Lange missed questions

Question 1

Treatment for MAOI-induced delirium?

Answer 1

IV benzodiazepines, particularly lorazepam (short acting)

Question 2

What is opisthotonos?

Answer 2

An EPS symptom seen with neuroleptic use - backward arching of the head, neck, and spine as in tetanus

Question 3

Best antidepressants for atypical depression?

Answer 3

MAOI

Atypical depression may present with weight gain, hypersomnia, and mood reactivity

Question 4

Probable cause of delayed effects of SSRIs and their most common sexual side effect in women?

Answer 4

Down regulation of post-synaptic 5HT-2 receptors

Anorgasmia is the most common sexual side effect seen in women

Question 5

Serious side effect that only results from thioridazine and not other typical antipsychotics?

Answer 5

Retinal pigmentation only occurs with thioridazine. May lead to blindness and may not remit when thioridazine is discontinued.

Question 6

What are the 2 most potent benzodiazepines?

Answer 6

Clonazepam and triazolam

Question 7

What are the minimum laboratory studies required before starting lithium therapy?

Answer 7

serum creatinine - kidney function
BUN and electrolytes - kidney function
thyroid studies - Li+ inhibits thyroid hormone synthesis and release
Urinalysis - Kidney function

Question 8

Pimozide

Answer 8

A dopamine receptor blocker useful in Tourette’s. It is slightly less powerful than Haloperidol.

Question 9

Medication that may improve TD in patients on typical antipsychotics and benztropine?

Answer 9

Clozapine

Question 10

Medication for treating bulimia nervosa?

Answer 10

Fluoxetine

Question 11

Antidepressants that affect carbamazepine levels?

Answer 11

Fluoxetine, nefazodone

Question 12

Trazodone uses and side effect?

Answer 12

Antidepressant that improves patient’s sleep. May cause priapism. Priapism is treated with prompt discontinuation of trazodone.

Question 13

Lithium effects on ECG and medications that increase Li+ concentrations?

Answer 13

T wave flattening, Sinus node dysfunction, 1st degree AV block, bradyarrhythmias, ventricular tachycardia, ventricular fibrillation.

Thiazide diuretics, spironolactone, traimaterene diuretics, NSAIDS excepts aspirin and sulindac, metronidazole and tetracycline, and ACE inhibitors.

Question 14

Most effective agent for OCD?

Answer 14

Clomipramine, a TCA, is the most effective. Several SSRIs are also effective.

Question 15

Which receptor is clozapine more active than any other neuroleptic?

Answer 15

D4

Question 16

Is clonazepam safe in pregnancy?

Answer 16

Yes

Question 17

Which antidepressant has both weight gain and sedation as (potentially useful) side effects?

Answer 17

Mirtazapine - 5HT-1 enhancement with H1 blockade leading to sedation.

Question 18

What medication may help a patient who has panic-like attacks due to frequently re-experiencing traumatic memories?

Answer 18

Clonidine, A2 agonist, also used for blood pressure control. Decreases symptoms of hyperarousal and re-experiencing.

Question 19

Why is flumazenil not immediately used in unknown intoxications?

Answer 19

It may lower the seizure threshold. Therefore, more background information must be obtained to indicate benzodiazepine overdose before it is given.

Question 20

What medication can be used for heroin detoxification, especially for first-time detoxers?

Answer 20

Clonidine. It suppresses the sympathetic response to heroin withdrawal, helps control agitation and autonomic instability (elevated blood pressure and heart rate)

Question 21

Prominent jaw, protruding ears, high forehead features in a child with developmental or educational delays?

Answer 21

Fragile X syndrome, fragile section on X chromosome

Question 22

Best antidepressant class for dysthymia?

Answer 22

TCA

Question 23

What four conditions is clonidine useful in?

Answer 23

ADHD, Tics, hyperarousal/flashbacks, opioid withdrawal

Question 24

Mood stabilizer which may have severe liver effects?

Answer 24

Valproic acid

Question 25

What study is best for narcolepsy?

Answer 25

Polysomnography

Question 26

Region of degradation in alzheimers?

Answer 26

Meynert

Question 27

Risperidone side effects

Answer 27

EPS greater than other atypical antipsychotics. 5HT2A, D2, and A1 antagonism MOA means orthostatic hypotension, Weight gain, galactorrhea (100-fold increase in prolactin, whereas olanzapine has ~0 increase))

Do not need to monitor hematologic effects, no significant anticholinergic effects.

Question 28

Yohimbine use and side effects?

Answer 28

Impotence.

Elevated blood pressure, heart rate, contraindications: cardiac, renal disease, glaucoma, ulcers.

Alpa-2 antagonist, opposite of clonidine, hence side effects.

Question 29

What receptors are TCAs active at?

Answer 29

Serotonin, Anticholinergic, A1-adrenergic blockade.
Thus, they are antidepressant due to 5HT actions, but also have anticholinergic effects of dry mouth, blurred vision, urinary retention, and cognitive impairment. They have anti-A1 effects of orthostatic hypotension

Question 30

Ericsson life cycle stages?

Answer 30

Ages 3-5: Initiative vs guilt
Ages 5-13: industry vs inferiority
Ages 13-20: Identity vs role confusion
Ages 20-40: ???
Ages 40-60: Generatively vs Stagnation (positive view of role in life and society as a whole)
Ages 60+: ego integrity vs despair (acceptance of place in life cycle vs regret of unfulfilled early life desires)