Week 7 - Psychiatric Diagnoses and Treatments Flashcards
Memantine
What is this drug used for and what do you do if someone has an elevated creatinine clearance?
Memantine is used for moderate/severe Alzheimer’s Disease
With an elevated creatinine clearance rate dose should be reduced.
What is the first line treatment for panic disorder?
SSRIS (fluoxetine, paroxetine, sertraline)
+ Cognitive behavioral therapy
What is first line treatment for performance anxiety?
Beta blockers - propranolol
What is the first line treatment for Generalized Anxiety Disorder?
Nondrug therapy
* Supportive therapy
* Cognitive behavioral therapy
* Biofeedback
* Relaxation training
Drug therapy
* SSRIs & SNRIs
o Venlafaxine (SNRI)
o Duloxetine (SNRI)
o Paroxetine
o escitalopram
* buspirone
o buspar
What are the treatment options for Depression?
- Pharmacotherapy
- depression specific pscyhotherapy
- somatic therapies
- electroconvulsive therapy
- transcranial magnetic stimulation
What treatment options are appropriate if first depression drug isn’t working?
- Increase dosage
- Switch to another drug in the same class
- Switch to another drug in a different class
- Add a second drug (like an atypical antidepressant)
How long do depression medications take to become effective?
4-8 weeks to assess for efficacy
What is the biggest risk with antidepressants?
All pose a risk for suicide
What is the first line treatment for sleep disturbances?
Benzodiazepines
- Diazepam
- Lorazepam
- Alprazolam
- Triazolam
Newer benzodiazepine receptor agonists
- Zolpidem
- Zaleplon
- eszopiclone
Which sleep med would help patients fall asleep if they don’t have trouble staying asleep?
- Ramelteon
- Zaleplon
What is the therapeutic drug level for lithium?
0.6-0.8mEq/L
What is the most significant drug interaction for lithium?
NSAIDS increase lithium levels by 60%
What are some common adverse reactions with first generation antipsychotics?
- Tardive dyskinesia (twisting, writhing movements)
- Dry mouth
- Constipation
- Urinary retention
What patient teaching should be given with first generation antipsychotics?
- Drugs may take a few weeks for full effectiveness
- Avoid alcohol, narcotics and other CNS depressants
What are the major drug interactions for SSRIs?
- Antiplatelet
- Anticoagulants
- MAOIs
- Lithium
- TCAs
What baseline data is needed when prescribing SSRIs?
Serum sodium in older adults and patients on diuretic therapy
What are common adverse effects of SSRIs?
- Anxiety
- CNS stimulation
- Headache
- Insomnia
- Nausea
- Nervousness
- Weight gain
What strategies can be used to minimize the adverse effects of SSRIs?
- Stop MAOIs at least 14 days before starting an SSRI
- Use caution with TCAs, lithium, antiplatelets, anticoagulants
What baseline data is needed when prescribing SNRIs?
Serum sodium in older patients and those taking diuretics
What strategies can be used to prevent adverse effects when prescribing SNRIs?
- Contraindicated with MAOIs (withdraw MAOI 14 days prior to starting an SNRI)
- Use in caution with TCA and SSRI
- Withdraw venlafaxine 7 days prior to starting MAOI
- Taper dose if stopping to avoid withdrawal.
What baseline data is needed to prescribe tricyclic antidepressants?
ECG especially for patients with dysrhythmias or those over 40
What patient education is needed when prescribing TCAs?
- Move slowly to reduce risk of falling due to orthostatic hypotension
What baseline data is needed to prescribe MAOIs?
Blood pressure
What patient education is needed when prescribing MAOIs?
Foods high in tyramine and symptoms of hypersensitivity crisis (nausea, vomiting profuse sweating, severe headache)
What dietary restrictions are needed for patients taking MAOIs?
Avoid tyramine containing foods to reduce the risk of hypertensive crisis
Name some benzodiazepines
- Lorazepam
- diazepam
- aprazolam
Name some benzodiazepine-like drugs
- Saleplon
- Eszopiclone
- Zolpidem
What type of drug is Ramelteon?
A melatonin receptor agonist.
What are symptoms of serotonin withdrawal?
- Dizziness
- Headache
- Nausea
- Sensory disturbances
- Tremor
- Anxiety
- dysphoria
