Psychiatry

Question 1

St. John’s is used for treatment of…. and can effect other drugs via…

Answer 1

efficacy in the treatment of mild to moderate depression equivalent to that of tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs). Patients who choose to use St. John’s wort should be cautioned about the lack of regulation of these products in the United States and the potential for drug interactions. St. John’s wort induces various P450 isozymes (CYP 1A2, 2C19, 2C9, and 3A4) and P-glycoprotein systems. Drug interactions with St. John’s wort can lead to treatment failures with many medications, including hormonal contraceptives, anti-retrovirals, immunosuppressive agents, narcotics, anticoagulants, and antifungals.

Question 2

This drug can be used to assist with alcohol abstinence?

Answer 2

Naltrexone has been shown to decrease alcohol cravings, reduce heavy drinking days (defined as >5 drinks/ for men and >4 for women), and increase days of abstinence. It can be initiated while the patient is still drinking. It is contraindicated in patients taking opioids and in those with acute hepatitis or liver failure.

Question 3

This drug is used for smoking cessation and treatment of depression….

Answer 3

Buproprion

Question 4

If a patient has tried an antidepressent without benefit, switched medication with new antidepressant and had partial benefit but still requires more treatment then this is a good medication to add…

Answer 4

Bupropion is an ideal choice as it is an activating antidepressant that does not cause weight gain or sexual side effects and has been used to treat SSRI-induced sexual side effects.
*Buproprion in contraindicated in patients with hx of seizures

Question 5

Citalopram treats depression as well as _______

Answer 5

insomnia

Question 6

Benzodiazepine use in older adults is associated with …

Answer 6

a higher incidence of falls and resulting fractures, with overall increases in mortality.
(Lorazepam, Diazepam, Clonazepam)

Question 7

For treating acutely agitated patient first try _____ then try ______ secondarily

Answer 7

Benzodiazepines (Lorazepam); antipsychotics (haloperidol)