MH701 Final

Buspirone (Buspar)

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?

Paroxetine (Paxil)

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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