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2020 Phase 3a (DB) > psych from psmd > Flashcards

psych from psmd Flashcards

1
Q

which class of drugs can cause vte in elderly?

A

atypical antipsychotics

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2
Q

what is a side effect of metoclopramide?

A

it is an anti-emetic and may cause extrapyramidal side effects such as tardive dyskinesia

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3
Q

which antidepressant post MI?

A

sertraline

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4
Q

how is tardive dyskinesia treated?

A

tetrabenazine (Tardive, Tetrabenazine)

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5
Q

how long should medication with SSRI be continued?

A

at least 6 months, dose reduced over 4 months

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6
Q

how does conversion disorder manifest?

A

typically involves loss of motor or sensory function

may be caused by stress

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7
Q

how does somatisation disorder present?

A

multiple symptoms present for 2 years

despite negative scans/test results, patients don’t accept reassurance

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8
Q

how does hypochondriasis present?

A

patient believes they have a specific illness

not reassured

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9
Q

what is the biggest risk factor for schizophrenia?

A

family history of schizophrenia

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10
Q

when do the symptoms of alcohol withdrawal start?

A

6-12 hours

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11
Q

when do seizures occur in alcohol withdrawal?

A

36 hours

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12
Q

when does delirium tremens occur?

A

72 hours after withdrawal

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13
Q

what are the symptoms of alcohol withdrawal?

A

tremor
sweating
tachycardia
anxiety

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14
Q

what are the symptoms of delirium tremens?

A 
course tremor
confusion
delusion
auditory/visual hallucinations
fever
tachycardia
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15
Q

what is the first line treatment of delirium tremens?

A

benzodiazepines such as chlordiazepoxide

in patients with hepatic failure, lorazepam

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16
Q

what is the treatment of delirium tremens in pts with hepatic failure?

A

lorazepam

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17
Q

should you use phenytoin for alcohol withdrawal seizures?

A

not as effective

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18
Q

when should serum lithium be checked

A

12 hours post dose!

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19
Q

which SSRI is first line in adolescents and children?

A

fluoxetine

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20
Q

what do you always need to rule out for patients presenting with symptoms of anxiety?

A

hyperthyroidism

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21
Q

what is the first line treatment of GAD?

A

SSRI

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22
Q

What is the second line treatment of GAD?

A

SNRI eg venlafaxine

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23
Q

what type of drug is zuclopenthixol?

A

typical antipsychotic

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24
Q

what is a common side effect of typical antipsychotics such as zuclopenthixol?

A

parkinsonism

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25
Q

what are the EPSEs?

A
  1. Parkinsonism
  2. Akathisia
  3. Tardive dyskinesia
  4. Acute dystonia
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26
Q

what is tardive dyskinesia?

A

late onset, sometimes irreversible side effect of typical antipsychotics

abnormal, involuntary movements such as:

  • chewing, pouting jaw, blinking,
    DIFFICULTY SWALLOWING
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27
Q

what is acute dystonia?

A

sustained muscle contractions such as torticollis/oculogyric crisis

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28
Q

how is acute dystonia managed?

A

procyclidine

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29
Q

how is tardive dyskinesia managed?

A

tetrabenazine

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30
Q

what is anankastic personality disorder also known as?

A

obsessive compulsive personality disorder

31
Q

what is the only absolute contraindication of ECT?

A

raised ICP

32
Q

what are the short term side effects of ECT?

A
  • headache
  • nausea
  • short term memory impairment
  • memory loss of events prior to ECT
  • CARDIAC ARRHYTHMIA
33
Q

what are some long term side effects of ECT?

A

memory impairment

34
Q

does ECT increase risk of epilepsy?

A

no

35
Q

what investigation should be carried out in older patients who present with new onset psychosis?

A

CT head to rule out organic cause for psychosis

36
Q

which psychiatry drugs can cause urinary retention and so overflow incontinence?

A

tricyclic antidepressants

amitriptylline

37
Q

why do TCAs cause urinary retention?

