Chapter 11: Behavioral Science Flashcards
Fluoxetine, Sertraline and Escitalopram are all which kind of medication?
SSRI
SE of SSRI
sexual dysfunction (anorgasmia);GI distress; SIADH; prolonged QT interval
Venlafaxine and Duloxetine are which kind of meds?
SNRI (serotonin norepinephrine reuptake inhibitor)
SE of SNRI
HTN, sedation, nausea
MOA of tricyclic antidepressants
serotonin and NE reuptake inhibitors
uses of TCA (give 6)
- Major depression
- OCD (Clomipramine)
- Chronic pain/neuropathy (Amitriptyline)
4.Nocturnal enuresis (Imipramine) - Migraine prophylaxis
- Nortriptyline and Desipramine best for elderly (short half-life)
adverse effects of TCA (give 6)
- increase dopamine (risk of mania)
- anticholinergic (urinary retention; tachycardia, dry mouth, hyperthermia)
3.block alpha 1 receptors (orthostatic hypotension) - block AV node conduction (prolong QT)
- block Na channels arrhythmia, seizure
- block histamine receptors (sedation)
management of TCA overdose
fluids and sodium bicarb
If you want to switch a pt. from SSRI to MAO inhibitor, how long should you discontinue the drug before starting MAO i?
4 weeks
If you want to switch from MAO i to SSRI, how long must the patient discontinue MAOi?
2 weeks
What are some contraindications of using MOAI?
tyramine consumption (wine and cheese) leads to overstimulation of sympathetic pathway; other contraindications: TCA, dextromethorphan, St. John’s wort all of these can precipitate serotonin syndrome
Which antidepressant can help stop smoking, and has the lowest sexual dysfunction but may lower seizure threshhold:
Buproprion (Wellbutrin)
Which antidepressant can also help with smoking cessation because it is a partial agonist at nicotinic Ach receptor, BUT has an increased risk of suicide?
Varenicline
Which mood stabilizer is the safest in pregnancy?
Lamotrigine
Which mood stabilizer is good for acute mania?
valproic acid
Which mood stabilizer could cause nephrogenic diabetes and is also a teratogen?
Lithium
Which problem is common in newborns born to mother’s who took lithium during the first trimester?
Ebstein’s anamoly
What problems could valproic acid cause in a newborn and why?
neural tube defects (folate deficiency)
Best treatment for a specific phobia
desensitization (CBT)
various treatments for generalized anxiety disorder
SSRI, buspirone, venlafaxine, benzodiazepine(cause sedation, do not use in elderly)
treatment for PTSD
CBT (best); SSRI, venlafaxine; Prazosin (for nightmares)
Brief Psychotic Disorder time period
more than one day, less than one month
Schizophreniform Disorder
more than 1 month, less than 6 months
Schizoaffective disorder
occurence of delusions or hallucinations + major mood disturbance (major depression or mania)
delusional disorder
a single, falsely held belief despite proof of contrary
delusional disorder
a single, falsely held belief despite proof of contrary (no impairment or dysfunction)
antipsychotics mainly work on which receptors
D2, D4
What is dopamine good for in the mesolimbic and mesocortical tracts?
hallucinations and vomiting
What is dopamine good for in nigrostriatal tract?
increases initial movement
What is dopamine good for in infundibular tract?
inhibits release of prolactin
Dopamine and prolactin are opposites, so if you administer antipsychotics, what will happen to prolactin and menstruation?
prolactin up, GnRH down= amenorrhea
TRH up, PRH up=galactorrhea
What kind of meds are D2 antagonists called?
typical antipsychotics
What kind of meds D4 effect is greater than D2 effect?
atypical antipsychotics
Which typical antipsychotic is an anti-emetic drug for children (D2 antagonist)?
Promethazine
Which typical antipsychotic is an anti-emetic drug for adults?
