MH701 Final
A Non-addictive and nonhabit forming alternative for the use in treating anxiety?
tyramine, hypertensive crisis
Substance to avoid when taking MAOI’s and why?
What SSRI has a shorter half-life and most often needs to be weaned to prevent issues with D/C?
TCA’s
What class of antidepressants is more lethal in an overdose?
Discontinuation Syndrome (rebound effect-feels worse than before starting the med)
What is a patient likely to exhibit if they suddenly stop taking Venlafaxine?
Fluvoxamine
SSRI that can often interact with many OTC and prescription drugs?
Bupropion
What anti-depressant is contraindicated with seizure disorder, anorexia and bulimia?
SSRI’s
First line treatment for depression and anxiety?
Serotonin Syndrome
Potentially life-threatening syndrome that is precipitated by the use of Serotonin Drugs?
St. John’s Wort
Which of the following OTC’s should be avoided when currently taking a SSRI medication?
Brain not fully developed till 25, uncertain of brains reaction.
Why is there a BBW on Antidepressants about suicide in child and adolescents?
Lorazepam (Ativan)
Short acting Benzo often used in elderly with dementia or PRN use?
Seizure
Abruptly stopping Benzodiazapine can lead to what?
Naproxen can increase lithium levels
Patient on lithium reveals she was recently started on Naproxen for pain daily. Your Response?
Lorazepam (Ativan)
Which medication is considered short-acting Benzodiazapine?
Propranolol (Inderal)
Beta Blocker used for anxiety. restlessness and agitation?
Agoraphobia
Anxiety about being in places or situations from which escape might be difficult?
Valproic Acid (Depakote)
Anxious patient struggles with weight, which medication is more likely to worsen this issue?
Acute Stress Disorder
Exposure to trauma, negative mood, irritability, sleep issues, flashbacks lasting 3 days to 1 month?
Prazosin (Minipress)
Medication believed to block effects of Adrenaline and suppress nightmares?
Add Bupropion
Patient who is stable, complains of decreased sex drive from Sertraline, possible solution?
Mirtazapine (Remeron)
Tetracyclic antidepressant that can help with sleep, appetite stimulation and nightmares.
Too Much Dopamine
Patient with Schizophrenia complains of constant Auditory hallucinations, what neurotransmitter is associated with this?
Delusions
False beliefs about external reality persisting despite evidence to the contrary?
Hallucinations
false sensory experiences, such as seeing something in the absence of an external visual stimulus
illusion
Something is there but is misinterpreted
decreased Serotonin, increased Dopamine, and increased or decreased GABA
Biochemical theory of having dis-regulation of what neurotransmitters can lead to psychosis?
Atypical
Which anti-psychotic class is more beneficial for both positive and negative symptoms?
Typical (Targets Dopamine)
Anti-psychotic class that targets just positive symptoms
Thorazine
Which medication is an example of a typical anti-psychotic?
Benzotropine (Cogentin)
Medication used to help reverse symptoms of EPS?
Propranolol
Often more beneficial with side effects of akathisia and tremor from lithium?
Clozapine (Clozaril) BC of neutropenia risk
Atypical anti-psychotic that a CBC must be obtained and monitored throughout treatment?
1500
Lowest Neutrophil count when taking Clozapine?
3000 (STOP MED)
Lowest WBC count when taking Clozapine
Neuroleptic Malignant Syndrome
Hyperexia, hypertension, tachycardia, tachypnea, diaphoresis and drooling may be signs of?
Stop Meds, fluids, lower fever labs-CPK inceased, Meds: Dantrolene and Amantadine
Treatment for someone in Neuroleptic Malignant Syndrome
Risperidone
Atypical with more likely chance to increase prolactin levels ( SX: breast growth, lactation, sexual side effects)
Sertraline (Zoloft), can activate mania ( R/t serotonin)
Which medication would most likely avoid in a patient with Bipolar 1? Why?
Normal Level (50-125)
Client has lab work back for a Depakote Level that is 80. How would you read these results?
Liver/Weight gain
Depakote is hard on what?
Start at 25 mg for 2 weeks then increase to 50mg to prevent rash
You plan to start Lamotrigine on a patient not on Depakote, how would you start and why?
Steven Johnsons Syndrome
If a pt is on Depakote and Lamotragine what does is increase their risk of?
