Treatments Flashcards
CAGE-AID
for alcohol
2+ yes to in depth assessment
other screening tools for alcohol
audit, dast, niad
alcohol withdrawl tx acuute
- BZDs is mainstay
- medium to long acting ones like diazepam or lorazepam
- clonidine or atenolol
- B vitamins
How do you assess alcohol withdraw and when to treat
CIWA scoring to assess severity. 8 to 10
how to treat levels of CIWA
mild is outpatient, moderate to severe is inpatient
mild is taper BZD and higher is regular BZD
Tx chronic alcohol use - what three medications
Thiamine, Naltrexone, Acamprosate
chronically TAN. think: alcoholics have tan/yellow skin
Psychosocial treatment for chronic alcohol use
motivational interviewing, CBT
Tobacco use tx
1st line recommended combo of long acting and short acting (oral)
or 1st line bupropion
or 1st line Varenicline
acute Opiod use withdrawl tx
-Methadone +/- Buphrenorphine
Adjunct clonidine or lofexidine
1) meth head who found a friend
+ apples
What symptoms does someone with opiate use have to have in order to treat their withdrawl
pupil dilation (mydriasis), piloerection, hot and cold flashes, general aches, tremor, anorexia
Opiate use withdrawl tx chronic
naltrexone, +/-methadone, buphrenorphine
meth head going up a trail with their friend
meth head only goes if they had 1 year of use, or 2 years on meth going back, or preg, or jail
Amphetamine related disorder treament for intoxication
IV BZDs for sedation
intubate, antihypertensives, hypertherma give cooling blankets, fluid resuscitation
Chronic use tx for amphetamines
Buproprion and Naltrexone 1st line
-Mirtazapine second line
imagery: lost the tv show
plane crash survivors walking through woods
2 days lader tazman devil tries to kill them like on lost
Anxiolytic disorder tx OD
flumazenil and long acting BZD for seizures tremors.
Anxiolytic use disorder chornic tx
Gradual taper of BZD, use long acting BZD, and use anticonvulsants to reduce craving
Cocaine use tx acute
DA antagonist bromocryptine
+ antipsychotic
psychotic bromine
Cocaine use long term tx
- Topiramate 1st line
- A DA agonist like destramphetatmine, methamphetamine, or modafinil
- Disulfiram
pirate holding two eggs plus snow + amphetamine
Cannabis use disorder tx
psychosocial interventions - CBT, motivational interviewing, peer support
Psychosocial > meds
-hot shower if N/V/D and abd pain
meds can be - gabapentin, topiramate, verencycline, acetylcysteine
PDD
persistent depressive disorder
first line SSRI
second line TCA, MAOI
Seasonal Affective disorder
Light therapy +SSRI
Bipolar disorder acute mania
For acute manic or hypomanic s/s:
.1.) evaluate inpt vs outpt (severe vs mod)
2.) Severe → antipsychotic + lithium or valproate 3.)
Mild-mod: monotherapy w/ antimanic drug (lithium, antipsychotic, anticonvulsant)
Consider other tx → BZDs (acute agitation), psychotherapy, ECT (refractory)
Acute depression BP
1.) outpt vs inpt
2.) Avoid antidepres monotherapy and
3.) start on anticonvulsant, lithium or antipsychotic from list below
Other tx → adjunct antidepressants, therapy, ECT (refractory)
closeted health inspect / gun
Anticonvulsants - carbamazepine, valproate , lamotrigine
Lithium (few weeks latency)
Antipsychotics - lurasidone, quetiapine, olanzapine, others
Antimanic drugs
Lithium (5-10d latency)
Anticonvulsants - carbamazepine, valpoate/valproic acid, divalproex sodium, Lamotrigine/Lamictal prevents mania
Antipsychotics - Quetiapine, lurasidone, risperidone
Bioplar Maintenance
1.) Preferred - psychotherapy + pharma
2.) 1st line - same med that managed acute
3.) 2nd line - Lithium or quetiapine (Seroquel), valoproate (Depakene), lamotrigine (Lamictal)
4.) 3rd line - other antipsychotics, combo tx
Potentially problematic - antidepressants, BZDs
