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Block 8 Week 3 > Peds Psychopharm > Flashcards

Peds Psychopharm Flashcards

(85 cards)

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1
Q

The hypothetical “essence” thought to cause human behavior

A

mind

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2
Q

What is the recurrent problem with mentalistic explanations of human behavior?

A

we cannot test hypotheses

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3
Q

What factors does good psychopharmacology depend on?

A 
rapport with the patient and family
good team functioning
solid formulation and diagnosis
treatment of other obvious factors
proper use of safe and effective meds
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4
Q

A psychiatric evaluation includes a (blank) evaluation.

A

medical

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5
Q

Things included in a medical evaluation?

A

growth charts - height, weight
blood pressure, pulse
labs

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6
Q

Two exams performed by the psychiatrist?

A

CV exam

neuro exam

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7
Q

Most psychotropic medications are not (blank) for children and adolescents

A

FDA approved

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8
Q

Children and adolescents generally metabolize (blank) than adults

A

faster

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9
Q

Sometimes with children, you treat (blank) rather than actual disorders

A

symptoms

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10
Q

T/F: Polypharmacy is sometimes used, although definitely not the ideal.

A

True

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11
Q

using a medication that has not received FDA approval for the clinical indication

A

off label use

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12
Q

A new field of study in which genotyping guides treatment decisions.
Example: allelic variation in CYP 2D6 can affect how quickly some drugs are metabolized.
Faster metabolism – needs higher doses.

A

genomics

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13
Q

Poor drug metabolizers are at higher risk for (blank). Rapid metabolizers are at risk for (blank)

A

adverse effects; treatment failure (inaffective treatment)

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14
Q

Which drugs are metabolized by Cyto 2D6?

A 
TCAs
Prozac, paxil, trazodone, remeron
Effexor, cymbalta
Many antipsychotics
Strattera, stimulants
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15
Q

Which drugs are metabolized by Cyto 2C19?

A 
Xanax, valium, TCAs
Clozaril
Methadone
Perphenazine
Zoloft, Celexa, Lexapro, Prozac, effexor
Thioridazine
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16
Q

Except in Asians, the (blank) serotonin transporter gene is associated with more favorable response to SSRIs

A

long form (esp with two copies)

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17
Q

What are some parental influences that come into play when prescribing drugs for kids?

A

parents buy into the notion of a quick fix
parents want to believe biology is to blame vs parenting styles
or
parents take too much responsibility for their child’s illness

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18
Q

There is a lack of safety and efficacy studies on psychotropic meds for children. Give two reasons why.