Valproic Acid
Which medication would worsen weight gain in a patient
Carbamazepine decreased birth control levels (d/t the CYP450) , Check CBC for Aplastic Anemia
Female taking birth control needs what teaching when taking Carbamazapine?
4-12
Plasma levels for Carbamazapine?
Lithium (Lithium Toxicity)
Pt has ataxia, dizziness, slurred speech, muscle weakness, like caused when reviewing what medication?
Hypomania
Period of abnormal elevated energy drecrease need for sleep or irritable mood, lasting 3-4 days
Lurasidone
Which anti-psychotic is less likely to cause weight gain and metabolic issues?
Olanzapine
Which anti-psychotic is Most likely to cause weight gain and metabolic issues?
Ziprasidone
Which medication does NOT come in a long-acting (injection) form?
Addiction
Compulsive drug craving, seeking, use that persists even in the face of negative consequences?
Dopamine
Which neurotransmitter is associated with addiction?
Substance Dependence
Maladaptive pattern of substance use with tolerance, withdrawal, and persistent desire to obtain?
Cage (Cute down? Annoyed by others? Guilty?Eye Opener?) , CIWA
What questionnaire can be used to determine alcohol dependence? Alcohol Withdrawal?
No more than 4 drinks on one occasion or 14 per week for males, <3 in one occasion or 7/week for women. BINGE= >5 in one night
Education on low-risk drinking?
Thiamine (b1)
Deficiency leading to decrease mental functioning, weakness, ataxia, and nystagmus?
Wernicke Encephalopathy
Risk for low thiamine?
Stimulants
Pt presents restless, Inc HR, Inc BP, dilated pupils, intoxication of what substances?
Opiod/heroine
Pinpoint/constricted pupils?
Dehydration & Hyperthermia
Most often cause of death with ecstasy? ( MDMA)
Serotonin
What neurotransmitter in ecstasy after multiple repeated use can deplete out?
Heroine
Insomnia, runny nose, diaphoresis, muscle aches, nausea, chills, fever, withdrawal from what?
opioid withdrawal
Flu-like symptoms?
Stimulants (Cocaine, PCP)
Withdrawal=low energy/depressed?
Methadone
Mu opioid receptors that blocks the effects of opioids while suppressing withdrawal symptoms?
Naltrexone
Does not stimulate mu receptors, it just blocks them from being capable of stimulation?
Disulfiram (Antabuse)
Aversion therapy medication that treats chronic alcoholism?
Methylphenidate
Inhibits the reuptake of dopamine and norepinepherine to treat ADHD?
Ampthetamine
Causes the body to make more dopamine?
Atomoxetine (Straterra)
Non-stimulant, norepinepherine reuptake inhibiter (NRI) does not hit dopamine
Lisdexamphetamine (Vyvanse)
Prodrug activated by lysine portion of molecule by enzymes resulting in gradual release of drug? Has to be taken in the gut?
Atomoxetine (Straterra)
First non-stimulant approved by FDA for ADHD, inhibits presynaptic norepinepherine transport?
Bupropion (wellbutrin)
Holds onto Dopamine/norepinepherine, non-stimulant?
Guafacine (Tenex)
Non-stimulant, not food for focus or attention
Alfa-adrenergic agonists
Reduces Hyperactivity and/or impulsivity, also used for tic disorder/tourette’s?
Add additional short-acting dose in afternoon, change to long acting medication and or adjunctive dose of alfa-adrenergic agonist
Child on Adderall seems more irritable and emotional in the afternoon?
delerium
rapid onset, hours to weeks duration, fluctuating attention impaired recent & immediate memory?
Donepezil (mild to moderate dementia)
Reduce inactivaiton acetylcholine and thus potentiate cholinergic neurotransmitter for memory?
Mamantine
Often used for moderate to severe dementia?
MMSE (Mini Mental Status Exam) or Slums for educated Pts
Tool for identifying stages of Dementia?
Memantine (Namenda)
Produces effects by blockade of NMDA receptors-indicated for moderate to severe memory loss?
Lorazepam
Benzo option-elderly that has no active metabolites, half-lives that do not increase with age?
Clonazepam and Diazepam
Medications to avoid in elderly bc of long-acting?
TCA’s
Often avoided in elderly due to significant orthostatic hypotension and anticholinergic effects?
Nortriptyline, desipramine
Considered safe in the elderly?
lithium, Valrpoic Acid
2 mood stabilizers with neuroprotective benefits
Anti-psychotics
BBW for elderly- increased death and can worsen cognition?
