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?

25
what lab results is seen in alcoholic hepatitis?
* Ratio 2:1 AST: ALT: alcoholic hepatitis * Macrocytic RBC (MCV >100) * Thrombocytopenia: increase bleeding risk * TG elevated: increase pancreatitis risk
26
what is the most accurate alcohol screening test?
AUDIT | alcohol use disorder identification test
27
T-ACE screening for AUD?
take >3 drinks to get high annoyed cut down eye opener
28
what vitamins should be replaced in AUD?
Thiamine (100 mg) folic acid (1 mg) B6 (2 mg)
29
contraindications to naltrexone?
- current opioid use or OUD - acute opioid withdrawal - acute hepatitis/liver failure
30
contraindications to acamprosate?
- severe renal impairment (CrCl <30 ml/min | - breastfeeding
31
most common side effects of naltrexone?
nausea headache dizziness
32
most common side effect of acamprosate?
diarrhea abdo pain and vomiting less frequent usually transient
33
what is the risk of smoking while on nicotine patches?
risk of acute MI, fatal arrythmias
34
when to start bupropion or varenicline?
one week before quit date
35
what is the most effective form of smoking cessation method? side effects?
varenicline (champix) nausea, insomnia, abnormal dreams
36
which NRT is safest to use in CAD, recent MI or angina?
nicotine patch *avoid lozenge, gum, spray, inhaler
37
DSM criteria for chronic insomnia
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
is diazepam a long acting benzo?
yes | half life >24 hours
39
what is the risk associated with kava kava?
liver injury (hepatitis, cirrhosis, fulminant liver damage)
40
common side effects of antipsychotics?
Metabolic syndrome Weight gain prolonged QTc
41
what is the preferred drug class to treat PTSD?
SSRI
42
what is the female athlete triad?
amenorrhea low bone mass low BMI
43
which SSRI is most likely to cause erectile dysfunction?
paroxetine
44
how long after ETOH discontinuation are peak symptoms of withdrawal observed
24-36 hours
45
AUD recommended dietary allowance for Mg
M: 400-420 mg day | Nonpregnant nonlactating F: 310-320 mg/day
46
which antidepressant will cause dose-dependent increase in BP?
venlafaxine
47
what is the difference between PTSD and acute stress disorder?
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
what medication class should be avoided in PTSD?
benzos - worsens PTSD
49
first line treatment for PTSD?
trauma-focused psychotherapy SSRI (sertraline, citalopram) as first line pharmacotherapy