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Pyschotherapy and Psychopharm Flashcards

1
Q

4 types of therapy

A
  1. individual (supportive, insight oriented)
  2. behavior (desensitization, substitution, hypnosis)
  3. cognitive
  4. social (marital, AA)
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2
Q

therapy to maintain defense mechanisms for improved function?
Indicated for?

A

Supportive

adjustment disorders, acute emotional crises

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3
Q

therapy to breakdown unconscious maladaptive defense mechanisms?
indicated for?

A

insight-oriented

depression, anxiety, somatoform/dissociative/personality, neuroses, trauma

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4
Q

indications for cognitive therapy?

A

major depression, self-defeating attitudes

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5
Q

3 classes of psychopharm

A
  1. antidepressants / mood stabilizers
  2. anti-psychotics
  3. anxiolytics / hypnotic
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6
Q

3 types of neurotransmitter targets of psychopharm

A
  1. monoamines (norepinephrine, dopamine, serotonin, acetylcholine, histamine)
  2. amino acids (GABA)
  3. glutamic acid
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7
Q

4 categories of antidepressants
Their mechanism
Their side effects

Which is most commonly used?

A
  1. SSRIs / SSNRIs
    reuptake inhibition of 5HT / 5HT-NE
    GI, sexual
  2. TCA
    reuptake reduction of NE and 5-HT
    anti-adrenergic - cardiac arrhythmias / orthostatic HoTN, anticholinergic, anti-histamine - weight gain; coma / convulsion / cardiotox
  3. MAOI
    breakdown inhibition
    HTN crisis if coupled w tyramine (wine, cheese, liver, smoked foods) - avoid unless atypical depression (overeating, oversleeping, irritability), orthostatic HoTN, somnolence, weight gain
  4. Miscellaneous

SSRIs

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8
Q

3 commonly used mood stabilizers

Their side effects

A
  1. Li - tremor, NDI, acne, hypothyroidism, cardiac arrythmias, weight gain, edema, leukocytosis, cleared renally thus avoid if low GFR
  2. Valproate - thrombocytopenia, pancreatitis, hair loss, NT defects
  3. Carbamazepine -slurring, transaminitis, craniofacial defects in newborn, agranulocytosis
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9
Q

1st gen antipsychotics
Mechanism?
Most effective for?
Side effects? - CNS, anticholinergic, CV, endocrine, metabolic

A
  • blocks central DA receptors
  • reducing pos symptoms of schizophrenia - hallucination and delusions
  • CNS: EPS (acute dystonia, akathisia, Parkinsonian), Tardive Dyskinesia, sedation, NMS (rigidity, autonomic dysregulation - tx w dantrolene / bromocriptine)
  • anticholinergic: hot as hare (increased temp), read as beet (flushing), blind as bat (mydriasis), dry as bone (dry mouth, no sweating), mad as hatter (delirium); opposite of DUMBBELSS (diarrhea, urination, miosis, bronchospasm, bradycardia, excitation, lacrimation, salivation, sweating)
  • CV: a-blockade -> orthostatic HoTN, QT elongation
  • Endocrine: hyperPRL -> gynecomastia, galactorrhea, sexual dysfunction
  • Metabolic: weight gain
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10
Q 
2nd gen (atypical) antipsychotics
How diff from 1st gen?
A

Less likely to have CNS side effects

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11
Q

Anxiolytics / hypnotics
mech?
side effects?
withdrawal consequence?

A

binds GABA receptors

sedation, behavioral disinhibition, psychomotor impairment, cognitive impairment, ataxia; addictive

seizure -> death

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12
Q

Stimulants
mech?
indication?

A

increases NE, DA activity

ADHD

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13
Q

tx for OCD

A

SSRI (fluoxetine, sertraline, paroxetine, fluovaxamine), clomipramine

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14
Q

TCA that causes EPS and NMS?

A

amoxapine (metabolite of loxapine, a 1st gen anti-psychotic)

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15
Q

TCA w most favorable side effect profile?

A

desipramine

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16
Q

med combo that leads to serotonin syndrome?

A

SSRI + MAO; separate by >5wks

17
Q

SSRIs w the following side effects

  1. diarrhea
  2. anticholinergic
  3. n/v
  4. fewer sexual side effects
A
  1. sertraline
  2. paroxetine
  3. fluvoxamine
  4. citalopram
18
Q

SNRI for anxiety (general and social)

A

venlafaxine

19
Q

SSRI for GAD and painful diabetic neuropathy

A

Duloxetine

20
Q

transdermal MAOI?

A

selegiline

21
Q

miscellaneous antidepressants: mech?

