Think Beyond Xanax Flashcards
4 aspects of assessment/presentation of a psych pt
- acute vs chronic
- thorough fam hx
- symptoms: SI, duration/frequency, intensity
- h/o of previous psychotropics
tool used to assess symptoms in psych pt
likert scale
max dose of lexapro
40 mg
2 contraindications when considering medications for psych patients
didn’t work in the past
increased dpn
4 types of therapy
- CBT
- DBT (dialectical behavior therapy)
- EMDR (eye movement desensitization/reprocessing)
- mindfulness
therapy for pt’s who have really big emotions (ex histrionic/alexithymia)
DBT
therapy for people who have had trauma
EMDR
lifestyle questions to ask pt before prescribing meds
social etoh?
THC?
party drugs/pills?
t/f: you can do a UA for toxicology screen in primary care
t!
screens for psych patients
PHQ9
GAD7
MDQ
epworth sleepiness scale
borderline personality screen
likert scale
psycheducation.org
max dose of prozac
80 mg
what is the pharmacotherapy journey
1-3 mo: to find therapeutic dose
6-9 mo: maintenance/remission phase
total length of the pharmacotherapy journey
12 months
~1 year on med for max efficacy
med for seasonal dpn
wellbutrin
only dpn med that can be given only during certain times of the year
during what phase of the pharmacotherapy journey can you augment
6-9 months
dpn med to avoid in pt w. IBS
zoloft -> causes diarrhea
med that is very helpful for acute SI
lithium
first line psych med
SSRI
you should try __ trials of SSRI
and then switch to __ if it is ineffective
2
SNRI
6 sx of serotonin syndrome
n/d
restlessness
confusion
tachycardia
hbp
sweating
3 PE exam findings of serotonin syndrome
dilated pupils **
loss of muscle coordination/twitching muscles
muscle rigidity
2 SSRI for OCD
zoloft (sertraline)
prozac (fluoxetine)
SSRI to avoid for OCD
lexapro (escitalopram)
SSRI for ED
prozac (fluoxetine)
SSRI that she rarely prescribes due to harsh s.e profile
prozac (fluoxetine)
most serotonergic SSRI
lexapro (escitalopram)
what is activation in relation to drug side effects
increase in activity - ex talking really fast, restlessness
activation is a predisposition for __
and can tip pt into __
bipolar
mania
which SSRI is activating
prozac (fluoxetine)
3 SNRIs
cymbalta (duloxetine)
pristiq (desvenlafaxine)
effexor (venlafaxine)
which SNRI causes GI upset
cymbalta
last resort SNRI due to harsh s.e profile
effexor
med combo that is good for psych pt with neuropathy
cymbalta + zoloft
2 considerations when starting pt on SNRI
longer time required to increase dose
longer time required to taper off
when dosing SSRI’s, you should titrate up q __
5-7 days
max dose of cymbalta
360 mg
with SNRI dosing, you should titrate up q __ days
14
you should titrate antipsychotics up q __ days
3
6 common side effects of psych meds
GI
dizzy
sedation
sexual dysfxn
anorexia
blunted affect
2 iatrogenic consequences of psych meds
TD
EPS
t/f: TD is irreversible
t!
5 adjunct psych meds
buspar
wellbutrin
abilify
lithium
lamictal
adjunct med for anxiety
buspar
adjunct med for motivation/sexual side effects
wellbutrin
adjunct med for mood lability/emotional reactivity
abilify
adjunct med for SI and dpn
lithium
adjunct med for emotional reactivity
lamictal
which adjunct med is “borderline glue”
lamictal
you need to warn pt about SJS with which adjunct med
lamictal
2 non drug approaches to ADHD
executive functioning coaching
neurofeedback
always check __ history before prescribing stimulant
PDMP
2 non stimulants for ADHD
straterra
ganfacine/intuniv
non stimulant for ADHD with better efficacy for emotional regulation in kids
guanfacine/intuniv
5 stimulants for ADHD
adderall
vyvanse
focalin
concerta
methylphenidate
benefit of stimulants over non stimulants for ADHD
you can take stimulants PRN
