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Step 2 Big Time Study Deck > Deck 1 COPY COPY > Flashcards

Deck 1 COPY COPY Flashcards

1
Q

what medication is best for helping with sleep hygeine

A

zolpidem

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2
Q

which benzo do you use for short term panic and anxiety

A

alprazolam

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3
Q

do you use benzos in sleep disorders

A

maybe a long acting but not a short acting, Z drugs are better to try first

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4
Q

when do you see delerium tremens

A

> 48 after last drink

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5
Q

what class of drug is doxepin

A

TCA

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6
Q

TCA OD signs

A

anticholinergic symptoms (mydriasis, flushed skin, tachy, HTN) + prolonged QT

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7
Q

which drug to use in a patient with poor kidney function in bipolar disorder

A

valproate (not lithium)

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8
Q

side effects of lithium

A

hypothyroidism, nephrogenic diabetes insipidus,

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9
Q

first step in elderly patients with acute changes in memory

A

medication review

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10
Q

what can MAO inhibitors lead to with wine and cheese

A

tyramine excess which causes a hypertensive crisis

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11
Q

when is it considered anorexia

A

<18 BMI

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12
Q

SS vs NMS reflexia

A

SS has hyperreflexia and NMS has regular reflexes

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13
Q

facial features of fragile X

A

Long face, wide set ears, macrocephaly

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14
Q

when does postpartum psychosis occur

A

within 2 weeks of delivery

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15
Q

can steroids cause acute mood disorders`

A

yes, especially in adolescents

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16
Q

if a patient has an OD on methadone, what do you do

A

naloxone and then you have to keep them in the hospital for >2 days because the half life of methadone is very long

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17
Q

if a patient does not want their procedure but a POA does, what do you do

A

get an eval to determine competency

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18
Q

treatment of bulemia and bing eating disorder

A

SSRI

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19
Q

treatment of anorexia

A

nutriitonal therapy and occasionally olanzapine

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20
Q

what class of drug is paroxetine

A

SSRI

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21
Q

treatment of premature ejaculation

A

SSRI

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22
Q

how to treat patients who are hyperventilating due to stress

A

reassurance and breathing retraining (no Paper bag!)

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23
Q

what types of therapy besides medication help prevent relapse of schizophreniaI

A

family therapy

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24
Q

imaging findings of patients with long history of schizophrenia

A

dilated ventricles

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25
Q

time range of brief psychotic disorder

A

1 day to 1 month

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26
Q

when do you keep patients on antidepressents indefintely

A

when they have had >2 relapses

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27
Q

what can you give to patients to immediately sedate if they are agitated

A

IM lorazepam or haldol (often given in combo)

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28
Q

dx of a patient keeps seeing herself killing mom with knife when using a knife

A

OCD

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29
Q

treatment of OCD

A

SSRI

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30
Q

can hypothyroid cause mood symptoms

A

yes extreme mood symptoms

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31
Q

TCA OD signs

A

seizures, anticholinergic effects, prolonged QT, mental status changes

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32
Q

PTSD diagnosis timeline

A

> 1 month symptoms

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33
Q

does adjustment disorder follow violence

A

no just after a stressful event, violence is more liely PTSD

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34
Q

presentation of pediatric depression

A

often irratibility rather than depressed mood

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35
Q

signs of cannabis withdrawal

A

irritability, depression, anxiety, weightloss, stomach pain, headache, shakiness, fevers, chills etc.

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36
Q

after what age should an imaginary freind be considered worrisome

A

after age 6

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37
Q

comorbid conditions of tourettes

A

OCD and ADHD

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38
Q

when do you use sertraline over citalopram

A

recent MI history

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39
Q

main AEs of clozapine

A

lowers seizure threshold and can cause agranulocytosis

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40
Q

timeframe of acute stress disorder

A

> 3 days < 1mo

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41
Q

can pregnant people take methadone

A

yace its safer than having them withdrawal

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42
Q

what is a nromal score on the MOCA

A

> or equal to 26/30

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43
Q

for a patient that just had one depressive episode how long do you trt them

A

6 months after remission, do not reduce the dose

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44
Q

next steps for a patient that has a SI and a plan and means

A

hospitalize them

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45
Q

what is considered an adequate trial on an antidepressant

A

> 6 weeks

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46
Q

waht do you do if an SSRI doesnt work for a patient

A

you try another SSRI or SNRI first before moving onto other antidepressants

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47
Q

signs of NMS

A

fever, muscle rigidity, normal reflexes, hyperthermia, altered mental status

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48
Q

how do differentiate between meth use and schizophrenia

A

meth will have severe dental problems like bruxism or tooth rot dry mouth etc

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49
Q

how to differentiate between normal adolescent behavior and depression

A

significant change to baseline and if their irratibility/moodniness is impacting their grades and social life

