psychopharmacology Flashcards

Question

classes of

Answer 1

lithium anticonvulsants antipsychotics

Answer 2

- first line prophylaxis for bipolar disorder - moderate to severe mania - augmentation of a n antidepressant reduces aggression and suicidality plasma levels renal toxicity and hypothyroidism lithium toxicity interaction w other drugs

Answer 3

``` GI distress - reduced appetite, N/V, diarrhoea Leucocytosis Impaired renal function Tremor(fine)/ teratogenic/ thirst Hypothyroidism/ hair loss Increased weight/ fluid retention Urine (polyuria) Metallic taste ``` ``` TOXICITY Tremor (coarse) Oliguric renal failure ataXia Increased reflexes Convulsions/coma/consciousness ```

Answer 4

mild -> 1.5-2.0 - vomiting, diarrhoea, ataxia, dizziness, slurred speech, nystagmus moderate -> 2.0-2.6 - NV, anorexia, blurred vision, clinic limb movements, convulsions, delirum, syncope sever -> >2.5 generalised convulsions, oliguria, renal failure

Answer 5

ACE i AII inhi diuretics - thiazide NSAIDs

Answer 6

mania, hypomania, bipolar depression SEs GI disturbances ``` Very fat Aggression LFTs Platelets low (thrombocytopenia) Reversible hair loss Oedema (peripheral Ataxia Tremor/Tiredness/Teratogenic Emesis ``` CIs pregnancy - NT defects spina bifida hepatic dysfunction porphyria ``` Before FBC LFTs PT pregnancy weight/BMI ``` LFTs and PT first 6 months LFTs FBC weight again after 6 months and then annually continupous monitoring FBC, LFT- 6 months ``` SEs NV weight gain sedation tremor hair loss ``` teratogen - not to be used in CBAG

Answer 7

prophylaxis of bipolar disorder 3RD LINE alcohol withdrawal ``` U&Es FBC LFTs Baseline weight monitor 6 monthly ``` ``` SEs GI disturbances rash - dermatits dizzy hyponatraemia blood disorders ``` monitoring WCC after a week LFTs and U&Es CI COCP

Answer 8

bipolar depression before starting FBC, LFTs, U&Es titration medication ``` SEs GI distubrances SJS/TEN headache tremor NV sedation diz ataxia ```

Answer 9

Dopamine D2 receptor antagonists, blocking dopaminergic transmission in the mesolimbic pathways - > Extrapyramidal side-effects - > hyperprolactinaemia elderly increases risk of stroke and VTE Haloperidol Chlopromazine depot rapid tranquilisationb low potency - low affinity interact w nondopaminergic cardiotoxic, anticholinergic - sedation, hypotensionchlorpromazine

Answer 10

Act on a variety of receptors (D2, D3, D4, 5-HT) - Extrapyramidal side-effects - hyperprolactinaemia less common Metabolic effects rispieridone, planzapine, clozapine

Answer 11

tabs, IM depot, rapidly dissolving less sedating tha olanzapine high potency increased extrapyramidal SEs induce hyperprolactinaemia weight gain and sedation DOSE DEPENDENT

Answer 12

rabs IM immediate release fasting blood glucose - after one month's Mx - every 4-6 months weight gain hypertriglyceridaemia, hypercholestrolemia, hyperglycaemia hyperprolcatinaemia trasaminitis

Answer 13

tab cause transaminitis good in bipolar weight gain, hypertriglyceridaemia, hypercholestrolemia, hyperglycaemia cause orthostatic hypotension

Answer 14

regular tabs, IM formulation, depot form partial agonist low extrapyramidal SEs no QT prolongation low sedation CYPD26 (Fluoxetine and paroxetine) and 3A4 (carbamezepine and ketoconazole) interactions - adjust dose POTENTIAL INTOLERABILITY DUE TO AKATHISIA/ACTIVATION

Answer 15

reserved for Mx resistant pts ass w granulocytosis - weekly bloods for 18 weeks, fortnightly for one year and then monthly fasting blood glucose after one months and then every 4-6 months ``` weight gain excessive salivation agranulocytosis neutropenia myocarditis arrhythmias constipation urinary incintineve increased seizures sedation transaminitis dyspepsia ``` hypertriglyceridaemia, hypercholestrolemia, hyperglycaemia

Answer 16

PAD-T -> Parkinsonism -weeks or months -> Akathisia (severe restlessness) - first months - > Dystonia - sustained muscle contraction (e.g. torticollis, oculogyric crisis) - may be managed with procyclidine - within days -> Tardive dyskinesia (late onset of choreoathetoid movements, abnormal, most common is chewing and pouting of jaw) Mx - tetrabenazine LATE ONSET (years)

Answer 17

anxiety disorders

Answer 18

insomina, parasomnias, anxiety bind to GABA, reduce the excitability of neurones CNS depressant withdrawal protocols ex. ETOH withdrawal ``` SEs somnolence congitive deficits ANTEROGRADE AMNESIA - memory recall and creation of new memories is significantly impaired disinhibition tolerance dependence ``` respiratory deprression - FLUMAZENIL

Answer 19

methyphenidate - inhibit DA and NA reuptake : increasing DA and NA levels in the synaptic cleft above stimulants

Answer 20

methyphenidate - inhibit DA and NA reuptake : increasing DA and NA levels in the synaptic cleft above stimulants DA - abuse potential

Answer 21

increase Na LEVELS IN SYNAPITC CLEFT

Answer 22

schizophrenia

Answer 23

weight gain clozapine is associated with agranulocytosis (see below) hyperprolactinaemia

Answer 24

increased risk of stroke | increased risk of venous thromboembolism

Answer 25

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

Answer 26

