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92 Cards in this Set
- Front
- Back
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What differentiates hypomania and mania?
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Hypomania: 4 days of sx, lack of social/occupational dysfxn, lack of hallucination/delusion
Mania: 7+ days, severe enough for hospitalization |
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Reduced serotonin in brain
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Depression
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What is the time period for the symptom of a depressed mood and/or loss of interest in things in MDD?
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2 or more weeks
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What is the time frame criteria for recurrent MDD?
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2 or more major depressive episodes w/ at least 2 months of normal mood symptoms in bt
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Melancholic features of depression are best treated w/?
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TCA's
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Major depression w/ atypical features are best treated w/?
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SSRI's & MOAI's
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St. John's Wort can be used to treat?
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Minor-moderate depressive disorder
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For depression, acute phase tx lasts for?
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10 weeks
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Continuation phase treatment for depression lasts for?
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6-9 months
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What is the essential feature of dysthymic d/o
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chronically depressed mood present for most of the day on more days than not for at least 2 years
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What part of the brain is thought to be affected in pts w/ bipolar?
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Frontal lobe, specifically the limbic stx: amygdala and ventral striatum
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First line treatment for acute mania?
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Mood stabilizers: Lithium, valproic acid, carbamazepine
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How long is the therapeutic benefit of mood stabilizers?
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3-4 weeks
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What can you combine to mood stabilizers in order to achieve a more rapid effect?
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Antipsychotics
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Which 2 mood stabilizers should not be used together
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Carbamazepine and lithium
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What antipsychotic can be used to treat acute mania?
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Typicals
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What long term effect can be detrimental if a pt w/ bipolar disorder is treated w/ typical antipsychotics?
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EPS, tardive dyskinesia, depressive symptoms
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What can be used to treat acute bipolar depression?
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Lamotrigine (anticonvulsant)
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Cautions to consider with lamotrigine?
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Must titrate up slowly to limit the risk of fatal rash
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Dosage for lamotrigine when used with valproate?
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Half the usual starting dose and titrated up twice as slow- valproate inhibits the metabolism of lamotrigine
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Dosages for lamotrigine when used with carbamazepine?
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Higher starting dose, aggressive titration- carbamazepine accelerates the metabolism of lamotrigine
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What is rapid cycling bipolar disorder characterized as?
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4 or more mood episodes in a 12 month period
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What is the MOA for Lithium?
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Alters transport of Na+ across the cell membrane to nerve & muscle cells; may influence reuptake of 5HT & NE
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Non-FDA uses for Lithium
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PTSD, conduct d/o in children
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Therapeutic range of Lithium
Acute mania Maintenance |
0.6-1.7
0.7-1.2 0.6-0.9 |
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What drug decreases the renal clearance of Lithium?
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Thiazide diuretics and ACE I's
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What drugs increase Lithium levels?
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Carbamazepine, CCBs, SSRI's, haldol, methyldopa, metronidazole, phenytoin, TCA's
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Which anticonvulsants are approved for tx of bipolar d/o?
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Valproic Acid(Depakote)
Lamotrigine(Lamictal) |
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What is the onset of action for Lithium?
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14 days
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Indications for valproate?
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1st line, rapid cycling bipolar (4+ episodes in 1 yr), mixed, tx resistant
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Onset of action for valproate?
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14 days
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What are the acceptable levels of valproate?
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50-100
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What is typically used to bridge the gap for the onset of action of Lithium?
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Atypical antipsychotics
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TOC for schizoaffective d/o?
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mood stabilizers, more specifically carbamazepine
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Tx of depression in schizoaffective d/o?
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SSRI's- fluoxetine(Prozac), sertraline(Zoloft)
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Pts who are agitated and insomniac w/ schizoaffective d/o respond to?
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TCA's
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Hypothesis for schizophrenia?
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Loss of GABAergic neurons that have a regulatory effect on dopamine, therefore excessive dopamine activity
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What is pathognomonic of schizo?
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loose associations
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What are the positive symptoms of schizophrenia?
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hallucination, delusions, bizarre behavior, or thought disorder
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What are negative symptoms of schizophrenia?
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Blunted affect, anhedonia, apathy, inattentiveness
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How long does it take for anti-depressants to take effect?
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6-8 weeks
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MOA of TCA's?
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Blocks the reuptake of NE & 5-HT
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Tertiary Amines (TCA's)
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Imipramine(Tofranil), Amitriptyline(Elavil), Doxepin(Sinequan), Clomipramine(Anafranil)
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Secondary Amines (TCA's)
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Desipramine(Norpramin), Nortriptyline(Pamelor), Protriptyline(Vivactil)
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What is the advantage of secondary amines?
