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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
How should we monitor medications?
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)
26
Give the classification of medications.
``` Anti-depressants Mood Stabilizers/Anticonvulsants Anti-psychotics Traditional Second Generation Anxiolytics Sleep Agents/Hypnotics Stimulants ```
27
What is the most widely used antidepressant in children?
SSRIs
28
What are the most commonly used antidepressants?
SSRIs atypical antidepressants TCA MAOIs
29
What are the potential concerns w/ SSRIs in children?
SI, mania, EKG changes, sleep problems, serotonin syndrome, sexual side effects, weight gain.
30
Aside from depression, what are other disorders that SSRIs can treat in a child?
``` OCD Tourette's Anxiety Disorders Selective Mutism PTSD Eating Disorders ```
31
What are the issues w/ TCAs in children?
ineffective | can cause sudden death
32
What are the side effects of SSRIs?
``` 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 ```
33
What is involved in serotonin syndrome?
(nausea, tremor, hyperthermia, rigidity or pain, ALOC, seizure)
34
What is discontinuation syndrome?
(dizziness, nausea, lethargy, irritability)
35
What are some atypical antidepressants?
``` Wellbutrin, Wellbutrin SR, Wellbutrin XL, Zyban (buproprion) Effexor, Effexor XR (venlafaxine) Cymbalta (Duloxetine) Desyrel (trazadone) Remeron (mirtazapine) ```
36
What are side effects associated with wellbutrin, an atypical antidepressant?
insomnia, CNS stimulation, headache, constipation, dry mouth, nausea, tremor, seizure (rare)
37
What are the side effects of trazodone?
sedation, weight gain, hypotension, dry mouth, priapism
38
What are the side effects of effexor?
hypertension, insomnia, anxiety, nausea, sweating, dizziness, high incidence of discontinuation syndrome
39
What are the side effects of remeron?
increased appetite, sedation, dry mouth, constipation
40
What are some common mood stabilizers?
``` Lithium Depakote (Valproic Acid) Lamotrigine Tegretol Trileptal ```
41
What are possible causes of priapism?
illness (hematologic, metabolic, neoplastic, neurological), trauma, drugs-including trazodone
42
Which hx taking do you need to do if you prescribe trazodone to men?
hx of delayed detumescence | present in 50% of people who end up with priapism
43
T/F Lower doses & lower duration of treatment is protective against priapism as a side effect of trazodone medication.
False. Not protective.
44
What is a difficulty with prescribing mood stabilizers?
following levels for Depakote, Lithium, Tegretol, for therapeutic level and for evaluating toxicity
45
What is lamictal used to treat? What does it put you at risk for?
used to treat bipolar depression | issue: Stevens Johnson Depression
46
What are the disadvantages & advantages with topamax?
dis: less effective mood stabilizer advantage: no weight gain, don't need to monitor levels as closely
47
What is the issue with diagnosing bipolar disorder in children?
there aren't pediatric standards | need to meet adult DSM5 criteria. Will need to perhaps use multiple medications.
48
What are some common mood stabilizers? How long does it take to reach a therapeutic effect? What form do these meds come in?
Lithobid, Eskalith, Lithonate, Eskalith CR (lithium) therapeutic effect: 4-6 weeks capsule & liquid form
49
How are mood stabilizers typically excreted? What are the baseline labs you would want?
excreted renally | chem panel, TFTs, CBC, pregnancy test
50
What is the healthy lithium serum range?
0.8-1.2 mEq/L
51
Which condition in childhood often develops into bipolar disorder in adulthood?
ADHD in childhood
52
What are the side effects 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
53
What are potential life threatening risks of lithium?
serotonin syndrome | neuroleptic malignant syndrome
54
Neuraleptic malignant syndrome & serotonin syndrome may be variants of what?
drug induced central hyperthermia
55
What are some symptoms of serotonin sickness?
``` mydriasis diaphoresis agitation tachycardia increased bowel sounds autonomic instability-often HTN clonus hyperreflexia tremor ```
56
What are some meds that can cause serotonin syndrome?
``` Anti-migraine pain medications illicit drugs herbal supplements OTC cough & cold meds anti-nausea meds linezolid ritonavir buprenorphine, oxycodone, hydrocodone ```
57
Which meds do you usu see serotonin syndrome with? NMS with?
SS--SSRIs | NMS-antipsychotics w/ chronic schizophrenia
58
What is the onset, symptoms, and signs of serotonin syndrome?
onset: sudden w/i 1 day of introduction of drug. Symptoms: agitation, diarrhea signs: dilated pupils, myoclonus, hyperreflexia
59
What is the onset, symptoms, signs of neuroleptic malignant syndrome?
