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Exam 2 Pharmacology

front 1 Major depressive disorder Complications?	back 1 Top reason for disability in the US Complication: death by suicide
front 2 Anxiety What are different types?	back 2 Types: Panic disorder GAD OCD social anxiety PTSD
front 3 Screening tools for depression	back 3 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
front 4 Anxiety and Depression Nuerobiology?	back 4 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

front 5 What are NT involved in mental health	back 5 Seratonin NE Dopamine GABA Achy
front 6 What is the goal of treatment for depression?	back 6 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
front 7 Treatment of Anxiety What is first line of treatment for GAD, Panic Disorder, and PTSD?	back 7 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
front 8 Goals for treatment of Anxiety	back 8 Reduction of symptoms Self management of symptoms w/out medications Understanding etiology/contributing symptoms Patient education Providing coping skills

front 9 What is insomnia?	back 9 Timing Transient - Few days Short term- 2-3 weeks Chronic Sleep hygiene measures should always be tried first
front 10 Special Populations What are considerations for Children & Adolescents? What are consideration for older adults?	back 10 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
front 11 Special Populations What are considerations for pregnant females?	back 11 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
front 12 What are nonpharmacological tx for depression?	back 12 Exercise CBT Exposure therapy Eye movement desensitization and reprocessing Psychotherapy

front 13 What is Lithium: Therapeutic Index Half Life and Steady State	back 13 TI: .6-1.5 15-36 hours- long half life 5-7 days
front 14 What are screening tools for ADHD?	back 14 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)
front 15 What are causes of ADHD Genetics & Environmental?	back 15 Genetics 28% of ADHD accounted for genetics Environmental Factors Low birth weight Prenatal complications Malnutrition
front 16 What are Evidence Based Guidelines for ADHD treatment by AAP?	back 16 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

front 17 Rationale Drug Selection for Preschoolers	back 17 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
front 18 Rationale Drug Selection for School Age Children	back 18 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
front 19 Rationale Drug Selection for Adolescents & Adults	back 19 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
front 20 What are nonpharmacologic treatments for Migraines? How can the patient keep track of migraines?	back 20 Migranol: feverfew, riboflavin, magnesium, vitamins Acupuncture Aromatherapy Hypnosis Reflexology Massage Yoga Ice Do a migraine diary

front 21 What do you educate patients regarding migraines	back 21 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
front 22 What is a tension HA? How long does it last? What is the goal of therapy?	back 22 Band like pressure Persistent dull pain PAIN IS NOT MADE WORSE BY EXCERCISE Last 30 minutes - 7 days Goal: decrease frequency & severity
front 23 What medications would you consider to Tx Tension HA? What are nonpharmacologic methods of treatment?	back 23 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
front 24 What are cluster HA? Where is the pain located? What are the goals of therapy?	back 24 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

front 25 What are medications to treat Cluster HA? What are preventative Tx & Nonpharmacological?	back 25 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
front 26 What do you need to monitor for Cluster HA? What do you need to educate?	back 26 SI Headache diary trend PT EDUCATION Diagnosis Self admin of medications ETOH avoidance
front 27 What are Live vaccines?	back 27 Intranasal flu vaccine MMR Oral polovirus Rotavirus Varicella Virus Vacccine Herpes Zoster Vaccine Typhoid Vaccine Yellow Fever Vaccine BCG
front 28 What are contraindications of Live Vaccines	back 28 Immunocompromised patients Pregnant mothers PREGNANCY SHOULD BE AVOIDED ONE MONTH AFTER VACCINATION Patients with fever illness

front 29

What are inactivated vaccines?

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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

front 30

What are things to consider and education about inactive vaccines?

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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

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Exam 2 Pharmacology