MTB 3 - Psychiatry (jenna created) Flashcards by Ryan Bird

Which receptor is associated with negative symptoms of schizophrenia

Muscarinic

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Dx requirement for schizophrenia

2/5.
1 must be hallucination, delusions, or disorganized SPEECH

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Reasons to hospitalize schiphrenia patients

Bizzare, paranoid, suicidal

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Rx duration after 1st episode of schizophrenia

6 months

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Other uses of antipsychotics

Sedation (with or instead of benzos if there is c/i)
Movement disorders (huntingtons, tourettes ticks)

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AE of thioidazine (melleril)

Prolonged QT and arrythmias
Abnormal retinal pigmentation

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Fluphenazine (Prolixin) (what category drug)

High dose typical antipsychotic

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Haldol (what category drug)

High dose typical antipsychotic

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Perphenazine (Trilafon) (what category drug)

High dose typical antipsychotic

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Thioidazine (Melleril) (what category drug)

Low dose typical antipsychotic

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Class of antipsychotic with worst anti-cholinergic, andti-alpha and anti-histamine effects

Low dose typical antipsychotic

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AE clozapine (clozaril)

Agranulocytosis
Seizures
Myocarditis

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atypical worst for weight gain

olanzapine (zyprexa)

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Atypical worst for galactorrhea

risperidone

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Atypical worst for EPS

risperidone

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Atypical worst for sedation

Quietapine (seroquel)

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Atypical with no hyperprolactinemia

aripiprazole (abilify)

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Atypical worst for QT prolongation

Ziprasidone (Geodon)

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Anticholinergics to treat EPS

Benztropine (Cogentin)
Diphenhydramine (Benadryl)
Trihexyphenidyl (Artane)

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Rx Acute dystonia

Anticholinergics

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Rx bradykinesia (parkinsonism)

Anticholinergics

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Rx akathesia

Benzos or propanolol

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NMS symptoms (6)

Fever/sweating
Unstable vitals
Altered LOC
Rigidity
Increased CK (rhabdo, ARF)
Increased WBCs

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Rx NMS

Dantroline
Amantadine
Bromocriptine

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Rx adjustment disorder

COuNSELING (it is normal)

Which has a precipitating event, panic disorders or phobic disorders?

Panic

Rx GAD

Citalopram (Celexa, SSRI) Venlafaxine (Effexor - SNRI) Buspirone (Buspar) Benzos

AE stopping benzos quickly

seizures

Rx OCD

SSRI Clomipramine (Anafranil - TCA)

Xanax

Alprazolam

Ativan

Lorazepam

Valium

Diazepam

Buspirone Benefits (3)

No sedation No cognitive impairment Non-addicting

Buspirone mechanism

Partial agonist @ 5HT1A

Acute stress disorder dx

Traumatic event symptoms start within 1 month of event Symptoms gone within 1 month of onset

Timeline of MDE

2 weeks

Iatrogenic causes of depression (4)

Beta blockers Antipsychotics Corticosteroids Reserpine (anti-HTN, anti-aggitation)

Hospitalizatoin criteria for MDD

SI/HI Paranoia

When to use ECT

Acute suicidality Pregnancy (don’t want AE of meds) Medications not working ECT useful in past

1st and 2nd line for dysthymic disorder

1) psychotherapy (insight-oriented) 2) SSRIs

Rx for narcolepsy

Modafenil (provigil) Amphetamines Armodafenil (NuVigil) Sodium oxybate (for cataplexy)

Neuroimaging changes in autism

Increased total brain volume

Neuroimaging changes in OCD

abnormal orbitofrontal cortex and striatum

Neuroimaging changes in PTSD

Decreased hippocampal volume

Neuroimaging changes in panic disorder

Decreased amygdala volume

Neuroimaging changes in schizophrenia

Increased cerebral ventricles

Rapid cycling bipolar

>4 episodes mania/year

DOC for acute mania

Risperidone

DOC for mania maintenance

Lithium

DOC for non-compliant severly manic patients

!M depot phenothiazine

DOC for preventing suicidal ideation in bipolar

lithium

Mgmt bipolar in pregnancy

1st trimester: ECT 2/3rd: Lamotrigine Lithium, valproate, and cabamazepine are teratogenic

1st line for bipolar (3)

