Test #3 Flashcards Preview

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Flashcards in Test #3 Deck (63):
1

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

oMedications could cause psychiatric symptoms

oCould lead to allergic reaction, could interact with OTC meds

oFailing to do so could lead the prescribing person to increase the dose of the medication that is responsible for the side effects.

oUnwarranted/inaccurate diagnoses could be made.

oUnnecessary medications could be added.

2

How do you differentiate antidepressant toxicity from worsening or reemerging depression

assess for the physiological symptoms of antidepressant toxicity
- tachycardia
- drowsiness
- dry mouth
- nausea, vomiting
- urinary retention
- headache
- hallucinations
- seizures
and monitor antidepressant blood levels

3

Pharmacologic treatment considerations for children and adolescents

- No informed consent, up to the parents!

-Parents think the drug will FIX IT ALL and dont make the effort to change psychological factors (messed up family)

- Children 7+ should be included in the convo about medication to not ruin their idea of mental health

- Metabolism

- Research Limits

-Fears Regarding Drug Addiciton

4

Treatment considerations for pregnant women (particularly the risks to the fetus)

- Teratogenesis (malformation of fetus or fetal organs) - risk greatest during 1st trimester

- Drug effects on growing/developing fetus

- Drug effects on labor and delivery

- Residual drug effects on newborn (neonatal)

- Behavioral teratogenesis (long-term effects on child resulting from drug exposure in utero)

- Pregnancy-induced changes in drug actions

- Drug effects on the breast-fed infant

5

(malformation of fetus or fetal organs) - risk greatest during 1st trimester

Teratogenesis

6

(long-term effects on child resulting from drug exposure in utero

Behavioral teratogenesis

7

Considerations
-Establish diagnosis and target symptoms
-Obtain complete medication hx
-Higher risk for drug-induced psychiatric symptoms
- Additive drug effects
- Multiple meds  psychotropic related falls
- Understand age-specific pharmacology
- Benzo drug accumulation (some more than others)
- Oversedation from benzos
- CNS changes  behavioral changes and unpredictable medication response
- Avoid frequent medication changes/experimentation
- Adjust dosage (start low, go slow!)
- Therapeutic monitoring (lab)
- Recognize/respond to SE promptly

Treatment considerations for geriatric patients

8

Treatment considerations for geriatric patients

Considerations
-Establish diagnosis and target symptoms
-Obtain complete medication hx
-Higher risk for drug-induced psychiatric symptoms
- Additive drug effects
- Multiple meds  psychotropic related falls
- Understand age-specific pharmacology
- Benzo drug accumulation (some more than others)
- Oversedation from benzos
- CNS changes  behavioral changes and unpredictable medication response
- Avoid frequent medication changes/experimentation
- Adjust dosage (start low, go slow!)
- Therapeutic monitoring (lab)
- Recognize/respond to SE promptly

9

Differentiating akathisia from agitation associated with worsening anxiety or psychosis

Akathisia as a result of 2nd-generation antipsychotics is more common in young patients and with high-potency agents

SSRIs (such as fluoxetine) can induce akathisia

Onset of akathisia can vary in onset (early/late)

If symptoms go away with anticholinergics -> akathisia

In some patients, response to antcholinergics is inadequate, so add a benzodiazepine or beta blocker (reduces emotional anxiety/agitation)

If symptoms go away with additional neuroleptic -> disease exacerbation

10

Stimulant Classes to Treat ADHD
M D A L

- Methylphenidat = Ritalin

- DECTROamphetamine = Dexerdine

-Amphetamines = Adderall

- LISDEXamphetamine = Vyvanse

11

Treatment considerations/approaches for borderline personality disorder

- Many, if not most, have comorbid major psychiatric disorders -> informs treatment!

- No medication treatment for personality disorders, per se… you can treat the TARGET SYMPTOM

12

Three cautions when working with clients with BPD

Treatment with antianxiety medications (benzodiazepines) is RISKY

Wellbutrin (Bupropion) should be used with CAUTION

Use medications with a LOW degree of TOXICITY when taken in overdose- High risk of suicidality (acting out)

13

Core Symptoms of . . .

o Generalized ego impairment**
Ego functioning: (1) insight; (2) agency & self-directedness; (3) self-esteem, acceptance, compassion; (4) empathy; (5) integration, purpose, thematic coherence; (6) philosophical and moral development

Chronic emotional instability

Chaotic interpersonal relations

Feelings of emptiness

Impaired sense of self

Low frustration tolerance

Impulsivity

Primitive defenses (e.g., splitting or acting out)

Irritability and anger-control problems

BPD

14

Core Symptoms of BPD


E I
I R
E
SOS
LFT
I
D
A

Core Symptoms of . . .

