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Final FA review > 3/29 psych > Flashcards

3/29 psych Flashcards

1
Q

Relationship btwn p-value & alpha

A

-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!

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2
Q

alpha:

  • rate of which type of error?
  • false pos? false neg?
A

type 1 error

-false positive

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3
Q

P =

-probability of ___

A

probability of making a type 1 error

  • alpha
  • false positive
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4
Q

If sensitivity of FOB screen is 66%.

-tell me the sentence of what that means.

A

-“If the pt has colon cancer, their probability of having a positive FOB screen is 66%”.

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5
Q

Factitious disorder

  • conscious or unconscious decision?
  • aka?
A
  • conscious

- munchausen or munchausen by proxy

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6
Q

Management of somatic symptom disorder:

A
  • Schedule regular visits w/same provider. Outpatient visits. Limit unneccessary workups/referrals to specialists.
  • in contrast to having symptom-driven visits.
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7
Q

Somatoform disorders

  • intentional or unintentional?
  • name the different disorders:
A
  • unintentional.
  • Somatic Sx disorder
  • Conversion disorder
  • Illness anxiety disorder (hypochondriasis)
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8
Q

Personality disorder

  • are people usually aware of their disorder?
  • what are the 3 clusters? mnemonic?
A

Nope

  • A, B, and C
  • Weird, Wild, and Worried based on symptoms.
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9
Q

Cluster A

  • mnemonic:
  • which ones are in cluster A?
A
  • Weird (weird, wild, & worried).

- paranoid, schizoid, schizotypal.

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10
Q

Paranoid personality disorder

  • which cluster?
  • whats their major ego defense mechanism?
A
  • Cluster A

- projection = immature defense.

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11
Q

Schizotypal

  • which cluster
  • menmonic?
A
  • Cluster A
  • schizoTypal = magical Thinking.
  • they’re weirdos
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12
Q

Cluster B

  • mnemonic:
  • which ones are in cluster B?
A
  • Wild (weird, wild & worried).
  • Antisocial
  • Borderline
  • Histrionic
  • Narcissistic
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13
Q

Borderline

  • which cluster?
  • describe some features:
  • whats their major defense mechanism?
A
  • cluster B
  • violent swings in affect, self-mutilation for attention, impulsive, suicidal ideation. Usually a woman.
  • Splitting = immature defense.
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14
Q

Histrionic

  • which cluster?
  • describe some features:
  • often accompanied w/which disorders?
A
  • cluster B
  • Excessive emotionality and excitability, attention seeking, sexually provocative, overly concerned with appearance.
  • Somatoform disorder.
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15
Q

Cluster C

  • mnemonic:
  • which ones are in cluster C?
A
  • Worried (weird, wild & worried).

- avoidant, obsessive-compulsive, dependent.

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16
Q

Avoidant

  • which cluster?
  • different vs schizoid?
  • describe:
A
  • cluster C
  • avoidant people DESIRE relationships, schizoid dont.
  • Hypersensitive to rejection, socially inhibited, timid, feelings of inadequacy.
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17
Q

Obsessive-compulsive personality disorder

  • which cluster?
  • ego-syntonic or ego-dystronic?
A

-ego-syntonic: behavior consistent with one’s own beliefs and attitudes (vs. OCD).

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18
Q

Obsessive-compulsive personality disorder

-vs. OCD

A

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.

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19
Q

Schizophrenic psychotic symptoms + bipolar or depressive mood disorder =

A

= Schizoaffective

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20
Q

Lanugo

  • what is it?
  • what disease is it associated with?
A
  • fine body hair.

- anorexia nervosa.

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21
Q

Gender dysphoria

-what is it?

A
  • Strong, persistent cross-gender identification.

- Affected individuals are often referred to as transgender.

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22
Q

Transsexualism

-define:

A

Desire to live as the opposite sex, often through surgery or hormone treatment.

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23
Q

Transvestism

A

-Paraphilia (sexual perversion), NOT gender dysphoria.
-Wearing clothes (e.g., vest) of the opposite sex
(cross-dressing).

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24
Q

Sleep terrors

-occur during which phase of sleep?

A

slow-wave sleep

*no memory of arousal.

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25
Q

Sleep terrors

-memory of the arousal?

A

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.
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26
Q

Narcolepsy

-REM latency:

A

shortened.

