notes from quesmed Flashcards
(32 cards)
refeeding syndrome treatment
Rapidly increasing insulin levels lead to shifts of potassium, magnesium and phosphate from extracellular to intracellular spaces. This is potentially fatal if refeeding is too rapid and must be treated with phosphate replacement. Prophylactic phosphate supplementation may be considered in those deemed high risk of refeeding syndrome
provision of high-dose vitamins (eg. Pabrinex) before feeding commences
Monitoring with daily bloods and replenishing electrolytes early
Building caloric intake gradually with the help of a dietitian‚ NICE recommends that refeeding is started at no more than 50% of calorie requirement in ‘patients who have eaten little or nothing for more than 5 days’
regular ECGs as prone to arrhythmias
core features of lewy body dementia
visual hallucinations
parkinsonism
fluctuating cognition
extrapyramidal symptoms associsted with some antipsychotics
Acute Dystonia
Akathisia
Parkinsonism
Tardive Dyskinesia: Involuntary, repetitive movements, especially of the face.
what is treatment resistnat schizophrenia
Schizophrenia that does not respond to two consecutive trials of antipsychotics
Clozapine is an antipsychotic medication reserved for these cases
what is delirium tremens and when does it occur
characterized by agitation, hallucinations, and seizures
it typically occurs 48-96 hours after the last drink
wernicke- korsakoff syndrome
neurological condition associated with thiamine (B1) deficiency and alcohol abuse
confusion, ataxia, and ophthalmoplegia
wernicke encephalopathy is the acute setting and reversible but korsakoff syndrome is not
treat with high dose thiamine and nutrition and abstinence from alcohol
side effects of clozapine
Agranulocytosis
neutropenia
myocarditis
intestinal obstruction
haloperidol is
and what needs to be watched
typical antipsychotic
ECG measurements are taken after dose changes of haloperidol, as well as annually due to QT interval prolongation (side effect of many antipsychotics)
ECG changes in refeeding syndrome
prominent u waves
hypokalaemia
small (0.5 mm) deflection immediately following the T wave, usually in the same direction as the T wave.
hypokalaemia
hypomagnesia
hypophosphatemia
oedema
confusion
tachycardia
depression treatment
SSRIs
mirtazepine helps with appeitite and sleep as sedative (tetracyclical antidepressant)
venlafaxine
mini mental state exam for cognitive impairment results
mild Alzheimer’s disease: MMSE 21–26
moderate Alzheimer’s disease: MMSE 10–20
moderately severe Alzheimer’s disease: MMSE 10–14
severe Alzheimer’s disease: MMSE less than 10.
treatment alzheimers
cholintesterase inhibitors- Donepezil, galantamine, rivastigmine
NMDA receptor blocker- memantine
used in moderate or severe AD or where cholinesterase inhibitors are not tolerated
cluster A disorders
basic mistrust of others, and tend towards a withdrawal from ordinary sociality
paranoid
schizoid
schizotypal (not in ICD10, just on the schizophrenia spectrum)
odd and eccentric
cluster B disorders
serious problems of behaviour and impulse control
borderline (emotionally unstable in ICD10)
narcissistic
antisocial
histrionic
dramatic and erratic
cluster C disorders
constitutional difficulty in the way anxiety is managed,
particularly anxiety relating to ordinary social roles and responsibilities
OCPD
dependant personality disorder
avoidant personality disorder (anxious avoidant in ICD10)
anxious or fearful
paranoid personality disorder
pervasive and enduring pattern of irrational suspicion and mistrust of others
hypersensitivity to criticism and potential slights
reluctance to confide in others
perceived conspiracies against themselves
schizoid personality disorder
enduring pattern of detachment from social relationships and a restricted range of emotional expression
pervasive lack of interest in or desire for interpersonal relationships, often preferring solitary activities
emotional coldness, detachment, or flattened affectivity
schizotypal personality disorder
impaired social interactions, distorted cognitions and perceptions, and eccentric behaviours
inappropriate or constricted affect, and peculiar, eccentric or bizarre behaviour
odd thinking and speech, such as magical thinking, peculiar ideas, paranoid ideation, and belief in the influence of external forces
maintains a more intact grasp on reality than schizophrenia
antisocial personality disorder
pervasive pattern of disregard for and violation of the rights of others.
lack of empathy and frequently engage in manipulative, impulsive actions.
aggressive, unremorseful behaviour, and consistent irresponsibility
borderline personality disorder
recurring pattern of abrupt mood swings, unstable personal relationships, and self-image instability.
propensity towards self-harm
splitting in relationships - extremes of idealisation and devaluation
inability to control temper and manage affective responses
history of previous trauma
histrionic personality disorder
attention-seeking behaviours and excessive displays of emotion.
inappropriate sexual behaviours
emotional expressions tend to be shallow, dramatic, and often perceived as exaggerated
often perceive relationships as being more intimate than they truly are
avoidant personality disorder
intense feelings of social inadequacy, fear of rejection and hypersensitivity to criticism
self-impose isolation to avoid potential criticism despite a strong desire for social acceptance and interaction
narcissistic personality disorder
persistent pattern of grandiosity, a strong need for the admiration of others, and a marked lack of empathy.
sense of entitlement and will exploit others to fulfil their own desires.
dependent personality disorder
pervasive and excessive need to be taken care of, leading to submissive and clinging behaviour
lack self-confidence and initiative
urgently seek new relationships as a source of care and support when existing ones end