o Generalized ego impairment**
Ego functioning: (1) insight; (2) agency & self-directedness; (3) self-esteem, acceptance, compassion; (4) empathy; (5) integration, purpose, thematic coherence; (6) philosophical and moral development

Chronic emotional instability

Chaotic interpersonal relations

Feelings of emptiness

Impaired sense of self

Low frustration tolerance

Impulsivity

Primitive defenses (e.g., splitting or acting out)

Irritability and anger-control problems

15

3 Subgroups of BPD
H S A

Hysteroid - Dysphoric - Norepinephrine

Schizotypal - (Dopamine)

Angry - Impulsive - (Serotonin)

16

Subgroup of BPD AND what neurotransmitter does it target

- Emotional lability
- Sensitive to interpersonal rejection, loss, and abandonment
- Desperate attempts to maintain attachments (clinging, manipulative suicidal threats or gestures)
- Great risk for recurring depression

Hysteroid - Dysphoric -

Norepinephrine

17

Subgroup of BPD AND what neurotransmitter does it target

- Odd thinking (ideas of reference, magical thinking, vagueness, very idiosyncratic beliefs)
- Marked episodes of depersonalization/derealization
- Transient psychosis

Schizotypal - (Dopamine

18

Subgroup of BPD AND what neurotransmitter does it target

- Hostile-aggressive interactions
- Low frustration tolerance; volatile
- Interpersonal relations are replete (ongoing intense frictions or multiple rejections)

Angry - Impulsive - (Serotonin)

19

What medications help individuals in the INTOXICATION phase of STIMULANT use ?

B C B A

- Beta Blockers

- Clonidine

- Benzodiazepines

- Antipsychotics

20

What medications help treat the Withdrawal/Abstinence/Maintenance phase of STIMULANT use?

W A A T M

- Wellbutrin

-Antabuse

-Acamprosate

- Topiramate

- Modafanil

21

What medications help individuals in a state of ACUTE INTOXICATION, related to opiates ?
N N

Naloxone

Naltrexone

22

What medications help individuals in a state of ACUTE WITHDRAWAL, related to opiates ?
M B


Opiates especially METHADONE and BUPRENORPHINE

Catapres/Kapyay (Clonodine)

Benzos

23

Reasons for medication non-adherence

Time
SE
MISS
FEAR
FINACNE
PSYCH

Not taking medication as prescribed = #1 cause of treatment failure!
Length of time required for clinical improvement
- Side effects
- Missing doses
- Fears and worries regarding adverse medication effects
- Financial concerns
- Psychological dynamics
1)feeling out of control
(2) biological focus
(3) secondary gain
(4) defeating the doctor
(5) patient overwhelm
(6) negative stigma
(7) messages from loved ones

24

Reasons for . . . Length of time required for clinical improvement
- Side effects
- Missing doses
- Fears and worries regarding adverse medication effects
- Financial concerns
- Psychological dynamics
1)feeling out of control
(2) biological focus
(3) secondary gain
(4) defeating the doctor
(5) patient overwhelm
(6) negative stigma
(7) messages from loved ones

Medication Non-Adherence

25

Schedules (percentages, lengths of time) to taper off medications during discontinuation

o Taper off SLOWLY
- Weeks or months
- Depends on: medication (class, dosage form, half-life) and length of time it has been taken

oDiscontinuation symptoms can occur
- Tapering off
- Switching from a drug with a longer half-life to a shorter half-life

o Discontinuation of a medication could lead to MEDICATION UNRESPONSIVNESS
- E.g., Lithium; some antidepressants and antipsychotics
- Kindling

26

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

- Medication Class

- Dosage

- Half-Life

- How long the person has been on the Medication

27

What medications help individuals in a state of Abstinence Maintenance, related to opiates ?

- Methadone

- Naltrexone

- LAAM

28

Specific opiate receptors and endogenous opioids

enkephalins and endorphins

Pleasure and pain

29

Specific Opioids

Morphine

heroin

Darvon (propoxyphene)

methadone

Demerol (meperidine),

Talwin (pentazocine),

Dilaudid(hydromorphone),

Percodan/Oxycontin
(oxycodone)

Vicodin/ Damason-P (hydrocodone)

codeine

30

How do you taper off hypnotics?

Taper off by skipping days

Daily dosing -> every other day -> every 3 days, etc.

31

Discontinuation symptoms associated with hypnotics


D
R I

- Dysphoria
- Rebound Insomnia

32

Withdrawal symptoms associated with discontinuing Hypnotics

A C

V

S

M P

T

S

Abdominal cramps

Vomiting

Sweating

Muscle pain

Tremors

Seizures

33

when will discontinuation of hypnotic resolve ?

in about 2 weeks but some sxs may persist.

