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Case based ish q's > Misc Psych Study > Flashcards

Misc Psych Study Flashcards

1
Q

Serotonin Syndrome sx

A
  • shivering
  • hyperreflexia/myoclonus
  • increased temperature
  • vital sign instability
  • encephalopathy (altered LOC)
  • restlessness
  • sweating
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2
Q

Serotonin Syndrome- when does it occur?

A
  • 2+ serotonergic meds

Common Offenders
* SSRI
* SNRI
* TCA
* MAOI
* Trazodone/Mirtazapine
* Triptans
* Anxiolytics
* Antiemetics
* herbals (st john’s wort)
* opioids
* anti-convulsants
* illicit substances

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3
Q

Discontinuation Syndrome- sx

A

FINISH
* flu like sx
* insomnia
* nausea
* imbalance
* sensory disturbances
* hyperarousal

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4
Q

Discontinuation Syndrome- pt education

A
  • advise pt to never abruptly stop meds
  • tape off meds over several wks (reduce dose by 25% each weak) or cross taper onto new med
  • Paxil has worst discontinuation syndrome; Prozac has lowest risk discontinuation
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5
Q

TCA OD

A
  • Vitals: hyperthermia, tachycardia, wide QRS
  • Neuro: seizure, confusion, diaphoresis
  • HEENT: dry mouth, dilated pupils, blurred vision
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6
Q

Metabolic Dysfunction

A
  • complication of psychotic meds
  • sx: wt gain, hyperglycemia, hyperlipidemia
  • dx: Q6-12 month lipids, wt, BP, A1C
  • tx: treat dysfunction as it develops; consider changing med if severe

more common with atypicals/2nd gen

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7
Q

Anti-HAM

A
  • Antihistamine: wt gain, sedation
  • Antiadrenergic: orthostatic hypotension, cardiac abnormalities, sexual dysfunction
  • Antimuscarinic: dry mouth, tachycardia, urinary retention, blurry vision, constipation, narrow angle glaucoma

more common with typicals/1st gen

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8
Q

Hyperprolactinemia

A
  • sx: low libido, galactorrhea, gynecomastia, impotence, amenorrhea

more common w/ typicals/1st gen

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9
Q

Neuromalignant Syndrome (NMS)

A
  • occurs in 3% of pt on neuroleptics; fatal if missed
  • sx: extreme rigidity, AMS, fever, unstable BP, myoglobinemia
  • tx: med cessation, dantrolene/bromocriptine, supportive care
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10
Q

EPS

A
  • Akathisia: inner restlessness, cant sit still (tx by reducing doses/changing meds; can give propranolol or clonazepam to manage sx)
  • Parkinsonian Sx: tremor, rigidity, shuffling gait, bradykinesia; begins w/in 1 mo of taking med; tx by reducing dose/changing med (or anti-parkinsonian drugs like levodopa)
  • Dystonia: acute complication but is curative; involuntary contraction of major msk group (tongue, neck, back, face); tx is anticholinergics (benztropine) and anti-park drugs
  • Tardive Dyskinesia: involuntary movements (facial grimacing, tongue protrusion, lateral jaw movements, lip smacking); develops over mo to yrs but can be permanent; tx is to stop ASAP and use VMAT-2 inhibitors (valbenazine/deutrabenazine) anti-cholinergics WORSEN this”
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11
Q

tx for nicotine withdrawal

A
  • Chantix/Varenicline (28d treatment; reduces cravings/withdrawal sx; causes crazy nightmares)
  • Bupropion/Wellbutrin (150-300mg XL QD)
  • Nicotine Replacement: patch, gum, lozenge, spray, inhaler (to slowly reduce dosage)
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12
Q

Anti-depressants (general overview)

A

Most antidepressants have similar efficacy in treating depression so your choice of antidepressant should be based on side effect profile and comorbidities

Lots of antidepressants work on multiple neurotransmitters

Start low and go slow
Peds patients typically start at ½ starting dose for 7 days then increase

All antidepressants have a BLACK BOX WARNING for increase suicidal ideation in patients under 25yo
Follow up closely with these patients

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13
Q

Serotonin Side Effects

A
  • Nausea, vomiting, diarrhea
  • Headaches, dizziness
  • Inducing mania/hypomania
  • Increased bleeding risk (serotonin receptors on platelets): Typically presents as easy bruising, but No need to hold medications prior to surgery
  • Bone fractures (up to 76% increased risk with SSRIs)
  • Seuxal Dysfunction - decreased libido, delayed or inability to climax (F>M)
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14
Q

SSRIs

A
  • Fluoxetine (10-40mg PO QD; Prozac)
  • Paroxetine (10-40mg PO QD: Paxil)
  • Sertaline (50-300mg PO QD; Zoloft)
  • Citalopram (10-40mg PO QD; Celexa)
  • Escitalopram (10-20mg PO QD; Lexapro)
  • Fluvoxamine (50-300mg PO QD; Luvox)
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15
Q

