Psych Flashcards
1
Q
Classical conditioning
- what is it
- example
A
- learning in which a natural response is elicited by a conditioned response that previously was presented in conjunction with an unconditioned stimulus
- salivating when a bell is rung because it was previously presented with food
2
Q
Operant conditioning
- what is it
- reinforcement
- punishment
- extinction
A
- learning in what action is elicited because it produces a punishment or reward
- behavior is followed by reward
- repeated application of aversive stimulus or removal of reward to extinguish unwanted behavior
- Discontinuation of reinforcement eliminates behavior
3
Q
Transference and countertransference
- what are they and ex
A
- transference: pt projects feelings about formative or other important persons onto physician (psychiatrist is seen as parent
- counter: doctor projects feelings about another person onto pt (pt reminds physician of younger sibling)
4
Q
Ego defenses immature
- acting out: what is it; ex
- denial: what is it; ex
- displacement: what is it; ex
- dissociation: what is it; ex
- fixation
- idealization
- identification
- intellectualization
- isolation
- passive aggression
- projection
- rationalization
- reaction formation
- regression
- repression
- splitting
A
- acting out: subconsciously coping w/ stressors or emotionl conflict using actions rather than reflections or feelings; pt skips therapy apt after deep discomfort from dealing w/ past
- denial: avoiding awareness of some painful reality; pt w/ CA plans a full-time work schedule despite being warned or significant fatigue during chemo
- displacement: redirection of emotions or impulses to neutral person or object; teacher is yelled at by principal and instead of confronting principal the teacher yells at husband later
- dissociation: temporary, drastic change in personality, memory, consciousness or motor behavior to avoid emotional stress; victim of sexual abuse suddenly appear numb when exposed to her abuser
- fixation: partially remaining at a more childish level of development; surgeon throwing tantrum bc case took too long
- idealization: expressing extremely positive thoughts of self and others while ignoring negative thoughts; pt boasts about physician and accomplishments while ignoring flaws
- identification: largely unconscious assumption of characteristics, qualities, or traits of other person or group; resident starts to put stethoscope in pocket like fav physician instead of wearing around neck like he used to
- intellect: using facts and logic to emotionally distance oneself from stressful situation; pt diagnosed w/ CA discussed pathophys of dx
- isolation: separating feelings from ideas and events; describing murder in graphic detail w/o emotion
- passive: demonstrating hostile feelings in confrontational manner; disgruntled employee repeatedly late
- projection: attributing an unacceptable internal impulse to external source; man who wants to cheat on wife accuses his wife being unfaithful
- rationalization: asserting plausible explanation for events that actually occurred for other reasons, usually to avoid self blame; after getting fired claiming that job wasn’t important
- reaction formation: replacing warded off idea or feeling w/ emphasis on its opposite; a patient w/ lustful thoughts enters a monastery
- regression: involuntarily turning back the maturational clock to earlier modes of dealing with the world; seen in children under stress such as bedwetting
- repression: involuntarily withholding an idea or feeling from conscious awareness; 20 yr old does not remember going to counseling during parents divorce 10 yrs earlier
- splitting: believing people are either all good or all bad at different times; pt says all nurses are cold and insensitive but doctors are warm and friendly
5
Q
Ego defenses mature
- sublimation
- altruism
- suppression
- humor
A
- sublimation: replacing an unacceptable wish w/ course of action that is similar to wish but socially acceptable; teenagers aggression bc of parents high expectation is channeled into excelling in sports
