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AMC Pharmacology > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

Gold Standard Tx for Autism Spectrum Disorder

A

Behavioral/ Developmental therapies

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2
Q

Medical Tx for Autism Spectrum Disorder

A

For repetitive stereotypical behavior , anxiety - SSRIs
For aggression , self injury - Antipsychotics ( only resperidone or aripriprazole)
For ADHD with ASD - methylphenidate

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3
Q

Initial TX for Tourettes Disorder

A

CBT or Habit reversal Therapy

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4
Q

Tx for severe or refractory Tourettes Disorder

A

1st line - Alpha- adrenergic agonists - guanfacine , clonidine OR tetrabenazine
typical or atypical antipsychotics

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5
Q

Tx for separation anxiety disorder

A
  • psychotherapy ( CBT , Exposure therapy)
  • play therapy
  • and SSRIs
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6
Q

Tx for selective mutism

A

CBT and SSRIs

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7
Q

Tx for Reactive Attachment disorder

A

behavioral modification for primary caregivers
referral to mental health professionals
tx of associated conditions

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8
Q

TX for ADHD

A

for pre-school children - only behavioral interventions
for school aged children and adults - Behavioral intervention PLUS stimulants ( methylphenidate / dexamphetamine/etc ) or non-stimulants like atomoxetine
Fish Oils

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9
Q

mechanism of action of stimulants

A

Increases noradrenalin and/or dopamine at the synapse

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10
Q

side effects of stimulants

A 
Common 
- decreased appetite 
- poor weight gain 
uncommon 
- headache/dizziness 
- stomach aches 
- insomnia 
- irritable , withdrawn or highly emotional
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11
Q

benefits of atomoxetine ( straterra) over stimulant use in ADHD

A
  • no potential for addiction

- good for use in history of substance abuse( pt or family)

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12
Q

limitation of atomoxetine use

A

increased risk of suicidal ideation in children and adolescents

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13
Q

Tx for pyromania or kleptomania

A

CBT

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14
Q

Tx of DMDD

A

psychotherapy

pharamacotherapy - stimulants , antidepressants and atypical antipsychotics

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15
Q

Tx of conduct disorder

A

psychotherapy
pharmacotherapy for comorbid disorders
antipsychotics or mood stabilizers for severe aggression

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16
Q

Tx for intermittent explosive disorder

A

CBT

pharmacotherapy - SSRIs or mood stabilizers

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17
Q

Tx in acute phase of Schizophrenia

A

first line - 2nd gen antipsychotics PO

  • if not effective within 3 weeks - increase dose
  • if not effective within 4-6 weeks
    a) switch to another 2nd gen antipsychotic OR
    b) switch to a 1st gen antipsychotic

Parenteral
- Haloperidol/Olanzapine + Benztropine/Zuclopenthixol Acetate

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18
Q

what should be added to the tx of a very agitated schizophrenic patient in Acute phase

A

IV Diazepam

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19
Q

TX for Acute Dystonia

A

Benztropine

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20
Q

Tx for Akathisia

A
  • lower dose
  • substitute with thioridazine
  • for short term - PO benztropine , propranolol or diazepam
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21
Q

Tx for Parkinsonism

A
  • lower dose
  • substitute with phenothiazine
  • For short term - benztropine or benzhexol
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22
Q

Tx for Tardive Dyskinesia

A
  • drug withdrawal

if ineffective - use tetrabenazine

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23
Q

how to prevent Tardive dyskinesia

A

use the lowest possible dose for chronic use of antipsychotics

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24
Q

side effect of chlorpromazine

A

corneal deposits - photosensitivity reactions

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25
Q

Tx of drug resistant schizophrenia

A

ECT

or trial of clozapine or olanzapine

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26
Q

Side effect of Clozapine

A

Agranulocytosis

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27
Q

side effects of antipsychotics

A 
1-Prolongation of QT interval - especially the phenothiazines 
2- NMS 
3-EPS 
a) acute dystonia 
b) akathisia 
c) Parkinsonism 
d) tardive dyskinesia
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28
Q

First line treatment in acute mania

A
  • hospitalization

olanzapine Or resperidone

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29
Q

second line treatment in acute mania

A
  • Haloperidol / any 1st gen antipsychotic
  • Lithium carbonate
  • Sodium Valproate
  • Carbamazepine
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30
Q

what to do if there is failure to respond to treatment in acute mania

A
  • ensure maximum concentration of first drug
  • switch to a different drug (1st - to 2nd line)
  • Combine drug (eg - 2nd gen antipsychotic + lithium)
  • or ECT
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31
Q