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50
Q

group A personality disorders

A

paranoid, schizoid, schizotypal

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51
Q

paranoid personality disorder

A

suspcioin and distrust of others, perception of benign remarks as attacks, oversensitivity

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52
Q

schizoid personality disorder

A

prefers to be alone, loaner, lack of interest in social connection, constricted affect

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53
Q

schizotypal personality disorder

A

kinda weird, socially awkward, ecessive discomfort in social situations

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54
Q

cluster B Personality disorders

A

antisocial, borderline, histrionic, narcissistic

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55
Q

antisocial PD

A

lack of respect for others rights, lack of remorse, kids with ODD have this >18

56
Q

borderline PD

A

extreme opinions, unstable emotions, difficulty maintaining relationships, high suicide attempts, intense anger, hates feeling abandoned

57
Q

narcissistic PD

A

excessive need for attention, lack of empathy, taking advantage of others

58
Q

histrionic PD

A

attention seeking and intensely emotional behavior, inappropriate, sexually provocative towards others

59
Q

cluster C personality disorders

A

avoidant, obsessive-compulsive, dependent

60
Q

avoidant PD

A

excessive shyness, sensitive to critism, low self esteem, fears relatinoships for fear of being rejected, strong desire for relationships

61
Q

OC personality disorder

A

need for order and control, efficiency, low flexibility

62
Q

dependent PD

A

fear of separation, excessive need for connection, difficulty diong things alone

63
Q

signs of tardive dyskinesia

A

abnormal involuntary movements, tongue protrusion, foot tapping, restlessness,

64
Q

how do you treat tardive dyskinesia

A

switch to a different non first gen antipsychotic (clozapine), reduce dose, use valbenazine (VMAT2 inhibitor)

65
Q

advice for parents for chlidren with specific phobias

A

read them stories about it, exposure etc.

66
Q

what type of antidperessant is paroxetine

A

SSRI

67
Q

how long do you have to have SIGECAPS to be dx

A

> 2 weeks

68
Q

onset of NMS vs. SS

A

NMS can be over a couple of days (not as acute) and SS is more rapid like <24 hours

69
Q

what is projection

A

this is when you attribute thoughts to another PERSON vs. displacement is a less threatening person/object

70
Q

what is denial

A

avoiding anxiety provoking thoughts by not accepting reality

71
Q

what is regression

A

this is when you revert to a child like state or move backwards in a maturational state

72
Q

what is displacement

A

this is when you shift your focus to a less threatening person or object

73
Q

what is intellectualization

A

Using abstract, rational, and/or logical reasoning to avoid affective expression and distance oneself from stress

74
Q

what is rationalization

A

Offering excuses or feasible explanations in an attempt to justify behaviors, attitudes, or beliefs to avoid self-blame

75
Q

what is reaction formation

A

Complete denial and/or rejection of an unacceptable impulse by acting in a diametrically opposite manner to avoid anxiety-provoking thoughts

76
Q

what is sublimation

A

this is when you shift your unacceptable/unattainable thoughts to soemthing goal directed

77
Q

what is suppression

A

this is when you conscoiuly suspend an anxiety provoking thought

78
Q

what is depersonalzation/derealization disorder

A

persistent feelings of being unattached to self or being an outside observer to your life or experiencing the surroundings as unreal

79
Q

what is dissociative amnesia

A

inability to recall information about yourself usually due to a stressor

80
Q

what is dissociative identity disorderq

A

discontinuity of self and loss of personal agency with >2 alters, associated with trauma/abuse

81
Q

signs of sleep apnea

A

depressed mood with normal range of affect, sleepiness, high BMI, male sex, HTN

82
Q

what can happen with prolonged QT

A

patients can go into torsades

83
Q

dx criteria for cyclothymia

A

> 2 yrs in adults of fluctuating moods not manic or major depressive episodes by hypo of both

84
Q

what is somatic symptom disorder

A

somatic symptoms (like leg pain) causing significant distress with repeated medical treatment despite negative workups

85
Q

risk factors for somatic symptom disorder

A

female, lower education level, hx of chlid abuse, sexual trauma, chronic illness

86
Q

what do you need to monitor for patients on antipsychotics

A

you need to check their metobolic levels (lipids, glucose, etc.)

87
Q

highest risk antipsychotics for metabolic effects

A

olanzapine and clozapine

88
Q

what is a distinguishing factor between major depressive disorder and normal stress resposne

A

MDD has to affect your life and ability to function in school, work, family etc.

