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PANRE > Panre-Psychiatry/Behavior Science > Flashcards

Panre-Psychiatry/Behavior Science Flashcards

1
Q

Bipolar disorder (Level 1)?

A
  1. Bipolar Disorder 1
  2. Bipolar Disorder 2
  3. Rapid cycling
  4. Cyclothymic

Demographics: Men = Women, avg onset 20-30y, rare for new onset >50y
● #1 risk factor: Family hx of 1st degree relative

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2
Q

Bipolar Disorder Type 1

A

≥1 manic or mixed episodes, usually requires hospitalization

○ Depressive episodes may be occasional but not required for diagnosis

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3
Q

Bipolar Disorder Type 2

A

At least one major depressive episode (MDE) + one hypomanic episode
○ Does not meet criteria for full manic or mixed episode

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4
Q

Rapid cycling

A

Involves 4+ episodes (MDE, manic, mixed or hypomanic) in 1 year

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5
Q

Cyclothymic

A

Chronic and less severe, alternating hypomania and moderate depression
for >2 years

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6
Q

Sx of mania: DIG FAST

A

D istractibility and D ecreased need for sleep
○ I mpaired judgement and I ncreased i mpulsivity
○ G randiosity/more G oal oriented
○ F light of ideas/racing thoughts
○ A ctivities/psychomotor a gitation
○ S exual indiscretions/other pleasurable activities
○ T alkativeness/pressured speech

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7
Q

Dx of mania:

A

1+ week of persistently elevated, expansive or irritable mood + 3 “DIG
FAST” sxs
○ Psychotic symptoms also common
○ Must have significant social/occupational impairment

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8
Q

Hypomania:

A

Similar to mania but does not cause significant life impairment, no
psychotic features, does not require hospitalization
○ Period of elevated, expansive or irritable mood for at least 4 days that is
different from usual non depressed mood
○ Does not include racing thoughts or excessive psychomotor agitation

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9
Q

Bipolar TX?

A

Bipolar mania is acute emergency due to impaired judgement and concern
for self/other harm
■ Tx with hospitalization + mood stabilizers such as lithium,
carbamazepine, valproic acid
○ Bipolar depression
■ Mood stabilizers with/without antidepressants
■ Antidepressants alone can trigger mania

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10
Q

Child/elder abuse, Spouse/partner abuse (Level 1)

A

Mandatory reporter of child/elder abuse
● Be suspicious when explanation does not match injury pattern
● Have knowledge of local resources

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11
Q

Child Abuse: Sexual abuse:

A

Abuser often male who is known to victim

● S/S: Genital/anal trauma, STIs, UTIs

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12
Q

Child Abuse: Physical abuse:

A

Abuser often primary caregiver, female
● S/S: Burns in stocking glove pattern, retinal hemorrhages, subdural hematoma,
bruises, spiral fractures

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13
Q

Child Abuse: ● Child neglect:

A

Failure to provide basic needs

● S/S: Failure to thrive, malnutrition, withdrawal

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14
Q

Elder Abuse?

A

Abuser is someone with ongoing relationship, duty toward elder
● Abuse may be physical, sexual or psychological
● Also neglect or financial exploitation

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15
Q

Elder Abuse s/s?

A

Skin tears, bruising, pressure sores, spiral long bone fractures, malnutrition,
dehydration

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16
Q

Elder Abuse warning signs of financial exploitation? screening questions?

A

Change in ability to pay for medical
services, utilities, food, housing; patient who lacks capacity to consent to property
or equity transfer.

Screening questions with patient alone:
○ Do you feel safe where you live?
○ Who prepares your meals?
○ Who handles your checkbook?

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17
Q

Spouse/partner abuse

A

Women>Men
● Intimate partner violence: Actual or threatened physical, sexual or psychological
harm by current or former partner
○ Does not require sexual intimacy
○ Occurs in both heterosexual and homosexual relationships.

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18
Q

Spouse/partner abuse s/s?

A

Apparent social isolation, overly attentive/verbal partner, delay in seeking
treatment, missed appointments, inappropriate affect (jumpy, fearful, avoid eye
contact), inconsistent explanation of injuries

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19
Q

Spouse/partner abuse associated?