A

they have anticholinergic effects

38
Q

what are the side effects of TCAs

A

tachycardia
dry mouth
mydriasis
urinary retention

39
Q

why must patients on MAOIs avoid tyramine?

A

tyramine + MAOIs = hypertensive crisis

40
Q

what are the features of post-concussion syndrome?

A

headaches
fatigue
anxiety
dizzness

41
Q

how to distinguish between post-concussion and PTSD?

A

PTSD - onset of symptoms delayed and last longer

42
Q

what are clang associations?

A

alliterative/rhyming words

43
Q

what scoring system is used for the management of alcohol withdrawal in hospital?

A

CIWA-Ar scale

score>8 needs medication

44
Q

what type of drug is clozapine?

A

atypical antipsychotic
5HT2a
binds to serotonin and dopamine receptors
treats negative symptoms of schizophrenia too

45
Q

what type of drug is olanzipine?

A

atypical antipsychotic
5HT2a
binds to serotonin and dopamine receptors (more to serotonin)

46
Q

what is the most common side effect of olanzipine?

A

weight gain

hyperprolactinaemia

47
Q

what are the side effects of clozapine?

A 
agranulocytosis
reduced seizure threshold
constipation
myocarditis
hypersalivation
48
Q

when is clozapine used?

A

if 2 or more antipsychotics have been tried (including 1 atypical) for 6-8 weeks

49
Q

which antipsychotic is associated with agranulocytosis?

A

clozapine

50
Q

what antipsychotic can cause drooling?

A

clozapine

51
Q

what baseline tests must you do before starting clozapine?

A

ECG - clozapine can cause myocarditis

FBC for agranulocytosis

52
Q

what is the risk of antipsychotics in the elderly?

A

increased risk of VTE/stroke

53
Q

what is the criteria for OCD diagnosis?

A

lasting for more than 2 weeks obsessions/compulsions

54
Q

what is a side effect of long term atypical antipsychotic use?

A

glucose dysregulation, diabetes

55
Q

what is flight of ideas a feature of?

A

mania

56
Q

what does SSRI use during the first trimester increase the risk of in fetus?

A

heart defects

57
Q

how do SSRIs affect fetus if used in third term?

A

persistent pulmonary hypertension

58
Q

which SSRI has an increased risk of congenital malformations?

A

paroxetine

59
Q

what drug can precipitate a leucocytosis?

A

lithium (also corticosteroids/betablockers)

- benign

60
Q

how often should lithium blood level be checked once the dose has been established?

A

every 3 months

61
Q

when should lithium levels be checked after dose change?

A

after a week and weekly until the levels have stabilised

62
Q

how would you treat mania in a patient with known BD

A

refer urgently to CMHT

63
Q

how would you treat hypomania in a patient with BD?

A

refer routinely to CMHT

64
Q

how would you differentiate between mania and hypomania

A

mania has psychosis/delusions

65
Q

what can cause a rise in clozapine levels without dose increase?

A

smoking cessation

66
Q

what electrolyte abnormality is associated with long term lithium use?

A

hypercalcaemia due to hyperparathyroidism

67
Q

what are the symptoms of hypercalcaemia?

A

stones bones moans and groans

kidney stones
bone/back pain
constipation
depression

usually caused by lithium long time use

68
Q

are antidepressants addictive?

A

no

patients should remain on them for at least 6 months

69
Q

what does zopiclone do in the elderly?

A

increase the risk of falls

70
Q

how does zopiclone work?

A

similar to benzodiazepines

enhances GABA by binding to GABA-a receptors

71
Q

how is akathisia treated?

A

propranolol

72
Q

what class of drug is mirtazipine?

A

noradrenergic and specific serotonergic antidepressants

Blocks alpha2 adrenoceptors

not the same as SNRI

73
Q

Which class of drugs can cause anterograde amnesia?

A

benzos
lorazepam etc

anterograde - memory recall and creation impaired

74
Q

what can steroids cause in psychiatry?

A

psychosis

2020 Phase 3a (DB) (20 decks)

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