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Flashcards in Psych Treatment Deck (73):
1

Treatment for ADHD

- Stimulants (methylphenidate)
- CBT
- Alternatives: atomoxetine, guanfacine, clonidine

2

Rett Syndrome

- X-linked dominant
- Girls, age 1-4
- REGRESSION - loss of development, loss of verbal abilities, intellectual disability, ataia, stereotyped HAND-WRINGING

3

Treatment for Conduct Disorder
- Violating basic rights of others or societal norms (aggression, destruction, theft)

CBT
- Antisocial personality disorder

4

Treatment for Oppositional Defiant Disorder
- Hostile to authority figures

CBT

5

Treatment for Separation Anxiety Disorder

CBT
Play therapy
Family therapy

6

Treatment for Tourette Syndrome

Psychoeducation and behavioral therapy
For intractable/distressing tics: high-potency antipsychotics (fluphenazine, pimozide), tetrabenazine, guanfacine, clonidine

7

Treatment for Delirium?

Treat underlying condition
Haloperidol used as needed
Benzodiazepines for alcohol withdrawal

8

Treatment for schizophrenia?

Atypical antipsychotics (Risperidone)

9

Treatment for bipolar?

Mood stabilizers (lithium, valproic acid, carbamazepine)
Atypical antipsychotics
AVOID ANTIDEPRESSANTS (can precipitate mania)

10

Treatment for depression?

CBT and SSRIs are first line
SNRIs, mirtazapine, buproprion can also be considered
ECT in select patients

11

Treatment for depression with atypical features?

CBT and SSRIs are first line
MAOi are effective but have lots of AE

12

Treatment for postpartum blues?

Supportive
Follow-up to assess for postpartum depression

13

Treatment for postpartum depression?

CBTs and SSRIs

14

Treatment for postpartum psychosis?

Hospitalization and initiation of atypical antipsychotic
ECT may be used

15

Treatment for panic disorder?

CBT, SSRIs, venlafaxine are first line
Benzodiazepines for acute attack

16

Treatment for specific phobia?

Systemic desensitization

17

Treatment for social anxiety disorder?

CBTs, SSRIs, and venlafaxine are first line
Benzodiazepine or Beta-blocker for occasional anxiety-inducing situations

18

Treatment for agoraphobia?

CBT, SSRIs, MAOi

19

Treatment for generalized anxiety disorder?

CBT, SSRIs, SNRIs are first line
Buspirone, TCAs, benzodiazepines are 2nd line

20

Treatment for adjustment disorder?

CBT, SSRIs

21

Treatment or OCD?

CBT, SSRIs, clomipramine

22

Treatment for body dysmorphic disorder?

CBT

23

Treatment for PTSD?

CBT,SSRIs, venlafaxine

24

Treatment for acute stress disorder?

CBT, pharmacotherapy not indicated

25

Treatment for anorexia nervosa?

Psychotherapy and nutritional rehabilitation are first line
- Watch out for Refeeding Syndrome (increased insulin --> hypophosphatemia --> cardiac complications)

26

Treatment for bulimia nervosa?

Psychotherapy, nutritional rehabilitation, antidepressants

27

Treatment for binge eating disorder?

Psychotherapy (CBT) is first line, SSRIs

28

Treatment for narcolepsy?

Daytime stimulants (amphetamines, modafinil) and nightime sodium oxybate (GHB)

29

Methadone

- Heroin detox or long-term maintenance
- Long-acting oral opiate

30

Naloxone + Buprenorphine

- Antagonist + partial agonist
- Naloxone is not orally bioavailable, so withdrawal sx occur if injected (lower abuse potential)
- QUICK

31

Naltrexone

- Long acting opioid antagonist
- Use for relapse prevention once detoxified

32

Treatment for alcoholism?

- Disulfiram (abstain from alcohol use)
- Acamprosate, naltrexone, supportive care
- Alcoholics Anonymous

33

Treatment for Wernicke-Korsakoff?

IV Vitamin B1

34

Treatment for alcohol withdrawal?

