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Behavioral Health EOR- Meds review
Terms in this set (42)
Bad kidney function in Bipolar
Valproic acid OR Carbamazepine
increases norepinephrine and serotonin receptor sensitivity
Signs of toxicity?
Hypothyroidism, sodium depletion, increased urination and thirst, headache
Tremor, diarrhea, vomiting
1st generation Anti-Psych- Haloperidol
2nd generation Anti-Psych- Risperidone/Olanzapine
List of most common SSRI
Serotonin syndrome antidote
GI (Upset stomach, Nausea, Diarrhea,)
List of most common SNRI
Watch out for serotonin syndrome if mixed with what?
2nd line depression
-Good for pain + depression
St. John Wart
Why use this?
Contraindicated in what kind of patients?
Bad side effect to know?
Norepinephrine and dopamine reuptake inhibitor
2nd line Antidepressant
-Useful in those who have bad sexual and GI SE from SSRI
-Useful in smoking cessation
-Helps you lose weight
Eating disorder patients
Lowers seizure threshold
Example of TCA
Don't use why?
TCA most common side effects
End in Triptyline OR Pramine
Risk of toxicity
Sedation, Anticholinergic (Dry mouth, constipation, blurry vision, urinary hesitancy)
Anticholineric toxicity antidote- Physostigmine
What class of drug?
Risks and benefits?
Better for what kind of symptoms?
Risk of what if take too much?
1st generation antipsychotic
Dopamine (D2) Antagonist
EPS such as rigidity, tremor, akathesia (Restlessness)
NMS, Tx with Bromocriptine
2nd generation antipsychotics (1st line)
What are the general and specific SE?
General MOA- D4 and serotonin (5HT2 receptor antagonist)
General SE- Weight gain, less EPS
Risperidone -Increases prolactin
(Partial D2 and 5HT2 receptor antagonist)
Olanzapine- Weight gain + DM
Alcohol withdrawal with impaired liver function
Normal Liver function or known alcoholic /1st line
Benzo overdose antidote?
Cousin to Benzo that is not addictive?
Longer acting Benzos
Short acting Benzos
-How does it work?
-Opioid antagonist, Reduces cravings
Alcohol withdrawal Tx
What is the most characteristic sign of alcohol withdrawal?
Withdrawal symptoms usually, but not always, occur in stages: tremulousness or jitteriness (6-8 hours), psychosis and perceptual symptoms (8-12 hours), seizures (12-24 hours), and DTs (24-72 hours, up to 1 week)
1)Long-acting benzodiazepines like Diazepam
2)Thiamine and magnesium BEFORE giving Glucose to prevent encephalopathy.
Opioid overdose Tx
Opioid Dependence AND Withdrawal TX
Symptoms of Opioid withdrawal
(Helps with detox by reducing or eliminating withdrawal sx)
2)Suboxone (Buprenophine + Naloxone)
Mydrasis, diaphoresis, rhinorrhea, flu-like symptoms, diarrhea, stomach cramps
Tobacco dependence treatment
1st line- Class/Examples/MOA/SE
2nd line- Class/Example
-Blocks D2 re-up
-Blocks D2/NE re-up & stimulates release
SE: Nausea, low appetite, Increase HR and BP,
NE re-up inhibitor
SE: Dry mouth, insomnia, low appetite
If manic symptoms all of a sudden occurred for the 1st time in a 75 y/o patient, think?
Right frontal hemisphere stroke
Medications to avoid in Bipolar
SSRI and TCA
-Can trigger Manic
What do you start a patient on who is having a Manic episode?
-Acute agitation, Delusions, Psychosis
What about maintenance?
Lithium, Valproic acid, Carbamazepine
Lithium common side effects
Can be precipitated by what class of drugs?
Tx for toxicity?
If lithium is given to pregnant lady in 1st trimester, what can happen?
Nausea, Diarrhea, excessive urination and thirst, Tremor, weight gain, psoriasis
Weakness, worsening tremors, vomiting, Ataxia
(Tremor induced by lithium can be tx with Propanolol)
- If creatinine above 4 OR CKD, Emergent dialysis
-Malformed tricuspid valve
Bipolar + Elevated LFT OR Hx of hepatitis Tx?
Most common complication of carbamazepine?
*If changing SSRI, MUST Taper down!
Symptoms if stop abruptly?
Which SSRI doesnt need to be tapered down?
HA, N/V/D, Dizziness
What if you cant get an erection anymore or ejaculate while on SSRI?
Switch to bupropion
-Contraindicated in Bulimia/Anorexia/Epileptics
Erection lasting greater than 3 hours from a medication that is supposed to help with sleep/anxiety?
Good for old, skinny, sad ladies?
Mirtazepine. ↑appetite and sleep
Pounding head, flushing, nausea,
myoclonus after eating cheese,
drinking red wine, taking
decongestant or merperidine?
Hypertensive crisis w/ MAOI.
Tx w/ 5mg IV phentolamine
Low potency antipsychotics
-Less EPS, more Anti-ACH
High potency antipsychotics
Purple grey metallic rash
over sun-exposed areas
and jaundice in patient with hx of schizo
Chlorpromazine (Low potency)
W/in hours of a haloperidol
injections, pt has ↑CPK, T =
103F, rigidity, autonomic
instability, and delirium.
Neuroleptic Malignant Syndrome.
1st- d/c the offending med.
2nd- cooling blankets and dantroline Na
or bromocriptine (2nd line).
Atypical agent w/ highest risk
for EPS and ↑prolactin?
obessive-compulsive disorder Tx
SSRI is 1st line
Clomipramine (TCA) is GS
What is Russel sign? What is this indicative of? .
calluses on her knuckles- Bulimia
A 78 y/o female presents with memory loss...
Fluctuation in consciousness,
visual hallucinations and
Think Lewy Body Dementia
Give Ach-Ease inhibitors. NOT L-dopa.
A 78 y/o female presents with memory loss...
Aphasia, apraxia, gets lost
Alcohol is metabolized
by zero order kinetics (same
amt/unit time = 25mg/hr)
Our next patient comes in
w/ confusion, ataxia and is a known alcoholic
Caused by thiamine deficiency
Give thiamine 1st, then glucose
Pt presents with dilated
pupils, seizure, tachycardia
Best 1st test?
- Tx of HTN and tachycardia?
EKG then urine tox screen. Tx seizure w/ lorazepam
Calcium channel blocker.
Beta-blockers are CONTRAINDICATED!
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