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Block 8 Week 3 > Peds Psychopharm > Flashcards

Peds Psychopharm Flashcards

1
Q

The hypothetical “essence” thought to cause human behavior

A

mind

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2
Q

What is the recurrent problem with mentalistic explanations of human behavior?

A

we cannot test hypotheses

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3
Q

What factors does good psychopharmacology depend on?

A 
rapport with the patient and family
good team functioning
solid formulation and diagnosis
treatment of other obvious factors
proper use of safe and effective meds
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4
Q

A psychiatric evaluation includes a (blank) evaluation.

A

medical

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5
Q

Things included in a medical evaluation?

A

growth charts - height, weight
blood pressure, pulse
labs

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6
Q

Two exams performed by the psychiatrist?

A

CV exam

neuro exam

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7
Q

Most psychotropic medications are not (blank) for children and adolescents

A

FDA approved

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8
Q

Children and adolescents generally metabolize (blank) than adults

A

faster

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9
Q

Sometimes with children, you treat (blank) rather than actual disorders

A

symptoms

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10
Q

T/F: Polypharmacy is sometimes used, although definitely not the ideal.

A

True

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11
Q

using a medication that has not received FDA approval for the clinical indication

A

off label use

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12
Q

A new field of study in which genotyping guides treatment decisions.
Example: allelic variation in CYP 2D6 can affect how quickly some drugs are metabolized.
Faster metabolism – needs higher doses.

A

genomics

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13
Q

Poor drug metabolizers are at higher risk for (blank). Rapid metabolizers are at risk for (blank)

A

adverse effects; treatment failure (inaffective treatment)

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14
Q

Which drugs are metabolized by Cyto 2D6?

A 
TCAs
Prozac, paxil, trazodone, remeron
Effexor, cymbalta
Many antipsychotics
Strattera, stimulants
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15
Q

Which drugs are metabolized by Cyto 2C19?

A 
Xanax, valium, TCAs
Clozaril
Methadone
Perphenazine
Zoloft, Celexa, Lexapro, Prozac, effexor
Thioridazine
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16
Q

Except in Asians, the (blank) serotonin transporter gene is associated with more favorable response to SSRIs

A

long form (esp with two copies)

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17
Q

What are some parental influences that come into play when prescribing drugs for kids?

A

parents buy into the notion of a quick fix
parents want to believe biology is to blame vs parenting styles
or
parents take too much responsibility for their child’s illness

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18
Q

There is a lack of safety and efficacy studies on psychotropic meds for children. Give two reasons why.

A

the brain continues to develop into early adulthood

impact of adding psychoactive meds to a developing brain remains unknown

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19
Q

Tetracyclines cause (blank) in kids

A

dental discoloration

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20
Q

SSRIs cause (blank) in children

A

suicidality

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21
Q

Aspirin causes (blank) in children

A

Reye’s syndrome

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22
Q

Cough suppressants can cause (blank) in children

A

pneumonia

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23
Q

Antiemetics can cause (blank) in children

A

dystonic and other movement disorders

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24
Q

FDA requires safety and efficacy studies for (blank) population only

A

target

**ex: only require studies for adults if the drug is intended to be used for adults

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25
Q

T/F: FDA guidelines do not limit which drugs you can prescribe

A

True

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26
Q

T/F: Research on children is complicated and costly and liability risk potential is higher

A

True

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27
Q

It is the job of the physician to educate and recommend drugs for children, but the parents are the informed consenters. If a parent refuses treatment, what should you do?

A

document the refusal

**this is just as important as informed consent

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28
Q

What are these?

Target symptoms
Standard of care/ Evidence-based
Least risk of serious side effects
FDA approval
Known previous responses of patient
Known previous responses of family members
Dosing schedule
Clinician preference
A

Things to consider when selecting a medication

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29
Q

With meds in kids, start with a low dose and continue to raise the dose until…

A

satisfactory remission of symptoms
upper limit of dose reached
side effects make the dose intolerable
plateau in symptoms or symptoms get worse

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30
Q

When giving stimulants, what are some things you should monitor?

