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Clinical Pharm > Psych review > Flashcards

Psych review Flashcards

1
Q

Whats important differentiate with MDD?

A

Differentiate between chronic depression and situational

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2
Q

T/F 80% of people who receive tx for depression, will improve

A

True

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3
Q

How long does SSRI take to work for MDD?

A

4-6 weeks to become fully effective but improve within the first week

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4
Q

T/F Antidepressants are non-habit forming

A

True

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5
Q

How long is the treatment?

A

4-9 months then graded discontinuation

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6
Q

What do you have to do for recurrent depression?

A

Continue medication indefinitely

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7
Q

What are the few anti-depressants?

A

SSRI
SNRI
TCA

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8
Q

What are the 1st line antidepressants?

A

SSRI and SNRI

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9
Q

What is MOA of SSRI

A

Selective serotonin reuptake inhibitors

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10
Q

What are examples of SSRI

A

Citalopram (Celexa), Escitalopram (Lexapro), Fluoxetine (Prozac), Paroxetine (Paxil), Sertraline (Zoloft

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11
Q

What is MOA for SNRI?

A

Serotonin-norepinephrine reuptake inhibitors

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12
Q

Examples of SNRI

A

Desvenlafaxine (Pristiq), Duloxetine (Cymbalta), Venlafaxine (Effexor)

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13
Q

Which one has more s/e, SSRI or SNRI

A

SNRI

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14
Q

Which one is useful for meloncholic depression

A

TCA - Amitriptyline

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15
Q

Why are TCA’s not 1st line?

A

lethal overdose, narrow therapeutic

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16
Q

TCA worse with sucidial idelation

A

True

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17
Q

What are examples of NDRI

A

Buproprion (Wellbutrin) Can be first-line

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18
Q

What is NDRI?

A

Norepinephrine-Dopamine Reuptake Inhibitor

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19
Q

What is MAOIs

A

MAOIs- Monoamine oxidase inhibitor

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20
Q

Can NDRI be 1st line?

A

yes but not choosen

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21
Q

What are examples of MAOIs

A

Isocarbozid (Marplan), Penelzine (Nardil)

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22
Q

What are other anti-depressants

A

Mirtazapine (Remeron), Trazodone (Desyrel) (concurrent insomnia/anxiety),

Aripiprazole (Abilify) and Quetiapine (Seroquel) – Resistant Depression

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23
Q

What is helpful for resistant depression?

A

Aripiprazole (Abilify) and Quetiapine (Seroquel) – Resistant Depression

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24
Q

What are indication for antidepressants

A

Depression
Anxiety
Chronic Pain
Premenstrual dysphoric disorder (PMDD)
Smoking cessation
Eating disorders

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25
Q

How to choose MDD meds

A

Indication
Cost
Availability
Drug interactions
Patient age and gender

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26
Q

ADR SSRI

A

Act on seretonin:
nausea, GI upset, Diarrhea, diminished sexual function (decreased interest, delayed orgasm, diminished arousal), headaches, weight gain

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27
Q

Whats a big s/e of SSRI

A

weight gain and sexual dysfx

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28
Q

T/F SSRI can be d/c suddenly

A

No, it can cause dizziness and paresthesia aka discontinuation syndrome

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29
Q

ADR for SNRI

A

Serotonergic adverse effects
Noradrenergic effects: increased BP, increased heart rate
CNS activation: insomnia, anxiety, agitation

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30
Q

TCA s/e

A

anticholinergic: dry mouth, constipation, urinary retention, blurred vision, confusion

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31
Q

T/F TCA d/c can cause cholinergic rebound and flu-like sx

A

TRUE

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32
Q

S/e for MAOI

A

Orthostatic hypotension and weight gain, highest rates of sexual effects

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33
Q

What should you caution with?

A
  • Suicide attempts are common
  • Overdose is most common method (esp with TCAs)
  • Drug interaction
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34
Q

TCA can be lethal (T/F)

A

True

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35
Q

Managing SE’s
GI Distress:
Sedation:
Agitation and Insomnia:
Sexual Dysfunction:
Anxiety/Panic:
Orthostatic HYPOTN:
Weight gain:

A

GI Distress: Take after meals
Sedation: Take at HS, most SSRIs are less sedating (Prozac)
Agitation and Insomnia: Switch to a more sedating options (Remeron, Celexa, Effexor)
Sexual Dysfunction: Less: Wellbutrin, Remeron, consider a PDE-5
Anxiety/Panic: Options include Paxil, Remeron, Effexor, TCAs (try to avoid BDZs)
Orthostatic HYPOTN: hydration, education on mvt
Weight gain: Less with Wellbutrin, Prozac, and Cymbalta

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36
Q

how should you d/c SSRI’s?

