Lange Q&A Somatic Treatment and Psychopharmacology Flashcards
Symptoms of phenelzine and tranylcypromine overdose?
These are the only two MAO-I approved for use in the U.S. Overdose can result in 12-24 hour asymptomatic period followed by hyperpyrexia, autonomic instability and ultimately rhabdomyolysis.
Treatment of MAO-I overdose?
Lorazepam
How long should you wait before starting a patient on an antidepressant if they just came off of a MAO-I?
SSRIs, TCAs, buspirone and SNRIs can cause serotonin syndrome if started within 14 days of discontinuing a MAO-I.
Atypical features of depression? How should you treat?
Weight gain, hypersomnia and mood reactivity. Treat with SSRIs even though MAO-Is are more effective in atypical depression.
Effect of eating tyramine-rich foods in a patient taking MAO-I?
Fatal hypertensive crisis
Drugs for alcohol withdrawal in a patient with normal liver function? What if his liver function is decreased?
Normal = chlordiazepoxide or diazepam because they have long half lives. Decreased = “LOT” lorazepam, oxazepam or temazepam.
Most common side effect in women taking SSRIs?
Anorgasmia
Management of akathisia in a patient recently started on an antipsychotic?
1) Lower the dose 2) Add benztropine for EPS 3) Add propranolol for symptomatic treatment
Management of acute dystonia in a patient recently started on an antipsychotic?
Diphenhydramine
Most common serious complication of NMS?
Rhabdomyolysis occurs in 25% of cases of NMS
Drug with side effect of retinal pigmentation at doses greater than 1000mg per day?
Thioridazine, this may result in blindness and does not typically reverse after stopping the medication.
Most to least potent benzodiazepines
1) clonazepam 2) triazolam 3) alprazolam 4) diazepam 5) clorazepate 6) chlordiazepoxide 6) flurazepam
Labs to order before starting lithium
BMP and UA to check kidney function. TSH to assess for pre-existing hypothyroidism and WBC to check baseline level.
Drugs that can make a patient on lithium supratherapeutic?
NSAIDs (except ASA and sulindac), thiazides, spironolactone, triampterene, metronidazole, tetracycline and ACE-I.
Most common side effects of methylphenidate?
Decreased appetitie and difficulty falling asleep
Treatment of Tourette’s with comorbid ADHD?
Still with a D2-antagonist like pimozide or haloperidol. Clonidine is less effective, but can be used because it lacks EPS. Don’t treat with a stimulant because these worsen the tics.
Only medication that my improve tardive dyskinesia?
Clozapine
Treatment of borderline personality disorder
SSRI for impulsivity and affective instability. Aripiprazole for impulsivity and psychotic thinking.
Treatment for bulemia nervosa?
Fluoxetine
Treatment of anorexia nervosa?
No great treatment exists. Avoid pro-arrhythmic drugs.
SSRI discontinuation syndrome
Begins 1-3 days after stopping, especially with paroxetine due to its short half life. Symptoms are flu-like with anxiety, irritability and crying spells.
SSRI to use if patient is on carbamazepine?
Paroxetine has not been reported to raise levels, so it is preferred.
How does trazodone work?
Weak SSRI and alpha-1, 5-HT1a, 5-HT1c and 5-HT2 receptor antagonist. It isn’t really used for depression, just sleep. Look out for orthostasis in the elderly!
Activating SSRI?
Fluoxetine
