Psych Flashcards
Depression:
How do we screen for it?
What are the first line medications?
PHQ2 –> +?
then do PHQ9
> 5? = depression DX
SSRI’s/ SNRI’s
name some SSRI’s
black box warning?
how long to see effects?
how long will pt be on medication?
- Types of SSRIs
esCITALOpram (Cipralex)
CITALOpram (Celexa)
EsCITALOpram (Lexapro)
fluoxeTINE (Prozac or Oxactin)
paroxeTINE (Paxil),
SertraLINE (Zoloft)
fluvoxaMINE (Faverin)
VilazoDONE
“SSorRIy PrAM!! your TINE on the ‘starters’ LINE is DONE! the position is MINE”
***black box warning: SSRI’s can cause suicidal ideation in pts <24 yrs old
-can induce mania in bipolar pts
how long to see effects? –> 4-6 weeks
how long will pt be on medication?
@ least 6 months
Name some SNRI’s
avoid in pt’s with:
SNRI
“So…No RI RI? - she has evil CYMBAL’s”
“the CYMBAL has an EFFEct on depression. the CYMBAL also has a DULe effect on neuro pain”…. what cymbal? I cant see it! this is too much pressure”
duloxetine (Cymbalta)
-helps w/neuropathic pain
venlafaxine (Effexor)
-BP issues may occur
avoid in pt’s with uncontrolled narrow-angle glaucoma
things to know about:
fluoxeTINE (ProZAC or Oxactin)
paroxeTINE (Paxil)
EscitaloPRAM (Lexapro)
SertraLINE (Zoloft)
fluoxeTINE (Prozac or Oxactin)
-Jittery, long 1/2 life
“zac is so jittery”
paroxeTINE (Paxil)
-sedating, ED
-short half life; needs to be weaned off slowly to prevent withdrawal symptoms
“your dic is short and looks like its sedated Paxman”
EscitaloPRAM (Lexapro)
-works quickly
“lex is a pro, she works quickly”
SertraLINE (Zoloft)
-best choice for the elderly (low SE profile)
Anxiety
screening?
tx?
GAD-7
5 points = mild anxiety
10 points = moderate anxiety
15 + = severe anxiety
“oh GAWD! 5/ 10/ 15 …? ah”
tx:
-cognitive therapy
-SSRI, SNRI
-Benzodiazepines
Difficulty falling asleep =
this can be caused by:
Difficulty falling asleep = Onset Insomnia
this can be caused by: GERD, Restless leg syndrome, depression
Insomnia
3 main categories:
-transient:
-short term:
-chronic:
Tx?
Transient:
-lasts < 1 wk
Short term:
-2-3 months
Chronic
3 months- to a lifetime
tx:
-Sleep Hygiene (no caffeine, bed used only for sleep, cog. behav therapy)
-Benzo’s:
*lorazepam (Ativan)
*diazepam (Valium)
*alprazolam (Xanax)
-Non-Benzo’s
*Ambien (Zolpidom)
*Lunesta
Atypical Antipsychotics
Ex:
Adverse effects:
Monitor:
Avoid in pts w/:
Ex:
quetiapine (SeroQUEL)
risperidone (RISPERdal)
Olanzapine (Zyprexa)
“be vewy quiet you fat SQUrEL- i wike to wISPER…. O LANni you are not a typical girl”
Adverse effects:
wt gain
hyperlipidemia
hyperglycemia
galactorrhea
Monitor:
BMI (check wt Q 3 months)
Avoid in pts w/:
Metabolic syndrome
Tricyclic antidepressants (TCA)
used for:
Ex:
Adverse effects:
Monitor:
Avoid in pt’s w/:
used for:
-depression (not first line)
-postherpetic/herpetic neuralgia (chronic pain after shingles)
-urinary incontinence
-migraine prophylaxis
Ex:
-amiTRIPtyLINE (Elavil)
-norTRIPtyLINE (Pamelor)
-DOXEpIN (Sinequan)
{Kaylee DOXy IN- is going to ride a TRICYCLe while playing volleyball
well… this is just DEPRESSING… its breaking my HEART and giving me a massive migrane…
ugh, it just hurts to watch (Neuralgia)
“oh DOXEPoo! your TRIPT on the LINE”
more like DOXE cant poo…}
Adverse effects:
-anticholinergic
-category X
Monitor:
**Cardiac evaluation needed BEFORE prescribing these
-overdose will cause fatal cardiac event
Avoid in pt’s w/:
-the elderly
-those taking SSRI’s/ MAOI’s (serotonin syndrome)
-suicidal pts (may hoard to overdose)
take at night (sedation)
Buspirone (Buspar)
used for:
warn pt’s about:
do not use with:
off label use:
“non-benzo”
used for:
-Anxiety
{I don’t want to SPAR! I’ve only trained for 4 weeks! scared/panic attack/dizzy/pooping himself….
