High Yield Psych-Drugs, Mood, Schiz, PDs Flashcards by Lindsay Hammons

Bipolar dz: incidence in population is _____; risk of same diagnosis in monozygotic twin is _____.

1%; 80-90%

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Bipolar dz: meds to avoid include _____/____; meds to start include ____/ _____ for agitation/delusions and ____, _____ or _____ for maintenance.

SSRIs/TCAs [trigger mania]; haloperidol/clonazepam; lithium; valproic acid; carbamazepine

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Pt taking advil develops n/v/d, coarse tremor, ataxia, confusion, slurred speech. What med is pt on?

Lithium–toxicity precip by NSAIDS; better meds include aspirin or sulindac (*NSAID prodrug, less SEs)

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EKG findings for lithium toxicity include ____ or _____. Treat with _______ or ____ if >4 or kidney disease.

T-wave flattening; U-wave inversion; fluid resuscitation; emergent dialysis; [therapeutic levels Li 0.6 to 1.2]

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Lithium–major SEs are _____; MOA is _____

weight gain, acne, GI irritation, cramps; inhibits inosital triphosphate

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Lithium–medical monitoring

Li levels q4-8weeks; TFTs q 6mo; Cr, UA, CBC, EKG

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Lithium–Contraindications; teratogenic effect

CKD, MI, diuretics/digoxin, MG, pregnancy/breastfeeding; Ebstein’s anomaly [malformed tricusp, atrializes part of RV if taken 1st trimester]

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Bipolar dz: preferred preg tx

clonazepam (esp in 1st trimester)

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Biplolar MCC elevated LFTs/hepatitis

valproate (can cause n/v/d/skin rash) [therapeutic level 6-12]

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Bipolar MCC SJS

Lamotrigine (carbamazepine less likely)

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Bipolar MCC agranulocytisis; if ANC

carbamazepine (check CBC regularly!!!, therapeutic 60-120); monitor closely; discontinue the medication

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Biploar MCC increased AFP in 20wk preg

Valproate/carbamazepine (NTDs)

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MC complication of carbamazepine

rash

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Depression: most important question + most dangerous RF

assess for suicidal ideation; previous attempt

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RFs for suicide

SADPERSONS = sex (male), age (>45), depression, previous attempt, EtOH/substance abuse, rational thought, sickness (chronic), organized plan, no spouse, social support lacking

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Depression: describe on polysomnogram

shortened REM latency, more freq REM

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Depression: atypical lab tests

dexamethasone suppression test (failure to suppress)

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Medications that may cause depression

IFN, ß-blockers, ∂ methyldopa, L-dopa, OCPs, EtOH, cocaine/amph withdrawal, opiates

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Diseases that may cause depression

HIV, Lyme, hypothyroidism, porphyria, uremia, Cushing’s, liver dz, Huntington’s, MS, lupus, L-MCA stroke

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Characteristics of ATYPICAL depression

overeating, gaining weight, sleeping more, LEADEN PARALYSIS [also hypersensitive to rejection; best treated with MAOIs]

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Uncomplicated bereavement is coded under Axis ___. There are NO ____ or _____

V; suicidal thoughts; psychosis (other than seeing/hearing loved one)

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Adjustment dz occurs within ____ of stressor; cannot persist longer than _____; treated with _____

3 months; 6 months; psychotherapyp

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MDD: first line tx

SSRIs (also for OCD, bulemia, anxiety, PTSD, premature ejaculation)

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MDD/SSRI: most drug-drug interactions; fewest drug-drug interactions

paroxetine; citalopram

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MDD/SSRI: don't have to taper when stopping; describe 5HT discontinuation syndrome

fluoxetine; HA, n/v/d, dizziness, fatigue when stopping meds suddenly

Serotonin Syndrome (SSRI + MAOI)

myoclonic jerks, tachycardia, high BP, hyperreflexia, n/v/d

Buproprion can also be used for ______ cessation; contraindications

smoking; bulemia, alcoholics, epileptics

MDD med cause of priapism

trazadone

MDD med good for old, skinny, sad ladies

mirtazepine (inc appetite and sleep)

MDD med avoid in HTN, especially if taking St. John's Wort

venlafaxine (SNRI)

MDD med causing HTN crisis; tx HTN crisis

MAOI plus tyramine-containing foods; tx w/ 5mg IV phentolamine

Kid ate some pills out of grandma's purse...has dry mouth, tachycardia, vomiting, urinary retention and seizures (widened QRS complexes w/ prolonged AT); Tx?