A

depression, suicidality, anxiety, PTSD, substance abuse, eating
disorders

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20
Q

Spouse/partner abuse screening questions?

A

Screening with SAFE questions: Ashur M. Asking About Domestic Violence: SAFE Questions.
JAMA.1993;269(18):2367
○ S tress/Safety: Do you feel safe in your relationship?
○ A fraid/Abused: Have you ever been in a relationship where you were
threatened, hurt or afraid?
○ F riend/Family: Are your friends/family aware you have been hurt?
○ E mergency plan: Do you have a safe place to go and the resources you need
in an emergency?

As providers, be non judgmental, assure appropriate confidentiality, non-hurried
discussion, reassurance that abuse is not their fault, no pressure to leave/report,
shared decision making, supportive listening

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21
Q

Generalized Anxiety Disorder (Level 2)

A

Definition: Uncontrollable, excessive anxiety or worry about multiple activities or
events that leads to significant impairment
Demographics: 2x more women>men, onset early 20s

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22
Q

Generalized Anxiety Disorder (Level 2) dx?

A

Anxiety on most days for 6+ months with 3+ somatic symptoms
○ Restlessness, fatigue, difficulty concentrating, irritability, muscle tension,
disturbed sleep

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23
Q

Generalized Anxiety Disorder (Level 2) tx

A

Short-term: Benzodiazepines
■ Side effects: ↓ duration of sleep, risk of abuse, tolerance and
dependence, disinhibition, confusion
■ Also hydroxyzine
■ 𝛃blockers
● Best for phobic disorders given before exposure
○ Long-term: Psychotherapy, cognitive behavioral therapy, medications
■ SSRIs, SNRIs
● Side effects: Nausea, somnolence, sexual dysfunction
Buspirone
● No tolerance, dependence or withdrawal

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24
Q

Major depressive disorder (Level 2)

A

Dx: Depressed mood or anhedonia along with 5+ symptoms almost every day for
most days for at least 2 weeks

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25
Q

Major depressive disorder (Level 2) s/s? Sig Em Caps

A

SIG EM CAPS
S leep insomnia or hypersomnia
○ I nterest (↓ interest or pleasure in activities)
○ G uilt (thoughts of worthlessness or inappropriate guilt)
○ E nergy ↓, fatigue
○ M ood ↓
○ C oncentration ↓
○ A ppetite and weight ↓ or ↑
○ P sychomotor agitation or retardation
○ S uicidal ideation (recurrent thoughts of death)

Symptoms must not be due to substance use, medical issues or bereavement
● Symptoms must cause distress/impairment in daily functioning
● Absence of mania or hypomania

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26
Q

Major depressive disorder (Level 2) RF?

A

Female 2x> Male, highest incidence 20-40s, FH
○ 15% commit suicide, ↑ suicide rates: White males > 45y, detailed plan,
substance abuse

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27
Q

Major depressive disorder (Level 2) TX?

A

Psychotherapy - 1st line in mild/moderate depression, cognitive behavioral
therapy (CBT)
○ SSRIs- 1st line for medicine; also SNRIs, TCAs, MAOIs; minimum 3-6 weeks
○ Electroconvulsive therapy (ECT) for pts who fail medical therapy;
transcranial magnetic stimulation (TMS)

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28
Q

Non-substance-related addictive disorders (Level 1)

A

Gambling disorder is the only DSM-5 recognized disorder
● Other behavioral addictions include pornography, sex, social media, video gaming,
shopping, food, exercise
● Screen for maladaptive behaviors similar to substance use disorder but there is
currently no specific diagnostic criteria except for gambling disorder
○ DSM 5 says “behavioral addictions…are not included because at this time
there is insufficient peer-reviewed evidence to establish the diagnostic
criteria…”

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29
Q

Gambling disorder dx:

A

Behavior leading to clinically significant impairment/distress
with 4+ sx in 1 year Extrapolate these diagnostic criteria to other behavioral
addictions, replace specific behavior for gamble/gambling
○ Need to increased amount/time gambling to achieve same excitement
○ Restless/irritable when attempting to cut down/abstain
○ Unsuccessful attempts to cut back/stop
○ Preoccupied by gambling
○ Gambles when distressed
○ Gambles even after losing money (“chasing losses”)
○ Lies about extent of gambling
○ Jeopardized or lost significant life relationship/job due to gambling
○ Relies on others for money to relieve financial stress caused by gambling

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30
Q

Panic disorder (Level 2) dx?

