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57 Cards in this Set
- Front
- Back
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Antidepressant Drugs
Side E in teens |
inc risk of impulsive behavior and suicidal ideation
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Antidepressant Drugs
Indications |
Mood Disorders
eating neuropathic paint (TCAs SNRIs ADHD (NRI: Atomoxetine) insomnia Enuresis (imipramine) narcoplepsy |
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SSRIs
Fluoxetine Paroxatine General |
first line and MDD
safter in overdose than TCA and MAOIs |
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SSRIs
Fluoxetine Paroxatine Side E |
headache
GI sex dysfxn rebound anxiety, akathisia, insomnia |
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TCAs
Imipramine Amitriptyline Clomipramine Side E! Cardio |
cardiotoxicity; 'quinidine like effect' prolong QTC interval
lethal in overdose |
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TCAs
Imipramine Amitriptyline Clomipramine Side E All |
sedation and weight - Hist
orthostatic hypotension and anticholinergic - alpha1 narrow angle glaucoma; exacerbate benign prostatic hypertrophy, dry mouth |
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MAOIs
Phenelzine Tranylcypromine |
used in refractory depression
can cause HTN crisis tyramine inc NE |
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NDRI antidepressants
Buproprion |
elevates NE and dopamine
smoking lacks sexual side E and wt gain. |
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NDRI antidepressants
Buproprion Side E |
decrease seizure threshold
contraindicated in eating disorders not as good for bipolar b.c could cause flip of symptoms |
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NDRI antidepressants
Mirtazapine |
alpha 2 antagonist
depression |
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Trazadone
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risk of priapism
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antidepressants and bipolar
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can worsen outcomes
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Lithium
General |
first line for mania
protect v suicide |
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Lithium
Excretion |
kidney, reab in prox tubule with na and h20
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Lithium
Toxicity |
must monitor drug levels
range .6-1.2 toxicity above 1.5 treat with dialysis |
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Lithium
Side E Ebstein anomaly |
Ebstein anomaly (triscupid valve abnormlaity in fetus)
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Lithium
Side E |
hypothyroidism, psoriasis
poluria, fine tremor, GI, wt gain, edema, benign leukocytosis |
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Lithium
interactions inc Li |
thiazide diuretics, tetracycline NSAIDs
ACE Digitalis |
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Lithium
interactions dec Li |
mannitol/acetazolamide
carbonica anhydrase inhibitors theophylline caffeine |
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Valproate
General |
first line bipolar
mania, mixed, rapid cycling inhances GABA |
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Valproate
Side E |
alopecia, severe pancreatitis, thrombocytopenia, polycystic ovarian syndrome
fatal hepatotoxic rxn, neural tube defects in preggers |
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Carbamazepine
Uses |
bipolar; manic and mixed
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Carbamazepine
Side E |
dizziness, rashed,
hematological! (lecuopenia, aplastic anemia and agranulocytosis hyponatremia!! neural tube defects |
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Carbamazepine
Rare Side E |
exfoliative dermatitis - Stevens-Johnson syndrome! lethal skin rash
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Carbamazepine
Metab |
P450 enz induces
autoinduction! - induces own metabolism |
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Carbamazepine
Interactions |
dec level of oral contraceptives!
some fetal malformations |
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Lamotrigine
General |
biploar
blcoks Na channels |
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Lamotrigine
Side E |
fulminant rash or Stevens Johnson syndrome
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second generation antipsychotics
Uses |
bipolar disorder
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second generation antipsychotics
Side E Risperidone |
EPS
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second generation antipsychotics
Side E ziprasidone |
cardiac
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second generation antipsychotics
Side E quetiapine |
excessive sedation and dizziness
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second generation antipsychotics
Side E ariprprazole |
akinthesia
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Valproic Acid
Side E |
polycystic ovarian syndrome
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Somatic Treatments
ECT Indications |
unresponsive to drugs
suicidal depression delusional depression severe catatonic states severe refract mania preggers who can take drugs |
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Somatic Treatments
ECT Contraindcations |
NO major
space occupying lesions inc ICP acute MI/arrhythmias malig HTN and recent hemorrhage |
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Somatic Treatments
ECT Treatment |
6-12 treatments
30-60 sec |
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Somatic Treatments
ECT Side E |
retrograde amnesia from anethetic
cognitive implcations and memory loss linger b.c of multiple anethesias fractures and dislocations if not sedated |
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Somatic Treatments
ECT Pre-ECT workup |
CBX
electrollytes EKG CXR m. relaxants |
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Somatic Treatments
ECT Pre treatment drugs |
Benzos stopped b.c inhibit seizures
must have anesthetia and m. relaxant succinycholine and m. anticholinergic drugs to dec secretions and m. tone |
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Somatic Treatments
ECT Electrode Placement |
unilateral - less cog. effects but longer
bilateral - quick but more cog. effects |
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Vagal Nerve Stimulation (VNS)
Indications |
depression
failed at 4 drugs |
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Vagal Nerve Stimulation (VNS)
Mech |
implants VNS device on vagus nerve
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Vagal Nerve Stimulation (VNS)
Efficacy |
low, 25%
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Vagal Nerve Stimulation (VNS)
Side E |
cough, hoarseness, failure of device
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Magnetic Stimulation (rTMS)
Mech |
electrical coil generates magnetic field
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Magnetic Stimulation (rTMS)
Advantages |
well tolerated
not requrie anesthesia no cognitive impairment |
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Magnetic Stimulation (rTMS)
Indications and efficacy |
depression
not as effective as ECT or meds |
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Phototherapy
Indications |
depression
seasonal |
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Phototherapy
Mech |
exposure to bright light in morning
15 min to 2 hrs cities where dark |
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Photothearpy
Side E |
headaches
nausea dizziness combine with drugs |
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Deep Brain Stimulation
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depression
parkinson's |
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Psych Emergencies
Risk Factors of violence |
thoughts
demographics - young, male, lower SES past history stressors |
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Psych Emergencies
Predicting violent behavior |
cannot absolutely predict
single best predictor - past history of violence |
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Psych Emergencies
Biochemical aggressive behavior |
associated with low CSF --hydroxyindoleacetic acid (5-HIAA) and serotonin metab.
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Psych Emergencies
Drugs |
haloperidol and ativant - benadryl and valium also used
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Psych Emergencies
Suicide |
almost always express intent
women fail attempts more b.c use drugs. |
