Psych exam 1 Flashcards

1
Q

What is the mental status exam (AMSIT)

A

documents patient’s CURRENT thinking, feeling, and behavior

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2
Q

AMSIT: A (general appearance, behavior, speech

A

demographics, physique, hair, clothes, cleanliness
inc or dec psychomotor activity, distractibility sterotypy
mutism, preservation, echolalia, neologisms

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3
Q

AMSIT: M (mood and affect)

A

position on 7 pt depression elation continuum
range, intensity, stability, appropriateness

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4
Q

AMSIT: S (sensorium)

A

orientation to time and place
memory
calculating ability

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5
Q

AMSIT: I (intellectual function)

A

level of current function: above ave, ave, below ave
general knowledge
use of vocab

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6
Q

AMSIT: T (thought)

A

Form tangentiality, circumstantiality, loose associations, flight of ideas
Content: delusions, hallucinations, ideas of referance
Judgement
Abstract ability
Insight

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7
Q

What is the purpose of the psychiatric rating scale

A

obj way of measuring sub data (thoughts, feelings, perceptions)
screen or diagnose disorders
evaluate adverse effects

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8
Q

What is a pink slip

A

application for emergency admission

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9
Q

Who can fill out a pink slip

A

psychiatrist, clinical psychologist, physician, health/police/parole officer, sheriff, CNP in psychiatry

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10
Q

How does someone fill out a pink slip

A

person must be taken inconspicuously
person must be treated with consideration and respect
person can make phone calls to attorney
obtain counsel to evaluate person’s mental condition

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11
Q

How long are people admitted from a pink slip

A

examined w/in 24 hr of arrival
not mentally ill needs to be released asap
if mentally ill, person may be detained for not more than 3 court days following exam day

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12
Q

At the end of the 3 day pink slip period what happens

A

admit the person as a voluntary pt or file and affidavit w/ court for mentall ill person or discharge pt

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13
Q

Civil vs criminal competency

A

civil: able to make reasonable decisions
criminal: able to testify or stand trial

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14
Q

What is guardianship

A

legal process used to protect individuals who are unable to care for themself

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15
Q

What is malingering

A

intentional production of false or exaggerated physical or psychological problems
goal is receiving a specific benefit

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16
Q

What is borderline

A

ongoing pattern of varying moods, self-image, and behavior
impulsive actions and problems in relationships, experience intense episodes of anger, depression and anxiety, view things in extreme

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17
Q

Onset of schizophrenia

A

late adolescence to early adulthood, earlier in males

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18
Q

What is schizophrenia

A

complex syndrome of disorganized and bizarre thought, delusions, hallucinations, inappropriate affect, and impaired psychosocial functioning

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19
Q

What medications precipitate psychosis

A

anticholinergics
dopamine/dopamine agonists
stimulants
steroids
cannabids
cocaine
lsd

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20
Q

What are the 4 dopamine hypothesis of schizophrenia

A

mesolimbic pathway (+ symptoms)
mesocortical pathway (- symptoms)
nigrostriatal pathway (extra-pyramidal side effects)
tuberoinfundibular pathway (hyperprolactinaemia)

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21
Q

For schizophrenia DSM-V one of the sx must be what

A

2 or more for significant portion of time in 1 month:
delusions, hallucinations, disorganized speech
(could also have disorganized or catatonic behavior, negative symptoms)

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22
Q

For schizophrenia DSM-V continuous signs of the disturbance persist for at least __ months

A

6

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23
Q

schizophrenia phases of disorder

A

prodromal, active, residual
(pt experience periods of remission)

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24
Q

schizophrenia acute episode

A

lost reality, disconnected thought process, hallucinations, delusions
uncooperativeness, hostility, poor hygiene, disrupted sleep and appetite

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25
Q

Positive symptoms of schizophrenia (most improved with antipsychotics)

A

suspiciousness, delusions, hallucinations, conceptual disorganization, ideas of reference, illusions, loose associations, agitation

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26
Q

Negative symptoms of schizophrenia (associated with poor psychosocial function)