Prophylactic regimens for recurrent bipolar disorder

A
  • Lithium
    OR
  • Lamotrigine/ carbamazepine/ sodium valproate
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32
Q

Side effects of Lithium

A
  • a fine tremor ( 1st sign)
  • muscle weakness
  • weight gain
  • GI symptoms
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33
Q

First line Tx of GAD

A
  • psychological therapy and non-drug strategies

eg - life coaching and CBT

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34
Q

tx of Anxiety disorders

generally for GAD , Panic attacks , phobias (SAD , Agoraphobia , specific phobias)

A
  • SSRIs and other antidepressants for at least 6 months
  • propranolol for performance subtype (Non -generalized) of SAD
  • psychotherapy in adjunct is always more beneficial
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35
Q

tx for anxiety that has NOT responded to both psychological therapy and antidepressants

A

Benzodiazepines

- only for less than 6 weeks

36
Q

pharma Tx for specific phobias

A

Benzodiazepines

37
Q

First line Tx of panic disorder

A

CBT + SSRIs

rarely benzodiazepines

38
Q

Side effects of Benzodiazepines

A
  • Over sedation
  • dependence
  • increased risk of accidents
  • interaction with alcohol and other drugs
  • potential for abuse and OD
  • iatrogenic , and is present in breast milk
  • muscle weakness
  • sexual dysfunction
  • diminished motivation
  • lowered self esteem
39
Q

First line med for GAD

A

SSRIs

40
Q

First line med for OCD

A

SSRIs

+CBT for obsessions / Exposure and response prevention for compulsions

41
Q

First line tx for generalized SAD

A

SSRIs

42
Q

first line tx for non-generalized SAD

A

propranolol

43
Q

first line tx for PTSD

A

SSRIs for at least 12 months + counseling

44
Q

type of psychotherapy for all phobias

A

behavioral therapy and cognitive therapy

45
Q

tx for body dysmorphic disorder

A

counseling and psychotherapy

46
Q

tx of acute stress disorder

A

debriefing and counseling

47
Q

tx for severe , persistent separation anxiety disorder

A
  • SSRIs , if psychotherapy fails
48
Q

tx for depression in Adolescents

A

1st line - counseling land psychological treatments

+/- SSRIs

49
Q

risk of using SSRIs as antidepressants in adolescents

A

increased risk of suicidality - hence close monitoring for the first 4 weeks

50
Q

tx of depression in anorexia nervosa

A
  • SSRIs especially fluoxetine
51
Q

Tx of nocturnal enuresis

A

1) Urotherapy
2) Alarm therapy
3) Meds
- desmopressin acetate
- TCAs
- Anticholinergics
- combinations - Alarm + meds / meds+ meds

52
Q

Tx of constipation

A

1) education and advice
2) behavioral modification
3) last resort pharma
a) first line - paraffin oil
b) osmotic laxative
c) macrogol 3350 with electrolytes

53
Q

management of severe constipation/fecal impaction

A
  • hospitalize + x-ray
  • macrogol 3350
  • microlax enema
  • if above doesn’t work - ColonLYTLEY via NG tube OR Sodium phosphate enema
54
Q

Tx for insomnia

A

Temazepam
Zopiclone
Zolpidem
Melatonin prolonged release

55
Q

Tx for sleep apnea

A

1) lifestyle mod
- Sleep hygiene ,weight loss , etc.
2) CPAP
3) surgery
4) Meds
- Amitriptyline - if severe and intolerable to CPAP
- Corticosteroid spray in children

56
Q

Tx for Narcolepsy

A
  • dexamphetamine/ Methylphenidate
  • TCAs - for sleep paralysis , cataplexy and hallucinations
  • Modafinil
57
Q

Tx for periodic limb movements (nocturnal myoclonus)

A
  • Levodopa+ carbidopa/ clonazepam/ sodium valproate
58
Q

Tx for Restless Leg Syndrome

A

Self help advice
pharm
- Levodopa+ carbidopa (or+ benserazide) / clonazepam
- if more severe - pramipexole/ropinirole

