Psychopharm

Question 1

Best antidepressant for patient with liver disease

Answer 1

Sertraline

Question 2

Starting dose of Sertraline

Answer 2

25 mg daily

Question 3

Is Haldol sedating?

Answer 3

No - has no anticholinergic or antihistaminic effects (hence the need for Ativan & Benadryl when giving ETO)

Question 4

Hold parameters for giving BP meds

Answer 4

SBP < 100 and HR < 60

Question 5

What to be aware of in post-op patients on SSRIs

Answer 5

SSRIs decrease pain relief of opioids for acute pain
- by inhibiting the liver enzyme which converts prodrug form of (hydrocodone and codeine) into their active pain-relieving metabolites

Needs to be a focus on better pain management!
Hydrocodone is converted to hydromorphine and codeine into morphine anyway, so giving Hydromorphone (dilaudid) and Morphine is more beneficial for these patients!

https://med.stanford.edu/news/all-news/2019/02/common-opioids-less-effective-for-patients-on-ssri-antidepressants.html

Question 6

FDA approved medications for bipolar depression:

Answer 6

1. Seroquel
2. Prozac + Zyprexa (Symbyax)
3. Latuda
4. Cariprazine (Vraylar)

Also Latuda + Valproate or Lithiumw

Question 7

Dosage of Zyprexa that anticholinergic effects increase in elderly patients

Answer 7

Above 7.5 mg

Question 8

Loading dose of Depakote

Answer 8

Give 20 mg/kg loading dose
Then maintenance (15 mg/kg) or loading dose (split to BID) the next day
Then after 5 days check depakote level & ammonia

Example:
Start 1500 day 1
Then 750 BID and check level on day 5 to adjust
Or 500 BID

Question 9

Only drug you truly should not prescribe in a woman of childbearing age

Answer 9

Valproic acid / Depakote
- on two forms of BC

• 15% chance of neural tube defects (way too high)

Other side effects - hirsutism, PCOS

Question 10

2 drugs that decrease risk of suicide

Answer 10

Clozaril & Lithium

Question 11

Med that can be added to antipsychotic to increase prolactin

Answer 11

Abilify

Question 12

Propanolol side effect

Answer 12

Depression / apathy