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Pharmacotherapy > psych > Flashcards

psych Flashcards

1
Q

diff categories of tx for depression

A

Pharmacotherapy
 Combination of Pharmacotherapy + Psychotherapy
 Others: ECT, light therapy, vagus nerve stimulation, transcranial magnetic stimulation

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2
Q

SSRI agents

A 
Fluoxetine
Paroxetine
Sertraline
Citalopram
Escitalopram
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3
Q

AE of SSRIs

A

GI, anxiety/nervousness, sexual dysfunction

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4
Q

AE of SNRIs

A

Mild to moderate insomnia, nausea, HA,
tremor, anxiety, dry mouth
 Sexual dysfunction common
 May ↑ BP; reports of HF worsening (class
effect)
  TG & LDL reported with De
 Substantial dose titration required (V)
 Do not use in patients with ESRD or hepatic
insufficiency (Du)

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5
Q

SNRI agents

A 
Venlafaxine
(Effexor)
Desvenlafaxine
(Pristiq)
Duloxetine
(Cymbalta)
Levomilnacipran
(Fetzima)
[Milnacipran
(Savella): only
approved to treat
fibromyalgia]
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6
Q

antidepressant not associated with weight gain or sexual dysfunction

A

buproprion (wellbutrin)

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7
Q

CI of buproprion

A

eating disorder or seizures and use of mAOI in last 14 days

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8
Q

CI of all antidepressants

A

use of MAOI in last 14 days

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9
Q

good antidepressant for someone also dealing with insomnia and/or needs to gain weight

A

noradrenergic and specific serotonergic antidepressant

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10
Q

AE of noradrengergic and specific serotonergic antidepressant Mirtazapine

A 
 High sedative and weight gain effects
 Mild to moderate anticholinergic effects and
dizziness
 Associated with agranulocytosis and
neutropenia
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11
Q

pros and cons of TCAs for depression

A

pros: once daily dosing, useful for other conditions (migraines, neuropathic pain)
cons: high degree of sedation and weight gain, dangerous in overdose, titration req’d

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12
Q

which antidepressant can cause priapism?

A

trazodone

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13
Q

1st line meds for depression

A

SSRIs, SNRIs, NDRIs (buproprion),

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14
Q

serotonin syndrome symtpoms

A

mental status change, agitation, myoclonus, hyperreflexia, fever, diaphoresis, ataxia, diarrhea. CAN PROGRESS TO hyperthermia, seizures, death

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15
Q

how do you avoid serotonin syndrome when switching agents?

A

taper off first agent, wait 5 half lives or a “wash out period” and then start next one

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16
Q

how do you avoid serotonin discontinuation period?

A

TAPER over 4 weeks

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17
Q

serotonin discontinuation sx:

A

Dizziness, nausea, fatigue most commonly seen; vomiting, agitation, insomnia, tremors,
myalgia less common

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18
Q

what is risk of GI bleed with SSRIs (and proprably SNRIs)?

A

3x risk if concurrently taking NSAIDs (for those already at risk of GI bleed)

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19
Q

which SSRI has shortest half life and thus a longer taper? what else should be known about it?

A

paroextine (paxil), btwn dose withdrawal in younger pts, avoid in younger pts

20
Q

which SSRI has most drug intx?

A

fluvoxamine (luvox)

21
Q

which SSRIs can prolong QT

A

citalopram and escitalopram

22
Q

acute phase of depression tx lasts how long? (until sx abate?)

A

usu 6-12 weeks

23
Q

important pt ed for antidepressants

A

AE may be felt right way, but therapeutic effects on mood may take 2-4 weeks to start and 6-8 wks to be at full effect

24
Q

why does a suicide risk increase in the 1st 1-2 weeks after starting an antidepressant?

A

energy increase 1st before mood does.

25
Q

adequate trial of antidepressant

A

adequate dose for at least 4 wks, 8 wks is preferable

26
Q

how long should people be on antidepressants before you can discontinue it?

A

4-9 months if their 1st or 2nd episodEOF MDD

27
Q

who should be on maintenance antidepressants?

A

multiple episodes, severe episodes, prior suicide attempts (esp those with comorbid psych conditions or chronic medical conditions)

28
Q

who is at highest risk of suicice on antidepressants?

A

children, adolescents and young adults–balance with clinical need

29
Q

trade names of SSRIs

A 
fluoxetine prozac
sertraline zoloft
paroextine paxil
citalopram celexa
escitalopram lexapro
30
Q

herbal therapy for depression

A

st. john’s wort

31
Q

common drugs used to augment resistant antidepressant tx

A

lithium,levothyroxine, atypical antipsychotics

32
Q

is psychotherapy rec’d for bipolar?

A

yes, or in combo with pharmacotherapy

33
Q

common AE of lithium

A

thirst, polyuria, cognitive complaints, tremor, weight gain, sedation, diarrhea, nausea
(watch for dehydration, which can lead to toxicity), hypothyroidism, transient leukocytosis.

34
Q

T or F: drugs for bipolar have a therapeutic range

A

T

35
Q

T or F: Lithium can abort a manic episode

A

T: it takes about 1-2 weeks

36
Q

T or F: Lithium is not effective at preventing gsuicide

A

F: it may help decrease risk of suicide and suicide attempts

37
Q

1st line mood stabilizers for bipolar disorder

A

lithium, valproic acid, carbamazepine, lamotrigine

38
Q

AE of valproic acid

A

tremor, sedation, diarrhea, nausea, weight gain, hair loss, LFT elevations, thrombocytopenia

39
Q

drugs for bipolar to avoid in pregnancy

A

valproic acid, carbamazepine

40
Q

carbamazepine AE

A

headache, nystagmus, ataxia, sedation, nausea, cognitive complaints, rash, leukopenia, mild
LFT elevations

41
Q

type of patient with bipolar that lamotrigine may be best for

A

those who are currently presenting with a depressive episode

42
Q

T or F: lamotrigine should be titrated

A

T to prevent a rash

43
Q

tx for patients w/ bipolar who are unresponsive to meds

A

ECT

44
Q

tx of mild to moderate depressive episodes in bipolar

A

Lithium or lamotrigine 1st (reserve antidepressants for those with severe depression)

45
Q

maintenance tx for bipolar

A

lithium or VPA

Pharmacotherapy (9 decks)

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