TCAs (anticholinergic effects); activated charcoal if within 1-2 hrs and give IV sodium bicarbonate (cardioprotective)

TCAs: MCC death due to ____

arrhythmias [torsades, vfib]

Schizophrenia: prevalence? for monozygotic twin? for sibling/parent?

0.5-1%; 50%; 10%

Schizophrenia: positive sxs from EXCESS dopamine in ____ area binding ___ R; neg sxs from DECREASED dopamine in _____/_____

limbic; D2; prefrontal cortex/meso-cortical tract

Brief psychotic dz: lasts between ____ and _____

1 week; 1 month

Schizophreniform Dz: lasts between ____ and _____

1 month; 6 months

Schizoaffective Dz: delusions/hallucinations for ______ in the absence of ____; tx?

>2weeks; mood sxs; atypical antipsychotics + SSRI [dep] or + Li [mania]

MDD with psychotic features tx

atypical antipsychotic + SSRI or ECT [preg!]

Delusional disorder tx

therapeutic relationships + meds

DOC for acute agitation/psychosis

IM haloperidol

MOA haloperidol; MC SEs

D2R antagonist at mesolimbic tract; hyperprolactinemia/EPS

Typical antipsychotics: low potency

chlorpromazine, thioridazine [less EPS, more anti-ACh]

Typical antipsychotics: high potency

haloperidol, fluphenazine [lots EPS]

Typical antipsychotic SE: purple-grey metallic rash over sun-exposed area

chlorpromazine

Typical antipsychotic SE: prolonged QTc and pigmentary retinopathy

thioridazine

Typical antipsychotics: Pt wakes up with eyes "stuck" looking up and head "stuck" to one side

Acute dystonia; tx benztropine or diphenhydramine

Typical antipsychotics: Akathesia occurs within _____. Tx with __ (first line) or ____

1-3 months; propranolol; benzo

Typical antipsychotics: Parkinsonism can occur after ____. Tx with ____

6months; benztropine/diphenhydramine, amantadine, bromocriptine

Typical antipsychotics: Tardative dyskinesia can occur after ____; tx

years; stop antipsychotic and switch to atypical/clozapine

Within hours of haloperidol injections, patient gets NMS. Name sxs and tx.

T >103, inc CPK, rigidity, autonomic instability, delirium; dantrolene and cooling blankets

Atypical antipsychotic: highest risk for EPS and increase prolactin levels

risperidone

Atypical antipsychotic: prolongs QT, mostly weight neutral

ziprazodone

Atypical antipsychotic: increases akathesia, mostly weight neutral

aripiprazole

Atypical antipsychotic: most associated w/ weight gain w/ MC SE sedation

olanzepine

Atypical antipsychotic: causes orthostasis and cataracts (due to alpha blocking properties)

quetiapine

Atypical antipsychotic: for refractory tx schizophrenia

clozapine

Clozapine: MC SE; most dangerous SE

sedation, weight gain, increased blood sugar/lipids; agranulocytosis/dec seizure threshold

Monitoring clozapine w/ labs; discontinue if WBC

CBC--check ANC qWeek for 6mo and q2wks for next 6mo; 3000; 1500

Panic attack: give _____ or ____ in short term; for GAD, first line is ______

alprazolam; clonazepam; SSRIs [*Note: don't give benzos to drug addicts, COPD, restrictive lung dz]

Pt w/ Hx panic attacks brought to hospital 3 months later w/ T 101, convulsions, confusion and HTN; what did she run out of? Tx?

benzos (withdrawal, similar to DTs); diazepam or chlordiazepoxide + haloperidol if psychotic

