Peds Psych Exam 2 (part 4)

20問 • 1年前

問題一覧

Medical adverse effects of Risperidone and Levetiracetam that cause psychiatric distrubance in children and adolescence are?

Akathesia and Irritability

What drugs do we use to treat agitated, violent, or psychotic patients?

-Antihistamines -Benzodiazepines -Neuroleptics -Atypical antipsychotics

Mood stabilizers primarily for Bipolar

-Lithium -Depakote-better for childhood bipolar -Tegretol-better for childhood bipolar

SSRIs for MDD

fluoxetine, escitalopram, citalopram, sertraline

Children 7 years & older: OCD; & 8 yo for MDD (FDA approved) • Advantage: half life 48-216 hr • Inhibits 2 D6-watch with other drugs; e.g. aripiprazole

Fluoxetine (Prozac)

Approved for OCD in children 6-12 and older • Used for depression in children and older, not FDA approved yet for MDD, however •Agitation, anxiety • S/E: little wt gain, little sedation, decreased appetite, agitation, tremor, sweating, more GI upset than others • 2D6 interactions

Zoloft (sertraline)

Not recommended for children due to risk of suicidal thinking (studies) -Side effects: tremor, diarrhea, somnolence, sweating , wt. gain in some -Mild anticholinergic s/e (muscarinic) -Constipation, dry mouth, sedation

Paxil (paroxetine)

FDA approved: OCD in children >8 yo • Approved for social phobia and OCD in adults • Used MDD, Anxiety disorders • Antagonist at sigma 1 receptors •Sedation and fatigue S/E •Rapid onset in anxiety & insomnia

Luvox (fluvoxamine)

• Give HS to minimize sedation Half life 15 hrs. • S/E Constipation, N/V, dry mouth, HA; wt gain unusual • LFT may be affected; do weekly during 1st month • Effect on P450 3A/4; 1A2, 2X9-caution with any other meds

Luvox (fluvoxamine)

Not FDA approved in children -Higher doses can cause QTc prolongation -Highly selective to 5HT -Mild antagonist action H1 receptors -May cause sedation, fatigue, weight gain -Half life 35 hours -Caution in children!

Celexa-citolapram

Inhibits CYP450 3A4, 1A2, 2C9/2C19 •Raise levels of theophylline & clozaril–P450 IA2 •Raise levels of carbamazepine & benzos–P450 3A4 •Raise levels of pimozide (3A4) •Caution re drug–drug interactions !

Luvox (fluvoxamine)

Isomer of citalopram “S” version -Highly selective SSRI -Start 5 mg or 2.5mg, can increase to 10 mg -Available 5 mg/5 ml -Now FDA approved in teens for MDD ages 12-17 years

Lexapro (escitalopram oxalate)

SSNRI, less potent inhibitor of dopamine re-uptake elevated liver enzymes -Not approved for use in children due to risk of hostility and suicidal ideation -½ life 12 hours

Cymbalta (duloxetine)

SNRI • New warning in children-hostility, suicidality (avoid use), self harm • Not for use in children with MDD or GAD • Taper slowly

Effexor (venlafaxine)XR

SNRI- not FDA approved in children/teens • S/E: nausea, dizziness, sweating, constipation, ↓ appetite • Monitor BP-may cause elevation diastolic BP • Caution re use of NSAID, ASA, warfarin • Lower incidence sexual side effects? • Not approved for children <18 years

Pristiq (desvenlafaxine)

NaSSA-noradrenergic and specific serotenergic antidepressant • Increases release of serotonin and norepinephrine by blocking presynaptic alpha2 adrenergic receptors that inhibit release • Blocker of 5 HT2 and 5HT3 also • S/E Weight gain and sedation—give at HS • For teen with poor sleep, poor appetite with weight loss S/E: Somnolence, wt. gain, increased appetite, cholesterol elevation, dizziness, agranulocytosis, neutropenia • Avoid CNS depressants, including benzodiazepines

Remeron (mirtazapine)

NDRI-Blocks reuptake of norepinephrine and dopamine • Not approved for children; used off label for depression • ADHD or ADHD with depression -some use >6yo • Smoking cessation in adolescents • CYP 2D6 inhibitor (see fluvoxamine) • Metabolite ½ life is 20-27 hours • Not used if history of seizure or eating disorder • Dose 150 mg XL Increase up to 300 mg XL • S/E Agitation, Nausea, Insomnia; vivid dreams

Buproprion (Wellbutrin)

Not for use in children under 12 • Can be used off label in teens with MDD • Boxed warning: suicidality • Avoid other antidepressants, pain meds, cough medicine to prevent Serotonin Syndrome • 6mg patch –no dietary restrictions • 9mg and 12 mg no tyramine foods (hypertensive crisis) • Risk: postural hypotension, potential for cognitive impairment, Pregnancy Category C • S/E site reaction, headache, insomnia, diarrhea, dry mouth, rash, pharyngitis, sinusitis

Selegiline (Emsam)

These SSRIs have no contraindications in children

fluoxetine, sertraline, escitolapram, fluvoxamine

These meds have no proof of efficacy in children

paroxetine, citalopram, TCA, and venlafaxine

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