A

height/weight
pulse
blood pressure
tics

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31
Q

When giving anticonvulsants, what are some things you should monitor?

A

liver function

blood count

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32
Q

When giving antipsychotics and mood stabilizers, what are some things you should monitor?

A

fasting blood sugar
lipids
weight
abnormal movements

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33
Q

How often should children on maintenance medications be seen by their prescribing clinician?

A

at least once every 3 months

**Children in acute settings, displaying unsafe behavior, experiencing significant side-effects, or not responding to a medication trial or in an active phase of a medication trial should be seen more frequently.

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34
Q

Although we have limited information on the long-term effects of drugs on a child’s brain, what is one reason to initiate medical therapy in the kids anyway?

A

untreated diseases get worse as they progress –> disrupted development can have long term consequences as well

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35
Q

Most widely used anti-depressants in children

A

SSRIs

36
Q

Problems with SSRIs in children?

A 
mania
EKG changes
sleep problems
serotonin syndrome
sexual side effects
weight gain
37
Q

What are atypical antidepressants?

A

may work on multiple receptors

38
Q

Ineffective in treating childhood depression

A

TCAs

**reports of sudden death

39
Q

SSRIs may be administered (blank)

A

once daily

40
Q

Side effects of SSRIs

A 
GI effects
headaches
insomnia or sedation
serotonin syndrome
sexual dysfunction
discontinuation syndrome
mania
41
Q

What are these?

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

atypical antidepressant

42
Q

Side effects of Wellbutrin?

A 
insomnia**
increased risk for seizures (avoid in pts with seizure disorders and those w anorexia/bulimia)
CNS stimulation
headache
constipation 
dry mouth
nausea
tremor
43
Q

Side effects of Trazodone?

A 
sedation **makes patients sleepy
weight gain
hypotension
dry mouth
priapism
44
Q

Side effects of Effexor

A 
hypertension**
insomnia
anxiety
nausea
sweating
dizziness
high incidence of discontinuation syndrome
45
Q

Side effects of Remeron?

A

increased appetite
sedation
dry mouth
constipation

46
Q

What are these?

Lithium
Depakote (Valproic Acid)
Lamotrigine  
Tegretol
Trileptal
A

Mood stabilizers

47
Q

Awkward side effect of many psychiatric meds

A

priapism

**can occur in females

48
Q

Does Dr. Zelan prescribe Trazodone in men? Why?

A

he doesn’t, because the risks are uncertain and potentially harmful, patients/doctors are under-educated and embarrassed to discuss em, benefits are so-so; if you do, careful history taking is required!!!

49
Q

What is one major clinical con for use of mood stabilizers?

A

following levels and evaluating for toxicity

50
Q

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

A

Lamictal

51
Q

rather less effective mood stabilizer but doesn’t cause weight gain (actually loss of appetite in some) and don’t need levels.

A

Topamax

52
Q

How is lithium excreted?

A

renally

53
Q

What must be done if you administer lithium?

A

baseline labs, including a pregnancy test (can’t be used in prego women)
follow lithium levels

54
Q

How long might lithium take to work?

A

~4-6 weeks

55
Q

Side effects of lithium?

A 
GI distress
weight gain
fuzzy thinking
polyuria with polydipsia (always have to pee, always thirsty)
hypothyroidism
cardiovascular
acne, rash, itching
hematology
56
Q

Two potentially life threatening side effects of lithium?

A

seratonin syndrome

neuroleptic malignant syndrome

57
Q

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

A

serotonin syndrome

58
Q

Meds that can cause serotonin syndrome in kids

A 
anti-migraine meds
pain meds
illicit drugs
herbal supps (St. John's wort)
OCC cold meds
anti-nausea meds
linezolid
ritonavir
59
Q

How is neuroleptic malignant syndrome (NMS) different from serotonin syndrome?