well that was disappointing… put some maoi on this will ya? }
warn pt’s about:
-full effect in 4 weeks
-GI S.E. and dizziness
do not use with:
-grapefruit juice
-MAOIs
off label use:
-panic attacks
Benzodiazepines:
Drug ending:
great for treating:
commonly causes:
big safety concern:
Drug ending:
“-ZPAM’s”
“-ZLAM’s”
CLONOzepam (Klonopm)
alpraZOLAM (xanax)
{ “your BENZ is ZO LAMe…”
{remember? you have AMNESIA or are TIRED or something, because that german guy CLONO was ADDICTED to saying that, homeboy was drunk….alot, its a shame because he’s CUTE. too bad he gives me anxiety. }
great for treating:
-acute anxiety
also
-seizures
-alcohol withdrawal
-insomnia (short term)
commonly causes:
-sedation
-memory loss
big safety concern:
-addictive (remember Jordan Peterson!)
-dont use with Kava Kava (anxiety) or valerian root (insomnia)
Haloperidol (Haldol)
used for:
adverse effects:
Monitor:
do not use with:
used for:
antipsychotic
{HODOR! HORDOR! went psycotic because he saw things… you know- fat guy… cant be still, a reTARD with whos heart skips a beat every time he see’s Mal’s Naughty Spot}
adverse effects:
-wt gain
-hyperlipidemia
-hyperglycemia
Tardive Dyskinesia
-QT prolongation
-AKAthisia
-***Malignant Neuroleptic Syndrome: life-threatening idiosyncratic reaction to antipsychotic drugs characterized by fever, altered mental status, muscle rigidity, and autonomic dysfunction.
Monitor:
-fasting blood glucose/lipid profile
do not use with:
frail elderly
HALDOL (or any other psyc med) is contraindicated in patients with Parkinson’s Disease or Dementia with Lewy Bodies
Lithium carbonate
Used for:
Therapeutic range:
Long-term concerns:
How does it work
S.E.:
Do not use with:
Monitor:
Used for: Bipolar disorder
{LITH drink thum SODa’s (the crazy mike tyson said in a lisp) , but, not mwor than 2, becauth thaths toxic!”
Tyson, was known as “Epstein’s anomaly”- until the emotional numbing wore off, and now he is as fat as a HYPO}
Therapeutic range:
0.6-1.2
>2g = toxic
Long-term concerns:
-emotional numbing
-**hypothyroid
-wt gain
How does it work?
-regulates sodium (NA) in nerve and muscle cells
S.E.:
-**“ebstine’s anomaly” congenital heart defect caused by Lithium
-hypothyroidism
-altered sodium (Na) levels
Do not use with:
grapefruit juice
Monitor:
serum trough level (12 hours after last dose)
Atypical Antidepressants:
Bupropion (Wellbutrin)
Buproprion (zyban)
adverse effects:
contraindicated:
depression
Wellbutrin can help PAXIL w/sexual dysfunction side effect
Zyban used for: smoking cessation
(pt are able to smoke while on it)
adverse effects:
Seizures
contraindicated:
-seizure disorders
-anorexia
-bulimia
{is having a coniption (seizure) the PROP you brought?
ZY BANned smoking in the ED. It can help you get WELL BUT not if you have an eating disorder
Major depression vs minor depression
minor depression = <5 but @ least 2 depression symptoms
major depression = 5+ depression symptoms