A

Dx: Recurrent, unexpected panic attacks (abrupt onset, peak within 10 min,
duration <60 min) with
○ At least 2 with one of the following for at least 1 mo
■ Panic attack followed by concern for future attack
■ Worry about implication of attack
■ Significant change in behavior d/t attack
○ At least 4 symptoms of panic attack
■ Tachypnea, chest pain, palpitations, diaphoresis, nausea, trembling,
dizziness, fear of dying/doom
○ Sxs not due to substance use, medical or other psychiatric condition
○ ± Agoraphobi

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31
Q

Panic disorder (Level 2) Demographics?

A

2x more women>men, average age of onset is 25y

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32
Q

Panic disorder (Level 2) Diff Dx?

A

Angina, MI, arrhythmias, hyperthyroidism, pheochromocytoma,

substance-induced anxiety, generalized anxiety disorder (GAD), PTSD

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33
Q

Panic disorder (Level 2) PE:

A

Perioral and/or acral paresthesias from hyperventilation (fairly specific to
panic attacks)

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34
Q

Panic disorder (Level 2)TX?

A

Short-term: Benzodiazepines, hydroxyzine
○ Long-term: Psychotherapy, cognitive behavioral therapy (CBT),
medications- SSRI

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35
Q

Post-traumatic stress disorder (Level 1)

A

Clinically significant stress/impairment in daily interactions due to exposure to a
life-threatening traumatic event either by: Direct experience of event
○ Witnessing event
○ Learning event happened to someone close
○ Occupational extreme or repeated exposure to details of event; Common traumatic events: Sexual assault, combat experiences, childhood abuse

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36
Q

Post-traumatic stress disorder (Level 1) Dx?

A

Presence of ≥ 1 of the following symptoms for > 1 mo:
○ Intrusion - reexperiencing event through nightmares, flashback, intrusive
thoughts
○ Avoidance of stimuli related to the event
○ Negative alterations in mood/cognitions- numbed responsiveness,
detachment, guilt, self-blame
○ Changes in arousal and reactivity- ↑ arousal, hypervigilance, exaggerated
startle, sleep disturbances, irritability, ↓ concentration

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37
Q

Post-traumatic stress disorder (Level 1)

A

SSRI, trazodone may help insomnia, CBT

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38
Q

Substance use disorders: illicit substances, prescription drugs, alcohol, tobacco (Level 1)

A

Maladaptive pattern of substance use that leads to clinically significant
impairment
○ Can be applied to most substances (not caffeine

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39
Q

Substance use disorders: illicit substances, prescription drugs, alcohol, tobacco (Level 1) Criteria for dx?

A

2 of 11 criteria within 1 year
Impaired control
■ 1. Consumption of greater amounts than intended
■ 2. Failed attempts to cut down/abstain
■ 3. Increased amount of time spent using/acquiring/recovering
■ 4. Craving
○ Social impairment
■ 5. Failure to fulfill responsibility at work/school/home
■ 6. Continued use despite recurrent social/interpersonal issues 2º to
substance
■ 7. Isolation from life activities
○ Risky use
■ 8. Use in physically hazardous situation
■ 9. Continued use despite recurrent physical/psychological issues 2º
to substance
○ Pharmacologic
■ 10. Tolerance and need for progressively larger amounts for same
effect
■ 11. Withdrawal symptoms when not using substance

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40
Q

Mild Dx of

Substance use disorders: illicit substances, prescription drugs, alcohol, tobacco (Level 1)

A

2-3 sx

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41
Q

Moderate: of

Substance use disorders: illicit substances, prescription drugs, alcohol, tobacco (Level 1)

A

4-5 sx

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42
Q

Severe; of

Substance use disorders: illicit substances, prescription drugs, alcohol, tobacco (Level 1)

A

> 6 sx

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43
Q

Substance use disorders labs?

