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Behavioral Health
| Question | Answer |
|---|---|
| SSRI MOA | Increase CNS serotonin, inhibit presynaptic serotonin reuptake |
| SSRI endocrine | blocks 5HT1A transport |
| SSRI lowers risk of | anticholinergic, sedating, or CV risk |
| SSRI adverse effects | GI, sleep impairments, sexual dysfunction, headache, change in energy, dry mouth, CNS stimulation, increase suicidality |
| How to fix SSRI sexual dysfunction | Lower dose, switch medications, add bupropion or phosphodiesterase-5-inhibitor |
| SSRI indications | Depression, anxiety, PTSD, OCD, panic disorder, PMDD/PMS |
| Fluoxetine is what kind of med | SSRI |
| Fluoxetine is best for | Bulimia, 1/2 life 2-4d, lowest risk of weight gain |
| Paroxetine is what kind of med | SSRI |
| Paroxetine AE | Weight gain, sexual dysfunction, antihistamine, anticholinergic |
| Citalopram is what kind of med | SSRI |
| Citalopram AE | QT prolongation |
| Escitalopram also known as | Lexpiro |
| Escitalopram is best SSRI for | decreased weight gain |
| Sertraline is what kind of med | SSRI |
| Fluvoxamine is what kind of med | SSRI |
| Vilazodone is what kind of med | SSRI |
| SNRI MOA | Block presynaptic reuptake of norepinephrine and serotonin, increased dopamine levels |
| SNRI AE | Hyponatremia (SIADH), GI, headache, fatigue, sleep impairment, dry mouth, sexual dysfunction, suicidality |
| SNRI Norepinephrine adverse effects | sweating, dizzy, dry |
| SNRI anticholinergic adverse effects | dry, dizzy, constipated, CNS stimulation, serotonin syndrome |
| SNRI indications | GAD and depression |
| Duloxetine is best SNRI for | depression and neuropathic pain |
| SNRI contraindications | MAOI use, renal/hepatic impairment, and seizures |
| When to use SNRI with caution | HTN, glaucoma, and other serotonin meds |
| Duloxetine class of med | SNRI |
| Venlafaxine class of med | SNRI |
| Venlafaxine when to use | Lower affect on norepinephrine |
| Venlafaxine when not to use | hypertension |
| Venlafaxine AE | HTN, abnormal bleeding, and pharyngitis |
| Desvenlafaxine class of med | SNRI |
| Levomilnacipran class of med | SNRI |
| Milnacipran class of med | SNRI |
| Bupropion | atypical antidepressant |
| Bupropion is also known as | Wellbutrin or Zyban |
| Bupropion MOA | norepinephrine and dopamine reuptake inhibitor |
| Bupropion does not act on | Serotonin |
| Because bupropion does not act on serotonin it | doesn't cause nausea or weight gain |
| Bupropion does not act on | Histamine |
| Histamine causes | sedation |
| Bupropion dosing | short half-life so dose often |
| Bupropion contraindications | Epilepsy and recent MAOI use |
| Bupropion indications | increase efficacy of SSRI/SNRI, MDD and seasonal depression, smoking cessation or nicotine dependence |
| Bupropion AE | Lowered seizure threshold, worse suicidality <25, CNS stimulant, Dopaminergic, and pharyngitis/rhinitis |
| Bupropion CNS stimulant AE | insomnia, agitation, anxiety, dry mouth |
| Bupropion dopaminergic AE | nausea and psychosis |
| Tricyclic antidepressant MOA | inhibit reuptake of both serotonin and norepi, muscarinic and histamine antagonist |
| Tricyclic antidepressant indications | depression, insomnia, neuropathies and pain, insomnia and anxiety, migraine prophylaxis, urge incontinence, bipolar, panic attacks, ADHD |
| Tricyclic antidepressants contraindications | MAOI use, cardiac history, seizure hx |
| Tricyclic antidepressant AE | toxicity, anticholinergic, antihistamine, alpha 1, serotonergic, prolonged QT, increased suicidality <25 |
| Tricyclic anticholinergic AE | Dry, tachy, mydriasis, orthostatic hypotension |
| Tricyclic antihistamine AE | sedation, drowsy, increased appetite, weight gain, confusion |