A

blunted, alogia (no speech), anhedonia (no pleasure), poor grooming, poor judgement, lack of abstract thinking, social w/drawal

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27
Q

Cognitive symptoms of schizophrenia (related w/ poor psychosocial function)

A

impaired attention, working memory, executive function, problem solving, and difficulty reading social cures

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28
Q

Affective symptoms of schizophrenia

A

guilt, anxiety, tension, irritability, worry

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29
Q

Aggressive/hostile symptoms of schizophrenia

A

overall hostility, verbal/physical abuse or assault, self-injurious behaviors, arson/property damage
social and occupational dysfunction

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30
Q

How to treat schizophrenia

A

pt compliance
meds
psychotherapy

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31
Q

Antipsychotic drugs strongly block postsynaptic ___ receptors in the CNS

A

D2

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32
Q

Drugs that increase dopaminergic activity either aggravate schizophrenia or produce what

A

psychosis

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33
Q

NMDA receptor antagonist causes symptoms similar to those of schizophrenia however __________ acts also as a potent D2 receptor partial agonist

A

phencyclidine

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34
Q

5-HT2 receptors modulate __________ neurotransmission

A

glutamate

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35
Q

What is the target for schizophrenia drugs

A

mescortical/mesolimbic pathways

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36
Q

The nigrostraiatal and tuberoinfundibular pathways causes what reaction

A

extrapyramidal side effects

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37
Q

Typical antipsychotics alleviate positive symptoms while atypicals alleviate what

A

positive and negative
(they block D2 and 5-HT2A)

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38
Q

Typical antipsychotics MOA

A

blockade of postsynaptic D2 receptors
-causes mesolimbic and mesocortical pathways to relieve some behavioral manifestations
-basal ganglia underlies the motor side effects
-tuberoinfundibular pathway increases prolactin secretion

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39
Q

Typical antipsychotics may also block what receptors

A

muscarinic, alpa 1 adrenergic, histamine, 5-HT2 receptors

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40
Q

extrapyramidal side effects and treatment for drug induced parkinsonism

A

antimuscarinic antiparkinsonian agents, lower dose of antipsychotic agent

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41
Q

extrapyramidal side effects and treatment for akathisia

A

antimuscarinic antiparkinsonian agents, lower dose of antipsychotic agent

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42
Q

extrapyramidal side effects and treatment for acute dystonia

A

spasma of muscles
antiparkinsonian agents

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43
Q

Thiothixene MOA

A

similar to phenothiazines, higher dopamine blocking potency, parkinsonian effects and prolactin elevation

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44
Q

Loxapine MOA

A

little anticholinergic effect, claimed no weight gain

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45
Q

Haloperidol MOA

A

more potent than phenothiazines; also used to treat Huntington’s disease and Tourettes syndrome

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46
Q

What happens when overdose with aliphatic and piperidine phenothiazines

A

CNS excitation followed by depression, coma

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47
Q

Overdose with piperazine phenothiazines, thioxanthenes, butyrophenones causes what

A

CNS excitation or depression
Acute dystonic reactions

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48
Q

Treatment for overdosing for neuroleptics

A

support vital signs
treat arrhythmias
gastric lavage
treat hypotension by volume expansion or alpha adrenergics

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49
Q

Molindone MOA

A

low affinity for D2 receptors than more antipsychotics agents and relatively low affinity for D1 receptors

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50
Q

Pimozide MOA

A

antagonist of D2, D3, and D4 receptor and the 5-HT7 receptor

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51
Q

Clozapine MOA

A

D4 antagonist, not very potent at D1 or D2, strong anticholinergic, 5-HT2A antagonist, anti-H1

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52
Q

Risperidone MOA

A

antagonist at D2 and 5-HT2 receptors, affinity for D2 similar to haloperidol

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53
Q

Quetiapine MOA

A

antagonist at D2 and 5-HT2 receptors, potent actions at alpha adrenergic receptors

