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TPX Neuro, Psych, & Sub abuse > Week 2: Schizophrenia, Depressive Disorders > Flashcards

Week 2: Schizophrenia, Depressive Disorders Flashcards

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1
Q

Schizophrenia (SPh: my abbreviation)

A

chronic mental disorder that affects the way a person, thinks, acts, expresses emotions, and perceives reality

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2
Q

DSM 5 Criteria for SPh

A

must have 2 or more of the following, each present for a significant portion time during a 1 month period ( or less if successfully treated. at least one must be

1.delusions (fixed false belief)

  1. Hallucinations
  2. Disorganized speech (frequent derailment or incoherence).
  3. Grossly disorganized or catatonic behavior
  4. negative symptoms (i.e diminished emotional expression or avolition

*note: for significant portion of the time since onset of disturbance, level of functioning in one or more areas such as work, interpersonal relations, or self-care, is markedly below the level achieved prior to the onset

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3
Q

Schizoaffective disorder

A

uninterrupted period of illness during which there is a for mood epode (depression or manic)

delusions or hallucinations for 2 or more weeks in the absence of major mood episode during ht lifetime of the illness

SS that meet criteria for major mood episode are present for the majority of the total duration of the illness

disturbance not attributable to the elects of a substance (

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4
Q

Diagnosis of SPh

A
  1. complete patient history
  2. Mental Status Exam
    *Rating Scales: PANSS (Positive and negative Syndrome Scale)
    *Brief Psychiatric Rating Scale
  3. rule out other conditions (Physical, Labs) and co occurring disorders to establish correct diagnosis

Drugs:
*coticosteroids
*stimulants
*marijuana
*DA-Augmenting agents
*Hallucinogens

Diseases:
hiv/aids
EPILEPSY
cva/tbi
infections
Huntingtons disease

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5
Q

Diagnosis of SPh

A
  1. complete patient history
  2. Mental Status Exam
    *Rating Scales: PANSS (Positive and negative Syndrome Scale)
    *Brief Psychiatric Rating Scale
  3. rule out other conditions (Physical, Labs) and co occurring disorders to establish correct diagnosis

Drugs:
*coticosteroids
*stimulants
*marijuana
*DA-Augmenting agents
*Hallucinogens

Diseases:
hiv/aids
EPILEPSY
cva/tbi
infections
Huntingtons disease

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6
Q

Positive symptoms

A

Hallucinations

delusions (fixed false beliefs)

ideas of influence (actions are controlled by external forces

disorganized speech

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7
Q

negative symptoms

A

flat Affect ( (no emotional expression)

alogia (inabilit to carryon a logical conversation)

Anhedonia (inability to experience pleasure int things you used to (depression)

Avolition( lack of motivation )

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8
Q

Cognitive symptomsOF-Schizophrenia

A

impaired attention

impaired working memory

impaired executive function

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9
Q

SPh Treatment

Non Pharm

A

comprehensive psychosocial services are needed in addition to psychotropic medication management to achieve success such as…

psychosocial rehabilitation
pshycoeducation
Therapeutic Alliance
Active community treatment…etc.

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10
Q

What are among the most important factors in choosing an aNTIPSYCHOTIC AGENT for an individual patient

A
  1. SIDE EFECT PROFILES

others include….
*drug interactions
*family history
*adherance
*cost

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11
Q

General Approach to Choosing therapyFOR-SCHIZOPHRENIA

A
  1. SE and other considerations drive choice since differentiating APS based on efficacy is challenging
  2. optimize mono therapy(facilitate balance between efficacy and SE)
  3. Combo drug therapy reserved for treatment resistant pts. (lack of evidence supporting polyp harm, but risks well known, such as non adherence)
  4. Clozapine For treatment resistance or earlier use indicated for suicidal pts.
  5. long acting injectables for those who prefer them
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12
Q

Patho of Dopamine antagonism at different sites

A

Nigrostiratal
*function: extraparymidal system, movement
*effect: movement disorders

Mesolimbic:
function: emotional function, motivational behavior
effect: relief of psychosis

