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PEBC- OTC > Psych disorders- agitation, alz, ADHD, anx, dep, bipolar, eating disorders > Flashcards

Psych disorders- agitation, alz, ADHD, anx, dep, bipolar, eating disorders Flashcards

1
Q

side effects of bupropion

A

dry mouth, nausea, insomnia (take in AM), increased suicidal thoughts in those under 25 esp

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2
Q

which drugs are used to treat acute delerium- give examples

A

antipsyhcotics- haloperiol= most evidence and studied (PO, IV, IM)- small regular doses preferred over prn but still use for short duration

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3
Q

elderly patients with dementia taking antipsychotics long term are at increased risk of

A

stroke and death (when used for several weeks to months)

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4
Q

why are second generation anti psychotics preferred over first generally

A

more favorable side effect profile

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5
Q

why is risperidone useful for alzheimers, what dose do you start at? what do you increase to?

A

has effect on agitation and other behavioural symptoms- start at 0.25mg daily and titrate to usual 1mg, upper limit 2mg

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6
Q

increased risk of falls with trazodone because of this side effect

A

postural hypotension

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7
Q

which two oral benzos are minimally affected by aging and have no active metabolites?

A

lorazepam and oxazepam

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8
Q

why shouldn’t olanzapine and benzodiazepines be combined in those with mental illness and agitation?

A

increased cardiac and resp complications

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9
Q

name second generation (AKA) antispychotics

A

ie atypical: risperidone, olanzapine, quetiapine, aripiprazole, ziprasidone

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10
Q

non pharm management of anxiety

A

decrease caffeine, regular sleep, aerobic exercise, stress reduction, mindfullness, meditation, CBT

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11
Q

initial approach to managing anxiety. Then what?

A

non pharm and use of benzo four days or less per week for acute time (1 week optimal). If continues, CBT or other medication added next. SSRI or SNRI preferred. No relief? increase dose or change within those two classes.No? Augment with 2nd gen antipsych, anticonvulsant or benzo

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12
Q

how long does it take for SSRI or SNRI to have full effect? How can you help?

A

8 weeks (up to 3 months). Add benzo short term (6-8 weeks)

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13
Q

what can be used to abort a panic attach

A

benzos; clonaz 0.25-0.5mg BID or loraz or diaz

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14
Q

drug useful for performance anxiety or stage fright and how to take

A

propranolol 10mg 30 minutes prior to event

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15
Q

medication for specific phobias

A

not generally used- CBT

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16
Q

why is quetiapine 2nd line for GAD

A

although effective, SE- metabolic regulation effects and weight gain esp, orthostatic hypotension, antichol SE

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17
Q

1st line GAD

A

SV-DEPP (Save Johnny Depp)- Sertraline, venlafaxine, duloxetine, escitalopram, paroxetine, pregabalin (advantage of rapid onset relief)

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18
Q

managing anxiety in pregnancy

A

CBT best, SSRO, SNRI, benzo- use lowest effective dose of any

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19
Q

benzo counselling

A

sedation/drowsiness (tolerance develops), dizzy, dependence with frequent use, retrograde amnesia, avoid alcohol and other CNS depressants, do not stop suddenly if on long time

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20
Q

gabapentin counselling. Differ from pregabalin?

A

somnolence, dizzy, ataxia, vision changes. Pregab can cause peripheral edema

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21
Q

reactions with MAOIs. Difference with reversible?

A

do not use with tyramine containing foods (severe hypertension- hypertensive crisis), and high risk of seratonin syndrome with: SSRI, SNRI, TCAs, meperidine, tryptophan. Reversible- diet not as strict, meperidine/TCA/SSRI worst risk SS.

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22
Q

symptoms of seratonin syndrome. Onset?

A

HTN, tremor, agitation, hypomania, sweating, racing heart. Onset:

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23
Q

drugs that can contribute to SS

A

SSRI, amphetamines, DM< dihydroergotamine, linezolid, lithium, meperidine, pentazocine, selegeline, st john’s wort, trazodone, triptans

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24
Q

which SSRI has the longest wash out/half life

A

fluoxetine- 5 weeks

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25
Q

comment on fluvoxamine vs other ssris

A

most DI and SE- N,C,Sedation

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26
Q

time between SSRI titration of dose

A

4 weeks

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27
Q

TCA SE

A

antichol, N, CV (increased HR, orthostatic hypo, arrhythmias), CNS (drowsy, HA, tremor, seizures)

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28
Q

does tolerance to BNZ anxiolytic effects happen

A

not usually

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29
Q

best SSRI in preg

A

fluox because most clinical experience

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30
Q

best drugs for OCD (SSRI)

A

Stop Pulling Faux Fur

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31
Q

buspirone in anxiety

A

only for generalized anxiety disorder

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32
Q

duration of trial when starting a stimulant for ADHD, when should see improvement in patient?

