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EOY3 > Psychiatry > Flashcards

Psychiatry Flashcards

(52 cards)

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1
Q

what medication can be used to treat sleep paralysis?

A

clonazepam

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2
Q

overdose antidotes

A 
paracetamol --> N-acetylcysteine
opiates --> naloxone 
benzodiazepines --> flumazenil 
warfarin --> vitamin K
beta-blockers --> glucagon 
TCAs --> sodium bicarbonate  
organophosphates --> atropine
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3
Q

pregabalin

A

used in GAD and neuropathic pain
is an anticonvulsant
ADR: dizziness, drowsiness, blurred vision, diplopia, confusion and vivid dreams

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4
Q

beta-blockers

A

e.g. propranolol
reduces somatic symptoms of GAD
CI in asthma

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5
Q

lamotrigine

A

anticonvulsant
used to treat BPAD as a mood stabilisers
less teratogenic than other mood stabilisers so used in women of child bearing age
ADR:
GI disturbance, rash, headache, tremor, patient must be informed to see doctor if signs of hypersensitivity reaction
avoid abrupt withdrawal

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6
Q

carbamazepine

A

used in epilepsy, neuropathic pain, alcohol withdrawal and BPAD unresponsive to lithium
blocks voltage dependent Na+ channels so prevents repetitive neuronal firing
ADR:
GI upset, dermatitis, dizziness, hyponatraemia, leukopenia and thrombocytopenia (monitor WCC after 1 week)
CI in pregnancy, AV conduction abnormalities and acute porphyria

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7
Q

sodium valproate

A

used to treat epilepsy (IV), BPAD (with lithium for rapidly cycling) and to prevent migraines
avoid in hepatic dysfunction, porphyria and pregnancy
ADR: “GI VALPROATE”
GI upset, very fat (weight gain), aggression, LFTs (increased), platelets (low - thrombocytopenia), reversible hair loss, oedema (peripheral), ataxia, tiredness/tremor/teratogenic, emesis

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8
Q

Lithium

A

1st line prophylaxis in BPAD, possible adjunct for depression
ADR: “GI LITHIUM”
GI upset, leucocytosis, impaired renal function, tremor (fine)/teratogenic/thirst (polydipsia), hypothyroidism/hair loss, increased weight and fluid retention, urine (polyuria), metallic taste
in TOXICITY
enhanced by DEHYDRATION, DRUGS (NSAIDS, ACEi), diuretics (thiazide), depletion of NA+
symptoms in toxicity “TOXIC” -
tremor (coarse), oliguric renal failure, ataxia, increased reflexes, convulsions/ coma/ consciousness reduced

normal therapeutic levels are 0.4-1.0mmol/l, toxic at 1.5 mmol/l - very narrow therapeutic window (must monitor levels 12hrs after first dose, then weekly until within range and stable for four weeks and then every three months)

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9
Q

antipsychotics

A

typical (e.g. haloperidol) more extra-pyramidal side effects, generally less tolerable, cause high prolactin

atypical (e.g. olanzapine, clozapine) are more likely to cause weight gain, T2DM, metabolic syndrome and stroke in the elderly.

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10
Q

haloperidol

A

typical antipsychotic
most ADRs, prolonged QTc (needs ECG monitoring)
available as a depot every 4 weeks
risk of neuroleptic malignant syndrome, extra-pyramidal side effects

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11
Q

sulpiride

A

typical antipsychotic
least ADRs, doesn’t really affect blood pressure
not available IM

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12
Q

chlorpromazine

A

typical antipsychotic
mainly used PO
risk of neuroleptic malignant syndrome

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13
Q

olanzapine

A 
atypical antipsychotic 
causes the most weight gain 
need a fasting glucose baseline, at 1 month and then every 4-6 months
an antidepressant at a low dose
available as a depot
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14
Q

clozapine

A

atypical antipsychotic
used in treatment resistant schizophrenia
need a fasting glucose baseline, at 1 month and then every 4-6 months
reduces seizure threshold, causes hypersalivation
good for negative symptoms
not available IM
causes neutropenia and agranulocytosis (need weekly WCC for 18 weeks, fortnightly for 1 year and then every 4-6 months)

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15
Q

risperidone

A

atypical antipsychotic
anti-manic at high dose (but increased risk of EPSE)
causes hyperprolactinaemia so avoid in women

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16
Q

aripiprazole

A

atypical antipsychotic

less ADRs, useful in the 1st episode of psychosis, doesn’t affect BP, available as a depot

