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Mental Health Medications > Internet Questions > Flashcards

Internet Questions Flashcards

1
Q

What are The Three Rules of Neurotransmission?

A
  1. What goes up must come down.
  2. A neurotransmitter is not easily fooled.
  3. With great power comes great responsibility.
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2
Q

What is the following drug affect?

Mimics the effect of a neurotransmitter

A

Agonist

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3
Q

What is the following drug affect?

Mimics the effect, but only to a point

A

Partial agonist

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4
Q

What is the following drug affect?

Blocks the effect

A

Antagonist

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5
Q

What is the following drug affect?

Produces the opposite effect

A

Inverse agonist

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6
Q

What are the functions of Dopamine?

A 
DOPAMINE:
D – Drive
O – psychOsis
P – Parkinsonism
A – Attention
M – Motor
I – Inhibition of Prolactin
N – Narcotics
E – Extrapyramidal Side Effects
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7
Q

Where is Dopamine released from ?

A

Ventral Tegmental Area

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8
Q

What are the functions of Serotonin?

A

Head
1. Involved with depression, anxiety, social interaction, impulsivity, sex drive, and
migraines
Red
1. Affects platelet binding and adhesion
2. SSRI’s associated with increased bleeding risk
Fed
1. Drives both GI motility as well as nausea
2. Drugs which block serotonin (e.g., ondansetron) prevent nausea

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9
Q

What syndrome causes CNS effects, flushing and hyperthermia, and has a significant mortality rate.

A

Serotonin syndrome

Head, red, dead

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10
Q

Where is serotonin released from?

A

Raphe nuclei

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11
Q

Where is Norepinephrine released from?

A

Locus ceruleus

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12
Q

What overdose will have a sign of pinpoint pupils?

A

Opiate overdose

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13
Q

A patient is given a drug which is intended to help treat depression by augmenting a specific neurotransmitter in the brain. Side effects of this drug include decreased sex drive, increased risk of bleeding, and diarrhea. The specific neurotransmitter affected by this drug is released primarily from which area of the brain?

a. Locus Ceruleus
b. Raphe Nuclei
c. Nucelus Accumbens
d. Basal Ganglia
e. Ventral Tegmental Area

A

B. Raphe Nuclei
Based on the drug’s indication (depression) and the side effects listed, you can infer that the drug works on serotonin, which is released in the raphe nuclei. Remember the mnemonic “Sir Raphael” to associate serotonin and the raphe nuclei. Answer A refers to the source of norepinephrine.
Answer C and E are associated with dopamine. Answer D involves multiple neurotransmitters, including
GABA, dopamine, and acetylcholine, but does not significantly involve serotonin.

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14
Q

A patient is released from the hospital following an acute psychotic episode. Several months later, he comes into clinic complaining that he is developing breasts. This is likely due to a medication which blocks dopamine’s effect on which of the following hormones?

a. FSH
b. LH
c. Prolactin
d. Oxytocin
e. Testosterone
f. Estrogen

A

C. Prolactin
Given the patient’s recent psychotic episode, an antipsychotic which blocks dopamine was likely given. Recall that dopamine was once known as Prolactin Inhibiting Factor, so blocking
dopamine results in increased prolactin. This can result in gynecomastia and/or milk letdown, which can be confusing or embarrassing for the patient. Answers A, B, and D–F are not significantly associated with dopamine.

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15
Q

An 18 y/o F college student is brought into the ED complaining of feeling “like my head is going to explode.” She is profoundly confused. On exam, she has noticeable facial flushing and profuse sweating. Vital signs show a pulse of 109 and a temperature of 101.7°F. Neurological exam reveals muscular rigidity and hyperreflexia. What neurotransmitter is most likely in excess?

a. Dopamine
b. Serotonin
c. Norepinephrine
d. GABA
e. Glutamate

A

B. Serotonin

Classic serotonin syndrome

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16
Q

Which of the following is not a function of acetylcholine?
a. Slowing digestion

b. Slowing heart rate
c. Muscle contraction
d. Memory
e. Penile erection

A

A. Slowing digestion
As part of the parasympathetic nervous system, acetylcholine will increase the rate of digestion, not slow it down (remember “rest and digest!”). Slowing heart rate, muscle contraction, memory, and penile erection are all correctly identified as functions of acetylcholine.

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17
Q

How long must someone be depressed in order to diagnosis major depressive disorder?

A

2 weeks

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18
Q

Which SSRI has the longest half-life?

