Flashcards in Psych Treatment Deck (73):
Treatment for ADHD
- Stimulants (methylphenidate)
- Alternatives: atomoxetine, guanfacine, clonidine
- X-linked dominant
- Girls, age 1-4
- REGRESSION - loss of development, loss of verbal abilities, intellectual disability, ataia, stereotyped HAND-WRINGING
Treatment for Conduct Disorder
- Violating basic rights of others or societal norms (aggression, destruction, theft)
- Antisocial personality disorder
Treatment for Oppositional Defiant Disorder
- Hostile to authority figures
Treatment for Separation Anxiety Disorder
Treatment for Tourette Syndrome
Psychoeducation and behavioral therapy
For intractable/distressing tics: high-potency antipsychotics (fluphenazine, pimozide), tetrabenazine, guanfacine, clonidine
Treatment for Delirium?
Treat underlying condition
Haloperidol used as needed
Benzodiazepines for alcohol withdrawal
Treatment for schizophrenia?
Atypical antipsychotics (Risperidone)
Treatment for bipolar?
Mood stabilizers (lithium, valproic acid, carbamazepine)
AVOID ANTIDEPRESSANTS (can precipitate mania)
Treatment for depression?
CBT and SSRIs are first line
SNRIs, mirtazapine, buproprion can also be considered
ECT in select patients
Treatment for depression with atypical features?
CBT and SSRIs are first line
MAOi are effective but have lots of AE
Treatment for postpartum blues?
Follow-up to assess for postpartum depression
Treatment for postpartum depression?
CBTs and SSRIs
Treatment for postpartum psychosis?
Hospitalization and initiation of atypical antipsychotic
ECT may be used
Treatment for panic disorder?
CBT, SSRIs, venlafaxine are first line
Benzodiazepines for acute attack
Treatment for specific phobia?
Treatment for social anxiety disorder?
CBTs, SSRIs, and venlafaxine are first line
Benzodiazepine or Beta-blocker for occasional anxiety-inducing situations
Treatment for agoraphobia?
CBT, SSRIs, MAOi
Treatment for generalized anxiety disorder?
CBT, SSRIs, SNRIs are first line
Buspirone, TCAs, benzodiazepines are 2nd line
Treatment for adjustment disorder?
Treatment or OCD?
CBT, SSRIs, clomipramine
Treatment for body dysmorphic disorder?
Treatment for PTSD?
Treatment for acute stress disorder?
CBT, pharmacotherapy not indicated
Treatment for anorexia nervosa?
Psychotherapy and nutritional rehabilitation are first line
- Watch out for Refeeding Syndrome (increased insulin --> hypophosphatemia --> cardiac complications)
Treatment for bulimia nervosa?
Psychotherapy, nutritional rehabilitation, antidepressants
Treatment for binge eating disorder?
Psychotherapy (CBT) is first line, SSRIs
Treatment for narcolepsy?
Daytime stimulants (amphetamines, modafinil) and nightime sodium oxybate (GHB)
- Heroin detox or long-term maintenance
- Long-acting oral opiate
Naloxone + Buprenorphine
- Antagonist + partial agonist
- Naloxone is not orally bioavailable, so withdrawal sx occur if injected (lower abuse potential)
- Long acting opioid antagonist
- Use for relapse prevention once detoxified
Treatment for alcoholism?
- Disulfiram (abstain from alcohol use)
- Acamprosate, naltrexone, supportive care
- Alcoholics Anonymous
Treatment for Wernicke-Korsakoff?
IV Vitamin B1
Treatment for alcohol withdrawal?
