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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
Q

SSRI SE profiles (2).

A

Serotonin Syndrome
SJS

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26
Q

Serotonin Syndrome 3 key sx

A

Mydriasis
Loss of m coordination/twitching
M rigidity

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27
Q

what SSRI can predispose pt to SJS

A

Lamectal

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28
Q

T/F: Every drug besides Welbutrin can cause sexual s/e

A

True

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29
Q

T/F: during the clinically effective phase, if a pt doesn’t feel the effect, you can just “switch off” the Rx

A

False.
Do a Challenge dose (optimize)
don’t switch off unless SE profile is too intolerable
Think effectiveness

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30
Q

Step 2 of medication initiation:
What are the 3 SSRI’s we covered?

A

Zoloft
Prozac
Lexapro

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31
Q

What is it called when a Rx can tip pt into mania?

A

Activating

32
Q

Zoloft
Drug class, dose, use, s/e

A

*SSRI
25mg – 250mg;
*results in 3 wks;
if modifying-2wks
*use: anxiety, depression, OCD, irritability
*s/e: GI disturbance, reflux, somnolence, libido

33
Q

Prozac
Drug class, dose, use, s/e

A

*SSRI
10mg – 80mg;
results in about 4 wks; 2-3wks
use: anxiety, depression, OCD, motivation
*s/e: Anorexia, activating, libido

34
Q

Lexapro
drug, dose, use, s/e

A

*SSRI
5mg – 40mg;
*results 3 wks; 2wks
*use: anxiety, depression
s/e:
Most serotonergic of the 3,
wt gain
not good for OCD

35
Q

Celexa: the good & bad

A

Good: PTSD
bad: QT prolongation
Not for young folk

36
Q

Vybriid: the good & bad

A

good: anxiety
bad: costly

37
Q

Trintellix: good & bad

A

bad: costly

38
Q

Paxil: good & bad

A

good: premature ejaculation
bad: wt gain
activating
tough s/e profile
squashes libido

39
Q

Luvox: good & bad

A

good: OCD
bad: costly

40
Q

Step 3 of Medication Initiation
What drug class is 2nd line?

A

SNRI

41
Q

What are 3 SNRI’s?

A

Cymbalta
Pristiq
Effexor

42
Q

Which SNRI is prof hill’s favorite?

A

Pristiq

43
Q

Which SNRI has wicked w/d syndromes and should be a last resort?

A

Effexor

44
Q

Cymbalta
drug, dose, use s/e

A

*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
Q

Pristiq
drug, dose, use, s/e

A

*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
Q

Effexor
drug, dose, use, s/e

A

*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
Q

Does more = better with antidepressant dosages?

A

NOPE

48
Q

How long can device time delay sleep by?

A

4hrs!

49
Q

Should you compound Rx?

A

No, pick class & stick to it

50
Q

Step 4 of Medication initiation
where is 5-HT made?

A

The gut

51
Q

rule of thumb for SSRI initiation

A

start low & go slow

52
Q

How long does it take SSRI’s to take effect?

A

5-7d

53
Q

Rule of thumb for SNRI initiation

A

start low & go slower

54
Q

How long does it take SNRI to take effect

A

14d (now modulating 2 NT)

55
Q

How long does it take antipsychotics to take effect?

A

3d

56
Q

what pre-existing conditions can cause issues?

A

Obesity, DM, thyroid, IBS, HTN, POTS

57
Q

common S/E of antidepressants

A

GI issues, N, HAs, dizziness, sedation
Sexual SE
Appetite changes - anorexia
Affect changes – blunted, flat

58
Q

what labs should we do after antidepressant initiation?

A

TSH, CMP (renal, liver, electrolytes), lipid panel, A1C,

59
Q

What 3 s/e should we watch for?

A

TD
EPS
Acathesia (restlessness)

60
Q

Crossing, what is the basic premise?

A

Think conservative approach

61
Q

3 adjunct medications to Antidepressant initiation

A

Buspar
Welbutrin
Abilify

62
Q

Is buspar well tolerated?

A

yes! and low s/e profile

63
Q

Welbutrin
dose, use, s/e

A

*SR 75mg – 400mg; XL 150mg – 450mg
*use: Motivation, sexual side effects, S.A.D.
*SE: ↑ anxiety, lowers sz threshold!

64
Q

Which adjunct med can cause EPS?

A

Abilify
ideration of risperdal

65
Q

Abilify
dose, use, s/e

A

2mg – 5mg
*use: Super charger for mood lability/emotional reactivity
↑ effectiveness of Antidepressant→↑ mood
Typically, don’t go above 5mg
s/e: EPS

66
Q

What labs to check for Abilify?

A

A1c, Lipids

67
Q

Lithium
dose & use

A

ER 300mg – 450mg (600mg)
Use: SI and depression (shuts down SI)

68
Q

Lithum labs

A

lithium level, TSH, CMP

69
Q

Lamictal
dose, use

A

25mg – 200mg (400mg)
Use: Emotional reactivity; borderline glue
(good for emotional rollercoasters)

70
Q

Lamictal labs

A

A1c, lipids

71
Q

What is 1 very bad s/e of Lamictal and how do we avoid it?

A

Rash
go low and very slow

72
Q

Important to do after writing an M1 hold?

A

DOCUMENT

73
Q

non drug approaches to ADHD

A

Executive functioning coaching
Neurofeedback

74
Q

How to see if an ADHD pt has had SUD?

A

PDMP

75
Q

2 non stimulant RX for ADHD & which is better for kids?

A

Strattera: 10mg – 100mg less s/e
Guanfacine/Intuniv:
(better efficacy in kids for emotional regulation)

76
Q

5 stimulant ADHD Rx and dosages

A

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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