A

Fluoxetine - about a week

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19
Q

Which SSRI has harsh GI side effects but is useful during pregnancy and breastfeeding

A

Sertaline (Zoloft)

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20
Q

Which SSRI causes QT prolongation at high doses.

A

Citalopram (Celexa)

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21
Q

Which SSRI has a serious side effect of priapism

A

Trazadone (Drsyrel)

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22
Q

Which SSRI is used for chronic pain

A

Duloxetine (Cymbalta)

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23
Q

Which drug can be used to augment appetite

A

Mirtazapine (Remeron)

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24
Q

Which drug can treat ADHD and depression simultaneously.

A

Bupropion (Wellbutrin)

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25
Q

Which drug does not have the sexual side effects of SSRI’s.

A

Bupropion (Wellbutrin)

26
Q

Which drug can help patients to quit smoking.

A

Wellbutrin (Bupropion)

27
Q

Which drug lowers the seizure threshold and is contraindicated in bulimic patients

A

Wellbutrin (Bupropion)

28
Q

Which drug overdose will have a wide QRS on EKG?

A

TCA overdose

29
Q

What the treatment for TCA overdose

A

Bicarbonate

30
Q

Which SSRI requires a 5 week washout before starting a TCA?

A

Fluvoxamine (Luvox)

31
Q

Which TCA is a second-line agent to control bedwetting

A

Imipramine (Tofranil)

32
Q

Which drug is Considered to be the gold-standard for medication treatment of OCD

A

Clomipramine (Anafranil)

33
Q

Having aged wine or cheese while on an MAOI can provoke what?

A

Hypertensive crisis due to excess Tyramine

34
Q

A 47 y/o M with a history of depression comes into your office reporting that he stopped taking his fluoxetine after “a couple of embarrassing nights” where he was unable to get an erection with his wife, which he finds intolerable. What is the most reasonable replacement for fluoxetine in this patient?

a. Citalopram
b. Sertraline
c. Venlafaxine
d. Bupropion
e. Trazodone
f. Imipramine
g. Nortriptyline

A

D. Bupropion (Wellbutrin)
Of all the listed options, bupropion has no significant serotonergic effects and therefore is useful in patients who experience significant sexual side effects on traditional serotonergic agents. Answer E may be tempting as trazodone use is associated with priapism, but remember that priapism is a medical emergency and should not be sought after as a side effect.
Answers F and G are particularly bad choices here because of the side effect profile of TCA’s.

35
Q

A 24 y/o M presents with a five year history of severe anxiety over having forgotten to lock the door. It has gotten to the point where he must wake up 4 hours early so that he can repeatedly check the locks before leaving for work. He describes his behavior as “extremely, extremely upsetting” to him but says he is unable to stop. What is the most reasonable medication to suggest? (Select up to two answer

choices. )
a. Clomipramine
b. Fluvoxamine
c. Bupropion
d. Sertraline
e. Phenelzine

A

B and D.
Recall that fluvoxamine is unique in that it is FDA-approved only for treatment of OCD. However, sertraline is a reasonable option here as well, as all SSRI’s are helpful to
treat OCD.
Answer A clomipramine may be tempting as it is the gold standard for pharmacologic treatment of OCD, but because of the high amount of side effects it should be reserved until the patient has failed therapy with an SSRI.
Answer C is incorrect as bupropion does not have serotonergic effects.
Answer E is incorrect as the side effect profile of MAOI’s makes phenelzine an inappropriate initial pharmacotherapy

36
Q 
A 26 y/o G2P1 single mother who recently gave birth brings her baby in for a 1-month check. The baby is back to its birth weight and seems to be doing well. She has been exclusively breastfeeding. During the interview, she lets on that she has been feeling sad and tearful since delivering. A complete history is 
consistent with post-partum depression. What medication is most often recommended to treat post-
partum depression?
a. Sertraline
b. Paroxetine
c. Fluoxetine
d. Escitalopram
e. Trazodone
A

A. Sertaline (Zoloft)
Use the “SQUIRT-raline” mnemonic to remember that sertraline is often recommended for post-partum depression, as little of it gets into the breastmilk. Paroxetine (answer B)
would be a particularly bad choice, as it is rapidly absorbed and could result in uncomfortable withdrawal symptoms if discontinued. Fluoxetine (answer C), with its long half-life, would be a good option if the patient had difficulty remembering to take medications regularly. Answer D is not entirely incorrect, as escitalopram is generally considered to be a good first-line agent for treatment of depression, but given the patient’s history it is not the best option here. Answer E is incorrect, as trazodone is most helpful for patients with insomnia related to depression.

