MOC Exam#3 Flashcards
Which medications decrease VALPROIC ACID blood levels/concentrations?
- Carbamzepine
- Phenytoin
- Cholestyramine
What does it mean that medication A can reduce, or decrease, blood concentrations of medication B?
- That Drug A increases elimination of Drug B
- That Drug A can decreased absorption of Drug B
Which medication can increase VALPROIC ACID blood concentration?
-ASA
How does CHOLESTYRAMINE decrease VALPROIC ACID levels?
-By decreasing intestinal absorption
Best approach to treatment of Factitious Disorder Imposed on Self
-symptom management and avoiding un-necessary procedures
Percentage of patients with bulimia that are male
-10%
Which P450 system metabolizes MODAFANIL?
-2D6
Name 2 SSRI inhibitors of 2D6
- Fluoxetine
- Paroxetine
Symptoms of MODAFANIL overdose
- dizziness
- sedation
- dry mouth
- tachycardia
What is the genetics of Rhett syndrome?
- spontaneous mutation on X chromosome gene (MECP2)
- almost exclusively in females (males don’t survive gestation due to only 1 copy of X chromosome
What is the initial presentation of infant with Rhett Syndrome?
- normal prenatal and perinatal development
- normal psychomotor development for at least the first 5 months
- normal head circumference at birth
What is the progression of symptoms for infant with Rhett Syndrome?
- decelerating head growth between 5-48 months
- loss of previously acquired purposeful hand movements and skills
- sterotyped hand movements (hand wringing)
- poorly coordinated gait and trunk movememnts
- severe psychomotor retardation
- loss of social engagement
Which opioids are also weak SSRI’s?
- meperidine
- tramadol
- methadone
- dextromethorphan
- propoxyphene
What is the risk of combining meperidine and MAOI?
- serotonin syndrome
- DEATH!!
Name the two age peaks for panic disorder, panic attack, onset
- males late teens to early 20’s
- females mid-30’s to 40’s
What percentage of patients have onset of panic attacks/disorder after age 40 y?
~15%
The total prevalence of panic attacks/disorder is the greatest for which age range?
15y-24y
What is a proven regimen for maintenance treatment of MDD after completion of course of ECT?
Nortriptyline and Lithium
ADHD treated with stimulants does not increase risk of developing substance use disorder in adolescents. TRUE or FALSE
TRUE
Which disorders in adolescents increase risk of developing substance use disorders?
- Untreated ADHD
- Undiagnosed ADHD
- Conduct Disorder
- Impulse Control Disorders
What is the clinical triad of Serotonin Syndrome
- Cognitive Effects
- Somatic Effects
- Autonomic Effects
List the Cognitive Effects of Serotonin Syndrome
- headache
- confusion
- agitation
- hypomania
- hallucinations
- coma
List the Somatic Effects of Serotonin Syndrome
- Myoclonus
- muscle twitching
- hyperreflexia
- tremor
List the Autonomic Effects of Serotonin Syndrome
All hypers
- hypertension
- tachycardia
- nausea
- sweating
How often should AIMS testing be done for pt who is not high risk?
- every 6 months for FGAs
- every 12 months for SGAs
How often should AIMS testing be done for pts at high risk for dyskinesia
- every 3 months for FGAs
- every 6 months for SGAs
Which pts are at increased risk for dyskinesias and Parkinsonism?
- elderly patients
- pts who have experienced acute dystonic reactions or EPS or akathisa
The single most predictive factor for successful adoption:
-young age of adoptive child
Other factors that predict successful adoption:
- short time in foster care
- older age of adoptive parents
- child without mental illness
Cell body nuclei and major neurotransmitters:
- Raphe nucleus: Serotonin
- Locus Coeruleus: NE
- VTA: Dopamine
Name the features of schizoid personality disorder
- social distance/withdrawal
- discomfort with human interaction
- introversion
- bland and constricted affect
- latent fearfulness
Best treatment for schizoid personality disorder
-supportive psychotherapy
Feature that distinguishes serious rash due to lamotrigine from benign rash
-lymphadenopathy (suggests systemic rash)
Risk of death from ECT
1/10,000 - 1/50,000
What is the mortality rate for ECT?
- 0.002% per treatment
- 0.01% per patient
- safer than child birth
- safer than getting struck by lightening
Annual relapse rate for patients with schizophrenia who are compliant with antipsychotics:
30%
Define the following cognitive distortions:
- Mindreading
- Catastrophizing
- All or nothing thinking
- Over inclusion
- Essentializing
- “jumping to conclusions”
- assuming the worst possible outcome or that the worst will happen
- no nuances allowed “it’s either this or that”
- inability to maintain boundaries between concepts (seen in schizophrenia)
- inappropriate reduction of complex situation to obvious details
Signs and symptoms of Wernicke’s Encephalopathy
- gait ataxia
- oculomotor abnormalities
- confusion
- vestibular dysfunction
What is permanent alcohol amnestic syndrome?
Korsakoff’s syndrome
Findings in patients with pyromania
- lower than average IQ
- significantly low CSF levels of 5-HIAA and MHPG
- absent fathers
- no remorse for actions
- intense curiosity about effects of fire
Most common form of competed suicide by teens in the US
FIREARMS
Define the following:
- Efficacy
- Effectiveness
- Potency
- Therapeutic Index
- ability of a drug to treat the condition it is supposed to treat
- how well a drug works in the real world setting (including ease of use, tolerability)
- amount of drug needed to produce effect
- Therapeutic dose/Toxic dose
The 2 antipsychotics approved by the FDA for treatment of Tourette’s Disorder
HALOPERIDOL & PIMIZODE
What is the Flynn Effect?
- increase in average IT test scores since 1936
- 3 IQ points per decade since 1936
Risk factors for alcohol use disorder
- white race
- male gender
- family history of alcohol use disorder
- psychiatric disorder (depression/anxiety)
Clinical features of Lewy Body Disease
- fluctuating consciousness
- visual hallucinations
- Parkinsonism motor symptoms
- sensitivity to dopamine antagonists (antipsychotic medications)
What are the safest and most effective medications for LBD?
Cholinesterase inhibitors (90% LBD pts report decrease in visual hallucinations
Which antipsychotics should be AVOIDED in pts with LBD?
- Risperdal
- Haloperidol
Which antipsychotic is considered safest and most tolerable for parkinsonian sx in pts with LBD?
QUETIAPINE
What is Charles-Bonnet Syndrome?
- macular degeneration with visual hallucinations
- Diabetes is a risk factor
