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PTSD Re-experiencing symptoms include:
- intrusive images
- sensory impressions
PTSD Avoidance symptoms include:
Avoiding people, situations, or circumstances
PTSD Emotional Numbing symptoms include:
- Lack of feelings
- Feeling detached
- Giving up on activities
PTSD Hyperarousal symptoms include:
- startled response
- difficulty concentrating
- sleep disturbances
Diagnosis for PTSD requires all of the following happening for at least 1 month
- At least 1 re-experiencing symptoms
- At least 3 avoidance symptoms
- At least 2 hyperarousal symptoms
- Symptoms that make daily life activities difficult
1st line therapy for PTSD:
**May also use TCAs and MAOIs**
These are the only two SSRIs with an FDA-approved indication for PTSD:
2nd line therapy for PTSD
- TCAs: Amitriptyline & Imipramine
- MAOI: Phenelzine
- SNRI: Venlafaxine ER
- Others: Trazadone, Bupropion, Mirtazapine
TCAs cause muscharinic side effects which include:
dry mouth, urinary retention, decreased GI motility
True or False: BZDs are not effective for PTSD symptoms
The acute phase of PTSD (the 1st four weeks) should be treated with:
Cognitive Behavioral Therapy (CBT)
What is the primary stress hormone involved in PTSD?
For PTSD, how many weeks after CBT should an SSRI be started?
After how many weeks of trialing an SSRI for PTSD would you switch to a different agent if no response?
8 - 12 weeks
For PTSD, how long should treatment be continued in patient's that are responding to pharmacotherapy?
at least 12 months (to 24 months)
The two neurochemicals thought to be in disruptions in OCD include:
Serotonin & Dopamine
For OCD, Obsessions are ________ and Compulsions are _______
Initial treatment for OCD should start with:
Cognitive Behavioral Therapy (CBT)
1st line pharmacotherapy agents for treating OCD are:
2nd/3rd Line pharmacotherapy agents for treating OCD are:
These are the only four antidepressants with an FDA-approved indication for OCD:
Sertraline Oral Concentrate Solution can only be diluted in:
- orange juice
- ginger ale
What is the safest drug to use during pregnancy for OCD?
What drug should be avoided?
For OCD, what drug can be used as an augmenting agent for the elderly?
For OCD, what drugs should be started at a lower dose in patients with renal disease?
The antidepressants used to treat OCD are metabolized extensively by the:
For OCD, what is the duration of therapy for CBT?
Once weekly for at least 13-20 weeks
For OCD, pharmacotherapy should be continued in patients for:
What is the source of Coca?
Dried leaves of Erythroxylum coca Lam. or E. truxillense
A tertiary amine diester
Low water solubility
HCl salt is the most common watersoluble derivative
Pharmacodynamics of Cocaine; 2 predominant actions
1. Local Anesthesia --- acting on the PNS
2. Stimulation --- acting on the CNS
Cocaine's MOA for stimulation:
Cocaine blocks the uptake of the following biogenic amines, via bindingto the transporters of these amines:
Dopamine / Norepinephrine / Serotonin
Major CNS AEs of Cocaine:
Respiratory Depression and Death
Temperature: Marked pyrexia (prominent feature of overdosage)
Major Cardiovascular AEs of Cocaine:
- Acute increase in arterial pressure (PNS)
- Increased risk for: stroke / MI
Latter stages: BP drops --> death may occur
Large IV doses of cocaine may produce immediate death due to direct toxicity on the myocardial musculature
Major Ophthalmic AEs of Cocaine:
- Sloughing of the corneal epithelium
- Corneal pitting
- Corneal ulceration
Major AEs of Cocaine-derived topical anesthetics
What is the method of administration for Coca Paste Abuse?
"freebasing" increases the effects/potency
What is the method of administration of Crack Cocaine?
What is the method of administratino of Cocaine Snorting?
Chemistry of LSD:
Indoleamine -- Conversion of tryptophan to this compound
**High Affinity for 5-HT2A receptor**
Binds to receptor - couples to G proteins - generates ITP - release of intracellular Ca++ ---- Causes Hallucinations
What is the source/chemistry of LSD?
- Does not occur naturallyPrepared:
- --Chemically, via semi-synthesis from (+)-lysergic acid chloride + diethylamine
- --Microbially, via the growth of Claviceps paspali with the hydroxyethylamide
The major actions of LSD are on the CNS which affects:
both pyramidal (conical portion of medulla oblongata) and extrapyramidal systems
Signs/Symptoms of Acute LSD Intoxication
- Hyperactive tendon reflexes
- Visual Hallucinations
What is the most common form of LSD abuse?
Tripping - intensify the environment / have a novel experience
Three well-established AEs of "bad tripping" with LSD include:
- Acute panic reactions
- Hallucinogen Persisting Perception Disorder (suicide is possible)
- Prolonged Psychosis (paranoia & schizophrenia)
For the diagnosis of Panic Disorder, how many Somatic or Cognitive symptoms does one have to have?
At least 4
Treatment for Panic Disorder includes:
- SSRIs: Fluoxetine, Paroxetine, Sertraline, Citalopram, Fluvoxamine
- TCAs: Clomipramine and Imipramine
- SNRI: Venlafaxine ER
Which BZDs are long-acting?
Which BZDs are short/intermediate acting?
Excessive anxiety and uncontrollable worry that persists for at least 6 months is:
Generalized Anxiety Disorder (GAD)
FDA-approved agents for GAD includes:
- SSRIs: Paroxetine, Escitalopram
- SNRIs: Venlafaxine ER, Duloxetine
- Beta-Blockers: Propranolol
- Hydroxyzine (Vistaril)
Max Buspirone Dose is?
Pharmacologic Treatment for Social Anxiety Disorder:
- 1st line: SSRI or Venlafaxine
- 2nd line: BZD (Clonazepam)
Which BZDs are good to use in the elderly?
**Those that undergo phase 2 metabolism**
BZD-receptor agonists MOA:
Interact with the GABAAα receptor subunit on or near BZD receptors
Primary difference between BZD-receptor agonists and BZDs is:
BZD-receptor agonists preserve stage 3 NREM sleep whereas BZDs do not
Agonist at the MT1 and MT2 receptors
H1 receptor antagonist
What is the antidote for acetaminophen?
What is the antidote for organophosphate?
What is the antidote for methanol/ethylene glycol?
What is the antidote for cyanide?
What is the antidote for opiods?
What is the appropriate therapy for Jimson Weed poisoning?
Physostigmine 0.5 to 2 mg via slow IV push
What are the risks associated with Dextromethorphan abuse?
- BLURRED VISION
- SLURRED SPEECH
- HALLUCINATIONS (Visual/Auditory)
- CNS DEPRESSION
Treatment of Dextromethorphan Abuse:
- Supportive Care
- SECONDARY TOXICITY: Acetaminophen, Diphenhydramine, & Decongestants