-typically enter REM sleep almost immediately.

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27
Q

Narcolepsy

-cause

A

Caused by dec. orexin production in lateral hypoT.

  • hypocretin-1 = orexin A
  • hypocretin-2 = orexin B
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28
Q

Narcolepsy

-Tx:

A
  • daytime stimulants = amphetamines, modafinil.

- nighttime sodium oxybate (GHB).

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29
Q

sodium oxybate

  • aka?
  • what does it treat?
A

aka GHB

-narcolepsy

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30
Q

Yawning, sweating, rhinorrhea

-withdrawal from what?

A

opioids

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31
Q

Which drugs decrease gag reflex?

A

opioids

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32
Q

Opioid withdrawal

-Tx:

A

-long-term support, methadone, buprenorphine.

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33
Q

Buprenorphine

-what is it?

A

partial opioid agonist

-used for opioid withdrawal.

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34
Q

Barbiturates

-withdrawal Sxs:

A

Delirium, life-threatening cardiovascular collapse.

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35
Q

Cocaine intox

-Tx:

A

Benzos

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36
Q

varenicline

  • mech:
  • used for:
A

varenicline = partial agonist at nicotinic receptor.

  • Tx of nicotine withdrawal
  • trade name = chantix
  • may cause depression.
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37
Q

Which drug of abuse can activate NMJ which gives them their super-human strength. May lead to rhabdo & acute tubularnecrosis.

A

PCP (phencyclidine).

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38
Q

How long is weed detectable in urine after you stop smoking?

A

4-10 days

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39
Q

Weed

  • how does it cause tachy?
  • how does it cause red eye?
A

Can cause significant tachycardia secondary to
vasodilation & hypotension.
-vasodilation also => red eye.

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40
Q

Addiction to what drug inc. risk of hemorrhoids?

A

Heroin

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41
Q

Naltrexone

  • what is it?
  • mech?
A

-Long-acting opioid antagonist used for relapse prevention once detoxified.

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42
Q

Naloxone

-mech:

A

pure opioid antagonist

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43
Q

Bulimia

-pharm Tx:

A

SSRIs

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44
Q

phentermine

-what is it?

A

CNS stimulant

  • appetite suppressor.
  • using for more than 3 months has been linked w/development of secondary pulmonary HTN.
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45
Q

CNS stimulants: OD

-Tx:

A

acidify urine

-ammonium chloride

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46
Q

fenfluramine

-what is it?

A

CNS stimulant

  • appetite suppressor.
  • using for more than 3 months has been linked w/development of secondary pulmonary HTN.
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47
Q

How do CNS stimulants treat ADHD? Seems counter productive.

A
  • 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.
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48
Q

enzyme sensitization:

-what parameter changes?

A

dec. Km

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49
Q

enzyme up-reg:

-what parameter changes?

A

inc. Vmax

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50
Q

Antipsychotics: typical

  • suffix?
  • outlier?
A

-haloperidol + “-azines”.

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51
Q

Antipsychotics: typical

-mechanism?

A
  • D2 blocker which inc. cAMP.

* D2 = Gi, so blocking it will inc. cAMP.

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52
Q

Antipsychotics

-besides psychosis & mania - what does it treat?

A

Tourette syndrome

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53
Q

Antipsychotics

-solubility?

A

-Highly lipid soluble and stored in body fat; thus,

very slow to be removed from body.

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54
Q

Antipsychotics: Extrapyramidal system side effects

-Tx:

A
  • 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!
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55
Q

Antipsychotics

-what are the endocrine side effects?

A

Blocking dopamine receptors = blocking dopamine’s inhibition on PRL secretion.
-hyperprolacinemia => agalactorrhea, amenorrhea (PRL inhibits GnRH).

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56
Q

Antipsychotics: side effects

-Besides D2 - what other receptors do these block?

A

-muscarinic, alpha-1, histamine.

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57
Q

Neuroleptic malignant syndrome (NMS)

  • due to what most commonly by what drug?
  • Sxs:
  • Tx:
A
  • 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.
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58
Q

Neuroleptic malignant syndrome (NMS)

-what do you see here that you dont see in serotonin syndrome?

A
  • NMS = rigidity

- SS = myoclonus

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59
Q

Neuroleptic malignant syndrome (NMS)

-why do you get hyperpyrexia?