- altriusm: alleviating negative feelings via unsolicited generosity which provides gratification; mafia boss makes large donation to charity
- suppression: intentionally withholding an idea or feeling from conscious awareness; choosing to not worry about big game until time to plat
- humor: lightheartedly expressing uncomfortable feelings to sift internal focus away from distress; nervous medical student jokes about boards
6
Q
Infant deprivation effects
- deprivation of
- results in
A
- affection
- failure to thrive, poor language, lack of basic trust, reactive attachment disorder, disinhibited social engagement
7
Q
Child abuse
- physical
- sexual
- emotional
A
- fractures, bruises, burns, w/ injuries in diff stages of healing; usually biological mothers; 40% deaths related to child abuse or neglect occur in children < 1 yr old
- STI, UTI, genital or oral trauma, children often exhibit sex knowledge or behavior incongruent w/ age; known to victim, male, peak is 9 to 12
- babies or young children may lack bond w/ caregiver but are overly affectionate w/ less familiar adults, older children prone to angry outbursts; male or female caregivers; 80% of young adult victims of childhood abuse meet criteria for > 1 psych illness by age 21
8
Q
Child neglect
- what is it
- most common form
- what has to be done
A
- failure to provide a child w/ adequate food, shelter, supervision, education, and or affection
- poor hygiene, malnutrition, withdrawal
- must be reported
9
Q
Vulnerable child syndrome
- what is it
- happens after
- sxs
A
- parents perceive the child as susceptible to illness of injury
- serious illness or life threatening event
- missed school or overuse of med services
10
Q
Childhood disorders
- ADHD: age, what is it, sxs
- autism: sxs
- conduct disorder: what is it
- disruptive mood dysregulation disorder: onset, what is it, tx
- intellectual disability: what is it
- oppositional defiant disorder: what is it, tx
- selective mute: onset, what is it, tx
- separation anxiety disorder: what is it, sequlae
- specific learning disorder: onset, what is it, tx
- tourette syndrome: age, what is it, coprolalia
A
- ADHD: onset before 12, greater than 6 months of limited attention span and poor impulse control; hyperactivity, impulsivity or inattention
- Autism: Poor social interaction, communication deficits, repetitive behaviors; can have intellectual disabilities
- Conduct: repetitive, pervasive behavior violating societal norms (aggression towards people, destruction of property, theft)
- Disruptive: onset before age 10; severe recurrent temper outbursts out of proportion to situation; child constantly angry and irritable between outbursts; tx: stimulant and anti-psych
- Intellectual: global cog deficits that affect reasoning, memory, abstract thinking
- Opp: enduring pattern of hostile, defiant behavior toward authority figures w/o serious violation of social norms; tx: psychotherapy
- selective mute: onset before age 5; anxiety lasting more than 1 month involving refraining of speech in certain situations; tx: behavioral therapy
- separation anxiety: overwhelming fear of separation from home or attachment figure lasting more than 4 wks; can be normal behavior up to age 3-4, can lead to factitious physical complaints to avoid school; tx: CBT
- specific learning: onset during school age years; inability to acquire or use information from specific subject near age expected proficiency for more than 6 months despite intervention; tx: academic support, counseling
- tourette: before 18 yrs; sudden, rapid, recurrent, non-rhythmic motor or vocal tics that persist for more than a year; coprolalia (involuntary obsence speech); tx: high potency anti-psych
11
Q
Amnesia
- retrograde
- anterograde
- korsakoff syndrome
A
- inability to remember things that occurred before CNS insult
- inability to remember things that occurred after a CNS insult
- amnesia caused by vitamin B1 deficiency and associated w/ destruction of mamillary bodies
12
Q
Dissociative disorder
- depersonalization
- dissociative amnesia
- dissociative identity disorder
A
- persistent feelings of detachment or estrangement from ones own body, thoughts, perceptions and actions; intact reality testing