59
Q

Tx of Nightmares and sleep terrors

A

Psychological evaluation with CBT
meds
- phenytoin
- clonazepam/ diazepam

60
Q

Tx of REM sleep behavior disorder

A

low dose clonazepam

61
Q

Tx of somnambulism

A

benzodiazepines

62
Q

tx to break a sleepless cycle

A
  • promethazine

- trimeprazine ( NOT for <6month old)

63
Q

tx of parasomnias (sleep terrors , walking and talking) in children

A

if persistent and severe

- phenytoin / diazepam/ imipramine

64
Q

Sleep problems in the elderly

A
  • benzodiazepines or zolpidem/zopliclone (- if they have chronic medical conditions)
  • melatonin prolonged release
  • if with depression - TCA
65
Q

Tx of psychogenic cause of erectile dysfunction

A

Psychotherapy and behavioral modification

66
Q

Tx of Hormonal cause of erectile dysfunction

A

a) If testosterone or gonadotrophin deficiency - Stepwise
1) oral - testosterone undecanoate
2) IM- testosterone enanthate
3) Implantation - testosterone implant

b) Thyroid - thyroxine
c) hyperprolactinaemia - Bromocriptine

67
Q

PO med for erectile dysfunction

A

PDE-5 inhibitors

68
Q

Side effect of PDE5 inhibitors

A

Headache

69
Q

Which which drug does PDE 5 - inhibitors have a interaction with & what happens

A

Nitrates

- causes a potentially fatal hypotensive response

70
Q

Contraindications of PDE-5 inhibitors

A
  • someone with
    1) unstable angina
    2) recent MI
    3) recent stroke
71
Q

4 basic rules when taking a PDE-5 inhibitor for erectile dysfunction

A

1) sexual stimulation is necessary
2) avoid fatty foods
3) minimal or no alcohol
4) no nitrates

72
Q

Tx of premature ejaculation

A

1) management strategies
- graded sensate focus
- “start-stop technique”
- squeeze technique

2) meds
- TCAs - clomipramine
- SSRIs
- local anesthesia - lignocaine+ prilocaine

73
Q

Tx of tobacco dependance

A

1) Nicotine replacement therapy
- Nicotine gum for moderate and high dependence
- Transdermal nicotine - for all stages of dependence
- Nicotine inhaler
- Nicotine lozenges and sublingual tablets
2) Combination therapy - NRT + other agents
- Buproprion
- Varenicline tartrate
- Nlortriptyline

74
Q

Drugs that help in abstinence of alcohol

A
  • acamprosate

- Naltrexone

75
Q

Tx of acute alcohol withdrawal symptoms

A

Fluid , electrolytes . nutrition , Vitamin B complex and thiamine
If meds are required - Diazepam
If psychotic features are present - Haloperidol

76
Q

Tx of delirium tremens

A 
Hospitalization 
fluids and electrolytes 
Tx of systemic infections 
Thiamine , diazepam
if psychosis - {+} haloperidol
77
Q

Tx of alcohol OD

A

supportive and symptomatic

78
Q

Tx of MDMA(ecstasy) OD

A
  • Correction of fluid and electrolytes
79
Q

Tx of fantasy OD & ketamine

A

symptomatic

80
Q

management of acute opioid toxicity

A

Naloxone

81
Q

Tx of opioid withdrawal

A

Initial dose

1) Buprenorphine
- if autonomic signs- +clonidine
- if anxiety and agitation - +diazepam

Maintenance
- methadone/Buprenorphine/Naltrexone

82
Q

Tx for Stimulant withdrawal (cocaine , amphetamines , ephedrine)

A
  • psychological support
    Desipramine
    bromocriptine - especially for cocaine
83
Q

Tx of hallucinogen induced symptoms (eg - psychosis , anxiety)

A

Haloperiodol
OR
Diazepam

84
Q

Tx of catatonia

A

Benzodiazepines ( eg - Lorazepam)

85
Q

Management of OCD

A

OCD can be treated with cognitive behavioral therapy (CBT), pharmacologic therapy or both.
CBT and SSRIs are considered to be first line therapy.
For individuals who do not respond initially to SSRIs, clomipramine or antipsychotic therapy can be attempted.
If SSRI fails for 8-12 weeks - try another SSRI
if OCD is resistant to SSRI then - use antipyschotic

86
Q

Tx of acute episode of PTSD

A
  • Benzodiazepines
87
Q

best long term and mortality lowering treatment of Bipolar disorder

A
  • Lithium

AMC Pharmacology (4 decks)

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