Psych Flashcards
(89 cards)
1
Q
Antidepressant categories, which is 1st line?
A
SSRI (First line)
SNRI
TCA
MAOI
2
Q
Why are SSRI first line for depression?
A
Low SE profile, low OD risk
3
Q
Fluoxetine dose
A
20 - 80mg Qday
4
Q
When should you take Fluoxetine
A
morning, can increase energy
5
Q
Fluoxetine SE
A
- Insomnia
- HA
- Nervousness (!)
- Decrease libido
- Somnolence
- N/D
- Anorexia
- Dry mouth
6
Q
Fluoxetine uses
A
- OCD
- Bulimia
- Panic DO
- Premenstrual dysphoric DO
7
Q
Symbyax MOA
A
combo fluoxetine + olanzapine (zyprexa)
8
Q
Symbyax use
A
depression associated with bipolar
9
Q
How should most all psych drugs be discontinued?
A
Gradual taper - rebound depression is common because they bottom out the receptors
10
Q
Sertraline (Zoloft) dose
A
50 - 200 mg Qday
11
Q
Sertraline (Zoloft) uses
A
- OCD
- Panic DO
- PTSD
- Social anxiety
- Nocturnal eating (!)
- Premestrual dysphoric DO
12
Q
Parozetine (Paxil) dose
A
20 - 60 mg Qday
- CR 12.5 - 7 mg/d
13
Q
Sertraline, Parozetine, Duloxetine SE
A
- Insomnia
- HA
- Dizziness (!)
- Fatigue (!)
- Decrease libido
- Somnolence
- N/D
- Anorexia
- Dry mouth
14
Q
SSRIs
A
- Fluoxetine (Prozac)
- Sertraline (Zoloft)
- Parozetine (Paxil)
- Citalopram (Celexa)
- Escitalopram (Lexapro)
15
Q
Parozetine (Paxil) uses
A
- Panic DO
- OCD
- GAD
- PTSD
- Social anxiety DO
- Premenstrual dysphoric DO
16
Q
Parozetine (Paxil) special SE
A
associated with more wt gain than other SSRI
17
Q
What SSRI is best for depression with anxiety?
A
Parozetine (Paxil)
18
Q
Citalopram (Celexa) dose
A
20 - 40 mg Qday
19
Q
Escitalopram (Lexapro) dose
A
10 - 20 mg Qday
20
Q
Escitalopram (Lexapro) SE
A
- Insomnia
- Somnolence
- HA
- N
- Ejaculator DO
21
Q
Escitalopram (Lexapro) uses
A
- GAD
22
Q
SNRIs
A
- Venlafaxine (Effexor)
- Desvenlafaxine (Pristiq)
- Duloxetine (Cymbalta)
23
Q
Venlafaxine (Effexor) dose
A
- Immediate and XR
- 37.5 - 225 mg Qday
24
Q
Venlafaxine (Effexor), Desvenlafaxine (Pristiq) SE
A
- Diaphoresis (!)
- Increase BP (!)
- Insomnia
- Somnolence
- HA
- Nervousness
- Dizziness
- N/D/C
- Anorexia
- Dry mouth
- Abn ejaculation/orgasm
25
How should you take Venlafaxine (Effexor)?
with food
26
Desvenlafaxine (Pristiq) dose
50 mg Qday
27
Duloxetine (Cymbalta) dose
40 - 60 mg Qday
28
Drug used for pain associated with DM neuropathy and fibromyalgia
Duloxetine (Cymbalta)
29
Duloxetine (Cymbalta) CI
Liver dz
30
Buproprion (Wellbutrin) MOA
Dopamine re-uptake inhibitor
31
Buproprion (Wellbutrin) dose
- 100 mg TID
- 150 - 200mg BID
- 150 - 450 mg Qday
32
How do you start Buproprion (Wellbutrin)?
with extended release dose
33
Buproprion (Wellbutrin) SE
- Insomnia
- HA
- Wt loss (!)
- Tachycardia (!)
- dry mouth
- dizziness
- HA
34
Which drug is associated with less sexual SE?
- Buproprion (Wellbutrin)
| - Mirtazapine (Remeron)
35
Which drug should be avoided by people with seizure d/o or anorexia?
Buproprion (Wellbutrin)
36
Interesting uses of Buproprion (Wellbutrin)
- SAD
- Smoking cessation (Zyban)
- Decrease drug cravings
37
Mirtazapine (Remeron) MOA
Alpha-2 Antagonist
| - Enhances noradrenergic and serotonergic transmission
38
Mirtazapine (Remeron) dose
7.5 - 45 mg
39
Mirtazapine (Remeron) SE
- Increase appetite (!)
- Wt gain (!)
- Increase cholesterol (!)
- Constipation
- Dry mouth
40
Which drug is used in elderly pts to help with depression, sleep and or appetite/wt?
Mirtazapine (Remeron)
41
How long does it take most antidepressants to work?