- inability to recall important personal info, usually subsequent to severe trauma or stress
- formerly known as multiple personality disorder; presence of more than 2 distinct identities or personality states; more common in women; associated w/ sex abuse, PTSD, depression, substance abuse
13
Q
Delirium
- what is it
- sxs
- cause
- when
- tx
A
- waxing and waning level of consciousness with acute onset
- disorganized thinking, hallucinations, misperceptions, disturbance in sleep and wake cycles
- usually secondary to other identifiable illness
- most common presentation of altered mental status in inpatient setting especially in ICU
- antipsychotics
14
Q
Pscyhosis
- delusions
- disorganized thoughts
- hallucinations
A
- distorted perception of reality
- false, fixed, idiosyncratic beliefs that persist despite evidence of contrary and are not typical of pts culture or religion
- perceptions in absence of external stimuli
15
Q
Types of hallucinations
- auditory
- visual
- tactile
- olfactory
- gustatory
- hypnagogic
- hypnopompic
A
- more commonly due to psych illness
- more commonly due to medical illness
- common in EtOH withdrawal and stimulant use
- often occur as aura of temporal lobe epilepsy
- rare, but seen in epilepsy
- occurs while going to sleep, sometimes seen in narco
- occurs while waking from sleep
16
Q
Schizophrenia
- positive
- negative
- dx
- caused by
- risks
- TX
- brief psychotic disorder
- schizophreniform disorder
- schizoaffective disorder
- delusional disorder
- schizotypal personality disorder
A
- hallucination, delusions
- flat or blunted affect
- delusion, hallucination, disorganized speech, disorganized behavior, negative sxs; need 2 or more
- increase in dopamine and serotonin
- male (teens to early 20s) and female (20s to 30s)
- cannabis
- atypical antipsychotics are first line
- 1 or more sxs lasting less than a month
- more than 2 sxs lasting 1-6 months
- sxs of both schizo and mood disorders, must have 2 weeks of schizo sxs w/o manic or depressive episode
- cluster A personality that falls on schizo spectrum
17
Q
Mood disorder
A
- characterized by abnormal range of moods or internal emotional states and loss of control over them
- episodic superimposed psych features may be present
18
Q
Manic episode
- what is it
- sxs
A
- distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increase in acitivty or energy lasting more than a week
- distractibility, impulsivity, grandiosity, flight of ideas, agitation, decrease need for sleep, talkativeness or pressured speech
19
Q
Hypomanic episode
- what is it
- does not contain
- time frame
A
- similar to manic episode but not severe enough to caused marked impairment in socal or occupational functioning or to necessitate hospitalization
- no psych features
- lasts less than 4 days
20
Q
Bipolar disorder
- I
- II
- between episodes
- suicide
- tx
- cyclothymic disorder
A
- > 1 manic episode +/- hypomanic or depressed episode
- > 1 hypomanic and depressive episode
- mood and function normalize
- high risk
- mood stabilizers: lithium, valproic acid, lamotrigene) or atypical antipschotics
- milder form of bipolar fluctuating between mild depressive and hypomanic sxs; must last more than 2 years w/ sxs present at least half the time with any remission shorter than 2 months
21
Q
Major depressive Disorder
- what is it
- screen for
- sxs
- MDD w/ psch fx
- persistent depressive disorder
- MDD w/ seasonal pattern
A
- episode of 5 or more of 9 characteristic sxs lasting more than 2 weeks
- hx of manic or hypomanic episodes to r/o bipolar
- Depressed mood, sleep disturbance, loss of interest, guilt/feeling of worthlessnesss, energy loss/fatigue, concentration problems, appetite/weight changes, psychomotor retardation, suicidal ideation
- MDD w/ hallucinations or delisions; antidepressant w/ atypical antipsych
- 2 depressive sxs lasting more than 2 years w/o being consecutive for more than 2 months
- lasting more than 2 years with more than 2 depressive episodes associated with seasonal pattern and absence of nonseasonal depressive episodes
22
Q
