Psych

Question 1

SSRI’s (drugs)

Answer 1

PPLZ “C”
Paxil (paroxetine) - most sedating and causes ED, wt gain. Shortest half life. Good for OCD and off label PMDD

Prozac (fluoxetine): causes jitters and has longest half life. Best for non- compliant pts. wt neutral. Good for bulemia.

Lexapro (escitalopram) - good for elderly - low S/E profile

Zoloft (sertraline) - high safety profile; good for elderly

-Celexa (citalopram): few drug interactions

Question 2

SSRI class,
adv effects, and warnings, special considerations

Answer 2

Thought to work by increasing levels of serotonin in the brain

Adv effects: anxiety, insomnia, sexual S/E, serotonin syndrome, anorexia

Black box warning: suicidal ideation, especially in those <24 years (assess for suicidal thinking after 2 weeks of therapy) and do not d/c abruptly. Avoid SSRI’s within 14 days of MAOIs (serotonin syndrome). Bipolar Patients may cause mania

May prolong QT interval
Elderly: citalopram (Celexa) and escalopram (Lexapro) have fewer drug interactions.
Avoid SSRI’s with anorexia or thin elderly d/t loss of appetite
Takes 4-12 weeks for effect
Do not stop abruptly- withdrawal symptoms may occur

Increased risk of bleeding if taken with blood thinners

Paxil= ED

Question 3

Atypical Antipsychotics drugs, adv effects and warning

Warnings: monitor er q 3 months

Answer 3

Drugs: zyprexa (olanzapine),
Risperdal (Risperidone), Seroquel (quetiapine)

Adv effects: obesity, DM2, hyperlipdemia, metabolic syndrome, hypothyroidism

Question 4

Anticonvulsants

Answer 4

Lamptrigine (lamictal), carbamazepine (tegretol), valproate (depakote)

Question 5

SNRI’s

Answer 5

vanalfexine (Effexor)
Desvenlafaxine (pristiq) duloxetine (CYmbalta)

SNRI’s are used for depression and neuropathic pain.

S/E: nausea, anticholinergic effects, excessive sweating

Adv effects: can worsen acute narrow angle glaucoma so warning to avoid with those who have glaucoma

Question 6

Typical Antipsychotics

Answer 6

Haloperidol (haldol)
Adv effects: increase lipids/triglycerides and malignant neuroleptic syndrome
Warning: monitor glucose and lipids
Black box warning: elderly = death

Question 7

TCA’s

Answer 7

Not 1st line depression meds
Good for postherpetic neuralgia, stress urinary incontinance, chronic pain

Imipramine (Tofranil)
Amitriptyline (elavil)
Nortryptaline (pamelor)
Doxepin (sinaquan)

Adv events: sedation, anticholinergic effects, category X pregnancy

Warning: “SADCUB”
Sedating, Anorexia, Dry mouth, Confusion, Constipation, Urinary retention, BPH

Do not combine SSRI’s with MAOI’s d/t increase in serotonin syndrome

Avoid with or who have hx of suicide (can hoard and OD)

Question 8

Lithium

Answer 8

Adv events: diarrhea, dry mouth, metallic taste

Warning: check blood levels

Question 9

Atypical antidepressants

Answer 9

Bupropion (Wellbutrin)
Zyban for smoking cessation

Adv events: seizures

Warning: be careful can cause seizures! contraindicated in patients with anorexia, bulimia (bc they are low of electrolytes and may lead to a seizure), hx of seizures

Question 10

MAOIs

Answer 10

Phenelzine (Nardil)
tranylcypromine (Pernate)

S/E: anticholinergic effects
special consideration: do not combine MAOI’s, SSRI, TCA - wait 2 weeks before switching groups

Warning MAOI’s are rarely used
d/t serious food/drug interactions with tyramine

Question 11

Benzodiazepines

Answer 11

1st line tx: anxiety, panic disorder, insomnia

Drugs (-Pam’s and -Lam’s)
-diazepam (Valium) for severe ETOH withdrawals
-midazolam (versed)
-alprazolam (Xanax)
-lorazepam (Valium)
-clonazepam (klonopin)

Special consideration: avoid long acting in elderly - Valium, Librium, Restoril, Klonipin

Warning: don’t d/c abruptly as it may cause seizures

Question 12

Other

Answer 12

Bupropion (zyban) used for smoking cessation- ok if used in conjunction with patches and gums;
Bupropion (Wellbutrin) used in conjunction for ED caused by SSRI’s
Duloxetine (Cymbalta) used for depression and neuropathic pain

Question 13

Acute Serotonin Syndrome

Answer 13

High risk when combining 2 drugs that both block serotonin (SSRI’s, MAOI’s, TCA’s, triptans, tryptophan. ***WHY we wait 2 weeks if switching drugs

Question 14

Malignant Neuroleptic Syndrome

Answer 14

Cause rare, life threatening rxn from typical (1st generation and atypical (2nd generation) antipsychotics

Following initiation of a new therapy or recent increase in dose. These drugs affect the dopinergic system of the brain.

S/S: acute high fever, muscular rigidity, mental status changes, tachyonea, elevated HR fluctuation inBO, urinary incontinence

Question 15

Depression in Pregnancy
Don’t give:
Give:

Answer 15

NO PAROXETINE (Paxil) in pregnancy

Give Fluoxetine (Prozac) or Sertraline (Zoloft) in pregnancy

Question 16

Depression in Elderly
Start with
Avoid:

Answer 16

Start with SSRI’s at a low dose
Avoid TCA’s

Question 17

Baker Act means

Answer 17

Provide mental health emergency services

Question 18

Depression screening
1st line meds
Risk with St John’s Wort
How long does it take for meds to work?

Answer 18

PHQ-2 if + do PHQ9
First line:SSRI and SNRI
Seratonin syndrome
4-6 weeks, if no symptom relief check for other causes

Question 19

What SSRI is notorious for additional wt gain?

Answer 19

Paxil

Question 20

What SSRI is bad for pts with anxiety because it can make them feel “jittery”

Answer 20

Prozac

Question 21

The SNRI, Effexor, cans cause issues with …

Answer 21

HTN

Question 22

Do a good cardiac evaluation exam and EKG before prescribing what class of antidepressant meds?

Answer 22

TCA’s (like Amitriptyline) can cause heart block, ventricular arrhythmias and sudden death

Question 23

SSRI’s helpful with PTSD

Answer 23

Paroxetine (Paxil), sertraline (Zoloft) and citalopram (Celexa)
Start lowest dose

Question 24

What SSRI is most likely to cause ED?

Answer 24

Paroxetine (Paxil)

Question 25

Wellbutrin increases the chance of a

Answer 25

Seizure

Question 26

Which med for depression should be avoided in patients with uncontrolled HTN?

Answer 26

Venalfaxine (Effexor)

Effexor effects BP!!!!