Psychiatry Flashcards
(42 cards)
Raised G’s and C’s raised of anorexia
G’s and C’s raised: GH, glucose, salivary glands, cortisol, cholesterol, carotinaemia
Cardiac SE of citalopram and escitalopram
dose-dependent QT interval prolongation
SSRI drug interactions
- NSAIDs: NICE dont combined but if need co-prescribe a PPI
- Warfarin / heparin: NICE guidelines recommend avoiding SSRIs and considering mirtazapine
- aspirin
- triptans - increased risk of serotonin syndrome
4.MAOIs- increased risk of serotonin syndrome
How stop SSRI?
stopping a SSRI the dose should be gradually reduced over a 4 week period
-this is not necessary with fluoxetine
-Paroxetine has a higher incidence of discontinuation symptoms.
oculogyric crisis rx
Procyclidine, an anticholinergic drug, is used in the management of extrapyramidal symptoms caused by antipsychotics. It works by blocking the action of acetylcholine in the central nervous system, which helps to reduce muscle stiffness and spasms.
Examples of atypical antipsychotics
clozapine
olanzapine: higher risk of dyslipidemia and obesity
risperidone
quetiapine
amisulpride
aripiprazole: generally good side-effect profile, particularly for prolactin elevation
Adverse effects of clozapine
agranulocytosis (1%), neutropaenia (3%)
reduced seizure threshold - can induce seizures in up to 3% of patients
constipation
myocarditis: a baseline ECG should be taken before starting treatment
hypersalivation
Dose adjustment of clozapine might be necessary if smoking is started or stopped during treatment.
Typical antipsychotics examples
MAO
SE
Haloperidol
Chlorpromazine
Dopamine D2 receptor antagonists, blocking dopaminergic transmission in the mesolimbic pathways
Extrapyramidal side-effects and hyperprolactinaemia common
ATypical antipsychotics examples
MAO
SE
Clozapine
Risperidone
Olanzapine
Act on a variety of receptors (D2, D3, D4, 5-HT)
Extrapyramidal side-effects and hyperprolactinaemia less common
Metabolic effects
Tricyclic antidepressants
More sedative
Amitriptyline
Clomipramine
Dosulepin
Trazodone*
Less sedative Tricyclic antidepressants
Imipramine
Lofepramine
Nortriptyline
Tricyclic antidepressants
inhibition of the reuptake of neurotransmitters
Noradrenaline (NA) & Serotonin (5-HT)
SSRI of choice post myocardial infarction
Sertraline
What type of drug is venlafaxine and duloxetine
Serotonin and noradrenaline reuptake inhibitors
Erotomania (De Clerambault’s syndrome)
Presence of a delusion that a famous is in love with them, with the absence of other psychotic symptoms
Capgras syndrome
. This is the delusion that a person closely related to the patient has been replaced by an impostor.
De Frégoli
This is the delusion of identifying a familiar person in various people they encounter.
Othello syndrome
delusion of sexual infidelity on the part of a sexual partner.
Ekbom syndrome
This is delusional parasitosis and describes the delusion of infestation.
how to withdraw a benzodiazepine
withdrawn in steps of about 1/8 (range 1/10 to 1/4) of the daily dose every fortnight.
Withdraw may present like alcohol withdrawel
Other drug causes of serotonin syndrome
The LOSt MD Took MDMA - Tramadol,
Linezolid,
Ondansetron,
St. John’s wort,
Triptans
Meperidine, Dextromethorphan, , and
MDMA.
serotonin syndrome rx
Management
supportive including IV fluids
benzodiazepines
more severe cases are managed using serotonin antagonists such as cyproheptadine and chlorpromazine
neuroleptic malignant syndrome MAO
associated with dopamine receptor blockade.
More commonly occurs Typical antipsychotic medications,
Neuroleptic malignant sx
More mscl rigidity