A

Dopamine also important in temp regulation. So blocking it may produce malignant hyperthermia, = neuroleptic malignant syndrome.

60
Q

Tardive dyskinesia

  • which drugs can cause it?
  • what is it?
A
  • 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.
61
Q

Antipsychotics: high potency

  • name them
  • mnemonic
A
  • Trifluoperazine, Fluphenazine, Haloperidol

- Try to Fly High.

62
Q

Antipsychotics: high potency

  • neuro (EPS) side effects or non-neuro?
  • why?
A
  • 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.
63
Q

Antipsychotics: low potency

  • neuro (EPS) side effects or non-neuro?
  • why?
A

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.
64
Q

Antipsychotics: low potency

  • name them
  • mnemonic
A

Chlorpromazine, Thioridazine

-Cheating Thieves are low.

65
Q

Chlorpromazine

  • what is it? potency?
  • unique side effect?
A
  • Low potency neuroleptic

- corneal deposits

66
Q

Thioridazine

  • what is it? potency?
  • unique side effect?
A
  • Low potency neuroleptic

- reTinal deposits

67
Q

Haloperidol

  • what is it? potency?
  • common side effects?
A

high potency neuroleptic

-NMS, tardive dyskinesia

68
Q

Anti-psychotics

Evolution of EPS side effects

A
  • 4 hr acute dystonia
  • 4 day akathisia (restlessness)
  • 4 wk bradykinesia (parkinsonism)
  • 4 mo tardive dyskinesia
69
Q

Blepharospasm

  • define:
  • seen in what?
A
  • second most common focal dystonia. Forced closure of the eyelids.
  • Initial Sx = uncontrollable blinking.
  • seen as EPS of antipsychotics: w/in 4 hours.
70
Q

akathisia

  • what is it?
  • how long into antipsychotic med use does it occur?
A
  • restlessness

- 4 days in.

71
Q

NMS

  • Sxs:
  • mnemonic?
A 
NMS, think FEVER:
Fever
Encephalopathy
Vitals unstable
Enzymes 
Rigidity of muscles
72
Q

atypical antipsychotic

-difference vs typical?

A

-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.

73
Q

atypical antipsychotics

  • name them:
  • mnemonic:
A

-Olanzapine, clozapine, quetiapine, risperidone,
aripiprazole, ziprasidone.
-It’s atypical for old closets to quietly risper from
A to Z.

74
Q

5HT2 receptor

  • function:
  • blocking it will do what?
A

-5HT2 receptor: like alpha-2, its pre synaptic and
is neg. feedback on serotonin release.
-Blocking it will inc. serotonin release.

75
Q

Do they treat positive or negative Sxs: Schizo

  • typical neuroleptics:
  • atypical neuroleptics:
A
  • typical = treats positive Sxs.

- atypicals = both pos & neg Sxs.

76
Q

atypical antipsychotics

-side effects vs typical?

A

Fewer extrapyramidal and anticholinergic side effects.

-

77
Q

Olanzapine/clozapine

  • what are they?
  • unique side effects?
A
  • atypical antipsychotics

- weight gain.

78
Q

Clozapine

  • what is it?
  • unique side effects?
A
  • atypical antipsychotics
  • agranulocytosis
  • req. weekly WBC monitoring.

*Must watch clozapine clozely!

79
Q

Which atypical antipsychotic requires weekly WBC monitoring?

-mnemonic?

A

Clozapine

*Must watch clozapine clozely!

80
Q

Risperidone

  • what is it?
  • unique side effects?
A
  • atypical antipsychotics

- may inc. PRL

81
Q

Man develops breasts after taking an antipsychotic

  • which one is he on?
  • mechanism?
A

Risperidone

-inc. PRL => gynecomastia.

82
Q

Ziprasidone

  • what is it?
  • unique side effects?
A
  • atypical antipsychotics

- may prolong the QT interval.

83
Q

Lithium

  • mech:
  • use:
A
  • dec PIP2, which means dec. Gq pathway.

- also lowers cAMP.

84
Q

Lithium

-use:

A

Bipolar disorder, SIADH

*causes nephrogenic DI.

85
Q

Lithium

-notable side effects:

A
  • hypothyroidism
  • polyuria (ADH antagonist causing nephrogenic DI)
  • Teratogen (Ebstein anomaly).
  • edema
  • heart block
  • tremor
86
Q

Lithium

-how is it excreted?