| Tricyclic antidepressant Alpha 1 AE | Orthostatic hypotension and dizzy |
| Best was to assess tricyclic antidepressant toxicity | QT |
| Anticholinergic tricyclic overdose signs | |
| Cyproheptadine MOA | Serotonin agonist |
| Cyproheptadine indication | Serotonin syndrome to improve autonomic instability |
| Cyproheptadine AE | Sedation and transient hypotension |
| Lithium avoided in | renal disease |
| Valproate avoided in | liver disease |
| Valproic acid and Carbamepine used for | Bipolar 1 - rapid cycling or mixed features |
| Quetiapine med class | 2nd gen atypical antipsychotic |
| Aripiprazole med class | 2nd gen atypical antipsychotic |
| Olanzapine med class | 2nd gen atypical antipsychotic |
| Risperidone med class | 2nd gen atypical antipsychotic |
| Lurasidone used for | bipolar depression |
| Quetiapine used for | bipolar depression |
| Cariprazine used for | bipolar depression |
| Olanzapine-Fluoxetine used for | bipolar depression |
| Valproate used for | Refractory bipolar depression |
| Delusion | Fixed belief of an external reality despite evidence to the contrary |
| Non-bizarre delusions | False belief that is plausible but highly unlikely |
| Most common hallucination with schizophrenia | Auditory |
| Auditory hallucinations | Sounds or voice, 3rd person voice, or command hallucinations |
| types of hallucinations | auditory, visual, olfactory, tactile, somatic, gustatory |
| Visual hallucinations | simple (flashing light) or complex (seeing faces) |
| Olfactory hallucinations | stench or foul smells |
| Tactile hallucinations | Insects on skin or being touched |
| Somatic hallucinations | Sensation arising from within body |
| Gustatory hallucinations | Can be part of persecutory delusions (tasting poison in food) |
| Types of delusions | Persecutory, reference, control, grandiose, nihilism, erotomania, jealousy, doubles |
| Persecutory delusion | Person or force is interfering with them, observing them or wishes harm to the patient |
| Delusion of reference | Random evens take on personal significance |
| Delusion of control | Some agency takes control of the patient's thoughts feelings or behaviors |
| Delusion of grandiosity | Unrealistic beliefs in one's powers and abilities |
| Delusion of nihilism | Exaggerated belief in the futility of everything and catastrophic events |
| Delusion of erotomania | Believes another person is in love with them |
| Delusion of jealousy | Somebody is suspected of being unfaithful |
| Delusion of doubles | Believes family member or close person has been replaced by identical double |
| Positive symptoms | added to normal behavior |
| Examples of positive symptoms | Delusions, hallucinations, disorganized speech, behavioral disturbances |
| Hallucinations | sensory perception without physical stimuli |
| Disorganized speech | thoughts are disconnected, tangential, and rambling |
| Negative symptoms | take away from behavior |
| Examples of negative symptoms | Absence of normal cognition, affect flat, alogia, avolition, anhedonia, asociality |
| Absence of normal cognition | Impairment in attention, working memory, and executive function |
| Affect flattening | Poor eye contact, unchanging facial expression, little change in affect, little spontaneous movement, lack of vocal inflection |
| Alogia | Poverty of speech, increased latency of response |
| Avolition | lack of will- poor hygiene/grooming, anergy, failure of proper role responsibility |
| Anhedonia | Lack of interest in stimulating activities, intimacy, or sex |
| Asociality | Failure to engage with others socially, socially withdrawn |