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17
Q

quetiapine

A

atypical antipsychotic
used in BPAD during a depressive episode
not available IM

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18
Q

antipsychotics side effects

A

anti-dopaminergic (EPSE - more common in typical)
serotonergic (improves affective and negative symptoms, responsible for metabolic symptoms - mainly atypical)
anti-histaminergic (causes weight gain and sedation)
anti-adrenergic (postural hypotension, tachycardia, and ejaculation failure)
anti-cholinergic and anti-muscarinic (can’t pee, can’t see, can’t sit, can’t shit)

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19
Q

extrapyramidal side effects

A
  • parkinsonism; bradykinesia, increased rigidity, coarse tremor, masked facies, shuffling gait, takes weeks-months to develop
  • akathisia: unpleasant feeling of restlessness, occurs in the first months of treatment, reduce dose and give propranolol temporarily
  • dystonia: acute painful spasms of the neck muscles, jaw and eyes (oculogyric crisis), can occur within days
  • tardive dyskinesia: late onset (years) in 40% of patients, may be irreversible - choreoathetoid movements: abnormal, involuntary movements, most commonly presents as chewing or pouting
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20
Q

neuroleptic malignant syndrome

A

a rare, life-threatening condition seen in patients taking antipsychotics in first 10 days or after increasing the dose
10% mortality
pyrexia, muscle rigidity, confusion, fluctuating consciousness and autonomic instability +/- delirium
Ix: increased creatinine kinase, leucocytosis, deranged LFTs
Rx: stop drug, monitor, IVF, cooling, dantrolene (muscle relaxant), bromocriptine (dopamine agonist), benzodiazepine
complications: PE, renal failure, shock

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21
Q

the “z” drugs

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A

zolpidem, zopiclone (used in insomnia), zaleplon
have reduced psychomotor and hangover effects compared to benzos
enhance GABA transmission, but mainly used as sedatives

22
Q

classes of antidepressants

Study These Flashcards
A 
SSRIs
SNRIs
NASSAs
NARIs
SARIs
TCAs
MAOIs
23
Q

selective serotonin reuptake inhibitors

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A

increase the concentration of serotonin in the synaptic cleft
safe in overdose
generally well tolerated
work quickly (effects from 1 week, clinically detectable benefits by 4-6 weeks)
low risk of mania
must reduce the dose gradually over 4 weeks to prevent discontinuation syndrome

ADR: GI upset and “STRESS”
sweating, tremor, rashes, EPSE, sexual dysfunction, somnolence

CI in mania, and if on warfarin/heparin, co-prescribe a PPI if on a NSAIDs

24
Q

citalopram

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A

1st line in depression, also used in OCD
dose dependant QT elongation
hepatotoxic at high dose

