-
Panic disorder tx
- avoid precipitating factors;
- antidepressants & benzos
- ALPRAZOLAM; PAROXETINE
- cbt
-
agoraphobia tx
- pharm like panic;
- therpay: supportive; insight; behavior; cognitive; virtural
-
SSRIs
- Prozac (fluoxetine)
- Paxil (paroxetine)
- Zoloft (sertraline)
- Celexa (citalopram)
- Lexapro (escitalopram)
- Luvox(fluxamine)
-
TCAs
- Tofranil (imipramine)
- Elvavil (amitriptyline)
- Sineuan (doxepin)
- Desipramine(norpramin)
- Nortiptyline (Pamelor)
-
SNRIs
- Effexor (venlafaxine)
- Cymbalta (duloxetine)
- Pristiq (desvenlafacine)
-
NDRIs
- Bupropion(Wellbutrin)
- Desyrel (Trazodone)
-
Mirtazapine (Remeron)
- TeCa
- Higher dose= less sedation
- Appetite stimulation
-
Mood stabilizers
- Carbamazepine
- Depakote
- Lamictal
- Topamax
- Lithium
-
Antipsychotics
- Risperal
- Zyprexa
- Seroquel
- Geodone
- Abilify
- Clozaril
- Fanapt
- Saphris
- Latude
- Haldol-first gen
-
Benzo od antidote
Romazicon
-
-
Serotonin syndrome sx
- Agitation; restless
- Confusion, tachycardia
- Sweating; shivering
- Myoclonus; fever
- Abd cramp
-
Drugs that may-> serotonin syndrome
- Linezolid
- Tedizolid
- Meperidine
- Tramadol
-
Serotonin syndrome tx
- Antivan(benzo)
- cyproheptidine
-
MAOI side effect
- Hypertensive crisis
- Serotonin syndrome
- Drowsiness/fatigue
- Low bp
- Dec sexual fx
- Wt gain
-
Hypertensive crisis
- Tyramine foods
- Antidote: phentolamine
-
MAOI drugs
- Nardil
- Parnate
- Marplan
- Emsam (selective)
-
TCA uses
- Tofranil-bed wetting
- Amitriptyline-neuropathic pain, insomnia
- Doxepin-itching
- Desipramine-insomnia
- Nortriptyline-neuropathic pain
-
Ssri long half life
Prozac
-
Ssri discontinuation syndrome drug
Paxil
-
Paxil
- Shortest half life
- Preg type D
- Strong 2d6 inhibitor
-
Prozac
- Most activating CNS ssri
- Titrate up
- Longest half life
-
NO tamoxifen/tramadol
- b.c strong 2D6 inhbitor
- paxil and prozax
-
qt prolongation
- celexa
- lexapro
- Geodon (antipsych)
-
-
Ssri side effects
- Bruxism
- Weird dreams
- Anhedonia
- Wt change
- Dec libido
-
SSRI discontinuation syndrome
- Flu-like rxn: HA, N, gi distress;
- Strange sensations of vision or touch
-
Effexor ctn
- CV: doses >225=HTN
- HA, wt loss nausea
-
Buproprion
- Lowers seizure threshold
- Doesn't cause wt gain or sexual dysfx
- Inhibits dopamine
- Ndris tx sex dys fx & wt gain
-
Trazadone
- PRIAPISM
- NOT MONOTHERAPY
- Sedation se
-
-
Carbamazepine
- Induces own metabolism
- HLAb*1502 INC RISK OF SJS
- Blurred vision; diplopia
- Leukopenia and hyponatremia
-
Depakote
- Migraines; anti epicleptic; bipolar
- +cabapenems=> SEIZURE
- SE: hyperinsulinemia; PANCREATITIS; pcos
- LIVER TOXICITY/FAILURE
-
LAMICTAL
- MOST SERIOUS ADR=RASH
- SE like carbamaine
- Cant take w/ Depakote
-
Topamax
- WEIGHT LOSS
- Kidney stones
- Adr: ataxia; add
-
REGULAR BLOOD WORK
- Carbamazepine: dec blood cells
- Depakote: LIVER
- Lithium-toxicity
-
Lithium DI
- Anthing w/ NA
- NSAID, dehydration; ACEI
- ARBs; diuretics;
-
Lithium
- Narrow therapeutic
- Avoid Na drugs
- Can be removed w/ hemodialysis
- Lithium tox
-
Lithium toxicity
- Repeated V/Dl tremors
- Difficulty walking
- Sleepiness
- Slurred speech
- Blurred vision
- Muscle twitches and seizures
-
SE atypical antipsych
- Dystonia
- Akathisisia
- Akinesia
- Nes
- TARDIVE DYSKINESIA
-
Neuroleptic malignant syncrome
- MEDICAL EMERGENCY
- Antipsychtoics
- Muscle stiffness; high fever
- Sweating tremors, confusion
- Unstable BP & HR
-
Typical antipsychs
- D2 receptor
- Higher risk of extrapyramidal se
-
Risperidone
- MOST LIKELY 2 INDUCE HYPERPROLACTINEMIA
- Im SHOTS
- Increased extrapyramil
- Antypical; fx like typical >6mg
-
Seroquel
- Drug of choice if psychosis and parkinsons
