Psych/Behavioral Health #2 Flashcards
Most common adverse effects of TCA’s (Amitriptyline, Nortriptyline, Clomipramine)
Anticholinergic effects: dry mouth, constipation, tachycardia, orthostatic hypotension
- Weight gain, prolonged QT interval
- Sedation, lowers seizure threshold, SIADH
What are the three indications of overdose of TCA’s?
3C’s
- Cardiotoxicity: wide complex tachycardia
- Convulsions (seizures)
- Coma
What can be used for treatment for cardio toxicity of TCA’s?
Sodium bicarbonate
What TCA is most useful in obsessive compulsive disorder because it is the most serotonin specific?
Clomipramine
When should you use MAO inhibitors for treatment?
Refractory depression or refractory anxiety disorders
Adverse effects of MAO inhibitors?
- Orthostatic hypotension (MC)
- Hypertensive crisis after ingesting foods high in tyramine (aged, smoked cheese or meats, red wine, beer, chocolates)
True or False: If MAO inhibitors are combined with SSRI’s, increased risk of serotonin syndrome?
True
Adverse effects of Trazodone
Sedation (MC)
Priapism
What is serotonin syndrome?
Life-threatening syndrome due to increased serotonergic activity in the CNS
Serotonin syndrome MC occurs ______ hours with initiation or change in serotonergic drugs such as SSRI’s, SNRI’s, TCA’s, and MAO’s.
within 24 hours (usually 6 hours)
Symptoms of serotonin syndrome
- AMS, agitation, hallucinations
- Hyperthermia, diaphoresis, blood pressure changes
- nausea, vomiting, diarrhea
- clonus, hypertonia (increased DTR), tremor
- Mydriasis, dry mucus membranes, flushed skin
Treatment for serotonin syndrome
- Prompt discontinuation of drugs
- IVF, oxygen, Benzodiazepines
- Cyproheptadine
What is the strongest risk factor for Bipolar 1 disorder?
Family history (10x more likely if 1st degree relative has it)
What is the only requirement for Bipolar 1 Disorder?
At least 1 manic or mixed episode (elevated expansive or irritable mood at least 1 week with marked impairment of social/occupational function
At least 3: mood (euphoria, labile), thinking (racing, flight of ideas, disorganized, spending sprees), behavior (physical hyperactivity, pressured speech, impulsivity, risk taking)
First-line treatment for Bipolar 1 Disorder
Lithium (also decreases suicide risk)
For acute mania, what is the treatment?
Antipsychotics (Risperidone or Olanzapine > Haloperidol) or mood stabilizers (Lithium) are most effective
Adverse effects of Lithium
- Hypothyroidism, Nephrogenic Diabetes Insipidus, Hyperparathyroidism
- Hypercalcemia
- Hypermagnesemia
When should levels be checked after starting Lithium therapy?
Prior to starting, get ECG, thyroid function, CBC, and beta-HCG
- Check levels after 5 days, then every 2-3 days until therapeutic
- Plasma levels checked every 4-8 weeks
Lithium is toxic in pregnancy and may be associated with ______ if taken during the first-trimester
Ebstein’s Anomaly
What is Ebstein’s Anomaly?
Tricuspid valve in the wrong direction and the valve’s leaflets are malformed.
When should Lithium NOT be used?
With NSAIDs, ACEi, or Thiazide Diuretics
What is Bipolar II Disorder?
History of at least 1 major depressive disorder + at least 1 hypomanic episode
What is a hypomanic episode?
Elevated, expansive, or irritable mood < 1 week and does not require hospitalization or have marked impairment of social or occupational function
Treatment for Bipolar II Disorder?
Lithium (first line) or Atypical Antipsychotics (Risperidone, Olanzapine, Ziprasidone, Quetiapine)