A

serotonin syndrome: sudden onset (w/i 24 hours), agitation and diarrhea, dilated pupils, myoclonus, hyperreflexia

NMS seen more with antipsychotics and chronic schizophrenia: slower onset (w/i 7 days), dysphagia, hypersalivation, incontinence, hyperthermia, akinesia, extrapyramidal rigidity

60
Q

How can lithium toxicity occur? What are the symptoms?

A

decreased fluids, increased fluid loss, decreased salt, drugs that act on renal system, too much lithium; GI (nausea, vom, diarrhea), coarse tremor, ataxia, slurred speech, confusion, arrythmias

61
Q

Severe lithium toxicity occurs when levels exceed (blank)

A

2.5mEq/L

62
Q

What are Depakote and Depakene (Valproic acid)?

A

mood stabilizers

63
Q

Depakote and Depakene should be avoided in patients with (blank) because it is cleared by the (blank)

A

liver disease; liver

64
Q

Do levels of Depakote and Depakene need to be monitored? When will therapeutic effect occur?

A

yes; check serum levels 7 days after first dose and then continue to monitor; terapeutic effect in 2-4 weeks

65
Q

Side effects of Depakote and Depakene?

A

sedation
dizziness
nausea
vom

*hepatitis
pancreatitis
etc

66
Q

Safer mood stabilizer for pregnancy, can cause rash

A

Lamictal (lamotrigine)

67
Q

This mood stabilizer affects blood count

A

Tegretol (carbamazepine)

68
Q

This mood stabilizer is better tolerated than Tegretol, but may not be as effective

A

Trileptal (oxcarbazepine)

69
Q

This mood stabilizer is not used for bipolar disorder

A

Topamax (topirimate)

70
Q

Alternatives to traditional mood stabilizers?

A

second generation antipsychotics

71
Q

Can progress to toxic epidermal necrolysis – medical emergency, sometimes ICU level (resemble severe burns).
Fever and rash, especially involving mucous membranes.
Rash may be preceeded by flu like symptoms (fever, sore throat, fatigue, cough).
Rash can be painful and involving blisters.

A

Stevens-Johnson syndrome

72
Q

Meds that can cause SJS?

A 
anticonvulsants
PCN
ibuprofen, tylenol, naproxen
allopurinol
radiation therapy
73
Q

In what disorders are antipsychotics OK for children?

A 
childhood schizo
childhood bipolar disorder
ASD
Tourette's disorder
substance induced psychosis
74
Q

What are some side effects of the second generation anti-psychotics?

A 
GI effects
headache
sedation
weight gain
dry mouth
75
Q

Second gen anti-psychotic that causes WEIGHT GAIN

A

Zyprexa, Zydis

76
Q

We know that antipsych drugs can cause cardiovascular risk factors. What are some compounding risk factors that might precipitate cardiovascular disease?

A

females
Low K+, low Mg++
CV disease
prolonged QT syndrome

77
Q

What are two psychostimulants?

A

ritalin

adderall

78
Q

Alternative meds given for ADHD?

A

Strattera (atomaxatine)
Wellbutrin (buproprion)

**used to give Tenex and clonidine

79
Q

What is one problem with anxiolytics?

A

fast acting anxiolytics may have a quick reinforcing effect, but then they wear off, which causes an emotional “roller coaster”

80
Q

Most effective treatment for anxiety?

A

behavioral therapy

**can use benzos but they cause tolerance and increasing demand

81
Q

What should be considered first in sleep disorders?

A

meds with low side effects like Benadryl or Atarax, can try remeron (a melotonin receptor agonist) or melatonin

82
Q

Rank the following in terms of safety/efficacy:

antipsychotics
SSRIs
mood stabilizers
stimulants

A

stimulants > SSRIs > mood stabilizers > antipsychotics

83
Q

T/F: MONOpharmacy is better than POLYpharmacy

A

True

84
Q

T/F: Although FDA approval is not necessary for final word, it is important to pay attention to different categories

A

Duh

85
Q

Always make sure to do this regardless of what you are prescribing

A

document!!!

Block 8 Week 3 (10 decks)

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