``` antimuscarinic cant see, cant pee, cant spit, cant shit - blurred vision - urinary retention - dry mouth - constipation ``` - tremor anithistaminergic - sedation - weight gain anti-adrenergic - postural hypotension - tachycardia - ejaculatory failure endocrine/metabolic - raised prolactin - sexual dys, reuced bone mineral, mestrual disturbances, breast enlargement - --> may result in galactorrhoea - impaired glucose tolerance neuroleptic malignant syndrome: pyrexia, muscle stiffness - reduced seizure threshold (greater with atypicals) Prolonged QT interval (particularly haloperidol)

Answer 27

``` increased mood change restlessness difficulty sleeping unsteadiness sweating gastrointestinal symptoms: pain, cramping, diarrhoea, vomiting paraesthesia ```

Answer 28

- Use during the first trimester gives a small increased risk of congenital heart defects - Use during the third trimester can result in persistent pulmonary hypertension of the newborn - Paroxetine has an increased risk of congenital malformations, particularly in the first trimester during breastfeeding - paroxetine and sertraline

Answer 29

- weight or BMI - pulse - blood pressure - fasting blood glucose or glycosylated haemoglobin (HbA1c) - blood lipid profile. - ECG - monitoring esp for haloperidol and MANDATORY FOR PIMOZIDE

Answer 30

FBC, U&Es and LFTs - annually - pulse and blood pressure after each dose change - weight or BMI weekly repeat at 3, 6 months and then yearly HbA1c, lipid profile, Glucose - repeat at 3, 6 months and yearly - prolactin - at 6 months then yearly - ECG - drug/dose change and yearly - response to treatment, including changes in symptoms and behaviour - side effects and their impact on physical health and functioning - the emergence of movement disorders - adherence

Answer 31

- hyperthermia - muscle rigidity - confusion - fluctuating consciousness - autonomic instability - tachycardia - fluctuating BP Ix - increase in CK - FBC - LFTs deranged Mx - stop antipsychotic - IV fluids for renal failure - cooling - dantrolene (muscle relaxant) - bromocriptine - dopamine agonist complications - PE - renal failure - shock

Answer 32

- long acting, slow release given IM every 1-4 weeks - typical antipscychotic - flupentixol, fluphenazine atypical - aripiprazole

Answer 33

increases death

Answer 34

licensed for anxiety disorders hypnotics induce sleep

Answer 35

``` benzodiazepines barbituates buspirone beta-blockers antipsychotics ```

Answer 36

benzodiazepines low dose amitriptyline Z drugs - zopiclone, zolpidem, zaleplon

Answer 37

long acting (>24 hours) - diazepam, chlordiazepoxide short acting (<12 hours) - lorazepam, midazolam lorazepam 0 short half life increase GAB

Answer 38

- insomnia - anxiety disorders - panic/phobia - delirium terens adn alcohol detoxicification - acute psychosis - violent behaviour 2-4 weeks Reduce the dose in steps of 1/8th of the daily dose every fortnight

Answer 39

- drowsiness/light headed - confusion + ataxia - amnesia - dependence - paradoxical increase in aggression - muscle weakness - respiratory depression

Answer 40

initially to help individuals to identify and challenge their automatic negative thoughts and then to modify any abnormal underlying core beliefs.

Answer 41

states that behaviour is reinforced if it has positive consequences for the individual, and it prevents any negative consequences.

Answer 42

This is particularly useful for those with stress-related and anxiety disorders. Here, the patient is asked to use techniques causing muscle relaxation during times of stress or anxiety. The patient also learns to put themselves in situations that they find relaxing, such as walking in the fields.

