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Lang Qs Flashcards

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1
Q

Which 3 antidepressants have no sex side effects

A

buproprion
mirtazapine
nefadozone

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2
Q

What is the treatment for MAO-I hypertensive crisis?

A

IV phentolamine (alpha blocker to control HTN)

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3
Q

Which SSRI is most prone to withdrawal sx? which is least?

A 
most = paroxetine
least = fluoxetine b/c long half life, don't need to taper
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4
Q

What comorbidity is duloxetine first line to treat?

A

MDD with pain (including fibromyalgia, neuropathic)

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5
Q

What is major side effect of venlafaxine?

A

hypertension

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6
Q

Which two 2nd gen antipsychotics are weight neutral?

A

ziprasidone

aripriprazole

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7
Q

What is copropraxia?

A

complex motor tick of making obscene gestures

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8
Q

What is the triad of wernicke?

A

confusion,ataxia, opthalmoplegia

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9
Q

What is the first line treatment for alzheimers?

A

cholinesterase inhibitors –> donepezil, galantamine, rivastigmine, tacrine

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10
Q

What age, gender, race risk factors for suicide?

A
  1. age >45
  2. male gender (thought women attempt more, men complete more)
  3. white race
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11
Q

What drug is a good sleep aid for patient with alcohol abuse history?

A

trazodone = antidepressant w/ sleep aid effects

benzos and zolpidem avoided b/c of abuse potential

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12
Q

What is first line for bipolar manic episode?

A

valproate or lithium w/ or w/out atypical antipsychotic

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13
Q

What 3 drugs first line for bipolar depression?

A

lithium, lamotrigine, or quietiapine

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14
Q

What drug is most effective for treatment tourettes?

A

antipsychotics like risperidone, olanzapine, haloperidol

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15
Q

What is first line treatment for mild tourettes? side effects?

A

clonidine (a2 agonist)

SE: dizzy,sedation

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16
Q

What is mainstay of treatment for enuresis? if that fails?

A

behavioral therapy is 1st line

if that fails –> DDAVP –> imipramine

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17
Q

What are physical features of fetal alcohol syndrome?

A

microcephaly, short plpebral fissure, flat midface, thin upper lip

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18
Q

What is most effective treatment for atypical depression?

A

MAOIs (althoguh tpically first line treatment is SSRI b/c of SEs)

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19
Q

What is a good choice for treatment of noncompliant psychotic pt?

A

long acting antipsychotics like risperidone consta

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20
Q

What is preferred treatment for bipolar with rapid cycling (greater than 3 manic or depressive ep per year)?

A

valproate or carbamazepine (better than lithium in rapid cycling)

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21
Q

What is treatment for bipolar in pregnancy?

A

haloperidol is safe

avoid carbamazepine/ lithium/ valproate

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22
Q

What is the treatment for autonomic hyperactivity in opioid withdrawal?

A

clonidine = alpha 2 agonist

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23
Q

What is the best acute treatment for bipolar depression?

A

lamotrigine

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24
Q

What is main sx in depression in adolescents vs kids that is different than adults?

A 
adolescents = irritable
kids = anxious w/ psychomotor agitation
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25
Q

What happens biologically in MDD?

A

increased cortisol, decreased catecholamines (5HT) / sex hormones / immune

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26
Q

How long does an untreated depressive episode last?

A

6-13 months

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27
Q

What are melancholic feat. of MDD?

A

anhedonia, psychomotor retardation, lack of reactivity to pleasurable stimuli, excess guilt, anorexia

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28
Q

What are atypical feat. of MDD?

A

weight gain, hypersomnia, mood reactivity, leaden paralysis, rejection sensitivity

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29
Q

What is most effective treatment for atypical MDD?

A

MAO inhibitors

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30
Q

What is chance of future episodes after one episode of MDE?

A

50% chance of future episodes

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31
Q

What is treatment of postpartum depression w/ psychotic feat?

A

SSRI and antipsychotic

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32
Q

What are major side effects of fluoxetine?

A

general: GI sx, insomnia, H/A
specific: activating –> agitation, worst sex dysfunction

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33
Q

What are major side effects of paroxetine?

A

general: GI sx, insomnia, H/A, sex
specific: sedating –> cognitive, discontinuation syndrome

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34
Q

What are major side effects of sertraline?

