3/29 psych Flashcards
Relationship btwn p-value & alpha
-so .05 is the alpha & p is judged against it!
-so p = alpha of the experiment, and .05 is the
set alpha we want to reach!
alpha:
- rate of which type of error?
- false pos? false neg?
type 1 error
-false positive
P =
-probability of ___
probability of making a type 1 error
- alpha
- false positive
If sensitivity of FOB screen is 66%.
-tell me the sentence of what that means.
-“If the pt has colon cancer, their probability of having a positive FOB screen is 66%”.
Factitious disorder
- conscious or unconscious decision?
- aka?
- conscious
- munchausen or munchausen by proxy
Management of somatic symptom disorder:
- Schedule regular visits w/same provider. Outpatient visits. Limit unneccessary workups/referrals to specialists.
- in contrast to having symptom-driven visits.
Somatoform disorders
- intentional or unintentional?
- name the different disorders:
- unintentional.
- Somatic Sx disorder
- Conversion disorder
- Illness anxiety disorder (hypochondriasis)
Personality disorder
- are people usually aware of their disorder?
- what are the 3 clusters? mnemonic?
Nope
- A, B, and C
- Weird, Wild, and Worried based on symptoms.
Cluster A
- mnemonic:
- which ones are in cluster A?
- Weird (weird, wild, & worried).
- paranoid, schizoid, schizotypal.
Paranoid personality disorder
- which cluster?
- whats their major ego defense mechanism?
- Cluster A
- projection = immature defense.
Schizotypal
- which cluster
- menmonic?
- Cluster A
- schizoTypal = magical Thinking.
- they’re weirdos
Cluster B
- mnemonic:
- which ones are in cluster B?
- Wild (weird, wild & worried).
- Antisocial
- Borderline
- Histrionic
- Narcissistic
Borderline
- which cluster?
- describe some features:
- whats their major defense mechanism?
- cluster B
- violent swings in affect, self-mutilation for attention, impulsive, suicidal ideation. Usually a woman.
- Splitting = immature defense.
Histrionic
- which cluster?
- describe some features:
- often accompanied w/which disorders?
- cluster B
- Excessive emotionality and excitability, attention seeking, sexually provocative, overly concerned with appearance.
- Somatoform disorder.
Cluster C
- mnemonic:
- which ones are in cluster C?
- Worried (weird, wild & worried).
- avoidant, obsessive-compulsive, dependent.
Avoidant
- which cluster?
- different vs schizoid?
- describe:
- cluster C
- avoidant people DESIRE relationships, schizoid dont.
- Hypersensitive to rejection, socially inhibited, timid, feelings of inadequacy.
Obsessive-compulsive personality disorder
- which cluster?
- ego-syntonic or ego-dystronic?
-ego-syntonic: behavior consistent with one’s own beliefs and attitudes (vs. OCD).
Obsessive-compulsive personality disorder
-vs. OCD
Personality disorder:
-has no obsessions or compulsions. Not the same as
OCD anxiety disorder.
-these are perfectionists.
-they love lists, crave rules, live life by rulebook
and insist everyone else does as well.
Schizophrenic psychotic symptoms + bipolar or depressive mood disorder =
= Schizoaffective
Lanugo
- what is it?
- what disease is it associated with?
- fine body hair.
- anorexia nervosa.
Gender dysphoria
-what is it?
- Strong, persistent cross-gender identification.
- Affected individuals are often referred to as transgender.
Transsexualism
-define:
Desire to live as the opposite sex, often through surgery or hormone treatment.
Transvestism
-Paraphilia (sexual perversion), NOT gender dysphoria.
-Wearing clothes (e.g., vest) of the opposite sex
(cross-dressing).
Sleep terrors
-occur during which phase of sleep?
slow-wave sleep
*no memory of arousal.
Sleep terrors
-memory of the arousal?
No
- happens in non-REM sleep (slow wave sleep) so there is no memory of it.
- unlike nightmares which happen during REM sleep and you remember it.
Narcolepsy
-REM latency:
shortened.
-typically enter REM sleep almost immediately.
Narcolepsy
-cause
Caused by dec. orexin production in lateral hypoT.
- hypocretin-1 = orexin A
- hypocretin-2 = orexin B
Narcolepsy
-Tx:
- daytime stimulants = amphetamines, modafinil.
- nighttime sodium oxybate (GHB).
sodium oxybate
- aka?
