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pantalons psychiatr2
pantalones psychrtria2
| Question | Answer |
|---|---|
| Diagnostic criteria for anxiety? | restlessness or hypervigilance, easy fatigability, irritability, sleep disturbance, muscl tension, difficulty concentrating. |
| Must be ruled out in order to dx as anxiety? | thyroid dysfunction, stimulant use, alcohol w/drawal, caffeine intoxication, cardiac arrythmias. |
| TX for anxiety? | SSRIs & buspirone (anxiolytic). TCAs also help, though not first line. Benzos are good adjuncts for short-term dt the risk of dependence of abuse. CBT or insight-oriented therapy. |
| Extreme anxiety, peaks in 10 min & declines w/in 30 min. rarely lasts longer than an hr w palps, tachy, sweating, trembling, dysp, feels choking, chest discomfort, N, depersonalization, derealization, fear of losing control/dying, ligh-headed, | Panic ATTACKS. W identifiable trigger, or totally unexpected. numbness or tingling, chills hot flashes. |
| Recurrent, unexpected panic attacks, w debilitating fear of having addtl attacks. feelings of impending harm or death, fear of ht attack or stroke, fears of "going crazy." | Panic DISORDER. Poss biologic cause, genetics psychosoc factors, Nervous sys dysregulation, abnml NE, serotonin & GABA activity. |
| Can cuase panic disorder or attacks? | IV Na lactate, CO2 inhalation. |
| TX of acute anxiety that causes panic episodes? | Short course of alprazolam or lorazepam. |
| After the acute anxiety phase of panic disorder is controlled and benzos are being tapered off, what med class is used for maintenance therapy to control panic disorder? | SSRIs paroxetine, fluoxetine, venlafaxine, sertraline for 8-12 months dt relapse. |
| How might mild cases of panic disorders be handled? | Psychotherapy, cognitive, insight-oriented, relaxation training & behavioral therapies. |
| TX of OCD? | SSRIs (sertraline, paroxetine, fluvoxamine, citalopram). TCA clomipramine, though w many SEs (↑ suicide, szs, orthostatic hypotn, QT prolong, stroke, extrapyramidal sxs. |
| TX of PTSD? | SSRIs (sertraline, paroxetine) 1st line tx. TCAs (imipramine, doxepin, amitriptyline). Buspirone. MAOIs (phenelzine, seregiline, isocarboxazid, rasagiline, trancypromine). Anticonvulsants carbamezapine/valproate. |
| Also help in PTSD? | Crisis counseling as preventive measure. support groups, fam therapy, CBT. Hypnosis, coping mechanisms, relaxation techniques. |
| Sxs occur w/in 1 month of traumatic event & last fr 2 days to 1 month. As oposed to ptsd where sxs last more than a month. w numbness, detachment, "in daze," derealization, depersonalization, dissociative amnesia of traumatic event. | Acute stress disorder. w exaggerated startle response. avoid stimuli that remind them of trauma (activities, places, ppl). |
| tx for acute stress disorder? | CBT & supportive counseling. Anxiolytics lorazepam, clonazepam to decr insomnia & irritability. Support groups, fam ther, SSRIs, TCAs & anticonvulsants (retard impulsiveness, jumpiness, jitteriness) |
| TX of phobias? | SSRIs esp paroxetine, fluoxetine, sertraline, velafaxine, 1st line therapy. |
| If SSRIs are not effective to tx phobias? | Benzos, buspirone & lastly TCAs (imipramine). Beta blockers (propranolol reduces autonomic hyperarousal & tremor assoc w performance situations). |
| An intense anxiety about placing oneself in which a grt prob could occur & w/o help. Extremely fearful of embarrasment or humiliation. fear public places where escape is difficult (bus, train, crowded places, mall, market & ltr just being outside the hm. | Agoraphobia. |