Mesocortical;
function:cognition, executive function
effect: Akathisia (inability to remain still), relief of psychosis

tuberoinfundibulnar
function: prolactin release
effect: increased prolactin

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13
Q

Treatment considerations for stabilization and maintenance-in-MDD

A

full efficacy could take 6-12 weeks or longer, 3-6 months for chronically ill pts.

partial responders would be evaluated for adherence

1st episode treatment:
12 months after remission, continue treatment, chronic lifelong therapy in most pts

treatment resistance: lack of improvement with at least 2 APS from diff classes at optimal dose for at least 8 weeks (some guidelines fewer)

rating scales to track progress

gradual discontinuation unless pt experiencing severe ADR

for switching agents, gradual taper off while other agent is slowly titrated up

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14
Q

treatment resistant-schizophrenia

A

lack of improvement with at least 2 APS from diff classes at optimal dose for at least 8 weeks (some guidelines fewer)

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15
Q

First Generation Antipsychotics
(Typical)

A

Chlorpromazine (Thorazine)
Fluphenazine (Prolixin)
Haloperidol (Haldol)
Perphenazine (Trilafon)
Thiordazine (Mellaril)
Thiothixene (Navane)

END-IN-ZINE-EXCEPT-HALOPERIDOL-AND-THIOTHIXENE

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16
Q

FGA class related side effects-and-BWW

A

extrapyrimdal side effects

Qtc prolongation

prolactin elevation

dermatologic

photosensitivity

blue-gray skin

orthostatic hypotension

altered thermoregulation

BBW: dementia related psychosis (i..e elderly pts with dementia

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17
Q

Black Box warning for FGA

A

Elderly patients with dementia related psychosis treated with FGA increased risk of death

DOES NOT MEAN IT CANNOT BE USED, careful monitoring must be done. benefit should outweigh the risk. can start with smaller dose

this BBW does not include the use of FGA in elderly pts with hx schizophrenia who was on long term treatment

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18
Q

Second Genration Antipsychotcs

A

Aripiprazole (Abilify)

Brexiprazole (Result)

Asenapine (Saphris)

Olanzipine (Zyprexa)

Cariprazine (Vrylar)

Clozapine (Clozaril, Fazaclo)

Iloperidone (Fanapt)

Lumateperone (Caplyta)

Lurasidone (Latuda)

Paliperidone (Invega)

Risperidone (Risperdal)

Ziprasidone (Geodon)

Quetiapine(Seroquel)

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19
Q

SGA (Atypicals) SE profile

A

Metabolic effects
*hypertriglyceriideemia
*hyperglycemia
*weight gain (waist circumference)

qtc prolongation

blood dyscrasia/neutropenia (most common offender clozapine)

decreased seizure threshold

anticholinergic effects (such as constipation(clozapine big offender)

sedation

prolactin elevation

opthalmic effects (quetiapine big offender)

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20
Q

Suggested Schizophrenia pharmacotherapy algorithm

A

Stage 1:
*Treatment naive: any antipsychotic except clozapine
(and olanzipine due to extensive SE profile)
*previously treated w. an APS, and treatment is being restarted : any app except clozapine or previous med that had poor efficacy or intolerance

…
NO IMPROVEMENT IN 2-4 WEEKS
…

Stage 2:
*inadequate response to above
*any psychotic (not used above) except clozapine
NOTE: Clozapine may be considered in severly suicial, EPS, hx violence or substance abuse

…
NO IMPROVEMENT IN 2-4 WEEKS
…

Stage 3:
*inadequate response to above
*considered treatment resistant
*Clozapine mono therapy

Stage 4:
* Inadequate response to above
*can use alternative antipsychotics, augmentation(mood stabilizers, APS polyp harm, etc.)