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54
Q

Ziprasidone MOA

A

antagonist at D2 and 5-HT2 receptor, modest SSRI-like

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55
Q

Olanzapine MOA

A

antagonist at D1, D2, and D4 receptors, may also block 5-HT2C, 5-HT3, and alpha 1 and H1
-may improve depression in psychotic depression
-approved for bipolar

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56
Q

Aripiprazole MOA

A

partical agonist at D2 receptors, 5-HT2A antagonist and partial agonist at 5-HT1A receptors, mild anticholinergic actions

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57
Q

Cariprazine MOA

A

partial agonist at D2 receptors, partial agonist at 5-HT1A receptors and antagonist activity at 5-HT2A receptors

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58
Q

General therapeutic goals for schizophrenia

A

management of acute psychotic episode within 7 days
stabil: 6-12 wk
maintenance: 1 yr, have drug for up to 5 yr

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59
Q

First gen antiphyschotics MOA

A

primarily block dopamine (D2) receptors, minimal serotonin (5-HT2A) receptor blockade

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60
Q

First gen antiphyschotics pathways

A

mesolimbic pathway good
mesocortical pathway bad
nigrostriatal pathway bad -> EPS
tuberoinfundibular pathway bad -> increase prolactin

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61
Q

What are the 4 EPS side effects

A

acute dystonic reaction
pseudoparkinsonism
akathisia
tardive dyskinesia

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62
Q

acute dystonic reaction potential reactions

A

oculogyric crisis
pharyngeal/laryngeal spasm
torticollis/retrocollis
glossospasm
opisthotonus
(considered medical emergency)

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63
Q

What is dystonia

A

bizarre involuntary tonic contractions of skeletal muscles appears within 24-96 hours

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64
Q

acute dystonic management

A

potent anticholinergics (NO PO)
Diphenhydramine 50 mg IM
Benztropine 2 mg IM
(cont oral for 1 wk)

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65
Q

pseudoparkinsonism signs and symptoms

A

tremor
rigidity
akinesia/bradykinesia
shuffling gait
(appears within 3 months)

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66
Q

pseudoparkinsonism management

A

decrease antipsychotic dose
change to atypical antipyschotic
Benztropine
Trihexyphenidyl
Amantadine

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67
Q

Akathisia (restlessness) signs

A

may be reason for noncompliance
can not sit still

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68
Q

Akathisia management

A

change to atypical antipsychotic
bezno
Propranolol

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69
Q

Tardive Dyskinesia signs and symptoms

A

long term exposure of drug
involuntary movements of face, lips, jaw, limbs

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70
Q

Tardive Dyskinesia management

A

commonly irreversible
use AIMS q6months
disc anticholinergic
Valbenazine
Deuterabenazine

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71
Q

NMS signs and symptoms

A

hyperthermia
extremem muscle rigidity
mental status change
autonomic disturbances
(can lead to rhabdo)

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72
Q

NMS management

A

disc antipsychotic
supportive care
Dantrolene IV
Bromocriptine
BZD
(restart antipsychotic after at least 2 wks)
(avoid high potency drugs and depots)

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73
Q

Other ADE of first gen antipsychotics

A

derm: allergic rxn, photosensitivity, long-term skin changes
hyperprolactinemia
QTc prolongation: thioridazine, haloperidol
M1, H1, alpha 1: anticholinergics, sedation, wt gain

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74
Q

Second gen antipsychotics MOA

A

potent serotonin (5-HT2A) antagonism, moderate to high dopamine (D2) antagonism

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75
Q

Second gen antipsychotics pathways

A

mesolimbic pathway good
mesocortical pathway good
nigrostriatal pathway good -> decrease EPS
tuberoinfundibular pathway bad -> decrease prolactin

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76
Q

Second gen antipsychotics weight gain

A

highest with clozapine, olanzapine
low risk aripirazole,brex, carip, lura, zipra
may not plateau
metformin may help

77
Q

Second gen antipsychotics lipid changes

A

triglycerides increased
metabolic syndrome
highest risk with clozapine, olanzapine, quetiapine

