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Psychopharmacology 552 > NSG 552 EXAM 2 > Flashcards

NSG 552 EXAM 2 Flashcards

PPTs, study guides, worksheets, YT videos, Cafer's book

1
Q

A patient experiencing SSRI-related sexual dysfunction should be switched to which medication?

  1. bupropion (Wellbutrin)
  2. venlafaxine (Effexor)
  3. trazodone (Desyrel)
  4. clomipramine (Anafranil)
  5. propranolol (Inderal)
  6. alprazolam (Xanax)
  7. flumazenil (Romazicon)
  8. buspirone (Buspar)
  9. prazosin (Minipress)
  10. naltrexone (Depade)
  11. flurazepam (Dalmane)
  12. zolpidem (Ambien)
  13. trazodone (Desyrel)
  14. ramelteon (Rozerem)
  15. triazolam (Halcon)
  16. armodafinil (Nuvigil)
  17. eszopiclone (Lunesta)
  18. sodium oxybate (Xyrem)
  19. fluoxetine (Prozac)
  20. escitalopram (Lexapro)
A

bupropion (Wellbutrin)

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2
Q

This drug class is the firstline treatment for chronic anxiety, GAD, and panic disorder.

“SS-“

  1. SSRIs
  2. TCAs
  3. β-adrenergic receptor antagonists (beta-blockers)
  4. SSRIs, SNRIs
  5. SSRIs and TCAs
  6. Benzodiazepines
  7. Alpha-1 receptor antagonist
  8. Non-benzo hypnotics
  9. Low Potency Opioids
A

SSRIs

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3
Q

Which drug class is this?

  • Treats comorbid depression
  • Lacks abuse risk
  • Low side effect rate

“S-“

  1. SSRIs
  2. TCAs
  3. β-adrenergic receptor antagonists (beta-blockers)
  4. SSRIs, SNRIs
  5. SSRIs and TCAs
  6. Benzodiazepines
  7. Alpha-1 receptor antagonist
  8. Non-benzo hypnotics
  9. Low Potency Opioids
A

SSRIs

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4
Q

A patient presents with depressive symptoms alongside pain complaints. Which two drug class medications will you consider?

  1. SSRIs
  2. TCAs
  3. β-adrenergic receptor antagonists (beta-blockers)
  4. SSRIs, SNRIs
  5. SSRIs and TCAs
  6. Benzodiazepines
  7. Alpha-1 receptor antagonist
  8. Non-benzo hypnotics
  9. Low Potency Opioids
A

SSRIs and TCAs

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5
Q

Which drug class has the highest anticholinergic effect?

“T-“

  1. SSRIs
  2. TCAs
  3. β-adrenergic receptor antagonists (beta-blockers)
  4. SSRIs, SNRIs
  5. SSRIs and TCAs
  6. Benzodiazepines
  7. Alpha-1 receptor antagonist
  8. Non-benzo hypnotics
  9. Low Potency Opioids
A

TCAs

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6
Q

This medication can be very activating (patients can be restless).

“ven-“

  1. bupropion (Wellbutrin)
  2. venlafaxine (Effexor)
  3. trazodone (Desyrel)
  4. clomipramine (Anafranil)
  5. propranolol (Inderal)
  6. alprazolam (Xanax)
  7. flumazenil (Romazicon)
  8. buspirone (Buspar)
  9. prazosin (Minipress)
  10. naltrexone (Depade)
  11. flurazepam (Dalmane)
  12. zolpidem (Ambien)
  13. trazodone (Desyrel)
  14. ramelteon (Rozerem)
  15. triazolam (Halcon)
  16. armodafinil (Nuvigil)
  17. eszopiclone (Lunesta)
  18. sodium oxybate (Xyrem)
  19. fluoxetine (Prozac)
  20. escitalopram (Lexapro)
A

venlafaxine (Effexor)

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7
Q

This drug class is generally most effective in the treatment of Akathisia.

“Bet-“

  1. SSRIs
  2. TCAs
  3. β-adrenergic receptor antagonists (beta-blockers)
  4. SSRIs, SNRIs
  5. SSRIs and TCAs
  6. Benzodiazepines
  7. Alpha-1 receptor antagonist
  8. Non-benzo hypnotics
  9. Low Potency Opioids
A

β-adrenergic receptor antagonists (beta-blockers)

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8
Q

Which medication (serotonergic agent) can cause priapism?

*not counting escitalopram (Lexapro).

  1. bupropion (Wellbutrin)
  2. venlafaxine (Effexor)
  3. trazodone (Desyrel)
  4. clomipramine (Anafranil)
  5. propranolol (Inderal)
  6. alprazolam (Xanax)
  7. flumazenil (Romazicon)
  8. buspirone (Buspar)
  9. prazosin (Minipress)
  10. naltrexone (Depade)
  11. flurazepam (Dalmane)
  12. zolpidem (Ambien)
  13. trazodone (Desyrel)
  14. ramelteon (Rozerem)
  15. triazolam (Halcon)
  16. armodafinil (Nuvigil)
  17. eszopiclone (Lunesta)
  18. sodium oxybate (Xyrem)
  19. fluoxetine (Prozac)
  20. escitalopram (Lexapro)
A

trazodone (Desyrel)

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9
Q

Which tricyclic antidepressant (TCA) is thought to be effective in the treatment of obsessive compulsive disorder (OCD)?

