Introduction to Pediatric Psychopharmacology-Zelan Flashcards
1
Q
What does good psychopharmacology depend on?
A
- proper use of safe and effective meds
- treatment of other obvious factors (medical conditions, toxic substances/environments)
- solif formulation and diagnosis
- good team functioning
- rapport with the patient and family
2
Q
What rating scale do you use to test for ADHD? depression? bipolar? OCD? BPD/suicidal behavior?
A
ADHD-connors
Depression-CDI
Bipolar-Y-MRS
Life Problem Inventory
3
Q
What are these: Informed consents Suicide and violence risk assessment Rating scales -Connors (ADHD) -CDI (depression) -Y-MRS, parent (bipolar disorder) -Y-BOCS (OCD) -BASC, Achenbach -Life problems inventory (borderline personality traites and suicidal behavior)
A
Things to consider when giving meds
4
Q
A psychiatric evaluation includes a (Blank)
A
medical evaluation
5
Q
When doing a pediatric medical eval what should you get in addition to the normal exam?
A
growth charts
6
Q
What exams does the psychiatrist do?
A
CV exam, neuro exam
7
Q
T or F
Many psychotropic medications are not FDA approved for children and adolescents
A
T
8
Q
Children and adolescents generally metabolize medications (slower/faster) than adults
A
faster
9
Q
Is polypharmacy ideal?
A
no, but it can be used sometimes
10
Q
(Blank) use refers to using a medication that has not received FDA approval for the clinical indication.
What is an example of this?
A
Off label
-Risperdal (Risperidone) or Seroquel (Quetiapine) for depression related anxiety and insomnia
11
Q
What is this:
a new field of study in which genotyping guides treatment decisions
A
Genomics
12
Q
(blank) metabolizers at higher risk for adverse effects
A
poor
13
Q
Individuals who are borderline (blank) metabolizers may be more susceptible to an inhibitor effect.
A
poor
14
Q
(blank) metabolizers at risk for treatment failure
A
rapid
15
Q
Allelic variation in (Blank) can affect how quickly some drugs are metabolized
A
CYP 2D6
16
Q
What are some psych 2D6 substrates?
A
- TCAs
- Prozac, luvox, trazodone, remeron
- effexor/cymbalta
- many antipsychotics (incl Hdl, Risp, Abilify, zyp)
- Strattera, stimulants
17
Q
What are some psych 2C19 substrates?
A
- Xanax, valium, many TCAs
- Clozaril
- Methadone
- Perphenazine
- Zoloft, Celexa, Lexapro, Prozac, effexor
- Thioridazine
18
Q
The (Blank) form of the serotinin transporter gene is associatd with more favorable response to SSRIs (except in Asians)
A
“long form”
19
Q
Brain continues to develop into (blank)
A
early adulthood
20
Q
T or F
Impact of adding psychoactive medications to a developing brain remains unknown
A
T
21
Q
There are some meds that are safe for use in adults but had unanticipated SEs for children…. What are these?
A
Tetracycline > dental discoloration SSRI’s > suicidality Aspirin > Reye’s syndrome Cough suppressants > pneumonia Antiemetics > dystonic / EPS reactions
22
Q
(blank) are the informed consenters of children, must be informed of the consequences of looking to medication to “do it all” or, alternatively, medication refusal.
What must you document?
A
Parents
informed consent or informed refusal
23
Q
How should you give and monitor medications?
A
start low and go slow
-continue to raise dose until satisfactory remission of symptoms, reach upper limit of dose, SEs that make dosing intolerable, plateau in symptoms or worsening with increase in dose
24
Q
WHen monitoring medications, you want to be looking at (blank) symptoms and (blank) levels
A
target (such as rating forms, collateral info)
serum (lithium, anticonvulsants)
25
If you are giving someone stimulants, what should you be monitoring?
height/weight, P, BP, tics
26
If you are giving someone anticonvulants, what should you be monitoring?
liver function, blood count
27
If you are giving someone antipsychotics and mood stabilizers, what should you be monitoring?