SSRI- specific med need to knows

A
  • Paroxetine: worst discontinuation syndrome; pregnancy category D
  • Escitalopram: “cleanest SSRI” (fewest side effects)
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16
Q

SNRIs

A
  • Venlafaxine (37.5-225mg PO QD; Effexor)
  • Desvenlafaxine (50-200mg PO QD; Pristiq)
  • Duloxetine (20-120mg PO BID; Cymbalta)
  • Levomilnacipran (20-120mg PO QD; Fetzima)
17
Q

Buproprion

A

avoid in alcohol use disorder, bulimic pts, and those w/ electrolyte disorders

lack of sexual side effects + appetite suppresion = good choice for those worried about this

18
Q

Typicals (1st gen)

A
  • MOA: decrease dopamine; works best on positive sx; highest risk EPS + anti-HAM

Meds
* Chlorpromazine (Thorazine)
* Thioridazine (Mellaril)
* Loxapine (Loxitane)
* Thiothixene (Navane)
* Molindone (Moban)
* Perphenazine (Trilafon)
* Haloperidol (Haldol)
* Fluphenazine (Prolixin)
* Trifluoperazine (Stelazine)
* Pimozide (Orap)

19
Q

Atypicals

A
  • MOA: decrease dopamine; increase serotonin; works on pos + neg sx; has more metabolic side effects

Meds (most end in “apine” or “idone”)
* Quetiapine (Seroquel)
* Ziprasidone (Geodon)
* Olanzapine (Zyprexa)
* Aripiprazole (Abilify)
* Iloperidone (Fanapt)
* Paliperidone (Invega)
* Asenapine (Saphris)
* Risperidone (Risperdal)
* Clozapine (Clozaril)

20
Q

Antipsychotics- specific med need to knows

A
  • Ziprasidone (Geodon): more QT prolongation than any other atypical
  • Olanzapine: expected 10-30 lb wt gain (why we give it to anorexics)
  • Risperidone + Paliperidone: causes most EPS + hyperprolactinemia of all atypicals (but typicals still cause more overall)
21
Q

AUD Tx options

A
  • Naltrexone
  • Acamprosate
  • Disulfiram
22
Q

Acamprosate

A
  • for AUD
  • glutamate neurotransmission modulation
23
Q

Naltrexone

A
  • MOA: mu opioid receptor blocker
  • LFT monitoring q6mo
  • reduces heavy drinking by 25%; suppresses EtOH consumption
24
Q

Disulfiram

A
  • causes unpleasant physiologic rxn when EtOH is consumed
  • MOA: inhibits aldehyde dehydrogenase & prevents the metabolism of EtOH’s primary metabolite, acetaldehyde
25
Q

Neglect

A

An act of omission in care leading to potential or actual harm
Most common type of child abuse

Includes:
Inadequate health care, education, or supervision
Lack of protection from hazards in the environment
Unmet basic needs (clothing, food, water)

26
Q

physical abuse

A

Intentional injury causingpain
Impairs physical functioning
May leave a physical mark
Includes burning, beating, shaking, and biting

Second most common type of child abuse
Carried out by the primary caregiver (>80%)

Greatest cause ofmortality:
70% of victims are < 3 years old

27
Q

sexual abuse

A

Involvement of a child (< 16 years in many states) in sexual activities that they cannot comprehend or consent to

Includes sexual activity (oral, anal or vaginal penetration), contact of anal, genital, or oral regions, genital fondling, or exposure to sexually explicit materials

Peaks in girls aged 9–12
Perpetrator is usually known to the victim

28
Q

emotional/psychological abuse

A

An act that would terrorize a child resulting in negativeaffect and future psychological illness

Includes verbal abuse, humiliation, threats of violence, rejection, withholding love, and witnessing domestic violence

Least reported because it is difficult to document

80% of the victims develop a psychiatric illness in adulthood

29
Q

clinical presentation/red flags for child abuse

A

Presentation:
* Failure to thrive: Most common presentation of child abuse; Suboptimal weight gain and growth (inadequate caloric intake)

Red Flags
* Frequent emergency department visits
* Delay inpresentation with injuries inconsistent with history

30
Q

fracture sites suggestive of abuse

A

The followingfracture sites are highly suggestive of abuse:
* Posterior aspect ofribs
* Scapula
* Spinous processes
* Sternum
* Metaphyseal corner fractures (also known as “bucket-handle” fractures) of the femur, tibia, or humerus
* Skull fracture
* Spiral diaphyseal fracture in non-walking infants

31
Q

TEN-4-FACESp

A

TEN
* Torso
* Ears
* Neck

FACCES
* Frenulum
* Angle of Jaw
* Cheeks
* Eyelids
* Subconjunctiva

4 mo or younger

p: patterned

Case based ish q's (4 decks)

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