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Psych review Flashcards

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1
Q

Whats important differentiate with MDD?

A

Differentiate between chronic depression and situational

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2
Q

T/F 80% of people who receive tx for depression, will improve

A

True

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3
Q

How long does SSRI take to work for MDD?

A

4-6 weeks to become fully effective but improve within the first week

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4
Q

T/F Antidepressants are non-habit forming

A

True

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5
Q

How long is the treatment?

A

4-9 months then graded discontinuation

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6
Q

What do you have to do for recurrent depression?

A

Continue medication indefinitely

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7
Q

What are the few anti-depressants?

A

SSRI
SNRI
TCA

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8
Q

What are the 1st line antidepressants?

A

SSRI and SNRI

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9
Q

What is MOA of SSRI

A

Selective serotonin reuptake inhibitors

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10
Q

What are examples of SSRI

A

Citalopram (Celexa), Escitalopram (Lexapro), Fluoxetine (Prozac), Paroxetine (Paxil), Sertraline (Zoloft

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11
Q

What is MOA for SNRI?

A

Serotonin-norepinephrine reuptake inhibitors

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12
Q

Examples of SNRI

A

Desvenlafaxine (Pristiq), Duloxetine (Cymbalta), Venlafaxine (Effexor)

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13
Q

Which one has more s/e, SSRI or SNRI

A

SNRI

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14
Q

Which one is useful for meloncholic depression

A

TCA - Amitriptyline

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15
Q

Why are TCA’s not 1st line?

A

lethal overdose, narrow therapeutic

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16
Q

TCA worse with sucidial idelation

A

True

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17
Q

What are examples of NDRI

A

Buproprion (Wellbutrin) Can be first-line

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18
Q

What is NDRI?

A

Norepinephrine-Dopamine Reuptake Inhibitor

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19
Q

What is MAOIs

A

MAOIs- Monoamine oxidase inhibitor

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20
Q

Can NDRI be 1st line?

A

yes but not choosen

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21
Q

What are examples of MAOIs

A

Isocarbozid (Marplan), Penelzine (Nardil)

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22
Q

What are other anti-depressants

A

Mirtazapine (Remeron), Trazodone (Desyrel) (concurrent insomnia/anxiety),

Aripiprazole (Abilify) and Quetiapine (Seroquel) – Resistant Depression

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23
Q

What is helpful for resistant depression?

A

Aripiprazole (Abilify) and Quetiapine (Seroquel) – Resistant Depression

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24
Q

What are indication for antidepressants

A

Depression
Anxiety
Chronic Pain
Premenstrual dysphoric disorder (PMDD)
Smoking cessation
Eating disorders