Fasting blood sugar, lipids, weight, abnormal movements
28
What is a ceruloplasm test?
tests copper metabolism
29
What are some labs you want to get for med eva?
CBC, metabolic panel, CA, Mg, Phos, TFTs, RPR, Lead, Vit B12/folate, lipid panel, Hgb A1c, ceruplasm, pregnancy, EKG
30
WHy do psychiatrists want to do CV exam?
becuase a lot of antipsychotic drugs mess with your heart
31
WHen you are actively titrating a person of off drugs, how often should you see the patient?
weekly
32
Children on maintenance medications should be seen by their prescribing clinician no less than....?
once every three months
33
What types of children should you see more often that once every three months?
Children in acute settings, displaying unsafe behavior, experiencing signif SEs, or not responding to a med trial or in an active phase of a med trial should be seen more frequently.
34
Why have psychiatrists decided that giving meds to kids is helpful?
Though we have little information about long-term effects on brain development (positive or negative), we do know that untreated diseases get worse as they progress, and that disrupted development has long-term consequences as well.
35
How do you classify meds for pediatric mental health problems?
- antidepressants
- mood stabilizers/anticonvulsants
- anti-psychotics (traditional, second generation)
- anxiolytics
- sleep agents/hypnotics
- stimulants
36
What are some common traditional anti-psychotics?
Haldol and Mellaril
37
Why is prozac sort of scary?
it is a CYP 2D6 inhibitor so you can have a lot of drug drug interaxns
38
What are some common second generation antipsychotics or atypical antipsychotics?
Zyprexa, Risperdal, Seroquel, Geodon, Abilifiy, and Clozaril
39
Seroquel can be helfpul with what three disorders?
anxiety, psychosis and insomnia
40
What are some sleep agents/hypnotics used for sleep?
amben, lunesta
41
What are the four categories of common antidepressants?
- SSRIs
- atypical antidepressants
- TCA
- MAOIs
42
(blank) are the most widely used anti-depressant in children
SSRIs
43
What are some potential concernts of antidepressants?
SI, mania, EKG changes, sleep problems, serotonin syndrome, sexual side effects, weight gain
44
Most antidepressants take a little while to show an effect on patients depression... usually (blank) weeks
3-6
45
It is though that pnts who have depression/anxiety might have lower levels of (blank) and SSRIs increase this
seritonin
46
Atypical antidepressants work on (Blank) neurotransmitters
multiple
47
(blank) helps to increase levels of dopamine and norepinephrine
wellbutrin
48
(blank) are another class that affect important neurotransmitters, not used as often because we have other efficacious drugs with less side effects. One you might be familiar with is elavil.
TCA
49
In a pooled analysis of studies looking at antidepressants in children, there was a significant difference in suicidality (behaviors and ideation)—4% in the antidepressant group and 2% in the placebo groups. There were no suicides in the study, but there was concern that in the first few months of treatment, there is (blank) suicidal ideation.
What was thought to be the cause of this?
increased
The medication might be stimulating enough, especially in the first few weeks, that it gives the patient a feeling of increased energy to consider acting on it, but they don’t tend to follow through with it.
50
What antidepressant is least likely to induce mania in a bipolar patient?
wellbutrin
51
Most studies have shown (blank) to be ineffective in treating childhood depression
TCA
52
There have been several reports of (blank) in children treated with tricyclics
sudden death
53
Side effects of (blank) are generally more tolerable than those of tricyclics and MAOIs
SSRIs
54
(blank) may be administered once daily
SSRIs
55
SSRIs have potential to treat a spectrum of childhood disorders... what are these?
OCD, Tourette's, anxiety disorders, selective mutism, PTSD, eating disorders
56
What are the side effects of SSRIs?