37
Q

A 36 y/o F with a long history of treatment-refractory depression and OCD is found passed out on the floor with an empty bottle of medications nearby. She is non-responsive. Heart rate is 138, blood pressure is 92/58. On EKG, there are wide QRS complexes noted. Cardiac enzymes are normal x1.
What is the most appropriate treatment after hydration and supportive measures?
a. Activated charcoal
b. Atropine
c. Propranolol
d. Sodium bicarbonate
e. Flumazenil

A

D. Sodium bicarbonate
The question stem describes a patient who has likely overdosed on TCA’s (remember that wide QRS complexes on EKG in the context of a medication overdose is very, very likely
to be from TCA overdose). The mnemonic “a biCARb runs over a TRICYCLE” should remind you that sodium bicarbonate is the treatment for tricyclic overdose. Answers A and E are incorrect: although both are antidotes for specific intoxicants, neither is appropriate for TCA overdose. Answer B is incorrect, as atropine will contribute further to tachycardia. Answer C is incorrect, as propranolol will (while stabilizing the tachycardia) further lower the blood pressure.

38
Q

A mother brings her 7 y/o boy into his pediatrician’s office with complaints of bed wetting. She states that his behavior has been present since he was 4, but she believed that he would soon outgrow it. Now that he is 7, she worries that it will be an issue at sleepover parties and requests treatment. What is a reasonable therapy to try?

a. No therapy (continue to wait)
b. Bedwetting alarms
c. Citalopram
d. Imipramine
e. Desmopressin

A

B. Bedwetting alarms
While the patient is certainly at the age where some form of therapy should be considered, (answer A) behavioral therapies should always be pursued before medications, as the available options (such as imipramine) all have significant side effects. Should the patient fail behavioral therapy, then imipramine or desmopressin (answers D or E) could be considered. Answer C is incorrect, as citalopram has no significant effect on nocturnal enuresis

39
Q

What are the symptoms of mania ?

A 
Digfast 
Distractibility
Irresponsibility
Grandiosity
Flight of Ideas
Agitation
Sleep
Talkativeness
40
Q

How long must a manic episode be present for?

A

1 week

41
Q

How do you treat acute mania?

A

Antipsychotics

42
Q

What drug class do you want to avoid for treatment of bipolar disease ?

A

Antidepressants

43
Q

What levels do you want to maintain lithium levels at?

A

1.0- 1.2

44
Q

The following are side effects of what medication: tremor, nephrotoxicity, hypothyroidism, and
teratogenesis.

A

Lithium

45
Q

Patient unconscious + working outside on a hot day + history of bipolar disorder =

A

Nephrotoxicity (due to the lithium being excreted through the kidneys)

46
Q

Lithium used in pregnancy can cause what?

A

Ebstein’s anomaly

47
Q

What drug can cause neural tube defects in pregnancy.

A

Valproic Acid (Depakote)

48
Q

What drug can cause liver necrosis.

A

Valproic Acid (Depakote)

49
Q

What drug is used to treat trigeminal neuralgia

A

Carbamazepine (Tegretol)

50
Q

What drug causes rashes and Stevens-Johnson syndrome?

A

Lamotrigine (Lamictal)

51
Q

What drug causes weight loss and mental dulling.

A

Topiramate (Topamax)

52
Q

What is first line for generalized anxiety disorder?

A

Buspirone (Buspar)

53
Q

What drug is used for sleep induction

A

Zolpidem (Ambien)

54
Q

A 23 y/o F is brought into the ED by worried family members who report that she has been “flying around the house” and has not slept in several days. During the interview, the patient talks incessantly and frequently refers to her plan to run for political office to “save the children.” What is the most important therapy to order immediately?

a. Lithium
b. Valproic Acid
c. Paroxetine
d. Trazodone
e. Olanzapine
f. Diazepam

A

E. Olanzapine
The most important immediate treatment for a patient in an acute manic episode is antipsychotics, in this case olanzapine. Mood stabilizers such as lithium or valproic acid should be ordered as well, but they work too slowly for acute management (answers A and B). Antidepressants such as paroxetine (answer C) should be avoided. Trazodone (answer D) and diazepam (answer F) might seem like good options as they help to sedate and induce sleep, but are not as effective as an antipsychotic