Note: A;WAYS VERIFY ADHERANCE. Use of Long acting injectables can be considered if poor adherence

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21
Q

treatment considerations for clozapine

A

extensive monitoring.

labs drawn

office visits once a week for first 6 mo.
every other week for next 6 months.

then once ammonite

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22
Q

Long acting Injectables treatment considerations

A
  • good for non adherent patients: HOWEVER, NON ADHERANCE SHOULD NOT BE DUE TO SE PROFILE

*stabilization on oral therapy best approach

oral challenge of the same drug before initiating LAI us best practice

most LAI do not take immediate effect, overlap is often needed, there are exceptions

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23
Q

FGA TREATMENT potencies

A

High
(Haloperidol:Haldol)
FLuphenazine ( Prolixin)

Moderte/ high
Thiothixine (Navane)
Trifluoperazine (Stelline)

Medium moderate
Lozapine
Molindone
Perphenazine

Low potency
Chlorpromazine
Thioridazine

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24
Q

what is the importance of potency

A

potency effects both EPS risk and anticholinergic risk

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25
Trend of anticholinergic and EPS risk with High vs Low potencies
Low potency: increased anticholinergic risk decreased EPS risk High potency: increased EPS risk decreased anticholinergic risk
26
Aripiprazole (Abilify) Unique MOA: Generation: Dosage form Availability and notes
Unique MOA: partial D2 and 5HT1A agonist Generation:second generation Dosage form Availability: PO tab LAI: Maintena: 14 day overlap Aristada: 21 day overlap Mycite
27
Apripiprazole (abilify clinical pearls
IMPULSIVITY: MUST COUNSEL little weight gain may cause insomnia, akathisia, restlessness, pts and caregivers should be alert for uncontrollable and excessive urges
28
Asenapine (Saphris) Unique MOA: Generation: Dosage form Availability and notes
Unique MOA: high affinity antagonism D2 sand 5HT2a Generation: SECOND GENERATION Dosage form Availability and notes; Topical Patch: wear for 24hours upper arm back, abdomen, or hip. can shower but cannot win, don't apply heat Sublingual tablet: must counsel cannot eat or drink for 10 min
29
Asenapine (Saphris) Clinical Pearls
NEW TOPICAL PATCH AVAILABLE among least anticholinergic and less sedating do not eat or drink after SL dose for 10 min high risk of QTC prolongation. CI: severe hepatic disease topical patch may cause skin irritation anaphylaxis may occur after single dose
30
Brexipprazole (Rexulti) Unique MOA: Generation: Dosage form Availability and notes
Unique MOA: partial 5HT1A and D2 receptor agonist and 5HT2A receptor antagonist Generation: second generation Dosage form Availability and notes: oral tab only
31
Brexipiprazole Clinical pearls
IMPULSIVITY dose related Akathisia, long half life (91 hours) Fewer metabolic changes than others
32
Clozapine (Clozaril) Unique MOA: Generation: Dosage form Availability and notes
Unique MOA: antagonist of D1 ad D4(D2 less, 5-HT2 and others, M4 for agonist Generation: second Dosage form Availability and notes: PO tablet ODT (oral disintegrating tablet) Oral solution: ODT and oral EXPENSIVE. NOT usually covered by insurance
33
Clozapine clinical pearls
gold standard for treatment resistant schizophrenia or earlier if pt has high suicidal risk BLOOD DYSCRASIA HIGH METABOLIC RISK CONSTIPATION-can lead to bowel obstruction. can lead to hospitalization or death. DDI: Clozapine/ olanzapine use with benzos(especially lorazepam IM) monitor ANC(absolute neutrophil count) levels as per REMS monitoring REMS monitoring program first 6 mo. q week every other week for next 6 mo. every month thereafter
34
Illoperidone Unique MOA: Generation: Dosage form Availability and notes
Unique MOA: high affinity D2, D3, and 5ht2a Generation: SECOND Dosage form Availability and notes PO
35
Illoperidone (Fanapt) clinical pearls
ORTHOSTATIC HYPOTENTION. slow titration needed no notable prolactin elevation reported qtc prolongation LLOWWWWW-BP