Gastrointestinal side effects (nausea, diarrhea, decreased appetite)
Headaches
Insomnia or sedation
Serotonin syndrome (nausea, tremor, hyperthermia, rigidity or pain, ALOC, seizure)
Sexual dysfunction (delayed ejaculation, anorgasmia, decreased libido)
Discontinuation syndrome (dizziness, nausea, lethargy, irritability)
Mania
Restlessness (akathisia or agitation)
Miscellaneous side effects: sweating, anxiety, dizziness, tremors, fatigue, dry mouth.
Priapism
57
When taking SSRIs, (Blank) usually improves after first few days of treatment, can give with meals or give meds at night. Decreased (Blank) is often secondary to this and is usually transient.
nausea
| appeptite
58
When taking SSRIs, you often can get a headached at (blank) of treatment-tends to resolve, but if it persists, you may need to switch to another class.
initiation
59
WHen taking SSRIs, will the children have insomnia or sedation?
How do you deal with this?
Hard to know how patients will respond. 1/3 will have insomnia, 1/3 will have sedation and 1/3rd may not notice anything different
If insomnia, give in morning. If sedating, give at night.
60
SSRIs can cause sexual dysfunction, for adults, if this is a concern, (blank or blank) can be given or the patient can be switched to an agent less likely to cause this such as (blank or blank)
Viagra or Levitra
| Remeron or Wellbutrin
61
(blank) have been used to treat premature ejaculation.
SSRIs
62
SSRIs should be tapered and not discontinued suddenly or (blank, blank, or blank) can result.
dizziness, nausea and irritiability
63
(blank) can induce mania in bipolar patients (TCAs more likely to do so)
SSRIs
64
(blank) is thought to be behind the increased suicidal ideation amongst some children who use SSRIs. It is thought that in the initial days of treatment, this burst of energy may lead children to consider acting on thoughts as I stated before. And other misc. side effects.
Restlessness
65
What are the some atypica antidepressants?
```
Wellbutrin, Zyban (buproprion)
Effexor, Effexor XR (venlafaxine)
Cymbalta (Duloxetine)
Desyrel (trazadone)
Remeron (mirtazapine)
```
66
(blank) is prescribed for MDD, ADHD, and can be a helpful adjunct in patients who desire to quit smoking. It comes in sustained release and extended release which affects dosing.
How is it given?
Wellbutrin
wellbutrin -> BID-TID
Wellbutrin sustained release -> BID
wellburin XL-> once a day
67
(blank) is often used for MDD and GAD,Social anxiety disorder and may have a role in treating ADHD.
How is it given?
Effexor
| Once a day
68
(blank) is most often used for sleep, but can also help some patients who have chronic pain syndromes.
Trazadone
69
(blank) can be used for depressive disorders. I like to use it for sleep and increasing appetite in depressed patients as an adjunct.
Remeron
70
Wellbutrin is thought to act mostly on (blank and blank)
dopamine and norepinephrine
71
Effexor is thought to act on (blank and blank)
norepinephrine and seritonin
72
SInce wellbutrin and effexor both work on norepinephrine, what does this mean about sleep?
it will inhibit sleep so should be taken in the morning
73
What are the SEs of wellbutrin?
insomnia, CNS stimulation, headache, constipation, dry mouth, nausea, tremor, SEIZURE(rare)
74
What are the SEs of Trazodone?
sedation, weight gain, hypotension, dry mouth, priapism
75
What are the SEs of Effexor?
hypertension, insomnia, anxiety, nausea, sweating, dizziness, high incidence of discontinuation syndrome
76
What are the SEs of Remeron?
increased appetite, sedation, dry mouth, constipation
77
Why shouldnt you give wellbutrin in patients with eating disorders?
b/c they tend to have electrolyte imbalances which make them more susceptiple to seizure
78
What are common mood stabilizers?
```
Lithium
Depakote (Valproic Acid)
Lamotrigine
Tegretol
Trileptal
```
(alternative to traditional mood stabilizers)
79
(blank)—is an ion, very effective medication for bipolar d/o and decreases suicidality. It requires monitoring for the forementioned reasons. SE: tremor, GI upset, altered mental status. Tremor can be expected and GI, but if AMS it can be a concern for toxicity. People can DIE from toxicity—this is a medical emergency. Some pts even require dialysis with toxic levels.