Depression w/ atypical fx
- mood
- other sxs
- TX
A
- mostly depression but can have transient moods in response to positive events
- hypersomnia, hyperphagia, leaden paralysis
- CBT and SSRI
23
Q
Peripartum mood disturbances
- maternal blues: incidence, sxs, when, resolves, tx
- MDD w/ peripartum onset: incidence, sxs
- postpartum psychosis: incidence, what is it, risk, tx
A
- 50-85% incidence rate; depressed affect, tearful, fatigue; 2-3 days after delivery; resolves within 10 days; tx: supportive
- 10-15%; depressed affect, anxiety, and poor concentration for > 2 wks; CBT and SSRI
- 0.1 - 0.2%; mood congruent delusions, hallucinations, and thoughts of harming the baby or self; hx bipolar/psych disorder, first pregnancy, family hx, recent discontinuation of psychotropic meds; hospitalization and initiation of atypical antipsychotic
24
Q
Grief
- 5 stages
- other sxs
- duration
- complicated
A
- denial, anger, bargaining, depression, acceptance
- shock, guilt, sadness, anxiety, yearning
- 6-12 months
- persistent, causes functional impairment
25
Electroconvulsive therapy
- what is it
- side effects
- induces tonic-clonic seizure while pt under anesthesia and NM blockade
- disorientation, headache, amnesia resolving in 6 mnths
26
Anxiety
- what is it
- tx
- inappropriate experience of fear/worry and physical manifestations incongruent w/ magnitude of stressor
- not attributable to other psych disorder
- CBT, SSRI, CNRI
27
Panic Disorder
- what is it
- time frame
- sxs
- side effect
- tx
- recurrent attack involving intense fear and discomfort , +/- trigger
- attacks peak in 10 min
- palpitation, paresthesia, depersonalization, abdominal distress/ nausea, intense fear of dying/ losing control
- requires attacks followed by more than 1 month of 1 or more of persistent concern, worrying about consequences, behaviorial changes related to attacks
- CBT, SSRI, venlafaxine
28
Phobia
- severe, persistent fear or anxiety due to presence or anticipation of specific object or situation
- CBT
- exaggerated fear of embarrassment in social situation; for performance type use Beta blocker
- irrational fear while facing or anticipating, closed spaces, lines, crowds, public transport; some refuse to leave homes; associated w/ panic disorder
29
Phobia
- what is it
- tx
- social anxiety: what is it
- agoraphobia: what is it
- severe, persistent fear or anxiety due to presence or anticipation of specific object or situation
- CBT
- exaggerated fear of embarrassment in social situation; for performance type use Beta blocker
- irrational fear while facing or anticipating, closed spaces, lines, crowds, public transport; some refuse to leave homes; associated w/ panic disorder
30
Generalized Anxiety
- excessive anxiety and worry about different aspects of daily life for most days for > 6 months
- restlessness, irritability, sleep disturbance, fatigue, muscle tension, diff concentrating
- CBT, SSRI, SNRI
31
OCD
- what is it
- explanation
- tx
- obsessions that cause severe distress, relieved by compulsions
- recurring thoughts, feelings, sensations relieved by performance of repetitive actions
- CBT and SSRI
32
Trichotillomania
- what is it
- sxs
- age
- tx
- compulsively pulling out hair
- areas of thinning hair or baldness on any area of body
- childhood
- psychotherapy
33
Trauma and stress disorders
- adjustment disorder: what is it, lasts, classified, tx
- PTSD: what is it, sxs, tx
- emotional sxs that occur w/i 3 months of identifiable psychosocial stressor; lasts less than 6 months once stressor has ended; then classified as GAD; CBT, SSRI
- experience life threatening situation that causes hyper arousal, avoidance of stimuli, intrusive re-rexperiencing of event causing changes in cognition or mood; CBT, SSRI, venlafaxine
34
Cluster A personality disorders
- schizoid
- schizotypal
- voluntary social withdrawal, limited emotional expression, content w/ social isolation
- eccentric appearance, odd beliefs / magical thinking, interpersonal akwardness
35
Cluster B personality disorders
- antisocial
- borderline
- histrionic
- narcissistic