| Meds that reduce risk of dystonia and severe EPS in acute schizophrenia | Diphenhydramine or benztropine |
| Serotonin Modulators | Trazidone, Nefadidone, Vilazodone, Vortixetine |
| Serotonin modulator MOA | Antagonist - postsynaptic 5HT2A and 5HT2C and presynaptic, and agonist, Alpha 1 adrenergic antagonism |
| Special about trazidone | Reduces levels of other neurotransmitters associated with arousal |
| Serotonin modulators indications | Antidepressant w anxiolytic hypnotic effects (insomnia) |
| Because tradidone reduces levels of other neurotransmitters associated with arousal it does not affect | REM sleep, cause anxiety, insomnia, or sexual adverse effects |
| AE of Serotonin modulators | sedation, dry, orthostatic hypotension, headache, priapism, increased suicidality <25 |
| Nefazodone black box | Fulminant hepatis |
| Most common AE of serotonin modulators | Sedation |
| Tetracyclic | Mirtazapine |
| Tetracyclic MOA | Alpha 2 adrenergic receptor antagonist, histamine H1 receptors, antagonist postsynaptic serotonin, muscarinic receptor antagonist (4 things) |
| How does tetracyclic affect Alpha 2 adrenergic receptor | Increased release of the amine serotonin and norepi |
| Because tetracyclics have high affinity for H1 | Sedative/calming affect |
| Tetracyclic serotonin postsynaptic receptors | 5-HT2A, 5-HT2C, 5-HT3, and 5-HT1A |
| Indications for Tetracyclic | Depression with insomnia or weight loss or anxiety |
| Benefits of tetracyclic | Fewer sexual affects |
| AE of Tetracyclic | Antihistaminic- drowsy, sedation, weight gain, dry, increased risk suicidality |
| Tetracyclic contraindications | Use with MAOI |
| MAOI nonselective | Tranylcypromine, phenelzine, isocarboxazid |
| MAO B only | Seleeiline |
| MAOI MOA | Breakdown neurotransmitters and inhibit monoamine oxidase which in turn increase norepi, serotonin, dopamine, epi, and tyramine |
| MAOI indications | Refractory or atypical depression or refractory anxiety |
| AE of MAOI | Orthostatic hypotension, insomnia, anxiety, weight gain, sexual dysfunction, CNS stimulant, hypertensive crisis if ingest tyramine foods |
| MC AE of MAOI | Orthostatic hypotension |
| Tyramine foods to avoid in MAOI usage | aged/fermented cheese, smoked meats, red wine, beer |
| Drug interactions with MAOI | Increased risk for serotonin syndrome if combined with SSRI or SNRI |
| How long to be off of MAOI before starting most SNRI/SSRI | 2w |
| How long to be off MAOI before starting fluoxetine (prozac) | 5w |
| Tricyclic antidepressants MOA | Inhibit reuptake of both serotonin and norepi and competitive antagonist on post synaptic andrenergic, muscarinic, and histamines |
| Tricyclic antidepressant adrenergic receptors | Alpha 1+2 |
| Tricyclic antidepressant histamine receptors | H1 |
| Tricyclic antidepressant indications | Depression, insonia, neuropathies and pain, anxiety, migrane propholaxis, urge incontinence, bipolar, panic attacks, phobic disorders, ADHD |
| Tricyclic antidepressant anticholinergic AE | Dry, tachy, mydriasis, orthostatic, confusion |
| Tricyclic antidepressant antihistamine AE | Sedation, drowsy, increased appetite, weight gain, and confusion |
| Tricyclic antidepressant adrenergic AE | orthostatic and dizzy |
| Tricyclic antidepressant serotonergic AE | Sexual dysfunction |
| Best way to assess Tricyclic antidepressant toxicity | QT |
| Contraindications for Tricyclic antidepressants | MAOI use, cardiac hx, and seizure hx |
| Tricyclic antidepressant OD symptoms | Cardiotoxicity, Convulsions, Coma |
| Treat tricyclic antidepressant cardiotoxicity w | Sodium bicarb |
| Treat tricyclic antidepressant convulsions w | Benzos, not phenytoin |
| Tertiary amines | Amitriptyline, Doxepin, Imipramine, Amoxapine, Clomipramine |