A

Almost exclusively through the kidneys.

-most is reabsorbed at the PCT following Na+ reabsorption.

87
Q

How does lithium cause tremor?

A

Lithium is VERY similar to Na! This can depolarize

cells and produce tremors.

88
Q

How does lithium cause hypothyroidism?

A

-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.

89
Q

How does lithium cause depression?

A

-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.

90
Q

How does lithium cause nephrogenic DI?

A
  • ADH receptors = Gs coupled, so now ADH wont work.

* Lithium lowers cAMP.

91
Q

Chronic loops/thiazides

-action on lithium clearance?

A
  • 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.
92
Q

Hyponatremia effect on lithium?

-which diuretic = most likely to cause hyponatremia?

A

Lithium will have inc. toxicity

  • you’re taking away Na which is its competitor.
  • thiazides have greatest potential out of diuretics to cause hyponatremia.
93
Q

SSRIs

  • name them
  • mnemonic:
A
  • Fluoxetine, paroxetine, sertraline, citalopram

- Flashbacks paralyze senior citizens.

94
Q

How long does it take for anti-depressants to have an effect?

A

It normally takes 4–8 weeks for antidepressants

to have an effect.

95
Q

Which opioid has an SSRI metabolite?

A

Meperidine (opiate) = its metabolite, normeperidine, is an SSRI

96
Q

SSRI

-side effects:

A

GI distress, sexual dysfunction (anorgasmia and dec. libido).

97
Q

SSRIs

-what can occur in the first few weeks? and how do you prevent it?

A
  • 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.
98
Q

Serotonin syndrome

-key Sxs:

A
  • hyperthermia
  • myoclonus
  • CV collapse
  • flushing, diarrhea
  • seizures
  • hyperreflexia
  • bruxism (teeth grinding)
  • no muscle rigidity like NMS.
99
Q

Serotonin syndrome

-Tx:

A
  • cyproheptadine (5-HT2 receptor antagonist)

* its a 1st gen antihistamine w/serotonin blocking action as well.

100
Q

cyproheptadine

  • mech:
  • whats it used for?
A
  • 5-HT2 receptor antagonist.
  • *its a 1st gen antihistamine w/serotonin blocking action as well.
  • Serotonin syndrome treatment.
101
Q

bruxism

-seen with drugs that inc. what?

A

serotonin

102
Q

Which antidepressant has an off-label use as treating premature ejaculation?

A

SSRIs (anorgasmia is a side effect but here its used as a mechanism of action).

103
Q

Can you switch from a MAO inhibitor to another anti-depressant right away?

A

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.

104
Q

SNRIs

  • name them
  • mech:
A
  • Venlafaxine, duloxetine.

- serotonin & NE reuptake inhibitor.

105
Q

duloxetine

  • what is it?
  • common use:
A
  • SNRI

- Diabetic peripheral neuropathy

106
Q

Venlafaxine

  • what is it?
  • common use:
A
  • SNRI

- generalized anxiety disorder

107
Q

SNRIs

-same mechanism of action as what other drugs?

A

TCAs

-except no autonomic side effects!

108
Q

SNRIs

-side effect

A

inc. BP

- some stimulant effects.

109
Q

TCAs

  • suffix?
  • exception?
A
  • iptyline or -ipramine

- doxepin and amoxapine

110
Q

doxepin

-what is it?

A

TCA

111
Q

amoxapine

-what is it?

A

TCA

112
Q

TCA

  • mech:
  • what other receptors do they block (that cause side effects)?
A

Block reuptake of NE & serotonin.
*same as SNRI.

-also block: alpha-1, muscarinic

113
Q

fibromyalgia

-which anti-depressant given?

A

TCA

114
Q

OCD

-best TCA to use?

A

clomipramine

115
Q

Which TCA = least sedating but has highest seizure rate?

A

Desipramine

116
Q

TCA

  • side effects
  • mnemonic:
A

Tri-C’s:

  • Convulsions, Coma, Cardiotoxicity (arrhythmias).
  • Also respiratory depression, hyperpyrexia
117
Q

Which TCA has least anti-cholinergic side effects.