78
Q

Second gen antipsychotics DM

A

way more common in schizophrenia
w/in 6 months of tx in most
mild insulin resistance to DKA

79
Q

Monitoring at baseline for antipsychotics

A

personal/ family history
BMI
waist circumference
BP
fasting blood glucose
fasting lipid profile

80
Q

Monitoring at 12 wk for antipsychotics

A

BMI
BP
fasting plasma glucose
fasting lipid profile

81
Q

Monitoring annually for antipsychotics

A

personal/family history
waist circumference
BP
fasting plasma glucose
fasting lipid profile

82
Q

QT prolongation with antipsychotics

A

Prolonged
men: >450
women: >470

83
Q

Other ADE of 2nd gen antipsychotics

A

EPS, increased prolactin, anticholinergic effects, orthostatic hypotension, sedation, seizures, hematologic, derm

84
Q

Drug interactions for antipsychotics

A

caution with QTc prolonging agents
smoking increase plasma levels
drugs that lower seizure threshold
synergistic sedation/respiratory depression

85
Q

Important to note with lurasidone

A

must take with >350 calories

86
Q

Important to note with quetiapine

A

Hypnotic: 50 mg
Antidepressant: 300 mg
Antipsychotic: 600 mg

87
Q

What antipsychotic has digital health tracking

A

aripiprazole

88
Q

Cobenfy

A

works on muscarinic receptors

89
Q

What is treatment resistant schizophrenia

A

clozapine DOC (failed two antipsychotic trials)
FDA approved for suicidal behavior

90
Q

Clozapine dosing

A

risk of orthostatic hypotension
12.5-25 mg qd or BID (in hosptial)
if missed >48 hours start lowest dose in hospital

91
Q

Clozapine BBW

A

neutopenia/agranulocytosis
myocarditis and cardiomyopathy
seizures

92
Q

Clozapine side effects

A

constipation, increased wt, hypersalivation

93
Q

Clozapine monitoring

A

ANC >1500 to start tx if under <1000 stop
due to risk of neutropenia

94
Q

ANC calculation

A

total WBC * (% neutrophils + % bands)/100

95
Q

When to check ANC on Clozapine

A

at start
weekly for first 6 months
q2w btw 6-12 months
q4w after 12 months

96
Q

What classifies as normal, mild, moderate, and severe neutropenia

A

normal: cont
1500
mild: increase monitoring
1000
moderate: interrupt
500
severe: disc (do not rechallenge)

97
Q

What is benign ethnic neutropenia

A

ANC is lower than normal
in African Americans, Middle Eastern, non-caucasian
can start Clozapine if ANC >1000
if drop under <500 do not rechallenge

98
Q

If patient on Clozapine gets myocarditis or cardiomyopathy what should you do

A

this happens in first 8 wk of therapy with peak at 3 wks of exposure
can be fatal, do not rechallenge

99
Q

Clozapine DDI

A

CYP1A2
smoking
avoid with carbamazepine, chemo
avoid with meds that lower seizure threshold
respiratory depression with BZD
avoid with QTc prolongation drugs

100
Q

What are the B52 drugs

A

diphenhydramine
haloperidol
lorazepam
DO NOT GIVE WITH BZD
used when acute agitation when verbal redirection and de-escalation are not successful

101
Q

What to give in acute psychosis

A

haloperidol +/- diphrnhydramine + lorazepam
or ziprasisone IM or olanzapine IM

102
Q

What are the NTs in depression

A

Serotonin, NE, Peptides, Growth Factors
(people make too much cortisol everyday, CRF)

103
Q

The elevation of NE and serotonin levels may lead to what

A

change in mRNA
neurogenesis (neuronal stem cells proliferate)

104
Q

What does brain-derived neurotrophic factor (BDNF) do

A

regulates neuronal differentiation and survival, synaptic signaling
activate TrkB receptor
antidepressants increase BDNF levels

105
Q

TCA MOA

A

NE and serotonin reuptake inhibition
(antidepressants will block the transporters)