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Less sedation, more potent for blocking NE reuptake
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TCA pharmokinetics?
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Narrow TI. Must monitor liver
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ADR of TCAs
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Cholinergic, histaminic, alpha 1 blockade(OH, ejaculatory dysfxn), seizures, serotonin syndrome, withdrawal syndrome
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Drug interactions with TCA's?
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Severe toxicity with MAOI's- must d/c 2-3 weeks in bt
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Indications for MOAI's?
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Atypical and refractory depression
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ADRs of MAOI's?
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tyramin interation- hypertensive crisis, liver toxicity, drug free period when using CNS/psych drugs
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MAOI's drug names?
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Phenelzine(Nardil), Tranylcypromine(Parnate), Isocarboxid(Marplan), Selegeline(Emsam) patch
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Indication for Trazadone?
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Used as a sedative to counteract insomnia d/t SSRI's
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MOA of bupropion?
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Weak inhibitor of dopamine & NE reuptake
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ADRs of bupropion?
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Seizure risk, CNS stimulation
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Indications for bupropion?
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Anti-depressant, smoking cessation
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MOA of SSRI's?
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Selectively blocks the reuptake of serotonin
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Half life of SSRIs?
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Long half life- given in the am bc of insomnia & nervousness
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MOA of SSRI's?
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Selectively blocks the reuptake of serotonin
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What drugs affect NE and serotonin receptors?
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Dual reuptake inhibitors
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Name the Dual Reuptake Inhibtors?
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Venlaxafine(Effexor), Duloxetine(Cymbalta), Desvenlaxfine(Pristiq), Milnacipran(Savella)
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Name a selective norepinephrine reuptake inhibitor
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amoxetine(Strattera)
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What is part of the "banana bag"?
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Thiamine, folic acid, MVI, magnesium sulfate
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Acute overdose management for opioid overdose?
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Narcan(Naloxone)
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Acute withdrawal management for opioids?
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Methadone and Clonidine
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What is given in the case of an overdose of benzodiazepine? (RARE)
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Flumazenil
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Benzo management for withdrawal?
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Librium, same as alcohol detox
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How long do the symptoms have to be present to dx schizophrenia?
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6 months
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1st line treatment for OCD?
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SSRI's
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Somatization disorder must include what sx?
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4 pain complaints: 2 gi, 1 pseudoneurologic, 1 sexual
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What is the best tx for somatization disorder?
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Psychotherapy
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When does conversion disorder usually occur?
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During or right after a crisis
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T/F: Conversion disorder has a high rate of spontaneous resolution
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True
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What can you use for tx of hypochondriasis?
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SSRI's
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What is the m/c of all the somatoform disorders?
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Pain disorder
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Girls with ADHD tend to have which type more often?
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Inattentive
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What are the core deficits in ADHD?
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attention, activity, impulsivity
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ADRs of stimulants?
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HA, abd pain, decr appetite, wt loss, insomnia
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What non-stimulant is approved for adult ADHD?
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Atomoxine
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What is the acute initial tx of anxiety?
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Benzodiazepine
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What is the maintenance tx of anxiety?
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SSRI's- take 4-6 weeks to take effect, continue tx for 8-12 months
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Pts w/ agoraphobia have coexisting?
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Panic disorder
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1st line treatment for agoraphobia?
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SSRI
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1st line treatment for specific phobia?
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desensitization
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1st line treatment for social phobia?
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SSRI- Paroxetine(Paxil)
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What is the time frame for adjustment disorder?
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Sx occur w/in 3 months of the stressor and end w/in 6 months
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Tx for GAD?
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Busprione, anti-depressants
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Cluster A personality disroders? Think MAD
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Schizoid, schizotypal, paranoid
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Cluster B personality? Think BAD
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antisocial, borderline, narcissistic, histrionic
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Cluster C personality? Think SAD
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avoidant, dependant, obsessive-compulsive
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A 45-year-old scientist
works in the lab most of the day and has no friends, according to his coworkers. He expresses no desire to make friends and is content with his single life. |
Schizoid
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A 35-year-old man dresses
in a space suit every Tuesday and Thursday. He has computers set up in his basement to “detect the precise time of alien invasion.” He has no evidence of auditory or visual hallucinations. |
Schizotypal
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What must you monitor when your patient is started on Quetiapine?
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Eye exam Q6mo
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