Interactions
Enzyme that converts codeine to morphine and tamoxifen to endoxifen
What is 2D6?
Antipsychotic that can reduce prolactin levels
What is aripiprazole?
Minimum length of a hypomania by DSM V
4 days
Average time frame for seeing initial improvement from antidepressants
2 weeks, if no response by 2-3 weeks then at least 70% chance of NON RESPONSE to this med at this dose.
2 factors that drive sleep
Homeostatic drive
Circadian Rhythms
Adding amitriptyline to benztropine and then adding benadryl potential class of side effects:
What is anticholinergic
4 antipsychotics licensed as ADJUNCT treatment for depression not responding to antidepressant monotherapy
What is:
abilify, brexpiprazole, cariprazine, quetiapine
26 year old male with 3 days of not sleeping, talking fast, impulsive spending, thinks he is "Superman," hears the voice of Batman talking to him, then is hospitalized. Diagnosis?
Bipolar I-- psychotic mania, length of time doesn't count as he was hospitalized.
Name 3 agents for augmentation that can be added to an antidepressant
SGAs: abilify/brexpiprazole/cariprazine/quetiapine
Lithium
T3
Pramipexole
L methyl folate
Very popular medicine for insomnia NOT approved by American Academy of Sleep Medicine
trazodone
Patient on high dose fluoxetine takes tramadol prn for pain and then adds dextromethorphan for a cough, gets sweats, shaky, nausea, twitching. Name the cause:
What is serotonin syndrome
2 antipsychotics that are bimodal in action when used in bipolar disorder
Quetiapine
Cariprazine
Target lithium level for a euthymic bipolar patient who is 35 years old.
.6 to .8
Evidence based combination of 2 antidepressants
SSRI/SNRI + mirtazepine
CBTi includes
Sleep hygiene, Relaxation training, Cognitive reframing, stimulus control, sleep restriction. Which one of these is least effective as a stand alone treatment
Sleep hygiene
23 year old female on OCPs , starts on Carbamazepine for mania. Two months later reports nausea in the morning. What happened?
Carbamazepine induced 3A4 which metabolizes estrogen leading to birth control failure and pregnancy.
2 antipsychotics specifically studied for bipolar II depression
Quetiapine
Lumateperone
Name 2 med combos that are superior to monotherapy in bipolar depression
Lithium + lamotrigine better than Lithium
Quetiapine + lamotrigine better than Quetiapine
Antidepressants with minimal sexual side effects (4)
bupropion
mirtazapine
vilazodone
vortioxetine
Name 3 medications that can help reduce mid cycle insomnia
Eszopiclone
Doxepin
Any of the 3 DORAs
What does Valproic Acid do to Lamotrigine levels?
What does Estrogen do to Lamotrigine levels:
Raise them
Lower them
2 antipsychotics NOT known to cause Tardive Dyskinesia
Clozapine
Xanomeline/Trospium
Antipsychotic used for bipolar depression with least potential for weight gain
Lumateperone (Caplyta)
This improves processing speed independent of its antidepressant effects
Vortioxetine
Lab to check if a patient reports unpleasant feelings in their legs upon going to bed
What is ferritin/iron studies?