Exam 2 Therapeutics Flashcards
What is the first line treatment for mania patients WITHOUT psychosis?
valproate
(can use lithium if patient previously responded well)
add BZD short term for agitation
What should you give a pregnancy women with mania?
lithium (avoid valproate)
What medications should you AVOID with acute mania?
carbemazepine, gabapentin, lamotrigine, topiramate
What is the first line tx for mania pts WITH psychosis?
lithium + APS + valproate
(stop or lower anti depressant dose if they are currently taking)
APS: olanzapine, quetiapine or risperdone
What is maintenance therapy for BPD?
continue meds that helped get out of acute mania
monotherapy is goal with: lithium valproate quetiapine or lamotrigine
What mood stabilizer is shown to reduce suicide?
lithium
What are SE of lithium?
causes tremor (has low TI)
What are SE of valproic acid?
hepatotoxicity
What medication is good to prevent rapid cycling in BPD?
valproate
What are SE of quetiapine?
tardive dyskinesia, metabolic syndrome, weight gain, sedation, orthostatic HTN
What are SE of lamotrigine?
stevens johnson syndrome
What are SE or risperidone?
aggression, increased risk of stroke, cardiac events in those with dementia
What are treatment options for tobacco use?
varenicline, buproprion, nicotine replacement therapy
What is MOA of varenicline? SE?
binds to nicotinic ACH receptors so you don’t get the benefits of smoking anymore
SE: nausea & sleep disturbance
What is varenicline dosing?
start 0.5 QD x 3 d then 0.5 BID x 4 d then 1 mg BID x12-23 wk
What are SE of buproprion? Cautions?
insomnia and dry mouth
caution with co-administration of nicotine and suicide risk (but good if depressed & a smoker!)
What is dosing of buproprion?
150 mg p-o BID
What is dosing of nicotine patch?
23 mg QAM remove at night then gradually reduce
What is dosing of nicotine gum & when do you need higher dose?
2 or 4 mg
4 if >1ppd, cig 1st thing QAM, severe withdrawal or failed lower dose
What is dosing of nicotine nasal spray?
0.5 mg per spray 2-10 per hr
What meds can be used to help obese patients lose weight?
orlistat (5.7 lb wt loss)
phentermine and topirmate
Metformin (OFF LABEL)
better tx is healthy eating and phys activity
Treatment for delirium
Treat the cause
re-orient, reassure, remove restraints and urinary catheters
quiet environment
haloperidol if need gentle sedation
Tx of psychosis?
verbal reassurance, cooling down
Haloperidol is necessary
Then LT will need APS or depot haloperidol
What medications are good for chemical restraints?
APS-Haldol 5 mg IM (repeat every 20-30 min(
Benzos: Lorezepam 1-2 mg IV/IM (repeat every 10-30 min)
What is tx of alcohol intoxication?
banana bag, treat injuries, prevent alcohol withdrawal (treat pphx with benzo or release early enough to drink)
Tx of opiate intoxication?
If breathing-ride it out
If not-Naloxne (Narcan) IM or IV0.4 mg-2mg
What should you never give to a pt presenting with sx of cocaine use
beta blocker
Tx for meth toxicity
ABCs!
Correct metabolic imbalances, treat agitation with benzodiazepines and haloperidol
Assess for MI, renal failure, rhabdomyolysis, seizures, hepatic dx and treat
What is recommended for patients with ED to help with skeletal complications?
Calcium and vitamin D
Why should typical APS be avoided in AN?
risk of QT prolongation
Tx for PD
Difficult to treat, especially because few patients are aware they need help. The disorders tend to be chronic and lifelong.
Pharmacologic treatment – limited usefulness unless treating comorbid mental conditions (MDD)
Antipsychotics sometimes used for schizotypal
SSRI for some symptoms of borderline personality (suicidality)
Benzodiazepines before social situations for avoidant personality
Tx for Bipolar I, II and cyclothymic
Mood stabilizing medications to decrease risk of relapse:
Lithium
Carbamazepine or valproic acid
Atypical antipsychotics
Psychotherapy
ECT (safe in pregnancy)
Avoid antidepressants
Tx for body dysmorphia
Vigorous exercise and sleep
CBT/psychotherapy
Some require SSRI, TCA, SNRI, or migraine therapies
Tx for illness anxiety
Educate, CBT, medicate anxiety
Tx for conversion d/o
Hypnosis, psychotherapy, physical therapy, expect recovery
Tx for factitious d/o
Confront, use CBT
Tx for OCD
Behavior and psychotherapy
SSRI at higher doses (fluvoxamine) than required for depression, and response takes longer
Chlorimipramine (TCA)
Tx for body dysmorphic d/o
CBT
SSRI
Those with delusional form, try adding a 2nd gen antipsychotic
Tx for hoarding
Might benefit from SSRIs, CBT.
Challenging treatment
Tx for Trichotillomania
Habit reversal CBT, hypnosis, wigs
SSRI or chlormipramine (TCA)
Topical steroids if itching prompts pulling out
Tx for Excoriation
Not well established
Usually treated similar to trichotillomania
SSRI + habit reversal
Tx for AN
CBT, Maudsley family therapy (give responsibility to parents)
APS (olanzapine or risperidone or quetiapine) to ↑ weight gain and ↓ anxiety-monitor lipids and hypotension
No antidepressants
Tx for BN and binge eating d/o
CBT
SSRI (fluoxetine) to ↓ binge episodes
Stimulants (vyvanse) to ↓ appetite-need to closely follow BP and HR
Tx of delirium
Treat the cause- re-orient, quiet environment, reassure, remove restraints (restraints, benzo only if necessary) and urinary catheters
Stop CNS affecting meds (including antiAcH)
haloperidol if need gentle sedation
Tx of major neurocognitive d/o
Most causes/subtypes are irreversible
Admit to hospital for eval of aggression, wandering, psychosis, depression, SI, rapid wt loss, acute worsening
Tx of neurocog due to alzheimers
Cholinesterase inhibitors (donepezil, rivastigmine, galantamine)
Memantine - NMDA receptor blocker - “cognitive enhancer”
Careful use of low dose APS or mood stabilizers for hostility, aggression
Tx of psychosis
verbal reassurance, cooling down
Haloperidol if necessary
Then LT will need APS or depot haloperidol
Tx of Alcohol Intoxication
Banana bag, benzodiazepine (for seizure prevention)
Tx of opiate Intoxication
If breathing-ride it out
If not-Naloxne (Narcan) IM or IV0.4 mg-2mg
Tx of cocaine Intoxication
If HTN & tachycardiad-benzodiazepine
If coronary vasospasm-ASA and nitro
NEVER BETA BLOCKER
Tx of meth Intoxication
ABCs!
Correct metabolic imbalances, treat agitation with benzodiazepines and haloperidol
