Psychopharm Nuggets Flashcards
Medications approved for OCD
fluvoxamine paroxetine sertraline fluoxeteine clomipraine (look for anticholinergic side effects and sedation)
TCA’s used for insomnia
Amitrityline
Doxepin
Common side effects associated with anticholinergics
dry mouth, constipation, tachycardia
Off label uses for wellbutrin other than the standard depression
ADHD, bipolar depression, and sexual dysfunction caused by SSRI
Target dose for wellbutrin for managing depression
300 mg total
Difference in how you dose wellbutrin when prescribing SR,IR,or ER
SR and IR need BID dosing (separate at least 6-8 hrs to decrease risk of seizures)- there is a higher risk for seizures with larger doses of wellbutrin in SR and IR versions
ER is once a day
Ways that seizure risk is increased with wellbutrin
SR/IR at high doses (>450)
Crushing and snorting it, chewing it, dividing it
Receptors that wellbutrin acts on
DA and NE reuptake inhibitors
Common side effects of wellbutrin
Agitation, insomnia, headache, nausea, vomiting, tremor, tachycardia, dry mouth, weight loss.
Ideal depressed patients that would benefit from wellbutrin
Those with poor concentration and fatigue and concerned about weight gain
Factors to base SSRI decision on
side effects, cost, and drug interactions
All of the SSRI’s are technically of the same efficacy
Which SSRI is associated with a prolonged QTc
Citalopram (studies noted that when given doses greater than 40 mg daily, QTc prolonged)
This is not seen with escitalopram
Which SSRI has the least drug interactions
Escitalopram, racemic version of citalopram
Which SSRI is most associated with anxiety, insomnia, and decreased appetite
fluoxeteine/prozac
What disorder is fluvoxamine often used for
OCD
Con’s with prescribing fluvoxamine
BID dosing and risk for drug interactions
What sexual dysfuntion is an SSRI helpful for
premature ejaculation
Which benzo is a good one to start with for anxiety if needed
clonazepam because of it’s long half life and has a gradual onset and offset
Time frame regimen for rx ssri + benzo
start patient on ssri and benzo, but then tell them the plan to stop the benzo in 2 weeks because they will no longer need it because the SSRI would have started to kick in by then
When is propranolol useful in anxiety
when the patient is experiencing somatic symptoms like heart pounding and shortness of breath and shaking/tremors
Why is prescribing benzos and opiates a no-no
increased risk of profound sedation, respiratory depression, coma, and death
Mechanism of propranolol
non-selective beta 1 and beta 2 antagonists
Dosage range for propranolol
10mg -40 mg BID
When would you want to use propranolol with lithium
if there is a lithium induced tremor