| Secondary amines | Desipramine, Nortriptyline, Maprotiline |
| Most cholinergic amines | Amitriptyline and Doxepin |
| Amitryptyline active metabolite | Nortriptyline |
| Imipramine active metabolite | Desipramine |
| Amitriptyline is best TCA for | Neuropathy and chronic pain due to Na block and sedative |
| Doxepin is best TCA for | Chronic pain and sleep aid in low dose |
| Imipramine is best TCA for | Enuresis in children and panic disorder |
| Clomipramine is best TCA for | OCD >10y, most serotonin specific |
| Desipramine is best TCA for | least sedating and least cholinergic |
| Nortriptyline is best TCA for | chronic pain, best tolerates, least likely to cause orthostatic |
| Best TCA for elderly | Nortriptyline |
| Bupropion is also known as | Wellbutryn or Zyban |
| Bupropion MOA | Norepinephrine Dopamine reuptake inhibitor- simulating nicotine |
| Bupopion does not affect | Serotonin or histamine |
| Bupropion indications | increase efficacy of SSRI/SNRI, MDD and seasonal depression, smoking cessation or nicotine dependence |
| Bupropion AE | Lowered seizure threshold, worse suicidality, CNS stimulant, dopaminergic affects, pharyngitis or rhinitis |
| CNS AE of bupropion | insomnia, agitation, anxiety, or dry mouth |
| Dopaminergic AE of bupropion | nausea and increased psychosis |
| Bupropion contraindications | Epilepsy/increased seizure risk (eating disorder), MAOI in last 14d, psychosis at high dose |
| SSRI MOA | increased CNS serotonin, inhibit presynaptic serotonin reuptake by blocking 5HT1A, prolonging synaptic serotonin |
| SSRI AE | sleep impairments, sexual dysfunction, headache, change in energy, dry mouth, CNS stimulation, increase SI <25 |
| SSRI CNS stimulation AE | weight change, serotonin syndrome, SIADH |
| To fix sexual dysfunction caused by SSRI | Lower dose, switch meds, add bupropion on phospodiesterase-5-inhibitor |
| SSRI indications | depression, anxiety, PTSD, OCD, panic disorder, PMS/PMDD |
| Meds in SSRI class | Fluoxetine, Paroxetine, Citalopram, Escitalopram, Sertraline, Fluvoxamine, Vilazodone |
| Fluoxetine facts | Only SSRI for Bulimia, 1/2 life 2-4d, lowest risk of weight gain, approved in peds for OCD |
| Paroxetine facts | Known for weight gain, sexual dysfunction, antihistaminic, and anticholinergic |
| Citalopram facts | Known for QT prolongation |
| Escitalopram facts | Known for less weight gain |
| Sertraline facts | causes delayed ejaculation, approved in peds OCD |
| Fluvoxamine facts | Approved in peds OCD |
| SNRI MOA | Block presynaptic reuptake of norepi and serotonin, increase dopamine levels |
| Indications for SNRI | GAD or depression |
| #1 med for depression and neuropathic pain | Duloxetine |
| AE of SNRI | Hyponatremia, GI, headache, fatigue, sleep impairment, dry mouth, sexual dysfunction, SI, sweating, dizzy, dry, constipated, CNS stimulant |
| SNRI contraindications | MAOI use, renal/hepatic impairment, seizures |
| When to use SNRI w caution | HTN, Glaucoma, other serotonin meds |
| SNRI meds | Duloxetine, Venlafaxine, Desvenlafaxine, Levomilnacipron, Milnacipran |
| Venlafaxine SNRI known for | Lower effect on Norepi, dont use if HTN |
| Advantages of haloperidol, fluphenazine, and perphenazine | Less sedation and Hypotension, come in long-acting deposits, given IM in acute psychosis |
| Disadvantages of haloperidol, fluphenazine, and perphenazine | Extrapyramidal symptoms |
| First gen typical anti-psychotics | Haloperidol, fluphenazine, perphenazine, chlorpromazine, and thioridazine |
| Chlorpromazine advantages | Lower frequency extrapyramidal AE |
| chlorpromazine disadvantages | Greater incidence of anticholinergic sedation and corneal deposits |
