Misc Psych Study Flashcards
Serotonin Syndrome sx
- shivering
- hyperreflexia/myoclonus
- increased temperature
- vital sign instability
- encephalopathy (altered LOC)
- restlessness
- sweating
Serotonin Syndrome- when does it occur?
- 2+ serotonergic meds
Common Offenders
* SSRI
* SNRI
* TCA
* MAOI
* Trazodone/Mirtazapine
* Triptans
* Anxiolytics
* Antiemetics
* herbals (st john’s wort)
* opioids
* anti-convulsants
* illicit substances
Discontinuation Syndrome- sx
FINISH
* flu like sx
* insomnia
* nausea
* imbalance
* sensory disturbances
* hyperarousal
Discontinuation Syndrome- pt education
- advise pt to never abruptly stop meds
- tape off meds over several wks (reduce dose by 25% each weak) or cross taper onto new med
- Paxil has worst discontinuation syndrome; Prozac has lowest risk discontinuation
TCA OD
- Vitals: hyperthermia, tachycardia, wide QRS
- Neuro: seizure, confusion, diaphoresis
- HEENT: dry mouth, dilated pupils, blurred vision
Metabolic Dysfunction
- complication of psychotic meds
- sx: wt gain, hyperglycemia, hyperlipidemia
- dx: Q6-12 month lipids, wt, BP, A1C
- tx: treat dysfunction as it develops; consider changing med if severe
more common with atypicals/2nd gen
Anti-HAM
- Antihistamine: wt gain, sedation
- Antiadrenergic: orthostatic hypotension, cardiac abnormalities, sexual dysfunction
- Antimuscarinic: dry mouth, tachycardia, urinary retention, blurry vision, constipation, narrow angle glaucoma
more common with typicals/1st gen
Hyperprolactinemia
- sx: low libido, galactorrhea, gynecomastia, impotence, amenorrhea
more common w/ typicals/1st gen
Neuromalignant Syndrome (NMS)
- occurs in 3% of pt on neuroleptics; fatal if missed
- sx: extreme rigidity, AMS, fever, unstable BP, myoglobinemia
- tx: med cessation, dantrolene/bromocriptine, supportive care
EPS
- Akathisia: inner restlessness, cant sit still (tx by reducing doses/changing meds; can give propranolol or clonazepam to manage sx)
- Parkinsonian Sx: tremor, rigidity, shuffling gait, bradykinesia; begins w/in 1 mo of taking med; tx by reducing dose/changing med (or anti-parkinsonian drugs like levodopa)
- Dystonia: acute complication but is curative; involuntary contraction of major msk group (tongue, neck, back, face); tx is anticholinergics (benztropine) and anti-park drugs
- Tardive Dyskinesia: involuntary movements (facial grimacing, tongue protrusion, lateral jaw movements, lip smacking); develops over mo to yrs but can be permanent; tx is to stop ASAP and use VMAT-2 inhibitors (valbenazine/deutrabenazine) anti-cholinergics WORSEN this”
tx for nicotine withdrawal
- Chantix/Varenicline (28d treatment; reduces cravings/withdrawal sx; causes crazy nightmares)
- Bupropion/Wellbutrin (150-300mg XL QD)
- Nicotine Replacement: patch, gum, lozenge, spray, inhaler (to slowly reduce dosage)
Anti-depressants (general overview)
Most antidepressants have similar efficacy in treating depression so your choice of antidepressant should be based on side effect profile and comorbidities
Lots of antidepressants work on multiple neurotransmitters
Start low and go slow
Peds patients typically start at ½ starting dose for 7 days then increase
All antidepressants have a BLACK BOX WARNING for increase suicidal ideation in patients under 25yo
Follow up closely with these patients
Serotonin Side Effects
- Nausea, vomiting, diarrhea
- Headaches, dizziness
- Inducing mania/hypomania
- Increased bleeding risk (serotonin receptors on platelets): Typically presents as easy bruising, but No need to hold medications prior to surgery
- Bone fractures (up to 76% increased risk with SSRIs)
- Seuxal Dysfunction - decreased libido, delayed or inability to climax (F>M)
SSRIs
- Fluoxetine (10-40mg PO QD; Prozac)
- Paroxetine (10-40mg PO QD: Paxil)
- Sertaline (50-300mg PO QD; Zoloft)
- Citalopram (10-40mg PO QD; Celexa)
- Escitalopram (10-20mg PO QD; Lexapro)
- Fluvoxamine (50-300mg PO QD; Luvox)
SSRI- specific med need to knows
