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Social And Behavioral 2 > Psychopharmacology > Flashcards

Psychopharmacology Flashcards

1
Q

With equal or greater to what score on the PHQ9 should you start treating?

A

10

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2
Q

Equal to less than what score on the PHQ9 suggests remission of depressive symptoms?

A

5

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3
Q

If depression lasts at least 2 years, what do you call it? Why is it important to make the distinction between it an MDD?

A

persistent depressive disorder - it’s important to differentiate because it will take longer to treat than MDD

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4
Q

What is the first step in deciding how you hsould treat a depression?

A

you have to determine if it’s recurrent vs persistent vs refractory

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5
Q

What is the difference between recurrent and refractory?

A

recurrent got better on drugs and then relapsed

refractory never responded to any drugs

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6
Q

What happens during the first week of antidepressant trx?

A
  1. decreased anxiety
  2. improvement in sleep
  3. improvement in appetite
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7
Q

What happens during the first 1-3 weeks of antidepressant trx?

A

increased activity, sex drive, self-care and memory
thinking and movements normalize
sleeping and eating patterns normalize

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8
Q

What happens during the 2-4 weeks of treatment with antidepressants?

A
  1. relief of depressed mood
  2. less hopeless/helpless
  3. less thoughts of suicide
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9
Q

If a patient fails her first antidepressant treatment (even with the optimized dose/duration), what should you do?

A
  1. add psychotherapy
  2. lithium augmentation
  3. 2nd generation antipsychotic augmentation
  4. T3 augmentation
  5. Switch to another antidepressant
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10
Q

What are the risks for T3 augmentaiton?

A

if the person’s thyroid is normal, the risks are for cardiac arrhythmias and osteopenia

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11
Q

What are 3 second generation antipsychotics you can use for augmentation with an antidepressant? Which two were found to not be effective

A

aripiprazole
olanzapine (esp combo with fluoxetine)
quetiapine

risperidone - not effective
ziprasidone - not effective

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12
Q

Which was the first 2nd gen antipsychotic to be approved for adjunctive therapy for MDD?

A

abilify

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13
Q

what are the side effects of abilify (aripirazole)?

A

akathisia (restlessness), weight gain

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14
Q

What three things should you consider for metabolic monitoring when giving 2nd gen antipsychotic augmentation?

A
  1. weight gain
  2. diabetes
  3. hyperlipidemia
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15
Q

What 5 things should you consider for neurological monitoring when giving a 2nd gen antipsychotic?

A
  1. dystonia
  2. pseudo-parkinsonism
  3. akathisia
  4. tardive dyskinesia
  5. neuroleptic malignant syndrome?
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16
Q

What are the risks for second gen antipsychotic augmentation in GENERAL?

A
  1. hyperprolactinemia
  2. hypotension/tachycardia
  3. prolonged QT interval
  4. constipation
  5. sedation
  6. sudden death risk in elderly
17
Q

What are the first line treatments for bipolar 1 depression?

A
  1. quetiapine (antipsychotic)
  2. lamotrigine (but taper up slowly)
  3. olanzapine/fluoxetine combo
  4. lithium
  5. lamotrigine + lithium
  6. combo mood stabilizer and AD
18
Q

Although there is no FDA approved treatment for borderlien perseonality disorder, what are some drugs you can give off label?

A
  1. aripiprazole (anger, psychosis, inpulsivity, depression, anxiety, interpersonal problems)
  2. olanzapine (anger, psychosis, anxiety)
  3. divalproex (anger, dep, IP)
  4. lamotrigine (anger impulsivity)
  5. topiramate (impulsivity IP)
19
Q

What is the first line treatment for PTSD?

A

cognitive behavioral therapy plus SSRIs (sertraline, paroxetine, fluoxetine)

20
Q

What are 3 augmentation strategies for PTSD treatment?

A
  1. give an alpha1 or 2 agonist to target the nightmares (like clonidine or trazodone)
  2. 2nd gen antipsychotic to treat psychosis and avoidance (like aripiprazole)
  3. anticonvulsants for the nightmares and the arousal (depakote)
21
Q

How do you manage opioid-induced hyperalgesia syndrome?

A
  1. withdraw the opioid
  2. give methadone or buprenorphine to ease decrease
  3. reduction of glial activation?
  4. treat secondary withdrawal symptoms with corticosteroids and or clonidine
22
Q

What three drugs are approved for treatment of fibromyalgia?

A
  1. duloxetine
  2. milnacipran
  3. pregabalin

Social And Behavioral 2 (18 decks)

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