Behavioral Health UWorld Flashcards
Side effects of first generation antipsychotics
Low potency: chlorpromazine and thioridazine
Antihistamine: sedation
Anticholinergic
Alpha-blocking: orthostasis
High potency: haloperidol and fluphenazine
EPS
Causes of new onset lithium toxicity
Thiazide diuretics: reduced Na+ reabsorption at the DCT results in increased Na+ and Li+ reabsorption at the PCT
NSAIDs (not ASA)
Reduced GFR: CHF, cirrhosis increase Na and Li uptake at proximal tubule
ACE-I
Drugs that can cause Parkinsonian like symptoms
Anti-psychotics (1st generation > 2nd generation)
Anti-emetics: prochlorperazine
Motility agents: metoclopramide
Treatment for drug-induced Parkinsonism
Anticholinergics (benztropine or trihexyphenidyl)
A mom feels depressed after her daughter leaves for college; however, she does not exhibit any social or occupational impairment as a result. What is your diagnosis?
Normal sadness. DSM-V diagnoses require significant occupational or social impairment for diagnosis.
Most common cause of death in patients intoxicated with PCP?
Trauma from violent behavior.
Strongest single risk factor for suicide
Prior attempts
Conditioning involved in an officer writing a speeding ticket
Positive punishment (punishment decreases behavior)
Conditioning involved in parents taking keys away from their teenager for disobedience.
Negative punishment (reward removal decreases behavior)
Conditioning involved in paying kids for good grades
Positive reinforcement (giving reward increases behavior)
Conditioning involved in deciding to use sunscreen after getting a bad sunburn last time at the beach
Negative reinforcement (removal of punishment increases behavior)
Conditioning involved in white coat hypertension
Classical: past doctor visits (unconditioned stimulus) that made patients feel anxious (unconditioned response) are associated with blood pressure cuffs (neutral stimulus). Repeated associated of the unconditioned stimulus with the neutral stimulus results in anxiety in the face of the neutral stimulus by itself (conditioned stimulus and conditioned response)
Expressing unacceptable feelings through actions
Acting out - immature
Behaving as if an aspect of reality does not exist
Denial - immature
Transferring feelings to an unrelated object
Displacement - immature
Using intellect to avoid uncomfortable feelings
Intellectualization - immature
Avoiding conflict by expressing hostility covertly
Passive-aggression - immature
Attributing one’s feelings to others
Projection - immature
Justifying behavior to avoid difficult truths
Rationalization - immature
Responding in a manner opposite to one’s actual feelings
Reaction formation - immature
Reverting to earlier developmental stages
Regression - immature
Seeing others as all bad or all good
Splitting - immature
Channeling impulses into socially acceptable behaviors
Sublimation - mature
Consciously putting unwanted feelings aside to cope with reality
Suppression - mature
What property of barbiturates make them more dangerous to use than benzodiazepines?
Benzodiazepines allosterically bind the GABAa receptor and increase the frequency at which the receptor opens, hyper polarizing the cell by Cl- influx.
Barbiturates act similarly, but increase the duration the channel is open, and at high concentrations can open the channels in the absence of GABA.
What happens when GABAb receptors are activated? GABAc?
GABAb = binds G-protein in brain -> K+ efflux, reduced Ca influx and inhibition of adenylate cyclase.
GABAc = Cl- channel in retina
Timeline of alcohol withdrawal symptoms
8 - 12 hours: autonomic hyperactivity, insomnia, tremors and anxiety
12 - 48 hours: withdrawal seizures
48 - 96 hours: delirium tremens (fever, disorientation and severe agitation)
Benzos to use in patients with alcohol withdrawal and liver disease
“LOT”: lorazepam, oxazepam and temazepam do not have active metabolites that need liver metabolism
When can patient confidentiality be breeched?
Stab/gunshot wounds, reportable communicable diseases, abuse and harm to self or others.
Disulfiram mechanism of action
Inhibits aldehyde dehydrogenase, resulting in accumulation of aldehyde and sickness if the patient drinks
Acamprosate mechanism of action
Modulates glutamate transmission at NMDA receptors
Behavioral treatment of insomnia
Sleep hygiene: environment, sleep schedule, exercise, avoid tobacco, caffeine and alcohol
Stimulus: use bed only for sleep and sex, leave bed if not sleeping, fixed wake up time
Relaxation
Sleep restriction
Why are HMO’s cheap insurance plans
There is a limited range of services patients can get within their network and they cannot get services outside of their network (as opposed to PPOs)
1st line SSRI for bulimia nervosa
Fluoxetine
Medication of choice for a patient with bipolar disorder and myoclonic seizures? Toxicity to watch for?
Valproate is first line for myoclonic seizures and works as a mood stabilizer for bipolar disorder. Look out for hepatotoxicity.
Next step in determining what, how and why an undesirable medical outcome has occurred?
Root-cause analysis
Circumstances when a minor does not need parental consent for medical care
Pre-natal care
STD treatment/screening
Substance abuse
Urgent care
Female athlete triad
Anorexia, amenorrhea and osteoporosis
Common drug-drug interactions implicated in serotonin syndrome
Antidepressants (TCAs, SSRIs, MAO-Is, SNRIs) Tramadol Ondansetron (5-HT3 antagonist) Linezolid Triptans
Where do you report physician intoxication in a non-emergent setting?
Physician health program and then the state licensing board if that doesn’t work