“Clo-“

  1. bupropion (Wellbutrin)
  2. venlafaxine (Effexor)
  3. trazodone (Desyrel)
  4. clomipramine (Anafranil)
  5. propranolol (Inderal)
  6. alprazolam (Xanax)
  7. flumazenil (Romazicon)
  8. buspirone (Buspar)
  9. prazosin (Minipress)
  10. naltrexone (Depade)
  11. flurazepam (Dalmane)
  12. zolpidem (Ambien)
  13. trazodone (Desyrel)
  14. ramelteon (Rozerem)
  15. triazolam (Halcon)
  16. armodafinil (Nuvigil)
  17. eszopiclone (Lunesta)
  18. sodium oxybate (Xyrem)
  19. fluoxetine (Prozac)
  20. escitalopram (Lexapro)
A

clomipramine (Anafranil)

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10
Q

These are symptoms of which condition?

  • muscle spasms, fever, racing heart, headache, and confusion

o S = Shivering
o H = Hyperreflexia/Myoclonic jerks
o I = Increased Temp (Fever)
o V = Vitals Instability (↑↓BP; ↑RR; ↑HR)
o E = Encephalopathy (Confusion)
o R = Restlessness
o S = Sweating (Diaphoresis)

  1. Serotonin Syndrome
  2. Discontinuation Syndrome
  3. Akathisia
  4. Benzodiazepine withdrawal
  5. Rebound insomnia
  6. Anxiety
  7. dissociative identity disorder (DID)
  8. Depersonalization
  9. Derealization
  10. Initial/sleep-onset Insomnia
  11. Middle/sleep maintenance insomnia
  12. Late/sleep offset insomnia
  13. Nonrestorative sleep
  14. daytime sleepiness associated with obstructive sleep apnea (OSA)
  15. Narcolepsy
  16. Cataplexy
  17. Restless Legs Syndrome (RLS)
  18. Periodic Limb Movements of sleep (PLMS)
  19. Periodic Limb Movement Disorder (PLMD)
  20. Somatic Symptom Disorder
  21. Factitious Disorder
  22. Conversion Disorder
  23. La Bell Indifference
  24. Malingering
  25. Anorexia and bulimia
  26. Anorexia Nervosa
  27. Bulimia Nervosa
  28. Binge Eating Disorder
A

Serotonin Syndrome

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11
Q

These are symptoms of which syndrome?

(FINISH)
F = Flu like symptoms (aches, pains, chills)
I = Insomnia
N = Nausea
I = Imbalance
S = Sensory disturbance (tremors, sensation of electrical shock)
H = Hyperarousal

“disc-“

  1. Serotonin Syndrome
  2. Discontinuation Syndrome
  3. Akathisia
  4. Benzodiazepine withdrawal
  5. Rebound insomnia
  6. Anxiety
  7. dissociative identity disorder (DID)
  8. Depersonalization
  9. Derealization
  10. Initial/sleep-onset Insomnia
  11. Middle/sleep maintenance insomnia
  12. Late/sleep offset insomnia
  13. Nonrestorative sleep
  14. daytime sleepiness associated with obstructive sleep apnea (OSA)
  15. Narcolepsy
  16. Cataplexy
  17. Restless Legs Syndrome (RLS)
  18. Periodic Limb Movements of sleep (PLMS)
  19. Periodic Limb Movement Disorder (PLMD)
  20. Somatic Symptom Disorder
  21. Factitious Disorder
  22. Conversion Disorder
  23. La Bell Indifference
  24. Malingering
  25. Anorexia and bulimia
  26. Anorexia Nervosa
  27. Bulimia Nervosa
  28. Binge Eating Disorder
A

Discontinuation Syndrome

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12
Q

Treatment for acute panic attacks?

  1. can use benzodiazepine short-term in addition to long-term SSRI
  2. CBT
  3. Meds + CBT
  4. SSRI (often need high doses of sertraline, fluoxetine); Luvox
  5. SNRI (e.g. venlafaxine) (Clomipramine=Anafranil)
  6. Psychotherapy
  7. ECT
  8. weight loss; avoidance of ETOH; CPAP; Uvulopalatopharyngoplasty
  9. Remove offending agent; iron replacement
  10. Psychotherapy (CBT, IPT)
A

Can use benzodiazepines short-term in addition to long-term SSRI.

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13
Q

Specific medication to treat performance anxiety?

“pro-“

  1. bupropion (Wellbutrin)
  2. venlafaxine (Effexor)
  3. trazodone (Desyrel)
  4. clomipramine (Anafranil)
  5. propranolol (Inderal)
  6. alprazolam (Xanax)
  7. flumazenil (Romazicon)
  8. buspirone (Buspar)
  9. prazosin (Minipress)
  10. naltrexone (Depade)
  11. flurazepam (Dalmane)
  12. zolpidem (Ambien)
  13. trazodone (Desyrel)
  14. ramelteon (Rozerem)
  15. triazolam (Halcon)
  16. armodafinil (Nuvigil)
  17. eszopiclone (Lunesta)
  18. sodium oxybate (Xyrem)
  19. fluoxetine (Prozac)
  20. escitalopram (Lexapro)
A

propranolol (Inderal)

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14
Q

Non-pharmacological treatment for performance anxiety?

“C-“

  1. can use benzodiazepine short-term in addition to long-term SSRI
  2. CBT
  3. Meds + CBT
  4. SSRI (often need high doses of sertraline, fluoxetine); Luvox
  5. SNRI (e.g. venlafaxine) (Clomipramine=Anafranil)
  6. Psychotherapy
  7. ECT
  8. weight loss; avoidance of ETOH; CPAP; Uvulopalatopharyngoplasty
  9. Remove offending agent; iron replacement
  10. Psychotherapy (CBT, IPT)
A

CBT

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15
Q

First-line drug classes (x2) to treat performance anxiety?