  1. decreased sexual dysfunction but hepatotox
  2. priapism, orthostatic HoTN, for sleep
  3. weight gain, no sexual / GI
  4. seizures, anorexia, for smoking cessation
  5. n/v/d/c, sexual dysfunction
  6. headache, for GAD and OCD
A
  1. nefazodone - 5-HT
  2. trazodone - 5-HT
  3. mirtazepine - NE and 5-HT antagonist
  4. bupropion - NE and DA reuptake inhibitor
  5. Vortioxetine - 5-HT stimulator
  6. Vilazodone - 5-HT
22
Q

Mood stabilizer: tremor, hypothyroid, arrythmias, NDI, (benign leukocytosis)
mech?
tox?
monitoring?

A
  • Li
  • inhibits AC
  • seizure, coma, death
  • Thyroid, renal, EKG, pregnancy, Li level
23
Q

Mood stabilizer: thrombocytopenia, pancreatitis, hair loss, NT defects
monitoring?

A
  • Valproic acid / divalproex

- CBC, LFT, pancreatic enzymes, hCG

24
Q

Mood stabilizer: slurring, transaminitis, craniofacial defects in newborn, agranulocytosis
monitoring?
drug drug interactions?

A
  • carbamazepine
  • CBC, LFTs, levels
  • potent inducer of P450s
25
Q

Mood stabilizer: leukopenia, hepatic failure, SJ syndrome

monitoring?

A
  • lamotrigine

- CBC

26
Q

Mood stabilizer: ataxia, leukopenia, weight gain

drug drug interactions?

A

Gabapentin

- none

27
Q

Mood stabilizer: psychomotor slowing, memory problems

A

Topiramate (“dopiramate”)

28
Q

1st generation anti-psychotics

  1. sedation and orthostatic HoTN very common
  2. EPS very common
  3. retinitis pigmentosa
  4. torsade de pointes
  5. IM depot available
A
  1. chlorpromazine
  2. haloperidol
  3. thioridazine
  4. mesoridazine
  5. haloperidol, fluphenazine
29
Q

2nd gen anti-psychotics

  1. agranulocytosis, NMS
  2. hyper PRL
  3. somnolence
  4. QT prolongation
  5. headache
  6. tachycardia
  7. present in breast milk
  8. cataracts
  9. diabetes
  10. increased mortality in elderly patients
A
  1. clozapine
  2. risperidone, olanzapine
  3. olanzapine
  4. ziprasidone
  5. lurasidone
  6. paliperidone (invega)
  7. risperidone
  8. quetiapine
  9. aripiprazole
  10. lurasidone, paliperidone
30
Q

long or short acting benzo

  1. diazepam
  2. lorazepam
  3. clonazepam
  4. alprazolam
  5. chlordiazepoxide
  6. oxazepam
  7. temazepam
  8. midazolam
  9. triazolam
A
  1. long
  2. long
  3. long
  4. medium
  5. long
  6. medium
  7. medium
  8. short
  9. short
31
Q

Anxiolytics / hypnotics:

  1. for GAD, avoid MAOI
  2. increased effect w alcohol or SSRIs
  3. amnesia
  4. melatonin receptor agonist
  5. anxiety, unusual dreams, unpleasant taste
A
  1. buspirone
  2. zolpidem
  3. zaleplon
  4. ramelteon
  5. eszopiclone
32
Q

Stimulants:

  1. slow children’s growth
  2. for narcolepsy only
  3. for ADHD and narcolepsy
  4. SNRI, no abuse potential
A
  1. dextroamphetamine and amphetamine (Adderall)
  2. modafinil
  3. dextroamphatmine, methylphenidate
  4. atomoxetine
33
Q

NMS vs. serotonin syndrome?

A

both have autonomic dysregulation but

  • NMS rigidity vs. serotonin clonus
  • antispychotic fx vs. anti-depressant fx
  • high CPK vs. seizures
  • hyperthermia vs. HTN crisis
34
Q

contraindications to buproprion

A
  1. seizure

2. eating disorder

35
Q

alcohol withdrawal tx?

What else could present like alcohol withdrawal?

A
  1. benzodiazepine

2. benzo withdrawal

36
Q

dx?

  1. diarrhea, restlessness / extreme agitation, hyperreflexia, autonomic instability, myoclonus, seizures, hyperthermia, rigidity, delirium, coma, death
  2. muscle rigidity, autonomic dysregulation, high WBC and CPK
A
  1. serotonin syndrome

2. NMS

37
Q

Alcohol withdrawal syndrome timeline

A 
by:
12hrs: tremors
24hrs: hallucinosis
48 hrs: seizures
96 hrs: delirium tremens (delirium, autonomics)

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