34

Risks of Medication Discontinuation

o Withdrawal Symptoms

o Side Effects

o Unresponsive to Treatment

35

Anti-Depressant Toxicity can look like . . .

Symptoms of depression re-appearing

36

Akathisia can look like . . .

Anxiety, psychosis if sever

37

Anticholinergic Delirium can look like . . .

Psychosis

38

Risks of Melatonin

- lack of evidence

- evidence suggests that dosages > 1 mg may increase DEPRESSION and destabilize BIPOLAR D/O

- Side Effects
*Sedations
*At higher doses - may aggravate DEPRESSION

39

- lack of evidence
- evidence suggests that dosages > 1 mg may increase DEPRESSION and destabilize BIPOLAR D/O
- Side Effects
*Sedations
*At higher doses - may aggravate DEPRESSION

Risks of Melatonin

40

General facts about OTC and herbal products

- Not approved prior to marketing
- regulated for efficacy by FDA
- Not sure about strength/potency
- May contain impurities/contaminants
-Allergic reactions
- May effect Liver, Metabolism, harmful drug interactions
- 70% Don't tell their DR.
-Not covered by insurances, high out of pocket cost

41

Sant Johns Wort treats . . .

Depression

42

SAM-e treats . . .

Depression

43

Omega- 3 fatty acids treats . . .

Mood D/O
Affect Instability

44

Folic Acid treats . . .

Mood D/O

45

Melatonin treats . . .

Sleep Disturbances

46

Gingko Biloba treats . . .

Cognitive Impairment

47

Yohimbine treats . . .

Treatment of Impotency

Adverse Psychiatric Effect - Anxiety

MAY INCREASE PSYCH SXS ANE BE DANGEROUS

48

Kava Kava treats . . .

Decrease Anxiety

Adverse Psychiatric Effect - associated with TOXICITY

MAY INCREASE PSYCH SXS ANE BE DANGEROUS

49

When to re-refer a patient the prescribing physician
F to Res
Dosage
Relap
New
SE
Dis

1. Failure to respond
2. Need for Dosage Adjustment
3. Unexplained Relapse
4. The onset of New Medical Conditions
5. Side Effect Problems
6. Discontinuation of Medication Treatment

50

When to refer to physician rather than to psychiatrist

Helpful and sometimes critical to refer to a physician first because many psychiatric symptoms may be caused by a general medical condition

51

Parkinson side effects can look like . . .

Psychomotor symptoms of depression

52

How do psychedelics affect the brain?


affect the brain's SEROTONIN receptors, which research shows alters emotion, vision, and sense of bodily integrity.

Experiences different views of the world

Effects EMOTIONS and SENSE OF SELF portions of the brain

53

How quickly can psychedelics work in comparison to psychotherapy or psychotropic medication therapy? (Look for a diagram)

Fast acting - after one time use individuals may see results

Benefits are seen 6 months after

4-8 hours

54

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

Serotonin Receptor Agonist

Psychedelics are agonists or partial agonists at the brain serotonin 5-HT2A receptor subtype. That means that they stimulate to a greater or lesser extent these brain receptors.

55

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

LSD - substance abuse

MDMA - PTSD
Psilocybin Mushrooms - Terminally ill cancer patients, anxiety, depression

Serotonin Receptor Agonists
- LSD, Psilocybin Mushrooms, DMT (Ayahuasca)

56

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" or "mind expanding"

57

2 ADHD drug classes that run the risk of addiction

-Stimulants
-Benzos

58

Which do you start with first when it comes to ADHD treatment? Immediate release or extended release

start with immediate then extended if well tolerate/effective

59

Alpha-2 adrenergic agonist are good for what symptoms of ADHD

REDUCE irritability, aggression, impulsivity, and in promoting sedation
treats core symptoms of ADHD

commonly combined with stimulants

60

Antidepressants help with what symptoms of ADHD

REDUCE mood sxs

61

These are examples of . . .
Morphine

heroin

Darvon (propoxyphene)

methadone

Demerol (meperidine),

Talwin (pentazocine),

Dilaudid(hydromorphone),

Percodan/Oxycontin
(oxycodone)

Vicodin/ Damason-P (hydrocodone)

codeine

Opiates

62

Generalized EGO impairment BPD
In
Ag
SE
EMp
I Pur
MORAL

Insight

Agency and Self Directedness

Self-Esteem, Acceptance, Compassion

Empathy

Integration, Purpose, Thematic Coherence

Philosophical and Moral Development.

63

3 factors to consider when discontinuing meds
HX
VULN
FEELINGS

- Patients Hx of previous episodes
- Your assessment of patients vulnerability to relapse
- Patients feelings about Discontinuing