- Paroxetine: worst discontinuation syndrome; pregnancy category D
- Escitalopram: “cleanest SSRI” (fewest side effects)
SNRIs
- Venlafaxine (37.5-225mg PO QD; Effexor)
- Desvenlafaxine (50-200mg PO QD; Pristiq)
- Duloxetine (20-120mg PO BID; Cymbalta)
- Levomilnacipran (20-120mg PO QD; Fetzima)
Buproprion
avoid in alcohol use disorder, bulimic pts, and those w/ electrolyte disorders
lack of sexual side effects + appetite suppresion = good choice for those worried about this
Typicals (1st gen)
- MOA: decrease dopamine; works best on positive sx; highest risk EPS + anti-HAM
Meds
* Chlorpromazine (Thorazine)
* Thioridazine (Mellaril)
* Loxapine (Loxitane)
* Thiothixene (Navane)
* Molindone (Moban)
* Perphenazine (Trilafon)
* Haloperidol (Haldol)
* Fluphenazine (Prolixin)
* Trifluoperazine (Stelazine)
* Pimozide (Orap)
Atypicals
- MOA: decrease dopamine; increase serotonin; works on pos + neg sx; has more metabolic side effects
Meds (most end in “apine” or “idone”)
* Quetiapine (Seroquel)
* Ziprasidone (Geodon)
* Olanzapine (Zyprexa)
* Aripiprazole (Abilify)
* Iloperidone (Fanapt)
* Paliperidone (Invega)
* Asenapine (Saphris)
* Risperidone (Risperdal)
* Clozapine (Clozaril)
Antipsychotics- specific med need to knows
- Ziprasidone (Geodon): more QT prolongation than any other atypical
- Olanzapine: expected 10-30 lb wt gain (why we give it to anorexics)
- Risperidone + Paliperidone: causes most EPS + hyperprolactinemia of all atypicals (but typicals still cause more overall)
AUD Tx options
- Naltrexone
- Acamprosate
- Disulfiram
Acamprosate
- for AUD
- glutamate neurotransmission modulation
Naltrexone
- MOA: mu opioid receptor blocker
- LFT monitoring q6mo
- reduces heavy drinking by 25%; suppresses EtOH consumption
Disulfiram
- causes unpleasant physiologic rxn when EtOH is consumed
- MOA: inhibits aldehyde dehydrogenase & prevents the metabolism of EtOH’s primary metabolite, acetaldehyde
Neglect
An act of omission in care leading to potential or actual harm
Most common type of child abuse
Includes:
Inadequate health care, education, or supervision
Lack of protection from hazards in the environment
Unmet basic needs (clothing, food, water)
physical abuse
Intentional injury causingpain
Impairs physical functioning
May leave a physical mark
Includes burning, beating, shaking, and biting
Second most common type of child abuse
Carried out by the primary caregiver (>80%)
Greatest cause ofmortality:
70% of victims are < 3 years old
sexual abuse
Involvement of a child (< 16 years in many states) in sexual activities that they cannot comprehend or consent to
Includes sexual activity (oral, anal or vaginal penetration), contact of anal, genital, or oral regions, genital fondling, or exposure to sexually explicit materials
Peaks in girls aged 9–12
Perpetrator is usually known to the victim
emotional/psychological abuse
An act that would terrorize a child resulting in negativeaffect and future psychological illness
Includes verbal abuse, humiliation, threats of violence, rejection, withholding love, and witnessing domestic violence
Least reported because it is difficult to document
80% of the victims develop a psychiatric illness in adulthood
clinical presentation/red flags for child abuse
Presentation:
* Failure to thrive: Most common presentation of child abuse; Suboptimal weight gain and growth (inadequate caloric intake)
Red Flags
* Frequent emergency department visits
* Delay inpresentation with injuries inconsistent with history
fracture sites suggestive of abuse
The followingfracture sites are highly suggestive of abuse:
* Posterior aspect ofribs
* Scapula
* Spinous processes
* Sternum
* Metaphyseal corner fractures (also known as “bucket-handle” fractures) of the femur, tibia, or humerus
* Skull fracture
* Spiral diaphyseal fracture in non-walking infants
TEN-4-FACESp
TEN
* Torso
* Ears
* Neck
FACCES
* Frenulum
* Angle of Jaw
* Cheeks
* Eyelids
* Subconjunctiva
4 mo or younger
p: patterned
