Week 1 Flashcards
Trazodone
Want to use in depressed pts with hard time going to sleep
- mixed
block post syn 5HT2
blocks reuptake of 5HT/NE
antagonist/agonist
adequate antidepressant trial is ____ weeks
8-14 weeks
Why would you pick SSRI over SNRI?
higher seizure risk withdrawal syndromes (flu-like electric shocks)
(bupripion also has higher seizure risk)
10 day supply of which antidepressant is lethal?
TCAs
dangerous in overdose
Antidepressants Good against sexual side effects
Venlafaxine (SNRI)
Bubproprion (other)
lesion to subthalamic nucleus
contralateral hemiballismus
Which is easier to tx? Mania or depression?
mania
(treating bipolar depression is very hard)
only approved tx
- quetiapine +
- Olanzapine + Fluoxetine
Best proven anti manic agent?
LITHIUM!
- best prove, best studies
- anti-suicical
- cheap
- narrow therapeutic window, hypothyroidism, diabetus
Comorbidities for ADHD
substance abuse anxiety disorders depression learning disorders oppositional behavior
5 models of why indiv with ADHD have comorbidities for other psychiatric disorders
- genetic
- developmental changes
- psychological effects
- living with others irritated by ADHD
- self treating problem
Most effective tx of ADHD
Stimulants
- well tolerated, most effective
- cause few symptoms
- make pt less annoying and give them better self-esteem
EARLY STIMULANT TX CAN DECREASE LATER RISK OF SUBSTANCE ABUSE AND DECREASE RELAPS IN SUBSTANCE ABUSE
Sedative-hypnotic drugs facilitate what, leading to diminished neuronal excitability?
Fac. action of GABA at GABAA receptor-Cl channel complex →
GABA opens ion channels to increase CL- conductance →
hyperpolarization →
diminished neuronal excitability
1st line tx for most anxiety disorders
SSRIs
BDZ does not affect excitatory NTs compaired to barbs, why is this important?
BDZ are incapable of inducing and maintaining surgical anesthesia
IM BDZ
Lorazepam
Buspirone
- action
- sedative properties
- additive CNS depression?
- anticonvulsants
- myorelaxant
5HT1A partial agonist at presynaptic nerve terminal
No sedative/additive CNS depression
No Anticonvulsant, or myorelaxant properties.
Just an anxiolytic
- must be administered on routine schedule: less pt acceptance
Post traumatic stress disorder #1 tx
CBT
- SSRI
Drug toxicity
pinpoint toxicity
-tx?
Opioid
-tx with naloxone
immediate
Clonidine
tx for withdrawl and relapse prevention
- good against opiod withdrawl
a2 agonist
Methadone
Alleviate withdrawal symptoms by cross tolerance/dependence
buprenorphine
partial agonist at mu opioid receptors
- helps with opioid withdrawal
Naltrexone
blocks reinforcing action of heroin/alcohol
CNS stimulants strong physical or psychological dependence?
Psychological
- lack of physical symptoms in withdrawal
not that bad
(OH, BDZ bad)
Hallucinogens
agonist action at 5HT2 R → hallucinatory action
Also induce DA release @ DA receptors
High dose of this drug induces rhabdo and kidney failure
Hallucinogens
Disulfiram (antabuse)
tx for alcohol restraint
inhibits aldehyde dehydrogenase causing increase in acetaldehyde
- nausea, vomitting, resp collapse, convulsion
Alcohol withdrawal syndrome tx
BDZ
a-2 adrenergic agonists (clonidine)
acute alcohol intoxication tx
no specific antidote
- IV fluids (thiamine, glucose, electrolytes)
- Support respiration
Reducing alcohol consumption
Disulfiram:
- alcohol sensitizing
Naltrexone:
- opioid antagonist
Acamprosate:
- NMDA receptor drugs
tx for opioids
Methadone
- opioid agonist (taper off)
Naltrexone
- opioid antagonist
Buprenorphine
- Partial opioid agonist
acamprosate
resembles GABA
- ENhances GABA transmission
Interferes with glutamate transmission and reduces CNS hyperexcitability