| 2 types. 1: Restricting: eats very little. 2: Binging & purging. findings: emaciation, orthostatic hypotn, brady, hypothermia, dry skin, lanugo, periph edema, salivary gland hypetropy, calluses/abrasions LEUKOPENIA, lyte imbalances, hypchloremia, hypo K | Anorexia nervosa. w elev BUN, metabolic alkalosis (vomits chl & K), arrythmias. |
| TX of anorexia nervosa? | Rarely sought by pts. Fam membs are first to seek attn for pt. 1st goal: restore pts nutritional state. Hospitalization, esp if pt 20% below expected wt. Correct fluid and lytes. |
| More OP help for anorexic pts? | OP tx: CBT, & supervised wt gain programs. Antidepressants (amitriptaline, paroxeinte, mirtazapine). An appetite stimulant. Also a drug that has wt gain as a SE. Overall, meds don't play a major role in treating anorexia Pg 240. |
| Antidepressant contraindicated in pts w eating disorders bc it lowers the SEIZURE THRESHOLD? | Bupropion. |
| Use of laxatives/diuretics, excessive exercise, purge, fasting, dental erosion, esophagitis, hypomagnsemia, hypo K & chl, sal gland hypertrophy? | Bulemia nervosa. |
| tx for bulemia nervsa? Better prognosis than that of anorexics. | Antidepressant SSRIs (fluoxetine), TCAs (amitriptyline, clomipramine, imipramine, doxepine), MAOIs (phenelzine, selegiline, isocarboxazid, rasagiline, tranycypromine). CBT. Hosp only if suicidal or w significant metabolic or lyte imbalance. |
| Drug avoided in bulimics (aswell as anorexics) bc it lowers the threshold for seizures? | Bupropion. |
| Being 20% or more over ideal body wt or w a BMI greater than 30? | Obesity. BMI= wt (kg)/height squared. (kg/m2) |
| TX for obesity? | Behavior modification therapy, food diaries, development of new eating patterns (slow, no snacking or when not seated), low cal, balanced diet, exercise. Group ther for educ & motivation. |
| Drugs used for obesity? | Sympathomimetics (amphetamine, dextroamphetamine, phendimetrazine, benzphetamine. Orlistat (xenical) a lipase inhibitor. Sibutramine (Meridia) a mixed NT reuptake inhibitor. gastric bypass, gastroplasty. |
| To help w alcohol withdrawal? | Usually a benzos, sucha as diazepam, chlordiazepoxide. Also thiamine, folic acid and multivitamin administration. |
| Drug to help stop drinking? | disulfiram(Antabuse), alcohol-deterrent, causes nausea when alcohol consumed. |
| To help withdrawal from nervous system depressants? | phenobarbitol. |
| If a person taking phenobarbital for CNS- depressant withdrawal, what meds can help settle agitation? | Anxiolytics (buspirone, hydroxyzine), or neuroleptics/antipsychotics (haloperidol, risperidone, chlorpromazine, fluphenazine, olanzapine, aripiprazole, ziprazidone, quetiapine). |
| Neuroleptics = antipsychotics: | haloperidol, risperidone, chlorpromazine, fluphenazine, olanzapine, aripiprazole, ziprazidone, quetiapine, risperidone |
| Anxiolytics: | buspirone, hydroxizine, SSRIs (citalopram, sertraline, paroxetine, fluoxetine, velafaxine, |
| MAOIs have many GI interactions that make them last resort drugs, include: | phenelzine, selegiline, tranylcypromine, isocarboxazid, rasagiline. |
| Muscle relaxants? | baclofen, cyclobenzaprine, clarisoprodol, chlorzoxazone, dantronel, metaloxone, methocarbamol, orphenadrine, tizanidine. |
| Antidepressants? | bupropion, nefazodone, trazodone, mirtazapine, SSRIs, amitriptyline, clonidine (alpha agonist, used in epidurals & severe CA pn, centrally-acting antihypertensive also), imipramine (TCA). |
| To help withdraw from opiods? | Slow taper of methodone or clonidine (centrally acting antihypertensive & epidural, blocks pn signals from going up to the brain) |
| If a pt is withdrawing fr opiods & is using slow taper of methodone or clonidine, but is having muscle cramps? | Ibuprofen. Loperamide for diarrhea & promethazine for nausea/ |