  1. SSRIs
  2. TCAs
  3. β-adrenergic receptor antagonists (beta-blockers)
  4. SSRIs, SNRIs
  5. SSRIs and TCAs
  6. Benzodiazepines
  7. Alpha-1 receptor antagonist
  8. Non-benzo hypnotics
  9. Low Potency Opioids
A

SSRIs, SNRIs

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16
Q

Which drug class treats generalized anxiety disorder (GAD)?

  1. SSRIs
  2. TCAs
  3. β-adrenergic receptor antagonists (beta-blockers)
  4. SSRIs, SNRIs
  5. SSRIs and TCAs
  6. Benzodiazepines
  7. Alpha-1 receptor antagonist
  8. Non-benzo hypnotics
  9. Low Potency Opioids
A

SSRIs

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17
Q

Which SSRI medications are used to treat generalized anxiety disorder (GAD)?

“epdv”

  1. escitalopram, paroxetine, duloxetine, and venlafaxine
  2. oxazepam, temazepam, lorazepam
  3. midazolam (Versed) and alprazolam (Xanax)
  4. lorazepam, oxazepam, temazepam
  5. diazepam, clonazepam, chlordiazepoxide, flurazepam
  6. sertraline (Zoloft), paroxetine (Paxil), and venlafaxine (Effexor)
  7. trazodone (Desyrel) [Mostly prescribed sedating antidepressant], and low doses of mirtazapine (Remeron)
  8. amitriptyline (Elavil), doxepin (Sinequan), mirtazapine (Remeron), trazodone (Desyel)
  9. fluoxetine (Prozac), duloxetine (Cymbalta), atomoxetine (Strattera), venlafaxine (Effexor)
  10. Dopamine agonists: pramipexole (Mirapex), ropinirole (Requip) and Benzos
  11. Gabapentin (Neurontin); pregabalin (Lyrica)
  12. Alprazolam and Lorazepam
A

Escitalopram, paroxetine, duloxetine, and venlafaxine

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18
Q

Which drug class is used to treat seasonal affective disorder (SAD)?

“SS-“

  1. SSRIs
  2. TCAs
  3. β-adrenergic receptor antagonists (beta-blockers)
  4. SSRIs, SNRIs
  5. SSRIs and TCAs
  6. Benzodiazepines
  7. Alpha-1 receptor antagonist
  8. Non-benzo hypnotics
  9. Low Potency Opioids
A

SSRIs

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19
Q

Which drug class should you initially use to treat panic attacks?

“ben-“

  1. SSRIs
  2. TCAs
  3. β-adrenergic receptor antagonists (beta-blockers)
  4. SSRIs, SNRIs
  5. SSRIs and TCAs
  6. Benzodiazepines
  7. Alpha-1 receptor antagonist
  8. Non-benzo hypnotics
  9. Low Potency Opioids
A

Benzodiazepines

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20
Q

First-line drug classes (x2) to treat panic disorder?

  1. SSRIs
  2. TCAs
  3. β-adrenergic receptor antagonists (beta-blockers)
  4. SSRIs, SNRIs
  5. SSRIs and TCAs
  6. Benzodiazepines
  7. Alpha-1 receptor antagonist
  8. Non-benzo hypnotics
  9. Low Potency Opioids
A

SSRIs, SNRIs

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21
Q

Second-line drug class treatment for panic disorder, though use is limited.

“T-“

  1. SSRIs
  2. TCAs
  3. β-adrenergic receptor antagonists (beta-blockers)
  4. SSRIs, SNRIs
  5. SSRIs and TCAs
  6. Benzodiazepines
  7. Alpha-1 receptor antagonist
  8. Non-benzo hypnotics
  9. Low Potency Opioids
A

TCAs

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22
Q

Adjunct treatment (which drug class?) to be used with caution on a short-term basis until other medications reach therapeutic efficacy.

  1. SSRIs
  2. TCAs
  3. β-adrenergic receptor antagonists (beta-blockers)
  4. SSRIs, SNRIs
  5. SSRIs and TCAs
  6. Benzodiazepines
  7. Alpha-1 receptor antagonist
  8. Non-benzo hypnotics
  9. Low Potency Opioids
A

Benzodiazepines

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23
Q

Which specific medication is FDA-approved for panic disorder?

“alp-“

  1. bupropion (Wellbutrin)
  2. venlafaxine (Effexor)
  3. trazodone (Desyrel)
  4. clomipramine (Anafranil)
  5. propranolol (Inderal)
  6. alprazolam (Xanax)
  7. flumazenil (Romazicon)
  8. buspirone (Buspar)
  9. prazosin (Minipress)
  10. naltrexone (Depade)
  11. flurazepam (Dalmane)
  12. zolpidem (Ambien)
  13. trazodone (Desyrel)
  14. ramelteon (Rozerem)
  15. triazolam (Halcon)
  16. armodafinil (Nuvigil)
  17. eszopiclone (Lunesta)
  18. sodium oxybate (Xyrem)
  19. fluoxetine (Prozac)
  20. escitalopram (Lexapro)
A

alprazolam (Xanax)

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24
Q

General treatment combination for OCD?