A

3-4 weeks. Effective? continue. No? try other or reassess diagnosis. See some effect in first week

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33
Q

first line ADHD tx (name)

A

stimulants- dextroamphetamine, disdecamfetamine, methylphenidate, mixed salts amphetamine)

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34
Q

which ADHD meds can be opened and sprinkles onto food for children who can’t swallow pills?

A

adderall XR, dexedrine spansules, vyvanse and biphentin

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35
Q

if stopping ADHD stimulant (no longer needed, etc) what is the best way?

A

over summer (no school), over 2-3 week trial period

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36
Q

drug useful for ADHD and tic symptoms

A

clonidine

37
Q

what is atomoxetine

A

a SNRI used as a non stimulant in ADHD, lasts 24 hours

38
Q

name short acting ADHD agents

A

ritalin, dexedrine

39
Q

name intermediate acting ADHD agents

A

ritalin SR, dexedrine spansules (up to 8 hours both)

40
Q

name long acting ADHD agents

A

concerta, biphentin, adderall, vyvanse - dosed once daily (up to 12 hours)

41
Q

what should be monitored at baseline for ADHD patients

A

height, weight, BMI, ECG if family hx of cardiac dsx, etc

42
Q

what is the significance of adhd meds and decreasing height and weight

A

about 1 inch and 2.7kg ie still adequate

43
Q

common stimulant SE for ADHD

A

decreased appetite (give doses with large meals, supplement with ensure/boost), insomnia (give earlier in day- LA all before 4pm for sure), headache, rebound hyperactivity (switch to longer acting), increased BP/HR

44
Q

which adhd stimulant can be taken dissolved in water

A

vyvanse (lisdex)

45
Q

which stimulant’s shell may be found in stool?

A

concerta (methylphenidate)- hard shell makes it difficult to divert and abuse!

46
Q

bipolar 1 vs 2

A

1 had to have had manic episode, 2 must have had hypo and never full manic. 1 may or may not have had depression, 2 has

47
Q

first thing to do when treating mania in bipolar

A

d/c any antidepressants

48
Q

first line agents for bipolar- mania

A

lithium, divalproex, second gen/atypical antipsych (if severe, use L or D in combo with 2nd gen x2weeks and reassess ). Carbamaz also okay. START WITH THE Loading Dose (LD= lithium, divalpro)

49
Q

first line agents for bipolar-depression

A

lithium, lamotrigine, quetiapine or combo of 2 of these if severe (LL-Qool Jay… very calm). Divalproex in combo or SSRI in combo (short acting incase of switch to mania) also approp. also carbamaz, or olanz with fluox

50
Q

why the controversy with antidepressant use in bipolar depression?

A

mod to severe can be considered, but some potential to promote rapid cycling in susceptible ppl

51
Q

what should patients taking lithium be mindful of

A

diet- maintain usual salt and caffeine and fluid intake/output - adjust accordingly (esp vomit/D)

52
Q

maintenance therapy bipolar- first line agents

A

lithium, lamotrigime, olanzapine, divalproex, quetiapine, several combinations

53
Q

2nd gen antispych common SE

A

sedation, dizzy, orthostatic hyoi, headache GI, less tremor vs 1st but still some

54
Q

asenapine ODT- counsel patients on what

A

not to eat or drink for 10 minutes after dissolving under tongue

55
Q

if you choose to d/c bipolar therapy, over what time period should it be done?

A

more than 4 weeks

56
Q

with bipolar meds, least favorable choices for: diabetes/metabolic syndrome, kidney failure or dsx,

A

DB- antipsychs, kidney-lithium

57
Q

common SE with lithium

A

acts like salt! polyuria/dypsia, sig weight gain, tremor } most common. Counsel to maintain consistent salt diet

58
Q

interactions with lithium

A

acts like a salt! ACE/ARB, diuretic, NSAIDs,

59
Q

signs of lithium toxicity

A

drowsy, tremor and slurred speech are first, followed by arrhythmia seizure coma death. Therapeutic level is 0.6-1 to be taken q6-12 months when stable

