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Block 8; Week 3 > PED pharmacology-Zelan > Flashcards

PED pharmacology-Zelan Flashcards

1
Q

Who was the first behavioral scientist to take a scientific approach?

A

Pavlov

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2
Q

How did Freud view the mind?

A

unconscious force

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3
Q

How did cognitive therapists view the mind?

A

a series of cognitive distortions

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4
Q

What’s the deal with Chomsky?

A

language & syntax come from within us

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5
Q

What do cognitive scientists view the mind as?

A

the software that accompanies the hardware of the brain

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6
Q

What are important factors for good psychopharmacology?

A 
rapport with patient & family
good team functioning
solid formulation & diagnosis
treatment of obvious factors-medical conditions
proper use of safe & effective meds
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7
Q

T/F Children need to be evaluated multiple times b/c they are not as good at reporting their internal psychiatric symptoms.

A

True.

Also need to interview collateral informants–teachers etc.

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8
Q

What are some important components of the general evaluation?

A 
History with target symptoms
History of prior medication use
History of side effects 
History of compliance with medications
Medical conditions or allergies
Assessment of other conditions
Other medications they are using
Reliability
Evidence-based or indications
Collateral information (multiple informants)
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9
Q

What are some important rating scales used in pediatric pharmacology?

A 
Connors (ADHD)
CDI (depression)
Y-MRS, parent (bipolar disorder)
Y-BOCS (OCD)
BASC, Achenbach
Life problems inventory
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10
Q

What are labs that are ordered on pediatric children?

A

CBC, metabolic panel, CA, Mg, Phos, TFTs, RPR, Lead, Vit B12/ Folate, Lipid panel, Hgb A1c, ceruloplasm (Wilson’s disease), pregnancy
EKG
CV & neuro exam

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11
Q

T/F Many psychotropic medications are not FDA approved for children and adolescents

Sometimes treating symptoms rather than actual disorders (but with evidence-based guidelines)

A

True.

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12
Q

How does a child metabolize a medication compared to an adult?

A

children metabolize medications faster

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13
Q

What are genomics?

A

a field of study in which genotyping guides treatment decisions
example: look at rate of metabolism by observing CYP2D6 variation. Determines dose.

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14
Q

What are the following patients at risk for?
Poor metabolizers
Borderline Poor
Rapid

A

Poor: high risk for adverse effects
Borderline Poor: more susceptible to inhibitor effect
Rapid: at risk for treatment failure

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15
Q

Why is prozac a tricky treatment?

A

it is metabolized by 2D6 & it inhibits it!

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16
Q

What are some 2D6 substrates?

A 
TCAs
Prozac, luvox, paxil, trazodone, remeron
Effexor / cymbalta
Many antipsychotics (incl Hdl, Risp, Abilify, zyp)
Strattera, stimulants
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17
Q

What are some important 2C19 substrates?

A 
Xanax, valium, many TCAs
Clozaril
Methadone
Perphenazine
Zoloft, Celexa, Lexapro, Prozac, effexor
Thioridazine
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18
Q

Which gene is associated with a better response to SSRIs?

A

serotonin transporter gene-long form.

except in asians.

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19
Q

Why are we concerned about using psychoactive medications in children?

A

b/c the brain continues to develop into adulthood

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20
Q

What are unexpected symptoms experienced by children w/ tetracycline?

A

dental discoloration

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21
Q

What are unexpected symptoms experienced by children w/ SSRIs?

A

suicidality

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22
Q

What are unexpected symptoms experienced by children w/ aspirin?

A

Reye’s syndrome

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23
Q

What are unexpected symptoms experienced by children w/ cough suppressants?

A

pneumonia

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24
Q

What are unexpected symptoms experienced by children w/ anti emetics?

A

dystonic, EPS reactions

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25
Q

How should we monitor medications?

A

Monitoring of target symptoms: rating forms, collateral information
Monitoring of serum levels – Lithium, Anticonvulsants
Monitoring of other physical assessments:
Height/weight, P, BP, tics (stimulants)
Liver function, blood count (anticonvulsants)
Fasting blood sugar, lipids, weight, abnormal movements (antipsychotics & mood stabilizers)
Medication ‘holidays’ and discussion of taking off medications (wean)

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26
Q

Give the classification of medications.

A 
Anti-depressants
Mood Stabilizers/Anticonvulsants
Anti-psychotics
    Traditional
    Second Generation
Anxiolytics
Sleep Agents/Hypnotics
Stimulants
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27
Q

What is the most widely used antidepressant in children?

A

SSRIs

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28
Q

What are the most commonly used antidepressants?

A

SSRIs
atypical antidepressants
TCA
MAOIs

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29
Q

What are the potential concerns w/ SSRIs in children?

