Psychiatry 3

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  1. What are early response symptoms antidepressants work on?
    Sleep, appetite, and energy
  2. What are delayed response symptoms?
    Mood, social interaction, anxiety, and suicidal ideation
  3. What antidepressants are better at reducing the time to onset of effect?
    Studies show they are all similar
  4. What antidep. Are used for melancholic depression?
    benefit seen with TCAs, possible role of venlafaxine, mirtazapine
  5. What meds are good for psychotic depression?
    combination of antidep. + antipsychotic
  6. MOA: what neurons do SSRI’s work on?
    • 5-HT → Selectively inhibit the reuptake of 5-HT by blocking the 5-HT transporter
    • - Pre / post synapse
    • - down regulation of autoreceptors causes neuron to release more 5-HT at the axon
  7. Which are the most potent 5-HT uptake blockers?
    Citalopram (Celexa) and paroxetine (Paxil)
  8. Which SSRIs have effect on norepinephrine
    Fluoxetine (Prozac) and paroxetine (Paxil)
  9. Which SSRI has the greatest anticholinergic activity?
    Paroxetine (Paxil)
  10. What are anticholinergic side effects?
    Dry mouth, increased perspiration, hypotension
  11. Most common Adverse effect of SSRI’s:
    • GI: diarrhea, nausea, bloating, cramping, heartburn
    • Sexual dysfunction: greatest with paroxetine (Paxil), least with citalopram (Celexa)
  12. Akathisia is most common with what SSRI?
    Fluoxetine (Prozac)
  13. How does serotonin syndrome manifest?
    • autonomic and neuromuscular responses:
    • Hyperreflexia
    • Tremor
    • GI complaints
    • CV problems
    • Seizures
    • Respiratory depression
    • Coma
    • Death
  14. What causes serotonin syndrome?
    Combo of SSRI + other drugs
  15. When do withdrawal symptoms occur from SSRIs
    2-7 days
  16. What are withdrawal symptoms?
    • Nightmares
    • flu-like symptoms
    • GI
    • shock-like sensations
    • insomnia
  17. When should you use most activated fluoxetine (Prozac)
    Beneficial in pts. with sedation, fatigue, or decreased energy
  18. When should you use less activating Paroxetine (Paxil)
    Beneficial in pts complaining of anxiety, agitation, or insomnia
  19. Which SSRI has a lower risk of sexual side effects?
    Citalopram (Celexa)
  20. Which SSRI’s have the least drug interactions?
    Citalopram (Celexa) and Escitalopram (Lexapro)
  21. What is the MOA of SNRI’s?
    Block the reuptake of 5-HT and NE and to a lesser extent DA
  22. What is meant by augmenting?
    adding a drug to an existing antidepressant → combination therapy
  23. In STAR D* what monotherapy should you start with?
    Citalopram (Celexa) and then augment or switch depending on patient
  24. What are 1st line agents for GAD?
    • Benzodiazepines
    • Selective serotonin reuptake inhibitors (SSRIs)
    • Selective norepinephrine reuptake inhibitors (SNRIs)
  25. Second line rx?:
    • Buspirone
    • Used for: current/history of substance abuse, intolerant to BZ therapy, refractory GAD
    • Less sedation and functional impairment than BZ
  26. What are advantages of buspirone treatment of GAD
    Lack of sedation and anxiolytic properties are major advantages
  27. What are the treatment goals for GAD?
    • Short term: Reduce severity and duration of symptoms. Improve functioning
    • Long term: Reduce length of episodes, Reduce severity of episodes, Prevent recurrence, and Achieve symptom remission (Facilitate patient’s return to pre-morbid level of functioning)
  28. What’s the moa of benzodiazepine?
    Potentates inhibitory effect of GABA
  29. SE’s of benzodiazepines?
    • Varying degrees of lipophilicity: Affects ability to cross the blood-brain barrier
    • May produce rapid onset of action
    • Experience rush of euphoria
    • Unpleasant feeling/loss of control
    • MOST common = sedation
  30. When do you use benzodiazepine?
    Acute anxiety relief
  31. Who should be careful rx benzod’s to?
    Patients with co-morbid conditions – alcoholics
  32. Should you quickly withdraw bezods?
    NO – taper, withdrawal rxns
  33. What’s the brand name of BUSpirone?
  34. What is an adequate trial for GAD?
    6-8 weeks
  35. When does the majority of response occur for GAD rx?
    Acute phase: period of 1-3 months
  36. How long should you taper anxiety meds for?
    4-6 months; maintenance phase = 1-2 years
  37. Should buspirone be used for panic disorders
    NO- might make it worse
  38. Whats the Rx options for Panic disorders?
    • 1st line Rx = SSRI , SNRI
    • 2nd line = TCA
    • benzodiazepines → acute response
  39. Do you dose higher or lower of SSRIs and SNRI’s for panic disorders then for major depression?
    Lower – half the dose
  40. What has benefits for agoraphobia?
  41. What is the brand name of Alprazolam?
    Xanax – benzodiazepine
  42. Brand name of fluoxetine?
    Prozac – SSRI
  43. What is the brand name for venlaxafine
    Effexor - SNRI
  44. Do beta-blockers have proven benefit for panic disorders?
  45. Can we cure OCD?
    Full remission is rare. Partial remission is Rx goal
  46. What are the treatment goals for OCD?
    • Reduction in the frequency of Obsessive thoughts and compulsive acts; Anxiety associated with SXs
    • Impairment social & occupational function
  47. How should you treat mild symptoms of OCD?
    Cognitive beh. Therapy- may take 20 weeks to improve – may work better for compulsions
  48. What is the 1st rx for OCD?
  49. Whats the 2nd line rx for OCD?
  50. What’ s the brand name of Clomipramine?
    Anafranil – TCA
  51. What is combination Rx for OCD?
    SSRI + clomipramine, atypical antipsychotic
  52. When do you consider lifelong treatment of OCD?
    2 to 4 severe relapse; 3 to 4 mild relapses
  53. What is the best pharm treatment for PTSD
    • Early cognitive behavioral therapy + SSRI’s (1st line),
    • venlafaxine, TCA’s, MAO-Is (2nd line)
    • TCA & MAO-I (3rd line)
  54. What are augmenting agents for treatment of PTSD?
    • atypical antipsychotics
    • prazocin → only with SSRIs for insomnia, psychosis hypervigilance
  55. What is Prazosin used for?
    Sleep disturbances
  56. Are benzodiazepines used for PTSD rx
    NO – makes it worse
  57. What are goals of treating PTSD?
    • Reduction in core SXs (re-experiencing, avoidance, hyperarousal)
    • Improvements in disabilities
    • Improvements in co-morbid axis I
    • Long-term goal is remission - Treatment response may take up to 36 months
  58. When should Rx of PTSD be started?
    Immediately - @ onset of symptoms
  59. How long should you treat the first episode?
    1-2 years
  60. What is an adequate med trial for PTSD?
    8-12 weeks
  61. How do you treat moderate-severe PTSD and OCD
    CBT & meds
Card Set:
Psychiatry 3
2011-05-17 15:19:41
DPAP2012 Psychiatry

Psychiatry questions made by classmate
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