Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Block 8 Week 3 > Introduction to Pediatric Psychopharmacology-Zelan > Flashcards

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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

A psychiatric evaluation includes a (Blank)

A

medical evaluation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

When doing a pediatric medical eval what should you get in addition to the normal exam?

A

growth charts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What exams does the psychiatrist do?

A

CV exam, neuro exam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

T or F

Many psychotropic medications are not FDA approved for children and adolescents

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Children and adolescents generally metabolize medications (slower/faster) than adults

A

faster

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Is polypharmacy ideal?

A

no, but it can be used sometimes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is this:

a new field of study in which genotyping guides treatment decisions

A

Genomics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

(blank) metabolizers at higher risk for adverse effects

A

poor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Individuals who are borderline (blank) metabolizers may be more susceptible to an inhibitor effect.

A

poor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

(blank) metabolizers at risk for treatment failure

A

rapid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Allelic variation in (Blank) can affect how quickly some drugs are metabolized

A

CYP 2D6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are some psych 2C19 substrates?

A
  • Xanax, valium, many TCAs
  • Clozaril
  • Methadone
  • Perphenazine
  • Zoloft, Celexa, Lexapro, Prozac, effexor
  • Thioridazine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

The (Blank) form of the serotinin transporter gene is associatd with more favorable response to SSRIs (except in Asians)

A

“long form”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Brain continues to develop into (blank)

A

early adulthood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

T or F

Impact of adding psychoactive medications to a developing brain remains unknown

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

If you are giving someone stimulants, what should you be monitoring?

A

height/weight, P, BP, tics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

If you are giving someone anticonvulants, what should you be monitoring?

A

liver function, blood count

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

If you are giving someone antipsychotics and mood stabilizers, what should you be monitoring?

A

Fasting blood sugar, lipids, weight, abnormal movements

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is a ceruloplasm test?

A

tests copper metabolism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are some labs you want to get for med eva?

A

CBC, metabolic panel, CA, Mg, Phos, TFTs, RPR, Lead, Vit B12/folate, lipid panel, Hgb A1c, ceruplasm, pregnancy, EKG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

WHy do psychiatrists want to do CV exam?

A

becuase a lot of antipsychotic drugs mess with your heart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

WHen you are actively titrating a person of off drugs, how often should you see the patient?

A

weekly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Children on maintenance medications should be seen by their prescribing clinician no less than….?

A

once every three months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What types of children should you see more often that once every three months?

A

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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Why have psychiatrists decided that giving meds to kids is helpful?

A

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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

How do you classify meds for pediatric mental health problems?

A
  • antidepressants
  • mood stabilizers/anticonvulsants
  • anti-psychotics (traditional, second generation)
  • anxiolytics
  • sleep agents/hypnotics
  • stimulants
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What are some common traditional anti-psychotics?

A

Haldol and Mellaril

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Why is prozac sort of scary?

A

it is a CYP 2D6 inhibitor so you can have a lot of drug drug interaxns

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What are some common second generation antipsychotics or atypical antipsychotics?

A

Zyprexa, Risperdal, Seroquel, Geodon, Abilifiy, and Clozaril

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Seroquel can be helfpul with what three disorders?

A

anxiety, psychosis and insomnia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What are some sleep agents/hypnotics used for sleep?

A

amben, lunesta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What are the four categories of common antidepressants?

A
  • SSRIs
  • atypical antidepressants
  • TCA
  • MAOIs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

(blank) are the most widely used anti-depressant in children

A

SSRIs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What are some potential concernts of antidepressants?

A

SI, mania, EKG changes, sleep problems, serotonin syndrome, sexual side effects, weight gain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Most antidepressants take a little while to show an effect on patients depression… usually (blank) weeks

A

3-6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

It is though that pnts who have depression/anxiety might have lower levels of (blank) and SSRIs increase this

A

seritonin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Atypical antidepressants work on (Blank) neurotransmitters

A

multiple

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

(blank) helps to increase levels of dopamine and norepinephrine

A

wellbutrin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

(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.

A

TCA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

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?

