MH701 Safety exam 1 Questions And Answers Verified 100% Correct

MH701 Safety exam 1 Questions And Answers Verified 100% Correct TCAs (tricyclic antidepressants) - ANSWER Amitriptyline (Elavil) is an example. Clomipramine (Anafranil) Anticholinergic effects and orthostatic hypotension may occur. LETHAL in OVERDOSE, weight gain and sexual side effects TCA contraindication - ANSWER 10% phenyl and suicidal patients; exacerbate adrenergic effects and can cause HTN crisis hepatic / renal disease, not for kids, eCT, concurrent use of opiates, benzos, etoh, cold medicine NOT in PREGNANCY Life threatening side effects TCA - ANSWER Lethal in Overdose, not for pts with current SI, cardiac disease Choosing/ switching antidepressants : clinical pearls - ANSWER < 1/3 receive remission with 1st med tried switching is nml if no resp 4-8 wk after optimal dose Pt just as likely to respond to another drug in same class once pt failed 2 drugs in same class consider diff class Careful with elderly, sexual dysfunction common (wellbutrin added helpful) Switching pearls - ANSWER sertraline, escitalopram, venlafaxine, mirtazapine, vortioxetine or bupropion good second agent transient serotonergic may occur early but not usually safety issue Discontinuation most common from serotonergic to non serotonergic (venlafaxine or paroxetine) Combining pearls - ANSWER >25% improvement on single, augment can further improve and retain current benefit watch for serotonin syndrome trazodone for sleep, wellbutrin weight issue, mirtazapine for appetite increase augmenting agents most evidence atypicals, lithium, cytomel Ketamine - ANSWER ability to produce rapid / robust effects in mood/ anxiety resistant to treatment short term 2-3 week course 2/3 x a week and taper scarcity of safety and long term 3 most common neurotransmitters with anxiety - ANSWER Norepinephrine serotonin GABA first line pharm for panic disorder - ANSWER SSRI paxil (paroxetine) Fluoxetine (prozac) Sertraline (zoloft) are FDA approved for panic SSRI > Benzo BUT alprazolam (xanax) & clonazepam (klonopin) also FDA approved Pharm for Anxiety Pearls - ANSWER -conservative approach = paroxetine, sertraline citalopram in isolated panic disorder -rapid control of symptoms = brief alprazolam concurrently with ssri and taper benzo long term Fluoxetine (prozac) effective for panic / depression 1st couple of weeks mimic panic symptoms Klonopin can be taken prn for anticipate panic 0.5-1 mg Education on Benzos - ANSWER avoid ETOH or other CNS depressant meds avoid driving/ operating when used in short periods 1/2 weeks usually have no tolerance/ dependance/ withdrawal > 12 weeks high rate of dependance 1st line pharm for Agoraphobia - ANSWER SSRI (1st line panic w or w-out agoraphobia) benzo rapid onset PRN xanax, ativan TCA's most effective dosage must be titrated slowly to avoid jitteriness and may not be achieved for 8-12 wks Social Anxiety Disorder (1st line therapy) - ANSWER 1. SSRI, 2. Benzo 3. venalfaxine (effexor) 4. Buspirone (buspar) buspirone shown best to augment SAD pharm for performance situations - ANSWER Beta blocker (b-adrenergic receptor antagonist) shortly before Tenormin 50-100 mg 1 hr, or propranolol 20-40 mg or lorazepam/ alprazolam GAD 1st line pharm - ANSWER SSRI FDA approved : Escitalopram (lexapro) *Paroxetine (Paxil) off label but EBP *citalopram (celexa) Fluoxetine (prozac) *Sertraline (zoloft) reasonable to begin treatment with SSRI plus benzo and then taper benzo after 2-3 weeks GAD treatment when not responding to SSRI - ANSWER Consider Venlafaxine (Effexor) Duloxetine (cymbalta) Consider anxiolytic buspirone (buspar) benzo alprazolam (xanax) for short term use (FDA +) Vistaril (hydroxyzine) histamine blocker help s/s may cause sedation Education on Benzo - ANSWER strong propensity for abuse (best for) 1-2 weeks while SSRI kicking in long term / high dose = depression /dementia increased GABA = decreased reactivity of brain benzo prevent pt working through root cause abrupt withdrawal can cause s/s seizures and can potentiate effects of etoh Advantages of Buspirone for treatment of Anxiety - ANSWER similar to benzo in its effect no physical dependence, withdrawal/ abuse less sedation / psychomotor impairment lack of interaction with etoh Risk of using buspirone and SSRI for trmt of anxiety - ANSWER small chance of increasing risk of serotonin syndrome Common treatment for OCD - ANSWER SSRI fluoxetine (Prozad) fluvoxamine (luvox), Paroxetine (paxil) sertraline (zoloft) TCA = clomipramine Common treatment for PTSD - ANSWER -SSRI : sertraline / Paroxetine (paxil) considered 1st line d/t efficacy, tolerability and safety ratings -Buspirone (Buspar) is serotonergic and may also be of use -Benzo "relatively contraindicated" TCA's used for PTSD - ANSWER Imipramine (tofranil) amitriptyline (elavil) Prazosin (Minipress) How helpful with PTSD - ANSWER suppress nightmares, particularly associated with ptsd excessive adrenaline can cause nightmares , blocks the noradrenergic stimulation of the alpha 1 receptor Drugs that affect GABA slowing down neurotransmission and decreasing the reactivity of brain - ANSWER Benzo Short acting intermediate long acting triazolam alprazolam flurazepam Barbiturates thiopental secobarbital phenobarbital