“m”+ “c”

  1. can use benzodiazepine short-term in addition to long-term SSRI
  2. CBT
  3. Meds + CBT
  4. SSRI (often need high doses of sertraline, fluoxetine); Luvox
  5. SNRI (e.g. venlafaxine) (Clomipramine=Anafranil)
  6. Psychotherapy
  7. ECT
  8. weight loss; avoidance of ETOH; CPAP; Uvulopalatopharyngoplasty
  9. Remove offending agent; iron replacement
  10. Psychotherapy (CBT, IPT)
A

Meds + CBT

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25
First-line specific treatment for OCD? *Drug class and three med examples? "SS-"... 1. can use benzodiazepine short-term in addition to long-term SSRI 2. CBT 3. Meds + CBT 4. SSRI (often need high doses of sertraline, fluoxetine); Luvox 5. SNRI (e.g. venlafaxine) (Clomipramine=Anafranil) 6. Psychotherapy 7. ECT 8. weight loss; avoidance of ETOH; CPAP; Uvulopalatopharyngoplasty 9. Remove offending agent; iron replacement 10. Psychotherapy (CBT, IPT)
SSRI (often need high doses of sertraline, fluoxetine); Luvox
26
Second-line specific treatment for OCD? *Drug class and two med examples? 1. can use benzodiazepine short-term in addition to long-term SSRI 2. CBT 3. Meds + CBT 4. SSRI (often need high doses of sertraline, fluoxetine); Luvox 5. SNRI (e.g. venlafaxine) (Clomipramine=Anafranil) 6. Psychotherapy 7. ECT 8. weight loss; avoidance of ETOH; CPAP; Uvulopalatopharyngoplasty 9. Remove offending agent; iron replacement 10. Psychotherapy (CBT, IPT)
SNRI (e.g. venlafaxine) (Clomipramine=Anafranil)
27
Which two benzodiazepines are commonly prescribed? 1. escitalopram, paroxetine, duloxetine, and venlafaxine 2. oxazepam, temazepam, lorazepam 3. midazolam (Versed) and alprazolam (Xanax) 4. lorazepam, oxazepam, temazepam 5. diazepam, clonazepam, chlordiazepoxide, flurazepam 6. sertraline (Zoloft), paroxetine (Paxil), and venlafaxine (Effexor) 7. trazodone (Desyrel) [Mostly prescribed sedating antidepressant], and low doses of mirtazapine (Remeron) 8. amitriptyline (Elavil), doxepin (Sinequan), mirtazapine (Remeron), trazodone (Desyel) 9. fluoxetine (Prozac), duloxetine (Cymbalta), atomoxetine (Strattera), venlafaxine (Effexor) 10. Dopamine agonists: pramipexole (Mirapex), ropinirole (Requip) and Benzos 11. Gabapentin (Neurontin); pregabalin (Lyrica) 12. Alprazolam and Lorazepam
Alprazolam and Lorazepam
28
MOA of benzodiazepines? 1. MOA: Potentiate effects of GABA (Remember GABA is inhibitory) → drowsiness, cognitive impairment, dampening of fear and anxiety, impaired balance, motor control, muscle tone and coordination, anterograde amnesia. 2. Partial agonist at 5HT-1A = ↓serotonergic activity
MOA: Potentiate effects of GABA (Remember GABA is inhibitory) → drowsiness, cognitive impairment, dampening of fear and anxiety, impaired balance, motor control, muscle tone and coordination, anterograde amnesia.
29
Clinical considerations regarding benzodiazepines (risks). 1. Increased fall risk, hip fracture risk 2. consider nonaddictive anxiolytic alternatives (e.g. gabapentin and antihistamines with anxiolytic properties (e.g. diphenhydramine or hydroxyzine) 3. Benzodiazepines may interfere with the psychological processes needed to benefit from CBT 4. high rate of comorbid substance use disorders and lack of efficacy. 5. note that these patients have depressive symptoms and hence ECT can be considered as a viable option especially in combination with psychotherapy.
Increased fall risk, hip fracture risk
30
What do benzodiazepines do regarding GABA? 1. Enhance activity of GABA at GABA-A receptor 2. Optimize 3. Increased incidence of comorbid anxiety disorders and major depression 4. severe stress and trauma 5. Tyramine rich foods: red wine, aged cheese, chicken liver, fava beans, cured meats 6. long half-life, increased risk for confusion and falls 7. 10 mg 8. 5 mg 9. binds to melatonin receptors in brain inhibiting neuronal firing 10. cardiac arrhythmias due to electrolyte disturbances (e.g. ↓K+)
Enhance activity of GABA at GABA-A receptor
31
Benzodiazepines can be used to treat which condition? "a-" 1. Serotonin Syndrome 2. Discontinuation Syndrome 3. Akathisia 4. Benzodiazepine withdrawal 5. Rebound insomnia 6. Anxiety 7. dissociative identity disorder (DID) 8. Depersonalization 9. Derealization 10. Initial/sleep-onset Insomnia 11. Middle/sleep maintenance insomnia 12. Late/sleep offset insomnia 13. Nonrestorative sleep 14. daytime sleepiness associated with obstructive sleep apnea (OSA) 15. Narcolepsy 16. Cataplexy 17. Restless Legs Syndrome (RLS) 18. Periodic Limb Movements of sleep (PLMS) 19. Periodic Limb Movement Disorder (PLMD) 20. Somatic Symptom Disorder 21. Factitious Disorder 22. Conversion Disorder 23. La Bell Indifference 24. Malingering 25. Anorexia and bulimia 26. Anorexia Nervosa 27. Bulimia Nervosa 28. Binge Eating Disorder