Answer 43

This is often used for phobic anxiety disorders. In this therapy, an individual is gradually exposed to a hierarchy of anxiety-producing situations

Answer 44

Unlike systemic desensitization, flooding therapy involves the patient rapidly being exposed to the phobic object without any attempt to reduce anxiety beforehand. They are required to continue exposure until the associated anxiety diminishes. It is not a technique commonly used.

Answer 45

his therapy can be used for a variety of anxiety disorders but is particularly useful for OCD and phobias. Patients are repeatedly exposed to the situation which causes them anxiety (e.g. exposure to dirt) and are prevented from performing the compulsive actions which lessens that anxiety (e.g. washing their hands). After initial anxiety on exposure, the levels of anxiety gradually habituate and decline

Answer 46

This therapy is used for depressive illness. The rationale behind it is that patients avoid doing certain things as they feel they will not enjoy them or fear failure in completing them. Behavioural activation involves making realistic and achievable plans to carry out activities and then gradually increasing the amount of activity.

Answer 47

Dissociative disorders, somatoform disorders, psychosexual disorders, certain personality disorders, chronic dysthymia, recurrent depression. It is based upon the idea that childhood experiences, past unresolved conflicts and previous relationships significantly influence an individual’s current situation. It is based on psychoanalytic principles. he unconscious is explored using free association (the client says whatever comes to their mind) and the therapist then interprets these statements. Conflicts and defence mechanisms (e.g. denial, projection) are explored and the client subsequently develops insight in order to change their maladaptive behaviour. Psychoanalysis is an intense therapy that usually involves between one and five 50-minute sessions per week, possibly for a number of years. This is a much longer duration than in CBT.

Answer 48

The patient re-experiences the strong emotions from early important relationships, in their relationship with the therapist. When the current emotions are positive it is said to be positive transference and vice versa for negative emotions.

Answer 49

The therapist is affected by powerful emotions felt by the patient during therapy and reflects what the patient is feeling.

Answer 50

delivery of information to people in order to help them understand and cope with their mental illness. 1) the name and nature of their illness; 2) likely causes of the illness, in their particular case; 3) what the health services can do to help them; and 4) what they can do to help themselves (self-help)

Answer 51

form of relieving distress and is undertaken by means of active dialogue between the counsellor and the client. Behaviour and emotional life are shaped by previous experience, the current environment, and the relationships that individuals have.

Answer 52

depression and eating disorders. deals with four interpersonal problems (grief at the loss of relationships, role disputes within relationships, managing changes in relationships and interpersonal deficits) which may be causing difficulty in initiating or maintaining relationships.

Answer 53

access and process traumatic memories with the goal of emotionally resolving them. PTSD client recalling emotionally traumatic material while focusing on an external stimulus

