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Flashcards in Test 3 Deck (36):
1

Why is it important to do a thorough medication history with your patients?

-Medications could cause psychiatric symptoms
-Could lead to allergic reaction, could interact with OTC meds
-Failing to do so could lead the prescribing person to increase the dose of the medication that is responsible for the side effects.
-Unwarranted/inaccurate diagnoses could be made.
-Unnecessary medications could be added.

2

How do you differentiate antidepressant toxicity from reemerging/worsening depression?

- asses for physiologic symptoms; tachycardia, drowsiness, dry mouth, nausea, vomiting, urinary retention, headache, hallucinations, seizures, monitor antidepreseent blood levels
--irritability
-confusion
-memory impairment
- anxiety
-agitation
-lethargy

3

What are some pharmacologic treatment considerations for children and adolescents?

-metabolism: high in children, teens similar to adults
-research limitations: lack of control on studies on children, fda mandated safety studies for child subjects
- fears regarding drug addiction, only 2 classes with risk, stimulants, and benzodiazepines

4

What are treatment considerations for ADHD?

-abuse risk low
-best to administer meds each day
-start with immediate release then extended release
-stimulant wears off, co administer antidepressants later in the day
-may require ongoing medication into adolscence and adulthood
-adverse consequences if misdiagnosed
-side effects: insomnia, anorexia, stomach ache, mild dysphoria

5

what are treatment considerations for pregnant women and what risks to the baby are there/

-risk factors associated with meds during pregnancy
- teratogenesis, malformations of fetus
-drugg effects on developing fetus
-drug effects on labor and delivery
-behavioral tertogensis on child
-pregnancy induced changes in drug actions
-drug effects on the breast fed child

6

What are some treatment considerations for geriatric patients/

-adjust dosage
- recognize response to SE promptly
-consider disgnosis and target symptoms
-get complete medication hx
-age specific pharmacology
-they have multiple medications
-higher risk for drug induced psychiatric symptoms

7

What is the difference from akathisitia vs agitation associated with worsening anxiety or psychosis?

-if symptoms go away with anticholingerics its akathisia, if not then ad additional neuroleptic

8

What can antidepressant toxicity look like?

-irritability
-confusion
-memory impairment
- anxiety
-agitation
-lethargy
-can be physiologic symptoms of antidepressant toxicity (tachycardia, drowsiness, dry mouth, nausea, vomiting, urinary retention, headache, hallucinations, seizures) and monitor antidepressant blood levels

9

What can akathisia look like?

-mild can look like increasing anxiety
-severe can look like psychosis

10

What can anticholinergic delirium look like?

-dry mucous membranes, increased heart rate, dilated pupils
-confusion, disorientation
-tactile or visual hallucinations
-consider recovery afteer discontinuation

11

What are the stimulant classes to treat ADHD?
Many Dogs Ate Lizards

-methyphenidate: ritalin
-dextroamphetamine: dexedrine
-amphetamines: adderall
-lisdezamphetamine: vyvanse

12

What are treatment considerations for borderline?

- treatment with antianxiety medication is risky, risk of abuse and increases suicidality
-wellbutrin increases psychosis in pre psychosis individuals
-use medications with low degree of toxicity, because high risk of suicidaliy
-most have comorbid disorders
-no medication but you can treat the target symptoms

13

What states do psychotropic medications target when treating substance related disorders?

-delusional disorder
-hallucinations

14

What are core symptoms/ defining features of borderline personality disorder

-generalized ego impairment: ego functioning, insight, self esteem, compassion, empathy, integration, moral development
-chronic emotional instability
-chaotic interpersonal relations
-feelings of emptiness
impaired sense of self
low frustration tolerance
impulsivity
primitive defeses
irritability and anger control problems

15

What are reasons for medication non-adherence?

-the length of time required for clinical improvement
-adverse side effects
-missing dose, too many
-fears and worries about adverse effects such as addiction, dependence, withdrawal
-financial concerns
-psychological dynamics, feeling out of control, biological focus, secondary gains, defeating the doctor, overwhelm, negative stigma, messages from loved ones

16

What are the lengths of time to taper off medication during discontinuation?

-weeks or months, depends on the medication and length of time it has been taken

17

What factors influence the schedule/timing to taper off of medication?

-medication class
-dosage form
-half life
-length of time it has been

18

Opiates information?

-Specific opiate receptors and endogenous opioids (enkephalins and endorphins)
Pleasure and pain
-Opioids:
Morphine, heroin, Darvon (propoxyphene), methadone, Demerol (meperidine), Talwin (pentazocine), Dilaudid (hydromorphone), Percodan/Oxycontin (oxycodone), Vicodin/ Damason-P (hydrocodone), and codeine

19

Discontinuation of hypnotics?

-potentially habit forming
-produce tolerance and dependence
-taper off by skipping days : every other day, every 3 days...
-resolve in apprx 2 weeks
discontinuation symptoms: dysphoria, rebound insomnia, withdrawal symtpoms

20

What are some risks of OTC medications?

-they may not contain all listed ingredients
-may contain impurities, lead, mercury
-adverse reactions
-side effects on liver and metabolism
-70% dont inform their doctor
-chronic pain, anxiety, insomnia, depression, fatigue, memory problems
-not covered by insurance and may cost a lot

21

General Facts about OTC and herbal products?

-they aren't FDA approved and can claim use in non disease conditions, but cannot advertise that they treat or prevent diseases
-yohimbine and kava kava may increase psych symptoms and be dangerous

22

What conditions do OTC products treat?

-saint johns wort- depression
-SAM-e: depression
-omega-3 fatty acids: mood disorders
folic acid: mood disorders
-meatonin: sleep disturbance
-gingko-biloba: cognitive impairment

23

When do you re-refer a Pt to the prescribing physician?

-failure to respond
-need for dosage adjustment
-unexplained relapse
-the onset of new medical conditions
-side effect problems
-discontinuation of medication treatment

24

What does psychedelic mean?

-drugs that get deep into the psyche, urge to change their consciousness
-concept derived from ancient greek, psyche means mind or soul and delein means to show or reveal, "mind revealing/expanding.

25

What drugs were mentioned in the videos to have potential mental health benefits

-mdma-ptsd
-philocybin cancer therapy
-lsd- mood, alcoholism,

26

In Psychedelics: Effects on the Human Brain and Physiology – what is the mechanism of action of these psychedelics?

-serotonin receptor agonist
-bind with your receptors

27

How quickly can psychedelics work in comparison to psychotherapy or psychotropic medication therapy?

-3 weeks

28

How do psychedelics affect the brain?

-temporarily dissolve inner road map, information can travel more freely in different parts of the brain
-brain more flexible

29

What are some lower toxicity threshold medication for borderline

-antipsychotics and antidepressents, snri, wellbutrin

30

What meds do you use for opiate acute intoxication

- naloxone, naltrexone

31

What meds do you use for opiate withdrawal

- opiates, methadone, buprenorphine
-catapres, benzos

32

What medication do you use for abstinence maintenance

- methadone
-naltrexone
LAAM

33

Which OTC drug can treat depression

-Saint John's Wort
- SAM-E

34

Which OTC drug can treat mood disorders

-Omega-3 Fatty acid
-Folic Acid

35

Which OTC drug can treat slee disturbances

-meatonin

36

What OTC drug can treat cognitive impairment?

-Gingko Biloba