Benzos (chlordiazepoxide, lorazepam, diazepam)

35

Methylphenidate
Dextroamphetamine
Methamphetamine

- Increases catecholamines in synaptic cleft (especially NE and DA)
- ADHD, narcolepsy, appetite control

36

Antipsychotics (ZINE)
- Haloperidol
- Trifluoperazine
- Fluphenazine
- Thioridazine
- Chlorpromazine

- MOA: block D2 R --> increase cAMP
- Use: schizophrenia (+ sx), psychosis, bipolar, derlirium, Tourette syndrome, Huntington DZ, OCD
-

37

High Potency Antipsychotics

- Trifluoperazine, Fluphenazine, Haloperidol
- Neuro AE (extrapyramidal sx)

38

Low Potency Antipsychotics

- Chlorpromazine, Thioridazine
- Non-neuro AE (anticholinergic, antihistamine, alpha1-blockade effects)
- SEDATION, orthostatic hypotension

39

Chlorpromazine AE

Corneal deposits

40

Thioridazine AE

Retinal depositis

41

Haloperidol AE

Neuroleptic malignant syndrome, tardive dyskinesia

42

Neuroleptic Malignant Syndrome

Rigidity, myoglobinuria, autonomic instability, hyperpyrexia
- Rx: dantrolene, D2 agonists (bromocriptine)

43

Tardive Dyskinesia

Orofacial chorea as result of long-term antipsychotic use

44

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

45

Onset of EPS

- Hrs-days: ACUTE DYSTONIA (muscle spasm, stiffnes, oculogyric crisis)
- Days-mo: AKATHISIA (restlessness) and PARKINSONISM (bradykinesia)
- Mo-yrs: TARDIVE DYSKINESIA

46

Atypical Antipsychotics
- Ariprazole
- Aenapine
- Clozapine
- Iloperidone
- Lurasidone
- Olanzapine
- Paliperidone
- Quetiapine
- Risperidone
- Ziprasidone

- 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

47

Ariprazole MOA

D2 partial agonist

48

"Pines" AE
- Cloazpine, Asenapine, Olanzapine, Quetiapine

Metabolic syndrome - weight gain, diabetes, hyperlipidemia
- Check fasting glucose and lipid panel at checkups
- Olanzapine = obesity

49

Clozapine AE

Agranulocytosis (monitor WBC weekly)

50

Risperidone AE

Hyperprolactinemia (amenorrhea, galactorrhea, gynecomastia)

51

Lithium

- Use: bipolar (blocks relapse and acute manic events)
- AE: tremor, hypothyroidism (GOITER), polyuria (NEPHROGENIC DI), teratogenesis
- Narrow TI

52

What congenital birth defect does lithium cause?

- Ebstein anomaly

53

What drug is implicated in lithium toxicity in bipolar patients?

THIAZIDE USE

54

Buspirone

- 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

55

Benefits to buspirone?

NO ABUSE POTENTIAL
NO SEXUAL DYSFUNCTION

56

SSRIs
- Fluoxetine
- Paroxetine
- Sertraline
- Citalopram

- 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)

57

SNRIs
- Venlafaxine
- Desvenlafaxine
- Duloxetine
- Levomilnacipran
- Milnacipran

- MOA: Inhibit 5-HT and NE reuptake
- Use: depression, GAD, diabetic neuropathy
- AE: HTN most comon

58

Uses for venlafaxine?

Social anxiety disorder, panic disorder, PTSD, OCD

59

Serotonin Syndrome

- Can occur with any drug that increases 5HT (MAOi, SNRIs, TCAs)
- Neuromuscular activity (clonus, hyperreflexia, hypertonia, tremor, seizure)
- Autnomic stimulation (hyperthermia, diaphoresis, diarrhea)
- Agitation

60

Treatment for serotonin syndrome?

CYPROHEPTADINE (5-HT2 R antagonist)

61

TCAs
- Amitriptyline
-Noritriptyline
- Imipramine
- Desipramine
- Clomipramine
- Doxepin
- Amoxapine

- 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

62

Which TCA is used for OCD?

Clomipramine

63

TCA OD?

- Convulsions, coma, cardiotoxicity (arrythmia due to NA+ CHANNEL INHIBITION), respiratory depression, hyperpyrexia
- Confusion and hallucinations in elderly
- Rx: NaHCO3 (prevents arrhythmia)

64

Which TCA has least amount of AE?

Nortriptyline

65

MOAi
- Tranylcypromine
- Phenelzine
- Isocarboxazid
- 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

66

Which MAOi is selective for MAO-B?

Selegiline

67

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

68

Buproprion

- MOA: increase NE and DA
- Use: depression, smoking cessation
- AE: stimulant (tachy, insomnia), HA, seizure in ANOREXIA/BULIMIC
- NO SEXUAL AE

69

What particular patient is Buproprion good for?

- Depression w/ increased sleep and decreased energy + smoker

70

What particular patient is Buproprion bad for?

Anorexic/bulimic

71

Mirtazapine

- 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

72

Trazodone

- MOA: blocks 5-HT2, alpha1-adrenergic, and H1 R, weakly inhibits 5HT reuptake
- Use: insomnia
- AE: sedation, nausea, PRIAPISM, postural hypotension

73

Varenicline

- MOA: nicotinic ACh R partial agonist
- Use: smoking cessation
- AE: sleep disturbance