Lithium
80
(blank) is effective for mood stabilization. SE: acne, weight gain. Requires lab work.
Depakote
81
(blank) is helpful with bipolar depression. Safer in pregnancy. Look for rash which can potentially be life threatening.
Lamotrigine
82
Second generation antipsychotics require (more/less) frequent monitoring than 1st generation
less
83
What is this:
Probably under-reported and under estimated, not well studied b/c trazodone is very old drug.
Can also occur with other psychiatric drugs, though lower rate usually.
Risk increases with various medical conditions that increase hypercoagulability or otherwise alter hemodynamics.
Many contributing risks may be occult.
Priapism
84
What is the cause of priapism? Can it occur in women?
illness (hematologic, metabolic, neoplastic, neurological), trauma, drugs
yes but it is rare
85
(blank) is getting a consistant measurement
| (blank) is a verification of the truth or the accuracy of your explanatory hypotheses
reliability
| validity
86
What shouldnt you prescribe to men cuz could cause priapism?
trazadone
87
IF you decide to prescribe trazadone, what is essential? why?
careful history taking
| -past hx of delayed detumescence is present in 50% with priapism
88
If you lower the dose of trazodone or duration of treatment are you likely to reduce the risk of priapism?
no
89
What is this:
| useful for treatment of bipolar depression, major problem is length of titration and risk of SJ syndrome
Lamictal
90
What is this:
rather less effective mood stabilizer but doesn’t cause weight gain (actually loss of appetite in some) and don’t need levels.
Topamax
91
For Depakote, Lithium, and Tegretol you have to do what?
evaluate levels for toxicity
92
For bipolar disorder, you may be forced to use (blank) medications
multiple
93
Consider side effect profile/ease of use vs (blank)
research data.
94
What is the current trend toward prescribing for mood stabilization?
antipsychotics
95
What is lithium?
a mood stabilizer (Lithobid, Eskalith, Lithonate, Eskalith CR )
96
Can you give lithium to pregnant people?
no (Class D-> affects fetal heart development)
97
How long does it take for lithium to work?
4-6 weeks on average
98
What are the forms of lithium?
How is it excreted?
What do you need to get before prescribing lithium?
What is the therapeutic levels of lithium?
capsule or liquid
renal
baseline labs
0.8-1.2 mEq/L
99
What are the SEs of lithium?
GI distress (nausea, vomiting), weight gain, fine tremor, cognitive impairment (“fuzzy thinking”).
Polyuria with polydipsia (20% of patients)
Hypothyroidism (monitor TSH a few times a year)
Cardiovascular
Dermatological (acne, rash, itching, psoriasis)
Hematologic (leukocytosis—elevated white count)
Neurologic-muscles weakness, slurred speech, headache
100
Why do teens hate lithium?
gives you acne, weight gain, and tremor
101
What are some life threatening risks of lithium?
-serotonin syndrome
-neuroleptic malignant syndrome
(check for drug interaxns and street drug use)
102
(blank) is a life-threatening, neurological disorder most often caused by an adverse reaction to neuroleptic or antipsychotic drugs. Symptoms include high fever, sweating, unstable blood pressure, stupor, muscular rigidity, and autonomic dysfunction.
Neuroleptic malignant syndrome
103
Neuroleptic Malignant syndrome and serotonin syndrome may be variants of drug induced (blank)
central hyperthermia
104
(blank) is super important for use of trazodone and lithium
patient education (especially for priapism)
105
```
What is this:
diaphoresis
mydriasis
agitation
tachycardia
autonomic instability, often hypertensive
increased bowel sounds
diarrhea
clonus (greatest in lower extremities)
tremor (greaters in lower extremities)
hyperreflexia (greater in lower extremities)
```
Severe Serotonin Syndrome
106
Hyperkinetic neuromuscular findings of tremor or clonus and hyperreflexia should lead the clinician to consider the diagnosis of the (blank).
serotonin syndrome
107
What are some serotonin syndrome med risks?