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25
How to choose MDD meds
Indication Cost Availability Drug interactions Patient age and gender
26
ADR SSRI
Act on seretonin: nausea, GI upset, Diarrhea, diminished sexual function (decreased interest, delayed orgasm, diminished arousal), headaches, weight gain
27
Whats a big s/e of SSRI
weight gain and sexual dysfx
28
T/F SSRI can be d/c suddenly
No, it can cause dizziness and paresthesia aka discontinuation syndrome
29
ADR for SNRI
Serotonergic adverse effects Noradrenergic effects: increased BP, increased heart rate CNS activation: insomnia, anxiety, agitation
30
TCA s/e
anticholinergic: dry mouth, constipation, urinary retention, blurred vision, confusion
31
T/F TCA d/c can cause cholinergic rebound and flu-like sx
TRUE
32
S/e for MAOI
Orthostatic hypotension and weight gain, highest rates of sexual effects
33
What should you caution with?
- Suicide attempts are common - Overdose is most common method (esp with TCAs) - Drug interaction
34
TCA can be lethal (T/F)
True
35
Managing SE's GI Distress: Sedation: Agitation and Insomnia: Sexual Dysfunction: Anxiety/Panic: Orthostatic HYPOTN: Weight gain:
GI Distress: Take after meals Sedation: Take at HS, most SSRIs are less sedating (Prozac) Agitation and Insomnia: Switch to a more sedating options (Remeron, Celexa, Effexor) Sexual Dysfunction: Less: Wellbutrin, Remeron, consider a PDE-5 Anxiety/Panic: Options include Paxil, Remeron, Effexor, TCAs (try to avoid BDZs) Orthostatic HYPOTN: hydration, education on mvt Weight gain: Less with Wellbutrin, Prozac, and Cymbalta
36
how should you d/c SSRI's?
Reduce over 4 weeks – slower if symptomatic
37
which d/c is worse? with SNRI or SSRI?
SNRI
38
T/F withdrawal is typically mild but still recommended
True
39
What are the OTC's proven for MDD?
St. John’s Wort and SAMe
40
What should St. John’s Wort and SAMe not be taking together?
serotonergic agent
41
St. John’s Wort is a potent inducer of ____?
CYP 450 ---> LOTS of interactions
42
what should you adj with medication therapy for MDD?
psychotherapy
43
when should you f/p after med initiation
4 weeks
44
T/F Schizophrenia can be treated, half of patients can be fully independent with aggressive treatment and compliance
TRUE
45
what is the average onset for schizophrenia
Men = late teen to early 20s Women = late 20's - 30's
46
T/F it is common for schizophrenia to be dx older than 40
False, more common in younger person
47
What are antipsychotics agents for?
- Reduce psychotic symptoms in schizophrenia, bipolar, psychotic depression, senile psychosis and drug-induced psychosis - Improve mood, reduce anxiety - Decrease sleep disorders
48
What are example of typical- first gen
- Chlorpromazine - Thiothixene - Haloperidol
49
When in holdol used?
High level of EPS, high potency, WIDELY USED Best used for acute, short-term symptom control
50
What are the s/e of typical?
- Dystonia- continuous spasm and muscle contractions - Akathisia- motor restlessness - Parkinsonism- irregular, jerky movements - Tardive dyskinesia- involuntary muscle movements in lower face and distal extremities - Bradykinesia-Slow movements - Tremors
51
Which one is the only typical for chronic but not used?
Chlorpromazine (Thorazine
52
What is first line for schizophrenia
Atypical esp Quetiapine
53
What are examples of atypical
- Quetiapine - Risperidone - Ziprasidone - Paliperidone - Aripiprazole
54
What are the s/e for: - Quetiapine - Risperidone - Ziprasidone
- Quetiapine --> weight gain - Risperidone --> less ESP, wt gain - Ziprasidone --> less wt gain, CVD and prolonged QT
55
When is clozapin used for schizophrenia ?
severe risk of neutropenia; reserved for refractory pts
56
When is Olanzapine (Zyprexa) used?
commonly prescribed; guidelines do not recommend as a first line agent
57
What is drug of choice for schizophrenia?
Atypical but look at: Adverse effects and efficacy Comorbities Cost
58
What is the dosage schedule for schizophrenia
- Divided daily doses - Titration to effective dose - Low end of dose should be tried for several weeks - After the effective daily dose has been discovered dose can be given once daily (typically at night) Simplification= > compliance
59
What are the acute options for schizophrenia?
Zyprexa – IM/ODT Haldol – IV Benzo’s