A

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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What antidepressant is least likely to induce mania in a bipolar patient?

A

wellbutrin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Most studies have shown (blank) to be ineffective in treating childhood depression

A

TCA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

There have been several reports of (blank) in children treated with tricyclics

A

sudden death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Side effects of (blank) are generally more tolerable than those of tricyclics and MAOIs

A

SSRIs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

(blank) may be administered once daily

A

SSRIs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

SSRIs have potential to treat a spectrum of childhood disorders… what are these?

A

OCD, Tourette’s, anxiety disorders, selective mutism, PTSD, eating disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What are the side effects of SSRIs?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

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.

A

nausea

appeptite

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

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.

A

initiation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

WHen taking SSRIs, will the children have insomnia or sedation?
How do you deal with this?

A

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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

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)

A

Viagra or Levitra

Remeron or Wellbutrin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

(blank) have been used to treat premature ejaculation.

A

SSRIs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

SSRIs should be tapered and not discontinued suddenly or (blank, blank, or blank) can result.

A

dizziness, nausea and irritiability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

(blank) can induce mania in bipolar patients (TCAs more likely to do so)

A

SSRIs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

(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.

A

Restlessness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

What are the some atypica antidepressants?

A 
Wellbutrin, Zyban (buproprion)
Effexor, Effexor XR (venlafaxine)
Cymbalta (Duloxetine)
Desyrel (trazadone)
Remeron (mirtazapine)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

(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?

A

Wellbutrin

wellbutrin -> BID-TID
Wellbutrin sustained release -> BID
wellburin XL-> once a day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

(blank) is often used for MDD and GAD,Social anxiety disorder and may have a role in treating ADHD.
How is it given?

A

Effexor

Once a day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

(blank) is most often used for sleep, but can also help some patients who have chronic pain syndromes.

A

Trazadone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

(blank) can be used for depressive disorders. I like to use it for sleep and increasing appetite in depressed patients as an adjunct.

A

Remeron

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Wellbutrin is thought to act mostly on (blank and blank)

A

dopamine and norepinephrine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Effexor is thought to act on (blank and blank)

A

norepinephrine and seritonin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

SInce wellbutrin and effexor both work on norepinephrine, what does this mean about sleep?

A

it will inhibit sleep so should be taken in the morning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

What are the SEs of wellbutrin?

A

insomnia, CNS stimulation, headache, constipation, dry mouth, nausea, tremor, SEIZURE(rare)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

What are the SEs of Trazodone?

A

sedation, weight gain, hypotension, dry mouth, priapism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

What are the SEs of Effexor?

A

hypertension, insomnia, anxiety, nausea, sweating, dizziness, high incidence of discontinuation syndrome

76
Q

What are the SEs of Remeron?

A

increased appetite, sedation, dry mouth, constipation

77
Q

Why shouldnt you give wellbutrin in patients with eating disorders?

A

b/c they tend to have electrolyte imbalances which make them more susceptiple to seizure

78
Q

What are common mood stabilizers?

A 
Lithium
Depakote (Valproic Acid)
Lamotrigine
Tegretol
Trileptal

(alternative to traditional mood stabilizers)

79
Q

(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.

A

Lithium

80
Q

(blank) is effective for mood stabilization. SE: acne, weight gain. Requires lab work.

A

Depakote

81
Q

(blank) is helpful with bipolar depression. Safer in pregnancy. Look for rash which can potentially be life threatening.

A

Lamotrigine

82
Q

Second generation antipsychotics require (more/less) frequent monitoring than 1st generation

A

less

83
Q

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.

A

Priapism

84
Q

What is the cause of priapism? Can it occur in women?

A

illness (hematologic, metabolic, neoplastic, neurological), trauma, drugs
yes but it is rare

85
Q

(blank) is getting a consistant measurement

(blank) is a verification of the truth or the accuracy of your explanatory hypotheses

A

reliability

validity

86
Q

What shouldnt you prescribe to men cuz could cause priapism?

A

trazadone

87
Q

IF you decide to prescribe trazadone, what is essential? why?