A

✔ urine and blood tox, LFTs, ETOH

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44
Q

Alcohol Use Disorder risks? Dx?

A

Risks: Men 4x>women, FH
● Dx: CAGE questions
○ Have you ever felt the need to CUT down on your drinking?
○ Have you ever felt ANNOYED by criticism of your drinking?
○ Have you ever felt GUILT about your drinking?
○ Have you ever had to take an morning EYE opener?

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45
Q

Alcohol Use Disorder Withdrawal sx?

A

Tremor, tachycardia, delirium tremens (DTs), seizures, agitation,
hallucinations, potentially fatal
Timeline after last drink
■ 6-24 hours: Uncomplicated sxs → tremor, anxiety, diaphoresis
■ 6-48 hours: Withdrawal seizure
■ 12-48 hours: Hallucinations with normal vitals and clear sensorium
■ 2-5 days: Delirium tremens → altered sensorium, abnormal vital
signs(associated with mortality rate of up to 5%)
Withdrawal seizures: Generalized tonic-clonic, begin within 12-48 hour after the last drink, often in chronic alcoholics, age 40-50 y/o
All puts with DTS required admission and IV benzos

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46
Q

Withdrawal tx of Etoh use?

A

Benzo taper, multivitamin + folic acid, thiamine to prevent

Wernicke encephalopathy; Pts with hx of complicated withdrawal can be prophylactically tx with oral chlordiazepoxide

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47
Q

Long term tx of Etoh use?

A

Disulfiram, naltrexone, group therapy/alcoholics anonymous

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48
Q

Complicatons of Etoh use?

A

GI bleeding d/t ulcers, varices, Mallory-Weiss tears, pancreatitis,
liver disease

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49
Q

Tobacco use disorder

A

Risk factor for major pulmonary, cardiac and cancer deaths
● Withdrawal sx: Anxiety, craving, irritability, sleep changes
● Tx: Nicotine tapering therapy ± bupropion, varenicline

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50
Q

Opioid use disorder intoxication s/s? Withdrawal s/s?

A

Intoxication s/s: Euphoria and sedation, pupillary constriction, respiratory
depression, bradycardia, hypotension, N/V, flushing, constipation
● Withdrawal s/s: “Hurts all over”, non life-threatening (no seizures), lacrimation,
hypertension, pupillary dilation, piloerections, sweating, diarrhea, tachycardia

51
Q

Opioid use disorder tx?

A

Acute intoxication: Naloxone, onset ~ 2 min IV, ~ 5 min IM
○ Withdrawal: Symptom control with clonidine, loperamide, NSAIDs,
buprenorphine + naloxone
Long term management: Methadone, suboxone

52
Q

Suicide risk (Level 2) RF?

A

1 predictive factor: previous attempt or threat

● Always ask patients if they have a plan, access to firearms
Other risk factors: Underlying psychiatric disorders, substance abuse, family
history

53
Q

Suicide risk (Level 2) Demographics?

A 
Suicide attempts: Female > Male
○ Suicide completions: Male > Female
○ Suicide rate ↑ with age
■ #1 elderly white males
○ White > Black
○ Alone > never married > widowed > separated/divorced > married without
kids > married with kids
54
Q

Suicide risk (Level 2) TX?

A

Medical stabilization, reduction of immediate risk, safety planning, managing
underlying psychiatric illness and factors, monitoring and follow up

55
Q

Narcolepsy

A

↓ ability to regulate sleep-wake cycles

56
Q

Narcolepsy CM?

A

→ mins), cataplexy (emotionally-triggered transient muscle weakness), sleep paralysis &/or
hallucinations when falling asleep or awakening; usually sleep about the same number of
hours at night as most people, but have interrupted sleep

57
Q

Narcolepsy Dx?