A

Reduce over 4 weeks – slower if symptomatic

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37
Q

which d/c is worse? with SNRI or SSRI?

A

SNRI

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38
Q

T/F withdrawal is typically mild but still recommended

A

True

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39
Q

What are the OTC’s proven for MDD?

A

St. John’s Wort and SAMe

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40
Q

What should St. John’s Wort and SAMe not be taking together?

A

serotonergic agent

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41
Q

St. John’s Wort is a potent inducer of ____?

A

CYP 450 —> LOTS of interactions

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42
Q

what should you adj with medication therapy for MDD?

A

psychotherapy

43
Q

when should you f/p after med initiation

A

4 weeks

44
Q

T/F Schizophrenia can be treated, half of patients can be fully independent with aggressive treatment and compliance

A

TRUE

45
Q

what is the average onset for schizophrenia

A

Men = late teen to early 20s
Women = late 20’s - 30’s

46
Q

T/F it is common for schizophrenia to be dx older than 40

A

False, more common in younger person

47
Q

What are antipsychotics agents for?

A
  • Reduce psychotic symptoms in schizophrenia, bipolar, psychotic depression, senile psychosis and drug-induced psychosis
  • Improve mood, reduce anxiety
  • Decrease sleep disorders
48
Q

What are example of typical- first gen

A
  • Chlorpromazine
  • Thiothixene
  • Haloperidol
49
Q

When in holdol used?

A

High level of EPS, high potency, WIDELY USED

Best used for acute, short-term symptom control

50
Q

What are the s/e of typical?

A
  • Dystonia- continuous spasm and muscle contractions
  • Akathisia- motor restlessness
  • Parkinsonism- irregular, jerky movements
  • Tardive dyskinesia- involuntary muscle movements in lower face and distal extremities
  • Bradykinesia-Slow movements
  • Tremors
51
Q

Which one is the only typical for chronic but not used?

A

Chlorpromazine (Thorazine

52
Q

What is first line for schizophrenia

A

Atypical esp Quetiapine

53
Q

What are examples of atypical

A
  • Quetiapine
  • Risperidone
  • Ziprasidone
  • Paliperidone
  • Aripiprazole
54
Q

What are the s/e for:
- Quetiapine
- Risperidone
- Ziprasidone

A
  • Quetiapine –> weight gain
  • Risperidone –> less ESP, wt gain
  • Ziprasidone –> less wt gain, CVD and prolonged QT
55
Q

When is clozapin used for schizophrenia ?

A

severe risk of neutropenia; reserved for refractory pts

56
Q

When is Olanzapine (Zyprexa) used?

A

commonly prescribed; guidelines do not recommend as a first line agent

57
Q

What is drug of choice for schizophrenia?

A

Atypical but look at:
Adverse effects and efficacy
Comorbities
Cost

58
Q

What is the dosage schedule for schizophrenia

A
  • Divided daily doses
  • Titration to effective dose
  • Low end of dose should be tried for several weeks
  • After the effective daily dose has been discovered dose can be given once daily (typically at night)
    Simplification= > compliance
59
Q

What are the acute options for schizophrenia?

A

Zyprexa – IM/ODT
Haldol – IV
Benzo’s

60
Q

How long should pt be on schizophrenia for/

A

least 6–8 weeks at a therapeutic dose.

61
Q

What are big S/e for schizophrenia?

A

Weight gain, hyperglycemia, diabetes mellitus, and hyperlipidemnia, hyperglycemia, ketoacidosis, coma, and death have been reported with SGA.

62
Q

Whats important to distinguish in schizophrenia?

A

distinguish between drug-induced psychosis and schizophrenia

63
Q

What should you do with new onset of schizophrenia

A

Admit

64
Q

To evaluate a pt completely, what should you do

A

antipsychotic

65
Q

what is first line for Schizophrenia?

A

SGA

66
Q

What the goal for acute alcohol withdrawal?

A

Prevent progression to delirium tremens
- AMS, onset 3-10 days post, lasts 2-3 days

67
Q

What are we trying to prevent with alcohol withdrawal?

