Lithium (MRCPsych course)

 MRCPsych course

Adverse Effects Of Lithium

Early lithium adverse effects:

4 T’s:

• Thirsty
• Tired
• Tremor (fine)
• Taste (metallic)

Long term lithium adverse effects:

•  Diabetic insipidus
•  Hypothyroidism
•  Hyperparathyroidism
•  Weight gain
•  Coarsening & Hair loss
•  Leucocytosis
•  Hypokalaemia ( maybe associated with arrhythmias & T wave flattening (ECG)

Toxic ( >1.5 mmol/l)

CAT Got your tongue, ears & eyes

• Cerebellar syndrome *(refer below)
• Anorexia
• Tremor (Coarse)
• Gut/ GIT symptoms (diarrhoea, vomiting)
• Tongue – dysarthria
• Ears – tinnitus
• Eyes – Blurred vision

         Hyperreflexia

*Cerebellar syndrome

VANISHED

• Vertigo
• Ataxia
• Nystagmus
• Intentional tremor
• Speech staccato
• H
• Exaggerated broad-based gait
• Dysdiadokinesia

Extreme toxicity (>2.5 mmol/l)

6 C’s:

• Confusion
• Convulsion
• Circulatory failure
• Collapse
• Coma
• Corpse (death)

Teratogenicity : (especially use during 1^st trimester)- Ebstein’s anomaly

Factors that can lead to Dangerous toxicity:

4D’s

• Diuretics
• Dietary Deficiency of Na+
• Dehydration
• Drugs :

o   NSAIDs,

o   Acetazolamide

o    Metronidazole (high risk of Li+ toxicity during co-administration & for up to 3 weeks afterwards)

o   High doses haloperidol (>20mg/day)

 MRCPsych course

Benzodiazepines (MRCPsych course)

 MRCPsych course

Adverse Effects Of Benzodiazepines

5 D’s

• Dependence
• Drowsiness (daytime)
• Dysarthria
• Diplopia
• Disorientation: ‘paradoxical reaction’ leading to hyperexcitability or Delirium (esp. In elderly)

Benzodiazepines withdrawal symptoms (Abrupt cessation after development of dependence):

10 S’s

•   Stress
•   Skinny
•   Strange experiences (hypersensitivity derealisation/depersonalization, transient psychosis/perceptual distortions)
•   Sadness
•   Sleep disturbance
•   Salivation
•   Sweating
•   Sexual disinterest
•   Shaking  (tremor)
•   Seizures

 MRCPsych course

Psychopharmacology MAOIs MRCPsych course

 MRCPsych course

 

Food/Substances that need to be avoided when taking MAOIs (Monoamine oxidase inhibitors):

ABCDEFG

Alcohol – chianti, red wines, beer

Broad bean pods

Cheeses (except Cream and Cottage cheeses)

Drugs (please refer below*)

Extracts of mea and yeast (Marmite, Bovril)

Fish, especially smoked or pickled (fresh fish is relatively safe)

Game

*Drugs

ABCDEFGHI

Antidepressants (TCA)

Barbiturates

Coccaine, pethidine and other narcotics

L-Dopa

Epherine

Fenfluramine

General anaesthetics

Anti-Hypertensives

Insulin

 MRCPsych course

Cytochrome P450 system MRCPsych course

MRCPsych course

P450 inhibitors

 SICKFACES.COM Group 

(You definitely don’t want to join this group as it inhibit your spirits)

 

 

Sodium valproate/SSRIs (except Escitalopram)

Isoniazide

Cimetdine/CPZ

Ketonazole

Fluconazole

Alcohol  binge-drinking

Chloramphenicol

Erythromycin (macrolides)

Sulfonamides

Ciprofloxacin

Omeprazole

Metronidazole

Grapefruit juice

                                             P450 enzyme

          Substrate + P450 inhibitor --------------------->  Increased levels of substrate in plasma

                                                        1A2 enzyme

E.g.  Clozapine + Fluvoxamine    ---------------------> Increased levels of Clozapine in plasma

P450 inducers

BullShit CRAP GPS (induces my rage!)

Barbiturates

St. John’s wort

Carbamazepine

Rifampicin

Alcohol (chronic)

Phenytoin

Griseofulvin

Phenobarbital

Sulphonylureas/Smoking

                                             P450 enzyme

          Substrate + P450 inducer --------------------->  Reduced levels of substrate in plasma

                                                       1A2 enzyme

E.g.  Clozapine + Smoking      -----------------------> Reduced levels of Clozapine in plasma

 MRCPsych course