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Step 1 > Psych Treatment > Flashcards

Psych Treatment Flashcards

1
Q

Treatment for ADHD

A
  • Stimulants (methylphenidate)
  • CBT
  • Alternatives: atomoxetine, guanfacine, clonidine
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2
Q

Rett Syndrome

A
  • X-linked dominant
  • Girls, age 1-4
  • REGRESSION - loss of development, loss of verbal abilities, intellectual disability, ataia, stereotyped HAND-WRINGING
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3
Q

Treatment for Conduct Disorder

- Violating basic rights of others or societal norms (aggression, destruction, theft)

A

CBT

- Antisocial personality disorder

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4
Q

Treatment for Oppositional Defiant Disorder

- Hostile to authority figures

A

CBT

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5
Q

Treatment for Separation Anxiety Disorder

A

CBT
Play therapy
Family therapy

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6
Q

Treatment for Tourette Syndrome

A

Psychoeducation and behavioral therapy
For intractable/distressing tics: high-potency antipsychotics (fluphenazine, pimozide), tetrabenazine, guanfacine, clonidine

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7
Q

Treatment for Delirium?

A

Treat underlying condition
Haloperidol used as needed
Benzodiazepines for alcohol withdrawal

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8
Q

Treatment for schizophrenia?

A

Atypical antipsychotics (Risperidone)

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9
Q

Treatment for bipolar?

A 
Mood stabilizers (lithium, valproic acid, carbamazepine)
Atypical antipsychotics
AVOID ANTIDEPRESSANTS (can precipitate mania)
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10
Q

Treatment for depression?

A

CBT and SSRIs are first line
SNRIs, mirtazapine, buproprion can also be considered
ECT in select patients

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11
Q

Treatment for depression with atypical features?

A

CBT and SSRIs are first line

MAOi are effective but have lots of AE

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12
Q

Treatment for postpartum blues?

A

Supportive

Follow-up to assess for postpartum depression

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13
Q

Treatment for postpartum depression?

A

CBTs and SSRIs

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14
Q

Treatment for postpartum psychosis?

A

Hospitalization and initiation of atypical antipsychotic

ECT may be used

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15
Q

Treatment for panic disorder?

A

CBT, SSRIs, venlafaxine are first line

Benzodiazepines for acute attack

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16
Q

Treatment for specific phobia?

A

Systemic desensitization

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17
Q

Treatment for social anxiety disorder?

A

CBTs, SSRIs, and venlafaxine are first line

Benzodiazepine or Beta-blocker for occasional anxiety-inducing situations

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18
Q

Treatment for agoraphobia?

A

CBT, SSRIs, MAOi

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19
Q

Treatment for generalized anxiety disorder?

A

CBT, SSRIs, SNRIs are first line

Buspirone, TCAs, benzodiazepines are 2nd line

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20
Q

Treatment for adjustment disorder?

A

CBT, SSRIs

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21
Q

Treatment or OCD?

A

CBT, SSRIs, clomipramine

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22
Q

Treatment for body dysmorphic disorder?

A

CBT

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23
Q

Treatment for PTSD?

A

CBT,SSRIs, venlafaxine

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24
Q

Treatment for acute stress disorder?

A

CBT, pharmacotherapy not indicated

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25
Q

Treatment for anorexia nervosa?

A

Psychotherapy and nutritional rehabilitation are first line

- Watch out for Refeeding Syndrome (increased insulin –> hypophosphatemia –> cardiac complications)

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26
Q

Treatment for bulimia nervosa?

A

Psychotherapy, nutritional rehabilitation, antidepressants

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27
Q

Treatment for binge eating disorder?

A

Psychotherapy (CBT) is first line, SSRIs

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28
Q

Treatment for narcolepsy?

A

Daytime stimulants (amphetamines, modafinil) and nightime sodium oxybate (GHB)

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29
Q

Methadone

A
  • Heroin detox or long-term maintenance

- Long-acting oral opiate

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30
Q

Naloxone + Buprenorphine

A
  • Antagonist + partial agonist
  • Naloxone is not orally bioavailable, so withdrawal sx occur if injected (lower abuse potential)
  • QUICK
31
Q

Naltrexone

A
  • Long acting opioid antagonist

- Use for relapse prevention once detoxified

32
Q

Treatment for alcoholism?