A

general: GI sx, insomnia, H/A, sex
specific: bad GI side effects

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35
Q

What are first sx to respond to SSRI?

A

sleep, energy, appetite = first to respond

libido/hopelessness/SI = respond later

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36
Q

What are contraindications for ECT?

A

space occupying lesion, recent MI

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37
Q

How do you differentiate adjustment vs MDD?

A

adjustment = does not meet criteria for MDD

sx do not last longer than 6 mo after stressor

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38
Q

How do you differentiate MDD vs bereavement?

A

bereavement = depressed mood but able to function w/ ADLs

no SI (other than would be better of dead / should have died with deceased), no significant distressing AH except as related to deceased, no guilt other than about actions taken

must not persist beyond 2 mo

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39
Q

What is risk of mono twin developing bipolar?

A

80-90%

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40
Q

What is postpartum psychosis?

A

delusion/hallucation within 1 week of delivery

most cases eventually manifest as bipolar

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41
Q

What is treatment for manic episode?

A

valproate or lithium

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42
Q

What is treatmetn for bipolar depression?

A

lamotrigine = specifically for depression

lithium, quietiapine also

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43
Q

What is cyclothymic d/o?

A

episodic mood disturbances of hypomania and subclinical depression, do not meet criteria for bipolar 1/2

treat = mood stabilizer

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44
Q

What is presentation of malignant catatonia? treat?

A

fever, autonomic instability, delirium, rigidity

treat: benzo

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45
Q

What differentiates delusional d/o from schizophrenia?

A

delusional d/o: have organized thought process and function in other aspects of life except as relate to delusion

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46
Q

What is capgras delusion?

A

belief that people have been replaced by identically appearing imposters

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47
Q

What is cotard delusion?

A

nihilistic delusion that you have lost posesssion, blood, heart. etc

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48
Q

What is fregoli delusion?

A

belief that familiar people assume guise of strangers

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49
Q

How does cocaine intoxication present?

A

tachycardia, diaphoresis, pupil dilation, can mimic mania or psychosis

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50
Q

How does cocaine withdrawal present?

A

dysphoric mood, hypersomnia, increased appetite, fatigue

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51
Q

How does cannabis withdrawal present?

A

mild, several weeks of decreased mood/appetite, increased irritability, anxiety, tension

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52
Q

How does amphetamine tox present?

A

euphoria, interpersonal sensitivity, anxiety, tension, anger, impaired judgment, pupil dilation, insomnia, sweat/chills, N/V

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53
Q

How does amphetamine withdrawal present?

A

fatigue, vivid dreams, sleep disturbance, increased appetite

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54
Q

How does alcohol tox present?

A

incoordination, judgment errors, mood lability, nystagmus, slurred speech

55
Q

What is alcoholic hallucinosis?

A

visual hallucinations 12-24 hours after stop alcohol and resolve in 24-48 hrs
pts are aware they are not real, no clouding of sensorium, normal vitals

56
Q

What is delirium tremens?

A

mental status change, vital abnormalities, and hallucinations 3-5 days after last drink

57
Q

What is outcome/mortality of delirium tremens?

A

30% untreated mortality

58
Q

What is mech/use of disulfiram?

A

aldehyde dehydrogenase inhibitor –> get physical discomfort of hangover = incentive to remain abstinent

59
Q

What is mech/use of naltrexone?

A

opioid antagonist –> use for opioid OD or alcohol abuse (increases time before relapse)

60
Q

What is prevalence of depression immediately after abstain from alcohol vs 4 weeks later?

A

40% are depressed within 1 week

only 5% still depressed after 4 weeks

61
Q

What is presentation and treatment of opioid OD?

A

decreased consciousness, resp depression, pinpoint pupils

treat w/ naloxone or naltrexone

62
Q

What is mech/use of buprenoprhone?

A

mixed opioid agonist/antagonist used to detoxify

63
Q

What is treatment of opioid withdrawal?

A

methadone

clonidine = alpha 2 agonist for autonomic sx

64
Q

What is presentation of inhalant intoxication?

A

rapid onset dizzy, nausea, ataxia, slurred speech, disorientation, visual disturbance, euphoria, nystagmus

65
Q

What is treatment for acetaminophen OD?

