Bcacp – Psych Final Exam Questions With Answers

Bcacp – Psych Final Exam Questions With Answers What are the side effects of starting a SSRI at too high of a dose? - ANSWER- irritability and agitation What were the results of the Star*D trial? - ANSWER- many patients will require several treatment trials and possibly combination therapy What were the augmentation after initial failure of citalopram in StarD trial? - ANSWERbupropion, buspirone, CBT What is the first line treatment for bipolar? - ANSWER- mood stabilizers lithium and valproic acid What is bipolar I and bipolar II? - ANSWER- 1: manic or mixed episodes intermingled with depressive; 2: depressive episodes intermingled with hypomanic episodes (bipolar depression) Bipolar II treatment? - ANSWER- lithium and lamotrigine (slowly increase dose to avoid SJS), with atypicals What is a concern with bipolar II antidepressant use? - ANSWER- that it may cause patient to "switch" into a manic episode Pregnancy and bipolar?: - ANSWER- most mood stab are D (VPA the worst can cause neural tube defects); atypical antipsyc C lithium can cause ebstein anomaly Side effects of typical and atypical antipsych? - ANSWER- typical with more movement disorders; atypical weight gain and metabolic symptoms Wht is the most effective antipsyc? - ANSWER- clozapine, reserved after failures of others What are the metabolic effects of concern for atypical? - ANSWER- blood pressure, blood sugar, lipids Relative metabolic effects of the different atypicals? - ANSWERClozapine~olanzapine>Risperidone~quetiapine> ziprasidone~aripiprazole. Common side effects of ADHD meds? - ANSWER- insomnia (give last dose by 4 pm or switch to long acting); growth suppression (drug holiday); decreased appetite htyv(give after meal if possible); increase bp/hr (monitor) lurasidone - ANSWER- Latuda....daily dosing...<metabolic effects...<EPS...more akathisia(agitation) paroxetine - ANSWER- (Paxil, CR) more wt. gain and sedation fluvoxamine - ANSWER- (Luvox, CR). Many DDIs. CYP 1A2 inhibitor n/v setraline - ANSWER- (Zoloft) GI disturbances citalopram - ANSWER- (Celexa) headache escitalopram - ANSWER- (Lexapro) less wt. gain and headache vilazodone - ANSWER- (Vibryd). Take with food. vivid dreams venlafaxine - ANSWER- (Effexor, XR) duloxetine - ANSWER- (Cymbalta) desvenlafaxine ER - ANSWER- (Pristiq) TCAs - ANSWER- amitriptyline (Elavil) doxepin (Sinequan) nortriptyline MAOIs - ANSWER- phenelzine (Nardil) isocarboxazid (Marplan) tranylcypromine (Pamate) selegiline transdermal (Emsam): MAOI-B bupropion - ANSWER- (Wellbutrin). DA + NE RI mirtazapine - ANSWER- (Remeron). NE + 5HT RI. Sedation, increased appetite. trazodone - ANSWER- (Desyrel). 5-HT + a1, histamine blocker. Sedation. aripiprazole - ANSWER- (Abilify) quetiapine - ANSWER- (Seroquel, XR) High metabolic risk - ANSWER- olanzapine (highest risk SGA), clozapine, risperidone, paliperidone, quetiapine QT prolongation - ANSWER- ziprasidone, risperidone, paliperidone, iloperidone, asenapine, lurasidone Hx of tardive dyskinesia - ANSWER- Avoid risperidone, paliperidone DSM-IV Dx Criteria of MDD - ANSWER- depressed mood or anhedonia (1 of 2) plus 4 of following x min 2 weeks Wt change sleep disturbance dec energy feelings of worthlessness or quilt dec conc psychomotor agitation or retardation recurrent thoughts of death or suicide SSRIs high CNS effect - ANSWER- Sedation: fluvox, parox (most) Activating: fluox (most), vilazodone H/A, vivid dreams/nightmares SSRIs with GI Effects - ANSWER- N/V/D/C (parox associated with most N/V, CR may reduce) sertraline SSRI and Anticholinergics effects - ANSWER- Parox worst (dry mouth, constipation,etc) SSRIs Misc ADE - ANSWER- bleeding/anemia due to plt serotonin depletion serotonin syndrome: confusion, hypomania, reslessness, myoclonus, hyperreflexia, diaphoresis, shivering, tremor, diarrhea, and incoordination (avoid meperidine, MAOIs, dextromethorphan, triptan, lithium, TCAs SNRIs, sympathomimetics, SSRIs) Sexual Dysfunction - ANSWER- any med affect