A

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

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30
Q

Aside from depression, what are other disorders that SSRIs can treat in a child?

A 
OCD
Tourette's
Anxiety Disorders
Selective Mutism
PTSD 
Eating Disorders
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31
Q

What are the issues w/ TCAs in children?

A

ineffective

can cause sudden death

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32
Q

What are the side effects of SSRIs?

A 
Gastrointestinal side effects 
Headaches
Insomnia or sedation
Serotonin syndrome 
Sexual dysfunction (delayed ejaculation, anorgasmia, decreased libido)
Discontinuation syndrome 
Mania
Restlessness (akathisia or agitation)
Miscellaneous side effects: sweating, anxiety, dizziness, tremors, fatigue, dry mouth.
Priapism
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33
Q

What is involved in serotonin syndrome?

A

(nausea, tremor, hyperthermia, rigidity or pain, ALOC, seizure)

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34
Q

What is discontinuation syndrome?

A

(dizziness, nausea, lethargy, irritability)

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35
Q

What are some atypical antidepressants?

A 
Wellbutrin, Wellbutrin SR, Wellbutrin XL, Zyban (buproprion)
Effexor, Effexor XR (venlafaxine)
Cymbalta (Duloxetine)
Desyrel (trazadone)
Remeron (mirtazapine)
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36
Q

What are side effects associated with wellbutrin, an atypical antidepressant?

A

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

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37
Q

What are the side effects of trazodone?

A

sedation, weight gain, hypotension, dry mouth, priapism

38
Q

What are the side effects of effexor?

A

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

39
Q

What are the side effects of remeron?

A

increased appetite, sedation, dry mouth, constipation

40
Q

What are some common mood stabilizers?

A 
Lithium
       Depakote (Valproic Acid)
       Lamotrigine  
       Tegretol
       Trileptal
41
Q

What are possible causes of priapism?

A

illness (hematologic, metabolic, neoplastic, neurological), trauma, drugs-including trazodone

42
Q

Which hx taking do you need to do if you prescribe trazodone to men?

A

hx of delayed detumescence

present in 50% of people who end up with priapism

43
Q

T/F Lower doses & lower duration of treatment is protective against priapism as a side effect of trazodone medication.

A

False. Not protective.

44
Q

What is a difficulty with prescribing mood stabilizers?

A

following levels for Depakote, Lithium, Tegretol, for therapeutic level and for evaluating toxicity

45
Q

What is lamictal used to treat? What does it put you at risk for?

A

used to treat bipolar depression

issue: Stevens Johnson Depression

46
Q

What are the disadvantages & advantages with topamax?

A

dis: less effective mood stabilizer
advantage: no weight gain, don’t need to monitor levels as closely

47
Q

What is the issue with diagnosing bipolar disorder in children?

A

there aren’t pediatric standards

need to meet adult DSM5 criteria. Will need to perhaps use multiple medications.

48
Q

What are some common mood stabilizers? How long does it take to reach a therapeutic effect? What form do these meds come in?

A

Lithobid, Eskalith, Lithonate, Eskalith CR (lithium)
therapeutic effect: 4-6 weeks
capsule & liquid form

49
Q

How are mood stabilizers typically excreted? What are the baseline labs you would want?

A

excreted renally

chem panel, TFTs, CBC, pregnancy test

50
Q

What is the healthy lithium serum range?

A

0.8-1.2 mEq/L

51
Q

Which condition in childhood often develops into bipolar disorder in adulthood?

A

ADHD in childhood

52
Q

What are the side effects 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

53
Q

What are potential life threatening risks of lithium?

A

serotonin syndrome

neuroleptic malignant syndrome

54
Q

Neuraleptic malignant syndrome & serotonin syndrome may be variants of what?

A

drug induced central hyperthermia

55
Q

What are some symptoms of serotonin sickness?

A 
mydriasis
diaphoresis
agitation
tachycardia
increased bowel sounds
autonomic instability-often HTN
clonus
hyperreflexia
tremor
56
Q

What are some meds that can cause serotonin syndrome?

A 
Anti-migraine
pain medications
illicit drugs
herbal supplements
OTC cough & cold meds
anti-nausea meds
linezolid
ritonavir
buprenorphine, oxycodone, hydrocodone
57
Q

Which meds do you usu see serotonin syndrome with? NMS with?

A

SS–SSRIs

NMS-antipsychotics w/ chronic schizophrenia

58
Q

What is the onset, symptoms, and signs of serotonin syndrome?

A

onset: sudden w/i 1 day of introduction of drug.
Symptoms: agitation, diarrhea
signs: dilated pupils, myoclonus, hyperreflexia

59
Q

What is the onset, symptoms, signs of neuroleptic malignant syndrome?