Benzos (chlordiazepoxide, lorazepam, diazepam)
- Increases catecholamines in synaptic cleft (especially NE and DA)
- ADHD, narcolepsy, appetite control
- MOA: block D2 R --> increase cAMP
- Use: schizophrenia (+ sx), psychosis, bipolar, derlirium, Tourette syndrome, Huntington DZ, OCD
High Potency Antipsychotics
- Trifluoperazine, Fluphenazine, Haloperidol
- Neuro AE (extrapyramidal sx)
Low Potency Antipsychotics
- Chlorpromazine, Thioridazine
- Non-neuro AE (anticholinergic, antihistamine, alpha1-blockade effects)
- SEDATION, orthostatic hypotension
Neuroleptic malignant syndrome, tardive dyskinesia
Neuroleptic Malignant Syndrome
Rigidity, myoglobinuria, autonomic instability, hyperpyrexia
- Rx: dantrolene, D2 agonists (bromocriptine)
Orofacial chorea as result of long-term antipsychotic use
General Antipsychotic AE
- Highly lipid soluble and stored in body fat --> slow to be removed from body
- Extrapyramidal systemi AE (dyskinesias) --> Rx: benztropine, diphenhydramine, benzos
- Endocrine AE due to DA R antagonistm --> hyperprolactinemia --> galactorrhea, oligomenorrhea, gynecomastia
- AE arising from blocking muscarinic (dry mouth, constipation), alpha1 (orthostatic hypotension), and HA (sedation) R
- Cause QT prolongation
Onset of EPS
- Hrs-days: ACUTE DYSTONIA (muscle spasm, stiffnes, oculogyric crisis)
- Days-mo: AKATHISIA (restlessness) and PARKINSONISM (bradykinesia)
- Mo-yrs: TARDIVE DYSKINESIA
- MOA: most are D2 antagonists with varied effects on 5-HT2, DA, alpha, and H1 R
- Use: schizophrenia (+ and - sx), bipolar, OCD, anxiety disorder, depression, mania, Tourettes
- AE: prolonged QT
- FEWER EPS AND ANTICHOLINERGIC AE THAN TYPICAL ANTIPSYCHOTICS
D2 partial agonist
- Cloazpine, Asenapine, Olanzapine, Quetiapine
Metabolic syndrome - weight gain, diabetes, hyperlipidemia
- Check fasting glucose and lipid panel at checkups
- Olanzapine = obesity
Agranulocytosis (monitor WBC weekly)
Hyperprolactinemia (amenorrhea, galactorrhea, gynecomastia)
- Use: bipolar (blocks relapse and acute manic events)
- AE: tremor, hypothyroidism (GOITER), polyuria (NEPHROGENIC DI), teratogenesis
- Narrow TI
What congenital birth defect does lithium cause?
- Ebstein anomaly
What drug is implicated in lithium toxicity in bipolar patients?
- MOA: stimulates 5-HT1A R
- Use: GAD
- Does not cause sedation, addiction, or tolerance
- Takes 1-2 weeks to take affect
- Does not interact with alcohol
Benefits to buspirone?
NO ABUSE POTENTIAL
NO SEXUAL DYSFUNCTION
- MOA: 5-HT specific reuptake inhibitors
- Use: depression, GAD, panic disorder, OCD, bulimia, social anxiety disorder, PTSD, premature ejaculation, premenstrual dysmorphic disorder
- Takes 4-8 weeks to have an effect
- AE: fewer than TCAs - GI distress, SIADH, SEXUAL DYSFUNCTION (anorgasmia, decreased libido)
- MOA: Inhibit 5-HT and NE reuptake
- Use: depression, GAD, diabetic neuropathy
- AE: HTN most comon
Uses for venlafaxine?
Social anxiety disorder, panic disorder, PTSD, OCD
- Can occur with any drug that increases 5HT (MAOi, SNRIs, TCAs)
- Neuromuscular activity (clonus, hyperreflexia, hypertonia, tremor, seizure)
- Autnomic stimulation (hyperthermia, diaphoresis, diarrhea)
Treatment for serotonin syndrome?
CYPROHEPTADINE (5-HT2 R antagonist)
- MOA: block reuptake of NE and 5HT
- Use: major depression (persistent, recurring), peripheral neuropathy, chronic pain, migraine prophylaxis
- AE: sedation, alpha1-blocking effects (postural hypotension, atropine-like AE - tachy, urinary retention, dry mouth), can prolong QT
Which TCA is used for OCD?
- Convulsions, coma, cardiotoxicity (arrythmia due to NA+ CHANNEL INHIBITION), respiratory depression, hyperpyrexia
- Confusion and hallucinations in elderly
- Rx: NaHCO3 (prevents arrhythmia)
Which TCA has least amount of AE?
- Selegiline (selective MAO-B)
- MOA: MAO inhibition --> increase amine NT (NE, 5-HT, DA)
- Use: atypical depression, anxiety
- AE: HTN crisis (w/ tyramine), CNS stimulation
Which MAOi is selective for MAO-B?
What drugs are contraindicated with MAOi use?
SSRIs, TCAs, St. John's wort, meperidine, dextromethorphan
- To prevent serotonin syndrome
- Wait two weeks after stopping MAOi before starting 5-HT drugs or stopping dietary restrictions
- MOA: increase NE and DA
- Use: depression, smoking cessation
- AE: stimulant (tachy, insomnia), HA, seizure in ANOREXIA/BULIMIC
- NO SEXUAL AE
What particular patient is Buproprion good for?
- Depression w/ increased sleep and decreased energy + smoker
What particular patient is Buproprion bad for?
- MOA: alpha2-antagonist (increases release of NE and 5-HT), 5-HT2 and 3 R antagonist, H1 antagonist
- Use: depression
- AE: sedation (desirable if they have insomnia), increased appetite/weight gain (desirable in elderly/anorexic), dry mouth
- MOA: blocks 5-HT2, alpha1-adrenergic, and H1 R, weakly inhibits 5HT reuptake
- Use: insomnia
- AE: sedation, nausea, PRIAPISM, postural hypotension