A

acetylcysteine

66
Q

What are some signs of bulimia?

A 
erosion of tooth enamel
abrasion of dorsum of hand
hypokalemic hypochloremic alkalosis (from vomit)
anemia
decreased protein
67
Q

What is 1st line treatment for bulimia? last line?

A

first line = SSRI (fluoxetine)

last = topiramate

68
Q

What are some signs of anorexia?

A

hypotension, bradycardia, lanugo, anemia, leukopenia

hypercholesterolemia

69
Q

What is difference sleep terror d/o vs nightmare d/o?

A

sleep terror = repeat ep of sudden awakening with panic sx in stage 3/4, unresponsive to comfort, lasts minutes, dont remember

nightmare = later in night during REM, when awakened quickly become oriented

70
Q

What is treatment for narcolepsy?

A

methylphenidate, modafanil

71
Q

What happens in Rett syndrome?

A

normal prenatal/perinatal development and head circumference

then between age 5 and 48 mo deceleration of head growth, stereotyped hand movements, los of social interaction, impaired language dev

only in girls w/ 100% concordance in mono twins

72
Q

What is required to dx tourettes?

A

multiple motor tics and one or more vocal, onset before 18 yo, present for at least 1 year

73
Q

How do you differentiate manic from ADHD?

A 
manic = euphoric
ADHD = often have low self-esteem
74
Q

What is mech of action atomoxetine?

A

nonstimulant NE reuptake inhibitor, for treatment of ADHD

75
Q

What is treatment for OCD?

A

CBT, SSRI (1st line), clomipramine (2nd line)

if refractory –> add 2nd gen antipsychotic to SSRI if some response; if no response to SSRI switch to different SSRI or to clomipramine

76
Q

What can you see on imaging in OCD?

A

increased activity in caudate, frontal lobes, cingulum

77
Q

What part of brain is hyperactive in anxiety states?

A

locus ceruleus

78
Q

What is maintenance med for panic d/o first line? last line?

A

first line = SSRI (sertraline)

last = TCA, MAOI

79
Q

What is med for immediate relief to abort panic attacks?

A

short acting benzo (alprazolam)

80
Q

What is reactive attachment disorder?

A

marked disturbed social relatedness beginning before age 5

81
Q

What psych illness is most common outcome of childhood abuse?

A

MDD

82
Q

What is use of prazosin in PTSD?

A

alpha 2 blocker for nightmares in pts not controlled by SSRI

83
Q

What is use of eye movement desensitiziation and reprocessing?

A

treat PTSD

84
Q

What is treatment for GAD?

A

buspurone (but requires wks for improvement)

benzo for quick sx reduction

85
Q

What is unconscious/conscious in factitious d/o?

A

unconscious desire to assume sick role

fully conscious sx production

86
Q

What is unconscious/conscious in malignering?

A

sx production and desire for secondary gain are both conscious

87
Q

What is kluver bucy?

A

bilateral amygdala problem –> docile, lack of fear response, anterograde amnesia, hyperphagia, hypersexuality

88
Q

What is arnold chiari?

A

have cerebellar anatomic/functional abnormalities, can have hydrocephalus

89
Q

What is boisu?

A

absence of facial nerves and nuclei, have bilateral facial paralysis

90
Q

What is mech of action memantine?

A

NMDA antagonist, adjunct to anticholinesterases

91
Q

What are the 4 cholinesterase inhibitors used in alzheimer?

A

donepezil
galantamine
rivastigmine
tacrine

92
Q

What is punchdrunk syndrome?

A

dementia pugilistica = acquired movement d/o and dementia assocaited w/ repeated traumatic damage to substantia nigra –> emotional lability, dystarthria, impulsivity

93
Q

What are unique feat of lewy body?

A

dementia + hallucinations + parkinsonian + EPS

94
Q

What is presentation of wilson disease?

A

kaiser fleischer rings, hemiballismus, psychiatric sx (psychosis, dementia)

95
Q

How does infarct of L frontal hemisphere (L MCA) present?

A

depression

96
Q

How does infarct of R frontal hemisphere (R MCA) present?

A

euphoria, inappropriate indifference, mania

97
Q

What is treatment for delirium?

A

antipsychotics like haldol or risperidone

benzo for agitation but avoid in elderly

98
Q

What is an example of a medication that worsens delirium?

