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Clin Pharm > Psych Medication Review > Flashcards

Psych Medication Review Flashcards

1
Q

What is an important part of the assessment of a BH pt?

A

A thorough family history

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2
Q

Should you ask a pt about SI?

A

Duh!
“ask the rough questions”

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3
Q

What is the likert scale?
What are the 3 ways it works?

A

Symptom severity scale
- Duration of sx (mild, mod, severe)
- Intensity (0-10)
- frequency of symptoms/episodes

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4
Q

With BH Rx, always go for the ____ dose and promote _____.

A

lowest
Therapy

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5
Q

6 Questions to ask in a pt assessment

A

*Chronic – breakthrough sxs?
*How long on current med?
*Were meds initially helpful?
*New stressors?
*H/o previous psychotropics?
*Failures/SE?

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6
Q

Who should be in therapy?

A

Everyone!
**Therapy for your mind is just as important as therapy for your bones!

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7
Q

3 Types of BH therapy & 1 novel type

A

*CBT (B around how you think)
*DBT: Dialectical (helpful for alexathymia)
Helps regulate mood and captures escalation & deescalate
*Mindfulness: good for pts experiencing trauma
*Sleep therapy is 1st-line for those who have issues with sleep - CBTi

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8
Q

How can you find out if your pt is using substances?

A

Just ask!

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9
Q

T/F: you should ask intrusive questions about social etoh, THC, party drugs & pills

A

yes! ask intrusive questions

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10
Q

T/F: Its ok to do a UA in a primary care clinic

A

True, it may change your management

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11
Q

Can you do pregnancy screenings for BH for postpartum?

A

yes

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12
Q

T/F: You shouldn’t punt pts to BH if you feel overwhelmed

A

lies. you can punt anytime

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13
Q

What is 1 thing PCP providers shouldnt do before sending a pt to BH?

A

Put the pt on “Closet Rx”
Costly & hard to change

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14
Q

How long is the pharmacotherapy journey?

A

12mo

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15
Q

what happens b/w the 1st 1-mo of the pharmacotherapy journey?

A

finding therapeutic dose &
dose becoming clinically effective

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16
Q

Rx trial = __+__

A

therapeutic dose + therapeutic duration

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17
Q

what happens b/w 6-9mo of the pharmacotherapy journey?

A

Maintenance/Remission phase

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18
Q

What phase of the pharmacotherapy journey can you augment the medication?

A

Maintenance/Remission Phase

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19
Q

For chronic med use, what 2 ways can you adjust current meds?

A

Challenge dose
Augment w/non antidepressant
Ie Welbutrin, buspar, abilify, lithium

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20
Q

When choosing a drug (SSRI/SNRI/Adjunct) what factors are influential?

A

comorbids
SSx
safety
DDI
$$COST$$

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21
Q

What is the 1 condition where BH pts don’t have to remain on a drug for ~1yr

A

SAD.
4-5mo of welbutrin/yr is good

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22
Q

What is important to know about all meds?

A

Max doses

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23
Q

Step 1 of Medication initiation:
What class is 1st line?

A

SSRI

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24
Q

How many SSRI must be challenged/failed before moving to next med class?

