Psychopharm Final Review Part 2

Front 1

what are risks & benefits of HRT w/estrogen during menopause (4)

Back 1

Reduce bone loss is osteoporosis
Increased cancer risk
May interact w/other meds
consider phytoestrogens instead (lower SEs? lower efficacy?)

Front 2

define pharmacogenetics

Back 2

Differences in biological responses to drugs (i.e., NOT about attitudes to meds)

Front 3

why do different ethnicities have different responses to meds?

Back 3

genetic polymorphisms (genetic differences in enzymes, especially in the liver bu talso in stomach/gut)

Front 4

How do the genetic differences in different ethnicities affect use of meds?

Back 4

Enzyme differences affect:
Drug plasma concentration
Therapeutic drug responses (increased or decreased sensitivity to a med)
Side effects (rate and severity)
These also INDIRECTLY influence adherence.

Front 5

Are the genetic differences 100% true for everyone in one category?

Back 5

no. It's typically expressed as a percentage of pop who are poor metabolizers of certain substances. Also the research categories can be poor (too broad).

Front 6

list 6 East Asian sensitivities to med categories

Back 6

Increased sensitivity to: Antipsychotics - need lower dose AND increased risk of TD for older and female cts
Lithium & BZs - lower dose
TCAs - greater risk of toxicity because metabolize them slowly and reach serum concentr. faster. Also clinical response at lower dose
MAOIs - often not prescribed bec. many Asian foods high in tyraine
SSRIs - have not been systematically studied

Front 7

list 3 latino sensitivities to meds

Back 7

Incrased sensitivity to:
Antipsychotics - both typ and atyp - 30% lower dose at times
Antidepressants - respond to lower dose; may have inc SEs

Front 8

list 3 African American sensitivities to meds

Back 8

increased sensitivity to:
Antipsychotics - higher risk of TD
Antidepressants - lower dose, more prone to toxic SEs
BZs - more sensitive to f/x

Front 9

discuss differential prescribing of BZs and antipsychotics w/African Americans

Back 9

antipsychotics often given in higher doses, more in depot form - probably overprescribed for depression & alcoholism when BZs would be ok
BZs are probably UNDERprescribed (anx may be under diagnosed)

Front 10

What sociocultural variables affect pharmacotherapy? 3

Back 10

Attitude toward diagnosis
Attitude toward authority
Attitude toward meds in general (esp in comparison to diet, herbs)

Front 11

How many people w/psychological diagnosis (BP, SZ, Mood d/o, Anx) also use substances?

Back 11

bipolar - 56%
SZ - 47%
Mood D/O (not Bip) - 32%
Anxiety D/O - 27%

Front 12

How many abusers of ETOH or other SA also have at least one other SMI?

Back 12

ETHO - 44%
Other SA - 64%

Front 13

DSM abuse vs dependence

Back 13

Abuse - socially defined construct. SA use showing Impairment OR haz behax OR legal probl OR signif problems
Dependence - 3 of the following: tolerance OR withdrawal OR take moer than intended OR can't cut down OR lots of time OR give up activities OR adverse consequences [more med model]

Front 14

discuss differences in mental health vs chem dependence treatment perspectives

Back 14

abstinence (CD) vs. harm reduction
drug free vs. use medication
confront vs support
spiritual vs scientific emphasis
outcome oriented vs. process oriented

Front 15

describe prognosis of ETOH addiction

Back 15

it is a primary, chronic disease that is often progressive and fatal. Caused by tenetic, psychosocial and environmental factors. Characterized by distorted thinking, notably denial.

Front 16

what are the classes of opiate effects?

Back 16

Relaxation (sedation, twilight sleep, reduc anxiety)
Analgesia (pain relief)
Euphoria (low dose - well-being; higher dose - euphoria)
Physiological - DECREASED BP, HR, respiration, pupils, GI inhib (constipation, nausea, dry mouth), cough supperssion

Front 17

Name some opiod analgesics

Back 17

morphine, codeine, heroin (diacetylmorphine), meperidine (Demerol), methadone (Dolophine), hydromorphone (Dilaudid), oxycodone (Oxycontin), fentanyl (Sublimaze), hydrocodone & aceteminophen (Vicodin)

Front 18

what is methadone? how taken? why that way?

