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AANP Leik and Fitzgerald > MH > Flashcards

MH Flashcards

1
Q

Malignant neuroleptic syndrome occurs from _________

A

reaction to typical and atypical antipyschotics

first gen eg chlorpromazine, haloperidol
second gen eg clozapine, risperidone, olanzapine
antiemetics eg metoclopramide
withdrawal of dopamine agonist in Parkinson’s

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2
Q

Symptoms of malignant neuroleptic syndrome?

FEVER

A 
Fever
Encephalopathy (mental status change)
Vital sign instability (fluctuating BP)
Elevated WBC and CPK
Rigidity
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3
Q

Symptoms of Serotonin Syndrome?

HARMED

or

SHIVERS

A 
Hyperthermia
	Autonomic instability
	Rigidity
	Myoclonus
	Encelphalopathy
        Diaphoresis, Dilated pupils 
	Shivering
	Hyperreflexia
        Increased temp
	Vital sign instability
        Encephalopathy
	Restlessness
        Sweating
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4
Q

what is the black box warning on SSRIs?

A

all SSRIs may cause suicidal ideation/plans in <24 years of age

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5
Q

contraindications for bupropion?

A

seizure disorder
ETOH disorder
anorexia
bulimia

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6
Q

which SSRI has the longest and shortest half life?

A

fluoxetine longest *least likely to have discontinuation symptoms, taper over 1-2 weeks

paroxetine shortest *most likely to have symptoms with taper, taper over 3-4 weeks or more

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7
Q

FINISH for SSRI discontinuation syndrome

A 
○ Flu-like
		○ Insomnia
		○ Nausea
		○ Imbalance
		○ Sensory changes
		○ Hyperactivity
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8
Q

what foods should be avoided with MAOI?

A

• Tyramine food: increase BP, risk of stroke

Fermented foods, beer, Chianti wine, aged cheese, fava beans

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9
Q

how long to wait in between MAOI and SSRI/TCA?

A

14 days

risk of serotonin syndrome

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10
Q

what is the time component for diagnosis of dysthymia?

A

Depressed mood for most of the day, for more days than not, for at least 2 years

individual has never been without symptoms in A or B for more than 2 months at a time

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11
Q

what are the 2 questions to ask in PHQ-2?

A

over the last 2 weeks:

  • felt down, depressed, hopeless (mood)
  • little interest/pleasure in doing things (anhedonia)
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12
Q

black box warning with antipsychotics?

A

avoid in elderly with dementia

risk of death

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13
Q

black box warning with SSRI?

A

increase SI in kids and young adults

esp 18-24 for first 1-2 months of treatment

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14
Q

what class of antidepressant should be considered with depression and concurrent stress urinary incontinence?

A

TCA

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15
Q

what medication can be added as adjunct to SSRI if sexual dysfunction occurs?

A

bupropion

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16
Q

what side effects are associated with antipsychotics?

A

pill rolling
shuffling gait
bradykinesia, akinesia (inability to initiate movement), akathesia (inability to sit still), tardive dyskinesia (involuntary lip smacking)

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17
Q

anticholinergic side effects

SADCUB

A 
Sedation
Anorexia
Dry mouth
Constipation, confusion
Urinary retention
BPH
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18
Q

what is the risk of St John’s wort with digoxin and birth control pills?

A

decreases digoxin effectiveness

breakthrough bleeding and decreased contraceptive effectiveness

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19
Q

what is the risk of St John’s wort with SSRI, TCA, MAOI

A

serotonin syndrome

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20
Q

time frame in DSM criteria for persistent complicated grief? prolonged grief?

A

in grief disorder, look at impact on FUNCTION
DSM criteria for persistent complicated grief-symptoms must be present for more than one year

Prolonged grief disorder: symptoms for 6+ months

21
Q

what is the definition of binge drinking?

A

Binge drinking:
Males 5+ drinks on at least 1 day in last 30 days
Females 4+ drinks on at least 1 day in last 30 days

22
Q

what is the blood alcohol threshold?

A

Elevated blood alcohol >0.08% illegal to drive in all US states

23
Q

ETOH guidelines in US

men and women

A

M: 2 drinks/day
F: 1 drink/day

24
Q

what ratio of AST: ALT is indicative of alcoholic hepatitis?

A

2:1

25
Q

what lab results is seen in alcoholic hepatitis?

A
  • Ratio 2:1 AST: ALT: alcoholic hepatitis
    • Macrocytic RBC (MCV >100)
    • Thrombocytopenia: increase bleeding risk
    • TG elevated: increase pancreatitis risk
26
Q

what is the most accurate alcohol screening test?

A

AUDIT

alcohol use disorder identification test

27
Q

T-ACE screening for AUD?

A

take >3 drinks to get high
annoyed
cut down
eye opener

28
Q

what vitamins should be replaced in AUD?

A

Thiamine (100 mg)
folic acid (1 mg)
B6 (2 mg)

29
Q

contraindications to naltrexone?

A
  • current opioid use or OUD
  • acute opioid withdrawal
  • acute hepatitis/liver failure
30
Q

contraindications to acamprosate?

A
  • severe renal impairment (CrCl <30 ml/min

- breastfeeding

31
Q

most common side effects of naltrexone?

A

nausea
headache
dizziness

32
Q

most common side effect of acamprosate?

A

diarrhea
abdo pain and vomiting less frequent
usually transient

33
Q

what is the risk of smoking while on nicotine patches?

A

risk of acute MI, fatal arrythmias

34
Q

when to start bupropion or varenicline?

A

one week before quit date

35
Q

what is the most effective form of smoking cessation method?

side effects?

A

varenicline (champix)

nausea, insomnia, abnormal dreams

36
Q

which NRT is safest to use in CAD, recent MI or angina?

A

nicotine patch

*avoid lozenge, gum, spray, inhaler

37
Q

DSM criteria for chronic insomnia

A

Chronic insomnia (DSM-5): associated with distress, impairment of daytime functioning lasting 3+ months for 3+ nights/week, occurs despite adequate opportunity for sleep, not explained by another disorder

38
Q

is diazepam a long acting benzo?

A

yes

half life >24 hours

39
Q

what is the risk associated with kava kava?

A

liver injury (hepatitis, cirrhosis, fulminant liver damage)

40
Q

common side effects of antipsychotics?

A

Metabolic syndrome
Weight gain
prolonged QTc

41
Q

what is the preferred drug class to treat PTSD?

A

SSRI

42
Q

what is the female athlete triad?

A

amenorrhea
low bone mass
low BMI

43
Q

which SSRI is most likely to cause erectile dysfunction?

A

paroxetine

44
Q

how long after ETOH discontinuation are peak symptoms of withdrawal observed

A

24-36 hours

45
Q

AUD

recommended dietary allowance for Mg

A

M: 400-420 mg day

Nonpregnant nonlactating F: 310-320 mg/day

46
Q

which antidepressant will cause dose-dependent increase in BP?

A

venlafaxine

47
Q

what is the difference between PTSD and acute stress disorder?

A

Acute stress disorder: symptoms of posttraumatic stress and impairment persist for at least 3 days and within 30 days of event

PTSD is diagnosed only if symptoms persist >1 month after event

48
Q

what medication class should be avoided in PTSD?

A

benzos - worsens PTSD

49
Q

first line treatment for PTSD?

A

trauma-focused psychotherapy

SSRI (sertraline, citalopram) as first line pharmacotherapy

AANP Leik and Fitzgerald (14 decks)

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