A

Seizures

68
Q

What should you do with labs with alcohol withdrawl?

A

potassium and magnesium

69
Q

What should we ppx and why for alcohol withdrawal?

A

prophylaxis w/ thiamine to prevent Wernicke’s encephalopathy

70
Q

What should the long term tx be for alcohol withdrawal?

A
  • Enroll pt in program
  • Work up for potential liver dz
  • Tx/manage other comorbidities
70
Q

What should the long term tx be for alcohol withdrawal?

A
  • Enroll pt in program
  • Work up for potential liver dz
  • Tx/manage other comorbidities
71
Q

Whats the 1st line alcohol withdrawl?

A

Barbiturates - Phenobarbital

72
Q

T/F Barbiturates is Becoming the treatment of choice for alcohol withdrawal and withdrawal seizures

A

True

73
Q

What can be adj for alcohol withdrawal?

A

Benzos, helpful for actively seizing

74
Q

T/F All benzodiazepines appear equally efficacious in reducing signs and symptoms of withdrawal

A

True

75
Q

What is dosing for barbs based on?

A

CIWA and SEWS scoring

76
Q

What is long acting benzos?

A

diazepam & chloradiazepoxide

77
Q

What is diazepam used for?

A

preventing withdrawal seizures and symptom control

78
Q

what required for long acting benzo’s

A

Clinical monitoring is required – increased toxicity risk – metabolized by the liver

79
Q

Why is chloradiazepoxide (Librium) better?

A

?

80
Q

What is short acting benzo’s?

A

lorazepam and oxazepam

81
Q

What are pros of short acting benzo’s

A

less affected by liver dysfunction and have fewer residual sedative effects

82
Q

T/F All benzo’s used for acute alcohol withdrawal should be front-loaded

A

True

83
Q

What are other option addition for alcohol withdrawal?

A

Agonists (Clonidine) can be safely added to this patient’s acute treatment regimen.
It has been shown to decrease symptoms in patients experiencing mild-to-moderate alcohol withdrawal.
In the short term, it should also help lower the patient’s BP and heart

84
Q

What should alcohol withdrawal be supplement with?

A

Thiamine
Folate

85
Q

Do you need to taper thiamine?

A

Yes, - home taper for 3 days

86
Q

When is seizure risk highest for alcohol risk?

A

6-72 hrs

87
Q

Can you give benzo’s for home alcohol withdrawul?

A

no, better option is librium

88
Q

What are some of the cessation medication for AW?

A

Disulfiram

89
Q

What should you never do with disulfiram?

A

NEVER GIVE TO SOMEONE WHO IS INTOXICATED

90
Q

when can you discharge AW pt?

A

hemodynamically stable
definitive f/up
Resources

91
Q

Review slide 40!!

A
92
Q

what are some of the lifestyle approach for insomnia?

A
  • Stimulus Control –> avoid alcohol, caffeine
  • Environment –> dark room, quiet, decrease pre-sleep activity
  • Behavioral therapy –> sleep hygiene, sleep restriction therapy, relaxation, CBT
93
Q

What are some dietary supplements that might help for insomnia?

A

Tryptophan (Turkey)
Melatonin

Valerian Root
Kava-Kava
Passion flower
Skullcap
Lavender
Hops

94
Q

What are top foods with tryptophan?

A

See slide 42

95
Q

What are OTC meds?

A

Many are antihistamine or anticholinergic agents

Benadryl, Tylenol PM, Sleep-Eze, doxylamine (Unisom)

96
Q

What are some of the s/e of OTC sleep?

A

vivid dreams and next day “hang over”

97
Q

What is unisom helpful?

A

N/V for pregnancy

98
Q

What is antidepressants for insomnia?

A

Doxepin and trazodone

99
Q

What are benzos for insomnia?

A

lorazepam, clonazepam, alprazolam (NOT A GOOD DAILY MED)

100
Q

What are non-benzo’s for insomnia?

A

zolpidem (ambien), Eszopiclone (lunesta)

101
Q

What class is benzo’s in pregnancy?

A

X!!

102
Q

What are the MOA for benzo’s/non-benzos insomnia?

A

Act on GABA receptors

103
Q

What is insomnia med safe in pregnancy?

A

Doxylamine in pregnancy
Ambien also safe

Clinical Pharm (8 decks)

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