Akathisia
32
Patient become physically dependent and build tolerance to which drug class? 1. SSRIs 2. TCAs 3. β-adrenergic receptor antagonists (beta-blockers) 4. SSRIs, SNRIs 5. SSRIs and TCAs 6. Benzodiazepines 7. Alpha-1 receptor antagonist 8. Non-benzo hypnotics 9. Low Potency Opioids
Benzodiazepines (BDZ)
33
There is potential for abuse and addiction regarding which drug class? 1. SSRIs 2. TCAs 3. β-adrenergic receptor antagonists (beta-blockers) 4. SSRIs, SNRIs 5. SSRIs and TCAs 6. Benzodiazepines 7. Alpha-1 receptor antagonist 8. Non-benzo hypnotics 9. Low Potency Opioids
Benzodiazepines (BDZ)
34
Choice of this drug class depends on time of onset, duration of action and method of metabolism. 1. SSRIs 2. TCAs 3. β-adrenergic receptor antagonists (beta-blockers) 4. SSRIs, SNRIs 5. SSRIs and TCAs 6. Benzodiazepines 7. Alpha-1 receptor antagonist 8. Non-benzo hypnotics 9. Low Potency Opioids
Benzodiazepines (BDZ)
35
These three specific benzodiazepines are "Outside The Liver" (OTL). They are not metabolized by the liver. 1. escitalopram, paroxetine, duloxetine, and venlafaxine 2. oxazepam, temazepam, lorazepam 3. midazolam (Versed) and alprazolam (Xanax) 4. lorazepam, oxazepam, temazepam 5. diazepam, clonazepam, chlordiazepoxide, flurazepam 6. sertraline (Zoloft), paroxetine (Paxil), and venlafaxine (Effexor) 7. trazodone (Desyrel) [Mostly prescribed sedating antidepressant], and low doses of mirtazapine (Remeron) 8. amitriptyline (Elavil), doxepin (Sinequan), mirtazapine (Remeron), trazodone (Desyel) 9. fluoxetine (Prozac), duloxetine (Cymbalta), atomoxetine (Strattera), venlafaxine (Effexor) 10. Dopamine agonists: pramipexole (Mirapex), ropinirole (Requip) and Benzos 11. Gabapentin (Neurontin); pregabalin (Lyrica) 12. Alprazolam and Lorazepam
oxazepam, temazepam, lorazepam
36
These are S/E of which drug class? - anticholinergic - unusual behaviors - hallucinations - daytime drowsiness - amnesia "Be-" 1. SSRIs 2. TCAs 3. β-adrenergic receptor antagonists (beta-blockers) 4. SSRIs, SNRIs 5. SSRIs and TCAs 6. Benzodiazepines 7. Alpha-1 receptor antagonist 8. Non-benzo hypnotics 9. Low Potency Opioids
Benzodiazepines (BDZ)
37
_________ _________ is like ETOH withdrawal. 1. Serotonin Syndrome 2. Discontinuation Syndrome 3. Akathisia 4. Benzodiazepine withdrawal 5. Rebound insomnia 6. Anxiety 7. dissociative identity disorder (DID) 8. Depersonalization 9. Derealization 10. Initial/sleep-onset Insomnia 11. Middle/sleep maintenance insomnia 12. Late/sleep offset insomnia 13. Nonrestorative sleep 14. daytime sleepiness associated with obstructive sleep apnea (OSA) 15. Narcolepsy 16. Cataplexy 17. Restless Legs Syndrome (RLS) 18. Periodic Limb Movements of sleep (PLMS) 19. Periodic Limb Movement Disorder (PLMD) 20. Somatic Symptom Disorder 21. Factitious Disorder 22. Conversion Disorder 23. La Bell Indifference 24. Malingering 25. Anorexia and bulimia 26. Anorexia Nervosa 27. Bulimia Nervosa 28. Binge Eating Disorder
Benzodiazepine withdrawal
38
The following are symptoms of which condition? * Insomnia * Anxiety * Hand tremors * Irritability * Anorexia * Nausea/vomiting * Autonomic hyperactivity (diaphoresis, tachycardia, HTN) * Tonic–clonic seizures = life threatening "ben-" 1. Serotonin Syndrome 2. Discontinuation Syndrome 3. Akathisia 4. Benzodiazepine withdrawal 5. Rebound insomnia 6. Anxiety 7. dissociative identity disorder (DID) 8. Depersonalization 9. Derealization 10. Initial/sleep-onset Insomnia 11. Middle/sleep maintenance insomnia 12. Late/sleep offset insomnia 13. Nonrestorative sleep 14. daytime sleepiness associated with obstructive sleep apnea (OSA) 15. Narcolepsy 16. Cataplexy 17. Restless Legs Syndrome (RLS) 18. Periodic Limb Movements of sleep (PLMS) 19. Periodic Limb Movement Disorder (PLMD) 20. Somatic Symptom Disorder 21. Factitious Disorder 22. Conversion Disorder 23. La Bell Indifference 24. Malingering 25. Anorexia and bulimia 26. Anorexia Nervosa 27. Bulimia Nervosa 28. Binge Eating Disorder
Benzodiazepine withdrawal
39
Abrupt abstinence after chronic use of which drug class(?) can be life threatening. 1. SSRIs 2. TCAs 3. β-adrenergic receptor antagonists (beta-blockers) 4. SSRIs, SNRIs 5. SSRIs and TCAs 6. Benzodiazepines 7. Alpha-1 receptor antagonist 8. Non-benzo hypnotics 9. Low Potency Opioids
Benzodiazepines (BDZ)
40