60
Q

how to start lithium, and maintenance dose

A

300mg HS, then 300mg BID- 1200mg HS is usual, 1800mg is max

61
Q

what is the mainstay of therapy in alzheimers and why

A

cholinesterase inhibitors- good for cognitive, functional, behavioural and psych symptpoms

62
Q

examples of cholinesterase inhibitors and general principles

A

galantamine, denepezil, rivastigmine - all equal efficacy, change to another if one doesn’t work or SE, higher doses improve outcomes, effectiveness is improvement or no change in target sx

63
Q

what is memantine

A

NMDA receptor antagonist- used for alzheimers, blocks glutamate induced neuronal excitotox (process in final pathway of neuronal death)

64
Q

which TCAs have a lower incidence of causing anticholinergic effects

A

desipramine, nortrip

65
Q

cholinesterase inhibitor SE

A

H/A, N, D } main, V, fatigue, sleep disturbance, syncope, urinary frequency, decreased HR possible (caution with bradycardia/HR lowering agents)

66
Q

major interaction cholinesterase inhibitors

A

anticholinergic agents

67
Q

how long does it take to see a noticeable effect from antidepressants? full effect? how long until bothersome SE go away?

A

2-4 weeks to see improvement. Full up to 8. 2 weeks to tolerate sx

68
Q

important counselling in depression

A

remember to keep taking even if you are feeling better, and if want to stop or taper see dr to make schedule

69
Q

2 of the most effective and well tolerated agents for depression

A

sertraline and escitalopram

70
Q

who should ssris be avoided in

A

those at increased risk of bleeding or with hx of it

71
Q

which se of ssris is it least likely to develop tolerance to- which agents may be better

A

sexual dysfunction- buprop, mirt, moclobemide

72
Q

how does buproprion work

A

NE and DA reuptake inhibition

73
Q

benefits of mirtazapine for depression, and downsides. How does it work?

A

ben- lower GI and sexual dysf, but more sedation and weight gain. NA and Seratonin mechanisms

74
Q

at what dose does venlafaxine also inhibit NE

A

greater than 150

75
Q

what makes TCAs 2nd line for depression?

A

tolerability, safety concerns esp cardiotox following overdose

76
Q

name the irreversible and reversible MAOI inhibitors

A

irr- tranylcypromine, phenelzine. rev- moclobemide

77
Q

what can be done when a patient shows partial response to an antidepressant, and what can you use

A

augment- lithium has great evidence. also 2nd gen antispych for insomnia and anxiety that persist, as long as not long term use.

78
Q

what are patients at risk of after 6 or more weeks especially of any antidepressant therapy if they suddenly stop

A

discontinuation syndrome- within 1-7 days of stopping, (untreated, subside in 3 weeks- severe sx within 3 days usually

79
Q

worst ssri in pregnancy

A

paroxetine- very short t1/2, CV malformations possible. If prescribed, use lowest effective dose (as with all other antidepr in preg)

80
Q

which antidepressants have low concentrations in breast milk

A

sertraline, paroxetine, nortriptylline

81
Q

how long should you taper antidepressants over

A

4-6 weeks- esp imp for venlafax and parox

82
Q

prokinetic agents used in anorexia-which is preferred? Which was pulled from market and why?

A

domperidone and metoclopramide- reduce feeling of fulness. Domperidone preferred becuase of lower EPS unless you need the antinauseant effect of meto. ALso prucalopride (seratonin agonist that normalizes colonic fx). cicapride had too much dysarrythmia and death so was pulled from market

83
Q

used in anorexia to increase weight gain rate

A

zinc gluconate- take with food to avoid N

84
Q

used for weight gain in anorexia

A

olanzapine- only up to BMI of 17 as after weight gain and increase in appetite are too much and patient’s don’t want. Typical duration 3 months

85
Q

how to manage anxiety of anorexia

A

clonazepam 0.25-0.5mg bID or quetiapine. SSRI, esp fluox

86
Q

what do you need to give at the beginning of refeeding in anorexia and why

A

thiamine 100mg daily f5d to prevent encephalopathy (wernicke-korsakoff syndrome)

87
Q

how to deal with laxative abuse in anorexia

A

taper over months to years

88
Q

treatment for bullemia

A

antidepressants can reduce binging episodes by greater than 50% in 2/3 patients. Fluox has most evidence, also other SSRI, venlafax and trazodone can be used. Continue 6-12 months and taper

89
Q

what is trazodone, and what are common side effects and dose?

A

100-500mg daily in single or divided, seratonin agonist, SE= sedation**, antichol SE

PEBC- OTC (21 decks)

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