2 - 8 weeks
42
What adjunct should be recommended in depression?
Group therapy
43
When do SE tend to resolve?
Usually resolve after 1 week
44
What may happen if pt does not complete a full course of therapy?
Relapse
45
What should you advise pts about d/c'ing meds?
Do not stop antidepressant before discussing it with clinician first
46
What is the most appropriate follow up after starting antidepressant?
1 - 2 weeks
47
What should you watch out for when starting med?
- Suicide (esp in first 1 - 2 months)
| - Mania due to bipolar
48
Recommended length of tx
4 - 9 months after determining therapeutic dose
49
How long should pts at risk for recurrence be on meds?
1 - 3 yrs of maintenance
50
Who is recommended to be on indefinite tx?
- pts with hx of multiple episodes (> 3)
| - Comorbid psychiatric or general med DO
51
When d/cing antidepressant, do so over ________.
2 - 4 weeks
52
Who should be hospitalized?
- Suicidal or homicidal ideations
- Severe psychomotor retardation or agitation
- Associated psychosis
53
Nociceptive pain
Tissue damage/injury
- Somatic - muscle, bones, joints
- Visceral - internal organs
54
How do you treat nociceptive pain? Acute vs Chronic
- Acute: NSAIDs up to short-acting opioids
| - Chronic: long-acting + SSRI/SNRIs
55
Neuropathic pain
- Nerve damage or inflammation
56
How do you tx neuropathic pain?
- Neurontin
- NSAIDs
- Opioids
Central: Clonidine/Baclofen
Peripheral: Lidocaine, SSRI/SNRI, long-acting opioids
57
Mild pain
- ASA
- Acetaminophen
- NSAIDs
- with adjuvants
58
Moderate pain
- Acet/Codeine
- Acet/Hydrocodone
- Acet/Oxycodone
- Acet/Dihydrocodeine
- Tramadol
- with adjuvants
59
What moderate pain med lowers seizure threshold?
Tramadol
60
Severe pain
- Morphine
- Hydromorphone
- Methadone
- Fentanyl
- Oxycodone
- with adjuvants
61
Acetaminophen dose
1000 mg Q 8 hrs
62
Acetaminophen SE
Hepatotoxicity
63
Acetaminophen, max dose
3 g/day
64
NSAIDs SE
- GI bleeding, use with PPI
| - Nephrotoxic
65
MOA
SSRI
66
How long can you use Ketorolac (Toradol)?
67
Ibuprofen, max dose
600 mg Q 6 hrs
68
NSAIDs
- Ketorolac (Toradol)
| - Ibuprofen
69
Codeine dose
15 - 60 mg Q 4 hrs
70
Hydrocodone dose
5 - 7.5 mg Q 4-6 hrs
71
Oxycodone dose
5 mg Q 4-6hrs
72
Caution with codeine preparations
- May contain acetaminophen
- 325-1000mg per pill
- Hepatotoxicity
- Do not exceed 3g/day
73
Tramadol (Ultram) MOA
opioid
74
Tramadol SE
- Decreases seizure threshold
| - Addictive
75
Long acting severe pain meds, used in
Acute and chronic pain
76
Short acting severe pain meds, used in
break through pain
77
Morphine dose
10 mg Q 4 hrs
78
Hydromorphone dose
4mg Q 4 hrs
79
Major SE of severe pain meds,
- N/V
- Constipation (Rx laxative with potent opioids)
- Dry mouth
- AMS
- Respiratory distress (this is what kills people)
- Tolerance ( dose for pain relief, not for dose to cause miosis or constipation, use least effective oral dose)
- Dependence
80
Dependence ______ addiction
does NOT equal
81
With DEA cert and SP approval, how many days worth can PA rx Schedule II and III?
30 days
82
Without DEA cert, how many days can PA rx?
- 72 hrs max, except if "dealing with potential loss of life or limb or major acute traumatic pain"
83
Max ___ rx in 6 months for CIV an CV
5
84
A primary neurobio dz characterized by impaired control over drug use, craving, compulsive use, and continued use despite harm
Addiction
85
Behaviors that appear to indicate addiction, but actually reflect untreated pain
Pseudoaddiction
86
A state of adaptation to a drug class that results in withdrawl signs and symptoms if the drug is abruptly stopped or the dose decreased significantly
Physical dependence
87
A physiologic state resulting from regular use of a drug in which an increased dose is needed to produce a specific effect, or a reduced effect is observed with a constant dose over time
Tolerance
88
Typical drug seeking behaviors
- Overreporting symptoms
- Vague, multiple symtoms
- Insist on specific meds
- Convenient allergies
- Demand brand name
- High tolerance
- First visit req
- Veiled or overt threats
- Flattery followed by req
- Early refill req
- Doctor shopping
89
Solutions and boundaries
- Screen for chemical dependency
- Document meds
- ID common sense
- Communicate with pharmacy
- Write careful rx
- Use alternatives if possible
- Get pharmacy and med hx
- Don't be cynical!