- disregard for rights of others w/ lack of remorse; involves criminality, impulsivity, hostility, manipulation
- unstable mood and interpersonal erlationships, fear of abandonment, impulsive, slef-mutilating, suicidal, sense of emotional emptiness
- attention seeking, dramatic speech and emotional expression, shallow and labile, sexually provocative
- grandiosity, sense of entitlement, lacks empathy and requires excessive admiration, often demands the best and reacts to criticism w/ rage or defensiveness, fragile self esteem
36
Cluster C personality disorders
- avoidant
- obsessive-compulsive
- dependent
- hypersensitive to rejection and criticism, socially inhibited, timid, feeling of inadequacy, desires relationships w/others
- preoccupation w/ order, perfectionism, and control, behvaior is consistent w/ ones own beliefs attitudes
- excessive need for support, low self confidence
37
Malingering
- what is it
- sxs
- sxs intentional and motivation is intentional
- pt consciously fakes, profoundly exaggerates, or claims to have a disorder in order to attain a specific secondary gain such as avoiding work or obtaining compensation
- poor compliance w/ tx or follow up of labs
38
Factitious Disorders
- difference from malingering
- imposed on self
- imposed on other
- sxs intentional but motivation is unconscious; pt created physical and/or psysch sxs in order to assume sick role and get medical attention and sympathy
- munchausen syndrome; factitous disoswe w/ hx of mult hospital admissions and willingness to undergo invasive procedures
- illness in child or elderly caused or fabricated by caregiver; motivation is to assume a sick role by proxy
39
Somatic Sxs and related disorder
- classification
- somatic sxs: what is it; tx
- conversion disorder: what is it
- illness anxiety disorder: other name, what is it
- sxs are unconscious, motivation is unconscious
- variety of body complaints lasting months to years, associated w/ excessive, persistent thoughts and anxiety about sxs; reg office visits w/ same physician in combo w/ psychotherapy
- loss of sensory or motor function following acute stressor
- hypochondriasis, preoccupation w/ acquiring or having serious illness, despite medical eval and reassurance
40
Eating disorder
- anorexia
- refeeding syndrome
- bulmia
- binge eating
- pica
- intense fear of weight gain, over-evaluate thinness and body image distortion -> calorie restriction and weight loss resulting in inappropriately low body weight; binge and purge type, restricting type
- occurs in significalty malnourished pts with sudden increase in calorie intake; food intake causes increase in insulin causes hypo-phosphatemia, kalemia, magnesmia -> cardiac complication, rhabdomyolysis, seizure
- recurring episodes of binge eating w/ compensatory purging behaviors at least weekly over 3 months; BMI normal or slightly over weight; psychotherapy, nutrition rehab, anti-depressants
- resurring episodes of binge eating w/o purging behaviors at leat weekly over last 3 months; psychotherapy, SSRI
- recurring episode of eating non-food substances over 1 month that are not culturally or developmentally recognized as normal; common in children or pregnancy; malnutrition, anemia, developmental disabilities, emotional trauma; psych therapy and nutritional rehab
41
Gender dysphoria
- what is it
- transgender
- transvestism
- significant incongruence between ones experienced gender and gender assigned at birth lasting > 6 mnths and leading to persistent distress
- desiring and making lifestyle changes to live as a different gender
- deriving pleasure from wearing clothes of opp sex
42
Sex dysfunction
- includes sex desire disorders (hypoactive, or sex aversion) , sex arousal disorder (ED), orgasmic disorder (anorgasmia, premature ejaculation), sex pain disorder (dyspareunia, vaginismus)
43
Sleep terror disorder
- periods of inconsolable terror w/ screming in middle of night
- children
- during slow wave/ deep non REM sleep w/ no memory of arousal episode
44
Enuresis
- what is it
- first line tx
- refractory cases
- urinary incontinence more than 2x a week for more than 3 months in person older than 5 years