A

2

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25
SSRI SE profiles (2).
Serotonin Syndrome SJS
26
Serotonin Syndrome 3 key sx
Mydriasis Loss of m coordination/twitching M rigidity
27
what SSRI can predispose pt to SJS
Lamectal
28
T/F: Every drug besides Welbutrin can cause sexual s/e
True
29
T/F: during the clinically effective phase, if a pt doesn't feel the effect, you can just "switch off" the Rx
False. Do a Challenge dose (optimize) don’t switch off unless SE profile is too intolerable ***Think effectiveness***
30
Step 2 of medication initiation: What are the 3 SSRI's we covered?
Zoloft Prozac Lexapro
31
What is it called when a Rx can tip pt into mania?
Activating
32
Zoloft Drug class, dose, use, s/e
*SSRI 25mg – 250mg; *results in 3 wks; if modifying-2wks *use: anxiety, depression, OCD, irritability *s/e: GI disturbance, reflux, somnolence, libido
33
Prozac Drug class, dose, use, s/e
*SSRI 10mg – 80mg; results in about 4 wks; 2-3wks use: anxiety, depression, OCD, motivation *s/e: Anorexia, activating, libido
34
Lexapro drug, dose, use, s/e
*SSRI 5mg – 40mg; *results 3 wks; 2wks *use: anxiety, depression s/e: Most serotonergic of the 3, wt gain not good for OCD
35
Celexa: the good & bad
Good: PTSD bad: QT prolongation Not for young folk
36
Vybriid: the good & bad
good: anxiety bad: costly
37
Trintellix: good & bad
bad: costly
38
Paxil: good & bad
good: premature ejaculation bad: wt gain activating tough s/e profile squashes libido
39
Luvox: good & bad
good: OCD bad: costly
40
Step 3 of Medication Initiation What drug class is 2nd line?
SNRI
41
What are 3 SNRI's?
Cymbalta Pristiq Effexor
42
Which SNRI is prof hill's favorite?
Pristiq
43
Which SNRI has wicked w/d syndromes and should be a last resort?
Effexor
44
Cymbalta drug, dose, use s/e
*SNRI 20mg – 120mg; *results in 4 wks, if tweaking 2-3wks *use: pain, anxiety, depression *s/e: GI disturbance, somnolence, libido, W/D syndrome (could do zoloft for depression & cymbalta for neuropathic pain)
45
Pristiq drug, dose, use, s/e
*SNRI 25mg – 100mg; *results in 4 wks; 3wks *use: anxiety, depression, and fibromyalgia at higher doses – up to 400mg (lose effectiveness for mood to some degree) *s/e: Pretty well tolerated as no metabolism in liver so lower risk of DDI Libido, W/D syndrome
46
Effexor drug, dose, use, s/e
*SNRI 37.5mg – 300mg; *results in 3-4 wks; 2wks *use: anxiety, depression, energy, and fibromyalgia *s/e: Libido, WICKED W/D SYNDROME (from liver metabolism)
47
Does more = better with antidepressant dosages?
NOPE
48
How long can device time delay sleep by?
4hrs!
49
Should you compound Rx?
No, pick class & stick to it
50
Step 4 of Medication initiation where is 5-HT made?
The gut
51
rule of thumb for SSRI initiation
start low & go slow
52
How long does it take SSRI's to take effect?
5-7d
53
Rule of thumb for SNRI initiation
start low & go slower
54
How long does it take SNRI to take effect
14d (now modulating 2 NT)
55
How long does it take antipsychotics to take effect?
3d
56
what pre-existing conditions can cause issues?
Obesity, DM, thyroid, IBS, HTN, POTS
57
common S/E of antidepressants
GI issues, N, HAs, dizziness, sedation Sexual SE Appetite changes - anorexia Affect changes – blunted, flat
58
what labs should we do after antidepressant initiation?
TSH, CMP (renal, liver, electrolytes), lipid panel, A1C,
59
What 3 s/e should we watch for?
TD EPS Acathesia (restlessness)
60
Crossing, what is the basic premise?
Think conservative approach
61
3 adjunct medications to Antidepressant initiation
Buspar Welbutrin Abilify
62
Is buspar well tolerated?
yes! and low s/e profile
63
Welbutrin dose, use, s/e
*SR 75mg – 400mg; XL 150mg – 450mg *use: Motivation, sexual side effects, S.A.D. *SE: ↑ anxiety, lowers sz threshold!
64
Which adjunct med can cause EPS?
Abilify ideration of risperdal
65
Abilify dose, use, s/e
2mg – 5mg *use: Super charger for mood lability/emotional reactivity ↑ effectiveness of Antidepressant→↑ mood Typically, don’t go above 5mg s/e: EPS
66
What labs to check for Abilify?
A1c, Lipids
67
Lithium dose & use
ER 300mg – 450mg (600mg) Use: SI and depression (shuts down SI)
68
Lithum labs
lithium level, TSH, CMP
69
Lamictal dose, use
25mg – 200mg (400mg) Use: Emotional reactivity; borderline glue (good for emotional rollercoasters)
70
Lamictal labs
A1c, lipids
71
What is 1 very bad s/e of Lamictal and how do we avoid it?
Rash go low and very slow
72
Important to do after writing an M1 hold?
DOCUMENT
73
non drug approaches to ADHD
Executive functioning coaching Neurofeedback
74
How to see if an ADHD pt has had SUD?
PDMP
75
2 non stimulant RX for ADHD & which is better for kids?
Strattera: 10mg – 100mg less s/e Guanfacine/Intuniv: (better efficacy in kids for emotional regulation)
76
5 stimulant ADHD Rx and dosages
Adderall XR/IR: 5mg – 60mg Vyvanse: 10mg – 70mg less street value Focalin XR/IR: 5mg – 40mg Concerta XR: 18mg – 72mg Methylphenidate IR/Ritalin: 5mg – 60mg

Clin Pharm (6 decks)

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