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34 Cards in this Set
- Front
- Back
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What is the time for effect of antidepressants?
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2 to 6 weeks
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What are the time to effect of benzodiazepines
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1 to 14 days
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What is the time to effect for antipsychotics
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1 to 4 days
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Which anti-depressants are available as elixirs?
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fluoxetine, paroxetine, sertraline, citalopram, escitalopram
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Which antipsychotics are available parenteral?
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haloperidol
fluphenazine (Prolixin) loxapine ziprasidone olanzapine |
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Besides psychosis what other effects do atypical antipsychotics have?
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sleep
mood psychosis agitation |
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What patients may require life-long antidepressant therapy?
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chronic symptoms
suicidal risk substance abuse medical comorbidity 3 or more episodes MDD |
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What agents are useful in patients with sexual dysfunction (may help with sexual dysfunction)?
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mirtazapine and buproprion
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What SSRI may help with sleep?
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paroxetine
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What medications work best for comorbid depression and anxiety?
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paroxetine, sertraline and effexor
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What medications are useful for the indication of chronic pain and depression?
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SNRIs such as duloxetine and effexor (less used); tricyclic antidepressants are also used at times
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What medications used for depression may also help with insomnia?
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paroxetine, mirtazapine and trazodone
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What is the incidence of priapism with the use of trazodone?
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1:10000
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What medications can assist with low-energy and depression?
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buproprion and effexor, rarely stimulants can be used
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What antidepressants may cause weight gain?
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mirtazapine and tcas
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What antidepressant may cause weight loss?
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buproprion
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What medications may cause serotonin discontinuation syndrome if stopped abruptly?
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all except fluoxetine and sertraline which have the longest half lifes* (beware when starting meds that could cause serotoning syndrome)
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Which medications lower the seizure threshold?
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all medications lower the seizure threshold, SR and XR wellbutrin are now similar to other meds
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If a patient with bipolar disorder has a high depression to mania ratio what meds should be considered?
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lamotrigine and lithium
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What are some considerations for cycling or mixed episodes?
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mood stabilizer combo such as lamictal and atypical antipsychotic
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Which atypical antispychotics help with insomnia?
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Risperdal, Olanzapine, Quetiapine
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What is the metabolic syndrome associated with use of atypical antipsychotics?
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diabetes, obesity, dyslipidemia, heart disease
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What is the QTc for which haldoperidol should be discontinued?
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500/ms more likely to lead to torasades des pointes
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What is the significant adverse effect of Olanzapine?
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it causes increased serum glucose, so should be used with extreme caution in patients with diabetes
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Why is it that clozapine should not be used in delirium?
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anticholinergic properties
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Why is it that atypical antipsychotics have less side effects of sedation and EPS?
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variable action on D2 receptors and action on 5 hydroxy tyramine 2 receptors
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What is the blackbox warning on atypical antipsychotics associated with elderly patients and dementia?
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Abilify, Zyprexa, Seroquel, Risperdal are associated with 1.6 to 1.7 fold increased risk of mortality
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What are the DSM IV Criteria for delirium?
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a) decreased attention, shifts in focus, difficulty sustaining
b) fluctuations that develop over a short period of time c) a physiological etiology of confusion d) change in cognition not accounted for by a previous preexisting dementia |
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What are the criteria for somatization d/o?
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Age before 30, 4 GI, 2 pain, 1 sexual 1 pseudo neurological
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What are some baseline characteristics that have to be met prior to diagnosing someone with somatoform disorder?
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1) not significantly impairing function
2) not due to a general medical condition |
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What percentage of patients diagnosed with conversion disorder eventually are diagnosed with another illness?
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30%
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What are some specific somatoform disorders?
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1) Somatization D/O
2) Conversion D/O 3) Pain 4) Hypochondriasis 5) Body dysmorphic 6) Somatoform D.O NOS |
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What is the difference between factitious disorder and malingering?
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Factitious disorder there is no secondary gain besides the "sick role"
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What does the acronym CARE-MD for treatment of somatoform disorders stand for?
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CBT/consult psych
Assess patient and do thorough diagnostic workup Regular visits Empathy become the patient Medical-psych interface Do not say this is pyschiatric or all in your head Do no harm -limit test ordering, gain collateral info |