  • aka its best to use to avoid confusion/hallucinations in elderly.
  • mnemonic:
A

nortriptyline

-Use nortriptyline so the old people wont “tryp”.

118
Q

Anti-cholinergic Sxs of TCAs & BPH.

A

Can worsen BPH urinary retention.

119
Q

amoxapine

-whats its metabolite & what can it cause?

A

Its metabolite is a dopamine antagonist so can lead to too much prolactin & subsequent side effects of that.

120
Q

TCAs

-how do they lead to arrythmias?

A
  • 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.

121
Q

TCA

-how do they get refractory hypotension?

A

dec. inotropy + alpha-1 blockade.

122
Q

MAO inhibitors

  • name them
  • mnemonic:
A
  • Tranylcypromine, Phenelzine, Isocarboxazid, Selegiline

- MAO Takes Pride In Shanghai.

123
Q

MAO inhibitors

-reversible or irreversible inhibitor of MAO?

A

irreversible

124
Q

Amine NTs

-what are they?

A

NE, serotonin, dopamine.

125
Q

MAO-A

-metabolizes what?

A

NE & serotonin.

126
Q

MAO-B

-metabolizes what?

A

dopamine

127
Q

Which opioids are C/I if using MAO inhibitors?

A

meperidine & dextromethorphan.

128
Q

Hypertensive crisis vs serotonin syndrome

A
  • build up too much NE => hypertensive crisis.

- build up too much serotonin => serotonin syndrome.

129
Q

Tyramine

  • causes release of what from the mobile pool?
  • can cause what if eaten w/MAO inhibitors?
A

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.

130
Q

Atypical depression:

  • define:
  • what do you treat this with?
A
  • Mood reactivity = key feature
  • leaden paralysis (arms/legs feel heavy).
  • “reversed” vegetative Sxs (eat more/gain weight).
  • rejection insensitivity.
  • MAO inhibitors = first line.
131
Q

Bupropion

  • mech:
  • use:
A
  • inc. NE & dopamine. unknown mech.

- Atypical antidepressant, smoking cessation.

132
Q

Bupropion

-side effects:

A
  • reduces seizure threshold.
  • stimulant.
  • seizure in bulimic pts (or anorexia w/purging).
  • NO sexual side effects.
133
Q

Why do some people use bupropion vs SSRIs?

A

No sexual side effects w/bupropion.

134
Q

SSRIs

-what causes the sexual dysfunction and why doesn’t bupropion cause it?

A
  • Muscarinic blockade = para block = no erection.
  • alpha-1 blockade = sym block = no emission.

*bupropion doesn’t have these autonomic side effects.

135
Q

Mirtazapine

  • mech:
  • use:
A
  • α2-antagonist => inc. release of NE & serotonin.
  • potent 5-HT2 and 5-HT3 receptor antagonist.
  • Atypical antidepressant
136
Q

Mirtazapine

-side effects:

A
  • weight gain

* desirable in anorexics/elderly.

137
Q

Trazodone

  • mech:
  • use:
A
  • Blocks 5-HT2 and α1-adrenergic receptors.
  • Insomnia.

*high doses needed for anti-depressant effects.

138
Q

Trazodone

  • side effect
  • mnemonic:
A
  • priapism
  • blocks alpha-1 so your vessels stay dilated and your penis stays engorged.

-Called trazobone due to male-specific side effects.

139
Q

Mood disorder w/psychotic features vs. schizoaffective

-how to differentiate?

A

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.
140
Q

Sertraline

-what is it?

A

SSRI

-flashbacks paralyze senior citizens.

141
Q

What is a feared side effect of TCA overdose?

A

cardiac arrythmia

142
Q

2nd gen H1 blockers

  • suffix?
  • exception:
A
  • adine

- cetirizine

143
Q

fexofenadine

-what is it?

A

2nd gen H1 blocker

144
Q

TCA OD

-how does it lead to arrythmia?

A

Block fast Na channel conductance.

-they’ll have a low BP bc inotropy is reduced as a result.

145
Q

Serotonin Sx:

-usually caused by:

A
  • MAO inhib + SSRI

- way too much SSRI

146
Q

Which drugs can lead to lithium toxicity?

A

NSAIDs, thiazides, ACE inhibitors.

147
Q

Restless leg syndrome

-Tx:

A

dopamine agonist

Final FA review (52 decks)

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