- Most likely to cause orthostatic hypoT
-
Geodon
- QT prolongation
- No assoc wt gain
- Absorption increased w/ food
-
Abilify
- Not assoc with wt gain
- No qt prolong; low EPS; low sedation
-
Clozaril
- Incr risk seizures
- Reserved for resistant pts
-
Fanapt
- Tirrate over 4 days
- Qt prolongation
-
-
Latuda
- Must administer w/ food
- No qt prolongation
-
Extrapyramidal side effects
- Acute dystonia
- Parkinson syndrome
- akathisia
- tx: benztropine; trihexyphenidyl; diphenhydramine
- propranolol
- amantadine
-
Busprione
- Good augmentation
- No sedation
- Reduce anxiety
-
benzodiazapines
- insomnia, parasomnias; anxiety tx
- valiu; Ativan; xanx
- ~~~"PAM"
- Flumazenil reverses effects
-
social anxiety tx
pharm & therapy: behavioral/cognitive methods
-
GAD tx
THERAPY, PHARM AND SOCIAL SUPPORTIVE; time consuming
-
Specific phobia tx
behavior therapy: systematic and intesnive; Virtual therapy; supportive
-
major neurocognitive tx
- tx treatable; psychosocial ;
- pharm: aricept; exelon; remiryl & cognex to tx alzheimers;
- AVOID ANTICHOLINERGIC
-
MDD
- antidepressants; psychotherapies;
- electroconvulsive therapy;
- hospitalization; phototherapy
-
persistent depressive
- complex d/2 multiple contributing factors;
- may require multiple approaches simultaneously
-
PMDD
- hormonal tx; antidepress/anxiety;
- therapy, diet, exercise, support grps
-
bipolar/cyclothmia tx
- pharm w/ mood stabilizers ie LITHIUM
- anticonvulsants ( valporic acid, carbamazepine, oxcarbazepine & lamotrigine) antidepressants, benzos and anti psychs prn sx control
- ECT effetive in severe depression/mania
-
OCD
- FLUVOXAMINE
- many pt reluctant; behavioral +meds:
- clomipramine; mood stabilizers;
-
HAORDING
MOST EFFECTIVE=CBT
-
OCD PD
GROUP AND COG BEHAVIOR THEYAPY
-
Avoidant
- Psychotherapy
- Group therapy
- Tx depression/anxiety
-
Paranoid pd
- PSYCHOTHERAPY
- Antianxiety (orap)
-
-
Pain disorder
- NO NARCOTICS
- SSRIS most effective
- Psychotherapy
- Cog therapy
- Biofeedback
-
Narcolepsy
- reginmen of forced naps;
- PROVIGIL to reduce sleep attacks
- TCAs/SSRI to reduce cataplexy
-
Hypersomnia
PROVIGIL: wake-promoting substance
-
Insomnia
- pharm: bze & hynotics;
- OTC sleep aids;
- CBT;
- universal sleep hygiene; relaxation & biofeedback
-
dissociative ident
- therapy: wide range of interventions;
- pharm: prn for sx and comorgid;
- ECT; adjunct therapies
- EMDR
-
Depersonal/real
SSRIs may be beneficial; therapies;
-
Dissociative amnesia
cognitive theray; hypnosis; somatic tx; groupt therapy
-
narcissitic
- meds4 sx tx (lithium)
- psychotherapy challenging: avoid self-apprecation or critizing pt
-
histrionic
- no meds; comorbid MDD;
- group therapy and CBT effective
-
-
antisocial pd
psychotherapy good in hospital settingl group therapy in jails; meds tx symptoms
-
requires higher levels Prozac
- bulimia
- outpt; antidepresant
- CBT and phychodynamic therapy
-
Anorexia
- hospitalization; in or out pt;
- CBT psychodynamically oriented; family;
- NO MEDS
-
First-line major depression tx
-
Only SSRI FDA for MDD children
Prozac
-
Antidepressant least likely to cause sexual SE
Bupropion
-
DOC bipolar maintenance tx
Lithium
-
Long acting injectable antipsych bipolar tx
Risperidone
-
Not monotherapy for bipolar
Citalopram
-
2nd gen antipsych warning label
Hyperglycemia
-
Anti psych improves +, - and cog sx
Quetiapine(Seroquel)
-
WBC and ANC clozapine values
-
-
-
AE lithium?
Increased urination
-
Black box warning liver failure
Nefazodone/ serzone
-
Antidepressant inhgits NE and 5-HT reuptake
-
Ssri electrolyte abnormality
hyponatremia
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