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Pysch med review Flashcards

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1
Q

In psych what is the most imp question?

A
  • Family hx bc family disposition so make sure to cover that
  • Gather all the sx; sleeping eating
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2
Q

Ask about how to ask certain questions

A

suicidal; duration, freq

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3
Q

Whats likert scale?

A

0-10, 10 being the worse, how is your depression? Helps with mild, moderate, severe intensity.

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4
Q

What are other important things you can asses?

A
  • Chronic – breakthrough sxs?
  • How long on current med?
  • Were meds initially helpful?
  • New stressors?
  • H/o previous psychotropics?
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5
Q

What are different types of non-drug therapy?

A

CBT, DBT, mindfulness
In fact, sleep therapy is first line for those who have issues with sleep - CBTi

DBT - helps recognize triggers and also escalation and bring them down

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6
Q

What is social question you should ask?

A
  • Substances
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7
Q

Can you order a UA?

A

yes! helps with management

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8
Q

What are some screenings

A

PHQ9
GAD 7
MDQ — may gain insight for mood d/o esp if strong FHx of BMD
Epworth Sleepiness Scale
Borderline personality screen
Likert scale

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9
Q

when you start a meds, how long does it take to be clinically effective?

A

1-3 months

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10
Q

Whats going on the 1st month?

A

changing the dose, finding the right dose

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11
Q

How long is maintenance phase?

A

6-9 months

About 12month journey

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12
Q

Whats the only med for short duration of sx?

A

Wellbutrin, on 5-6 months year and then off

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13
Q

T/F If chronic pt, you can challenge dose.

A

True

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14
Q

T/F you can add adjunctive

A

True

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15
Q

Whats the top 3 SSRI for our guest lecture?

A
  • lexapro
  • zoloft (s/e diarrhea)
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16
Q

How to begin?

A

1st line - SSRI

Challenge and two fail before moving along

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17
Q

Sx for serotionin syndrome

A
  • N/D, restlessness, confusion, tachy, HBP, sweating
  • Dilated pupils**
  • Loss of muscle coordination or twitching muscles.
  • Muscle rigidity
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18
Q

What are two s/e for psych meds

A
  • serotonin syndrome
  • SJS
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19
Q

What meds give possible rash?

A

lamictol

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20
Q

Whats the two 3 SSRI?

A
  • Zoloft
  • Prozac
  • Lexapro
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21
Q

How long does it take for zoloft to work?

A

3 weeks

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22
Q

Whats zoloft used for mainly?

A

anxiety, depression, OCD, irritability

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23
Q

What are the s/e of zoloft?

A

GI disturbance, reflux, somnolence, libido

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24
Q

When does prozac work?

A

4 weeks

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25
Whats prozac used for?
Profiled for anxiety, depression, OCD, motivation
26
Whats the s/e for prozac?
Anorexia, activating, libido
27
How long does it take for lexapro to work?
3 weeks
28
when is lexapro used for?
anxiety, depression
29
Which meds is the most serotonergic (zoloft, prozac, lexapro)?
lexapro
30
which drug would you want to get EKG?
Celexa
31
What happens if you fail SSRI?
Go to SNRI, takes awhile to ramp up. Created for neuropathic pain
32
What are the three SNRI?
- Cymbalta - Pristiq - Effexor
33
How long does it take for SNRI to work?
about 4 weeks
34
What is SNRI used for?
pain, anxiety, depression
35
Whats the s/e of cymbalta?
lots of GI disturbance, somnolence, libido, W/D syndrome
36
Whats the s/e for pristiq?
Pretty well tolerated as no metabolism in liver so lower risk of DDI Libido, W/D syndrome
37
Whats the s/e for effexor
Libido, WICKED W/D SYNDROME
38
Adding sleep meds?
- Start with one med - Sleep hygiene, structure,
39
T/F Don't compound your medication, pick a class and stick to it
True, one drug from one class
40
How to start SSRI
- Start low and go slow - 5-7 days
41
Example of starting zoloft
- start 25mg - Give them grace period, 5-7 days - See how they are doing - Advance to 50mg
42
Example of starting cymbalta, if pt has severe depression?
Start to 30, rather than 20 but always 14 days to start working
43
for SNRI, how many days do you give to adjust?
14 days
44
How many days do you give for anti-psychotics to adjust?
3 days
45
What are the more common s/e?
GI issues, N, HAs, dizziness, sedation
46
What are the other s/e?
Sexual SE Appetite changes - anorexia Affect changes – blunted, flat
47
What labs do you need to order?
lipids and A1c - imp with SSRI - Thyroid, kidneys, liver fxn, lipids, A1c, electrolyte imbalances
48
What Iatrogenic you should look out for?
Weight gain Cardiac implications – QT prolongation Serotonin syndrome TD**EPS**
49
Whats akathisa?
Restlessness ---> TD --> EPS
50
Crossing
decrease one and increase one for each med but give them 3 days for each change
51
Whats Buspar for?
Anti-anxiety, long term, BID, start low
52
Whats the s/e for buspar?
Dizziness
53
Whats wellbutrin for?
Motivation, sexual s/e
54
Whats wellbutrin s/e?
↑ anxiety, lowers sz threshold
55
When to use abilify?
Super charger for mood lability/emotional reactivity
56
What labs should you order with abilify?
A1c and lipids
57
What is lithium for?
SI and depression
58
If lithium is >600mg, what labs should you order?
lithium lvl, TSH, CMP
59
Whats lamictal used for?
emotional reactivity, boderline, roller coaster "seal them up"
60
Whats the important lamictal s/e?
Rash! go to the ED
61
What labs should you order for lamictal?
A1c and lipids
62
what should you do for ADHD?
Screen appropriately, Do Neuro-psych testing
63
what are non-pharm approach for ADHD?
Executive functioning coaching Neurofeedback
64
What should you do if h/o of addiction?
Check your PDMP!!
65
Whats are example of non-stimulants?
- Strattera - Guanfacine/Intuniv

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