- behavioral modification and positive reinforcement
- bed wetting, oral desmopressin
45
Narcolepsy
- what is it
- caused by
- tx
- excessive daytime sleepiness w/ recurrent episodes of rapid-onset, overwhelming sleepiness more than 3x a week for the last 3 months
- due to decrease in orexin production in lat hypothalamus and dysregulated sleep-wake cycles
- good sleep hygiene, daytime stimulants, and nightime sodium oxybate
46
Stage in overcoming addiction
- pre-contemplation: denying problem
- contemplation: acknowledges problem, but unwilling to change
- preparation/determination: preparing for behavioral changes
- action/willpower: changing behavior
- maintenance: maintaining behavior
- relapse
47
Psych emergencies
- serotonin syndrome
- hypertensive crisis
- neurleptic malignant syndrome
- delirium tremens
- acute dystonia
- lithium tox
- TCA tox
- caused by any drug that increase 5-HT; increase in activity (clonus, hyper relfaxia, tonia, tremor, seizure), autonomic instability (hyperthermia, diarrhea), altered mental status; cyproheptadine
- eating tyramine rich foods, hypertensive crisis, phentolamine
- antipsychotic and genetic predisposition; myoglobinuria, fever, encephalopathy, increase enzymes; dantrolene, dopamine agonist
- alcohol withdrawl - 2 to 4 days after last drink; altered mental status, hallucinations, autonomic hyperactivity, anxiety, seizure, tremor; benzos
- typical anti-convulsants; sudden onset of muscle spasms, stiffness, and/or oculogyric cirisis; benztropine or diphenhydamine
- high lithium dosage or decreased kidney elimination; nausea, vomitting, slurred speech, hyper-reflexia, seizures; discontinue lithium hydrate aggressively w/ isotonic NA Cl
- TCA overdose, resp depression, hyperpyrexia, prolonged QT; tuppostive tx, NaHCO3, activated charcoal
48
Depressive drugs
- alcohol: intoxication
- barbituates: intoxication, intoxication tx, withdrawal
- benzos: intoxication; withdrawal
- opioids: intoxication; intox tx; withdrawal
- emotional lability, decreased anxiety, sedation, behavioral dis-inhibition, resp depression
- resp depression; tx: sxs management; delirium and life threatening CV collapse
- ataxia, minor resp depression; flumazenil; sleep disturbances, depression
- euphoria, resp and CNS depression, decrease gag reflex, pupillary constriction; naloxone; sweating, dilated pupils, piloerection, rhinorrhea, lacrimation
49
Stimulant drugs
- amphetamine: intoxication, tx for intoxication
- caffeine: intoxication, withdrawal
- cocaine: intoxication, tx of intoxication
- nicotine: intoxication, withdrawal
- euphoria, grandiosity, pupillary dilation, prolonged wafefilness and attention, severe cardiac arrest, seizure; benzos
- restlessness, increased diuresis, muscle twitching; headache, difficulty concentrating, flu-like sxs
- impaired judgement, pupillary dilation, hallucination, paranoia, angina, sudden cardiac death; benzo
- restlessness; irritability, anxiety, restlessness, difficulty concentrating; nicotine patch, gum, lozenges
50
Hallucinogens
- Lysergic acid diethylamide
- marijuana: psych effect, physical effects, drug form - used for
- MDMA (ecstasy)
- Phenylcyclidine (PCP)
- perceptual distortion, depersonalization, anxiety, paranoia, psychosis, flashbacks
- euphoria, anxiety, paranoid delusion, perceptions of slowed time; increase appetite, dry mouth, conjunctiva injection, hallucinations; dronabinol - used as anti-emetic and appetite stimulant
- hallucinogenic stimulant; euphoria, disinhibition, hyper activity, distorted sensory and time perception, bruxism; life threatening effects include hypertension, tachycardia, hyperthermia, hyponatremia, serotonin syndrome
- violence, impulsivity, psychomotor agitation, nystagmus, tachycardia, hypertension, analgesia, psychosis, delirium, seizures
51
Wernicke-kosakoff syndrome
- deficiency
- encephalopathy
- syndrome
- associated w
- TX
- vit B1
- confusion, opthalmoplegia, ataxia
- memory loss, confabulation, personality change
- periventricular hemorrhage/ necrosis of mammillary bodies
- IV vitamin B1
52
Meds for psych conditions
- ADHD
- alcohol withdrawal
- bipolar
- bulimia
- depression