36
Lorasidone (Latuda) Unique MOA: Generation: metabolism Dosage form Availability and notes
Unique MOA: antan: D2 and 5HT2a Generation:second metabolism: cyp3a4 Dosage form Availability and notes: PO
37
Lorasidone (Latuda) clinical Pearls
DO NOT USE WITH STRONG CYP3A4 inhibitors/inducer alsoindicated for use in adolescents indicated for depression associated w. bipolar disorder or in adolescents with major depressive episodes
38
Lumateperone (Caplyta) Unique MOA: Generation: Dosage form Availability and notes
Unique MOA: Generation: second Dosage form Availability and notes: oral capsule
39
Lumateperone Clinical Pearls
DO NOT USE WHEN BREASTFEEDING may impair fertility especial if taken in 3rd trimester
40
Olanzipine (Zyprexa) Unique MOA: Generation: Dosage form Availability and notes
Unique MOA: Generation: SECOND Dosage form Availability and notes PO, ODT short acting IM LAI (Relprevv): requires 3 hr observation period due to post injection delirium and sedation
41
Olanzipine (zyprexa)Treatment-considerations
can cause DRESS METABOLIC ISSUES post injection delirium-PDSS REMS PROGRAM FOR LAI Qtc-risks sedation anticholinergic
42
Paliperidone (Invega) Unique MOA: Generation: Dosage form Availability and notes
Unique MOA: Generation: Dosage form Availability and notes: PO: OROS TABLET,LAI
43
Paliperidone clinical pearls
EPS Prolactin No PO overlap required for LAI med shell may be seen in stool
44
Pimavanersin (Nuplazid) Unique MOA: Generation: Dosage form Availability and notes
Unique MOA: TARGETS SERETONIN Generation: Dosage form Availability and notes
45
Pimavanserin (Nuplazid)-Considerations
NO DOPAMINE indicated for hallucination and delusions associated with Parkinson's disease psychosis
46
Quetiapineclinical pearls
sedation (often used as a sleep aide) may be misused by pts. anticholinergic effects cataracts
47
Risperidone Unique MOA: Generation: Dosage form Availability and notes
Unique MOA: Generation: Dosage form Availability and notes: tab odt LAI (IM ORSQ) SQ uncomfortable, administer carefully, if use SQ, don't touch or rub
48
Risperidone clinical pearls
EPS PROLCTIN
49
Ziprasidone Unique MOA: Generation: Dosage form Availability and notes
Unique MOA: Generation:-second Dosage form Availability and notes-oral-tab SAI-requires,reconstitution
50
Ziprasidone Clinical Perals
CI in those w. increased risk for QTc prolongation DRESS
51
Special populations consideration-for-schizophrenia-treatment
elderly: start low, use cation for renal or hepatic impairment Pregnancy/ lactation: lowest effective dose, higher doses for clozapine and olanzapine Peds: may be more sensitive to EPS and metabolic effects
52
PED aprovals for Schizophrenia also-BBW
Aripiprazole Lurasidone Olanzapine Paliperidone Quetiapine Risperidone all of these also indicated for depression BBW: increased suicidal thoughts in children, adolescents and young adults
53
Long acting Injectables
first gen: fluphenazine haloperidol second gen: aripiprazole olanzapine Risperiodne Paliperidone
54
Acute dystonias Signs high risk APs Treatments
painful prolonged muscle contractions highriskAP:high,potency,or,FGA, treatment: A)anticholinergics(benzotropin,diphenhydramine,trihexylphenydil,biperidin) b)IM-BZDS c)decrease-or-DC-offending-agent
55
pseudoparkinsonism Signs high risk APs Treatments
bradikinesia, tremor, pill rolling, cogwheel rigidity high-risk-APS:high-potency-or-FGA Treatments:- a)anticholinergics- b)d/c-offending-agent
56
akathisia Signs high risk APs Treatments
restlessness,pacing,shuffling,compulsion-to-stay-in-motion.Subjective-feelings-of-distress high-risk-APS:high-potency,FGA-aripiprazole,risperidone treatment:-Beta-blockers,D/C-offending-agent
57
tardive dyskenisia Signs high risk APs Treatments
tongue thrusting chewing lip smacking grimacing highriskAPS:high-potency-or-high-dose-FGA treatment: a)prevention b)d/c-offending-agent c)anticholinergics-MASKKK-SYMPTOMS
58
Major Depressive Disorder Etiology