A

clinical; polysomnography (REM occurs at sleep onset)

58
Q

Narcolepsy TX

A

lifestyle changes (daytime naps); CNS stimulants (eg. modafinil, methylphenidate

59
Q

Parasomnias

A

Disruptive sleep disorders that occur during arousals from non-rapid eye movement (NREM)
or rapid eye movement (REM) sleep – can occur while falling asleep, sleeping or waking up

60
Q

Parasomnias NREM dz?

A

often run in families & usually occur in children or adolescents; pts usually
return to sleep & are amnestic to events in the morning – most pts outgrow these conditions
by young adulthood

61
Q

Parasomnias REM dz?

A

usually involve dream enactment & pts usually recall the dream and
associated actions – these conditions most often occur late in adult life & are associated with
degenerative brain dz

62
Q

Parasomnias Dx?

A

clinical; polysomnography for REM sleep behavior disorder

63
Q

Parasomnias TX?

A

Sleep hygiene
o Avoiding substance use
o Injury protection (sleeping close to floor level, removing surrounding sharp objects)
o Possibly benzodiazepines (eg. clonazepam) to promote sleep depth & continuity; also,
melatonin
o Sleep medicine consult

64
Q

NREM disorders:

A

Somnambulism (sleep walking); Sleep (night) terrors:

65
Q

Somnambulism

A

NREM, Sleep walking; Sitting, moving around or walking with eyes wide open, but actually still in deep NREM
sleep – may wake up during an episode & appear confused, or get back into bed without
waking; most people do not recall the event

66
Q

Sleep (night) terrors

A

NREM; Abrupt arousal in a state of terror often screaming, crying or flailing, ↑ heart &
respiratory rates, sweating, skin flushing – pt may appear to be awake, but is confused
and unable to communicate normally; most people do not recall the event

67
Q

REM disorders

A

REM sleep behavior disorder; Nightmares:

68
Q

REM sleep behavior disorder

A

Vocalization (sometimes profane) & often aggressive movements (punching, kicking) that
reflect physical acting out of dreams; pts usually recall vivid dreams upon awakening

69
Q

Nightmares:

A

Abrupt arousal in a state of fear, terror and/or anxiety brought about by vivid dreams
during sleep; pts can usually describe detailed dream content – usually due to illness,
anxiety or traumatic event

70
Q

Selective serotonin
reuptake inhibitors
(SSRI) MoA?

A

Highly selective for
blocking serotonin reuptake
at neuronal membrane

71
Q

Selective serotonin
reuptake inhibitors
(SSRI Names?

A 
Citalopram
Escitalopram
Fluvoxamine
Fluoxetine
Paroxetine
Sertraline
72
Q

Selective serotonin
reuptake inhibitors
(SSRI) Indications?

A 
#1 for depression &amp;
anxiety
• Obsessive compulsive
disorder (OCD)
• Bulimia nervosa
• Premenstrual dysphoric
disorder (PMDD)
73
Q

Selective serotonin
reuptake inhibitors
(SSRI) S/E?

A 
GI upset
• Sexual dysfunction
• Headache Insomnia
• Anxiety
• Weight changes
Serotonin syndrome
especially if used with
MAOI →
74
Q

Serotonin syndrome

A 
especially if used with
MAOI →
Acute altered mental
status
• Coma
• Restlessness
• Diaphoresis
• Tremor
• Hyperthermia
• N/V
• Abdominal pain
• Tachycardia
75
Q

Selective serotonin
reuptake inhibitors
(SSRI) CI

A 
Avoid citalopram in
patients with long QT
syndrome
• Avoid paroxetine in
pregnancy (can cause
pulmonary HTN)
76
Q

Selective serotonin
reuptake inhibitors
(SSRI) Special Considerations?

A 
Benefits:
• Preferred for children
• Easy dosing
• Less side effects
• Low toxicity in overdose
77
Q

Serotonin and
norepinephrine
reuptake inhibitors
(SNRI) Names?

A

Desvenlafaxine
Duloxetine
Venlafaxine

78
Q

Serotonin and
norepinephrine
reuptake inhibitors
(SNRI) MOA?