Lithium Lamotrigine Riperidone

2nd line bipolar

Divalproex (Depakote) Olanzapine Aripiprazole Quietapine

DOC in cyclothymia

Divalproex (depakote)

After which birth # do you get these usually: Blues Depression Psychosis

Blues = any Depression = 2nd Psychosis = 1st

Zoloft

Sertraline

Prozac

Fluoxetine

Paxel

Paroxetine

Celexa

Citalopram

DOC for atypical depression

MAOIs

Nordil

Phenylzine (MAOI)

When to use Buproprion

Want to quit smoking Had sexual AE or weight gain with SSRIs

AE buproprion and c/i

Seizures c/I benzos, alcohol, eating disorders

Beneifts of mirtazapine (Remeron; atypical antidepressant)

weight gain

Antidepressant for enuresis

Imipramine (TCA)

Antidepressant for insomnia

Trazodone

Antidepressent that also treats chronic pain

Amitriptyline (TCA)

Welbutrin

Buproprion

Desyrel

Trazodone

SNRIs

Cymbalta - Duloxetine Effexor - venlafaxine

AE TCAs

seizures anticholinergic sedating arrythmias (long QT, QRS, PR) akpha-blocker

RX TCA EKG abnormalities

sodium bicarb

Drugs that alter lithium levels

NSAIDS ACE-I ARBs Antiepileptics diuretics SSRIs

Lithium toxicity s/s (6)

GI (N/V/D) Headaches Acute disorientation tremors seizures increased DTRs

AE lithium (5)

Hypothyroid Ebstein fetus DI acne Weight gain

AE depakote (2)

Blood dyscrasias liver toxicity

AE cabamazepine (5)

Agranulocytosis sedation aplastic anemia SIADH CYP 450 inducer

How doe slithium cause SIADH

Stored in CD, increases prostaglandin E2, causes lysosomal degradation of aquaporin channels

Rx lithium toxicity

dialysis

Serotonin syndrome s/s

Aggitatoin Hyperreflexia Volume contraction Hyperthermia Rigidity

Serotonin syndrome rx

IVF Cyproheptadine (5HT and histamine antagonist) Benzos

Pt hx in Serotonin syndrome vs. MAOI hypertensive crisis

Serotonin syndrome = on MAOI, add SSRI or tryptan (migrains) MAOI HTN = on MAOI, take antihistamine, nasal degongestant, tyramine foods (cheese, pickled food)

Medical rx anorexia

olanzapine (zyprexa)

Medical rx bulemia

SSRIs, especially fluoxetine (prozac)

BMI of anorexia

Rx BDD

High dose SSRIs

Dx intermitten exploside disorder

Age >6 2x/week for 3 months PR 3+ distructive episodes (assault) in 1 year aggression out of proportion to stressor

Rx intermittent exploside d/o

SSRI and mood stabilizer

Conduct disorder dx

3+ behaviours in 12 months (with 1 in past 6 months) childhood-adolescence

oppositional-defiant dx

problems with authority

Hightst risk of spousal abuse

3rd trimester pergnancy

Medications for PDs

Cluster B can use SSRIs and mood stabilizers

How many CAGE needed for alcohol abuse?

Acute inaptient alcohol mgmt

Thiamine B12 folate Magnesium Glucose

Rx alcoholic seizures

DOC = Librium (chlordiazepoxide) or valium (diazepam) DOC if severe liver disease = ativan (lorazepam) or Serax (oxazepam)

Drugs to decrease alcoholic relapse rate

Acamprosate Naloxone

s/s DTs (7)

HTN Low-grade fever tachycardia Hallucinations Disorientation agitation Diaphoresis

seizure prophylaxis for alcohol withdrawal

NO!

Rx heroin withdrawal (2)

Clonidine Methadone

Benzo/barb intoxication s/s

Inapropriate sexual or aggressive behaviour Impairment memomry/concentration

Rx benzo/barb intoxication

Flumazenil

Rx benzo/barb withdrawal

long-acting benzo/barb (chlordiazepoxide or phenobarbital)

Ss benzo/barb withdrawal

autonomic hyperactivity tremors insomnia anxiety seizures

Frotteurism

rubbing against/touching non-consenting partner

rx paraphilic d/o

individual psychotherapy + aversive conditioning SSRI or anti-androgens to decrease sex drive if severe