Pysch III Flashcards
(21 cards)
Describe the key symptoms of discontinuation of antidepressants [+]
Discontinuation symptoms
* increased mood change
* restlessness
* difficulty sleeping
* unsteadiness
* sweating
* gastrointestinal symptoms: pain, cramping, diarrhoea, vomiting
* paraesthesia
What is a potentially adverse effect of SSRI in pregnancy on child:
- 1st trimester
- 3rd trimester
Which antidepressant class is the drug of choice? [1]
SSRIs in pregnancy:
- 1st trimester: congenital heart disease
- 3rd trimester: PPH newborn
TCAs are preferable in pregnancy
[SSRI] has a higher incidence of discontinuation symptoms
Paroxetine has a higher incidence of discontinuation symptoms
What are key adverse effects of Lithium salts? [+]
- GI tract s-ms (nausea/diarrhoea)
- pretibial oedema
- polyuria/polydipsia
- fine hand tremor
- hypothyroidism
- Teratogenicity potential - to be avoided in pregnancy
- nephrotoxicity: polyuria, secondary to nephrogenic diabetes insipidus
LITHIUM
L - lethargy
I - diabetes insipidus
T - tremor
H - hyper/hypothyroid
I - insides (GI upset)
U - increased urine (due to DI)
M - metallic taste
Lithium Toxicity =>[] mmol/L
Toxicity =>1.4mmol/L
Describe the features of lithium toxicity [4]
coarse tremor, lethargy, marked polyuria
neurological signs:
* convulsions
* coma
renal failure
When are BDZ severly contraindicated? [3]
Why? [1]
Concomitant use of BDZ with pregabalin, alcohol opiates
- Risk of respiratory suppression
A patient takes pregabalin, x alcohol.
They go into resp suppression.
How do you treat? [2]
Rx flumazenil and naloxone
What are key symptoms of withdrawal from BDZ drugs? [5]
- anxiety, nightmares, insomnia
- perceptual problems, psychotic states, pyrexia, seizures
In longer term use - need for tapering off !!
PM:
* Insomnia
* Irritability
* Anxiety
* Tremor
* Loss of appetite
* Tinnitus
* Perspiration
* Perceptual disturbances
* Seizures
Describe how you would monitor someone who is taking lithium? [5]
when checking lithium levels, the sample should be taken 12 hours post-dose
after starting lithium levels should be performed weekly and after each dose change until concentrations are stable
once established, lithium blood level should ‘normally’ be checked every 3 months
thyroid and renal function should be checked every 6 months
What are key thyroid effects of lithium ? [2]
hypothyroidism and hyperparathyroidism
- lithium affects calcium homeostasis by altering set points for calcium-sensing receptors (CaSR) in parathyroid cells. Lithium acts as a direct agonist at the CaSR. The result is an increased set point for calcium-inhibited parathyroid hormone (PTH) secretion causing inappropriate PTH secretion relative to serum calcium levels
What are the contraindications to anti-pyschotics? [4]
Known hypersensitivity:
- Antipsychotics should not be administered to patients with a known hypersensitivity to the drug or any of its components.
Comatose state or CNS depression - Antipsychotics are contraindicated in patients suffering from a comatose state or severe central nervous system depression
.
Blood dyscrasias:
- Certain antipsychotic medications, such as clozapine, are contraindicated in individuals with blood dyscrasias due to the risk of agranulocytosis.
Pheochromocytoma and untreated narrow-angle glaucoma:
- These conditions can worsen with the use of certain antipsychotics like thioridazine.
Which patients should you be cautious with prescribing anti-pyschotics to? [5+]
Elderly patients with dementia-related psychosis:
- There is an increased risk of cerebrovascular adverse events and mortality in this population. Use of antipsychotics should be carefully evaluated against potential risks.
- In particular, atypical antipsychotics have been associated with an elevated risk of stroke and transient ischemic attack in elderly patients.
Parkinson’s disease and Lewy body dementia:
- Patients may exhibit sensitivity to the extrapyramidal side effects of antipsychotics.
Epilepsy:
- Antipsychotics may lower seizure threshold; caution should be exercised with patients with a history of seizures or EEG abnormalities.
Cardiovascular disease:
- Antipsychotics, especially atypical ones, may cause QT prolongation and postural hypotension. Regular monitoring of ECG is recommended in patients with cardiovascular disease.
Liver and renal impairment:
- Dose adjustments may be necessary due to altered drug metabolism and elimination.
What are the EPSE of antipyschtoics? [4]
Parkinsonism
Acute dystonia: sustained muscle contraction (e.g. torticollis, oculogyric crisis)
Akathisia (severe restlessness)
Tardive dyskinesia (late onset of choreoathetoid movements, abnormal, involuntary, may occur in 40% of patients, may be irreversible, most common is chewing and pouting of jaw)
What are the non-EPSE of antipyschtics? [+]
When antipsychotics are used in elderly patients:
* Increased risk of stroke
* Increased risk of venous thromboembolism
Other side-effects
* Antimuscarinic: dry mouth, blurred vision, urinary retention, constipation
* Sedation, weight gain
* Raised prolactin: galactorrhoea, impaired glucose tolerance
* Neuroleptic malignant syndrome: pyrexia, muscle stiffness
* Reduced seizure threshold (greater with atypicals)
* Prolonged QT interval (particularly haloperidol)
What are the lab. monitoring needed when giving anti-pyschotics? [5]
Blood tests
- Baseline full blood count (FBC), liver function tests (LFTs), renal function tests (RFTs), lipid profile and glucose levels are recommended before initiating treatment. These should be monitored throughout treatment according to British National Formulary guidelines.
- Clozapine requires more frequent monitoring including weekly FBCs for the first 18 weeks of treatment.
ECG: Baseline ECG should be performed in patients with cardiovascular risk factors before initiating antipsychotics, especially those known to prolong the QT interval. Regular monitoring is advised for these patients.
Body Mass Index (BMI):
- Patients on antipsychotics, particularly atypical ones, are at risk of weight gain. Monitor BMI regularly and provide lifestyle advice as necessary.
Prolactin levels:
- Antipsychotics can cause hyperprolactinaemia leading to symptoms such as galactorrhoea, amenorrhoea and sexual dysfunction. Monitor prolactin levels if these symptoms are reported.
For moderate/severe OCD, [] may be used as an alternative first-line drug treatment to an SSRI if the person prefers [] or has had a previous good response to it, or if an SSRI is contraindicated
For moderate/severe OCD, clomipramine may be used as an alternative first-line drug treatment to an SSRI if the person prefers clomipramine or has had a previous good response to it, or if an SSRI is contraindicated
A 75-year-old woman presents to the emergency department with new onset confusion. She has a past medical history of depression, for which she takes sertraline, and oesophagitis for which she takes omeprazole. She also has a diagnosis of type 2 diabetes. Her dose of sertraline was last increased two weeks ago. Her physical observations are within normal parameters.
What would you perform first to identify the cause of this patient’s confusion?
Urea and electrolytes
- The BNF advises when starting a serotonin specific reuptake inhibitor (SSRI) to ‘observe all people taking antidepressants for signs of hyponatraemia.
How often should you monitor for hyponatraemia in U&Es in SSRI tx? [3]
For people at high risk, measure the serum sodium level before starting treatment, 2-4 weeks after starting treatment and every 3 months thereafter.’
A 45-year-old female complains of lower back pain, constipation, headaches, low mood, and difficulty concentrating.
Her presentation is likely due to which of the following medications?
Clozapine
Quetiapine
Olanzapine
Imipramine
Lithium
Long-term lithium use can result in hyperparathyroidism and resultant hypercalcaemia
