Unit 5 - Quizlet Flashcards
Which of the following statements about ergotamines
is false?
A. are effective for tension-type headaches
B. act as 5-HT1A and 5-HT1D receptor agonists
C. have potential vasoconstrictor effect
D. should be avoided in the presence of coronary artery
disease
a
Causes of insomnia
+ Depression
+ Manic disorders
+ Abuse of ETOH (can be cause of or secondary to a sleep disturbance)
+ Heavy smoking (> pack/day)
+ Other medical conditions (e.g. delirum, pain, respiratory distress, uremia, asthma, thyroid disorders, nocturia r/t BPD)
What medications can be given as “transitional therapy” for 2 weeks or so until prophylactic medications for cluster HA become effective?
+ Prednisone – 60 mg daily for 5 days, followed by gradual withdrawal over 7 - 10 days.
+ Ergotamine tartrate – 0.5 - 1 mg nightly via rectal suppository, 2 mg daily PO, or 0.25 mg TID SQ five days per week.
Fluoxetine
+ Generic name - Fluoxetine
+ Class – SSRI
+ Indications for use
– OCD in adults
– Depression
+ Contraindications
CAUTION IN ETOH use, concurrent CNS depressant use, elderly, pts < 25 years, pregnancy 3rd trimester, hepatic impairment, QT issues, bradycardia, DM
+ Common side effects – Insomnia, nausea, HA, diarrhea, libido ↓, dirrhea, anorexia, somnolence, anxiety, can ↑ serum concentrations of some meds.
+ Dosage
– OCD: Up to 60-80 mg day (start at 20 qd and increase after several weeks. taper to d/c)
– Depression: Starting dose of 10 mg/day for 1 week, before increasing to avg daily dose of 20 mg/day.
Candesartan (not FDA approved for migraine)
+ Generic name – Candesartan
+ Class – Angiotensin receptor blocker
+ Indications for use - Prophylaxis of migraine
+ Contraindications
– CONTRAINDICATED in pregnancy, pts < 1 year old
– CAUTION in renal or hepatic impairment, hyponatremia
+ Common side effects – Dizziness, cough, diarrhea, fatigue
+ Dosage – PO, 8 - 32 mg once daily
Pharmaceutical interventions for anxiety in pediatric patients
Pharmaceutical interventions for anxiety in pediatric patients
+ SSRIs and alpha agonists have shown some benefit, but are not FDA approved for < 8 years old
+ Benzos are not recommended for peds because the developing brain is at increased risk for dependency and iatrogenic substance abuse.
Medication approved for tx of OCD in children and adolescents?
Medication approved for tx of OCD in children and adolescents?
+ Fluoxetine (Prozac)
+ Sertraline (Zoloft)
+ Fluvoxetine (Luvox)
Conversion disorder
Conversion disorder
+ Conversion of psychic conflict into physical symptoms commonly co-occurs wtih panic disorder or depression. (e.g. paralysis for panic disorder)
Treatment of OCD in kids
Treatment of OCD in kids
+ CBT-specific for OCD
+ SSRIs – specifically fluvoxamine and sertraline – have FDA approval for treatment of pediatric OCD
NOTE: Combination of CBT plus medicatio is the most effective tx for patients who do not respond to either treatmetn alone.
Ages in childhood during which sleep-disordered breathing peaks?
Between ages 2 - 6
First line treatment for GAD
First line treatment for GAD
CBT with possible addition of SSRI if response is insufficient
Behavioral states in children
\+ Crying state \+ Quiet alert state \+ Active alert state \+ Transitional state \+ Deep sleep state
– These states are 1) maintained until NECESSARY to shift to another, 2) STABLE over several minutes, 3) SAME STIMULUS elicts a STATE-SPECIFIC response different from other states
– Behavior is more easily influenced during TRANSITIONAL state
What is a “washout time”?
Time between switching from one group of antidepressants to another durig which the previous med clears the system.
++ 2-3 weeks between stopping MAOI and starting TCA
++ at LEAST 2 weeks between stopping SSRI and starting MAOI (ALLOW 4-5 weeks for fluoxetine!)
No washout time is needed for switching WITHIN groups.
Other types of medications often used to treat peripheral symptoms of PTSD
+ Beta blockers - Helps with anxiety (e.g. propranolol)
+ Noradrenergic agents - Help with hyperarousal (e.g. clonadine)
+ α-adrenergic blockers - Decrease nightmares (e.g. prazosin)
+ Antiseizure medications - Mitigate impulsivity and difficulty with anger management (e.g. carbamazepine)
+ Benzodiazepines - Reduce anxiety and panic attacks but CAUTION WITH DEPENDENCE (e.g. clonazepam)
NOTE: 2nd generation antipsychotics have not proven useful.
Differential dx for agoraphobia
+ Other anxiety disorders
+ PTSD
+ Depression
+ Medical conditions (eg inflammatory bowel disease)
Circumcision related to UTI
reduces risk in males
Encopresis
Encopresis
+ Repeated passage of stool into clothes or bed by a child who is chornologically or developmentally older than 4 years.
+ Occurs each month for at least 3 months and is not attributable to meds or medical condition (except for constipation)
Screening tool for pediatric patients and their parents
M-CHAT
Headache associated with pregnancy?
Preeclampsia
McPhee p 39
Components of chronic pain syndrome
Components of chronic pain syndrome \+ Anatomic changes \+ Chronic anxiety and depression \+ Anger \+ Changed lifestyle
UTI gold standard for diagnosis
urine culture
Clinical Findings and treatment: Phobic Disorder
FINDINGS:
+ Fear of a specific object or situation
+ Rule out all underlying medication disorders
TREATMENT:
+ SSRIs (e.g. paroxetine, sertraline and fluoxamine) are used.
+ Certain phobias may respond to moderate doses of beta blockers.
+ Behavioral therapies such as systematic desensitaivation have been successful.
“Thunderclap headache” is the classic presentation of what condition?
Subarachnoid hemorrhage! Should precipitate IMMEDIATE workup!
McPhee p 39
Signs of aneurysm prior to rupture
Signs of aneurysm prior to rupture
+ Usually asymptomatic unless they compress adjacent structures.
+ Some pts have headaches with nausea and neck stiffness a few hours or days before massive hemorrhage occurs. (r/t “warning leaks”)