Psychiatric Flashcards
MDD diagnostic criteria
SIGECAPS (5 or more of these for 2 weeks or more)
Which labs should be included in a depression evaluation?
CBC, CMP, TSH, folate, drug serum levels
What are some common medication causes of depression? (6)
Alpha and beta interferons
levetiracetam
natalizumab
steroids (> 80 mg per day prednisone equivalents)
Progesterone
Efavirenz
Isotretinoin
(Beta-blockers)
What is SIGECAPS
Sleep
Interest
Guilt
Energy
Concentration
Appetite
Psychomotor
Suicidal
Which 3 SSRIs are preferred in the older adult?
Citalopram, escitalopram, sertraline
Which SNRIs are preferred in the older adult?
Venlafaxine, duloxetine
Which antidepressants increase the risk of bleeding from warfarin due to decreased platelet aggregation?
SSRI, SNRI, TCAs
Which SSRIs increase the risk of bleeding from warfarin by inhibiting CYP2C9?
Fluvoxamine, fluoxetine
Which antidepressants are CYP2D6 antagonists?
Duloxetine.
Paroxetine.
Bupropion
Which analgesics can be blocked by antidepressant treatment?
Codeine
Tramadol
Which Alzheimer’s disease medication’s are substrates for CYP2D6 and CYP3A4, and therefore at risk of antagonism from antidepressants?
Galantamine
Donepezil
What should be done when the patient has no response to a therapeutic dose of an antidepressant?
Change to another first line antidepressant
What do you do when the patient has a partial response to an antidepressant?
1) switch
2) combination Rx; add bupropion or mirtazapine
3) augmentation: add lithium, aripiprazole (liothyronine, buspirone, quetiapine, brexpiprazole)
What labs Should be done to assess for medical or medication causes of anxiety?
TSH, CBC, CMP, urine/serum toxicology screen
Which two agents are first line choices for medication therapy of PTSD?
Sertraline and venlafaxine
Common medication causes of insomnia
Decongestants, stimulants, Stimulating antidepressants and anticonvulsants (Lamotrigine), alcohol, diuretics
What Medications are used for management of excessive daytime sleepiness in OSA consistently using CPAP?
Modafinil, armodafinil, Solriamfetol
Rapid eye mouvement sleep behaviour disorder (RBD) treatment medications
Melatonin 3-15 mg, 1 hour before sleep
Clonazepam 0.5 - 2 mg qhs
Restless leg syndrome management, first line
Dopamine agonist: pramipexole or rotigotine patch
Gabapentinoids: gabapentin enacarbil (Horizant)
(Cost constraints: pregabalin, plain gabapentin)
Restless leg syndrome reduce or eliminate triggers
Serotonergic antidepressant, anti-histamine, Check ferritin level
CIWA-Ar At what score is benzodiazepine treatment indicated
> 8
Benzodiazepines FDA approved for alcohol withdrawal
Chlordiazepoxide, diazepam, oxazepam
Alcohol use disorder management (2)
Naltrexone or acamprosate 
Opioid withdrawal symptoms (3 or more of) (10)
Dysphoria
Nausea, vomiting
Myalgias
Lacrimation, rhinorrhea, diarrhea
Mydriasis
Piloerection.
Sweating
Yawning
Fever
Alcohol withdrawal symptoms (2 or more of) (7)
Autonomic hyper activity.
Hand tremors.
Insomnia.
Hallucinations, psychomotor agitation
Nervousness
Seizure activity
Opioid withdrawal symptom management - diarrhea
Loperamide
Opioid withdrawal symptom management - nausea
Ondansetron
Opioid withdrawal symptom management - muscle cramping/pain
Ibuprofen (caution in older adults)
Opioid withdrawal symptom management - GI cramping
Dicyclomine
Buprenorphine drug interaction risks 
QT prolongation, CYP3A4 substrate
Which medication for treatment of alcohol use disorder is appropriate in patients with hepatic disease?
Acamprosate