A

careful history taking

-past hx of delayed detumescence is present in 50% with priapism

88
Q

If you lower the dose of trazodone or duration of treatment are you likely to reduce the risk of priapism?

A

no

89
Q

What is this:

useful for treatment of bipolar depression, major problem is length of titration and risk of SJ syndrome

A

Lamictal

90
Q

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.

A

Topamax

91
Q

For Depakote, Lithium, and Tegretol you have to do what?

A

evaluate levels for toxicity

92
Q

For bipolar disorder, you may be forced to use (blank) medications

A

multiple

93
Q

Consider side effect profile/ease of use vs (blank)

A

research data.

94
Q

What is the current trend toward prescribing for mood stabilization?

A

antipsychotics

95
Q

What is lithium?

A

a mood stabilizer (Lithobid, Eskalith, Lithonate, Eskalith CR )

96
Q

Can you give lithium to pregnant people?

A

no (Class D-> affects fetal heart development)

97
Q

How long does it take for lithium to work?

A

4-6 weeks on average

98
Q

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?

A

capsule or liquid
renal
baseline labs
0.8-1.2 mEq/L

99
Q

What are the SEs of lithium?

A

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
Q

Why do teens hate lithium?

A

gives you acne, weight gain, and tremor

101
Q

What are some life threatening risks of lithium?

A

-serotonin syndrome
-neuroleptic malignant syndrome
(check for drug interaxns and street drug use)

102
Q

(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.

A

Neuroleptic malignant syndrome

103
Q

Neuroleptic Malignant syndrome and serotonin syndrome may be variants of drug induced (blank)

A

central hyperthermia

104
Q

(blank) is super important for use of trazodone and lithium

A

patient education (especially for priapism)

105
Q 
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)
A

Severe Serotonin Syndrome

106
Q

Hyperkinetic neuromuscular findings of tremor or clonus and hyperreflexia should lead the clinician to consider the diagnosis of the (blank).

A

serotonin syndrome

107
Q

What are some serotonin syndrome med risks?

A
  • 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
Q

Is it common to have an SSRI overdose?

A

2002: 27,000 exposures to SSRIs, 7300 with toxicity, 93 deaths.
15% of SSRI overdoses

109
Q

(blank) is usually seen more with antipsychotics (esp older ones) and chronic schizophrenia, but not exclusively

A

NMS (utilize education and documentation)

110
Q

What is the onset for serotonin syndrome?
What are the symptoms?
What are the signs?
What is the mortality?

A
  • sudden, w/in 24 h following introduction of a serotonergic agent
  • agitation, diarrhea
  • dilated pupils, myoclonus, hyperreflexia
  • 23 deaths
111
Q

What is the onest for NMS?
What are the symptoms?
What are the signs?
What is the mortality?

A
  • 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
Q

What can cause lithium toxicity?

A
  • 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
Q

What are the symptoms of lithium toxicity?

A

GI (nausea, vomiting, diarrhea), coarse tremor, ataxia, slurred speech, confusion, arrythmias

114
Q

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?

A

mild to moderate: 1.5-2.0 mEq/L
Severe: >2.5mEq/L
Death: >4mEq/L

Tx: stopping lithium, hydration, and hemodialysis

115
Q

What is depakote?
What forms does it come in?
What patients should you NOT give depakote to?

A

A mood stabilizer/anticonvulsants

  • capsules, oral suspension, tablets
  • Pnts w/ liver disease
116
Q

What screening labs should you get before giving someone depakote?
When should you check serum levels?

A

CBC, LFTs (liver function test,) pregnancy test

7 days after first dose, then continue to monitor

117
Q

WHen does depakote (AED, mood stabilizer) become therapeutically active?

A

2-4 weeks

118
Q

What are the side effects of Depakote?

A
  • sedation
  • dizziness
  • nausea
  • vomiting
  • abnormal liver function test
119
Q

What are the rare side effects of depakote?

A

hepatitis, pancreatitis, hematological (decreased platelets) dermatological (rash), neurological (tremor, ataxia).

120
Q

What is the therapeutic level of depakote?
What do you use it for?
How is it metabolized?