A
  • Disulfiram (abstain from alcohol use)
  • Acamprosate, naltrexone, supportive care
  • Alcoholics Anonymous
33
Q

Treatment for Wernicke-Korsakoff?

A

IV Vitamin B1

34
Q

Treatment for alcohol withdrawal?

A

Benzos (chlordiazepoxide, lorazepam, diazepam)

35
Q

Methylphenidate
Dextroamphetamine
Methamphetamine

A
  • Increases catecholamines in synaptic cleft (especially NE and DA)
  • ADHD, narcolepsy, appetite control
36
Q

Antipsychotics (ZINE)

  • Haloperidol
  • Trifluoperazine
  • Fluphenazine
  • Thioridazine
  • Chlorpromazine
A
  • MOA: block D2 R –> increase cAMP
  • ## Use: schizophrenia (+ sx), psychosis, bipolar, derlirium, Tourette syndrome, Huntington DZ, OCD
37
Q

High Potency Antipsychotics

A
  • Trifluoperazine, Fluphenazine, Haloperidol

- Neuro AE (extrapyramidal sx)

38
Q

Low Potency Antipsychotics

A
  • Chlorpromazine, Thioridazine
  • Non-neuro AE (anticholinergic, antihistamine, alpha1-blockade effects)
  • SEDATION, orthostatic hypotension
39
Q

Chlorpromazine AE

A

Corneal deposits

40
Q

Thioridazine AE

A

Retinal depositis

41
Q

Haloperidol AE

A

Neuroleptic malignant syndrome, tardive dyskinesia

42
Q

Neuroleptic Malignant Syndrome

A

Rigidity, myoglobinuria, autonomic instability, hyperpyrexia

- Rx: dantrolene, D2 agonists (bromocriptine)

43
Q

Tardive Dyskinesia

A

Orofacial chorea as result of long-term antipsychotic use

44
Q

General Antipsychotic AE

A
  • Highly lipid soluble and stored in body fat –> slow to be removed from body
  • Extrapyramidal systemi AE (dyskinesias) –> Rx: benztropine, diphenhydramine, benzos
  • Endocrine AE due to DA R antagonistm –> hyperprolactinemia –> galactorrhea, oligomenorrhea, gynecomastia
  • AE arising from blocking muscarinic (dry mouth, constipation), alpha1 (orthostatic hypotension), and HA (sedation) R
  • Cause QT prolongation
45
Q

Onset of EPS

A
  • Hrs-days: ACUTE DYSTONIA (muscle spasm, stiffnes, oculogyric crisis)
  • Days-mo: AKATHISIA (restlessness) and PARKINSONISM (bradykinesia)
  • Mo-yrs: TARDIVE DYSKINESIA
46
Q

Atypical Antipsychotics

  • Ariprazole
  • Aenapine
  • Clozapine
  • Iloperidone
  • Lurasidone
  • Olanzapine
  • Paliperidone
  • Quetiapine
  • Risperidone
  • Ziprasidone
A
  • MOA: most are D2 antagonists with varied effects on 5-HT2, DA, alpha, and H1 R
  • Use: schizophrenia (+ and - sx), bipolar, OCD, anxiety disorder, depression, mania, Tourettes
  • AE: prolonged QT
  • FEWER EPS AND ANTICHOLINERGIC AE THAN TYPICAL ANTIPSYCHOTICS
47
Q

Ariprazole MOA

A

D2 partial agonist

48
Q

“Pines” AE

- Cloazpine, Asenapine, Olanzapine, Quetiapine

A

Metabolic syndrome - weight gain, diabetes, hyperlipidemia

  • Check fasting glucose and lipid panel at checkups
  • Olanzapine = obesity
49
Q

Clozapine AE

A

Agranulocytosis (monitor WBC weekly)

50
Q

Risperidone AE

A

Hyperprolactinemia (amenorrhea, galactorrhea, gynecomastia)

51
Q

Lithium

A
  • Use: bipolar (blocks relapse and acute manic events)
  • AE: tremor, hypothyroidism (GOITER), polyuria (NEPHROGENIC DI), teratogenesis
  • Narrow TI
52
Q

What congenital birth defect does lithium cause?

A
  • Ebstein anomaly
53
Q

What drug is implicated in lithium toxicity in bipolar patients?

A

THIAZIDE USE

54
Q

Buspirone

A
  • MOA: stimulates 5-HT1A R
  • Use: GAD
  • Does not cause sedation, addiction, or tolerance
  • Takes 1-2 weeks to take affect
  • Does not interact with alcohol
55
Q

Benefits to buspirone?

