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Psychiatry > High Yield Psych-Drugs, Mood, Schiz, PDs > Flashcards

High Yield Psych-Drugs, Mood, Schiz, PDs Flashcards

1
Q

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

A

1%; 80-90%

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2
Q

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

A

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

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3
Q

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

A

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

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4
Q

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

A

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

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5
Q

Lithium–major SEs are _____; MOA is _____

A

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

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6
Q

Lithium–medical monitoring

A

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

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7
Q

Lithium–Contraindications; teratogenic effect

A

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

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8
Q

Bipolar dz: preferred preg tx

A

clonazepam (esp in 1st trimester)

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9
Q

Biplolar MCC elevated LFTs/hepatitis

A

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

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10
Q

Bipolar MCC SJS

A

Lamotrigine (carbamazepine less likely)

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11
Q

Bipolar MCC agranulocytisis; if ANC

A

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

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12
Q

Biploar MCC increased AFP in 20wk preg

A

Valproate/carbamazepine (NTDs)

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13
Q

MC complication of carbamazepine

A

rash

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14
Q

Depression: most important question + most dangerous RF

A

assess for suicidal ideation; previous attempt

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15
Q

RFs for suicide

A

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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16
Q

Depression: describe on polysomnogram

A

shortened REM latency, more freq REM

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17
Q

Depression: atypical lab tests

A

dexamethasone suppression test (failure to suppress)

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18
Q

Medications that may cause depression

A

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

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19
Q

Diseases that may cause depression

A

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

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20
Q

Characteristics of ATYPICAL depression

A

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

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21
Q

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

A

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

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22
Q

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

A

3 months; 6 months; psychotherapyp

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23
Q

MDD: first line tx

A

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

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24
Q

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

A

paroxetine; citalopram

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25
Q

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

A

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

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26
Q

Serotonin Syndrome (SSRI + MAOI)

A

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

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27
Q

Buproprion can also be used for ______ cessation; contraindications

A

smoking; bulemia, alcoholics, epileptics

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28
Q

MDD med cause of priapism

A

trazadone

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29
Q

MDD med good for old, skinny, sad ladies

A

mirtazepine (inc appetite and sleep)

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30
Q

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

A

venlafaxine (SNRI)

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31
Q

MDD med causing HTN crisis; tx HTN crisis

A

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

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32
Q

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?

A

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

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33
Q

TCAs: MCC death due to ____

A

arrhythmias [torsades, vfib]

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34
Q

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

A

0.5-1%; 50%; 10%

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35
Q

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

A

limbic; D2; prefrontal cortex/meso-cortical tract

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36
Q

Brief psychotic dz: lasts between ____ and _____

A

1 week; 1 month

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37
Q

Schizophreniform Dz: lasts between ____ and _____

A

1 month; 6 months

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38
Q

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

A

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

39
Q

MDD with psychotic features tx

A

atypical antipsychotic + SSRI or ECT [preg!]

40
Q

Delusional disorder tx

A

therapeutic relationships + meds

41
Q

DOC for acute agitation/psychosis

A

IM haloperidol

42
Q

MOA haloperidol; MC SEs

A

D2R antagonist at mesolimbic tract; hyperprolactinemia/EPS

43
Q

Typical antipsychotics: low potency

A

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

44
Q

Typical antipsychotics: high potency

A

haloperidol, fluphenazine [lots EPS]

45
Q

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

A

chlorpromazine

46
Q

Typical antipsychotic SE: prolonged QTc and pigmentary retinopathy

A

thioridazine

47
Q

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

A

Acute dystonia; tx benztropine or diphenhydramine

48
Q

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

A

1-3 months; propranolol; benzo

49
Q

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

A

6months; benztropine/diphenhydramine, amantadine, bromocriptine

50
Q

Typical antipsychotics: Tardative dyskinesia can occur after ____; tx

A

years; stop antipsychotic and switch to atypical/clozapine

51
Q

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

A

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

52
Q

Atypical antipsychotic: highest risk for EPS and increase prolactin levels

A

risperidone

53
Q

Atypical antipsychotic: prolongs QT, mostly weight neutral

A

ziprazodone

54
Q

Atypical antipsychotic: increases akathesia, mostly weight neutral

A

aripiprazole

55
Q

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

A

olanzepine

56
Q

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

A

quetiapine

57
Q

Atypical antipsychotic: for refractory tx schizophrenia

A

clozapine

58
Q

Clozapine: MC SE; most dangerous SE

A

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

59
Q

Monitoring clozapine w/ labs; discontinue if WBC

A

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

60
Q

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

A

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

61
Q

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?

A

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

62
Q

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

A

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

63
Q

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

A

social phobia; propranolol and/or benzos

64
Q

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

A

avoidant PD; CBT

65
Q

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

A

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

66
Q

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

A

Tourettes; SSRIs (clomipramine is first line)

67
Q

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

A

1 month; 1 month; 3-6months

68
Q

PTSD: tx

A

sertraline/paroxetine + CBT

69
Q

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

A

Munchausen [primary gain, taking laxatives]

70
Q

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

A

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

71
Q

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

A

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

72
Q

Anorexia: lab abnormalities

A

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

73
Q

Anorexia: endocrine abnormalieies

A

high cortisol, low LF/FSH, low estrogen

74
Q

Anorexia: MCC death, 2nd MCC

A

heart disease; suicide

75
Q

Anorexia: tx

A

admit and maximize nutrition (SSRIs help BULEMIA only)

76
Q

Anorexia: Refeeding syndrome labs

A

low PO4, low Mg/Ca and fluid retension

77
Q

Morbidities in stage 3/4 of sleep

A

sleep walking/talking/night terrors

78
Q

Insomnia: impairment in fxn > _____; tx

A

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

79
Q

Sleep: Benzos reduce _____ and increase ____

A

sleep latency; stage 3/4/REM

80
Q

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

A

10; CPAP [reduce pulmonary HTN]

81
Q

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

A

Paranoid PD; low-dose antipsychotics

82
Q

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

A

Schizoid PD

83
Q

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”.

A

Schizotypal PD

84
Q

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.

A

Antisocial PD

85
Q

Antisocial PD: ____ also have substance abuse

A

66%

86
Q

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

A

Borderline PD [commonly use splitting]

87
Q

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

A

Histrionic PD

88
Q

Histrionic PD: also associated with ____ or _____

A

eating disorder; substance abuse

89
Q

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.”

A

Narcissistic PD [can give individual therapy]

90
Q

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

A

Avoidant PD

91
Q

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

A

Dependent PD

92
Q

Avoidant PD: tx

A

SSRI +/- beta blockers for social phobias

93
Q

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

A

depression; anxiety; SSRI

94
Q

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

A

OCPD

Psychiatry (2 decks)

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