Random Flashcards
Three features of autism required for diagnosis?
Impaired social relationships Ritualistic and compulsive phenomena Global impairment of language and communication
What screening tool is used to diagnose post natal depression?
Edinburgh Postnatal Depression Scale >13 is positive Important to distinguish between baby blues, post natal depression and puerperal psychosis Baby Blues : 3-7 days, anxious fearful and irritable. Health visitor PND: 1/12-3/12, resembles depression. CBT, SSRIs (preferable paroxetine due to low milk/plasma ratio. Avoid fluoxetine due to half life)
Postnatal depression: Best Drug Pick Worst Drug Pick
Paroxetine - Low milk/plasma ratio - SSRI Fluoxetine - Long half life - SSRI
Which SSRI has a the highest incidence of discontinuation syndrome ?
Paroxetine When stopping SSRI the dose should be gradually reduced over a 4 week period (except with fluoxetine).
What anti depressant is recommended for patients on warfarin or heparin?
Mirtazapine
Features of PTSD
Re experiencing Emotional Numbing Avoidance of resembling situstions Hyperarousal Depression Substance Misuse Anger Somatisation
How many symptoms are required from the DSM - IV criteria to be diagnosed with depression?
- Mild, moderate and severe refer to the interference with functioning PHQ9 - 9 questions marked 0-3 each. Not depressed: 0-4 Mild: 5-9 Moderate: 10-14 Moderately Severe: 15-19 Severe: 20-27 HAD - 14 questions each 0-3 Normal : 0-7 8-10 : Borderline 11+ : Depressed/Anxious
Drug Management for Alzheimer’s: mild - moderate: Moderate - Severe:
mild - moderate: ACHesterase Inhibitors (Donepezil, Galantamine and Rivastigmine) Moderate - Severe: NMDA receptor antagonist (Memantine)
Pharmacological Management for Sleep Paralysis?
Clonazepam
Therapeutic Drug Monitoring Timing: How long after each of these drugs is administered should the dose be measured? Lithium, Cyclosporine, Digoxin, Phenytoin
Lithium: 12 hours post dose. Cyclosporine: Trough levels immediately before dose Digoxin: 6 hours post dose Phenytoin: If adjusting dose, suspected toxicity or non adherence is suspected then the TROUGH dose should be checked immediately before the next dose
What is the therapeutic Range for lithium?
0.4-1.0 mmol/l Taken 12 hours after dose
Adverse effects of clozapine
Agranulocytosis Neutropenia Reduced seizure threshold
What seasons are suicide more common in?
Spring and early summer
What term is given to a strong belief that regarding someone of a higher status being in love with them?
Erotomania
What are features of catatonic schizophrenia?
Motor immobility Strange movements excessive negativism
Features of EPS following administration of antipsychotic medication - what drug?
Procyclidine - anti muscarinic agent
Somatisation Disordee
Multiple physical symptoms 2 years Refuses to accept reassurance or negative test results 6 or more symptoms from 14
Conversion disorder
motor or sensory loss non-conscious feigning of symptoms
Safest antidepressant post-MI
Sertraline
SSRIs contraindicated in people with long QT risk or taking other QT prolonging drugs
Escalitopram Citalopram
SSRI of choice in adolescents and children
Fluoxetine
Which SSRIs have a higher rate of drug reactions (2)
Paroxetine Fluoxetine
NICE guidelines on giving SSRI alongside NSAID
AVOID but if you have to give alongside PPI
NICE guidelines on giving SSRIs alongside warfarin or heparin
AVOID and give mirtazapine