Cumulative Review Gooty Aires 531 Study Guide

What are the symptoms of depression?

D SIG E CAPS

Depressed mood, Sleep change, Interest decreased, Guilt, Energy decreased, Concentration decreased, Appetite change, Psychomotor retardation or agitation, Suicidal thoughts

(1 of them has to be D or I)

How many symptoms of depression do you have to have for a diagnosis?

5 or more from D SIG E CAPS

How long do symptoms of depression have to be present for a diagnosis?

2 or more weeks

What is your recommendation for a bipolar patient with severe manic symptoms on Prozac 20 mg po qam?

The antidepressant should be discontinued and mood stabilizers + antipsychotics should be initiated. Antidepressants can cause a switch from bipolar disorder to mania.

What is the usual therapeutic lithium level range?

0.6-1.2 mEq/L

What are common DDIs that can cause higher and possible toxic lithium levels?

NSAIDs: reduce lithium clearance (exceptions = aspirin and sulindac)

Thiazide diuretics: reduce lithium clearance, increase serum concentration

Which anticonvulsants are prescribed for the treatment of bipolar disorder?

FDA Approved: Carbamazepine (all), Divalproex (mania), Lamotrigine (Maintenance)

Oxacarbazepine prescribed but not FDA approved

Which anticonvulsants are prescribed for bipolar mania?

Carbamazepine, Oxcarbazepine, Divalproex

Which anticonvulsants are prescribed for bipolar mixed?

Carbamazepine, Oxcarbazepine, Divalproex

Which anticonvulsants are prescribed for bipolar maintenance?

Carbamazepine, Oxcarbazepine, Divalproex, Lamotrigine

Which anticonvulsants are prescribed for bipolar rapid cycling?

Divalproex, Lamotrigine

Why is it important to taper temazepam 30 mg po qhs prn insomnia (used nightly for >1 year) to zolpidem 10 mg po qhs prn insomnia?

Temazepam (Benzodiazepine) has withdrawal symptoms (AIMS): anxiety, muscle tension/tremor, seizures

(insomnia is not a side effect in this case)

Which BZD can you recommend for patients with compromised hepatic function?

LOTe - Lorazepam (Ativan), Oxazepam (Serax), Temazepam (Restoril)

What drinks should be avoided with BDZs? Why?

Alcohol: cross tolerance can lead to fatal overdoses

Grapefruit juice: inhibits CYP3A4 and thus increases metabolism of BZDs (decreases effect of BDZ)

Explain why patients with alcohol use disorder can tolerate high doses of BZD.

Cross tolerance

Name 2 classes of antidepressants that are most commonly used for anxiety disorders.

SSRIs and SNRIs

What commonly used ADs can cause insomnia?

bupropion (Wellbutrin) and fluoxetine (Prozac)

Which antidepressants have the least risk for sexual ADRs?

bupropion (Wellbutrin) and mirtazapine (Remeron)

Other than the FDA-approved hypnotics, name the 3 psychiatric drugs that are commonly used at lower doses off-label for insomnia.

Quetiapine (Seroquel), trazodone (Desyrel), mirtazapine (Remeron)

What is the FDA-approved treatment for Parkinson’s psychosis?

Pimaverserin (Nuplazid)

What is the most effective class of medications for the treatment of ADHD?

psychostimulants

What are the side effects and contraindications for the use of psychostimulants?

Side effects: GI distress, decrease appetite and wt, anxiety, insomnia, high HR/BP, excessive —> hallucinations, tics.

Contraindications: advanced arteriosclerosis, symptomatic cardiovascular disease, moderate to severe hypertension, hyperthyroidism, known hypersensitivity to the sympathomimetic amines, glaucoma, agitated states, history of drug abuse. During or within 14 days following the administration of MAO-Is.

Which antidepressant (increase DA and NE) is prescribed off-label for ADHD?

bupropion (Wellbutrin)

What are the 2 indications for Vyvanse?

Binge eating disorder and ADHD

Your patient with Alzheimer’s disease was given Tylenol PM for sleep. What’s the problem?

Decrease in ACh

Which are the top 3 antipsychotics with higher incidence of metabolic syndrome (weight gain increase blood sugar and triglyceride)?

Clozapine (Clozaril), Olanzapine (Zyprexa), Quetiapine (Seroquel)

Which is the most prevalent psychiatric disorder in the US?

Anxiety disorders (GAD, PD, OCD, PTSD, SAD, phobias)

Describe the cluster B personality disorders.

Antisocial, Borderline, Histrionic, Narcissistic

What is considered an adequate trial on an antidepressant for the treatment of depression?

Therapeutic doses for 4-6 weeks

Your patient has been on OTC and Rx pain meds for back pain for years. She is clinically depressed and will be prescribed an AD. What can be considered for both depression and chronic pain?

duloxetine (Cymbalta)

Which mood stabilizer can cause high TSH (hypothyroidism)?

lithium

Your patient has eating disorder and depression? What AD is contraindicated?

bupropion (Wellbutrin)

Which antipsychotics should be taken with food?

lurasidone (Latuda) and ziprasidone (Geodon)

Which AD should be taken with food?

vilazodone (Viibryd)

Which antipsychotic is reserved for refractory schizophrenia? Why is WBC and ANC monitored frequently?

clozapine (Clozaril) and agranulocytosis (low WBC and ANC)