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College Royal Takser > CANMAT > Flashcards

CANMAT Flashcards

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1
Q

MDD + ADHD: first line pharmacoTx

A

Bupropion
antidepresseur + long life stimulant
antidepresseur + CBT

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2
Q

MDD + ADHD : 2nd line pharmacoTx

A

desipramine
nortriptylline
Effexor

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3
Q

BD + ADHD : 1st line pharmacoTx

A

Bupropion

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4
Q

BD + ADHD: 2nd line pharmacoTx

A

methyphenidate
modafinil
CBT

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5
Q

mood disorder + personnality disorder: management

A

no level of evidence
screen PD for MD and vise versa
assess in resitant MD
reassess after MD episode
collateral Hx for co-occurence + longitudinal Hx
Tx of both, Axis I first

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6
Q

post-stroke Depression; CANMAT recommendations

A

1st line - Citalopram (level 2)
2nd line - Nortriptylin (level 1)
3rd line - Amitryptyline - Trazodone - ECT

avoid
Paroxetine (inh CYP 2D6)
Fluoxetine (inh CYP 1A2, 2D6, 3A4, 2C)
Antipsychotics

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7
Q

MD + CVD: recommendations

A

screen for Depression
Treat with SSRI/SNRI (level 2)

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8
Q

prévalence de syndrome métabolique chez MD

A

20-65%

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9
Q

obesity management recommendations

A

1st line: Metformin
2nd line: Topiramate (in BD)

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10
Q

Bulimia management

A

in BD: Lamotrigine

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11
Q

Précautions chez Pts avec hypertension

A

effet des psychotropes sur TA

SSRI - neutral
SNRI - increase
bupropion - increase
mirtazapine / trazodone / nefazodone - neutral
MAOI - decrease
Li/antipsychotics/mood stabilizers - neutral

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12
Q

mood disorders and cancer: recommendations

A

no specific recommendations for phramacoTx or PsychoTx

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13
Q

mood disorders and HIV: recommendations

A

try SSRI first (fluoxetine, paroxetine, sertraline, citalopram, escitalopram) Citalopram et escitalopram - less drug-drug interaction with HAART

then TCA

stimulants (level 2): dextroamphetamine, methylphenidate

psychoTX (CCT, IPT, supportive, group)

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14
Q

recommandations concernant ostéoporose

A

pts >40 ans avec 2ans d’antidepresseur - screen bone density

Pts sur long term mood stabilizer - screen

Pts >50 ans - Vit D

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15
Q

Mood disorder + epilepsy: recommandations

A
  1. control seizures
  2. post surgery Pts (anterotemoral lobectomy) are at risk of D
  3. avoid AEDs with depressogenic properties (GABA with no serotoninergic effect) - lower dose or switch to AED with mood stabilizer effect - lamictal, epival, carbamazepine
  4. if antidepressant - diminuer CYP interaction - citalopram, escitalopram, sertraline; if failed - effexor; TCA and MAOI - only in resistant cases
  5. lamotrigine en monoTx or adjunct
  6. CBT + antidepresseur
  7. ECT
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16
Q

CANMAT MAB et comorbidité 2012

A

1 line: Gabapentin, quetiapine
2 line: epival, Lamotrigine, IRSR, olanzapine, Olanzapine - Fluoxetine
3 line: Li, Risperdal, aripiprazole, pregabaline, benzos

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17
Q

CAT 1ere ligne en depression

A

modéré-sévère:
pharmaco (cipralex, celexa, zoloft, effexor, remeron, fluvoxamine, paroxétine, desvenlafaxine, duloxetine, bupropion, vortioxétine)
adjuvant 1ere ligne - aripiprazole, quetiapine, risperidone

legère:
psychoTx (aigue - CBT, IPT, BA; maintien - CBT, MBCT)
exercice

EDC saisonier - luminoTx

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18
Q

effets secondaires des AD

A

QT, chute, fracture hypoNa, risque saignements GI

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19
Q

pharmacoTx selon specificateur de la D

A

catatonie - benzo
psychotique - ajouter AP
mixte - lurazidone, ziprazidone
dysfonction cognitive - vortioxetine, bupropion, duloxetine,
alteration sommeil - agomelatine, mirtazapine, seroquel, trazodone

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20
Q

duree Tx AD

A

6-9 mois apres resolution Sx
2 and et plus si reccurente, sévère, comorbidités, Sx résiduels

21
Q

neurostimulation: Tx de 1ere ligne

A

ECT - 1ere ligne pour aigu et maintien
rTMS - 1ere ligne pour aigu si Pt a échoué Tx par AD

