Test #3 Flashcards
Why is it important to do a thorough medication history with your patients?
oMedications could cause psychiatric symptoms
oCould lead to allergic reaction, could interact with OTC meds
oFailing to do so could lead the prescribing person to increase the dose of the medication that is responsible for the side effects.
oUnwarranted/inaccurate diagnoses could be made.
oUnnecessary medications could be added.
How do you differentiate antidepressant toxicity from worsening or reemerging depression
assess for the physiological symptoms of antidepressant toxicity - tachycardia - drowsiness - dry mouth - nausea, vomiting - urinary retention - headache - hallucinations - seizures and monitor antidepressant blood levels
Pharmacologic treatment considerations for children and adolescents
- No informed consent, up to the parents!
- Parents think the drug will FIX IT ALL and dont make the effort to change psychological factors (messed up family)
- Children 7+ should be included in the convo about medication to not ruin their idea of mental health
- Metabolism
- Research Limits
- Fears Regarding Drug Addiciton
Treatment considerations for pregnant women (particularly the risks to the fetus)
- Teratogenesis (malformation of fetus or fetal organs) - risk greatest during 1st trimester
- Drug effects on growing/developing fetus
- Drug effects on labor and delivery
- Residual drug effects on newborn (neonatal)
- Behavioral teratogenesis (long-term effects on child resulting from drug exposure in utero)
- Pregnancy-induced changes in drug actions
- Drug effects on the breast-fed infant
(malformation of fetus or fetal organs) - risk greatest during 1st trimester
Teratogenesis
(long-term effects on child resulting from drug exposure in utero
Behavioral teratogenesis
Considerations
- Establish diagnosis and target symptoms - Obtain complete medication hx - Higher risk for drug-induced psychiatric symptoms - Additive drug effects - Multiple meds psychotropic related falls - Understand age-specific pharmacology - Benzo drug accumulation (some more than others) - Oversedation from benzos - CNS changes behavioral changes and unpredictable medication response - Avoid frequent medication changes/experimentation - Adjust dosage (start low, go slow!) - Therapeutic monitoring (lab) - Recognize/respond to SE promptly
Treatment considerations for geriatric patients
Treatment considerations for geriatric patients
Considerations
- Establish diagnosis and target symptoms - Obtain complete medication hx - Higher risk for drug-induced psychiatric symptoms - Additive drug effects - Multiple meds psychotropic related falls - Understand age-specific pharmacology - Benzo drug accumulation (some more than others) - Oversedation from benzos - CNS changes behavioral changes and unpredictable medication response - Avoid frequent medication changes/experimentation - Adjust dosage (start low, go slow!) - Therapeutic monitoring (lab) - Recognize/respond to SE promptly
Differentiating akathisia from agitation associated with worsening anxiety or psychosis
Akathisia as a result of 2nd-generation antipsychotics is more common in young patients and with high-potency agents
SSRIs (such as fluoxetine) can induce akathisia
Onset of akathisia can vary in onset (early/late)
If symptoms go away with anticholinergics -> akathisia
In some patients, response to antcholinergics is inadequate, so add a benzodiazepine or beta blocker (reduces emotional anxiety/agitation)
If symptoms go away with additional neuroleptic -> disease exacerbation
Stimulant Classes to Treat ADHD
M D A L
- Methylphenidat = Ritalin
- DECTROamphetamine = Dexerdine
- Amphetamines = Adderall
- LISDEXamphetamine = Vyvanse
Treatment considerations/approaches for borderline personality disorder
- Many, if not most, have comorbid major psychiatric disorders -> informs treatment!
