Rapid Tranquillisation & Mood Stabilisers Flashcards
(29 cards)
What is the first step in treating someone acutely psychotic?
- Always talk to patient and de-escalate first line
- Try non-drug techniques first, assess the level of risk - is sedation necessary?
What medications can be used in rapid tranquillisation?
1) Lorazepam
2) Haloperidol ± promethazine
3) Olanzapine (also risperidone, aripiprazole)
How would you give medication for rapid tranquillisation first line?
Oral (if pt is willing)
Why is IM last resort?
The patient would need to be restrained
What would you do next if that patient won’t calm down from talking?
Try and convince them to take medication orally
When should you use lorazepam for rapid tranquillisation (avoid antipsychotics)?
1) Dementia & delirium
2) Parkinson’s
3) Lewy body dementia
When would you use antipsychotic for rapid tranquillisation (haloperidol)?
1) If pt already takes an antipsychotic they might respond better to haloperidol
2) If don’t want to cause respiratory depression (low RR?)
What medications should you have on hand when doing rapid tranquillisation?
Flumazenil and procyclidine
Why should you not give antipsychotics to patients with Parkinson’s or LBD?
Bc they are dopamine blockers
What should you do for patients if giving them rapid tranquillisation?
- Check their obs
- Do ECG if giving antipsychotic
- Monitor for side effects
When should you not use medication for rapid tranquillisation?
Delirium
When would you use IM medication dose of medication for rapid tranquillisation?
After an hour of waiting for oral dose to work and continuing non-drug approaches - use the same drug
What drugs can be used as mood stabilisers?
1) Lithium
2) Anticonvulsants
What are examples of anticonvulsants that can be used as mood stabilisers?
- Carbamazepine
- Sodium valproate
- Lamotrigine
What can mood stabilisers be used to treat?
- Bipolar disorder lithium long term
- Treatment resistant depression/anxiety
- Personality disorders
Why does lithium cause cardiac, renal and thyroid problems?
Lithium deposits can cause cardiomyopathy, thyroid problems, or decline in renal function (stuck in glomerular apparatus)
What do you need to do if eGFR is really low on lithium?
Have to come off it otherwise need renal replacement
Why does lithium need close monitoring?
It has a narrow therapeutic window
How do you monitor lithium levels?
Need regular serum levels (aim 0.4-1.0 mmol/L)
- Start with weekly serum lithium levels
- Then 3 monthly when stable
- Then 6 monthly
What should you measure before starting lithium?
Baseline cardiac, renal and thyroid function
What should you measure every 6 months other than lithium levels when taking lithium?
- BMI
- eGFR
- TFTs
- U&Es
What level is lithium toxicity?
Serum lithium 2.0-3.0
What are the signs and symptoms of lithium toxicity?
- Drowsiness
- Confusion
- Ataxia
- Coarse tremor
- Muscle weakness
- Seizures
What are adverse effects of lithium?
- N&V
- Anorexia
- Diarrhoea
- Fine tremor
- Dry mouth
- Polydipsia & polyuria
- Hypothyroidism
- Weight gain
