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68 Cards in this Set

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  • Back
What is the one thing that is most important to diagnose a psychiatric dz?
timeline!
When is it appropriate to treat a psychiatric patient?
Treatment can begin at any stage of a disease - timelines for actual diagnosis do not need to be made
Why should we not give anti-depressant to a bipolar patient?
90% of the time bipolars are in a DOWN stage (depressed) - if we give them antidepressant we put them into a manic state the patient may commit suicide
What is meant by the "DOWNS"?
Depressive mood disorders
EVERYTHING is slowed down: mentation, movements, HR, GI, fatigue
What is the end ruslt of all patients with the "DOWNS"?
Suicide - as soon as they get enough energy to kill themselves
What are the 5 stages of grief?
Denial, Anger, Bargaining, Guilt, Acceptance
How long does normal grief usually take?
95% usually takes 5 years
5% takes > 5 years
What is the best treatment for grief?
Empathy!
What is the definition of melancholy? Does the patient need treatment?
Deep sadness, but patient is functional

Tx: No meds needed
What is the definition of Dysthymia?
2 years of sadness

Patient is functional
What is the definition of Cyclothymia?
Patient is sad but has cycles of near normal mood for 2 years
Patient is functional
No meds needed
What is the definition of mania?
Increased ATP, fight/flight ideas, no sleep, spend money, grandiose ideas
What are the signs/symptoms of Bipolar type I?
Major Depression > 2 weeks
Mania > 1 week
What are the signs/symptoms of Bipolar type II?
Major Depression > 2 weeks
Hypomania < 5 days (minor sx)
What is the treatment of Bipolar Type I patient? Bipolar Type II patient?
Type I - Admit so they won't kill themselves while manic
Type II - Treat outpatient - use mood stabilizer
What diseases are associated with bipolar dz?
OCD and ADHD
What are the 2 signs that define Major Depression?
Anhedonia
Failure to Function
What other signs may be present in Major Depression?
SIGECAPS: Sleep inc/dec, Interest dec, Guilt inc, Energy dec, Concentration dec, Appetite inc/dec, Psychomotor retardation inc, Suicide
What treatments are used for depression?
Increase catecholamines: Serotonin, Epi, NE
What are the big NO-NO's of prescribing psych meds?
1. NEVER prescribe SSRI and MAOI
2. NEVER prescribe two drugs from the same class
What receptors does NE bind?
alpha1, alpha2, Beta1
What receptors does Serotonin bind?
5HT; sympathetic in CNS, parasympathetic in PNS
What receptors does Epi bind?
alpha1, alpha2, Beta1, Beta2
What is the function of alpha1? Beta 2?
alpha 1 vasoconstricts, Beta 2 vasodilates - this is important for use of vasodilators and vasoconstrictors
How long does it take catecholamine levels to return to normal once patient takes SSRI?
4 weeks
How long does it take for the patient to feel better once SSRI have been started?
6-8 weeks
What are the signs seen on X-ray for an Alzheimer's patient?
cortical atrophy
basal ganglia atrophy
hippocampus atrophy
What are the stats for patient response to SSRI? What is the only drug that can improve those stats?
30% remission, 30% relapse, 40% inconclusive
Add Buproprion --> 40% remission
What drug is a 2nd line drug for antidepression? How does it function?
Tricyclic antidepressants, blocks reuptake of catecholamines (inc 5HT, NE, Epi)
What are the side effects of TCAs?
Strongly anticholinergic, blocks alpha one receptors (orthostatic hypotension), Blocks AV conduction in the heart (see QRS widening or long QT on EKG)
What should be given to patient if they overdose on TCAs?
NaHCO3 to balance the acid of the drug
What are the TCAs?
Imipramine,Amitryptaline, Clomipramine, Desipramine, Nortryptaline
Which TCA drug can be used as a 2nd line treatment for bed wetting?
Imipramine
Which TCA drug can be used as a treatment for chronic pain?
Amitryptaline
Which TCA drug can be used as a 2nd line for OCD?
Clomipramine
Which TCA drug has the least side effects?
Desipramine
Which TCA drug is best for elderly? Why?
Nortryptaline - least alpha1 symptoms
What is the mecahnism of action of SSRIs?
Block reuptake of serotonin only (increase 5HT)
What are the side effects of serotonin?
Anorgasmia
What are the indications for starting a patient on SSRIs?
Depression, OCD, Chronic Panic, Post-traumatic stress disorder, Phobia, Eating Disorders, PMDD
What drugs are SSRIs?
Fluoxetine, Sertraline, Luvoxetine, Paroxetine, Citalopram, Escitalopram
Which SSRI has been on the market the longest?
Fluoxetine - Prozac
Which SSRI is the only one to be approved in teenagers?
Paroxetine
Which SSRIs are used for stroke patients who are depressed?
Citalopram and Escitalopram
What is PMDD?
PMS symptoms that extend beyond bleeding and patient becomes depressed
When is a depressed patient most at risk of commiting suicide?
During the first 90 days of therapy - this is why we must talk to our patients to gauge their suicidal intentions
What class of drugs is 2nd line TCAs? How do they work?
Heterocyclics
They block reuptake of catecholamines (inc NE, 5HT, Epi)
What drugs are heterocyclics?
Nefazadone, Trazadone, Duolexetine, Amoxapine, Venlafaxine, Buproprion
Which HCAs are SNRIs?
Nefazadone and Duoloxetine
Which HCA requires daily BP monitoring?
Duoloxetine
What are the added benefits of Buproprion as an HCA?
Smoking cessation, no anorgasmia (can exchange for SSRI)
What is the major side effect of Buproprion? In which patients is this drug contraindicated?
Seizure - don't use in pt with electrolyte abnormalities, epileptics
What are MAOIs used for? Which drugs are MAOIs?
2nd line antidepressants: Tranylcypramine, isocarboxazid, Phenylxine, Selegyline
Which MAOIs inhibit MAO-A? Which catecholamines do they increase?
Tranylcypramine, Isocarboxazid, Phenylxine - increase NE, and Epi
Which MAOI inhibits MAO-B? Which catecholamines are increased? What is its special use?
Selegyline, increase dopamine - use for Parkinson's
What is the benefit of Electroconvulsive Therapy?
Can be used in acute situations, resets patient's mind, may be used during pregnancy
What is the 1st line drug for smoking cessation?
veranicline (stimulates nicotine receptors)
What is the most common side effect of ECT?
Anterograde memory loss (forget things that happened just prior to treatment)
Which HCAs are SNRIs?
Nefazadone and Duoloxetine
Which HCA requires daily BP monitoring?
Duoloxetine
What are the added benefits of Buproprion as an HCA?
Smoking cessation, no anorgasmia (can exchange for SSRI)
What is the major side effect of Buproprion? In which patients is this drug contraindicated?
Seizure - don't use in pt with electrolyte abnormalities, epileptics
What are MAOIs used for? Which drugs are MAOIs?
2nd line antidepressants: Tranylcypramine, isocarboxazid, Phenylxine, Selegyline
Which MAOIs inhibit MAO-A? Which catecholamines do they increase?
Tranylcypramine, Isocarboxazid, Phenylxine - increase NE, and Epi
Which MAOI inhibits MAO-B? Which catecholamines are increased? What is its special use?
Selegyline, increase dopamine - use for Parkinson's
What is the benefit of Electroconvulsive Therapy?
Can be used in acute situations, resets patient's mind, may be used during pregnancy
What is the 1st line drug for smoking cessation?
veranicline (stimulates nicotine receptors)
What is the most common side effect of ECT?
Anterograde memory loss (forget things that happened just prior to treatment)