55
Q

A 21 y/o M with a history of known bipolar I disorder on valproic acid comes to see his psychiatrist. He states that he is “as depressed as I have ever been” and is unable to work due to neurovegetative symptoms. His psychiatrist suggests discontinuing valproic acid and attempting a trial of lamotrigine. What side effects should the patient be counseled on?

a. Dermatologic reactions
b. EKG abnormalities
c. Urinary retention
d. Rapid cycling mood
e. Neuropathic pain

A

A. Dermatologic reaction
Lamotrigine has a high rate of skin reactions, occurring in 5-10% of patients started on the drug. However, there is an association with Stevens-Johnson syndrome, which can be life-threatening, so patients should be counseled to seek emergency services immediately if there is fever or mucous membrane involvement. None of the other side effects are associated with lamotrigine, and it may even help prevent rapid cycling.

56
Q

A 24 y/o G2P1A1 F with a 5-year history of bipolar I disorder has just given birth to a newborn boy. Several hours after birth, the newborn becomes agitated and appears to be in respiratory distress. On exam, his lips are observed to have a bluish tinge. Transthoracic echocardiogram reveals significant structural abnormalities. What is the most likely cause of this presentation?

a. Aspiration of foreign object
b. Congenital malformation
c. Medication side effect
d. TORCH infections
e. Smoking during pregnancy

A

C. Medication side effect
Specifically, the vignette alludes to lithium, as the patient likely has Ebstein anomaly related to maternal lithium use. Ebstein anomaly refers to a low-implanted tricuspid. The other
options are unlikely given the significant risk factors for lithium exposure.

57
Q

Which medication is incorrectly paired with its side effect?
a. Lithium – Hypothyroidism

b. Oxcarbazepine – Agranulocytosis
c. Topiramate – Mental dulling
d. Valproic acid – Hepatic necrosis
e. Lamotrigine – Stevens-Johnson syndrome

A

B. Oxcarbazepine – Agranulocytosis
Agranulocytosis is associated with carbamazepine use, not oxcarbazepine. All other medications are correctly paired with their classic side effects.

58
Q

A 47 y/o overweight F presents to her primary care provider with a chief complaint of intense right cheek pain when brushing her teeth. The pain “feels electrical” and happens several times per day. It has gotten to the point where she is afraid of eating or brushing her teeth for fear of triggering the pain. What is the best treatment option?

a. Ibuprofen
b. Percocet
c. Carbamazepine
d. Gabapentin
e. Topiramate
f. Cognitive behavioral therapy

A

C. Carbamazepine (Tegretol)
This is a classic case of trigeminal neuralgia. You can remember from the CBZ mnemonic that carbamazepine is helpful in treating trigeminal neuralgia, the “Cranial Nerve of CBZ.
The other options are not as specific for treatment of trigeminal neuralgia.

59
Q

A 42 y/o M was brought to the Emergency Department by police officers who found him wandering the streets obviously intoxicated with alcohol. He is well known by the ED staff who have seen him several times for alcohol related incidents. When rounding with your team, the attending states, “We will have to monitor him closely for alcohol withdrawal. I’d suggest using a benzodiazepine with a long half-life.” Which of the following options would work best here?

a. Chlordiazepoxide
b. Triazolam
c. Alprazolam
d. Lorazepam
e. Midazolam

A

A. Chlordiazepoxide
Of all the options listed, only chlordiazepoxide is considered to have a long (>40 hours) half-life, which makes it an excellent choice for a benzodiazepine taper in a patient withdrawing from alcohol. Triazolam and midazolam (answers B and E) are both considered short half-life benzodiazepines, while alprazolam and lorazepam (answers C and D) are medium half-life.

60
Q

A 33 y/o F comes into your office at a free county clinic for patients without health insurance. She states that she is concerned because 3 or 4 times per month she will lay awake in bed for hours simply unable to fall asleep. She denies feeling depressed or anxious. What would be the best pharmacologic option for this patient?

a. Zolpidem
b. Eszopiclone
c. Doxylamine
d. Lorazepam
e. Alprazolam

A

C. Doxylamine (Unisom)
Doxylamine is a first-generation antihistamine that is an effective sleeping aid for patients without significant comorbidities. In particular, its low cost and over-the-counter status make it a good recommendation in this setting. For patients without health insurance, expensive options such as zolpidem and eszopiclone would be unrealistic (answers A and B). Remember that benzodiazepines are not first-line agents for insomnia, so lorazepam and alprazolam (answers D and E) are incorrect.

Mental Health Medications (4 decks)

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