A

Onset: w/i 1 week of introduction of drug.
Symptoms: dsyphagia, hypersalivation, incontinence
Signs: hyperthermia, akinesia, extrapyramidal rigidity
rhabdomyolysis

60
Q

What causes lithium toxicity while taking lithium?

A

decreased fluid intake, increased fluid loss (sweating excessively/diuretics), reduced salt intake, medications that act on the renal system (NSAIDS/ACE inhibitors), taking too much Lithium!

61
Q

What are the symptoms of lithium toxicity?

A

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

62
Q

What are considered severely toxic levels of lithium?

A

> 2.5

63
Q

What is the treatment for lithium toxicity?

A

stop the lithium
hydration
hemodialysis

64
Q

What is the issue with clozapine?

A

can cause bone marrow suppression

65
Q

What is the birth defect associated w/ lithium usage? Depakote?

A

Lithium: cardiac toxicity
Depakote: NTD

66
Q

What do you need to do to monitor depakote usage?

A

don’t use in patients with liver disease

monitor serum levels 7 days after first dose.

67
Q

What are common & rare side effects w/ depakote usage?

A

Side effects: sedation, dizziness, nausea, vomiting, abnormal LFTs.

Other rarer side effects: hepatitis, pancreatitis, hematological, dermatological, neurological.

68
Q

Give a list of some mood stabilizers/anticonvulsants.

A 
Lamictal
Tegretol
Trileptal
Tegretol
Topamax
69
Q

What is the bad side effect of lamictal?

A

safer in pregnancy, rash

70
Q

What is the bad side effect of tegretol?

A

affects blood count

71
Q

What is the bad side effect of trileptal?

A

better tolerated, less effective

72
Q

What is the bad side effect of topamaxl?

A

not used for bipolar disorder

73
Q

What are the symptoms to look out for with stevens johnson syndrome? What can it develop into?

A

fever & rash–mucous membranes
preceded by flu like symptoms
can progress into toxic epidermal necrolysis

74
Q

What are things that can cause SJ syndrome?

A

Can be caused by acute infection or medications.
Anticonvulsants (esp. lamictal but others also).
PCN
Ibuprofen, Tylenol, naproxen.
Allopurinol
Radiation therapy

75
Q

What are justifiable uses of antipsychotics in children?

A 
Childhood Schizophrenia
Childhood Bipolar Disorder
Autistic Spectrum Disorders
Tourette’s Disorder
Substance Induced Psychosis
76
Q

What are some atypical antipsychotics & their safe dosages?

A 
Aripiprazole		5-30 mg/day
Olanzapine		5-20 mg/day
Quetiapine		25-400 
Risperidone		0.5-6 
Ziprasidone		20-160
77
Q

What are some examples of second generation side effects?

A 
Abilify (aripiprazole)
Geodon (ziprasidone)
Zyprexa, Zydis (olanzapine)
Seroquel (quetiapine)
Risperdal (risperidone)
Clozaril (clozapine)
78
Q

What are some bad side effects of stimulants?

A

numb
GI
headache
watch out for elevations in HR, BP, and suppression of appetite-can cause reduction in growth!!

79
Q

What are the 2 most important psychostimulants? What are they meant to treat?

A

used to treat executive function-frontal lobe…ADHD
Ritalin (methylphenidate)
Adderall (mixed amphetamine salts)

80
Q

What are the side effects of ability/aripiprazole?

A

GI effects, headache, sedation (higher dosages).

81
Q

What are the side effects of geodon/ziprasidone?

A

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

82
Q

What are the side effects of zyprexa/zydis/olanzapine?

A

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

83
Q

What are the side effects of seroquel/quetiapine?

A

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

84
Q

What are the side effects of risperdal/risperidone?

A

orthostatic hypotension, weight gain, elevated prolactin levels.

85
Q

What are the side effects of clozaril/clozapine?

A

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

86
Q

Which meds can cause bad CV effects?

A

older antipsychotics–arrhythmia, BP
don’t want prolonged QTC
***esp consider if you are dealing with a female, hypokalemia, hypo magnesium, CV disease

87
Q

What are the medical emergencies associated w/ anti-psychotics?

A 
Parkinsonianism
Acute dystonia
Acute akathisia
Tardive dyskinesia (TD)
Neuroleptic malignant syndrome (NMS)
88
Q

What are some alternative medications used for ADHD?

A

Strattera (atomoxatine)

Wellbutrin (buproprion)

89
Q

What are some medication used as sleep agents?

A 
Benadryl
Atarax
Remeron
Melatonin
Sonata
Behavioral therapy
90
Q

What is the hierarchy of safety & efficacy?

A

Stimulants > SSRI’s > mood stabilizers > antipsychotics

91
Q

T/F Monopharmacy is better than polypharmacy b/c of the potential side effects.

A

True.

Block 8; Week 3 (11 decks)

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