A

NO ABUSE POTENTIAL

NO SEXUAL DYSFUNCTION

56
Q

SSRIs

  • Fluoxetine
  • Paroxetine
  • Sertraline
  • Citalopram
A
  • MOA: 5-HT specific reuptake inhibitors
  • Use: depression, GAD, panic disorder, OCD, bulimia, social anxiety disorder, PTSD, premature ejaculation, premenstrual dysmorphic disorder
  • Takes 4-8 weeks to have an effect
  • AE: fewer than TCAs - GI distress, SIADH, SEXUAL DYSFUNCTION (anorgasmia, decreased libido)
57
Q

SNRIs

  • Venlafaxine
  • Desvenlafaxine
  • Duloxetine
  • Levomilnacipran
  • Milnacipran
A
  • MOA: Inhibit 5-HT and NE reuptake
  • Use: depression, GAD, diabetic neuropathy
  • AE: HTN most comon
58
Q

Uses for venlafaxine?

A

Social anxiety disorder, panic disorder, PTSD, OCD

59
Q

Serotonin Syndrome

A
  • Can occur with any drug that increases 5HT (MAOi, SNRIs, TCAs)
  • Neuromuscular activity (clonus, hyperreflexia, hypertonia, tremor, seizure)
  • Autnomic stimulation (hyperthermia, diaphoresis, diarrhea)
  • Agitation
60
Q

Treatment for serotonin syndrome?

A

CYPROHEPTADINE (5-HT2 R antagonist)

61
Q

TCAs

  • Amitriptyline
  • Noritriptyline
  • Imipramine
  • Desipramine
  • Clomipramine
  • Doxepin
  • Amoxapine
A
  • MOA: block reuptake of NE and 5HT
  • Use: major depression (persistent, recurring), peripheral neuropathy, chronic pain, migraine prophylaxis
  • AE: sedation, alpha1-blocking effects (postural hypotension, atropine-like AE - tachy, urinary retention, dry mouth), can prolong QT
62
Q

Which TCA is used for OCD?

A

Clomipramine

63
Q

TCA OD?

A
  • Convulsions, coma, cardiotoxicity (arrythmia due to NA+ CHANNEL INHIBITION), respiratory depression, hyperpyrexia
  • Confusion and hallucinations in elderly
  • Rx: NaHCO3 (prevents arrhythmia)
64
Q

Which TCA has least amount of AE?

A

Nortriptyline

65
Q

MOAi

  • Tranylcypromine
  • Phenelzine
  • Isocarboxazid
  • Selegiline (selective MAO-B)
A
  • MOA: MAO inhibition –> increase amine NT (NE, 5-HT, DA)
  • Use: atypical depression, anxiety
  • AE: HTN crisis (w/ tyramine), CNS stimulation
66
Q

Which MAOi is selective for MAO-B?

A

Selegiline

67
Q

What drugs are contraindicated with MAOi use?

A

SSRIs, TCAs, St. John’s wort, meperidine, dextromethorphan

  • To prevent serotonin syndrome
  • Wait two weeks after stopping MAOi before starting 5-HT drugs or stopping dietary restrictions
68
Q

Buproprion

A
  • MOA: increase NE and DA
  • Use: depression, smoking cessation
  • AE: stimulant (tachy, insomnia), HA, seizure in ANOREXIA/BULIMIC
  • NO SEXUAL AE
69
Q

What particular patient is Buproprion good for?

A
  • Depression w/ increased sleep and decreased energy + smoker
70
Q

What particular patient is Buproprion bad for?

A

Anorexic/bulimic

71
Q

Mirtazapine

A
  • MOA: alpha2-antagonist (increases release of NE and 5-HT), 5-HT2 and 3 R antagonist, H1 antagonist
  • Use: depression
  • AE: sedation (desirable if they have insomnia), increased appetite/weight gain (desirable in elderly/anorexic), dry mouth
72
Q

Trazodone

A
  • MOA: blocks 5-HT2, alpha1-adrenergic, and H1 R, weakly inhibits 5HT reuptake
  • Use: insomnia
  • AE: sedation, nausea, PRIAPISM, postural hypotension
73
Q

Varenicline

A
  • MOA: nicotinic ACh R partial agonist
  • Use: smoking cessation
  • AE: sleep disturbance

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