A known sleep-related limitation of Benzodiazepine treatment is which condition? 1. Serotonin Syndrome 2. Discontinuation Syndrome 3. Akathisia 4. Benzodiazepine withdrawal 5. Rebound insomnia 6. Anxiety 7. dissociative identity disorder (DID) 8. Depersonalization 9. Derealization 10. Initial/sleep-onset Insomnia 11. Middle/sleep maintenance insomnia 12. Late/sleep offset insomnia 13. Nonrestorative sleep 14. daytime sleepiness associated with obstructive sleep apnea (OSA) 15. Narcolepsy 16. Cataplexy 17. Restless Legs Syndrome (RLS) 18. Periodic Limb Movements of sleep (PLMS) 19. Periodic Limb Movement Disorder (PLMD) 20. Somatic Symptom Disorder 21. Factitious Disorder 22. Conversion Disorder 23. La Bell Indifference 24. Malingering 25. Anorexia and bulimia 26. Anorexia Nervosa 27. Bulimia Nervosa 28. Binge Eating Disorder
rebound insomnia
41
Short-acting = < 6hrs half life * used for seizure disorders and panic attacks Which two BDZ are these? 1. escitalopram, paroxetine, duloxetine, and venlafaxine 2. oxazepam, temazepam, lorazepam 3. midazolam (Versed) and alprazolam (Xanax) 4. lorazepam, oxazepam, temazepam 5. diazepam, clonazepam, chlordiazepoxide, flurazepam 6. sertraline (Zoloft), paroxetine (Paxil), and venlafaxine (Effexor) 7. trazodone (Desyrel) [Mostly prescribed sedating antidepressant], and low doses of mirtazapine (Remeron) 8. amitriptyline (Elavil), doxepin (Sinequan), mirtazapine (Remeron), trazodone (Desyel) 9. fluoxetine (Prozac), duloxetine (Cymbalta), atomoxetine (Strattera), venlafaxine (Effexor) 10. Dopamine agonists: pramipexole (Mirapex), ropinirole (Requip) and Benzos 11. Gabapentin (Neurontin); pregabalin (Lyrica) 12. Alprazolam and Lorazepam
midazolam (Versed) and alprazolam (Xanax)
42
Intermediate-acting = (6-20 hours half life * used for insomnia and anxiety Which three BDZ are these? "lot-" 1. escitalopram, paroxetine, duloxetine, and venlafaxine 2. oxazepam, temazepam, lorazepam 3. midazolam (Versed) and alprazolam (Xanax) 4. lorazepam, oxazepam, temazepam 5. diazepam, clonazepam, chlordiazepoxide, flurazepam 6. sertraline (Zoloft), paroxetine (Paxil), and venlafaxine (Effexor) 7. trazodone (Desyrel) [Mostly prescribed sedating antidepressant], and low doses of mirtazapine (Remeron) 8. amitriptyline (Elavil), doxepin (Sinequan), mirtazapine (Remeron), trazodone (Desyel) 9. fluoxetine (Prozac), duloxetine (Cymbalta), atomoxetine (Strattera), venlafaxine (Effexor) 10. Dopamine agonists: pramipexole (Mirapex), ropinirole (Requip) and Benzos 11. Gabapentin (Neurontin); pregabalin (Lyrica) 12. Alprazolam and Lorazepam
lorazepam, oxazepam, temazepam
43
Long-acting = (>20 hours half life) * Used for moderate-severe anxiety * Good for ETOH withdrawal Which four BDZ are these? "dccf" 1. escitalopram, paroxetine, duloxetine, and venlafaxine 2. oxazepam, temazepam, lorazepam 3. midazolam (Versed) and alprazolam (Xanax) 4. lorazepam, oxazepam, temazepam 5. diazepam, clonazepam, chlordiazepoxide, flurazepam 6. sertraline (Zoloft), paroxetine (Paxil), and venlafaxine (Effexor) 7. trazodone (Desyrel) [Mostly prescribed sedating antidepressant], and low doses of mirtazapine (Remeron) 8. amitriptyline (Elavil), doxepin (Sinequan), mirtazapine (Remeron), trazodone (Desyel) 9. fluoxetine (Prozac), duloxetine (Cymbalta), atomoxetine (Strattera), venlafaxine (Effexor) 10. Dopamine agonists: pramipexole (Mirapex), ropinirole (Requip) and Benzos 11. Gabapentin (Neurontin); pregabalin (Lyrica) 12. Alprazolam and Lorazepam
diazepam, clonazepam, chlordiazepoxide, flurazepam
44
Which medication would you give to reverse the effects of benzodiazepine overdose? 1. bupropion (Wellbutrin) 2. venlafaxine (Effexor) 3. trazodone (Desyrel) 4. clomipramine (Anafranil) 5. propranolol (Inderal) 6. alprazolam (Xanax) 7. flumazenil (Romazicon) 8. buspirone (Buspar) 9. prazosin (Minipress) 10. naltrexone (Depade) 11. flurazepam (Dalmane) 12. zolpidem (Ambien) 13. trazodone (Desyrel) 14. ramelteon (Rozerem) 15. triazolam (Halcon) 16. armodafinil (Nuvigil) 17. eszopiclone (Lunesta) 18. sodium oxybate (Xyrem) 19. fluoxetine (Prozac) 20. escitalopram (Lexapro)
flumazenil (Romazicon)
45
To reverse the effects of benzodiazepine OD, which medication would you give? 1. bupropion (Wellbutrin) 2. venlafaxine (Effexor) 3. trazodone (Desyrel) 4. clomipramine (Anafranil) 5. propranolol (Inderal) 6. alprazolam (Xanax) 7. flumazenil (Romazicon) 8. buspirone (Buspar) 9. prazosin (Minipress) 10. naltrexone (Depade) 11. flurazepam (Dalmane) 12. zolpidem (Ambien) 13. trazodone (Desyrel) 14. ramelteon (Rozerem) 15. triazolam (Halcon) 16. armodafinil (Nuvigil) 17. eszopiclone (Lunesta) 18. sodium oxybate (Xyrem) 19. fluoxetine (Prozac) 20. escitalopram (Lexapro)
