Exam 2 Pharmacology Flashcards

• Top reason for disability in the US
• Complication: death by suicide

Types:

• Panic disorder
• GAD
• OCD
• social anxiety
• PTSD

Screening tools:

• PHQ-2
• PHQ-9
• Depression Inventory
• Zung Depression Scale
• Mood Disorder Questionnaire

PCP first to identify anxiety/depression treatment

Important to screen, early detection & identification, assessment, treatment, referral

Structures involved

cerebral cortex, frontal lobes, brain stem, basal nuclei, limbic system, endocrine system, genetic factors, environmental factors

Depression

Deficiency in NT

Dysregulation of brain circuits in different parts of the brain

• problems processing in the areas of amygdala & prefrontal cortex

Anxiety

dysfunction in circuits of amygdala

chronic stress= atrophy of hippocampus and amygdala

Seratonin

NE

Dopamine

GABA

Achy

Remission of MDD

Titrate to optimal doses reach remission

Achieving remission may take up to 14 weeks

Use other options if available (therapy)

Augment with exercise and cognitive behavioral therapy

GAD

• First line drug is SSRI

Panic Disorder

• First line of drug is Antidepressants
  • Citalopram, Sertraline, Paroxetine, Fluoxetine, Desvenlafaxine, Vilazodone, Vortioxetine, Venlafaxine

PTSD

• First-line treatment: Sertraline, Paroxetine
• Clonidine, propranolol, prazosin

Reduction of symptoms

Self management of symptoms w/out medications

Understanding etiology/contributing symptoms

Patient education

• Providing coping skills

Timing

• Transient - Few days
• Short term- 2-3 weeks
• Chronic
• Sleep hygiene measures should always be tried first

Children & Adolescents:

• SSRI approved for kids
  • Fluoxetine
  • Escitalopram
  • Fluvoxamine
  • Sertraline
• Use half the adult dose
• Assess for SI- can increase risk w/ Q drug initiation and dose titration

Older Adults

• Start low and go slow
• Avoid Benzos
• Consider medical comorbidities & Drug interactions

Antidepressants can cause:

• mild congenital abnormalities
• low-birth weight
• premature deliveries
• cardiac malformations
• PAROXETINE during first trimester= pulmonary HTN in newborns

Untreated depression = poor neonatal outcomes & poor self care

• screen for post partum depression

Discuss risk & benefits before pregnancy

• Exercise
• CBT
• Exposure therapy
• Eye movement desensitization and reprocessing
• Psychotherapy

TI: .6-1.5

15-36 hours- long half life

5-7 days

DSM-V Diagnostic Criteria:

• Persistent pattern across settings of inattention
• Hyperactivity
• Impulsivity

Screening Tools

• Vanderbilt for Children
• WHO Adult ADHD Self Report Scale & Diagnostic Interview for ADHD in Adults (DIVA2.0)

Genetics

• 28% of ADHD accounted for genetics

Environmental Factors

• Low birth weight
• Prenatal complications
• Malnutrition

American Academy of Pediatrics

• Children
  • Children < 5 behavioral therapy
  • Children > 6 first line treatment is stimulants
  • Children 6-11 CBD therapy + medications
• Adolescents
  • First line tx behavioral therapy

** can start intermediate release then titrate to start them on XR

• BEHAVIORAL THERAPY FIRST
• Dextroamphetamine FDA approved
• AAP guidelines: methylphenidate safe & effective in preschool age group
  • use short term formulas to allow for more precise dosing & adjustments

• STIMULANTS first line drug
• Choice based on formulation, duration of action, & parent preference
• If one class of medications does not work, change to another class
• PERMIT DRUG HOLIDAYS IF NOT GAINING WEIGHT (spring break, winter break, weekends)
• MONITOR FOR ADEQUATE SLEEP

Teens

• stimulants first
• long acting meds
• protentional for abuse & diversion

Adults

• Stimulants first
• Atomoxetine second line
• Long acting alpha agonist may be used as adjunctive to treat sleep issues BC SE IS DROWSINESS

Migranol: feverfew, riboflavin, magnesium, vitamins

Acupuncture

Aromatherapy

Hypnosis

Reflexology

Massage

Yoga

Ice

Do a migraine diary

Use nonpharmacologic measures

Need to create migraine diary for effect track of medication effectiveness

Expectations of treatment

• Medication administration, ADR, Interactions, Max dose, medication overuse headache
• OTC should not be used unless part of the treatment plan

• Band like pressure
• Persistent dull pain
  • PAIN IS NOT MADE WORSE BY EXCERCISE
• Last 30 minutes - 7 days
• Goal: decrease frequency & severity

• Mild analgesics (Tylenol NSAIDs, ASA)
  • Acetaminophen for pregnant people

PREVENTION MEDICATIONS

• Beta Blockers
• Tricyclic Antidepressants
• SNRIs

NON PHARM

• Stress management
• Exercise
• Heat/Ice
• Acupuncture
• Trigger point injections
• Biofeedback

• Intense HA for 15 minutes- 2 hours
• Occurs in clusters, intense pain, not true known cause
• Pain around one eye, excessive lacrimation & redness in eye on the side of the HA
• Goal: relief pain & decrease length of cluster

• Tx w/ 100% O2 for 15-30 minutes
• Ergo
  • Suppositories
  • Intranasal
  • IM Dihydroergotamine
• Sumatriptan

PREVENTATIVE TX

• Verapamil
• Divalproex
• Lithium

NON PHARM

• Avoid ETOH
• Avoid Tobacco, stress, vigorous activity

• SI
• Headache diary trend

PT EDUCATION

• Diagnosis
• Self admin of medications
• ETOH avoidance

• Intranasal flu vaccine
• MMR
• Oral polovirus
• Rotavirus
• Varicella Virus Vacccine
• Herpes Zoster Vaccine
• Typhoid Vaccine
• Yellow Fever Vaccine
• BCG

Immunocompromised patients

Pregnant mothers

• PREGNANCY SHOULD BE AVOIDED ONE MONTH AFTER VACCINATION

Patients with fever illness

Diphtheria, tetanus, and pertussis vaccine
Haemophilus B conjugate vaccine
Inactivated poliovirus vaccine
Hepatitis B virus (HBV) vaccine
Hepatitis A virus (HAV) vaccine
Human papillomavirus (HPV) vaccine
Influenza vaccine
Pneumococcal vaccine

Meningococcal polysaccharide vaccine
Lyme disease vaccine
Typhoid vaccine
Cholera vaccine
Japanese encephalitis virus vaccine
Plague vaccine
Rabies vaccine

• inactivated vaccines are killed viruses
• may be coadministered with other vaccines
• no need to restart series if patient gets off schedule - catch-up schedule used instead