A

Inhibits serotonin,
norepinephrine & dopamine
reuptake

79
Q

Serotonin and
norepinephrine
reuptake inhibitors
(SNRI) Indications?

A

1 for depression with

significant fatigue or pain
syndromes
• 2nd line to SSRI

80
Q

Serotonin and
norepinephrine
reuptake inhibitors
(SNRI) S/e?

A

Similar to SSRI +
hyponatremia &
noradrenergic symptoms

81
Q

Serotonin and
norepinephrine
reuptake inhibitors
(SNRI) CI ?

A 
Cautions:
• MAOI
• Renal/hepatic
impairment
• Seizures
• HTN
82
Q

Serotonin and
norepinephrine
reuptake inhibitors
(SNRI) Special considerations?

A 
Avoid abrupt
discontinuation
• ↑ serotonin syndrome
risk when used with St
John’s Wort
83
Q

Tricyclic

antidepressants (TCA) Names?

A 
Amitriptyline
Clomipramine
Desipramine
Doxepin
Imipramine
Nortriptyline
84
Q

Tricyclic

antidepressants (TCA) Moa?

A

nhibits presynaptic
reuptake of serotonin &
norepinephrine

85
Q

Tricyclic

antidepressants (TCA) Indications?

A 
Depression
• Insomnia
• Diabetic neuropathic pain
• Post-herpetic neuralgia
• Migraine
• Urge incontinence
• Enuresis (imipramine)
86
Q

Tricyclic

antidepressants (TCA) S/e?

A 
Anticholinergic effects
(dry mouth, constipation,
urinary retention,
sedation)
• Weight gain
• Prolonged QT interval
• Overdose: Na⁺channel
blocker effects, wide
complex tachycardia
(correct with
bicarbonate), ARDS,
SIADH
87
Q

Tricyclic

antidepressants (TCA) CI

A 
MAOI
• Recent MI
• Hx of seizure
• Check ECG before
starting to r/o AV blocks
Contraindications:
• Pregnancy
88
Q

Tricyclic

antidepressants (special considerations)

A 
• Used less often due to
SE &amp; severe overdose
toxicity
• Non-depressed patients
feel sleepy
• Depressed patients have
mood elevation
89
Q

Mirtazapine Drug class and MOA?

A

Tetracyclic
compounds; Enhances central
noradrenergic &
serotonergic activity

90
Q

Mirtazapine Indications

A

Depression

91
Q

Mirtazapine S/E

A 
Sedation
• Dry mouth
• Constipation
• Weight gain
• Agranulocytosis
92
Q

Mirtazapine CI

A

Caution with MAOI

93
Q

Mirtazapine Special Considerations?

A

Less sexual dysfunction

94
Q

MAO inhibitors

(MAOI) Drug name and MOA

A

Phenelzine

95
Q

Phenelzine Indications

A

Refractory depression

96
Q

Phenelzine S/E

A 
Insomnia
• Anxiety
• Orthostatic hypotension
• Weight gain
• Sexual dysfunction
• Hypertensive urgency/
emergency (with
tyramine containing
foods)
97
Q

Phenelzine CI

A

Caution + SSRI →
serotonin syndrome
• Caution + TCA →
delirium & HTN

98
Q

Phenelzine Special Considerations?

A

Avoid tyramine containing
foods - aged/fermented
cheese, wine, beer, smoked
meats

99
Q

Bupropion Drug class and MOA?

A

Atypical ; Inhibits neuronal uptake of

dopamine

100
Q

Bupropion Indications

A 
Depression
• Smoking cessation
• Attention-deficit
hyperactivity disorder
(ADHD)
• Seasonal affective
disorder (SAD
101
Q

Bupropion S/E

A 
↓ seizure threshold
• Agitation
• Anxiety
• Restlessness
• Weight loss
• HTN
• Headache
• Dry mouth
102
Q

Bupropion CI

A 
Cautions:
• Seizure disorder
• Eating disorder
• MAOI use
• Drug/ETOH
detoxification
103
Q

Bupropion Special Considerations?

