Final exam part 2 Flashcards
FDA approved for panic disorder
Alprazolam (Xanax) paroxetine (Paxil) clonazepam fluoxetine sertraline
First-line meds for OCD
fluoxetine
fluovxamine
sertraline
paroxetine
First-line meds for PTSD
Sertraline (Zoloft)
paroxetine (Paxil)
Medication for nightmares
Prazosin
key neurotransmitter in anxiety
GABA - deficit
serotonin
norepinephrine
FDA approved for GAD
Alprazolam (Xanax) duloxetine (cymbalta) escitalopram (Lexapro) paroxetine (Paxil) venlafaxine (Effexor)
alternative to benzos for anxiety
Gabapentin
Lyrica
Good for performance axiety
beta blockers (propanolol)
manic episodes with or without psychosis and/or major depression
Bipolar I
hypomanic episode with major depression; no history of manic or mixed episodes
Bipolar II
Cyclothymia
hypomania and depressive symptoms that do not meet criteria for bipolar for at least 2 years- no major depressive episodes
Lithium therapeutic level
0.5-1.5 mEq/L
Pregnancy considerations for lithium
excretion increases during pregnancy but decreases after delivery
excreted in breast milk
Meds that increase lithium levels
NSAIDs
Thiazide diuretics
ACE inhibitors
Metronidazole
signs of lithium toxicity
Mild: vomiting, dizziness, slurred speech, ataxia
Moderate: Anorexia, blurred vision, convulsions, delirium
Severe: Convulsions, renal failure, oliguria
litium toxicity levels
Mild: 1.5-2.0
Moderate: 2.0-2.5
Severe: >2.5
Management of lithium toxicity
Mild: Contact provider, go to ER
D/C lithium, lithium levels, CMP, Renal function, EKG
Severe: Emesis, GI lavage, activated charcoal, hemodialysis (>4)
patient education with lithium
last dose should be 12 hours before lab draw
no sudden changes in diet or fluid
caffeine and alcohol lower serum concentrations
vigorous exercise may affect lithium levels
therapeutic depakote level
50-100 mcg/mL
Lamictal side effects
dizziness, ataxia, headaches, blurred vision, rash
lamictal and depakote
depakote doubles lamictal concentration
Important dosing information about lamictal
escalate slowly to BID starting at 25 mg/day for two weeks, double every two weeks until 200 mg/day
take with or without food
Tegretol important factor
Lots of D2D interactions (CYP450 inducer)
Decreases concentration of several drugs including birth control
What medications to avoid with treatment of bipolar
antidepressants
symbyax is the exception - olanzapine/fluoxetine
first line treatment for pregnant bipolar
antipsychotic
best mood stabilizer for pregnancy (only if antipsychotic is not tolerated)
Lithium
Tegretol therapeutic level
4-12 mcg/mL
lamotrigine and birth control
birth control may decrease Lamictal concentration