Onset: w/i 1 week of introduction of drug. Symptoms: dsyphagia, hypersalivation, incontinence Signs: hyperthermia, akinesia, extrapyramidal rigidity rhabdomyolysis
60
What causes lithium toxicity while taking lithium?
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
What are the symptoms of lithium toxicity?
GI (nausea, vomiting, diarrhea), coarse tremor, ataxia, slurred speech, confusion, arrythmias.
62
What are considered severely toxic levels of lithium?
>2.5
63
What is the treatment for lithium toxicity?
stop the lithium hydration hemodialysis
64
What is the issue with clozapine?
can cause bone marrow suppression
65
What is the birth defect associated w/ lithium usage? Depakote?
Lithium: cardiac toxicity Depakote: NTD
66
What do you need to do to monitor depakote usage?
don't use in patients with liver disease | monitor serum levels 7 days after first dose.
67
What are common & rare side effects w/ depakote usage?
Side effects: sedation, dizziness, nausea, vomiting, abnormal LFTs. Other rarer side effects: hepatitis, pancreatitis, hematological, dermatological, neurological.
68
Give a list of some mood stabilizers/anticonvulsants.
``` Lamictal Tegretol Trileptal Tegretol Topamax ```
69
What is the bad side effect of lamictal?
safer in pregnancy, rash
70
What is the bad side effect of tegretol?
affects blood count
71
What is the bad side effect of trileptal?
better tolerated, less effective
72
What is the bad side effect of topamaxl?
not used for bipolar disorder
73
What are the symptoms to look out for with stevens johnson syndrome? What can it develop into?
fever & rash--mucous membranes preceded by flu like symptoms can progress into toxic epidermal necrolysis
74
What are things that can cause SJ syndrome?
Can be caused by acute infection or medications. Anticonvulsants (esp. lamictal but others also). PCN Ibuprofen, Tylenol, naproxen. Allopurinol Radiation therapy
75
What are justifiable uses of antipsychotics in children?
``` Childhood Schizophrenia Childhood Bipolar Disorder Autistic Spectrum Disorders Tourette’s Disorder Substance Induced Psychosis ```
76
What are some atypical antipsychotics & their safe dosages?
``` Aripiprazole 5-30 mg/day Olanzapine 5-20 mg/day Quetiapine 25-400 Risperidone 0.5-6 Ziprasidone 20-160 ```
77
What are some examples of second generation side effects?
``` Abilify (aripiprazole) Geodon (ziprasidone) Zyprexa, Zydis (olanzapine) Seroquel (quetiapine) Risperdal (risperidone) Clozaril (clozapine) ```
78
What are some bad side effects of stimulants?
numb GI headache watch out for elevations in HR, BP, and suppression of appetite-can cause reduction in growth!!
79
What are the 2 most important psychostimulants? What are they meant to treat?
used to treat executive function-frontal lobe...ADHD Ritalin (methylphenidate) Adderall (mixed amphetamine salts)
80
What are the side effects of ability/aripiprazole?
GI effects, headache, sedation (higher dosages).
81
What are the side effects of geodon/ziprasidone?
cardiac effects (caution in those with cardiac history), dizziness, nausea, sedation (IM).
82
What are the side effects of zyprexa/zydis/olanzapine?
metabolic syndrome, weight gain, dry mouth, akathisia, insomnia, GI effects, tremor, lightheadedness.
83
What are the side effects of seroquel/quetiapine?
sedation, metabolic syndrome, weight gain, orthostatic hypotension, GI effects, and dry mouth.
84
What are the side effects of risperdal/risperidone?
orthostatic hypotension, weight gain, elevated prolactin levels.
85
What are the side effects of clozaril/clozapine?
hematological changes (agranulocytosis), orthostatic hypotension, sedation, constipation, hyperthermia, hypersalivation, seizure (higher dosages), myocarditis.
86
Which meds can cause bad CV effects?
older antipsychotics--arrhythmia, BP don't want prolonged QTC ***esp consider if you are dealing with a female, hypokalemia, hypo magnesium, CV disease
87
What are the medical emergencies associated w/ anti-psychotics?
``` Parkinsonianism Acute dystonia Acute akathisia Tardive dyskinesia (TD) Neuroleptic malignant syndrome (NMS) ```
88
What are some alternative medications used for ADHD?
Strattera (atomoxatine) | Wellbutrin (buproprion)
89
What are some medication used as sleep agents?
``` Benadryl Atarax Remeron Melatonin Sonata Behavioral therapy ```
90
What is the hierarchy of safety & efficacy?
Stimulants > SSRI’s > mood stabilizers > antipsychotics
91
T/F Monopharmacy is better than polypharmacy b/c of the potential side effects.
True.

Block 8; Week 3 (11 decks)

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