A

the brain continues to develop into early adulthood

impact of adding psychoactive meds to a developing brain remains unknown

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19
Q

Tetracyclines cause (blank) in kids

A

dental discoloration

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20
Q

SSRIs cause (blank) in children

A

suicidality

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21
Q

Aspirin causes (blank) in children

A

Reye’s syndrome

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22
Q

Cough suppressants can cause (blank) in children

A

pneumonia

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23
Q

Antiemetics can cause (blank) in children

A

dystonic and other movement disorders

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24
Q

FDA requires safety and efficacy studies for (blank) population only

A

target

**ex: only require studies for adults if the drug is intended to be used for adults

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25
T/F: FDA guidelines do not limit which drugs you can prescribe
True
26
T/F: Research on children is complicated and costly and liability risk potential is higher
True
27
It is the job of the physician to educate and recommend drugs for children, but the parents are the informed consenters. If a parent refuses treatment, what should you do?
document the refusal **this is just as important as informed consent
28
What are these? ``` Target symptoms Standard of care/ Evidence-based Least risk of serious side effects FDA approval Known previous responses of patient Known previous responses of family members Dosing schedule Clinician preference ```
Things to consider when selecting a medication
29
With meds in kids, start with a low dose and continue to raise the dose until...
satisfactory remission of symptoms upper limit of dose reached side effects make the dose intolerable plateau in symptoms or symptoms get worse
30
When giving stimulants, what are some things you should monitor?
height/weight pulse blood pressure tics
31
When giving anticonvulsants, what are some things you should monitor?
liver function | blood count
32
When giving antipsychotics and mood stabilizers, what are some things you should monitor?
fasting blood sugar lipids weight abnormal movements
33
How often should children on maintenance medications be seen by their prescribing clinician?
at least once every 3 months **Children in acute settings, displaying unsafe behavior, experiencing significant side-effects, or not responding to a medication trial or in an active phase of a medication trial should be seen more frequently.
34
Although we have limited information on the long-term effects of drugs on a child's brain, what is one reason to initiate medical therapy in the kids anyway?
untreated diseases get worse as they progress --> disrupted development can have long term consequences as well
35
Most widely used anti-depressants in children
SSRIs
36
Problems with SSRIs in children?
``` mania EKG changes sleep problems serotonin syndrome sexual side effects weight gain ```
37
What are atypical antidepressants?
may work on multiple receptors
38
Ineffective in treating childhood depression
TCAs **reports of sudden death
39
SSRIs may be administered (blank)
once daily
40
Side effects of SSRIs
``` GI effects headaches insomnia or sedation serotonin syndrome sexual dysfunction discontinuation syndrome mania ```
41
What are these? ``` Wellbutrin, Wellbutrin SR, Wellbutrin XL, Zyban (buproprion) Effexor, Effexor XR (venlafaxine) Cymbalta (Duloxetine) Desyrel (trazadone) Remeron (mirtazapine) ```
atypical antidepressant
42
Side effects of Wellbutrin?
``` insomnia** increased risk for seizures (avoid in pts with seizure disorders and those w anorexia/bulimia) CNS stimulation headache constipation dry mouth nausea tremor ```
43
Side effects of Trazodone?
``` sedation **makes patients sleepy weight gain hypotension dry mouth priapism ```
44
Side effects of Effexor
``` hypertension** insomnia anxiety nausea sweating dizziness high incidence of discontinuation syndrome ```
45
Side effects of Remeron?
increased appetite sedation dry mouth constipation
46
What are these? ``` Lithium Depakote (Valproic Acid) Lamotrigine Tegretol Trileptal ```
Mood stabilizers
47
Awkward side effect of many psychiatric meds
priapism **can occur in females
48
Does Dr. Zelan prescribe Trazodone in men? Why?
he doesn't, because the risks are uncertain and potentially harmful, patients/doctors are under-educated and embarrassed to discuss em, benefits are so-so; if you do, careful history taking is required!!!
49
What is one major clinical con for use of mood stabilizers?
following levels and evaluating for toxicity
50
useful for treatment of bipolar depression, major problem is length of titration and risk of SJ syndrome.
Lamictal
51
rather less effective mood stabilizer but doesn’t cause weight gain (actually loss of appetite in some) and don’t need levels.
Topamax
52
How is lithium excreted?
renally
53
What must be done if you administer lithium?
baseline labs, including a pregnancy test (can't be used in prego women) follow lithium levels
54
How long might lithium take to work?
~4-6 weeks
55
Side effects of lithium?
``` GI distress weight gain fuzzy thinking polyuria with polydipsia (always have to pee, always thirsty) hypothyroidism cardiovascular acne, rash, itching hematology ```
56
Two potentially life threatening side effects of lithium?
seratonin syndrome | neuroleptic malignant syndrome
57
Hyperkinetic neuromuscular findings of tremor or clonus and hyperreflexia should lead the clinician to consider the diagnosis of (blank)
serotonin syndrome
58
Meds that can cause serotonin syndrome in kids
``` anti-migraine meds pain meds illicit drugs herbal supps (St. John's wort) OCC cold meds anti-nausea meds linezolid ritonavir ```
59
How is neuroleptic malignant syndrome (NMS) different from serotonin syndrome?
serotonin syndrome: sudden onset (w/i 24 hours), agitation and diarrhea, dilated pupils, myoclonus, hyperreflexia NMS seen more with antipsychotics and chronic schizophrenia: slower onset (w/i 7 days), dysphagia, hypersalivation, incontinence, hyperthermia, akinesia, extrapyramidal rigidity
60
How can lithium toxicity occur? What are the symptoms?
decreased fluids, increased fluid loss, decreased salt, drugs that act on renal system, too much lithium; GI (nausea, vom, diarrhea), coarse tremor, ataxia, slurred speech, confusion, arrythmias
61
Severe lithium toxicity occurs when levels exceed (blank)
2.5mEq/L
62
What are Depakote and Depakene (Valproic acid)?
mood stabilizers
63
Depakote and Depakene should be avoided in patients with (blank) because it is cleared by the (blank)
liver disease; liver
64
Do levels of Depakote and Depakene need to be monitored? When will therapeutic effect occur?
yes; check serum levels 7 days after first dose and then continue to monitor; terapeutic effect in 2-4 weeks
65
Side effects of Depakote and Depakene?
sedation dizziness nausea vom *hepatitis pancreatitis etc
66
Safer mood stabilizer for pregnancy, can cause rash
Lamictal (lamotrigine)
67
This mood stabilizer affects blood count
Tegretol (carbamazepine)
68
This mood stabilizer is better tolerated than Tegretol, but may not be as effective
Trileptal (oxcarbazepine)
69
This mood stabilizer is not used for bipolar disorder
Topamax (topirimate)
70
Alternatives to traditional mood stabilizers?
second generation antipsychotics
71
Can progress to toxic epidermal necrolysis – medical emergency, sometimes ICU level (resemble severe burns). Fever and rash, especially involving mucous membranes. Rash may be preceeded by flu like symptoms (fever, sore throat, fatigue, cough). Rash can be painful and involving blisters.
Stevens-Johnson syndrome
72
Meds that can cause SJS?
``` anticonvulsants PCN ibuprofen, tylenol, naproxen allopurinol radiation therapy ```
73
In what disorders are antipsychotics OK for children?
``` childhood schizo childhood bipolar disorder ASD Tourette's disorder substance induced psychosis ```
74
What are some side effects of the second generation anti-psychotics?
``` GI effects headache sedation weight gain dry mouth ```
75
Second gen anti-psychotic that causes WEIGHT GAIN
Zyprexa, Zydis
76
We know that antipsych drugs can cause cardiovascular risk factors. What are some compounding risk factors that might precipitate cardiovascular disease?
females Low K+, low Mg++ CV disease prolonged QT syndrome
77
What are two psychostimulants?
ritalin | adderall
78
Alternative meds given for ADHD?
Strattera (atomaxatine) Wellbutrin (buproprion) **used to give Tenex and clonidine
79
What is one problem with anxiolytics?
fast acting anxiolytics may have a quick reinforcing effect, but then they wear off, which causes an emotional "roller coaster"
80
Most effective treatment for anxiety?
behavioral therapy **can use benzos but they cause tolerance and increasing demand
81
What should be considered first in sleep disorders?
meds with low side effects like Benadryl or Atarax, can try remeron (a melotonin receptor agonist) or melatonin
82
Rank the following in terms of safety/efficacy: antipsychotics SSRIs mood stabilizers stimulants
stimulants > SSRIs > mood stabilizers > antipsychotics
83
T/F: MONOpharmacy is better than POLYpharmacy
True
84
T/F: Although FDA approval is not necessary for final word, it is important to pay attention to different categories
Duh
85
Always make sure to do this regardless of what you are prescribing
document!!!

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