Psych Flashcards
What is considered first-line treatment for most anxiety disorders?
CBT
What class of medications is considered first-line for all anxiety disorders and PTSD?
SSRIs
What is the maximum citalopram dose for patients > 60 years old?
20 mg/day
Which SNRI has more data to support its use in anxiety disorders?
Venlafaxine
What type of anxiety disorder is buspirone approved for?
GAD
When may beta blockers be appropriate for anxiety disorders?
Performance-related social anxiety disorders (such as public speaking)
What is the role of prazosin in PTSD management?
PTSD-associated nightmares
What type of anxiety disorder are BZDs more effective?
GAD
What is the recommended duration of BZD treatment for anxiety?
Short-term (2-3 weeks while initiating and titrating a first-line treatment)
What anxiety disorder should BZDs be avoided with?
PTSD (can interfere with effectiveness of trauma-based psychotherapy)
Which BZDs are preferred in the elderly?
-Lorazepam
-Oxazepam
*both lack an active metabolite
When is a taper necessary with BZD therapy?
In those receiving BZDs regularly for > 2-4 weeks
Which insomnia medications help with sleep latency?
-Ramelteon
-Trazodone
-Zaleplon
-Zolpidem IR
What insomnia medications help with sleep maintenance?
-Doxepin
What insomnia medications help with both sleep latency and maintenance?
-Temazepam
-Daridorexant
-Eszopiclone
-Lemborexant
-Suvorexant
-Zolpidem CR
What are side effects of Z-hypnotics?
-Amnesia
-Dizziness
-Increase risk of falls and fractures
What is a benefit of ramelteon over Z-hypnotics?
Not associated with dependence or tolerance and can be used for chronic insomnia
What is a counseling point for orexin receptor antagonists?
There must be at least 7 hours between taking the dose and having to wake up
What class of insomnia medications should be avoided in those with sleep apnea?
BZDs (decrease upper airway tone and ventilatory response to hypoxia)
What is the general approach to treating depression?
-Psychotherapy +/- medication (SSRI/SNRI, bupropion, mirtazapine, vortioxetine, vilazodone)
-Change medication
-Third medication trial w/ different MOA or augmentation (bupropion, mirtazapine, lithium, selected SGAs, lithyronine, methylphenidate, TMS)
**if not had > 50% reduction in symptoms, change over augment
What are common side effects of SSRIs?
-Irritability
-Sedation
-Insomnia
-Sexual dysfunction
-Headache
-Sweating
-GI effects
How can sexual dysfunction side effects w/ SSRIs be managed?
-Lower dose of antidepressant
-Add or change to bupropion or mirtazapine
-Add PDE-5 inhibitor
What enzyme does fluoxetine and paroxetine inhibit?
CYP2D6
In which patient population should caution be used with SNRIs?
Uncontrolled HTN
What are side effects of TCAs?
-Sedation
-Anticholinergic effects
-Weight gain
-Sexual dysfunction
What is required when switching from a MAOI to SSRI/SNRI (or vice versa)?
Washout period before/after of 2 weeks (5 weeks w/ fluoxetine)
What black box warning dose nefazodone carry?
Hepatoxicity
What are SSRI/SNRI withdrawal symptoms?
-Increased anxiety
-Dizziness
-Irritability
-Feeling of mild electric shocks
-Flu-like symptoms
-GI symptoms
What are symptoms of serotonin syndrome?
-Autonomic instability (labile BP, tachycardia, hyperthermia)
-Mental status changes (agitation, hallucinations)
-Neuromuscular symptoms (hyperreflexia, incoordination)
-GI distress (nausea, vomiting, diarrhea)
Which SSRI should be avoided in pregnancy?
Paroxetine
What should a woman do if she discovers she is pregnant while taking an antidepressant?
Continue that antidepressant rather than change
What therapies may be used for an acute manic episode in bipolar disorder?
-Lithium
-Divalproex
-SGA
What therapies may be used for acute bipolar depression?
-Quetiapine
-Lurasidone
-Olanazapine/fluoxetine
-Lumateperone
-Cariprazine
What therapies may be used for an acute mixed episode in bipolar disorder?
Valproate + an antipsychotic
What is the therapeutic serum concentration of lithium for bipolar disorder?
0.6-1.2 mEq/L
What are side effects of lithium therapy?
-GI upset
-Tremor
-Diabetes insipidus
-Weight gain
-Acne
-Alopecia
-Leukocytosis
-Hypothyroidism
-Renal toxicity
Which medications increase lithium concentrations?
-NSAIDs
-Thiazide diuretics
-ACE-Is/ARBs
What is the preferred mood stabilizer for mixed episodes and rapid cyclers?
Divalproex/valproic acid
What are side effects of divalproex/valproic acid?
-GI upset
-Weight gain
-Thrombocytopenia
-Hyperammonemia
-Alopecia
-Tremor
-Hepatotoxicity**
-Pancreatitis**
-PCOS
-Amenorrhea
-Leukopenia
-Osteoporosis
-Sedation
Which antipsychotics are approved for maintenance of mania in bipolar disorder?
-Asenapine
-Quetiapine
-Risperidone
-Ziprasidone
Which antipsychotics are approved for bipolar depression?
-Cariprazine
-Lurasidone
-Olanzapine/fluoxetine
-Quetiapine
What is the recommended treatment for mixed symptoms of bipolar disorder?
-SGA (aripiprazole, asenapine, cariprazine, olanzapine, quetiapine)
-VPA
What are the 5 main features of schizophrenia?
-Hallucinations
-Delusions
-Disorganized speech
-Disorganized or abnormal motor behavior
-Negative symptoms
What symptoms of schizophrenia do typical antipsychotics treat?
Positive symptoms
For which atypical antipsychotics is there a long-acting injectable formulation available?
-Aripiprazole
-Olanzapine
-Paliperidone
-Risperidone
What are extrapyramidal symptoms associated with antipsychotics?
-Acute dystonic reactions (can treat w/ benztropine)
-Psuedoparkinsonism
-Akathisia (inner restlessness - can treat w/ propranolol)
-Tardive dyskinesia
Which antipsychotics is hyperprolactinemia more common with?
-Haloperidol
-Risperidone
-Paliperidone
Which antipsychotics is sedation more common with?
-Chlorpromazine
-Olanzapine
-Clozapine
-Quetiapine
What is the composition of Metadate CD?
30% IR beads + 70% ER beads
What is the first-line treatment recommendation for ADHD in patients 6-18 years old?
Methylphenidate
OR
Amphetamine products
What are second-line treatment options for ADHD in patients 6-18 years old?
-Atomoxetine
-Guanfacine ER
-Clonidine ER
What is the first-line treatment recommendation for adults with ADHD?
Methylphenidate
OR
Lisdexamfetamine
Which ADHD medication(s) is not used as monotherapy?
Clonidine and guanfacine (target impulsivity and hyperactivity)
What are symptoms of nicotine withdrawal?
-Anxiety
-Craving
-Difficulty concentrating
-Increased appetite
Which BZDs are used for the treatment of alcohol withdrawal?
-Chlordiazepoxide
-Diazepam
-Lorazepam**
-Oxazepam**
**preferred in liver dysfunction
What are first-line treatment options for AUD?
-Naltrexone
-Acamprosate
What are second-line treatment options for AUD?
-Topiramate
-Gabapentin
-Disulfiram
What are symptoms of opioid withdrawal?
-Nausea, vomiting, diarrhea
-Anxiety
-Headache
-Muscle pain
-Fever
-Elevated BP/HR
What is the only FDA-approved treatment for opioid dependence for pregnant individuals?
Methadone
