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
What are the lengths of time to taper off medication during discontinuation?
-weeks or months, depends on the medication and length of time it has been taken
What factors influence the schedule/timing to taper off of medication?
- medication class
- dosage form
- half life
- length of time it has been
Opiates information?
-Specific opiate receptors and endogenous opioids (enkephalins and endorphins)
Pleasure and pain
-Opioids:
Morphine, heroin, Darvon (propoxyphene), methadone, Demerol (meperidine), Talwin (pentazocine), Dilaudid (hydromorphone), Percodan/Oxycontin (oxycodone), Vicodin/ Damason-P (hydrocodone), and codeine
Discontinuation of hypnotics?
-potentially habit forming
-produce tolerance and dependence
-taper off by skipping days : every other day, every 3 days…
-resolve in apprx 2 weeks
discontinuation symptoms: dysphoria, rebound insomnia, withdrawal symtpoms
What are some risks of OTC medications?
- they may not contain all listed ingredients
- may contain impurities, lead, mercury
- adverse reactions
- side effects on liver and metabolism
- 70% dont inform their doctor
- chronic pain, anxiety, insomnia, depression, fatigue, memory problems
- not covered by insurance and may cost a lot
General Facts about OTC and herbal products?
- they aren’t FDA approved and can claim use in non disease conditions, but cannot advertise that they treat or prevent diseases
- yohimbine and kava kava may increase psych symptoms and be dangerous
What conditions do OTC products treat?
-saint johns wort- depression
-SAM-e: depression
-omega-3 fatty acids: mood disorders
folic acid: mood disorders
-meatonin: sleep disturbance
-gingko-biloba: cognitive impairment
When do you re-refer a Pt to the prescribing physician?
- failure to respond
- need for dosage adjustment
- unexplained relapse
- the onset of new medical conditions
- side effect problems
- discontinuation of medication treatment
What does psychedelic mean?
- drugs that get deep into the psyche, urge to change their consciousness
- concept derived from ancient greek, psyche means mind or soul and delein means to show or reveal, “mind revealing/expanding.