- Anti-migraine medications such as triptans, tegretol and Depakote
- Pain medications Flexeril, fentanyl, Demerol, tramadol, talwin,
- Illicit drugs, including LSD, Ecstasy, cocaine and amphetamines
- Herbal supplements, including St. John's wort, ginseng and nutmeg
- Over-the-counter cough and cold medications esp. with dextromethorphan, but caution with all OTC cough meds
- Anti-nausea medications such as granisetron, reglan, droperidol, Zofran
- Linezolid
- Ritonavir
- Buprenorphine, oxycodone, hydrocodone
108
Is it common to have an SSRI overdose?
2002: 27,000 exposures to SSRIs, 7300 with toxicity, 93 deaths.
15% of SSRI overdoses
109
(blank) is usually seen more with antipsychotics (esp older ones) and chronic schizophrenia, but not exclusively
NMS (utilize education and documentation)
110
What is the onset for serotonin syndrome?
What are the symptoms?
What are the signs?
What is the mortality?
- sudden, w/in 24 h following introduction of a serotonergic agent
- agitation, diarrhea
- dilated pupils, myoclonus, hyperreflexia
- 23 deaths
111
What is the onest for NMS?
What are the symptoms?
What are the signs?
What is the mortality?
- slower, w/in 7 days following intro of a neuroleptic agent
- dysphagia, hypersalivation, incontinence
- hyperthermia (>38 C), akinesia, extrapyramidal, "lead pipe" rigidity, rhabdomyolysis
- 15-20%
112
What can cause lithium toxicity?
- decreased fluid intake
- increased fluid loss (sweating excessively, diuretics)
- reduced salt intake
- meds that act on renal system (NSAIDS/ACE inhibitors)
- Taking too much lithium!
113
What are the symptoms of lithium toxicity?
GI (nausea, vomiting, diarrhea), coarse tremor, ataxia, slurred speech, confusion, arrythmias
114
With lithium, you must check blood levels. What levels are mild to moderate toxicity? What levels are severe toxicity? When will death occur?
How do you treat it?
mild to moderate: 1.5-2.0 mEq/L
Severe: >2.5mEq/L
Death: >4mEq/L
Tx: stopping lithium, hydration, and hemodialysis
115
What is depakote?
What forms does it come in?
What patients should you NOT give depakote to?
A mood stabilizer/anticonvulsants
- capsules, oral suspension, tablets
- Pnts w/ liver disease
116
What screening labs should you get before giving someone depakote?
When should you check serum levels?
CBC, LFTs (liver function test,) pregnancy test
| 7 days after first dose, then continue to monitor
117
WHen does depakote (AED, mood stabilizer) become therapeutically active?
2-4 weeks
118
What are the side effects of Depakote?
- sedation
- dizziness
- nausea
- vomiting
- abnormal liver function test
119
What are the rare side effects of depakote?
hepatitis, pancreatitis, hematological (decreased platelets) dermatological (rash), neurological (tremor, ataxia).
120
What is the therapeutic level of depakote?
What do you use it for?
How is it metabolized?
50-125 micrograms/milliliter
- bipolar, schizoaffective disorder, seizure, migraine prophylaxis
- Liver (so avoid giving it to patients with liver disease)
121
How often should you monitor depakote?
weekly, biweekly, monthly
122
What mood stabilizer/anticonvulsant is this:
| safe(r) in pregnancy. rash
lamictal (lamotrigine)
123
What mood stabilizer/anticonvulsant is this:
| affects blood count
tegretol (carbamazepine)
124
What is the birth defect associated with lithium?
| with depakote?
cardiac
| neural tube
125
What mood stabilizer/anticonvulsant is this:
| better tolerated than Tegretol, may not be as effective
trileptal (oxcarbazepine)
126
Clozaril (clozapine) will suppress (blank) so you have to monitor (blank)
bone marrow
| white count
127
What mood stabilizer/anticonvulsant is this:
| not used for bipolar disorder, used instead for impulse control disorders, migraine prophylaxis, alcohol craving
Topamax (topirimate)
128
(blank) can progress to toxic epidermal necrolysis- medical emergency, sometimes ICU level (resembles severe burns)
SJ syndrome
129
WHat is this:
fever and rash, especially involving mucous membranes
What might the rash be precede by?