106
Q

Amitriptyline MOA

A

5-HT and NE reuptake inhibition
block alpha 1 adrenergic and H1 receptors

107
Q

Clomipramine MOA

A

5-HT and NE reuptake inhibition
anticholinergic activity

108
Q

Desipramine MOA

A

NE reuptake inhibition
anticholinergic block of alpha 1 adrenergic and H1 receptors

109
Q

Imipramine MOA

A

5-HT and NE reuptake inhibition
anticholinergic blockade of alpha 1 and H1 receptors

110
Q

Nortriptyline MOA

A

5-HT and NE reuptake inhibition
block alpha 1 and H1 receptors

111
Q

Side effect of central anti-histamine

A

sedation, weight gain

112
Q

Side effect of anticholinergics

A

dry mouth, constipation, cycloplegia

113
Q

Side effect of increase 5-HT and NE

A

increase appetite

114
Q

Side effect of peripheral alpha 1 blockade

A

sedation, postural hypotension

115
Q

Phenelzine and Tranylcypromine MOA

A

irreverisble or long acting inhibitors of MAO and are non selective (inhibit MAO-A and MAO-B)

116
Q

Phenelzine and Tranylcypromine side effect

A

covalent bonding requires a 3-4 wk drug washout

117
Q

SSRIs are used for what

A

anxiety disorders, bulimia, smoking withdrawal, OCD
(only prozac for depression)

118
Q

MOA of SSRIs

A

block 5-HTT
desensitize 5-HT1A receptors
desensitize 5-HT1B receptors

119
Q

Effects of stress and antidepressants on BDNF expression

A

increase cortisol, inhibits BDNF
SSRIs increase 5-HT and increase BDNF

120
Q

Specific issues with depression

A

suicidality (SSRIs are better than TCA)
pregnancy (do not use paxil)
SSRI disc syndrome (mainly paxil least with fluoxetine)

121
Q

Serotonin syndrome

A

confusion, agitation, hypomania
sweating, HTN, hyperthermia, nausea, diarrhea
tremor, rigidity, hyperreflexia, restlessness, myoclonus
DO not combine with TCA or MAO

122
Q

Trazodone MOA

A

block central alpha 1, H1 and 5-HT2A receptors

123
Q

Nefazodone MOA

A

like SSRIs action and 5-HT2 blockade
(serotonin antagonist and reuptake inhibitor SARI)
OFF market

124
Q

Bupropion MOA

A

dopamine reuptake inhibitor
for ADHS and smoking cessation

125
Q

Venlafaxine/Desvenlafaxine MOA

A

5-HT and NE reuptake inhibition
for depression, anxiety, panic disorder, OCD

126
Q

Duloxetine MOA

A

5-HT and NE reuptake inhibition
for anxiety, diabetic neuropathy, chronic pain

127
Q

Mirtazapine MOA

A

5-HT2 and 5-HT3 blockade
central alpha 2 adrenergic blockade, H1 antagonist, anticholinergic

128
Q

St Johns Wort

A

ineffective in severe depression

129
Q

Onset of depression

A

males peak >55 yo
feamales peak 35-45

130
Q

What is depression

A

one or more major depressive episodes without a h/o mania or hypomania

131
Q

Pathophysiology of depression

A

monoamine: depression caused by decreased brain levels of serotonin, dopamine, and NE
dysregulation: failure of homeostatic NT system regulation contributes or causes depressive symptoms

132
Q

Clinical presentation and diagnosis of depression

A

5 or more symptoms present for 2 wks (SIG EP SAC)
sleep, interest, guilt
energy, psychomotor
suicide, appetite, concentration

133
Q

Common presenting somatic complaints of depression

A

headache, malaise, vague ab or joint pain, disturbed sleep, sex or relationship problems, chronic fatigue

134
Q

Response, Remission, Recovery, Relapse, Recurrence of depression

A

Response: 50% reduction in sx
Remission: absence of sx (back at baseline)
Recovery: no sx/relapse after remission
Relapse: return of sx w/in 6 months of remission
Recurrence: separate episode of depression (longer than 9-12 months)