- No medication treatment for personality disorders, per se… you can treat the TARGET SYMPTOM
Three cautions when working with clients with BPD
Treatment with antianxiety medications (benzodiazepines) is RISKY
Wellbutrin (Bupropion) should be used with CAUTION
Use medications with a LOW degree of TOXICITY when taken in overdose- High risk of suicidality (acting out)
Core Symptoms of . . .
o Generalized ego impairment**
Ego functioning: (1) insight; (2) agency & self-directedness; (3) self-esteem, acceptance, compassion; (4) empathy; (5) integration, purpose, thematic coherence; (6) philosophical and moral development
Chronic emotional instability
Chaotic interpersonal relations
Feelings of emptiness
Impaired sense of self
Low frustration tolerance
Impulsivity
Primitive defenses (e.g., splitting or acting out)
Irritability and anger-control problems
BPD
Core Symptoms of BPD
E I I R E SOS LFT I D A
Core Symptoms of . . .
o Generalized ego impairment**
Ego functioning: (1) insight; (2) agency & self-directedness; (3) self-esteem, acceptance, compassion; (4) empathy; (5) integration, purpose, thematic coherence; (6) philosophical and moral development
Chronic emotional instability
Chaotic interpersonal relations
Feelings of emptiness
Impaired sense of self
Low frustration tolerance
Impulsivity
Primitive defenses (e.g., splitting or acting out)
Irritability and anger-control problems
3 Subgroups of BPD
H S A
Hysteroid - Dysphoric - Norepinephrine
Schizotypal - (Dopamine)
Angry - Impulsive - (Serotonin)
Subgroup of BPD AND what neurotransmitter does it target
- Emotional lability
- Sensitive to interpersonal rejection, loss, and abandonment
- Desperate attempts to maintain attachments (clinging, manipulative suicidal threats or gestures)
- Great risk for recurring depression
Hysteroid - Dysphoric -
Norepinephrine
Subgroup of BPD AND what neurotransmitter does it target
- Odd thinking (ideas of reference, magical thinking, vagueness, very idiosyncratic beliefs)
- Marked episodes of depersonalization/derealization
- Transient psychosis
Schizotypal - (Dopamine
Subgroup of BPD AND what neurotransmitter does it target
- Hostile-aggressive interactions
- Low frustration tolerance; volatile
- Interpersonal relations are replete (ongoing intense frictions or multiple rejections)
Angry - Impulsive - (Serotonin)
What medications help individuals in the INTOXICATION phase of STIMULANT use ?
B C B A
- Beta Blockers
- Clonidine
- Benzodiazepines
- Antipsychotics
What medications help treat the Withdrawal/Abstinence/Maintenance phase of STIMULANT use?
W A A T M
- Wellbutrin
- Antabuse
- Acamprosate
- Topiramate
- Modafanil
What medications help individuals in a state of ACUTE INTOXICATION, related to opiates ?
N N
Naloxone
Naltrexone
What medications help individuals in a state of ACUTE WITHDRAWAL, related to opiates ?
M B
Opiates especially METHADONE and BUPRENORPHINE
Catapres/Kapyay (Clonodine)
Benzos
Reasons for medication non-adherence
Time SE MISS FEAR FINACNE PSYCH
Not taking medication as prescribed = #1 cause of treatment failure!
Length of time required for clinical improvement
- Side effects
- Missing doses
- Fears and worries regarding adverse medication effects
- Financial concerns
- Psychological dynamics
1)feeling out of control
(2) biological focus
(3) secondary gain
(4) defeating the doctor
(5) patient overwhelm
(6) negative stigma
(7) messages from loved onesReasons for . . . Length of time required for clinical improvement
- Side effects
- Missing doses
- Fears and worries regarding adverse medication effects
- Financial concerns
- Psychological dynamics
1) feeling out of control
(2) biological focus
(3) secondary gain
(4) defeating the doctor
(5) patient overwhelm
(6) negative stigma
(7) messages from loved ones
Medication Non-Adherence
Schedules (percentages, lengths of time) to taper off medications during discontinuation
o Taper off SLOWLY
- Weeks or months - Depends on: medication (class, dosage form, half-life) and length of time it has been taken
oDiscontinuation symptoms can occur
- Tapering off
- Switching from a drug with a longer half-life to a shorter half-life
o Discontinuation of a medication could lead to MEDICATION UNRESPONSIVNESS
- E.g., Lithium; some antidepressants and antipsychotics - Kindling
