Psychiatry BCACP Test Questions And Answers

Psychiatry BCACP Test Questions And Answers Anxiety tx meds - ANSWER- first line: SSRI, then SNRI, then TCA, MAOI Onset 2-4 weeks LOWER DOSES Acute options are - ANSWER- BZD if severe GAD - ANSWER- SSRI, SNRI, can add try pregabalin**, buspirone**, hydroxyzine pamoate form (less effective than SSRI) **hydroxyzine is a antihistamine mostly just sedative. *rmr initial doses for anxiety are lower for SNRI's dulxoetine 30 mg daily venlafaxine 37.5 mg daily buspirone 7.5 mg BID initial maintenance dose is 15-60 mg daily Social anxiety disorder - ANSWER- escitalopram, paroxetine, sertraline, citalopram or venlafaxine XR obessive compulseive - ANSWER- CBT alone SSRI alone Combination SSRI + CBT ...can try TCA, limited by anticholinergic effects, sedation, sexual dysfuncion. DOC: fluvoxamine, clomipramine works too **fluxoetine, fluxoxamine, paroxetine, sertraline, **f ones good for obsessive disorders PTSD SSRI nightmares insomnia? - ANSWER- Sertraline and paroxetine. (ONLY TWO) nightmares: prazosin insomnia: trazodone. SSRI anxiety doses - ANSWER- paroxetine 10 mg citalopram 10 mg sertraline 25 mg when in doubt for SSRI pick - ANSWER- Paroxetine, Sertraline which benzo for panic attack - ANSWER- alprazolam- greatest efficacy. AVOID in PTSD high risk of substance abuse and suicidal ideation. which benzo to use in older adults - ANSWER- clonazepam or LORAZEPAM due to shorter acting. SSRIs high CNS effect - ANSWER- paroxetine/fluvoaxamine: sedation Activating: fluox (most), vilazodone H/A, vivid dreams/nightmares DSM scales - ANSWER- HAM-D MADRS BECK:: all of them aboe 20 ish is moderate to severe depression. DSM-IV Dx Criteria of MDD - ANSWER- depressed mood or anhedonia (1 of 2) plus 5 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 with GI Effects - ANSWER- N/V/D/C (parox associated with most N/V, CR may reduce) 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) citalopram SE dosing - ANSWER- not recommended in pts w/ long QT- causes QT prolongation correct hypokalemia and hypomag before starting citalopram 40 mg/day will need cardiovascular monitoring 60 age should use dose of 20 mg/day or if you have hepatic impairment or on 2c19 inhib drugs. DI if QTC 500 Sexual Dysfunction - ANSWER- any med affects serotonin can affect, SSRI, TCAs fluox /= sert, cital, escital fluvox; addition of bupriopion may help delayed ejac anorgasmia imparied libido ED (less common) What SSRI is associated with QT prolonation? - ANSWER- citalopram at doses 40mg/day elderly max 20m