Test 3 Flashcards
Why is it important to do a thorough medication history with your patients?
- Medications could cause psychiatric symptoms
- Could lead to allergic reaction, could interact with OTC meds
- Failing to do so could lead the prescribing person to increase the dose of the medication that is responsible for the side effects.
- Unwarranted/inaccurate diagnoses could be made.
- Unnecessary medications could be added.
How do you differentiate antidepressant toxicity from reemerging/worsening depression?
- asses for physiologic symptoms; tachycardia, drowsiness, dry mouth, nausea, vomiting, urinary retention, headache, hallucinations, seizures, monitor antidepreseent blood levels
- -irritability
- confusion
- memory impairment
- anxiety
- agitation
- lethargy
What are some pharmacologic treatment considerations for children and adolescents?
- metabolism: high in children, teens similar to adults
- research limitations: lack of control on studies on children, fda mandated safety studies for child subjects
- fears regarding drug addiction, only 2 classes with risk, stimulants, and benzodiazepines
What are treatment considerations for ADHD?
- abuse risk low
- best to administer meds each day
- start with immediate release then extended release
- stimulant wears off, co administer antidepressants later in the day
- may require ongoing medication into adolscence and adulthood
- adverse consequences if misdiagnosed
- side effects: insomnia, anorexia, stomach ache, mild dysphoria
what are treatment considerations for pregnant women and what risks to the baby are there/
- risk factors associated with meds during pregnancy
- teratogenesis, malformations of fetus
- drugg effects on developing fetus
- drug effects on labor and delivery
- behavioral tertogensis on child
- pregnancy induced changes in drug actions
- drug effects on the breast fed child
What are some treatment considerations for geriatric patients/
- adjust dosage
- recognize response to SE promptly
- consider disgnosis and target symptoms
- get complete medication hx
- age specific pharmacology
- they have multiple medications
- higher risk for drug induced psychiatric symptoms
What is the difference from akathisitia vs agitation associated with worsening anxiety or psychosis?
-if symptoms go away with anticholingerics its akathisia, if not then ad additional neuroleptic
What can antidepressant toxicity look like?
- irritability
- confusion
- memory impairment
- anxiety
- agitation
- lethargy
- can be physiologic symptoms of antidepressant toxicity (tachycardia, drowsiness, dry mouth, nausea, vomiting, urinary retention, headache, hallucinations, seizures) and monitor antidepressant blood levels
What can akathisia look like?
- mild can look like increasing anxiety
- severe can look like psychosis
What can anticholinergic delirium look like?
- dry mucous membranes, increased heart rate, dilated pupils
- confusion, disorientation
- tactile or visual hallucinations
- consider recovery afteer discontinuation
What are the stimulant classes to treat ADHD?
Many Dogs Ate Lizards
- methyphenidate: ritalin
- dextroamphetamine: dexedrine
- amphetamines: adderall
- lisdezamphetamine: vyvanse
What are treatment considerations for borderline?
- treatment with antianxiety medication is risky, risk of abuse and increases suicidality
- wellbutrin increases psychosis in pre psychosis individuals
- use medications with low degree of toxicity, because high risk of suicidaliy
- most have comorbid disorders
- no medication but you can treat the target symptoms
What states do psychotropic medications target when treating substance related disorders?
- delusional disorder
- hallucinations
What are core symptoms/ defining features of borderline personality disorder
-generalized ego impairment: ego functioning, insight, self esteem, compassion, empathy, integration, moral development
-chronic emotional instability
-chaotic interpersonal relations
-feelings of emptiness
impaired sense of self
low frustration tolerance
impulsivity
primitive defeses
irritability and anger control problems
What are reasons for medication non-adherence?
- the length of time required for clinical improvement
- adverse side effects
- missing dose, too many
- fears and worries about adverse effects such as addiction, dependence, withdrawal
- financial concerns
- psychological dynamics, feeling out of control, biological focus, secondary gains, defeating the doctor, overwhelm, negative stigma, messages from loved ones