A

50-125 micrograms/milliliter

  • bipolar, schizoaffective disorder, seizure, migraine prophylaxis
  • Liver (so avoid giving it to patients with liver disease)
121
Q

How often should you monitor depakote?

A

weekly, biweekly, monthly

122
Q

What mood stabilizer/anticonvulsant is this:

safe(r) in pregnancy. rash

A

lamictal (lamotrigine)

123
Q

What mood stabilizer/anticonvulsant is this:

affects blood count

A

tegretol (carbamazepine)

124
Q

What is the birth defect associated with lithium?

with depakote?

A

cardiac

neural tube

125
Q

What mood stabilizer/anticonvulsant is this:

better tolerated than Tegretol, may not be as effective

A

trileptal (oxcarbazepine)

126
Q

Clozaril (clozapine) will suppress (blank) so you have to monitor (blank)

A

bone marrow

white count

127
Q

What mood stabilizer/anticonvulsant is this:

not used for bipolar disorder, used instead for impulse control disorders, migraine prophylaxis, alcohol craving

A

Topamax (topirimate)

128
Q

(blank) can progress to toxic epidermal necrolysis- medical emergency, sometimes ICU level (resembles severe burns)

A

SJ syndrome

129
Q

WHat is this:
fever and rash, especially involving mucous membranes

What might the rash be precede by?

A

SJ syndrome
Rash can be painful and involving blisters*

flu like symptoms (fever, sore throat, fatigue, cough)

130
Q

What can cause SJ syndrome?

A

acute infection or medications

131
Q

What medications can cause SJ syndrome?

A 
Anticonvulsants (esp. lamictal but others also).
Penicillin (PCN)
Ibuprofen, Tylenol, naproxen. 
Allopurinol
Radiation therapy
132
Q

What are some justifiable uses of antipsychotics in children?

A 
Childhood Schizophrenia
Childhood Bipolar Disorder
Autistic Spectrum Disorders
Tourette’s Disorder
Substance Induced Psychosis
133
Q 
What are these:
aripiprazole
olanzapine
quetiapine
risperidone
ziprasidone
A

Atypical antipsychotics

134
Q

What is the dosage of aripiprazole?

A

5-30 mg/day

135
Q

What is the dosage of olanzapine?

A

5-20 mg/day

136
Q

What is the dosage of quietiapine?

A

25-400 mg/day in divided doses

137
Q

What is the dosage of risperidone?

A

0.5-6mg/day (available in oral solution)

138
Q

What is the dosage of ziprasidone?

A

20-160mg/day in divided doses with food

139
Q

What are the side effects of abilify (aripiprazole)?

A

GI effects, headache, sedation (higher dosages).

140
Q

What are the side effects of Geodon (ziprasidone)?

A

cardiac effects (caution in those with cardiac history), dizziness, nausea, sedation (IM)

141
Q

What are the side effects of Zyprexa, Zydis (olanzapine)?

A

metabolic syndrome, weight gain, dry mouth, akathisia, insomnia, GI effects, tremor, lightheadedness.

142
Q

What are the side effects of seroquel (quetiapine)?

A

sedation, metabolic syndrome, weight gain, orthostatic hypotension, GI effects, and dry mouth

143
Q

What are the side effects of Risperdal (risperidone)?

A

orthostatic hypotension, weight gain, elevated prolactin levels.

144
Q

What are the side effects of Clozaril (clozapine)?

A

hematological changes (agranulocytosis), orthostatic hypotension, sedation, constipation, hyperthermia, hypersalivation, seizure (higher dosages), myocarditis.

145
Q

Any medications that block (blank) receptors can cause lactation

A

dopamine

146
Q

If a child has hypersalivation how do you fix this?

A

with an anticholinergic

147
Q

What is the major problem with zyprexa?

A

weight gain weight gain weight gain

148
Q

(blank) effect of older antipsychotics have been known for some time (arrthymia, BP)

A

CV

149
Q

What is the normal QTc interval for a male? What about for a female?

A

<450

150
Q

What is the borderline QTc interval for a male? What about for a female?

