Manejo Racional de Psicofármacos en la Mujer - IGBA

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Luteal phase administration of agents for the treatment of premenstrual dysphoric disorder. Freeman EW CNS Durgs 2004;18(7):453-68 This review focuses on current information about luteal phase administration (i.e. typically for the last 2 weeks of the menstrual cycle) of pharmacological agents for the treatment of premenstrual dysphoric disorder (PMDD). Compared with continuous administration, a luteal phase administration regimen reduces the exposure to medication and lowers the costs of treatment. Based on evidence from randomised clinical trials, SSRIs are the first-line treatment for PMDD at this time. Of these agents, sertraline, fluoxetine and paroxetine (as an extended-release formulation) are approved by the US FDA for luteal phase, as well as continuous, administration. Clinical trials of these agents and citalopram have demonstrated that symptom reduction is similar with both administration regimens. When used to treat PMDD, SSRI doses are consistent with those used for major depressive disorder. The medications are well tolerated; discontinuation symptoms with this intermittent administration regimen have not been reported. Other medications that have been examined in clinical trials for PMDD or severe premenstrual syndrome (PMS) using luteal phase administration include buspirone, alprazolam, tryptophan and progesterone. Buspirone and alprazolam show only modest efficacy in PMS (in some but not all studies), but there may be a lower incidence of sexual adverse effects with these medications than with SSRIs. Symptom reduction with tryptophan was significantly greater than with placebo, but the availability of this medication is strictly limited because of safety concerns. Progesterone has consistently failed to show efficacy for severe PMS/PMDD in large, randomised, placebo-controlled trials
¨¨Perlas¨¨ a tener en cuenta en todo tratamiento con ATD • 50% de los pacientes o no reciben una dosis adecuada o no están tratados por un período de tiempo adecuado con ATD • 10–20% de pacientes presentan intolerancia inicial transitoria. • 25–30% de pacientes que completan un tratamiento adecuado no muestran una respuesta aceptable. • Las estrategias para lograr la remisión incluyen: – Maximizar la dosis tolerada. – Switching a una clase ATD diferente – Combinar diferentes ATD.
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Manejo Racional de Psicofármacos e
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Behavioral health care integration
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Continuous or intermittent dosing w
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Secuencia clínica progresiva Estr
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Relación Circular Ansiedad / Enfer
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TRASTORNOS POR ANSIEDAD. • Trasto
Page 13 and 14: Criterios fundamentales para el Epi
Page 15 and 16: DIAGNÓSTICOS DIFERENCIALES • Tra
Page 17 and 18: Comorbilidad Ansiedad \ Depresión
Page 19 and 20: Componentes Centrales del Sistema d
Page 21 and 22: Locus Coeruleus SNS Corteza prefron
Page 23 and 24: Ansiedad, Depresión y Neurogénesi
Page 25: Los puntos oscuros indican neuronas
Page 28 and 29: Estrés, Hipocampo, y Glutamato Mc
Page 30: Atrofia de neuronas hipocámpicas e
Page 35 and 36: Alteraciones estructurales en el hi
Page 37: Factores de Crecimiento Neuronal
Page 40 and 41: Farmacología Racional de los Trast
Page 42 and 43: FUNCIONES GABA • Sedante, anticon
Page 45 and 46: Clasificación de las BZD
Page 47 and 48: Método de empleo seguro • Inicio
Page 49 and 50: Efectos secundarios y Toxicidad •
Page 51: Dosis Efecto Tiempo Horas \ Días D
Page 55 and 56: DISFUNCIÓN rCR/ HIPERACTIVIDAD CRF
Page 57 and 58: Clasificación de los ATD • Inhib
Page 59 and 60: Elección del ATD • Evaluación d
Page 61 and 62: • Eficacia: Terapia con IRSS - Pr
Page 63: El problema del ¨¨Switch¨¨ Man
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Manejo Racional de Psicofármacos en la Mujer - IGBA

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