SJ syndrome
***Rash can be painful and involving blisters****
flu like symptoms (fever, sore throat, fatigue, cough)
130
What can cause SJ syndrome?
acute infection or medications
131
What medications can cause SJ syndrome?
```
Anticonvulsants (esp. lamictal but others also).
Penicillin (PCN)
Ibuprofen, Tylenol, naproxen.
Allopurinol
Radiation therapy
```
132
What are some justifiable uses of antipsychotics in children?
```
Childhood Schizophrenia
Childhood Bipolar Disorder
Autistic Spectrum Disorders
Tourette’s Disorder
Substance Induced Psychosis
```
133
```
What are these:
aripiprazole
olanzapine
quetiapine
risperidone
ziprasidone
```
Atypical antipsychotics
134
What is the dosage of aripiprazole?
5-30 mg/day
135
What is the dosage of olanzapine?
5-20 mg/day
136
What is the dosage of quietiapine?
25-400 mg/day in divided doses
137
What is the dosage of risperidone?
0.5-6mg/day (available in oral solution)
138
What is the dosage of ziprasidone?
20-160mg/day in divided doses with food
139
What are the side effects of abilify (aripiprazole)?
GI effects, headache, sedation (higher dosages).
140
What are the side effects of Geodon (ziprasidone)?
cardiac effects (caution in those with cardiac history), dizziness, nausea, sedation (IM)
141
What are the side effects of Zyprexa, Zydis (olanzapine)?
metabolic syndrome, weight gain, dry mouth, akathisia, insomnia, GI effects, tremor, lightheadedness.
142
What are the side effects of seroquel (quetiapine)?
sedation, metabolic syndrome, weight gain, orthostatic hypotension, GI effects, and dry mouth
143
What are the side effects of Risperdal (risperidone)?
orthostatic hypotension, weight gain, elevated prolactin levels.
144
What are the side effects of Clozaril (clozapine)?
hematological changes (agranulocytosis), orthostatic hypotension, sedation, constipation, hyperthermia, hypersalivation, seizure (higher dosages), myocarditis.
145
Any medications that block (blank) receptors can cause lactation
dopamine
146
If a child has hypersalivation how do you fix this?
with an anticholinergic
147
What is the major problem with zyprexa?
weight gain weight gain weight gain
148
(blank) effect of older antipsychotics have been known for some time (arrthymia, BP)
CV
149
What is the normal QTc interval for a male? What about for a female?
<450
150
What is the borderline QTc interval for a male? What about for a female?
431-450
| 451-470
151
What is a prolonged QTc interval for a male? What about for a female?
>450
| >470
152
What are compounding CV risk factors?
- Female gender
- hypokalemia, hypomagnesaemia
- CV disease
- History of prolonged QTc
- Other meds on board that can prolong QTc
- Need to check literature on current data
153
What are medical urgencies/emergencies associated with anti-psychotics?
- Parkinsonianism
- Acute dystonia
- Acute akathisia
- Tardive dyskinesia (TD)
- Neuroleptic malignant syndrome (NMS)
154
(blank) are drug induced movement disorders that include acute and tardive symptoms.
Extrapyramidal symptoms
155
Extrapyramidal symptoms are mostly seen with the (blank)
traditional antipsychotics
156
(blank) is characterized by tremor, rigidity, bradykinisea (slow movements).
What causes this?
How do you fix this?