Prochlorperazine
Which typical antipsychotic has a long half-life and good for homeless or noncompliant pts?
fluphenazine
Which typical antipsychotic is best for acutely psychotic or delirious patients?
haloperidol (“vitamin H”)
What are the first line atypical antipsychotics?
Qetiapine and Aripiprazole
Which atypical antipsychotic could you use after 2 others have failed but you must watch out for agranulocytosis?
Clozapine
What is akathisia, and which med is good for it?
inability to stop movement; beta blocker (propranolol)
What is acute dystonia and which meds can be used for it?
sustained contraction of a muscle group; benztropine or Diphenhydramine (antihistamine)
What is akinesia, dyskinesia, bradykinesia and meds?
akinesia: the inability to start movement
dyskinesia: impairment in starting movement
bradykinesia: slow starting movement
meds: benztropine, diphenhydramine)
What is tardive dyskinesia and its treatment?
facial grimacing, tongue protrusion, lip smacking; stop current med; switch to risperidone or clozapine
What is it called when there is uncoupling of ETC by neuroleptic drug causing hyperthermia due to inability to release heat and since ATP is not produced, the muscles are unable to relax?
neuroleptic malignant syndrome
How do you treat neuroleptic malignant syndrome?
antihistamines can keep muscles from contracting; dantrolene (sequesters Ca); bromocriptine
What are the signs of serotonin syndrome?
up temp.; muscle aches; CV collapse (hypertension or hypotension)
treatment of serotonin syndrome
discontinue drug; cyproheptadine
Which drugs can increase GABA?
benzodiazepines, barbituates, zolpidem (Lanesta)
What effects does GABA have on body?
anticonvulsant, muscle relaxant, sedative, anxiolytic
What is the difference between MOA of benzodiazepine and MOA of barbituates?
benzos increase the frequency of opening Cl channels
barbs increase the duration of Cl opening
What is the fast acting and short half life benzo that is good for all procedures (endoscopy, colonoscopy)?
Midazolam
Which benzo is good for status epilepticus?
diazepam or lorazepam
Which benzo helps elderly to initiate sleep?
triazolam : TRIazolam “TRI” to sleep; TeMAzepam MAintain sleep
Best benzo for anxiety in middle aged women
Lorazepam (8 hour half-life)
Drug of choice for restless leg syndrome?
pramipexole or ropinirole
Benzo for delirium tremens?
chlordiazepoxide
benzo for delirium tremens with liver disease?
lorazepam
benzo overdose med
flumazenil
Which opioid doesn’t give “pinpoint pupils”?
Meperidine
Which opioid is used for traveller’s diarrhea?
Loperamide
Which drug is used to cause withdrawal in heroin addict?
Buprenorphine
drug for opioid OD
Naloxone (IV); Naltrexone
Which med. is used for neuropathy in heart disease patients?
gabapentin
Name the personality disorder: distrusting and suspicious of everything
paranoid personality disorder
conscious decision to socially withdrawal
schizoid personality disorder
perfer to be by themselves; awkward and have magical thinking
schizotypal PD
person who lies, cheats, steals destroys without remorse before age 18
conduct disorder
person who lies, cheats, steals, destroys without remorse after age 18
antisocial
in their mind everything is black or white; splitting (love/hate)
borderline PD
sexually provocative, flirtatious
Histrionic PD
think the world revolves around them
narcissistic PD
avoids problems; afraid of rejection
avoidant PD
need to be orderly, perfectionist, in control
Obsessive-compulsive PD
needs to be taken care of by someone, clingy
dependent
a disorder where a person obsesses about one illness for at least 6 months
illness anxiety disorder
a physical occurence because of internal struggle
conversion disorder (gf loses function of legs because bf broke up with her)
pt believes he/she has a new illness every time he/she visits the doctor
somatic symptom disorder
fake illness to get attention
factitious disorder
fake illness of another to get attention or gain something
factitious disorder imposed on another (before was called Munchhausen by proxy)
What is dissociative identity disorder?
