?

Not at all

Perfectly

What the common s/e of typical antipsychotics medicines. (7)

EPSE
Anticholinergics
QT prolongation
Lowers seizure threshold
Antiadrenergic
NMS
Sedation

How well did you know this?

Not at all

Perfectly

What are the investigations before starting therapies? (9)

Weight
Waist circumference
Pulse + BP
Fasting BM
HbA1c
Prolactin levels
Movement disorders
Nutritional status, diet and physical activities.
ECG

How well did you know this?

Not at all

Perfectly

What are the investigations during therapies? (5)

Tx response
Symptom/behavioural changes.
S/e
Weight
Adherence
Physical health (CV)

How well did you know this?

Not at all

Perfectly

What antipsychotic gives the least risk of psychosis? (1)

Aripiprazole

How well did you know this?

Not at all

Perfectly

What is GASS? (1)

Glasgow Antipsychotic S/E scale:
- Self reporting questionnaire aims to identify s/e of antipsychotic medication.
- Consists of 22 questions with assigned points based on answers given by the px.

How well did you know this?

Not at all

Perfectly

What is NMS? (2)

Life-threatening neurological disorder caused by ADR to neuroleptics/antipsychotics drugs.

Disorder develops within the 1st 2 weeks of tx with the drug but disorder can develop at any time during the tx period. Can occur in people taking anti-Parkinsonism.

How well did you know this?

Not at all

Perfectly

What are the symptoms of NMS? (6)

High fever
Sweating
Unstable BP
Stupor
Muscular rigidity
Autonomic dysfunction

How well did you know this?

Not at all

Perfectly

What are the main features of anti-psychotic induced hyperprolactinaemia? (4)

Hyperprolactinaemia: Endocrine disorder but can be associated with significant morbidity.
Presents as menstrual problems in women and sexual problems in men.
Persistent asymptomatic hyperprolactinaemia can be linked to long-term physical morbidity e.g. OP and breast cancer.
Hyperprolactinaemia managed asymptomatically.

How well did you know this?

Not at all

Perfectly

Give e.g. of an antipsychotic that has the least risk of inducing hyperprolactinaemia. (1)

Aripiprazole

How well did you know this?

Not at all

Perfectly

What are the main features of Clozapine? (5)

Used when px is unresponsive to or intolerant of conventional antipsychotic drugs.
If px misses 48 hrs or more of Clozapine dose, the clozapine must be discontinued and slowly re-titrated.
Potentially fatal risk of intestinal obstruction, faecal impact ion and paralytic ileus.
Neutropenia and agranulocytosis reported.

How well did you know this?

Not at all

Perfectly

Give e.g. of clinical situations that can increase the risk of Clozapine toxicity. (5)

Px stops smoking or switches or an e-cigarette.
Concomitant medicines may interact to increase clozapine levels
Patient has pneumonia or other serious infection.
Reduced Clozapine metabolism is suspected.
Toxicity is suspected.

How well did you know this?

Not at all

Perfectly

What monitoring is considered to manage Clozapine toxicity? (1)

Blood concentration levels carried out in addition to required blood tests to manage risk of agranulocytosis.

How well did you know this?

Not at all

Perfectly

What factors are considered for antidepressants? (7)

Choice
Initiation
Adjuvants
Non-drug Tx
Risk in OD
Counselling
S/E

How well did you know this?

Not at all

Perfectly

What are the key s/e of SSRI’s? (7)

Insomnia/Anxiety/Agitation
GI bleeding
Sexual dysfunction
5-HT syndrome
Suicidal thoughts
FINISH withdrawal
Physiological symptoms

How well did you know this?

Not at all

Perfectly

What are the key s/e of TCA? (4)

Anti-histamine
Anti-adrenergic
Anti-cholinergic
Cardiac

How well did you know this?

Not at all

Perfectly

What are the key s/e of MAOIs? (6)

Hypertensive crisis
Postural hypotension
Anti-cholinergic
5-HT syndrome
Hepatotoxicity (phenelzine)
Weight gain

How well did you know this?

Not at all

Perfectly

What is FINISH? (6)

Study These Flashcards

Discontinuation syndrome.
Flu-like symptoms
Insomnia
Nausea
Imbalance
Sensory disturbances
Hyperarousal (anxiety/agitation)

What are the key s/e of Venlafaxine? (5)

Study These Flashcards

Cardiac effects
Blood dyscrasias/ Bleed risk
SIADH
Suicidal behaviour
Withdrawal syndrome

What are the key s/e of Reboxetine? (6)

Study These Flashcards

Cardiac effects
Hyponatraemia
Hypokalaemia on prolonged tx
Suicidal behaviour
Urinary retention
Impaired vision (caution in glaucoma)

What are the key s/e of Moclobemide? (3)

Study These Flashcards

Lower risk of hypertensive crisis
Troublesome interactions (< MAOI)
Hyponatraemia

What are the key s/e of Mirtazapine? (6)

Study These Flashcards

Not many antimuscarinic effects.
Sedating
Blood disorders
Withdrawal syndrome
Weight gain
Psychotic symptoms

What are the common s/e of general antidepressants? (5)

Study These Flashcards

Potential for an initial increase in agitation, anxiety on starting tx.
Hyponatraemia
Sexual dysfunction
Withdrawal effects
Bleeding risk

Explain the main features of Hyponatraemia with antidepressants. (9)

Study These Flashcards

SSRI = high risk.
Common in elderly.
Symptoms: LOW SODIUM
Occurs within 30 days of starting antidepressants but can take months.
Can be transient or persistent
If identified, stop antidepressant and sodium levels should normalised within 1-2 weeks.
Urgent care if severe (<125mmol/L)
Withdrawal symptoms can occur (less likely at beginning of tx)

What are the main features of SSRI/SNRI and bleeding risk? (1)

Reducing 5-HT uptake by platelets. SSRI reduces ability of platelets to aggregate and increase risk of haemorrhage, particularly GI bleeding.