- generalized anxiety disorder
- OCD
- Panic disorder
- PTSD
- Schizophrenia
- Social anxiety disorder
- Tourettes
- stimulants
- benzos
- lithium, valproic acid, carbamazepine, lamotrigine
- SSRI
- SSRI
- SSRI, SNRI
- SSRI, venlafaxine
- SSRI, venlafaxine, benzo
- SSRI, venlafaxine
- atpical antipsychotics
- SSRI
- Antipsychotics
53
Central Nervous system stimulants
- examples
- MOA
- indications
- side effects
- methylphenidate, dextroamphetamine, methamphetamine, lisdexamfetamine
- increase catecholamines in synaptic cleft
- ADHD, narcolepsy, binge eating
- nervousness, anxiety, insomnia, anorexia
54
Typical antipscyhoctics
- examples
- MOA
- indications
- high potency
- low potency
- adverse effect: lipids, enodcrine, metabolic, anti-muscarinic, anti-histamine, alpha1 blockade, cardiac, opthalmologic, extra pyramidal
- haloperidol, pimozidem
- block D2 receptor
- schizophrenia, psychosis, bipolar disorder, delirium, tourette, huntington
- haloperidol, trifluoperazine
- cholorpromazine, thioridazine
- lipid soluble -> stored in body fat -> slow to be removed from body; dopamine antagonist -> increase in prolactin; dyslipidemia, weight gain, hyperglycemia; dry mouth, constipation; sedation; orthostatic hypotension; QT prolongation; corneal and retinal deposits; acute dystonia, restlessness, bradykinesia
55
Atypical antipsychotics
- examples
- MOA
- indications
- side effects
- asenapine, clozapine, olanzapine, quetiapine; iloperidone, paliperidone, risperidone
- Most are 5-HT and D2 antagoinst
- schizo, bipolar, OCD, anxiety, depression, mania, tourette
- prolonged QT
56
Lithium
- MOA
- indications
- side effects
- inhibits phosphoinositol
- mood stabilizer for bipolar
- tremor, thyroid abnormalities, polyuria, teratogens, ebstein anomaly
57
Buspirone
- MOA
- indication
- time length
- does not interact
- stimulates 5-HT A1 receptors
- generalized anxiety
- 1-2 wks
- with EtOH
58
SSRI
- examples
- MOA
- indications
- side effect
- fluoxetine, paroxetine, sertraline, escitalopram
- Inhibits 5-HT re-uptake
- depression, generalized anxiety, panic disorder, OCD
- serotonin syndrome, GI distress, SIADH, sex dysfunction
59
SNRI
- examples
- MOA
- indications
- side effect
- venlafaxine, duloxetine
- inhibits 5-HT and NE uptake
- depression, anxiety, diabetic neuropathy
- increase BP, stimulant effects, sedation, nausea
60
TCA
- examples
- MOA
- indications
- side effect
- amitriptyline, nortriptyline, imipramine
- inhibit 5-HT and NE uptake
- MDD, peripheral neuropathy, chronic pain, migrain prophylaxis
- sedation, alpha 1 blocker causing hypotension, convulsions, coma, cardiotoxicity
61
Monoamine Oxidase Inhibitors
- examples
- MOA
- indication
- side effect
- contraindicated
- tranylcypromine, phenelzine, isocarboxazid
- selective MAO inhibition -> increase levels of amine NT's
- atypical depression, anxiety, parkinsons
- CNS stimulation -> hypertensive crisis
- SSRI, TCA, St. John wort
62
Atypical antidepressants
- buproprion
- mirtazapine
- trazadone
- varenicline
- vilazodone
- vortioxetine
- inhibits NE and DA reuptake; used for smoking cessation; tox- stimulant effects, headache, seizure; favorable sex side effect profile
- alpha 2 antagonist; 5-HT antagonist; sedation, increase appetite, weight gain
- primarily blocks 5-HT, alpha 1 adrenergic, and H1 receptors; weakly inhibits 5-HT reuptake; used primarily for insomnia; sedation, nausea, postural hypertension
- nicotinic ACh receptor agonist; smoking cessation; sleep disturbance and depressed mood
- inhibits 5-HT reuptake; used for MDD; headache,, diarrhea, nausea, anti-cholinergic effects
- inhibit 5-HT reuptake; used for MDD; nausea, sex dysfunction, sleep disturbances, anti-cholinergic effects
63
Opioid withdrawal and detox
- methadone
- buprenorphine
- naloxone
- naltrexone
- long acting oral opiate; used for heroin detox or long term maintenance
- sublingual form used to prevent relapse
- short acting opioid antagonist given IM, IV, or a nasal spray to treat acute opioid overdose, particularly to reverse respiratory and CNS depression
- long acting oral opioid antagonist used after detox to prevent relapse