25
fluoxetine
safest in pregnancy and breast feeding preferred choice in adolescents used in OCD and bulimia longest half life so less withdrawal risk but a greater risk of serotonin syndrome
26
sertraline
safest if there is cardiac disease safe in pregnancy increases motivation for suicide (so must review after 1 week) used for PTSD and OCD
27
paroxetine
increased risk of drug interactions, increased risk of discontinuation symptoms used in PTSD, GAD, OCD, social phobia
28
escitalopram
used in OCD, panic disorder, social phobia, depression and long QTc
29
serotonin and noradrenaline reuptake inhibitors
are not used if high risk of cardiac arrhythmias or if there is uncontrolled HTN ADR include nausea, dry mouth, headache, dizziness and sexual dysfunction are second/third line for depression and anxiety ``` duloxetine venlafaxine (long QTc and blood pressure problems, take BP monitoring) ```
30
noradrenaline serotonin specific antidepressants
mirtazapine - 2nd line in depression for those who need to gain weight and have insomnia ADR: postural hypotension (caution if frail), increased appetite and weight gain, sedative
31
noradrenaline reuptake inhibitors
reboxetine - 2nd/3rd line for major depression caution in CVD, prostatic hypertrophy, pregnancy and urinary retention ADR: hypokalaemia in the elderly, nausea, tachycardia, palpitations, postural hypotension, impotence avoid abrupt withdrawal
32
serotonin antagonist and reuptake inhibitors
trazodone - used in depression where sedation is required or in dementia/anxiety with agitation or insomnia ADR: minimal anticholinergic SE and relatively low cardiotoxicity compared with TCAs, may cause dizziness, sedation and GI upset
33
tricyclic antidepressants
amitriptyline - used for chronic neuropathic pain and headache & migraine prophylaxis ADR: anticholinergic (dry mouth, constipation, urinary retention, confusion and blurred vision) hypersensitivity reactions (urticarial, photosensitivity) CVS (arrhythmias, postural hypotension, tachycardia, syncope) psychiatric (hypomania/mania, confusion, delirium) metabolic (increased appetite and weight gain, changes in blood glucose) endocrine (testicular enlargement, gynaecomastia, galactorrhoea) neurological (convulsions, dyskinesia, dysarthria, paraesthesia, taste disturbance) CI in recent MI, arrhythmias (particularly heart block), mania, agranulocytosis)
34
monoamine oxidase inhibitors
phenelzine and Isocarboxide - irreversible moclobemide - reversible ADR: get a hypertensive reaction with tyramine containing foods - cheese, pickled herring, liver, Bovril, oxo, marmite, and some red wines CI in acute confusional states, pheochromocytoma
35
serotonin syndrome
a rare but life-threatening complication of increased serotonin activity, usually rapid - occurring within minutes of taking the medication most commonly caused by SSRIs but can also be caused by TCAs and lithium - cognitive effects (headache, agitation, hypomania, confusion, hallucinations, coma) - autonomic effects (shivering, sweating, hyperthermia, HTN, tachycardia) - somatic effects (myoclonus, hyperreflexia and tremor) management - stop the offending drug and use supportive measures
36
benzodiazepines
``` long acting (>24hrs); diazepam, chlordiazepoxide short acting (<12hrs): lorazepam used for delirium tremens and status epilepticus ADR: amnesia, confusion and ataxia, dependence and respiratory depression OD = ataxia, dysarthria, nystagmus, coma and respiratory depression --> IV flumazenil ```
37
buspirone
non-sedating anxiolytic used for GAD no dependence ADR: nausea, headaches, light-headedness and dizziness
38
causes of delirium
``` "I WATCH DEATH" infection withdrawal acute metabolic trauma CNS pathology hypoxia deficiencies - B1, B3, B9, B12 endocrinopathies acute vascular toxins/ drugs heavy metals ``` 25% hyperactive, 20% hypoactive, 35% mixed management - treat cause +/- low dose haloperidol/ olanzapine
39
schizophrenia
symptoms must be present for >1 month precipitators - cannabis, adverse life events, poor coping strategies perpetuating - substance abuse, poor compliance, adverse life events, reduced social support clinical features - positive and negative symptoms
40
Schneider's first rank symptoms
- delusional perception - third person auditory hallucinations - thought interference - passivity phenomenon
41
schizophrenia positive symptoms
``` delusions hallucinations (3rd person, auditory) formal thought disorder thought interference (insertion/ withdrawal/ broadcast) passivity phenomenon ```
42
schizophrenia negative symptoms
``` avolition (reduced motivation) asocial behaviour anhedonia (reduced pleasure) alogia (poverty of speech) affect blunted attention deficits ```
43
types of schizophrenia
paranoid (positive symptoms) post-schizophrenic depression hebephrenic (thought disorganisation dominant) catatonic schizophrenia (unresponsive) simple (negative symptoms, no psychosis) undifferentiated residual (psychotic episode then 1 year of negative symptoms)
44
differentials of schizophrenia
``` drug induced psychosis schizoaffective disorder delirium dementia vitamin B12 deficiency porphyria ```
45
treatment of schizophrenia
risperidone/ olanzapine
46
depressive disorder symptoms
affective mood disorder characterised by persistent low mood, loss of pleasure +/- lack of energy accompanied by emotional, cognitive and biological symptoms depressed mood for > 2 weeks early morning wakening, weight loss, psychomotor retardation
47
treatment of depression
CBT, exercise, social support SSRIs suicide risk assessment
48
bipolar affective disorder
chronic episodic mood disorder characterised by mania followed by mania/ depression ALL cases of mania will eventually develop a depressive episode bipolar I is the most severe, bipolar II is milder rapid cycling - >4 mood swings in 1 year with no asymptomatic phases - poor prognosis
49
differentials of depression
bipolar hypothyroidism secondary to other psychiatric disorders or substance abuse normal bereavement
50
symptoms of mania
``` "I DIG FASTER" irritability distractibility/ disinhibited impaired insight/ increased libido grandiose delusions flight of ideas activity/ appetite increased sleep reduced talkative - pressure of speech elevated mood/ energy increased reduced concentration/ reckless behaviour and spending ```
51
differentials for mania
must do a CT head to rule out a SoL (can cause disinhibition), frontal lobe tumour schizoaffective disorder EUPD
52
treatment of mania
``` "CALMER" CBT/ consider hospitalisation atypical antipsychotics - olanzapine mood stabilisers - lithium ECT risk assessment ```

EOY3 (20 decks)

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