Answer 54

``` paracetamol - N-acetylcysteine opiates - naloxone benzodiazepines - flumazenil warfarin - vitamin K beta-blockers - Glucagon TCAs - sodium carbonate organophosphates - atropine ``` Activated charcoal: for the majority of drugs taken in overdose, early use of activated charcoal (within one hour of ingestion) can prevent or reduce absorption of the drug. 􏰀 TOXBASE can be viewed for information on rarer poisons.

Answer 55

􏰀 Suicide: A fatal act of self-harm initiated with the intention of ending one’s own life. 􏰀 Attempted suicide: The act of intentionally trying to take one’s own life with the primary aim of dying, but failing to succeed in this endeavour. 􏰀 Risk assessment: In a psychiatric context, it is assessing the risk of self-harm, suicide and/or risk to others.

Answer 56

History of DSH or attempted suicide 􏰀 The rate of suicide in people who have self-harmed increases and is 50–100 times greater than in the general population. Psychiatric illness 􏰀 Including depression, schizophrenia, substance misuse, alcohol abuse and personality disorder. Childhood abuse 􏰀 History of childhood sexual or physical abuse. Family history 􏰀 Family history of suicide or suicide attempt in first-degree relatives increases the risk. Medical illness 􏰀 Physically disabling, painful or terminal illness.

Answer 57

Male gender 􏰀 Males are 3x more likely than females. Male suicide attempts are more likely to be violent and therefore successful. Age 􏰀 Highest in the age group 40 to 44 in men. Employment and financial status 􏰀 Those unemployed and who have low socioeconomic status are at higher risk. Occupation 􏰀 Vets, doctors, nurses and farmers are at higher risk of suicide. Access to lethal means 􏰀 The most lethal means of suicide are firearms, followed by hanging, strangling, and suffocation. Social support 􏰀 Low social support, living alone, institutionalized, e.g. prisons, soldiers. Marital status 􏰀 Those that are single, widowed, seperated or divorced. Recent life crisis 􏰀 e.g. Bereavement, family breakdown.

Answer 58

Preoccupation with death 􏰀 Sense of isolation and withdrawal from society. 􏰀 Emotional distance from others. 􏰀 Distraction and lack of pleasure: Often are ‘in their own world’ and suffer from anhedonia. 􏰀 Focus on the past: They dwell on past losses and defeats and anticipate no future; they voice the notion of Beck’s cognitive triad that the world would be better off without them. 􏰀 Feelings of hopelessness and helplessness.

Answer 59

Questionnaires - Tool for Assessment of Suicide Risk (TASR), Beck Suicide Intent Scale.

Answer 60

􏰀 Detect and treat psychiatric disorders. 􏰀 Urgent hospitilization under the Mental Health Act. 􏰀 Involvement of the Crisis Resolution and home treatment team.

Answer 61

Public education and discussion. 􏰀 Reducing access to means of suicide, e.g. encouraging patients to dispose of unwanted tablets, safer prescribing, safety rails at high places. 􏰀 Easy, rapid access to psychiatric care or support groups, e.g. Samaritans (who provide emergency 24 hour support). 􏰀 Decreasing societal stressors, e.g. unemployment and domestic violence. - reducing substance misuse

Answer 62

small electrical current through the brain with a view to inducing a modified epileptic seizure which is therapeutic.

Answer 63

ECT’ (Euphoric Catatonic Tearful): 1. Prolonged or severe mania (Euphoric). 2. Catatonia(Catatonic). 3. Severe depression (Tearful): 􏰀 Treatment-resistant depression. 􏰀 Suicidal ideation or serious risk to others. 􏰀 Life-threatening depression, e.g. when the patient refuses to eat or drink. NOTE: (1) Severe depression is the most common indication for the use of ECT.

Answer 64

􏰀 ECT is a procedure where written, informed consent is vital. 􏰀 For patients detained under the Mental Health Act, an independent second opinion must be obtained to determine suitability for ECT.

Answer 65

PC DAMS Peripheral Nerve palsies Cardiac arrhythmias, Confusion Dental and oral trauma Anaesthetic risks 􏰅 laryngospasm, sore throat, N+V Muscular aches and headaches Short-term memory impairment, Status epilepticus NOTE: ECT may precipitate a manic episode in patients with bipolar affective disorder.

Answer 66

Anterograde and retrograde amnesia – the deficit is greater in those who receive bilateral ECT versus unilateral ECT.

Answer 67

􏰀 MI (<3 months ago), Major unstable fracture. 􏰀 Aneurysm (cerebral). 􏰀 Raised ICP, e.g. intracranial bleed, space-occupying lesion (the only absolute contraindication). 􏰀 Stroke <1 month ago, a history of Status epilepticus, Severe anaesthetic risk (e.g. severe cardiovascular or respiratory disease). NOTE: The risks associated with ECT may be enhanced during pregnancy, in older people, and in children. Therefore clinicians should exercise particular caution in these groups.

Answer 68

aripiprazole

Answer 69

This can be used to specify conditions to which the patient is subject to on discharge, and the patient may be recalled to hospital if the conditions are not met. For example, if the patient does not comply with their medication in the community, they can be recalled to hospital regardless of whether they would otherwise currently meet the required criteria for detention under a Section of the Mental Health Act – This means clinicians needn’t wait for the patient to relapse and become risky before re-admitting them to hospital, thus avoiding relapses and possible consequences of relapses.

Answer 70

Paliperidone is a depot version of Risperidone. This is not a medication which Mr S has previously tried or had adverse reactions to. - Paliperidone does not require oral medication (Risperidone) to be taken during initiation, so is a good choice in a patient who is currently refusing all oral medications. It is initiated through loading doses of IM injections (Day 1 and Day 8 of treatment, then monthly thereafter). - If a patient remains stable for at least four months on the monthly dose of IM Paliperidone, they can instead be given a formulation which only requires administration every 3 months.

Answer 71

• Binds to voltage gated calcium channels in neurones • Increases extra-cellular amounts of the enzyme responsible for synthesis of GABA and therefore increases GABA concentrations in the brain • Reduces neuronal activity (i.e. is a CNS depressant) • Used in anxiety, neuropathic pain and epilepsy • Less potential for misuse and dependence (and tolerance) than benzodiazepines – but still misused – nickname “Budweisers” • BNF says short term use – often used indefinitely • Causes sedation and can cause weight gain

Answer 72

reduce the dose of SSRI and maybe increase it at the end of ECT

psychopharmacology Flashcards

(97 cards)