SSRI’s
First-line treatment for depression in children?
Fluoxetine (Prozac)
SSRI with one of the longest half-lives
Serotonin Syndrome
Risk if patient currently on antidepressants adjuncts treatment with St. John’s wart
Hyper reflexes
Tell-take sign of serotonin syndrome
Antipsychotics
Neuroleptic malignant syndrome associated with what?
Neuroleptic Malignant Syndrome
High fever normal BP
Serotonin Syndrome
Low grade fever and high BP
Fluvoxamine (Luvox)
SSRI with benefits for OCD but requires teaching and compliance d/t too many drug interactions?
Escitalopram (Lexapro)
May lead to hypomania if ex to bipolar 1
Venlafaxine (Effexor)
Antidepressant that education about not abruptly stopping and weaning is needed?
Duloxetine (Cymbalta)
Anti commonly rx for depression, anxiety, and chronic pain!
TCA’s
Class of antidepressants associated with more anticholinergic and cardiac effects? Also more lethal in overdose
Imipramine
Pt has a hx of suicide attempt with overdose, which would be contraindicated for use?
Chef salad with blue cheese- risk for htn crisis with tyramine
Patient is on isocatboxazid, would need to avoid which dinner choice?
Bupropion (Wellbutrin)
Used to help decrease sexual effects from other serotonin containing antidepressants?
Mitrazapine (Remeron)
Antidepressant may be beneficial for appetite, sleep, and nightmares?
Buspirone-taken TID
Non-addictive partial agonist serotonin medication used for tax in anxiety?
Propranolol (Inderal)
Medication can be used PRN social anxiety and used anticipatory for panic and anxiety management?
Prazosin (Minipress) 1-2 mg at bedtime
Alpha-1 blocker used commonly to suppress nightmares in it’s pts?
Lorazepam
Bento commonly used in the treatment of alcohol withdrawal and panic disorder?
Seizures
Pt taking alprazolam 7 years anxious, irritable, nausea, shaking, out of meds 3 days. Risk for?
Stop med, call provider, possible adverse effects
Pt begins lamotrigine 9 days ago and notes blistering rash on leg, pt needs to do what?
Report change in exercise or aerobic activity, avoid nsaids, monitoring of kidney Fox, and maintain normal fluid intake.
Teach about Lithium?
NSAIDs/thiazides
Interfere with lithium levels
Valporic Acid (Depakote)
Mood stabilizer used for acute mania, neuroprotective benefits and requires hepatic monitoring? Avoid PCOS patients
Haloperidol (Haldol)
Antipsychotic targets more positive symptoms and very little to no effect on negative?
Dopamine
Positive symptoms associated with what
Seratonin
Negative symptoms associated with what
Fluphenazine (Prolixin)
What is more likely to cause eps and traduce dyskinesia?
Lurasidone (Latuda)
Bipolar pt-hx of obesity,diabetes, htn, what’s less likely to cause metabolic effects?
Clozapine (Clozaril)
Carries a high risk of agranulocytosis
Cocaine
Pt in ER- tachy, dilated pupils, restless, htn, intoxicated from what?
Naloxone
Component in suboxone poorly absorbed sublingual and prevents misuse of medication?
Once pt has gone through detox
When should disulfiram be started on a patient?
Thiamine
Chronic alcohol consequence of what deficiency for wernickes and korsakoff?
Amphetamines
Increase dopamine release across the brain for treatment of adhd symptoms?
Guafacine
Non-stimulant beneficial for hyperactive and impulsive sx in ADHD
Valproic Acid
Mood stabilizer contraindicated in pregnancy known to cause neural tube defects and hepatoxicity?
Post pastime depression
Postpartum female experiencing tearfulness, dysphoria, lack of sleep three weeks after birth?
Melatonin
Hormone produced by the pineal gland that plays a role in regulating sleep and circadian rhythm?
N-acetylcysteine
Antioxidant precursor used in range of psychiatric disorders, specifically benefit trichotillomania?
Dopamine
Called the pleasure chemical, too much- schizophrenia, too little- depression
Serotonin
Plays role in mood, anxiety, sleep, appetite, too little-depression
4-6 weeks
What is the expected time most antidepressants take to exert significant effect?
SSRI
Citalopram is an example of what class of antidepressant?
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