Back 18

synthetic opiate, like morphine. Orally since better absorbed.

Front 19

Why use methadone

Back 19

Used to get off heroin and other opiates. It has a slower release, so gives less euphoria. Relies on cross tolerance.

Front 20

What is buphrenorphine (Buprenex)? How administered? How prescribed?

Back 20

newer synthetic morphine substitute, used like methadone. Can withdraw from it in a few days (vs methadone weeks) and fewer withdrawal SEs. Take IV or sublingual. Can be abused so give with naloxone (opiod antagonist)

Front 21

Why look at herbal and atl meds in this class?

Back 21

40% use them in US and 70% fail to inform MD that they are.

Front 22

Why use ST Johns's Wort?

Back 22

May be useful if do not meet criter for MDD OR if ct does not want to take prescription med

Front 23

botanical name for st john's wort

Back 23

hypericum perforatum

Front 24

What is active ingredient, strength of it and dosing for st john's wort? How long before see efficacy?

Back 24

.3% Hypericin
Take 300 mg 3x/day
Need to wait 4 - 6 wks for efficacy

Front 25

Risks of using st john's wort?

Back 25

abortifacient - don't use if considering or are pregnant
low rates of lethargy or insomnia, GI slowdown, etc (Very Low rates)
HEAVY use increases photosensitivity (increased risk of sunburn)

Front 26

What's the most important thing to know about St john's wort?

Back 26

Have client tell their MD about it since it does have interactions w/other meds, and changes efficacy of some

Front 27

Why do people take Omega-3 fatty acids?

Back 27

Decreased levels are found in ppl w/ADHD, Alzheimer's, SZ and MDD. Take it to modify the risk for these. More research needed.

Front 28

Discuss Omega-3 fatty acids and Bipolar D/O

Back 28

Taken in conjunction w/mood stabilizers may have less relapse. Can't rely on it alone (not effective)

Front 29

What are some other herbals/alt meds used for MH?

Back 29

melatonin (sleep), ginko biloba (cognitio), tryptophan, (sleep) kava (antianxiolytic), ephedra aka ma huang (wt loss, stimulant), valerian (sleep)

Front 30

What to keep in mind re: using botanicals

Back 30

Not for kids
Not in bulk
Only if known safe
Discontinue w/adverse reax
Only if needed
Experiment conscientiously

Front 31

5 advantages of "split treatment"

Back 31

Each focuses on specialty
Permits diff tx styles (open vs closed Qs)
Ct gets 2 perspectives
Can reduce treater burnout
Can save $ since MD costs more

Front 32

4 disadvantes of "split treatment"

Back 32

May foster resistance to one mode of tx
Can slow integration of the dx
Can undermine other mode by fostering dependency or reduce motivation for other mode
May have increased potential for SUICIDE - no one person in charge (esp BiP, SZ MDD)

Front 33

5 points for psychotherapist to remember re: meds and pscyoed

Back 33

Educate to avoid misconceptions (meds not drugs)
Avoid paternal attitude (promotes passivity)
Avoid old medical model (insufficient explanation)
Educate for adherence (pros and cons re a med, relapse, etc.)
Elicit info re SEs (but don't use direct Qs - the more open the better)

Front 34

What to keep in mind re: Monitoring you ct's med use (5)

Back 34

Know the ct's meds and dosages
Assess for rec drug use/abuse
Communicate w/MD
Know your limits (MD is authority re: meds)
Do not practice outside area of competency

Front 35

What are 5 influences n the treatment of mental d/o's?

Back 35

psychotherapy
prescription meds
sociocultural environment
alternative therapies (exercise, acupuncture, etc.)
Other conditions (pregnancy, other diseases, etc.)