What factors can increase the bleeding risk when taking SSRI/SNRI? (4)

Elderly Px with Hx of peptic ulcers Alcohol excess Co-administration with other drugs associated with bleeding risk (NSAIDs, Antiplatelets, CS, Warfarin)

What factors can reduce the risk of bleeding when taking SSRI/SNRI? (4)

Avoid SSRI/SNRI Avoid concomittant drugs If no suitable alternative can be found, consider GI protection. NICE suggests GI protection in older px who are taking NSAIDs/Aspirin.

What are the cautions and c/i of antidepressants? (3)

CVD disease + QT prolongation: - Antidepressant can cause QT prolongation. - Medication Hx, Lab monitoring and baseline ECG necessary to identify px at risk for QT prolongation before starting an antidepressant that may prolong QT interval. - Significant QT prolongation can occur through drug-drug interactions where another medication known to affect QT interval is used concomittantly or when a medication alters the metabolism of another drug which is known to affect the QT interval. Considered when new medications are added, even for short-term use e.g. ABx/Antiemetics.

What are the risk factors of QT interval prolongation? (8)

Cardiac conditions e.g. bradycardia, MI/HF. Electrolyte disturbances e.g. hypokalaemia/hypomagnesemia/hypocalcaemia. Female Genetic Polymorphisms Age > 65 yrs Congenital long QT syndrome or other inherited cardiac abnormalities. Concomittant medication or disease states.that prolong QT interval or affect electrolytes (e.g. diuretics, renal dysfunction.) Hx of QT prolongation

What does MHRA drug safety state about the use of Citalopram + Escitalopram? (7)

Associated with dose-dependent QT interval prolongation. Avoid use in: - Congenital long QT syndrome - Known pre-existing QT interval prolongation - Combination with other medicines that prolong QT interval. ECG for px with cardiac disease. Electrolyte disturbances corrected prior tx. Citalopram max daily dose: 40mg (adults), 20mg (> 65 yrs), 20mg (hepatic impairment) Escitalopram max dose: > 65 yrs reduced to 10mg/day. Dose reduction in first 2 weeks of tx is recommended in px with mild/moderate hepatic impairment or poor metabolisers of CYP2C19 (e.g. Omeprazole). GI protection with SSRI in px at risk of bleeds.

What is the general relationship between antidepressants and # risk? (1)

High risk of # for using TCA / SSRI.

What does MHRA/CHM state about the use of SSRI/SNRI? (1)

SSRI/SNRI antidepressants have a small risk of postpartum haemorrhage when used in the month before delivery.

What are the characteristics of 5-HT syndrome? (3)

Altered mental status Neuromuscular Hyperactivity Autonomic Instability

What are the symptoms of 5-HT syndrome? (4)

Agitation Confusion Delirium Hallucinations

What are the neuromuscular features of 5-HT syndrome? (5)

Profound shivering Tremor Teeth Grinding Myoclonus Hyperreflexia

What are the signs of autonomic instability? (7)

Tachycardia Fever Hypertension/Hypotension Flushing Diarrhoea Vomiting

What are the signs of severe 5-HT syndrome? (7)

Drowsiness Coma Seizures Hyperthermia Rhabdomyolysis Renal Failure Coagulopathies

What factors can increase the risk 5-HT syndrome? (2)

Concomittant use of antidepressants with other 5-HT drugs (Tramadol, triptans) Dopaminergic drugs (selegiline) Close monitoring is advised if co-Rx, alternative drugs are considered.

What is common s/s of 5-HT syndrome? (7)

SHIVERS: - Shivering - Hyperreflexia - Increased temp - Vital signs abnormal - Encephalopathy - Restlessness - Sweating

Which antidepressants has an overdose risk? (2)

TCA Venlafaxine

Explain the process of antidepressant withdrawal. (2)

When stopping an antidepressant, gradually reduce dose over 4 weeks. Some people may need longer periods e.g. drugs with shorter half-life (Paroxetine/Venlafaxine) Not required for fluoxetine (long half life)

What are the common interactions with antidepressants? (8)

High risk of QT prolongation CYP45O inhibitors/inducers 5-HT syndrome High bleeding risk Warfarin Anticonvulsants effect Sedation risk (TCA) Anticholinergics s/e (TCA)

What are the main features of MAOI? (8)

Used when no response to other antidepressants. May be useful in px refractory to other tx. Food/drug interactions E.g. Phenelzine, Isocarboxacid, Tranylcypromine, Moclobemide (reversible MAOI with less s/e) Withdrawal symptoms Can cause hepatic impairment. May carry a MAOI tx card.

What type of ADR can occur when taking MAOI? (1)

Hypertensive crisis s/e which can be fatal can occur if an MAOI is taken with food or drink that has high tyramine content

Mental Health Update Flashcards

(44 cards)