flumazenil (Romazicon)
46
MOA of buspirone (Buspar)? 1. MOA: Potentiate effects of GABA (Remember GABA is inhibitory) → drowsiness, cognitive impairment, dampening of fear and anxiety, impaired balance, motor control, muscle tone and coordination, anterograde amnesia. 2. Partial agonist at 5HT-1A = ↓serotonergic activity
Partial agonist at 5HT-1A = ↓serotonergic activity
47
This medication has low potential for abuse/addiction. Low potential for causing dependence. "bus-" 1. bupropion (Wellbutrin) 2. venlafaxine (Effexor) 3. trazodone (Desyrel) 4. clomipramine (Anafranil) 5. propranolol (Inderal) 6. alprazolam (Xanax) 7. flumazenil (Romazicon) 8. buspirone (Buspar) 9. prazosin (Minipress) 10. naltrexone (Depade) 11. flurazepam (Dalmane) 12. zolpidem (Ambien) 13. trazodone (Desyrel) 14. ramelteon (Rozerem) 15. triazolam (Halcon) 16. armodafinil (Nuvigil) 17. eszopiclone (Lunesta) 18. sodium oxybate (Xyrem) 19. fluoxetine (Prozac) 20. escitalopram (Lexapro)
buspirone (Buspar)
48
If a patient reports medication is not working, look at the dose, _______ it before switching it. 1. Enhance activity of GABA at GABA-A receptor 2. Optimize 3. Increased incidence of comorbid anxiety disorders and major depression 4. severe stress and trauma 5. Tyramine rich foods: red wine, aged cheese, chicken liver, fava beans, cured meats 6. long half-life, increased risk for confusion and falls 7. 10 mg 8. 5 mg 9. binds to melatonin receptors in brain inhibiting neuronal firing 10. cardiac arrhythmias due to electrolyte disturbances (e.g. ↓K+)
optimize
49
Benefits of this drug class as compared to antidepressants? - rapid onset of action - effective - well-tolerated "ben-" 1. SSRIs 2. TCAs 3. β-adrenergic receptor antagonists (beta-blockers) 4. SSRIs, SNRIs 5. SSRIs and TCAs 6. Benzodiazepines 7. Alpha-1 receptor antagonist 8. Non-benzo hypnotics 9. Low Potency Opioids
benzodiazepines
50
Patients with comorbid substance use: 1. Increased fall risk, hip fracture risk 2. consider nonaddictive anxiolytic alternatives (e.g. gabapentin and antihistamines with anxiolytic properties (e.g. diphenhydramine or hydroxyzine) 3. Benzodiazepines may interfere with the psychological processes needed to benefit from CBT 4. high rate of comorbid substance use disorders and lack of efficacy. 5. note that these patients have depressive symptoms and hence ECT can be considered as a viable option especially in combination with psychotherapy.
Consider non-addictive anxiolytic alternatives (e.g. gabapentin and antihistamines with anxiolytic properties (e.g. diphenhydramine or hydroxyzine)
51
These medical condition may precipitate which condition? * Heart disease * Hyperthyroidism * COPD/asthma * Drug abuse * ETOH/benzo withdrawal * Chronic pain * IBS * Adrenal tumor * Seizure * Diabetes mellitus 1. Serotonin Syndrome 2. Discontinuation Syndrome 3. Akathisia 4. Benzodiazepine withdrawal 5. Rebound insomnia 6. Anxiety 7. dissociative identity disorder (DID) 8. Depersonalization 9. Derealization 10. Initial/sleep-onset Insomnia 11. Middle/sleep maintenance insomnia 12. Late/sleep offset insomnia 13. Nonrestorative sleep 14. daytime sleepiness associated with obstructive sleep apnea (OSA) 15. Narcolepsy 16. Cataplexy 17. Restless Legs Syndrome (RLS) 18. Periodic Limb Movements of sleep (PLMS) 19. Periodic Limb Movement Disorder (PLMD) 20. Somatic Symptom Disorder 21. Factitious Disorder 22. Conversion Disorder 23. La Bell Indifference 24. Malingering 25. Anorexia and bulimia 26. Anorexia Nervosa 27. Bulimia Nervosa 28. Binge Eating Disorder
Anxiety
52
What are the first line medications for PTSD? (2 SSRIs and 1 SNRI) "spv" 1. escitalopram, paroxetine, duloxetine, and venlafaxine 2. oxazepam, temazepam, lorazepam 3. midazolam (Versed) and alprazolam (Xanax) 4. lorazepam, oxazepam, temazepam 5. diazepam, clonazepam, chlordiazepoxide, flurazepam 6. sertraline (Zoloft), paroxetine (Paxil), and venlafaxine (Effexor) 7. trazodone (Desyrel) [Mostly prescribed sedating antidepressant], and low doses of mirtazapine (Remeron) 8. amitriptyline (Elavil), doxepin (Sinequan), mirtazapine (Remeron), trazodone (Desyel) 9. fluoxetine (Prozac), duloxetine (Cymbalta), atomoxetine (Strattera), venlafaxine (Effexor) 10. Dopamine agonists: pramipexole (Mirapex), ropinirole (Requip) and Benzos 11. Gabapentin (Neurontin); pregabalin (Lyrica) 12. Alprazolam and Lorazepam
