AAW - Psych

Question 1

patient with history of depression has:

urinary retention, dry mouth, convulsions, something wrong with their heart, hallucinations and diminishing mental status

what did they take too much of
antidote?

Answer 1

probably took too much of a TCA:

tri-Cyclics: Convulsions, Coma, Cardiotoxicity

treat with sodium bicarb

Question 2

trazadone mech and use

Answer 2

blocks 5-HT2 and alpha 1 receptor

used mainly for insomnia, high doses have antidepressant effects

Question 3

patient has hyperthermia, confusion, myoclonus, flushing, hyperreflexia, dilated pupils

how do you treat

Answer 3

give cyproheptadine for their probable serotonin syndrome

(SS: dilated pupils, hyperreflexia, hyperactive bowels
NMS: hyporeflexia, normal pupils, normal bowel sounds)

Question 4

SE unique to thoridazine

Answer 4

reTinal deposits

Question 5

buspirone mech

Answer 5

stimulates 5-HT1A receptors, used in generalized anxiety

takes 1-2 weeks to take effect
no interaction with EtOH

Question 6

duloxetine mech

Answer 6

SNRI

inhibits 5-HT and NE reuptake

Question 7

doxepin mech

Answer 7

amy, the traumatic care attendant has a “DOCtor PIN”

TCA - blocks reuptake of NE and 5-HT

Question 8

amoxapine mech

Answer 8

amy, the traumatic care attendant is wearing A MOCCASIN

A MOXccasin

TCA - blocks reuptake of NE and 5-HT

Question 9

chlorpromazine SE

Answer 9

corneal deposits

Question 10

risperidone specific side effect

Answer 10

its an atypical antipsychotic

it can increase prolactin (causing lactation and gynecomastia leading to decreased GnRH, LH, and FSH)

Question 11

mirtazapine mech, SE

Answer 11

alpha2 antagonist (increases release of NE and 5-HT)

also

5-HT2 and 5-HT3 receptor antagonist

SE: sedation, increased appetite, weight gain, dry mouth

Question 12

patient has neuroleptic malignant syndrome

what happens to their calcium

Answer 12

it goes down because of rhabdo

combination of hyperkalemia, hyperphosphatemia, hyperuricemia

due to a combination of low albumin, hyperphosphatemia, tissue deposition of calcium, and impaired PTH secretion

Question 13

old person being treated for fatigue, loss of appetite, difficulty concentrating, decreased sleep

put on a drug

then then get urinary retention, blurred vision, constipation, aggravation of glaucoma

what drug

Answer 13

a TCA causing cholinergic SE

Question 14

Tx for NMS \

name 2

Answer 14

bromocriptine

benztropine

Question 15

what does TCA overdose do you your acid base status

Answer 15

combined metabolic and respiratory acidosis

metabolic acidosis because TCAs reduce cardiac contractility leading to decreased tissue perfusion and production of lactic acid

also depresses breathing, causing a respiratory acidosis

Tx is bicarb

Question 16

homeless man

somnolence, inability to perform tandem walking, oriented only to self, hepatomegaly, nystagmus

he has a vit def

what is his acid base status

Answer 16

metabolic acidosis with high lactate

B1 def

B1 helps catalyze pyruvate to Ach CoA, and if impaired, the pyruvate forms lactate instead

Question 17

what part of the brain is blocked by antipsychotics in order to decrease the positive symptoms associated with schizophrenia

what part is

Answer 17

mesolimbic pathway blockage helps decrease the positive symptoms

Question 18

treatment for benzo toxicity

mech

Answer 18

flumazenil - competitive antagonist at the benzodiazepine receptor site of the GABA-A channel

Question 19

define akathisia and what neuro drug classically causes it after about 4 days

Answer 19

`state of agitation, distress, and restlessness that is an occasional SE of antipsychotic and antidepressant drugs

extrapyramidal effect seen with the use of antipsychotics

Question 20

patient treated by a psychiatrist suddenly has facial twitching and tounge protrusion

what drug are they on

Answer 20

one that inhibits dopamine - usually first gen antipsychotics like haloperidol, fluphenazine, trifluphenazine

these “tardive dyskinesia” symptoms are probably because of upregulation of dopamine receptors after years of dopamine blockage

Question 21

mech of benzos

Answer 21

increase the frequency of GABA channels opening and closing