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Human Behavior > Exam 2 Therapeutics > Flashcards

Exam 2 Therapeutics Flashcards

1
Q

What is the first line treatment for mania patients WITHOUT psychosis?

A

valproate
(can use lithium if patient previously responded well)

add BZD short term for agitation

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2
Q

What should you give a pregnancy women with mania?

A

lithium (avoid valproate)

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3
Q

What medications should you AVOID with acute mania?

A

carbemazepine, gabapentin, lamotrigine, topiramate

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4
Q

What is the first line tx for mania pts WITH psychosis?

A

lithium + APS + valproate
(stop or lower anti depressant dose if they are currently taking)

APS: olanzapine, quetiapine or risperdone

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5
Q

What is maintenance therapy for BPD?

A

continue meds that helped get out of acute mania

monotherapy is goal with:
lithium
valproate
quetiapine
or lamotrigine
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6
Q

What mood stabilizer is shown to reduce suicide?

A

lithium

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7
Q

What are SE of lithium?

A

causes tremor (has low TI)

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8
Q

What are SE of valproic acid?

A

hepatotoxicity

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9
Q

What medication is good to prevent rapid cycling in BPD?

A

valproate

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10
Q

What are SE of quetiapine?

A

tardive dyskinesia, metabolic syndrome, weight gain, sedation, orthostatic HTN

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11
Q

What are SE of lamotrigine?

A

stevens johnson syndrome

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12
Q

What are SE or risperidone?

A

aggression, increased risk of stroke, cardiac events in those with dementia

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13
Q

What are treatment options for tobacco use?

A

varenicline, buproprion, nicotine replacement therapy

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14
Q

What is MOA of varenicline? SE?

A

binds to nicotinic ACH receptors so you don’t get the benefits of smoking anymore

SE: nausea & sleep disturbance

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15
Q

What is varenicline dosing?

A

start 0.5 QD x 3 d then 0.5 BID x 4 d then 1 mg BID x12-23 wk

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16
Q

What are SE of buproprion? Cautions?

A

insomnia and dry mouth

caution with co-administration of nicotine and suicide risk (but good if depressed & a smoker!)

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17
Q

What is dosing of buproprion?

A

150 mg p-o BID

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18
Q

What is dosing of nicotine patch?

A

23 mg QAM remove at night then gradually reduce

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19
Q

What is dosing of nicotine gum & when do you need higher dose?

A

2 or 4 mg

4 if >1ppd, cig 1st thing QAM, severe withdrawal or failed lower dose

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20
Q

What is dosing of nicotine nasal spray?

A

0.5 mg per spray 2-10 per hr

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21
Q

What meds can be used to help obese patients lose weight?

A

orlistat (5.7 lb wt loss)
phentermine and topirmate
Metformin (OFF LABEL)

better tx is healthy eating and phys activity

22
Q

Treatment for delirium

A

Treat the cause

re-orient, reassure, remove restraints and urinary catheters

quiet environment

haloperidol if need gentle sedation

23
Q

Tx of psychosis?

A

verbal reassurance, cooling down

Haloperidol is necessary

Then LT will need APS or depot haloperidol

24
Q

What medications are good for chemical restraints?

A

APS-Haldol 5 mg IM (repeat every 20-30 min(

Benzos: Lorezepam 1-2 mg IV/IM (repeat every 10-30 min)

25
Q

What is tx of alcohol intoxication?

A

banana bag, treat injuries, prevent alcohol withdrawal (treat pphx with benzo or release early enough to drink)

26
Q

Tx of opiate intoxication?

A

If breathing-ride it out

If not-Naloxne (Narcan) IM or IV0.4 mg-2mg

27
Q

What should you never give to a pt presenting with sx of cocaine use

A

beta blocker

28
Q

Tx for meth toxicity

A

ABCs!

Correct metabolic imbalances, treat agitation with benzodiazepines and haloperidol

Assess for MI, renal failure, rhabdomyolysis, seizures, hepatic dx and treat

29
Q

What is recommended for patients with ED to help with skeletal complications?

A

Calcium and vitamin D

30
Q

Why should typical APS be avoided in AN?

A

risk of QT prolongation

31
Q

Tx for PD

A

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

32
Q

Tx for Bipolar I, II and cyclothymic

A

Mood stabilizing medications to decrease risk of relapse:

Lithium
Carbamazepine or valproic acid
Atypical antipsychotics

Psychotherapy
ECT (safe in pregnancy)

Avoid antidepressants

33
Q

Tx for body dysmorphia

A

Vigorous exercise and sleep

CBT/psychotherapy

Some require SSRI, TCA, SNRI, or migraine therapies

34
Q

Tx for illness anxiety

A

Educate, CBT, medicate anxiety

35
Q

Tx for conversion d/o

A

Hypnosis, psychotherapy, physical therapy, expect recovery

36
Q

Tx for factitious d/o

A

Confront, use CBT

37
Q

Tx for OCD

A

Behavior and psychotherapy

SSRI at higher doses (fluvoxamine) than required for depression, and response takes longer

Chlorimipramine (TCA)

38
Q

Tx for body dysmorphic d/o

A

CBT

SSRI

Those with delusional form, try adding a 2nd gen antipsychotic

39
Q

Tx for hoarding

A

Might benefit from SSRIs, CBT.

Challenging treatment

40
Q

Tx for Trichotillomania

A

Habit reversal CBT, hypnosis, wigs
SSRI or chlormipramine (TCA)

Topical steroids if itching prompts pulling out

41
Q

Tx for Excoriation

A

Not well established

Usually treated similar to trichotillomania
SSRI + habit reversal

42
Q

Tx for AN

A

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

43
Q

Tx for BN and binge eating d/o

A

CBT

SSRI (fluoxetine) to ↓ binge episodes

Stimulants (vyvanse) to ↓ appetite-need to closely follow BP and HR

44
Q

Tx of delirium

A

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

45
Q

Tx of major neurocognitive d/o

A

Most causes/subtypes are irreversible

Admit to hospital for eval of aggression, wandering, psychosis, depression, SI, rapid wt loss, acute worsening

46
Q

Tx of neurocog due to alzheimers

A

Cholinesterase inhibitors (donepezil, rivastigmine, galantamine)

Memantine - NMDA receptor blocker - “cognitive enhancer”

Careful use of low dose APS or mood stabilizers for hostility, aggression

47
Q

Tx of psychosis

A

verbal reassurance, cooling down

Haloperidol if necessary

Then LT will need APS or depot haloperidol

48
Q

Tx of Alcohol Intoxication

A

Banana bag, benzodiazepine (for seizure prevention)

49
Q

Tx of opiate Intoxication

A

If breathing-ride it out

If not-Naloxne (Narcan) IM or IV0.4 mg-2mg

50
Q

Tx of cocaine Intoxication

A

If HTN & tachycardiad-benzodiazepine
If coronary vasospasm-ASA and nitro

NEVER BETA BLOCKER

51
Q

Tx of meth Intoxication

A

ABCs!

Correct metabolic imbalances, treat agitation with benzodiazepines and haloperidol

Human Behavior (5 decks)

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