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Human Behavior > Exam 2 Therapeutics > Flashcards

Exam 2 Therapeutics Flashcards

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1
Q

What is the first line treatment for mania patients WITHOUT psychosis?

A

valproate
(can use lithium if patient previously responded well)

add BZD short term for agitation

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2
Q

What should you give a pregnancy women with mania?

A

lithium (avoid valproate)

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3
Q

What medications should you AVOID with acute mania?

A

carbemazepine, gabapentin, lamotrigine, topiramate

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4
Q

What is the first line tx for mania pts WITH psychosis?

A

lithium + APS + valproate
(stop or lower anti depressant dose if they are currently taking)

APS: olanzapine, quetiapine or risperdone

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5
Q

What is maintenance therapy for BPD?

A

continue meds that helped get out of acute mania

monotherapy is goal with:
lithium
valproate
quetiapine
or lamotrigine
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6
Q

What mood stabilizer is shown to reduce suicide?

A

lithium

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7
Q

What are SE of lithium?

A

causes tremor (has low TI)

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8
Q

What are SE of valproic acid?

A

hepatotoxicity

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9
Q

What medication is good to prevent rapid cycling in BPD?

A

valproate

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10
Q

What are SE of quetiapine?

A

tardive dyskinesia, metabolic syndrome, weight gain, sedation, orthostatic HTN

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11
Q

What are SE of lamotrigine?

A

stevens johnson syndrome

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12
Q

What are SE or risperidone?

A

aggression, increased risk of stroke, cardiac events in those with dementia

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13
Q

What are treatment options for tobacco use?

A

varenicline, buproprion, nicotine replacement therapy

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14
Q

What is MOA of varenicline? SE?

A

binds to nicotinic ACH receptors so you don’t get the benefits of smoking anymore

SE: nausea & sleep disturbance

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15
Q

What is varenicline dosing?

A

start 0.5 QD x 3 d then 0.5 BID x 4 d then 1 mg BID x12-23 wk

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16
Q

What are SE of buproprion? Cautions?

A

insomnia and dry mouth

caution with co-administration of nicotine and suicide risk (but good if depressed & a smoker!)

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17
Q

What is dosing of buproprion?

A

150 mg p-o BID

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18
Q

What is dosing of nicotine patch?

A

23 mg QAM remove at night then gradually reduce

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19
Q

What is dosing of nicotine gum & when do you need higher dose?

A

2 or 4 mg

4 if >1ppd, cig 1st thing QAM, severe withdrawal or failed lower dose

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20
Q

What is dosing of nicotine nasal spray?

A

0.5 mg per spray 2-10 per hr

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21
Q

What meds can be used to help obese patients lose weight?

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A

orlistat (5.7 lb wt loss)
phentermine and topirmate
Metformin (OFF LABEL)

better tx is healthy eating and phys activity

22
Q

Treatment for delirium

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A

Treat the cause

re-orient, reassure, remove restraints and urinary catheters

quiet environment

haloperidol if need gentle sedation

23
Q

Tx of psychosis?

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A

verbal reassurance, cooling down

Haloperidol is necessary

Then LT will need APS or depot haloperidol

24
Q

What medications are good for chemical restraints?

Study These Flashcards
A

APS-Haldol 5 mg IM (repeat every 20-30 min(

Benzos: Lorezepam 1-2 mg IV/IM (repeat every 10-30 min)

25
What is tx of alcohol intoxication?
banana bag, treat injuries, prevent alcohol withdrawal (treat pphx with benzo or release early enough to drink)
26
Tx of opiate intoxication?
If breathing-ride it out If not-Naloxne (Narcan) IM or IV0.4 mg-2mg
27
What should you never give to a pt presenting with sx of cocaine use
beta blocker
28
Tx for meth toxicity
ABCs! Correct metabolic imbalances, treat agitation with benzodiazepines and haloperidol Assess for MI, renal failure, rhabdomyolysis, seizures, hepatic dx and treat
29
What is recommended for patients with ED to help with skeletal complications?
Calcium and vitamin D
30
Why should typical APS be avoided in AN?
risk of QT prolongation
31
Tx for PD
Difficult to treat, especially because few patients are aware they need help. The disorders tend to be chronic and lifelong. Pharmacologic treatment – limited usefulness unless treating comorbid mental conditions (MDD) Antipsychotics sometimes used for schizotypal SSRI for some symptoms of borderline personality (suicidality) Benzodiazepines before social situations for avoidant personality
32
Tx for Bipolar I, II and cyclothymic
Mood stabilizing medications to decrease risk of relapse: Lithium Carbamazepine or valproic acid Atypical antipsychotics Psychotherapy ECT (safe in pregnancy) Avoid antidepressants
33
Tx for body dysmorphia
Vigorous exercise and sleep CBT/psychotherapy Some require SSRI, TCA, SNRI, or migraine therapies
34
Tx for illness anxiety
Educate, CBT, medicate anxiety
35
Tx for conversion d/o
Hypnosis, psychotherapy, physical therapy, expect recovery
36
Tx for factitious d/o
Confront, use CBT
37
Tx for OCD
Behavior and psychotherapy SSRI at higher doses (fluvoxamine) than required for depression, and response takes longer Chlorimipramine (TCA)
38
Tx for body dysmorphic d/o
CBT SSRI Those with delusional form, try adding a 2nd gen antipsychotic
39
Tx for hoarding
Might benefit from SSRIs, CBT. Challenging treatment
40
Tx for Trichotillomania
Habit reversal CBT, hypnosis, wigs SSRI or chlormipramine (TCA) Topical steroids if itching prompts pulling out
41
Tx for Excoriation
Not well established | Usually treated similar to trichotillomania SSRI + habit reversal
42
Tx for AN
CBT, Maudsley family therapy (give responsibility to parents) APS (olanzapine or risperidone or quetiapine) to ↑ weight gain and ↓ anxiety-monitor lipids and hypotension No antidepressants
43
Tx for BN and binge eating d/o
CBT SSRI (fluoxetine) to ↓ binge episodes Stimulants (vyvanse) to ↓ appetite-need to closely follow BP and HR
44
Tx of delirium
Treat the cause- re-orient, quiet environment, reassure, remove restraints (restraints, benzo only if necessary) and urinary catheters Stop CNS affecting meds (including antiAcH) haloperidol if need gentle sedation
45
Tx of major neurocognitive d/o
Most causes/subtypes are irreversible Admit to hospital for eval of aggression, wandering, psychosis, depression, SI, rapid wt loss, acute worsening
46
Tx of neurocog due to alzheimers
Cholinesterase inhibitors (donepezil, rivastigmine, galantamine) Memantine - NMDA receptor blocker - “cognitive enhancer” Careful use of low dose APS or mood stabilizers for hostility, aggression
47
Tx of psychosis
verbal reassurance, cooling down Haloperidol if necessary Then LT will need APS or depot haloperidol
48
Tx of Alcohol Intoxication
Banana bag, benzodiazepine (for seizure prevention)
49
Tx of opiate Intoxication
If breathing-ride it out | If not-Naloxne (Narcan) IM or IV0.4 mg-2mg
50
Tx of cocaine Intoxication
If HTN & tachycardiad-benzodiazepine If coronary vasospasm-ASA and nitro NEVER BETA BLOCKER
51
Tx of meth Intoxication
ABCs! Correct metabolic imbalances, treat agitation with benzodiazepines and haloperidol

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