A

431-450

451-470

151
Q

What is a prolonged QTc interval for a male? What about for a female?

A

> 450

>470

152
Q

What are compounding CV risk factors?

A
  • 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
Q

What are medical urgencies/emergencies associated with anti-psychotics?

A
  • Parkinsonianism
  • Acute dystonia
  • Acute akathisia
  • Tardive dyskinesia (TD)
  • Neuroleptic malignant syndrome (NMS)
154
Q

(blank) are drug induced movement disorders that include acute and tardive symptoms.

A

Extrapyramidal symptoms

155
Q

Extrapyramidal symptoms are mostly seen with the (blank)

A

traditional antipsychotics

156
Q

(blank) is characterized by tremor, rigidity, bradykinisea (slow movements).
What causes this?
How do you fix this?

A
  • Parkinsonianism
  • the effects of antipsychotics on dopamine
  • reduce dosage, change to another medication, give an anticholinergic
157
Q

(blank) are brief or prolonged muscle contractions.

How do you fix this?

A

dystonias

anticholinergics

158
Q

(blank) is restlessness.

How do you fix this?

A

akathisia

-reduce med or give anticholinergics

159
Q

(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?

A

Tardive dyskinesia

stop med, may not go away :(

160
Q

(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

A

neuroleptic malignant syndrome (NMS)

161
Q

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?

A

NMS

Dantrolene or bromocriptine

162
Q

What do you give psychostimulants for?

A

ADHD and narcolepsy

163
Q

Can you treat bipolar disorder with stimulants?

A

no! (it can worsen mania)

164
Q

Can refills be given on psychostimulants?

A

no, a new perscription is needed every 30 days

165
Q

What are the types of stimulants?

A

ritalin, metadate, focalin, adderall, concerta

166
Q

What is the trade name for ritalin?

A

Methylphenidate

167
Q

What is the trade name for adderall?

A

mixed amphetamine salts

168
Q

What is ritalin LA?

A

it has an immediate release and then second release (via enteric coated delayed release beads)

169
Q

What is concerta and metadate CD?

A

long acting stimulants that allow for once a day dosing

170
Q

What should you evaluate before giving a patient stimulants?

Why?

A

BP and weight

can decrease wt and increase BP

171
Q

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?

A

Tics and Tourette’s syndrome

Growth

172
Q

What are the SEs of stimulants?

When time should you avoid giving stimulants?

A

psychomotor agitation, insomnia, loss of appetite, dry mouth, palpitations
After 12PM so you can sleep

173
Q

What are alternative medications for ADHD?

A
  • Strattera (atomoxatine)
  • Wellbutrin (buproprion)
  • Tenex and Clonidine
174
Q

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?

A

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
Q

(blank) and (blank) were originally used to treat HTN. What are they also used for?

A

clonidine tenex

Children with ADHD, aggression or anxiety

176
Q

Why do anxiolytics not have that great of a rap?

A

because they are fast acting and then wear off fast creating a need for dependence and an emotional rollercoaster… also can disrupt sleep

177
Q

Benzos (anxiolytic) tend to cause (blank) and (blank) demand

A

tolerance

increasing

178
Q

(blank) withdrawal like alcohol withdrawal can be life threatening

A

Benzos

179
Q

What are the four reasons to avoid anxiolytics?

A

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
Q

What are the main benzos?

A 
Ativan
Xanax
Klonopin
Valium
Librium
181
Q

If you have to use benzos, use them (blank), if you have a chronic problem use (blanK)

A

benzos

SSRIs

182
Q

What are sleep agents/hypnotics for kids?

A

Benadryl or Atarax
Remeron
Melatonin
In young adults: Sonata

183
Q

(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.

A

Remeron

184
Q

What is the rough hierarchy of the psych drugs (going from most safe/effective to least)?

A

stimulants> SSRIs> mood stabilizers> antipsychotics

185
Q

T or F

MONOPHARMACY is better than POLYPHARMACY

A

T

186
Q

Whenever you treat or get a refusal to treat you must do what?

A

document!

Block 8 Week 3 (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions