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Psychiatry > Lange Q&A Somatic Treatment and Psychopharmacology > Flashcards

Lange Q&A Somatic Treatment and Psychopharmacology Flashcards

1
Q

Symptoms of phenelzine and tranylcypromine overdose?

A

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.

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2
Q

Treatment of MAO-I overdose?

A

Lorazepam

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3
Q

How long should you wait before starting a patient on an antidepressant if they just came off of a MAO-I?

A

SSRIs, TCAs, buspirone and SNRIs can cause serotonin syndrome if started within 14 days of discontinuing a MAO-I.

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4
Q

Atypical features of depression? How should you treat?

A

Weight gain, hypersomnia and mood reactivity. Treat with SSRIs even though MAO-Is are more effective in atypical depression.

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5
Q

Effect of eating tyramine-rich foods in a patient taking MAO-I?

A

Fatal hypertensive crisis

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6
Q

Drugs for alcohol withdrawal in a patient with normal liver function? What if his liver function is decreased?

A

Normal = chlordiazepoxide or diazepam because they have long half lives. Decreased = “LOT” lorazepam, oxazepam or temazepam.

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7
Q

Most common side effect in women taking SSRIs?

A

Anorgasmia

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8
Q

Management of akathisia in a patient recently started on an antipsychotic?

A

1) Lower the dose 2) Add benztropine for EPS 3) Add propranolol for symptomatic treatment

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9
Q

Management of acute dystonia in a patient recently started on an antipsychotic?

A

Diphenhydramine

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10
Q

Most common serious complication of NMS?

A

Rhabdomyolysis occurs in 25% of cases of NMS

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11
Q

Drug with side effect of retinal pigmentation at doses greater than 1000mg per day?

A

Thioridazine, this may result in blindness and does not typically reverse after stopping the medication.

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12
Q

Most to least potent benzodiazepines

A

1) clonazepam 2) triazolam 3) alprazolam 4) diazepam 5) clorazepate 6) chlordiazepoxide 6) flurazepam

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13
Q

Labs to order before starting lithium

A

BMP and UA to check kidney function. TSH to assess for pre-existing hypothyroidism and WBC to check baseline level.

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14
Q

Drugs that can make a patient on lithium supratherapeutic?

A

NSAIDs (except ASA and sulindac), thiazides, spironolactone, triampterene, metronidazole, tetracycline and ACE-I.

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15
Q

Most common side effects of methylphenidate?

A

Decreased appetitie and difficulty falling asleep

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16
Q

Treatment of Tourette’s with comorbid ADHD?

A

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.

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17
Q

Only medication that my improve tardive dyskinesia?

A

Clozapine

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18
Q

Treatment of borderline personality disorder

A

SSRI for impulsivity and affective instability. Aripiprazole for impulsivity and psychotic thinking.

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19
Q

Treatment for bulemia nervosa?

A

Fluoxetine

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20
Q

Treatment of anorexia nervosa?

A

No great treatment exists. Avoid pro-arrhythmic drugs.

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21
Q

SSRI discontinuation syndrome

A

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.

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22
Q

SSRI to use if patient is on carbamazepine?

A

Paroxetine has not been reported to raise levels, so it is preferred.

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23
Q

How does trazodone work?

A

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!

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24
Q

Activating SSRI?

A

Fluoxetine

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25
Q

A patient overdosed on a medication that resulted in ECG changes of T-wave flattening, SA node dysfunction and first-degree AV block. What drug was it?

A

Lithium

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26
Q

1st line drug for OCD?

A

Clomipramine (TCA)

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27
Q

Mirtazapine mechanism. How does this contribute to its side effect profile?

A

Central alpha-2 antagonist and H1, 5-HT2/5-HT3 antagonist. Blocking 5-HT2 and 5-HT3 leads to increased 5-HT1 stimulation, leading to increased appetite and weight gain. H1 antagonism causes sedation, but this may be counteracted by alpha-2 blockade and increased NE.

28
Q

Typical neuroleptics

A

Haloperidol, chlorpromazine, fluphenazine, perphenazine, thioridazine and perphenazine.