- what does it treat?
aka GHB
-narcolepsy
Yawning, sweating, rhinorrhea
-withdrawal from what?
opioids
Which drugs decrease gag reflex?
opioids
Opioid withdrawal
-Tx:
-long-term support, methadone, buprenorphine.
Buprenorphine
-what is it?
partial opioid agonist
-used for opioid withdrawal.
Barbiturates
-withdrawal Sxs:
Delirium, life-threatening cardiovascular collapse.
Cocaine intox
-Tx:
Benzos
varenicline
- mech:
- used for:
varenicline = partial agonist at nicotinic receptor.
- Tx of nicotine withdrawal
- trade name = chantix
- may cause depression.
Which drug of abuse can activate NMJ which gives them their super-human strength. May lead to rhabdo & acute tubularnecrosis.
PCP (phencyclidine).
How long is weed detectable in urine after you stop smoking?
4-10 days
Weed
- how does it cause tachy?
- how does it cause red eye?
Can cause significant tachycardia secondary to
vasodilation & hypotension.
-vasodilation also => red eye.
Addiction to what drug inc. risk of hemorrhoids?
Heroin
Naltrexone
- what is it?
- mech?
-Long-acting opioid antagonist used for relapse prevention once detoxified.
Naloxone
-mech:
pure opioid antagonist
Bulimia
-pharm Tx:
SSRIs
phentermine
-what is it?
CNS stimulant
- appetite suppressor.
- using for more than 3 months has been linked w/development of secondary pulmonary HTN.
CNS stimulants: OD
-Tx:
acidify urine
-ammonium chloride
fenfluramine
-what is it?
CNS stimulant
- appetite suppressor.
- using for more than 3 months has been linked w/development of secondary pulmonary HTN.
How do CNS stimulants treat ADHD? Seems counter productive.
- all about the chronic use and chronic overload of amphetamines at the synpatic cleft.
- whole idea = downregulation & desensitization of the receptors.
- dont suddenly stop, you can get depressed and suicidal.
enzyme sensitization:
-what parameter changes?
dec. Km
enzyme up-reg:
-what parameter changes?
inc. Vmax
Antipsychotics: typical
- suffix?
- outlier?
-haloperidol + “-azines”.
Antipsychotics: typical
-mechanism?
- D2 blocker which inc. cAMP.
* D2 = Gi, so blocking it will inc. cAMP.
Antipsychotics
-besides psychosis & mania - what does it treat?
Tourette syndrome
Antipsychotics
-solubility?
-Highly lipid soluble and stored in body fat; thus,
very slow to be removed from body.
Antipsychotics: Extrapyramidal system side effects
-Tx:
- benztropine or diphenhydramine.
- you have low dopamine which means high ACh - so treat by inc. ACh.
- you do NOT want to treat by inc. dopamine, bc psychotic pts have too high a dopamine and thats why you’re using anti-dopamine drugs like antipsychotics in the first place!
Antipsychotics
-what are the endocrine side effects?
Blocking dopamine receptors = blocking dopamine’s inhibition on PRL secretion.
-hyperprolacinemia => agalactorrhea, amenorrhea (PRL inhibits GnRH).
Antipsychotics: side effects
-Besides D2 - what other receptors do these block?
-muscarinic, alpha-1, histamine.
Neuroleptic malignant syndrome (NMS)
- due to what most commonly by what drug?
- Sxs:
- Tx:
- due to D2 blockade via haloperidol.
- rigidity, myoglobinuria, autonomic instability, hyperpyrexia.
- dantrolene, D2 agonists (e.g., bromocriptine)
- so in this case you can give D2 agonists - but you dont give D2 agonists for the extra-pyramidal side effects.
Neuroleptic malignant syndrome (NMS)
-what do you see here that you dont see in serotonin syndrome?
- NMS = rigidity
- SS = myoclonus
Neuroleptic malignant syndrome (NMS)
-why do you get hyperpyrexia?
Dopamine also important in temp regulation. So blocking it may produce malignant hyperthermia, = neuroleptic malignant syndrome.
Tardive dyskinesia
- which drugs can cause it?
- what is it?
- anti-psychotics
- stereotypic oral-facial movements as a result of long-term antipsychotic use. Potentially irreversible.
- involuntary perioral movement ie. biting, chewing, grimacing, tongue protrustions.-Doesn’t have to be constant, can come and go. Usually arived after 4 mo of treatment.
Antipsychotics: high potency
- name them
- mnemonic
- Trifluoperazine, Fluphenazine, Haloperidol
- Try to Fly High.
Antipsychotics: high potency
- neuro (EPS) side effects or non-neuro?
- why?
- primarily neuro side effects aka EPS, due to potent D2 antagonism.
- they’re very potent so you dont have to give a lot which means the extra-neuro side effects will be minimal.
- if you gave a much higher dose than was required im sure you’d get some extra-neuro side effects as well.
Antipsychotics: low potency
- neuro (EPS) side effects or non-neuro?
- why?
Low potency
- so takes a lot to have neuro effects.
- so it makes sense that there aren’t that make neuro side effects but you’ll have a lot of non-neuro side effects bc you have to give a lot of this drug bc its low potency.
Antipsychotics: low potency
- name them
- mnemonic
Chlorpromazine, Thioridazine
-Cheating Thieves are low.
Chlorpromazine
- what is it? potency?
- unique side effect?
- Low potency neuroleptic
- corneal deposits
Thioridazine
- what is it? potency?
- unique side effect?
- Low potency neuroleptic
- reTinal deposits
Haloperidol
- what is it? potency?
- common side effects?
high potency neuroleptic
-NMS, tardive dyskinesia
Anti-psychotics
Evolution of EPS side effects
- 4 hr acute dystonia
- 4 day akathisia (restlessness)
- 4 wk bradykinesia (parkinsonism)
- 4 mo tardive dyskinesia
Blepharospasm
- define:
- seen in what?
- second most common focal dystonia. Forced closure of the eyelids.
- Initial Sx = uncontrollable blinking.
- seen as EPS of antipsychotics: w/in 4 hours.
akathisia
- what is it?
- how long into antipsychotic med use does it occur?
- restlessness
- 4 days in.
NMS
- Sxs:
- mnemonic?
NMS, think FEVER: Fever Encephalopathy Vitals unstable Enzymes Rigidity of muscles
atypical antipsychotic
-difference vs typical?
-blocks dopamine and 5HT2 receptors.
*5HT2 receptor: like alpha-2, its pre synaptic and
is neg. feedback on serotonin release. So blocking
5HT2 receptor will inc. serotonin release.
atypical antipsychotics
- name them:
- mnemonic:
-Olanzapine, clozapine, quetiapine, risperidone,
aripiprazole, ziprasidone.
-It’s atypical for old closets to quietly risper from
A to Z.
5HT2 receptor
- function:
- blocking it will do what?
-5HT2 receptor: like alpha-2, its pre synaptic and
is neg. feedback on serotonin release.
-Blocking it will inc. serotonin release.
Do they treat positive or negative Sxs: Schizo
- typical neuroleptics:
- atypical neuroleptics:
- typical = treats positive Sxs.
- atypicals = both pos & neg Sxs.
atypical antipsychotics
-side effects vs typical?
Fewer extrapyramidal and anticholinergic side effects.
-
Olanzapine/clozapine
- what are they?
- unique side effects?
- atypical antipsychotics
- weight gain.
Clozapine
- what is it?
- unique side effects?
- atypical antipsychotics
- agranulocytosis
- req. weekly WBC monitoring.
*Must watch clozapine clozely!
Which atypical antipsychotic requires weekly WBC monitoring?
-mnemonic?
Clozapine
*Must watch clozapine clozely!
Risperidone
- what is it?
- unique side effects?
- atypical antipsychotics
- may inc. PRL
Man develops breasts after taking an antipsychotic
- which one is he on?
- mechanism?
Risperidone
-inc. PRL => gynecomastia.
Ziprasidone
- what is it?
- unique side effects?
- atypical antipsychotics
- may prolong the QT interval.
Lithium
- mech:
- use:
- dec PIP2, which means dec. Gq pathway.
- also lowers cAMP.
Lithium
-use:
Bipolar disorder, SIADH
*causes nephrogenic DI.
Lithium
-notable side effects:
- hypothyroidism
- polyuria (ADH antagonist causing nephrogenic DI)
- Teratogen (Ebstein anomaly).
- edema
- heart block
- tremor
Lithium
-how is it excreted?
Almost exclusively through the kidneys.
-most is reabsorbed at the PCT following Na+ reabsorption.
How does lithium cause tremor?
Lithium is VERY similar to Na! This can depolarize
cells and produce tremors.
How does lithium cause hypothyroidism?