unknown and complicated but common consensus that there are altered neurotransmitters
59
MDD Oresentation
initial symptoms develop over days to weeks SS of anxiety often appeared if left untreated, can last 4 months or more symptoms vary person to person repeat episodes are common medical disorders must be ruled out
60
MDD Emotional symptoms
diminished capacity to experience pleasure in activities that once brought them pleasure anxiety symptoms psychotic features , but may require hospitalization and stabilization with APS
61
MDD physical presentation
psychomotor retardation (sow movement and speech) chronic fatigue, pain sleep disorders like insomnia, changes in appetitie
62
MDD physical presentation
psychomotor retardation (sow movement and speech) chronic fatigue, pain sleep disorders like insomnia, changes in appetitie watch for residual symptoms
63
Major Depressive Disorder DSM5-criteria
depressed mood most of the day , everyday diminished interest or pleasure significant weightloss insomnia or hypersomnia phychomotor agitation fatugue or loss of energy gelling of worthlessness or excessive inappropriate guilt diminished ability to think or concentrate recurrent thoughts of death (suicidal ideation, w. or w.o a plan)
64
FACTORSTHAT-INCRease-risks of suicide
male single/ living alone scribing feelings of hopelessness/ spice plans substance abuse unusual behavior-missed work, giving things away during initial stages of medication therapy
65
BBW for antidepressants what to do
increased risk of sucide in children, adolescents and young adults. what to do? counsel patients possible ADRs could include agitation deal with subject of suicide directly get help immediately
66
Frist Line therapy for Depression
Selective Seretonin Reuptake Inhibitors (SSRI's) Selective Serotonin and Norepinephrine Reuptake Inhibitors (SNRI) buproprion mirtazipine Vortioxetine
67
antidepressive agent classes
SSRI SNRI Seretonin modulators Triciclyc antidepressants nd other norepinephrine inhibitors Monoamine Oxidase Inhibits (MAO-I) Miscellaneous
68
Treatment considerations for MDD
* all antidepressants equally efficacious, so must consider other factor such as se PROFILEs for treatment options *black box warning for ages up to 24 * carefully assess for possible BIPOLAR disorder. monotherapy antidepressive treatment in bipolar disorder could induce manic/mixed episode
69
General MDD Treatment Approach
* thorough initial evaluation and med review first line agents: SSRI's, SNRI's bupropion, mirtazipine, vortioxetine if response to treatment ( 50% reduction of symptoms) after 4 weeks, AD @optimal doseshould be continued and evaluated at 6, 8, and 12 weeks if symptoms persist after an adequate trial (4-8 weeks), guidelines suggest switching to alternative AD or AUGMENTING with an AD with dif MOA, SGA or psychotherapy
70
pharmacotherapy for MDD approach
antidepressant pharmacotherapy initiated ... AFTER 1-4 WEEKS ... Partial or no response: *assess adherance *increase dose if clinically indicated *assess issued with toldrability *for sever symptom, consider etc Full response: maintain treatment if no issues with tolerability ... AFTER 4-8 WEEKS ... partial or no response: *increase dose OR *change or augment AD OR consider ECT Full response: *move to continuation phase
71
pharmacotherapy for MDD approach
antidepressant pharmacotherapy initiated ... AFTER 1-4 WEEKS ... Partial or no response: *assess adherance *increase dose if clinically indicated *assess issued with toldrability *for sever symptom, consider etc Full response: maintain treatment if no issues with tolerability ... AFTER 4-8 WEEKS ... partial or no response: *increase dose OR *change or augment AD OR consider ECT Full response: *move to continuation phase
72
Phases of therapy for MDD Acute phase Length: Goal:
Phases of therapy for MDD Acute phase Length: 2-3 months Goal: remission (absence of symptoms)
73
Phases of therapy for MDD Remission phase Length: Goal:
Phases of therapy for MDD Length: 4-9 months Goal: prevent relapse or residual symptoms
