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

psych from psmd Flashcards

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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
what are the EPSEs?
1. Parkinsonism 2. Akathisia 3. Tardive dyskinesia 4. Acute dystonia
26
what is tardive dyskinesia?
late onset, sometimes irreversible side effect of typical antipsychotics abnormal, involuntary movements such as: - chewing, pouting jaw, blinking, DIFFICULTY SWALLOWING
27
what is acute dystonia?
sustained muscle contractions such as torticollis/oculogyric crisis
28
how is acute dystonia managed?
procyclidine
29
how is tardive dyskinesia managed?
tetrabenazine
30
what is anankastic personality disorder also known as?
obsessive compulsive personality disorder
31
what is the only absolute contraindication of ECT?
raised ICP
32
what are the short term side effects of ECT?
- headache - nausea - short term memory impairment - memory loss of events prior to ECT - CARDIAC ARRHYTHMIA
33
what are some long term side effects of ECT?
memory impairment
34
does ECT increase risk of epilepsy?
no
35
what investigation should be carried out in older patients who present with new onset psychosis?
CT head to rule out organic cause for psychosis
36
which psychiatry drugs can cause urinary retention and so overflow incontinence?
tricyclic antidepressants | amitriptylline
37
why do TCAs cause urinary retention?
they have anticholinergic effects
38
what are the side effects of TCAs
tachycardia dry mouth mydriasis urinary retention
39
why must patients on MAOIs avoid tyramine?
tyramine + MAOIs = hypertensive crisis
40
what are the features of post-concussion syndrome?
headaches fatigue anxiety dizzness
41
how to distinguish between post-concussion and PTSD?
PTSD - onset of symptoms delayed and last longer
42
what are clang associations?
alliterative/rhyming words
43
what scoring system is used for the management of alcohol withdrawal in hospital?
CIWA-Ar scale | score>8 needs medication
44
what type of drug is clozapine?
atypical antipsychotic 5HT2a binds to serotonin and dopamine receptors treats negative symptoms of schizophrenia too
45
what type of drug is olanzipine?
atypical antipsychotic 5HT2a binds to serotonin and dopamine receptors (more to serotonin)
46
what is the most common side effect of olanzipine?
weight gain | hyperprolactinaemia
47
what are the side effects of clozapine?
``` agranulocytosis reduced seizure threshold constipation myocarditis hypersalivation ```
48
when is clozapine used?
if 2 or more antipsychotics have been tried (including 1 atypical) for 6-8 weeks
49
which antipsychotic is associated with agranulocytosis?
clozapine
50
what antipsychotic can cause drooling?
clozapine
51
what baseline tests must you do before starting clozapine?
ECG - clozapine can cause myocarditis | FBC for agranulocytosis
52
what is the risk of antipsychotics in the elderly?
increased risk of VTE/stroke
53
what is the criteria for OCD diagnosis?
lasting for more than 2 weeks obsessions/compulsions
54
what is a side effect of long term atypical antipsychotic use?
glucose dysregulation, diabetes
55
what is flight of ideas a feature of?
mania
56
what does SSRI use during the first trimester increase the risk of in fetus?
heart defects
57
how do SSRIs affect fetus if used in third term?
persistent pulmonary hypertension
58
which SSRI has an increased risk of congenital malformations?
paroxetine
59
what drug can precipitate a leucocytosis?
lithium (also corticosteroids/betablockers) | - benign
60
how often should lithium blood level be checked once the dose has been established?
every 3 months
61
when should lithium levels be checked after dose change?
after a week and weekly until the levels have stabilised
62
how would you treat mania in a patient with known BD
refer urgently to CMHT
63
how would you treat hypomania in a patient with BD?
refer routinely to CMHT
64
how would you differentiate between mania and hypomania
mania has psychosis/delusions
65
what can cause a rise in clozapine levels without dose increase?
smoking cessation
66
what electrolyte abnormality is associated with long term lithium use?
hypercalcaemia due to hyperparathyroidism
67
what are the symptoms of hypercalcaemia?
stones bones moans and groans kidney stones bone/back pain constipation depression usually caused by lithium long time use
68
are antidepressants addictive?
no | patients should remain on them for at least 6 months
69
what does zopiclone do in the elderly?
increase the risk of falls
70
how does zopiclone work?
similar to benzodiazepines enhances GABA by binding to GABA-a receptors
71
how is akathisia treated?
propranolol
72
what class of drug is mirtazipine?
noradrenergic and specific serotonergic antidepressants Blocks alpha2 adrenoceptors not the same as SNRI
73
Which class of drugs can cause anterograde amnesia?
benzos lorazepam etc anterograde - memory recall and creation impaired
74
what can steroids cause in psychiatry?
psychosis

2020 Phase 3a (DB) (20 decks)

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