-TSH binds to Gs coupled receptors on thyroid but
lithium dec. cAMP so prevents action of TSH.
-Lithium also = peripheral deiodinase inhibitor.
-hypothyroidism can cause depression.
How does lithium cause depression?
-TSH binds to Gs coupled receptors on thyroid but
lithium dec. cAMP so prevents action of TSH.
-Lithium also = peripheral deiodinase inhibitor.
-hypothyroidism can cause depression.
How does lithium cause nephrogenic DI?
- ADH receptors = Gs coupled, so now ADH wont work.
* Lithium lowers cAMP.
Chronic loops/thiazides
-action on lithium clearance?
- chronic loops & chronic thiazides will dec. lithium clearance thru aldo mechanism.
- Lithium is like Na. Remember, thiazides and loops dec. Na resorption proximally, but that will inc. Na resorption via aldo effect. So instead use potassium sparing diuretics.
Hyponatremia effect on lithium?
-which diuretic = most likely to cause hyponatremia?
Lithium will have inc. toxicity
- you’re taking away Na which is its competitor.
- thiazides have greatest potential out of diuretics to cause hyponatremia.
SSRIs
- name them
- mnemonic:
- Fluoxetine, paroxetine, sertraline, citalopram
- Flashbacks paralyze senior citizens.
How long does it take for anti-depressants to have an effect?
It normally takes 4–8 weeks for antidepressants
to have an effect.
Which opioid has an SSRI metabolite?
Meperidine (opiate) = its metabolite, normeperidine, is an SSRI
SSRI
-side effects:
GI distress, sexual dysfunction (anorgasmia and dec. libido).
SSRIs
-what can occur in the first few weeks? and how do you prevent it?
- SSRIS: their initial activating affects can lead to increased agitation and anxiety during this period.
- thus, a temporary course of benzos is sometimes used during SSRI initiation if there is a significant increase in anxiety-related Sxs.
Serotonin syndrome
-key Sxs:
- hyperthermia
- myoclonus
- CV collapse
- flushing, diarrhea
- seizures
- hyperreflexia
- bruxism (teeth grinding)
- no muscle rigidity like NMS.
Serotonin syndrome
-Tx:
- cyproheptadine (5-HT2 receptor antagonist)
* its a 1st gen antihistamine w/serotonin blocking action as well.
cyproheptadine
- mech:
- whats it used for?
- 5-HT2 receptor antagonist.
- *its a 1st gen antihistamine w/serotonin blocking action as well.
- Serotonin syndrome treatment.
bruxism
-seen with drugs that inc. what?
serotonin
Which antidepressant has an off-label use as treating premature ejaculation?
SSRIs (anorgasmia is a side effect but here its used as a mechanism of action).
Can you switch from a MAO inhibitor to another anti-depressant right away?
NO
-The inhibition of MAO is irreversible. If a patient wishes to switch medications from a MAOI to an alternative medication such as an SSRI, they must wait at least two weeks in order to regenerate MAO to prevent a hypertensive crisis.
SNRIs
- name them
- mech:
- Venlafaxine, duloxetine.
- serotonin & NE reuptake inhibitor.
duloxetine
- what is it?
- common use:
- SNRI
- Diabetic peripheral neuropathy
Venlafaxine
- what is it?
- common use:
- SNRI
- generalized anxiety disorder
SNRIs
-same mechanism of action as what other drugs?
TCAs
-except no autonomic side effects!
SNRIs
-side effect
inc. BP
- some stimulant effects.
TCAs
- suffix?
- exception?
- iptyline or -ipramine
- doxepin and amoxapine
doxepin
-what is it?
TCA
amoxapine
-what is it?
TCA
TCA
- mech:
- what other receptors do they block (that cause side effects)?
Block reuptake of NE & serotonin.
*same as SNRI.
-also block: alpha-1, muscarinic
fibromyalgia
-which anti-depressant given?
TCA
OCD
-best TCA to use?
clomipramine
Which TCA = least sedating but has highest seizure rate?
Desipramine
TCA
- side effects
- mnemonic:
Tri-C’s:
- Convulsions, Coma, Cardiotoxicity (arrhythmias).
- Also respiratory depression, hyperpyrexia
Which TCA has least anti-cholinergic side effects.
- aka its best to use to avoid confusion/hallucinations in elderly.
- mnemonic:
nortriptyline
-Use nortriptyline so the old people wont “tryp”.