A

• Less sexual dysfunction &
GI distress than SSRI
• Avoid abrupt withdrawal

104
Q

Trazodone Drug class and MOA?

A

Atypical;
Serotonin antagonist &
reuptake inhibitor

105
Q

Indications

A

Depression
• Anxiety
• Insomnia

106
Q

S/E

A

Sedation

• Priapism

107
Q

Typical 1st Generation Drug class?

A

Butyrophenones

Phenothiazines

108
Q

Butyrophenones Drug class and MOA

A

Typical 1st Generation ; Droperidol
Haloperidol; Blocks CNS D2 receptors
• Dopamine antagonist

109
Q

Butyrophenones Indications

A 
Psychosis
• Schizophrenia (especially
positive symptoms)
• Tourette syndrome
• Alcoholic hallucinosis
• Antiemetic
110
Q

Butyrophenones S/E

A 
• Extrapyramidal symptoms
(EPS)
• QT prolongation
• Weight gain
• ↑ prolactin
• Sedation
111
Q

Butyrophenones CI

A

Liver disease
• Haloperidol CI with
Parkinson disease
• Anticoagulant use

112
Q

Butyrophenones Delivery options?

A 
IM Depot Preparations
for non-compliant
patients
• Haloperidol q 4 wks
• Fluphenazine q 2 wks
113
Q

Phenothiazines Drug class and MOA

A 
Chlorpromazine
Fluphenazine
Thioridazine; Blocks CNS D2 &amp; 5HT2
receptors
• Dopamine antagonist
114
Q

Phenothiazines Indications

A

Psychosis
• Schizophrenia
• Chlorpromazine for
intractable hiccups

115
Q

Phenothiazines S/E

A 
EPS
• QT prolongation
• Weight gain
• ↑ prolactin
• Sedation
• Thioridazine can cause
irreversible retinitis
pigmentosa
116
Q

Phenothiazines CI

A

• Liver disease

117
Q

Mood stablizers

A

Lithium
Carbamazepine
Lamotrigine
Valproic acid

118
Q

Lithium MOA, Indications, S/E, CI, Special Considerations.

A 
• Alters cation transport
across cell membrane
• Influences reuptake
of serotonin and/or
norepinephrine;• # 1 mood stabilizer
especially in suicidal
patients
• Management of bipolar
disorder (BPD)
• Acute mania in BPD
• Last drug of choice for
SIADH; Lithium induced
diabetes insipidus: treat
with amiloride
• Fine tremor: treat with
propranolol
• Hypothyroidism
• N/V
• Leukocytosis
• Cardiac arrhythmias
• Toxicity: ataxia,
dysarthria, delirium,
acute renal failure; • ↓ renal function
• Pregnancy; • ↓ suicide risk
• Narrow therapeutic
window so must monitor
blood levels
• Toxicity >1.5 mEq/L
119
Q

Carbamazepine MOA, Indications, S/E, CI,

A 
Stabilizes electrical activity
in the brain; 
• 2nd line mood stabilizer
• Anticonvulsant
• Trigeminal neuralgia; 
• Hyponatremia
• Diplopia
• Ataxia
• Aplastic anemia
• Agranulocytosis:
monitor CBC; 
Cautions:
• Gout
• DM 2
120
Q

Lamotrigine MOA, Indications, S/E, Special Considerations.

A 
Stabilizes electrical activity
in the brain ; 
• 2nd line mood stabilizer
• Anticonvulsant ; 
• Rash/SJS
• Visual disturbance; 
↑ dose slowly &amp; monitor
for rash
121
Q

Valproic acid MOA, Indications, S/E, CI,

A 
Stabilizes electrical activity
in the brain; 
• BPD
• Anticonvulsant; 
• Pancreatitis
• Hepatotoxicity
• GI upset; 
• Pregnancy
• Hepatic disease
122
Q

Amitriptyline use for?

A

Chronic pain, Diabetic neuropathic pain
• Post-herpetic neuralgia
•

123
Q

Imipramine use for

A

Bedwetting

124
Q

Clomipramine use for

A

OCD

PANRE (15 decks)

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