| For nicotine/tobacco cravings? bupropion (zyban) & varenicline (chantix). | Nicotine patches, nasal sprays, gum, lozenges, inhaler and antidepressants bupropion (zyban) or varenicline (chantix). |
| To help marijuana, phencyclidine (PCP) & hallucinogen withdrawal? | Usually no tx req, but anxiolytics can help. If a pt w h/o acute psychosis withdrawing fr PCP or hallucinogens, neuroleptics/antipsychotis (risperidone, haloperidol, chlorpromazine, fluphenazine, olanzapine, aripiprazole, ziprazidone, quetapine can help. |
| Used in schizophrenia? | risperidone. |
| Used in psychosis, tourette syndrome, acute atitation? | haloperidol. |
| ADD/ADHD? | Hyperactivity, impulsivity, inattentiveness, emotional immaturity, lability, poor soc skills, sometimes clumsy, disruptive, peer rejection, deflated self image, mal portados, explossive/irritable. |
| Could possibly contribute to ADHD/ADD? | prenatal infxn, toxins, prenatal complications, familial/genetic factors, psychosocial factors, neurochemical dysregulation. |
| First-line tx pharmacology for ADHD/ADD? Stimulants! | methylphenidate (Ritalin, concerta, metadate), dexmethylphenidate, amphetamine/dextroamphetamine (Adderall). |
| Selective NE reuptake inhibitor, nonstimulant, used in ADD/ADHD w less freq SEs? | Atomoxetine (Strattera). |
| Drug class that helps in ADHD/ADD? | Antidepressants (bupropion, venlafaxine, imipramine and centrally acting antihypertensives clonidine & guanfacine. |
| High comorbidity w ADD/ADHD, learning disability, mood disorder, drug abuse, violates rights of others, social norms, aggressive to animals & ppl, destruction of property, deceitfulness, serious rule violation? | Conduct disorder. |
| TX for conduct disorder? | Multimodal, incl env, beh modifications & psychotherapy (counseling). pharmacotherapy for specific behaviors. |
| Pts w conduct disorder who are aggressive/assaultive? | Haloperidol, lithium, risperidone, olanzapine. |
| For pts w conduct disorder to reduce impulsivity & to stabilize their mood liability/irritability? | SSRIs (paroxetine, citalopram, sertraline, fluoxetine) |
| Impaired soc interaction, impaired comm, & repetitive, stereotyped patterns of behaviors & activities? | Autism. Supportive tx |
| Impaired soc interaction (NO impaired communication) & restricted or stereotyped behavior, interestes, or activitites? | Asperger's disorder. Supportive tx |
| Decreasing head circumference(per ht & wt), loss of previously learned behaviors, soc intereactions, & motor & lang development, almost exclusively seen in girls? | Rett's disorder. Supportive tx |
| Retinal hemorrhages or hyphemas (BL in ant chamber of eye) should raise suspicion of? | Shaken baby sindrome. |
| Child abuse can result in future psychiatric disturbances such as? | Anxiety, aggressive/violent, PTSD, depression, suicide, subs abuse, low esteem, dissociative disorders, paranoia. Failure to thrive. |
| Any of these shoul raise suspicion of sexual abuse in a child? | Evidence of STD, anogenital bruising, pn, itching, trauma., detailed knowledge about sexual acts that are inappropriate for age, child initiates sex acts, esp w peers., child exhibits sex knowledge through play. |
| In a rape case? | Prophylactic abx (ceftriaxone 250mg IM & metronidazol 2g PO or doxy 100mg PO), also give the option of emergency contraception (progestin only: levonorgestrel., estrogen/progestin combo., copper IUD., Selective progesterone-receptor modulator: uliprsitar. |
| TX for uncomplicated bereavement? | Social contact & reassurance. Antidepressants probably won't help in this situation. Benzos, in short-term can help w insomnia. |
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tupapi