74
Phases of therapy for MDD if indefinite or lifelong Length: Goal:
Phases of therapy for MDD Length:indefinite/ lifelong Goal: prevent recurrence
75
Phases of therapy for MDD if indefinite or lifelong Length: Goal:
Phases of therapy for MDD Length:indefinite/ lifelong Goal: prevent recurrence
76
Tratment expectationsfor-MDD Week 1 Week 1-3 Weeks 2-4
Week 1: decreased anxiety improved sleep improved appetite Week 2: increased activity, sex drive, self care, and memory thinking and movements become more normal sleeping and eating become more normal weeks 2-4 relief of depressed mood thoughts of suicide begin to subside
77
Tratment expectations Week 1 Week 1-3 Weeks 2-4
Week 1: decreased anxiety improved sleep improved appetite Week 2: increased activity, sex drive, self care, and memory thinking and movements become more normal sleeping and eating become more normal weeks 2-4 relief of depressed mood thoughts of suicide begin to subside
78
Pt education for SSRIs
timeline symptoms Discontinuation Syndrome: FINISH: flu like symptoms, insomnia, nausea, imbalance , sensory disturbances, hyper arrousal. also electric shock sensations must taper if possible, except for prozac due t o long t1/2 may be initial anxiety so start low and go slow with dosing. insomnia, headache are common initial adverse effects hyponatremia and SIADH (rare). monitor for increased lethargy mentallerl status insomnia or sedation: take in morning or switch to another with less insomnia . increased-bleeding-for-pts-on-nsaids,ANTI-PLATELETS,and-anticoagulants sexual dysfunction: may need to switch to another agent such as bupropion Seretonin syndrome counsel on symptoms: mental status changes autonomic disability neuromuscular abnormality GI symptoms
79
Seretonin syndrome ******
SS: BASICALLY-HYPERACTIVITY agitation restlessness confusion diarrhea sweating tachycardia HTN dilated pupild loss of muscle coordination muscle rigidity can occur if taking multiple agents with serotonin such as... triptan migraine agents pain medication such as fentanyl and tramadol nausea products such as zofran(ondansetron) and reglan(metoclopramide) Busprione Linezolid Ritonavir avoid drugs that impair the metabolism of serotonin
80
SSRI DDI
Qtc prolongation with concaminant meds increased risk of bleeding with Nsaids, anti platelets or anticoagulants
81
SSRI considerations
discontinuation syndrome abnormal bleeding due to 5HT reuptake on patelets hyponatremia seretonin syndrome potential cognitive and motor impairment. degrees of Qtc prolongation require caution/ dose modifications with hepatic impairment
82
SSRI Special considerations drugs specific Citalopram(Celexa)
QTc prolongation MDD 20 mg for *elderly pts. CYP2C19 hepatic repairmen
83
SSRI Special considerations drugs specific Escitalopram (Lexapro)
MDD 10 mg for hepatic empairment also-used-for-GAD
84
SSRI Special considerations drugs specific FLuvoxamine
one of most sedating NOT-USED-FOR-MDD.JUST-APPROVED-FOR-OCD
85
SSRI Special considerations drugs specific Fluoxetine
Once weekly dosing
86
SSRI Special considerations drugs specific Paroxetine
avoid in pregnancy short half life
87
SSRI Special considerations drugs specific Sertraline
concentrate can be mixed WITH only WATER, GINGERALE, LEMON/LIME SODA, LEMonade, or orange juice
88
SNRI considerations
abnormal bleeding due to 5HT reuptake on platelets potential for increased activation of mania elevated BP hyponatremia and seretonin syndrome discontinuation syndrome tend to be more energy boosting than any other AD
89
SNRI Special considerations drugs specific Desvenlafaxine
3a4 interactions, don't crush or chew hyperlipidemia reported eosinophilic pneumonia
90
SNRI Special considerations drugs specific Venlafaxine
Give with food 2d6 Interactions BP changes seen at higher doses and Eosinophillic pneumonia reported Dose reductions up to 50% for mild to moderate hepatic or renal impairment
91
SNRI Special considerations drugs specific Duloxetine(cymbalta)
