Week 7 - Psychiatric Diagnoses and Treatments Flashcards

1
Q

Memantine

What is this drug used for and what do you do if someone has an elevated creatinine clearance?

A

Memantine is used for moderate/severe Alzheimer’s Disease

With an elevated creatinine clearance rate dose should be reduced.

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2
Q

What is the first line treatment for panic disorder?

A

SSRIS (fluoxetine, paroxetine, sertraline)
+ Cognitive behavioral therapy

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3
Q

What is first line treatment for performance anxiety?

A

Beta blockers - propranolol

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4
Q

What is the first line treatment for Generalized Anxiety Disorder?

A

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

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5
Q

What are the treatment options for Depression?

A
  • Pharmacotherapy
  • depression specific pscyhotherapy
  • somatic therapies
    • electroconvulsive therapy
    • transcranial magnetic stimulation
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6
Q

What treatment options are appropriate if first depression drug isn’t working?

A
  • 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)
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7
Q

How long do depression medications take to become effective?

A

4-8 weeks to assess for efficacy

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8
Q

What is the biggest risk with antidepressants?

A

All pose a risk for suicide

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9
Q

What is the first line treatment for sleep disturbances?

A

Benzodiazepines
- Diazepam
- Lorazepam
- Alprazolam
- Triazolam
Newer benzodiazepine receptor agonists
- Zolpidem
- Zaleplon
- eszopiclone

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10
Q

Which sleep med would help patients fall asleep if they don’t have trouble staying asleep?

A
  • Ramelteon
  • Zaleplon
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11
Q

What is the therapeutic drug level for lithium?

A

0.6-0.8mEq/L

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12
Q

What is the most significant drug interaction for lithium?

A

NSAIDS increase lithium levels by 60%

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13
Q

What are some common adverse reactions with first generation antipsychotics?

A
  • Tardive dyskinesia (twisting, writhing movements)
  • Dry mouth
  • Constipation
  • Urinary retention
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14
Q

What patient teaching should be given with first generation antipsychotics?

A
  • Drugs may take a few weeks for full effectiveness
  • Avoid alcohol, narcotics and other CNS depressants
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15
Q

What are the major drug interactions for SSRIs?

A
  • Antiplatelet
  • Anticoagulants
  • MAOIs
  • Lithium
  • TCAs
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16
Q

What baseline data is needed when prescribing SSRIs?

A

Serum sodium in older adults and patients on diuretic therapy

17
Q

What are common adverse effects of SSRIs?

A
  • Anxiety
  • CNS stimulation
  • Headache
  • Insomnia
  • Nausea
  • Nervousness
  • Weight gain
18
Q

What strategies can be used to minimize the adverse effects of SSRIs?

A
  • Stop MAOIs at least 14 days before starting an SSRI
  • Use caution with TCAs, lithium, antiplatelets, anticoagulants
19
Q

What baseline data is needed when prescribing SNRIs?

A

Serum sodium in older patients and those taking diuretics

20
Q

What strategies can be used to prevent adverse effects when prescribing SNRIs?

A
  • 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.
21
Q

What baseline data is needed to prescribe tricyclic antidepressants?

A

ECG especially for patients with dysrhythmias or those over 40

22
Q

What patient education is needed when prescribing TCAs?

A
  • Move slowly to reduce risk of falling due to orthostatic hypotension
23
Q

What baseline data is needed to prescribe MAOIs?

A

Blood pressure

24
Q

What patient education is needed when prescribing MAOIs?

A

Foods high in tyramine and symptoms of hypersensitivity crisis (nausea, vomiting profuse sweating, severe headache)

25
What dietary restrictions are needed for patients taking MAOIs?
Avoid tyramine containing foods to reduce the risk of hypertensive crisis
26
Name some benzodiazepines
- Lorazepam - diazepam - aprazolam
27
Name some benzodiazepine-like drugs
- Saleplon - Eszopiclone - Zolpidem
28
What type of drug is Ramelteon?
A melatonin receptor agonist.
29
What are symptoms of serotonin withdrawal?
- Dizziness - Headache - Nausea - Sensory disturbances - Tremor - Anxiety - dysphoria