135
Q

Acute phase of depression

A

6-12 wk
induce remission
return to baseline level of functioning
reduce likelihood of relapse and recurrence

136
Q

Continuation phase of depression

A

4-9 months
goal to eliminate residual sx or prevent relapse

137
Q

Maintenance phase of depression

A

at least 12 months
goal to prevent recurrence
maintenance therapy: 3 or more episodes after recovering

138
Q

What happens in the first 3 wks of depression tx

A

wk 1: improved sleep/appetite, decreased anxiety
wk 2: increased activity and libido, improved self-care
wk 3: improved mood, less helplessness, decreased suicidal thoughts

139
Q

When should you follow up after starting depression meds

A

call in 7 days
meet in office at 2 weeks

140
Q

The combination of what 2 things have the best results for patients

A

psychotherapy and medications

141
Q

ECT

A

more effective than medications
controlled seizure
indicated when risk outweigh the benefits, h/o resistant depression, pt preference
needs anesthetics, neuromuscular blocking agents, and anticholinergics

142
Q

CI of ECT

A

none (cautious of)
CHF, recent stroke, elevated intracranial pressure, aneurysms, signs of hemodynamic instability

143
Q

VNS (vagal nerve stimulation)

A

for chronic depression lasting more than 2 yrs
depression not responding to 4 antidepressants +/- ECT

144
Q

TMS (transcutaneous magnetic stimulation)

A

sends short magnetic field pulses to the prefrontal cortex

145
Q

First line tx for depression

A

antidepressants first-line for mod-severe episode
acceptable first line: SSRI, SNRI, bupropion, mirtazapine
other: TCA, serotonin modulators, MAOI

146
Q

Warnings and precautions with depression meds

A

handouts needed for all antidepressants, stimulants, some antipsychotics, hypnotics
need info on: prevent ADE, help decision-making regarding ADE, ensure adherence to directions

147
Q

Box warnings on antidepressants

A

increase suicidal thoughts
no increased risk in adults over 24
decreased over age of 65

148
Q

What is the best depression rating scale

A

HAM-D (gold standard)
<7 normal, 8-13 mild, 14-18 moderate, 19-22 severe, >23 very severe)

149
Q

_____ are considered the first-line antidepressants due to their relative safety in overdose and tolerability

A

SSRIs
(approved for depression and some anxiety disorders)

150
Q

Mechanism of SSRIs

A

inhibit the reuptake of serotonin increasing serotonin activity in the brain. Little to no effect on other neurotransmitters

151
Q

ADE of SSRIs

A

headahce, akathisia, tremor, n/v/d (only lasts 1-2 wks)
dose-dependent: nausea, anxiety, fatigue, sex dysfunction

152
Q

What happens during sertraline withdrawal

A

suicidal thoughts increase
irritability
nausea or vomiting
dizziness
nightmares
headaches
tingling sensations on the skin

153
Q

Serotonin syndrome is assocaited with what antidepressants

A

any that increase serotonergic NT
could be fatal

154
Q

Serotonin syndrome (shivers)

A

shivering
hyperflexia
increased temp
vital signs instability
encephalopathy
restlessness
sweating

155
Q

How to treat mild then moderate to severe serotonin syndrome (resolves in 1-2 days)

A

mild: drug w/drawal (lorazepam for agitation)
mod-sev: block serotonin action (cyproheptadine, chlorpromazine)
Propranolol 1-3 mg IV q5m up to 0.1 mg/kg

156
Q

Serotonin Syndrome: onset, course, neuromuscular findings, reflexes, pupils

A

onset: abrupt
course: rapid resolving
neuromuscular findings: myoclonus and tremor
reflexes: increased
pupils: mydriasis
(DDI or overdose)

157
Q

Neuroleptic Malignant Syndrome: onset, course, neuromuscular findings, reflexes, pupils

A

onset: gradual
course: prolonged
neuromuscular findings: rigidity
reflexes: decreased
pupils: normal
(idiosyncratic, dopamine antagonists)

