MH Flashcards
Malignant neuroleptic syndrome occurs from _________
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
Symptoms of malignant neuroleptic syndrome?
FEVER
Fever Encephalopathy (mental status change) Vital sign instability (fluctuating BP) Elevated WBC and CPK Rigidity
Symptoms of Serotonin Syndrome?
HARMED
or
SHIVERS
Hyperthermia
Autonomic instability
Rigidity
Myoclonus
Encelphalopathy
Diaphoresis, Dilated pupils
Shivering
Hyperreflexia
Increased temp
Vital sign instability
Encephalopathy
Restlessness
Sweating
what is the black box warning on SSRIs?
all SSRIs may cause suicidal ideation/plans in <24 years of age
contraindications for bupropion?
seizure disorder
ETOH disorder
anorexia
bulimia
which SSRI has the longest and shortest half life?
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
FINISH for SSRI discontinuation syndrome
○ Flu-like ○ Insomnia ○ Nausea ○ Imbalance ○ Sensory changes ○ Hyperactivity
what foods should be avoided with MAOI?
• Tyramine food: increase BP, risk of stroke
Fermented foods, beer, Chianti wine, aged cheese, fava beans
how long to wait in between MAOI and SSRI/TCA?
14 days
risk of serotonin syndrome
what is the time component for diagnosis of dysthymia?
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
what are the 2 questions to ask in PHQ-2?
over the last 2 weeks:
- felt down, depressed, hopeless (mood)
- little interest/pleasure in doing things (anhedonia)
black box warning with antipsychotics?
avoid in elderly with dementia
risk of death
black box warning with SSRI?
increase SI in kids and young adults
esp 18-24 for first 1-2 months of treatment
what class of antidepressant should be considered with depression and concurrent stress urinary incontinence?
TCA
what medication can be added as adjunct to SSRI if sexual dysfunction occurs?
bupropion
what side effects are associated with antipsychotics?
pill rolling
shuffling gait
bradykinesia, akinesia (inability to initiate movement), akathesia (inability to sit still), tardive dyskinesia (involuntary lip smacking)
anticholinergic side effects
SADCUB
Sedation Anorexia Dry mouth Constipation, confusion Urinary retention BPH
what is the risk of St John’s wort with digoxin and birth control pills?
decreases digoxin effectiveness
breakthrough bleeding and decreased contraceptive effectiveness
what is the risk of St John’s wort with SSRI, TCA, MAOI
serotonin syndrome
time frame in DSM criteria for persistent complicated grief? prolonged grief?
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
what is the definition of binge drinking?
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
what is the blood alcohol threshold?
Elevated blood alcohol >0.08% illegal to drive in all US states
ETOH guidelines in US
men and women
M: 2 drinks/day
F: 1 drink/day
what ratio of AST: ALT is indicative of alcoholic hepatitis?
2:1
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
what is the most accurate alcohol screening test?
AUDIT
alcohol use disorder identification test
T-ACE screening for AUD?
take >3 drinks to get high
annoyed
cut down
eye opener
what vitamins should be replaced in AUD?
Thiamine (100 mg)
folic acid (1 mg)
B6 (2 mg)
contraindications to naltrexone?
- current opioid use or OUD
- acute opioid withdrawal
- acute hepatitis/liver failure
contraindications to acamprosate?
- severe renal impairment (CrCl <30 ml/min
- breastfeeding
most common side effects of naltrexone?
nausea
headache
dizziness
most common side effect of acamprosate?
diarrhea
abdo pain and vomiting less frequent
usually transient
what is the risk of smoking while on nicotine patches?
risk of acute MI, fatal arrythmias
when to start bupropion or varenicline?
one week before quit date
what is the most effective form of smoking cessation method?
side effects?
varenicline (champix)
nausea, insomnia, abnormal dreams
which NRT is safest to use in CAD, recent MI or angina?
nicotine patch
*avoid lozenge, gum, spray, inhaler
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
is diazepam a long acting benzo?
yes
half life >24 hours
what is the risk associated with kava kava?
liver injury (hepatitis, cirrhosis, fulminant liver damage)
common side effects of antipsychotics?
Metabolic syndrome
Weight gain
prolonged QTc
what is the preferred drug class to treat PTSD?
SSRI
what is the female athlete triad?
amenorrhea
low bone mass
low BMI
which SSRI is most likely to cause erectile dysfunction?
paroxetine
how long after ETOH discontinuation are peak symptoms of withdrawal observed
24-36 hours
AUD
recommended dietary allowance for Mg
M: 400-420 mg day
Nonpregnant nonlactating F: 310-320 mg/day
which antidepressant will cause dose-dependent increase in BP?
venlafaxine
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
what medication class should be avoided in PTSD?
benzos - worsens PTSD
first line treatment for PTSD?
trauma-focused psychotherapy
SSRI (sertraline, citalopram) as first line pharmacotherapy