89
Q

what is akathesia

A

subjective restlessness, inability to sit still

90
Q

how do you treat akathisia

A

decrease antipsychotic and add propanolol

91
Q

how do you treat parkinsonium

A

this is when you use benztropine and amantadine

92
Q

how do you treat acute dystonia

A

benztropine and diphenhydramine

93
Q

reaction formation

A

this is when you have a position but then do the exact opposite

94
Q

sublimation vs. reaction formation

A

in sublimation the behavior provides satisfaction and in reaction formation it does not

95
Q

if a patient has increased anxiety from starting an SSRI what do you do

A

you decrease their SSRI dose

96
Q

if a patient has a difficult time giving a history of events and they have been sexually abused what is the likely dx

A

dissociative identidy disorder

97
Q

what do you do with an aggressive patient

A

first make sure their needs are met like offering food and water, keep a safe distance, keep door open

98
Q

drugs to treat opioid withdrawal

A

clonidine, methadone, benzos, antiemetics, antidiarrheals

99
Q

sleep changes in depression

A

decreased REM latency time, and decreased slow wave sleep (Phase III and IV)

100
Q

treatment of depression with psychotic features

A

antidepressant with antipsychotic or electroconvulsive therapy

101
Q

signs of language disorder in a child

A

persistent difficulties with comprehension and/or production (expression), ex grammar, syntax, content..

102
Q

what is PMDD

A

pre menstrual dysphoric disorder where you get really irritable and bloaty before a period

103
Q

what is the pathophys of NMS

A

decreased central dopaminergic activity

104
Q

treatment of PTSD non medical

A

CBT

105
Q

treatment of acute stress disorder

A

CBT

106
Q

ways to decrease rate of rehospitalization in schizophrenic patients

A

LAI, family therapy

107
Q

DMDD dx timeline

A

before age 10

108
Q

treatment for acute mania

A

antipsychotic, lithium, valproate

109
Q

treatment for acute dystonia

A

diphenhydramine

110
Q

how to manage a patient with body dysmorphic disorder

A

Ask them how others would perceive of them

111
Q

if a patient has suicidal thoughts what do you do

A

you need to first do a suicide risk assessment and then based on that can 302 them

112
Q

what is kleptomania

A

the intense urge to steal things of small monetary value, guilt and shame usually follow

113
Q

treatment for acute bipolar depression

A

quetiapine and lorasadone

114
Q

what substance can buproprion help with

A

cigs

115
Q

what substances can buprenophrine help with

A

cocaine, meth, opioids

116
Q

what do you give to reinforce abstinance in a patient that has not relapsed on opioids

A

naltrexone

117
Q

what drug do you use for patients with high risk OUD or in current using

A

methadone

118
Q

treatment of acute serotonin syndrom

A

sedation with a benzo, cyproheptadine, short term antihypertensives like esmolo

119
Q

what is bromocriptine

A

dopamine agonist used to treat NMS

120
Q

if a patient failed one antipsychotic whats next

A

try a different class, clozapine only after two fails

121
Q

what are the non stimulant drugs for ADHD

A

clonidine, guanfacine, atomoxetine

122
Q

what are signs of adrenal insufficiency

A

depression, decreased body hair, craving saltiness

123
Q

how do you test for primary adrenal insufficiency

A

cosyntropin test (synthetic ACTH)

124
Q

what is the hallmark of bulemia

A

bing eating WITH compensatory behavior (vomiting, excess exercise, etc)

125
Q

treatment of body dysmorphic disorder

A

SSRI

126
Q

if a patient has both poor appetite and insomnia what is a good antidepressant to use

A

mirtazapine

127
Q

how do you monitor opioid use in a chronic pain patient

A

query the prescription drug database every month

128
Q

what is delusional disorder

A

when you have one specific delusion but it does not impede other functioning

129
Q

early side effects of SSRIs

A

headache nausea insomnia

130
Q

signs of suripticious sulphonylurea use

A

weight loss, hypoglycemia sx, high insulin and C-peptide

131
Q

what medications can be used for alcohol use disorder

A

acomprosate, naltrexone
, disulfiram

132
Q

when does postpartum depression occur

A

4-6 weeks post birth but up to a year after

133
Q

treatment of postpartum depression

A

SSRI

134
Q

when do postpartum blues occur

A

2-3 days post birth, no trt

135
Q

what is the principle of proportionality

A

methods used to achieve a goal are necessary, appropriate and not excessive

136
Q

signs of cocaine withdrawal

A

acute depression, hyperphagia, increased sleep, increased vivid dreaming, drug cravings

137
Q

is there more or less slow wave sleep in depression

A

less

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