(before known as multiple personality): person creates new personality with something they cannot handle
what is temporary loss of recall memory caused by disassociation (voluntary or involuntary)
dissociative amnesia
What is it called when a person detaches self from emotions?
depersonalization
What is it called when a person detaches from their surroundings, like living in a dream
derealization
In which defense mechanism you don’t want to face the truth:
denial
In which defense mechanism, you put off your own feelings to benefit another
isolation of affect
In which defense mechanism do you pretend something is real, magical thinking
fantasy
a person who does by not doing
passive aggressive
Which defense mechanism do you put away feelings or emotions
repression
Which defense mechanism do you revert to infantile way of acting
regression
Which defense mechanism do you put your thoughts into someone else?
projection
Which defense mechanism do you do the exact opposite of what you used to do
undoing
Which defense mechanism do you take your feelings out on someone else?
displacement
Which defense mechanism do you react opposite to how you feel?
reaction formation
Which defense mechanism do you do something that you are terrified of?
counterphobic behavior
Which defense mechanism do you act like someone more famous or powerful?
identification
Which defense mechanism you always want everything to be ideal?
idealization
Which defense mechanism do you exaggerate the positive of someone and ignore the negative?
idolization
Which defense mechanism do you make something sexual out of everything that happens?
sexualization
When a pt. projects to doctor feelings they have toward someone else
Transference
When a doctor projects to pt. feelings they have toward someone else?
countertransferance
using rational explanations to justify unacceptable attitudes, beliefs
rationalization/justification
intellectual reasoning used to block confrontation with a conflict
intellectualization
Mature defense mechanism where you consciously put away an emotion
repression
Mature defense mechanism where you can laugh at your mistakes and use jokes to get through conflict
humor
putting oneself before others
altruism
making something positive out of something negative
sublimation
giving to those less fortunate
philanthropy
criteria for anorexia diagnosis
BMI less than 18.5; doesn’t want to eat (restrict calories) and excessive exercise
treatment for anorexia
hospitalize, correct electrolytes, CBT, family therapy; SSRI if needed
criteria for bulimia nervosa diagnosis
body weight can be normal or low; recurrent episodes of binge eating and purging; use of laxatives or excessive exercise to lose weight; occurs at least once a week for 3 months;
treatment for bulimia
check electrolytes and treat; cBT; SSRI
What is kleptomania
likes to steal
What is pyromania?
deliberately sets on fire (fear and anxiety before act (fascination) and release of fear after the act (gratification)
What is it called when someone pulls his/her own hair out?
trichotillomania
What is intermittent explosive disorder?
When a person has episodes of aggressiveness that results in assault or destruction of property and they are out of proportion to the stressor
What are the stages of sleep?
Stage 1 alpha and theta waves (brief) and can be easily woken
Stage 2: sleep spindles and k complexes (down HR and lasts about 20 min)
Stage 3 delta waves (transitional)
Stage 4 delta waves: hardest to be awakened; bedwetting and sleep walking happen
REM about 90 min. after initial falling asleep, saw tooth waves, dreams, eye movement; RR up; sexual arousal, muscles relaxed, brain is active
What is Narcolepsy?
excessive daytime sleepiness more than 3 months
treatment
better sleeping; if sleep is not a problem then modafinil (amphetamines)
Sleep terrors stage of sleep
3 and 4; cannot wake up but have no memory of the event
What stage of sleep do nightmares occur in?
REM
ADHD diagnostic criteria
before age 12; hyperactivity and impulsivity for more than 6 months
Treatment for Tourette’s
antipsychotics (haloperidol) quetiapine
Rett syndrome
normal development followed by regression ages 1-5; handwringing; mostly girls because males die before birth; MECP2 mutation
Disruptive mood dysregulation disorder
verbal or aggressive outburst that are out of proportion to trigger; mood is irritable and unhappy between outbursts; at least 3 times a week for more than 12 months
Difference between delirium and dementia:
reversible, acute, fluctuating level of consciousness vs. insidious onset and caused by neurodegenerative disorders, personality changes