- Parkinsonianism
- the effects of antipsychotics on dopamine
- reduce dosage, change to another medication, give an anticholinergic
157
(blank) are brief or prolonged muscle contractions.
| How do you fix this?
dystonias
| anticholinergics
158
(blank) is restlessness.
| How do you fix this?
akathisia
| -reduce med or give anticholinergics
159
(blank) is a late appearing movement disorder. A neurological disorder characterized by involuntary movements of the face and jaw and fingers/toes.
How do you fix this?
Tardive dyskinesia
| stop med, may not go away :(
160
(blank) is a life-threatening, neurological disorder most often caused by an adverse reaction to neuroleptic or antipsychotic drugs. Symptoms include high fever, sweating, unstable blood pressure, stupor, muscular rigidity, and autonomic dysfunction
neuroleptic malignant syndrome (NMS)
161
What are these signs of:
Muscular rigidity, elevated body temperature/elev blood pressure, Altered Mental Status (confusion), tachycardia (fast heart reate), tremor.
How do you treat it?
NMS
| Dantrolene or bromocriptine
162
What do you give psychostimulants for?
ADHD and narcolepsy
163
Can you treat bipolar disorder with stimulants?
no! (it can worsen mania)
164
Can refills be given on psychostimulants?
no, a new perscription is needed every 30 days
165
What are the types of stimulants?
ritalin, metadate, focalin, adderall, concerta
166
What is the trade name for ritalin?
Methylphenidate
167
What is the trade name for adderall?
mixed amphetamine salts
168
What is ritalin LA?
it has an immediate release and then second release (via enteric coated delayed release beads)
169
What is concerta and metadate CD?
long acting stimulants that allow for once a day dosing
170
What should you evaluate before giving a patient stimulants?
| Why?
BP and weight
| can decrease wt and increase BP
171
What do you want to watch for precipitation of when giving a patient stimulants?
What should you monitor throughout the use of stimulants in your patient?
Tics and Tourette's syndrome
| Growth
172
What are the SEs of stimulants?
| When time should you avoid giving stimulants?
psychomotor agitation, insomnia, loss of appetite, dry mouth, palpitations
After 12PM so you can sleep
173
What are alternative medications for ADHD?
- Strattera (atomoxatine)
- Wellbutrin (buproprion)
- Tenex and Clonidine
174
Why do you give tenex and clonidine at night?
| Why is there concern for taking a stimulant during the dat and tenex and clonidine at night for ADHD?
because it is very sedating (lowers BP and Pulse -> sometimes resulting in dizziness)
-affects the heart give you a cardiac rollercoaster i.e hypertensive during the day and hypotensive during the night
175
(blank) and (blank) were originally used to treat HTN. What are they also used for?
clonidine tenex
| Children with ADHD, aggression or anxiety
176
Why do anxiolytics not have that great of a rap?
because they are fast acting and then wear off fast creating a need for dependence and an emotional rollercoaster... also can disrupt sleep
177
Benzos (anxiolytic) tend to cause (blank) and (blank) demand
tolerance
| increasing
178
(blank) withdrawal like alcohol withdrawal can be life threatening
Benzos
179
What are the four reasons to avoid anxiolytics?
1) abuse potential
2) disinhibiting (makes behavior worse)
3) dangerous when combined with alcohol for teens (LOC or sleepiness)
4) other agents you can choose from
180
What are the main benzos?
```
Ativan
Xanax
Klonopin
Valium
Librium
```
181
If you have to use benzos, use them (blank), if you have a chronic problem use (blanK)
benzos
| SSRIs
182
What are sleep agents/hypnotics for kids?
Benadryl or Atarax
Remeron
Melatonin
In young adults: Sonata
183
(blank) is a great drug for someone who is depressed, doesn’t have much of an appetite and needs to gain weight. Used a lot in the elderly.
Remeron
184
What is the rough hierarchy of the psych drugs (going from most safe/effective to least)?
stimulants> SSRIs> mood stabilizers> antipsychotics
185
T or F
| MONOPHARMACY is better than POLYPHARMACY
T
186
Whenever you treat or get a refusal to treat you must do what?
document!