Anti-cholinergic Sxs of TCAs & BPH.
Can worsen BPH urinary retention.
amoxapine
-whats its metabolite & what can it cause?
Its metabolite is a dopamine antagonist so can lead to too much prolactin & subsequent side effects of that.
TCAs
-how do they lead to arrythmias?
- cardiac fast Na channels blocked.
- phase 0 prolonged = QRS prolonged.
- this also have negative inotropic effects bc you have impaired excitation-contraction coupling w/diminished release of Ca from SR. Remember - the influx of Na & resultant depolarization is what causes the Ca channels to open. So this is being screwed up.
*combine this neg. inotropy w/alpha-1 blockade & you have refratory hypotension.
TCA
-how do they get refractory hypotension?
dec. inotropy + alpha-1 blockade.
MAO inhibitors
- name them
- mnemonic:
- Tranylcypromine, Phenelzine, Isocarboxazid, Selegiline
- MAO Takes Pride In Shanghai.
MAO inhibitors
-reversible or irreversible inhibitor of MAO?
irreversible
Amine NTs
-what are they?
NE, serotonin, dopamine.
MAO-A
-metabolizes what?
NE & serotonin.
MAO-B
-metabolizes what?
dopamine
Which opioids are C/I if using MAO inhibitors?
meperidine & dextromethorphan.
Hypertensive crisis vs serotonin syndrome
- build up too much NE => hypertensive crisis.
- build up too much serotonin => serotonin syndrome.
Tyramine
- causes release of what from the mobile pool?
- can cause what if eaten w/MAO inhibitors?
Causes release of catecholamines = NE, epi, dopamine.
-can lead to hypertensive crisis NOT serotonin syndrome bc it does not cause release of serotonin!
*catecholaminergic neurons are not the same as serotoninergic neurons.
Atypical depression:
- define:
- what do you treat this with?
- Mood reactivity = key feature
- leaden paralysis (arms/legs feel heavy).
- “reversed” vegetative Sxs (eat more/gain weight).
- rejection insensitivity.
- MAO inhibitors = first line.
Bupropion
- mech:
- use:
- inc. NE & dopamine. unknown mech.
- Atypical antidepressant, smoking cessation.
Bupropion
-side effects:
- reduces seizure threshold.
- stimulant.
- seizure in bulimic pts (or anorexia w/purging).
- NO sexual side effects.
Why do some people use bupropion vs SSRIs?
No sexual side effects w/bupropion.
SSRIs
-what causes the sexual dysfunction and why doesn’t bupropion cause it?
- Muscarinic blockade = para block = no erection.
- alpha-1 blockade = sym block = no emission.
*bupropion doesn’t have these autonomic side effects.
Mirtazapine
- mech:
- use:
- α2-antagonist => inc. release of NE & serotonin.
- potent 5-HT2 and 5-HT3 receptor antagonist.
- Atypical antidepressant
Mirtazapine
-side effects:
- weight gain
* desirable in anorexics/elderly.
Trazodone
- mech:
- use:
- Blocks 5-HT2 and α1-adrenergic receptors.
- Insomnia.
*high doses needed for anti-depressant effects.
Trazodone
- side effect
- mnemonic:
- priapism
- blocks alpha-1 so your vessels stay dilated and your penis stays engorged.
-Called trazobone due to male-specific side effects.
Mood disorder w/psychotic features vs. schizoaffective
-how to differentiate?
In mood disorders, the psychotic Sxs occur only during manic or depressive episodes.
- to Dx schizoaffective disorder, there have to be at least 2 weeks of psychosis w/o any mood disorder.
- but mood mood Sxs do have to be present for the majority of the illness in schizoaffective.
Sertraline
-what is it?
SSRI
-flashbacks paralyze senior citizens.
What is a feared side effect of TCA overdose?
cardiac arrythmia
2nd gen H1 blockers
- suffix?
- exception:
- adine
- cetirizine
fexofenadine
-what is it?
2nd gen H1 blocker
TCA OD
-how does it lead to arrythmia?
Block fast Na channel conductance.
-they’ll have a low BP bc inotropy is reduced as a result.
Serotonin Sx:
-usually caused by:
- MAO inhib + SSRI
- way too much SSRI
Which drugs can lead to lithium toxicity?
NSAIDs, thiazides, ACE inhibitors.
Restless leg syndrome
-Tx:
dopamine agonist