| thioridazine disadvantages | Retinal deposits and prolonged QT |
| Varenicline MOA | Block nicotine receptors to reduce nicotine activity, partial agonist on Alpha 4 Beta 2 |
| Best treatment to quit smoking | Varenicline |
| AE of Varenicline | Nausea, disordered sleep, increased SI, neuropsychic conditions |
| Most common AE of Varenicline | Nausea |
| Nicotine replacement therapy examples | gum, nasal spray, lozenges, patch, inhaler |
| Nicotine replacement therapy dosage | Based on number they smoke a day |
| Best use of nicotine replacement therapy | Long and short acting combined |
| Considered standard of care for stopping smoking | 2 Nicotine replacements |
| Lithium MOA | Exact is unknown, thought to alter neuronal sodium transport and influence reuptake of serotonin and norepinephrine, inhibits phosphoinositide recycling |
| Lithium indications | Bipolar - acute mania or mood stabilizer, Decrease SI, and Schizoaffective |
| Lithium AE | Endocrine, neurologic, GI, cardiac, and hematologic |
| Lithium endocrine AE | hypo parathyroid, hyperglycemia, hypermagnesemia, AVD/ADH, hypothyroidism |
| Lithium neurologic AE | Tremor, headache, seizures |
| Lithium GI AE | Nausea, vomit, weight gain |
| Lithium cardiac AE | edema and arrhythmia |
| Lithium hematologic AE | Leukocytosis |
| Lithium therapeutic index | toxic above >1.5 |
| Lithium contraindications | Pregnancy, severe renal disease, drug interactions |
| Lithium in pregnancy can cause | Ebstein anomaly |
| Lithium drug interactions - increase blood levels | Dehydration, thiazide, tetracycline, NSAIDs, and ACEi |
| Lithium drug interactions- decrease blood levels | Bronchodilators, verapamil, theophylline, carbonic anhydrase inhibitor |
| Risperidone | Uzedy |
| Risperidone AE | movement disorders and hyper prolactin |
| Risperidone indications | Schizophrenia and bipolar |
| Risperidone is processed in liver to | Paliperidone |
| Quetiapine known for | lower extrapyramidal symptoms |
| Quetiapine AE | QT prolongation |
| Quetiapine indication | Schizophrenia |
| Olanzapine AE | weight gain, dyslipidemia, DM, orthostatic hypotension, transaminase elevated |
| What to check on with olanzapine | Lipids |
| Olanzapine indications | Schizophreia |
| #1 med for refractory schizophrenia | Clozapine |
| Clozapine works on | D4 and 5HT2A receptor |
| Clozapine is not first line due to | agranulocytosis, myocarditis, seizures, metabolic syndromes, or anti muscarinic |
| Clozapine has decreased risk for | suicide or depression and TD |
| Before starting clozapine check | Neutrophils >1500 and CBC |
| Ziprasidone | Geodon |
| Ziprasidone AE | Higher risk QT prolongation |
| Ziprasidone is known for | less likely to cause significant weight wain and metabolic affect |
| Ziprasidone indications | Schizophrenia and delusional disorder |
| Lurasidone is known for | safest antipsychotic in pregnancy and less sedation |
| Lurasidone AE | Higher risk akathisia and antihistamine AE |
| Lurasidone indications | Bipolar or schizophrenia |
| Ariprazole | Abilify |
| Ariprazole MOA | partial D2 and 5HT1A agonist and 5HT2A antagonist |
| Ariprazole is known for | little to no metabolic effect and less sedation |
| Ariprazole AE | increased risk akathisia, antihistamine AE |
| Ariprazole indications | schizophrenia and delusional disorder |
| 2nd gen antipsychotics | Risperidone, Quetiapine, Olanzapine, Clozapine, Ziprasidone, Lurasidone, Ariprazole, Cariprazine, |
| Antipsychotic AE | Extrapyramidal, hyperprolactinemia, metabolic, QT prolongation, Neuroleptic malignant syndrome |
| Breaking rules/age appropriate norms | running away, skipping school, mischief, pranks, early sexual activity |