avoid use in pts w. liver dysfunction or ESRD avoid ETOH 1a@ and 2D6 interactions: . do not crush or chew potential hepatotoxicity urinary retention HYPOTENSION reported less insomnia report than other SNRIs
92
SNRI Special considerations drugs specific Levomilnacipran
Urninary retention increased heart rate
93
Tricyclic Antidepressants special considerations
anticholinergic and cardiovascular events CV ventricular tachycardia and heart block (Qt prolongation AE: Weight gain sexual dysfunction drug interaction baseline EKG TCA withdrawal syndrome (insomnia, sweating, abdominal pain, diarrhea)
94
examples of TCAs
amitriptyline amoxapine clamipramine desipramine Doxepin Imipramine Notriptyline Maprotiline
95
Monoamine oxidase Inhibitors MAO-I considerations
* after stopping an interacting medication, must wait 4-5 t1/2 before starting MAO-I fluoxetine(>5 weeks) and vortioxetine(3 weeks) have longest t-1/2 of the SSRi's so need to wait >2 weeks before starting MAO-I dietary restrictions of tyramine containing foods: aged products, smoked and pickled products, yeast extracts- can cause hypertensive crisis. MONITOR BP other SE: postural hypotension, diarrhea, anticholinergic drying effects, sexual dysfunction typical REserved for last resort
96
MAO-I DDI
hypertensive crisis amphetamines decongestants methylphenidate seretonin syndrome with dextromethorphan, etc.
97
MAO-I inhibitor examples
Phenelzine Selegiline Tranlycypromine
98
Seretonin Modulators
ex: Trazadone, Nefazadone mixed 5HT Nefazedone hepatic BBW: life threatening hepatic failure have been reported. TRazadone: sedating risk of priapism
99
Vortioxetine (tritellix) cosiderations
RAPID ONSET OF ACTION IMPROVED TOLERABILITY-COGNITIVE EFFECTS
100
Buproprion considerations
lowers seizures threshold caution in pts with eating disorders or alcohol use disorders CI: anorexia
101
Mirtazipine considerations
sedating weight gain cholesterol elevation
102
Spravato (Esketamine) treatment connsiderations
treatment resistant depression failure of atleast2 other drugs NMDA receptor antagonist designed to be used in combo with po antidepressant CI in pts with hx of aneurysmal vascular disease or intracranial hemmorhae increase BP, cognitive impairment, impaired ability to drive or operate machinery AE: dissociation, dizziness, N/V, sedation, vertigo, hypoeshesia, anxiety, lethargy, increased bp, feeling drunk BBW: sedation, dissociation, abuse and misuse, suicidal thoughts and behaviors must be administered by health care professional and must be monitored for 2 hours after admin.
103
Brexanolone
post partum depression apart of REMS . monitor pulse ox
104
recommending an optimal therapeutic regimen-for-MDD
consider pt preferences multiple use of single agents
105
agents to avoids for certain conditions
seizure disorders: bupropion substance abuse: benzos cardiac complications (TCA's gi bleeding and anticoagulation: SSRIs
106
Treatment Resistance depression
non responsive to 2 separate trip of ad WITH ADEQUATE DOSE AND DURATION (4weeks to start seeing effects, 6-8 weeks for full effects what to do; switch to an alternative . can cross titrate od d/c and start
107
Augmentation agents for MDD
lithium triiodothyronine SGA(aripiprazole,brexipiprazole,eutiapine,combo-olanzapine/fluoxetine buspirone stimulant
108
Neuroleptic malignant syndrome (NMS) cause ss trtmt
dopamine antagonists onset variable 1-2 days htn hyperthermia diaphoresis pallor LEAD PPIPE RIGIDITY HYPOREFLEXIA NORMAL PUPILS NORMAL OR DECREASED BOWELS confusion oincreased muscle tone/ rigidity increased WBC, CPK, LFTs cause: high potency APS, including clozapine treatment: *d/c offending agent *can rechallenge. acceptable in most w. observation for atleast 2 weeks or choose diff SGA or low potency FGA, slow dose titration
109
Seretonin syndrome
seretonin agents onset variable htn hyperthermia hypersalivation diaphoresis increased tone in lower extremities HYPERREFLEXIA DILATED PUPILS HYPERACTIVE BOWEL SOUNDS

TPX Neuro, Psych, & Sub abuse (7 decks)

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