22
Q

EDC en grossesse/allaitement - 1ere ligne

A

TCC ou IPT

23
Q

EDC en grossesse - 2eme ligne

A

Celexa, Cipralex, Zoloft

24
Q

EDC allaitement - 2eme ligne

A

Celexa, Cipralex, Zoloft
combinaison ISRS + psychoTx

25
Q

EDC perimenopause - 1ere ligne

A

Desvenlafaxine
TCC

26
Q

EDC perimenopause - 2eme ligne

A

patch estrogene
ISRS, nortriptyline, remeron, effexor

27
Q

depression tardive: 1ere ligne

A

Duloxétine, remeron, nortriptyline, bupropion, citalopram, escitalopram, effexor, desvenlafaxine, sertraline, vortioxétine

28
Q

depression tardive: 2eme ligne

A

switch: nortriptyline, moclobemide, phenelzine, quetiapine, trazodone, bupropion

combinaison: abilify, Li, methylphenidate

29
Q

depression tardive: 3eme ligne

A

switch: amitriptyline, imipramine
combinnaison: ISRS ou IRSN avec bupropion

30
Q

MAB: gestion agitation 1ere ligne

A

ALLO:
Aripiprazole
Lorazepam
Loxapine
Olanzapine

31
Q

MAB: gestion agitation 2eme ligne

A

Haldol seul ou combiné avec midazolam ou promethazine
Risperidone
Ziprazidone
Azenapine

32
Q

Manie ou depression MAB: mesures générales

A

EVALUER
dangerosité
autocritique
adherence à la Tx
comorbidités
support social

R/O
organicité ou consommation

CESSER antidepresseur
CESSER psychostimulants

+ en depression: psychoeducation et stratégies cpt, PsychoTx (TCC, FFT, IPSRT)

33
Q

Manie: Tx 1ere ligne

A

MONO
Li, quetiapine, divalproex, asenapine, aripiprazole, paliperidone, risperidone, cariprazine

COMBO
quetiapine + Li/DVP
aripiprazole + Li/DVP
Risperidone + Li/DVP
asenapine + Li/DVP

34
Q

Manie: 2eme ligne

A

olanzapine, carbamazepine
olanzapine + Li/DVP
Li+DVP
ziprazidone
haldol, ECT

35
Q

Manie : non recommandé

A

gabapentin, lamorigine, omega3, topiramate

36
Q

Manie avec détresse anxieuse: Tx

A

DVP, quetiapine, olanzapine, carbamazepine

37
Q

Manie avec char mixtes

A

antipsychotique atypique + DVP ou COMBO

38
Q

MAB Depression: TX 1ere ligne

A

quetiapine
lurasidone mono ou + Li/DVP
Lamotrigine (mono ou adj)

39
Q

MAB depression: 2eme ligne

A

DVP
SSRI/bupropion(adj)
ECT
cariprazine
Olanzapine + Fluoxétine

40
Q

MAB maintien : 1ere ligne

A

MONO
Li, quetiapine, divalproex, asenapine, lamotrigine, aripiprazole

COMBO
quetiapine + Li/DVP
aripiprazole + Li/DVP

41
Q

MAB maintien : 2ere ligne

A

olanzapine, risperidone consta, carbamazepine, paliperidone
lurasidone + Li/DVP
ziprazidone + Li/DVP

42
Q

MAB maintien: type stabilisateur selon characteristiques Pt

A

Li - gold standard, hx fam MAB, faible comorbidité, pattern classique
Lamotrigine - polarité depressive et comorbidité anxieuse
quetiapine - mixtes

43
Q

MAB type 2 depression: 1ere ligne

A

quetiapine

44
Q

MAB type 2 depression: 2ere ligne

A

Li
lamotrigine, bupropion (adj)
sertraline, effexor
ECT

45
Q

MAB type 2 maintien: 1ere ligne

A

Quetiapine
Li
Lamotrigine

46
Q

MAB type 2 maintien: 2ere ligne

A

effexor

47
Q

recommandations MAB chez FEMMES en cas de contraception, Préconception

A

si stable 4-6 mois à faible risque de rechute - considerer d/c

si Rx - dose minimale

attention à la contraception - interaction COC avec carbamazépine, topiramate et lamotrigine

48
Q

MAB et grossesse

A

depistage MAB en grossesse et postpartum - Edinburgh

si Tx d/c en grossesse - 87% risque de reccurence

si Tx maintenu - 37%

Epival tératogène

chmt volume durant grossesse - ajuster dose

49
Q

Tx MAB postpartum

A

reccurénce 66% si d/c
23% avec Rx

allaitement - quetiapine et olanzapine le mieux

College Royal Takser (10 decks)

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