60
How long should pt be on schizophrenia for/
least 6–8 weeks at a therapeutic dose.
61
What are big S/e for schizophrenia?
Weight gain, hyperglycemia, diabetes mellitus, and hyperlipidemnia, hyperglycemia, ketoacidosis, coma, and death have been reported with SGA.
62
Whats important to distinguish in schizophrenia?
distinguish between drug-induced psychosis and schizophrenia
63
What should you do with new onset of schizophrenia
Admit
64
To evaluate a pt completely, what should you do
antipsychotic
65
what is first line for Schizophrenia?
SGA
66
What the goal for acute alcohol withdrawal?
Prevent progression to delirium tremens - AMS, onset 3-10 days post, lasts 2-3 days
67
What are we trying to prevent with alcohol withdrawal?
Seizures
68
What should you do with labs with alcohol withdrawl?
potassium and magnesium
69
What should we ppx and why for alcohol withdrawal?
prophylaxis w/ thiamine to prevent Wernicke’s encephalopathy
70
What should the long term tx be for alcohol withdrawal?
- Enroll pt in program - Work up for potential liver dz - Tx/manage other comorbidities
70
What should the long term tx be for alcohol withdrawal?
- Enroll pt in program - Work up for potential liver dz - Tx/manage other comorbidities
71
Whats the 1st line alcohol withdrawl?
Barbiturates - Phenobarbital
72
T/F Barbiturates is Becoming the treatment of choice for alcohol withdrawal and withdrawal seizures
True
73
What can be adj for alcohol withdrawal?
Benzos, helpful for actively seizing
74
T/F All benzodiazepines appear equally efficacious in reducing signs and symptoms of withdrawal
True
75
What is dosing for barbs based on?
CIWA and SEWS scoring
76
What is long acting benzos?
diazepam & chloradiazepoxide
77
What is diazepam used for?
preventing withdrawal seizures and symptom control
78
what required for long acting benzo's
Clinical monitoring is required – increased toxicity risk – metabolized by the liver
79
Why is chloradiazepoxide (Librium) better?
?
80
What is short acting benzo's?
lorazepam and oxazepam
81
What are pros of short acting benzo's
less affected by liver dysfunction and have fewer residual sedative effects
82
T/F All benzo’s used for acute alcohol withdrawal should be front-loaded
True
83
What are other option addition for alcohol withdrawal?
Agonists (Clonidine) can be safely added to this patient’s acute treatment regimen. It has been shown to decrease symptoms in patients experiencing mild-to-moderate alcohol withdrawal. In the short term, it should also help lower the patient’s BP and heart
84
What should alcohol withdrawal be supplement with?
Thiamine Folate
85
Do you need to taper thiamine?
Yes, - home taper for 3 days
86
When is seizure risk highest for alcohol risk?
6-72 hrs
87
Can you give benzo's for home alcohol withdrawul?
no, better option is librium
88
What are some of the cessation medication for AW?
Disulfiram
89
What should you never do with disulfiram?
NEVER GIVE TO SOMEONE WHO IS INTOXICATED
90
when can you discharge AW pt?
hemodynamically stable definitive f/up Resources
91
Review slide 40!!
92
what are some of the lifestyle approach for insomnia?
- Stimulus Control --> avoid alcohol, caffeine - Environment --> dark room, quiet, decrease pre-sleep activity - Behavioral therapy --> sleep hygiene, sleep restriction therapy, relaxation, CBT
93
What are some dietary supplements that might help for insomnia?
Tryptophan (Turkey) Melatonin Valerian Root Kava-Kava Passion flower Skullcap Lavender Hops
94
What are top foods with tryptophan?
See slide 42
95
What are OTC meds?
Many are antihistamine or anticholinergic agents Benadryl, Tylenol PM, Sleep-Eze, doxylamine (Unisom)
96
What are some of the s/e of OTC sleep?
vivid dreams and next day “hang over”
97
What is unisom helpful?
N/V for pregnancy
98
What is antidepressants for insomnia?
Doxepin and trazodone
99
What are benzos for insomnia?
lorazepam, clonazepam, alprazolam (NOT A GOOD DAILY MED)
100
What are non-benzo's for insomnia?
zolpidem (ambien), Eszopiclone (lunesta)
101
What class is benzo's in pregnancy?
X!!
102
What are the MOA for benzo's/non-benzos insomnia?
Act on GABA receptors
103
What is insomnia med safe in pregnancy?
Doxylamine in pregnancy Ambien also safe

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