A

diphenhydramine

99
Q

What is most common mech of medication induced delirium?

A

blockade of cholinergic receptors

100
Q

What is localized amnesia?

A

memory loss surrounding discrete period of time, occurs after traumatic event

101
Q

What are signs of wernicke/korsakoff?

A

b/l abducens nerve palsy, horizontal nystagmust, ataxia, global confusion, apathy

102
Q

What is presentation of neurosyphilis?

A

sensory ataxia (wide based gait, romberg + , loss of vibration/proprioception), argyll robertson

103
Q

What is general paresis of neurosyphillis?

A

dementia w/ pupil abnormalities, tremors, dyscoordination, spasticity

104
Q

What psych illness can pheochromocytoma mimic?

A

GAD

105
Q

What is presentation of hepatic encephalopathy?

A

asterixis, tremors, increased DTR, altered sensorium, change in personality, abrupt mood swing, change in cognitive ability

106
Q

What is presentation of hyperthyroid?

A

depression, irritability, cognitive difficulties

can present w/ depression, anxiety, psychosis, mania, delirium

107
Q

What is psych presentation of SLE?

A

depression common, can also have delirium, personality change, anxiety, psychosis, cognitive impairment

108
Q

What is presentaiton of hypoglycemia?

A

tachycaria, tremor, hypertension, seizrue

109
Q

What antidepressants to use in pregnancy?

A

use fluoxetine

MAOI contraindicated b/c exacerbate HTN

110
Q

What is most anticholinergic of the SSRIs?

A

paroxetin

111
Q

What is major side effect of nefadozone?

A

black box warning for hepatitis and liver failure

112
Q

What is effect of alpha 1 blockade in TCA?

A

orthostasis esp in elderly

113
Q

What is placebo vs standard therapy response for antidepressants?

A

30% placebo vs 70% antidepressants

114
Q

What happens in MAOI OD?

A

12-24 hrs after get hyperpyrexia, autonomic instability, rhabdo

115
Q

What is treatment for MAOI OD?

A
  • benzo if delirium (lorazepam)

- lidocaine if ventricular arrhythmia

116
Q

What is effect of SSRIs in neonate?

A

cause elevated pulmonary vascualr resistance

117
Q

Which side effect of SSRIs does not go away with time?

A

sex dysfunction

118
Q

What is treatment or comorbid MDD + OCD/

A

fluvoxamine = SSRI

119
Q

What is mech of action trazodone?

A

weak reuptake and antagonist at 5HT1/2 –> ahve some sedative effects via alpha block and some histamine block

120
Q

What are major side effects of mirtazapine?

A

increased appetite (weight gain) and sedation

use in elderly with low appetite or with MDD + insomnia

121
Q

Besides as mood stabilizer what are indications for topiramate for psych?

A

binge eating and bulimia –> causes weight loss / decreased appetite

122
Q

What is effect of OCP use on lamotrigine?

A

higher rate of clearance of lamotrigine in women on OCP

123
Q

What is treatment for akathisia?

A

reduce neureleptic dose, give propanolol

124
Q

What is treatment of choice if pt with EPS gets anticholinergic SE from benztropine?

A

give amantadine

125
Q

What is the only med that can improve tardive dyskinesia sx?

A

clozapine

126
Q

What is treatment for anticholinergic tox?

A

physostigmine = anticholinesterase

127
Q

What is treatmetn for anticholinesterase tox?

A

atropine = antimuscarinic

128
Q

What type of antipsychotics safest in pregnancy/labor?

A

high potency typicals = haloperidol

129
Q

What is treatment for drooling in clozapine use?

A

clonidine = reduces volume of saliva

130
Q

What is treatment for delirium with long QT?

A

low dose antipsychotic such as olanzapine

b/c haldol increases QT

131
Q

Which antipsychotic can cause fever, nausea, malaise, pruritis?

A

chlorpromazine = obstructive jaundice

132
Q

What is most potent of the benzos?

A

clonazepam

133
Q

What is treatment for pt w/ altered consciousness?

A

IV dextrose, thiamine, naloxone

134
Q

WHen is psychoanalysis contraindicated?

A

pts with poor reality testing –> schizo

Psych Clerkship (3 decks)

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