PTSD Flashcards
True/False: PTSD is a normal event that happens after a traumatic event
False. It is an anxiety disorder that follows a traumatic event and is debilitating to those it affects
Risk factors for developing PTSD
Woman - more sx and longer duration
Events involving masses of people
Sudden/unexpected loss of a loved one
Three Core Sx of PTSD and how many of each is needed for dx
Re-experiencing: 1
Avoidance: 3
Arousal: 2
What is required in the DSM-IV of the event?
Experienced/witnessed by patient
In real danger of death/injury
Response was fear, horror, etc
How long do sx have to cause distress/impairment until before being able to be diagnosed?
1 month
Explain the difference between acute, chronic and delayed onset PTSD
Acute <3 months
Chronic ≥3 months
Delayed onset not seeing sx until at least 6 months after the event
Comorbid Disease State Considerations
MDD Anxiety Substance Abuse Sleep disorders Suicidal Ideation
Comorbid Disease State Considerations
MDD Anxiety Substance Abuse Sleep disorders Suicidal Ideation
First Line
SSRI Helps with: sleep, nightmares, re-experiencing Does not help with: Avoidance sx Dosing: Start low and go slow Adequate trial length: 6-8 weeks
First Line
SSRI Helps with: sleep, nightmares, re-experiencing Does not help with: Avoidance sx Dosing: Start low and go slow Adequate trial length: 6-8 weeks
Which SSRI do we avoid and why?
Paxil
Lots of Anti-Ach - hypotension
Weight gain
Which SSRI do we avoid and why?
Paxil
Lots of Anti-Ach - hypotension
Weight gain
What side effects are most common?
GI upset when initiating and changing dose
Sexual dysfunction
What side effects are most common?
GI upset when initiating and changing dose
Sexual dysfunction
What side effects are rarer and more serious?
GI bleed
SR syndrome
SIADH
What side effects are rarer and more serious?
GI bleed
SR syndrome
SIADH
2nd Line
SNRI
Helps with: PTSD and 2˚ pain
Dosing: ER formulation ONLY
Adequate trial length: 6-8 weeks
2nd Line
SNRI
Helps with: PTSD and 2˚ pain
Dosing: ER formulation ONLY
Adequate trial length: 6-8 weeks
What SNRI side effects are most common?
GI upset Headache Agitation Insomnia Sexual dysfunction
What SNRI side effects are most common?
GI upset Headache Agitation Insomnia Sexual dysfunction
Which SNRI AEs are rarer and more serious?
SR syndrome
GI bleed
Which SNRI AEs are rarer and more serious?
SR syndrome
GI bleed
Which medications have the worst d/c syndrome?
Paxil and Effexor
Which medications have the worst d/c syndrome?
Paxil and Effexor
Third Line
Phenelzine (MAOi)
Remeron
Third Line
Phenelzine (MAOi)
Remeron
Adjunct or 1˚ Treatment for Nightmares in PTSD
Name: Prazosin
MOA: alpha 1 blocker
Why this over other in same class? Crosses BBB
Clinical effect: Reduces night terrors, more REM sleep
Dosing: Start at 1mg at bedtime and titrate based on ADRs and effect
Monitoring: Orthostatic hypotension
Adjunct or 1˚ Treatment for Nightmares in PTSD
Name: Prazosin
MOA: alpha 1 blocker
Why this over other in same class? Crosses BBB
Clinical effect: Reduces night terrors, more REM sleep
Dosing: Start at 1mg at bedtime and titrate based on ADRs and effect
Monitoring: Orthostatic hypotension
What do we avoid in PTSD?
BZDs
TCAs
What do we avoid in PTSD?
BZDs
TCAs