Diagnose: pt deathly afraid of flying that inhibits her from interviewing at a job; tx

specific phobia; CBT w/ flooding or exposure, can give benzos situationally

Diagnose: pt deathly afraid of presenting case in grand rounds; tx

social phobia; propranolol and/or benzos

Diagnose: pt keeps to herself and doesn't talk w/ peers b/c afraid they will laugh; tx

avoidant PD; CBT

Diagnose: pt difficulty falling asleep b/c keeps thinking about failing classes and can't concentrate in class b/c worries about bf, sxs >6mo; tx

GAD; buspirone (5HT1a partial agonist, can take 3wks to work so give benzos to start)

OCD: 5-7% also have comorbid ____; tx

Tourettes; SSRIs (clomipramine is first line)

PTSD for GREATER than _____; Acute stress reaction LESS than _____; Adjustment disorder is within _____, but not deadly trauma

1 month; 1 month; 3-6months

PTSD: tx

sertraline/paroxetine + CBT

Diagnose: 54yo RN w/ hx 2mo diarrhea and abd pain, he presented to 4 other hosp w/ same prob and colonoscopy shows pigmentation

Munchausen [primary gain, taking laxatives]

Diagnose: concerned mom presents w/ 15mo baby having seizures, requests MRI, sleep EEG, etc.

Munchausen syndrome by proxy [ form of child abuse, 10% children die before reaching adulthood]

Diagnose: 45yo unemployed man in car accident who sues driver stating he has nerve damage to LE and can't walk but video shows him dancing the night before

Malingering [Axis V; associated w/ antisocial PD; secondary gain]

Anorexia: lab abnormalities

hypotension, bradycardia, hypothermia, leukopenia, high bicarb/LFTs/amylase, low Cl/K, high cholesterol

Anorexia: endocrine abnormalieies

high cortisol, low LF/FSH, low estrogen

Anorexia: MCC death, 2nd MCC

heart disease; suicide

Anorexia: tx

admit and maximize nutrition (SSRIs help BULEMIA only)

Anorexia: Refeeding syndrome labs

low PO4, low Mg/Ca and fluid retension

Morbidities in stage 3/4 of sleep

sleep walking/talking/night terrors

Insomnia: impairment in fxn > _____; tx

1 month; sleep hygiene ed, benzos, [zolpidem, zaleplon, escopiclone] = GABAa receptor agonists

Sleep: Benzos reduce _____ and increase ____

sleep latency; stage 3/4/REM

OSA: dx requires polysomnogram with greater than _____ hyponeic/apneas per hour; tx

10; CPAP [reduce pulmonary HTN]

Diagnose: 30 y/o man and is wife present for couples counseling. He constantly accuses her of cheating even though she is not; tx

Paranoid PD; low-dose antipsychotics

Diagnose: 30 y/o man, never been married or have any close friends. Works as a night security guard

Schizoid PD

Diagnose: 30 y/o man, unemployed because he spends his time reading books on how to communicate with animals so he can “be at one with nature”.

Schizotypal PD

Diagnose: 25y/o man comes to court mandated counseling for beating his girlfriend. He was kicked out of high school for fighting & just got out jail for stealing a car.

Antisocial PD

Antisocial PD: ____ also have substance abuse

66%

Diagnose: His girlfriend has a hx of unstable relationships, has superficial cuts on both wrists, is impulsive in her spending and sexual practices.

Borderline PD [commonly use splitting]

Diagnose: 26 y/o, her classmates complain that she dresses too provocatively to class. She recently tried to seduce a professor.

Histrionic PD

Histrionic PD: also associated with ____ or _____

eating disorder; substance abuse

Diagnose: A 22 y/o doesn’t feel like he needs to come to any classes or labs because he “already has the brilliance to be a doctor."

Narcissistic PD [can give individual therapy]

Diagnose: 30 y/o woman has no friends and avoids happy hours with her coworkers b/c she fears ridicule and rejection

Avoidant PD

Diagnose: 30 y/o woman calls her friends and family >20x a day to get their input on her daily decisions

Dependent PD

Avoidant PD: tx

SSRI +/- beta blockers for social phobias

Dependent PD: also look for co-morbid ____ and ____ ; tx

depression; anxiety; SSRI

Diagnose: 25 y/o M4 spends more time color coding her notes and textbook highlighting than actually studying. She makes lists and study schedules 3 times per day

OCPD