29
Q

Clozapine mechanism

A

D1, D2, D4, H1, muscarinic, alpha-1 adrenergic, 5-HT2, 5-HT2c and 5-HT3. Effectiveness compared to other antipsychotics is thought to be due to D4 and 5-HT2 action.

30
Q

Why prefer nortriptyline over other TCAs in the elderly?

A

It has less alpha-1 blocking activity than other TCAs and less orthostatic hypotension.

31
Q

Atypical antidepressant that lowers seizure threshold

A

Bupropion

32
Q

SNRI that can cause increased diastolic blood pressure at higher doses?

A

Venlafaxine

33
Q

Mood stabilizers that are risk factors for neural tube defects if taken during pregnancy?

A

Carbamazepine and divalproex sodium

34
Q

Cardiac effects of TCAs

A

Quinidine-like slowing of conduction leading to long QTc, widened QRS, bradycardia and hypertension.

35
Q

Why haloperidol for delirium?

A

More potent = lower dose = fewer anticholinergic and orthostatic side effects.

36
Q

Neuroleptic least likely to cause orthostatic hypotension?

A

Haloperidol has the least activity at alpha-1 receptors

37
Q

Disulfiram mechanism

A

Inhibits aldehyde dehyrodgenase -> acetaldehyde accumulation -> discomfort and avoidance of drinking.

38
Q

Drug used to decrease alcohol cravings?

A

Naltrexone

39
Q

Treatment of numbing symptoms of PTSD

A

SSRIs

40
Q

Treatment of re-experiencing symptoms of PTSD

A

Clonidine (alpha-2 agonist)

41
Q

Drugs used to treat Alzheimer’s

A

Cholinesterase inhibitors: donepezil and tacrine

42
Q

Non-narcotic method to detox patient from heroin

A

Clonidine

43
Q

Why bupropion works for smoking and can make schizophrenia worse?

A

Increased dopamine transmission

44
Q

Drugs that can cause agranulocytosis

A

Clozapine and carbamazepine

45
Q

Big side effect of olanzapine? Benefits?

A

Weight gain and sedation. Limited elevation of prolactin.

46
Q

Risperidol side effects

A

Weight gain, orthostasis, galactorrhea and EPS

47
Q

Consequences of blocking dopaminergic receptors in the nigrostriatal system, mesolimbic system and tuberoinfundibular system?

A

Nigrostriatal = EPS. Mesolimbic = decreased AVH. Tuberoinfundibular = galactorrhea

48
Q

Yohimbine

A

Central alpha-2 antagonist for impotence.

49
Q

Mechanisms of Wernicke encephalopathy in alcoholics

A

Body attempts to metabolize glucose in the absence of thiamine.

50
Q

Atypical antipsychotics that have greatest risk for dyslipidemia, hyperglycemia and diabetes? Lowest?

A

Olanzapine and clozapine. Aripiprazole and ziprasidone are the lowest.

51
Q

Mood stabilizer with risk for pancreatitis

A

Valproate

52
Q

Mood stabilizer with risk of diabetes insipidus?

A

Lithium

53
Q

Oral anti-depressants that do not cause sexual dysfunction?

A

Bupropion, mirtazapine and nefazodone

54
Q

Antipsychotic with side effect of sialorrhea

A

Clozapine

55
Q

Anti-viral drug used to treat Parkinsonian symptoms

A

Amantadine

56
Q

Treating bipolar depression

A

Lamotrigine

57
Q

Relative contraindications to ECT

A

MI in past 6 months, space-occupying intracranial lesion.

58
Q

Antipsychotic with reduced suicidality in schizophrenia

A

Clozapine

59
Q

Why use second generation atypical antipsychotics for schizophrenia?

A

They have a more profound effect on negative symptoms

60
Q

Lamotrigine side effects

A

Stevens-Johnson syndrome

61
Q

Carbamazepine side effect

A

Aplastic anemia

62
Q

Treating depression AND peripheral neuropathy

A

Duloxetine

63
Q

Antipsychotic with side effect of obstructive jaundice

A

Chlorpromazine

64
Q

Site of action of alcohol and benzos?

A

GABA-A. GABA-B = baclofen

65
Q

Time period of delirium tremens

A

96 hours, then you’re in the clear

Psychiatry (2 decks)

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