| Aggressive conduct | Fights, bullying, or intimidating, cruelty to others or animals, rape or molestation |
| Destructive conduct | destroying property or fire setting |
| Deceitful | lying, theft, shoplifting, delinquency |
| Dantrolene | Muscle relaxant, blocks Ca2+ |
| Medication for Neuroleptic Malignant rigidity and fever | Dantrolene |
| Modanifil | Wake promoting medication, improved control of sleepiness, and promotes wakefulness into early evening |
| Modanifil MOA | unknown, thought to inhibit dopamine reuptake |
| Modanifil AE | HA, dry mouth, diarrhea, decreased appetite, nausea, increase blood pressure |
| Solriamfetol | Oral selective dopamine and norepi reuptake |
| Ideas of reference | Misinterpretation of incident as having direct personal reference |
| Opiates | drug derived from alkaloids of opium poppy |
| Opioid class of drugs | opiates, opioid peptides, all synthetic, and semisynthetic |
| Biots breathing symptom of | Opioid intoxication |
| Biots breathing | groups of quick shallow breathing followed by regular or irregular period of apnea |
| ADHD characteristics | neurodevelopmental disorder w persistent inattention, impulsive, and hyperactivity that is not age appropriate |
| Adults w ADHD manifestations | Procrastination, mood instability, low self-esteem, more impulsive or inattentive |
| ADHD inattentive symptoms | Maintaining attention, doesnt appear to lisen, doesnt pay close attention to detail, careless mistakes, easily distracted, loses things, struggles to follow instructions, avoids or dislikes tasks that require thinkings |
| ADHD hyperactive/impulsive symptoms | engage w activity quietly, fidget w hands or feet, climb excessively, restless, difficulty staying seated, blurts out, interrupts others |
| Onset of ADHD | <12 years old |
| ADHD chemical imbalance | Norepi and dopamine- smaller frontal cortex, cerebellum, subcortical, prefrontal, and parietal |
| Sub categories of ADHD | combined, predominantly inattentive, predominantly hyperactive |
| Combined ADHD | hyperactive/impulsive and inattentive >6m |
| Predominantly inattentive ADHD time requirement | 6m |
| Predominantly hyperactive/impulse ADHD time requirement | 6m |
| Rx ADHD >6yr | meds w behavior therapy - rapid onset and safety |
| Number one med for ADHD | Stimulants |
| Stimulant medications | Dexmethylphenidate, Methylphenidate, Amphetamines, Dextroamphetamines |
| Rx for pt w ADHD and hx substance use | Nonstimulants |
| Autism | spectrum of developmental disorders characterized by impairment in social interaction or communication, restricted, repetitive, or stereotyped behaviors |
| Larges clue of autism | Deterioration of social and or language skills during first two years |
| Autism social interaction difficulties | emotional discomfort or detachment, lack of sharing interests, lack of awareness/understanding thoughts/feelings of others |
| Autism impaired communication | inability to communicate/choose not to, difficulty understanding what is not explicitly stated |
| Autism restricted/repetitive/stereotyped behavior | rocking, flapping, spinning, insistent on sameness/routine, fixed interest |
| Most common genetic link to autism | Fragile X |
| Autism assessments | Autism diagnostic interview-revised or Autism diagnostic observation schedule |
| Primary goals of autism rx | decrease patient deficit and family distress, maximize function and increase independence, improve quality of life |
| Stages of grief | denial, anger, bargaining, depression, acceptance |
| Abnormal grief symptoms | >1yr, SI, or hallucinations people think are real |
| Persistent complex bereavement timeline | >1yr in adults and 6m in children |
Created by:
kendallmk