158
Q

Which SSRIs cause QT prolongation

A

citalopram
escitalopram

159
Q

Which SSRI is the most activating and which is the most sedating

A

activating (take in AM): fluoxetine
sedating (take in PM): paroxetine

160
Q

Which SSRI is preferred in patients with cardiac risk

A

sertraline

161
Q

SNRI MOA

A

inhibit the reuptake of BOTH 5-HT and NE increasing their activity in the brain

162
Q

Duloxetine ADE

A

urinary difficulty/hesitancy
hepatotoxicity

163
Q

Venlafaxine ADE

A

dose related increase in diastolic BP
>300: 13%

164
Q

What is duloxetine CI in for CrCl and what is it also approved for

A

<30 ml/min
GAD, diabetic neuropathy, fibromyalgia, chronic musculoskeletal pain

165
Q

Why do TCAs have a reduced use in depression practice

A

risk of overdose and availability of equally effective meds with fewer side effects

166
Q

TCA MOA

A

inhibit reuptake of 5-HT and NE, also block H1, M1, and alpha 1 receptors

167
Q

TCA ADE

A

dose related anticholinergic effects
cardiotoxicity with overdose

168
Q

What TCAs have less side effects tertiary or secondary

A

secondary (desipramine and nortriptyline)

169
Q

What is the most activating antidepressant

A

bupropion (ER preferred, doses must be 8 hours apart)
CI in eating disorders (bulimia, anorexia)

170
Q

Bupropion MOA

A

inhibit reuptake of NE and dopamine
(no serotonergic effect)

171
Q

Bupropion ADE

A

dose related seizures (CI in those pts)
minimal sex dysfunction
anxiety, wt loss, insomnia

172
Q

Mirtazapine MOA

A

pre-synaptic alpha 2 adrenergic antagonist (increase release of NE and 5-HT)

173
Q

Mirtazapine ADE

A

somnolence, dry mouth, increased appetite, wt gain
stimulates appetite in older pts (inc wt loss)
good for sleep promoting

174
Q

Serotonin modulators MOA

A

exhibit mixed serotonergic effects

175
Q

Serotonin modulators ADE

A

sedation (trazodone), dizziness, orthostatic hypotension, dry mouth, priapism

176
Q

MAO-I MOA

A

inhibit enzyme monoamine oxidase which is responsible for breakdown of NE, DA< and 5-HT

177
Q

MAO-I ADE

A

hypotension, sedation, insomnia, wt gain, sex dysfunction

178
Q

MAO-I DDI

A

hypertensive crisis
serotonin syndrome
hypotension and sedation
must have 14 day wash out (5 wks for fluoxetine)

179
Q

MAO-I drug food interaction

A

MAO-I + Tyramine = HTN crisis
No: aged cheddar, blue, swiss cheese, smoked foods_

180
Q

What 3 drugs are potent CYP2D6 inhibitors

A

fluoxetine, paroxetine, bupropion

181
Q

Alternative pharmacotherapy options

A

st. johns wart (mild depression)
omega-3 fatty acids

182
Q

What agents added to antidepressants are augmentation therapies

A

antipsychotics
mood stabilizers
(aripiprazole, quetiapine)

183
Q

Esketamine indication and MOA

A

treatment-resistant depression as monotherapy or in conjunction with oral antidepressant
NMDA receptor antagonist

184
Q

Peds treatment for depression

A

fluoxetine preferred in pt under 18 yo
sx: boredom, anxiety, somatic complaints, impulsivity)

185
Q

How are ped pt different than adults in their response to antidepressants

A

activation (increased energy)
more sensitive to withdrawal
indiction of mania (may develop bipolar)

186
Q

Agent to use in pregnancy depression

A

cardiac defects, pulmonary HTN with paroxetine
all agents are relatively safe

187
Q

What is the risk of untreated depression in pregnancy

A

poor prenatal care, wt gain, affects child development, increased risk of post-partum depression

188
Q

What drug is used to treat post-partum depression

A

brexanolone