sertraline (Zoloft), paroxetine (Paxil), and venlafaxine (Effexor)
53
Which medication is used for treatment for PTSD-related flashbacks and nightmares? "Pra-" 1. bupropion (Wellbutrin) 2. venlafaxine (Effexor) 3. trazodone (Desyrel) 4. clomipramine (Anafranil) 5. propranolol (Inderal) 6. alprazolam (Xanax) 7. flumazenil (Romazicon) 8. buspirone (Buspar) 9. prazosin (Minipress) 10. naltrexone (Depade) 11. flurazepam (Dalmane) 12. zolpidem (Ambien) 13. trazodone (Desyrel) 14. ramelteon (Rozerem) 15. triazolam (Halcon) 16. armodafinil (Nuvigil) 17. eszopiclone (Lunesta) 18. sodium oxybate (Xyrem) 19. fluoxetine (Prozac) 20. escitalopram (Lexapro)
prazosin (Minipress)
54
Which drug class is used for treatment for PTSD-related flashbacks and nightmares? 1. SSRIs 2. TCAs 3. β-adrenergic receptor antagonists (beta-blockers) 4. SSRIs, SNRIs 5. SSRIs and TCAs 6. Benzodiazepines 7. Alpha-1 receptor antagonist 8. Non-benzo hypnotics 9. Low Potency Opioids
Alpha-1 receptor antagonist
55
This medication targets flashbacks, nightmares, and hypervigilance? "pra-" 1. bupropion (Wellbutrin) 2. venlafaxine (Effexor) 3. trazodone (Desyrel) 4. clomipramine (Anafranil) 5. propranolol (Inderal) 6. alprazolam (Xanax) 7. flumazenil (Romazicon) 8. buspirone (Buspar) 9. prazosin (Minipress) 10. naltrexone (Depade) 11. flurazepam (Dalmane) 12. zolpidem (Ambien) 13. trazodone (Desyrel) 14. ramelteon (Rozerem) 15. triazolam (Halcon) 16. armodafinil (Nuvigil) 17. eszopiclone (Lunesta) 18. sodium oxybate (Xyrem) 19. fluoxetine (Prozac) 20. escitalopram (Lexapro)
prazosin (Minipress)
56
Regarding the use of benzodiazepines in patients with PTSD? 1. Increased fall risk, hip fracture risk 2. consider nonaddictive anxiolytic alternatives (e.g. gabapentin and antihistamines with anxiolytic properties (e.g. diphenhydramine or hydroxyzine) 3. Benzodiazepines may interfere with the psychological processes needed to benefit from CBT 4. high rate of comorbid substance use disorders and lack of efficacy. 5. note that these patients have depressive symptoms and hence ECT can be considered as a viable option especially in combination with psychotherapy.
Benzodiazepines may interfere with the psychological processes needed to benefit from CBT.
57
Avoid addictive medications (e.g., Benzodiazepines) due to: 1. Increased fall risk, hip fracture risk 2. consider nonaddictive anxiolytic alternatives (e.g. gabapentin and antihistamines with anxiolytic properties (e.g. diphenhydramine or hydroxyzine) 3. Benzodiazepines may interfere with the psychological processes needed to benefit from CBT 4. high rate of comorbid substance use disorders and lack of efficacy. 5. note that these patients have depressive symptoms and hence ECT can be considered as a viable option especially in combination with psychotherapy.
high rate of comorbid substance use disorders and lack of efficacy.
58
This condition predominantly develops in victims of significant and chronic childhood trauma. "dis-" 1. Serotonin Syndrome 2. Discontinuation Syndrome 3. Akathisia 4. Benzodiazepine withdrawal 5. Rebound insomnia 6. Anxiety 7. dissociative identity disorder (DID) 8. Depersonalization 9. Derealization 10. Initial/sleep-onset Insomnia 11. Middle/sleep maintenance insomnia 12. Late/sleep offset insomnia 13. Nonrestorative sleep 14. daytime sleepiness associated with obstructive sleep apnea (OSA) 15. Narcolepsy 16. Cataplexy 17. Restless Legs Syndrome (RLS) 18. Periodic Limb Movements of sleep (PLMS) 19. Periodic Limb Movement Disorder (PLMD) 20. Somatic Symptom Disorder 21. Factitious Disorder 22. Conversion Disorder 23. La Bell Indifference 24. Malingering 25. Anorexia and bulimia 26. Anorexia Nervosa 27. Bulimia Nervosa 28. Binge Eating Disorder
dissociative identity disorder (DID)
59
Patients with this condition often cope with PTSD. 1. Serotonin Syndrome 2. Discontinuation Syndrome 3. Akathisia 4. Benzodiazepine withdrawal 5. Rebound insomnia 6. Anxiety 7. dissociative identity disorder (DID) 8. Depersonalization 9. Derealization 10. Initial/sleep-onset Insomnia 11. Middle/sleep maintenance insomnia 12. Late/sleep offset insomnia 13. Nonrestorative sleep 14. daytime sleepiness associated with obstructive sleep apnea (OSA) 15. Narcolepsy 16. Cataplexy 17. Restless Legs Syndrome (RLS) 18. Periodic Limb Movements of sleep (PLMS) 19. Periodic Limb Movement Disorder (PLMD) 20. Somatic Symptom Disorder 21. Factitious Disorder 22. Conversion Disorder 23. La Bell Indifference 24. Malingering 25. Anorexia and bulimia 26. Anorexia Nervosa 27. Bulimia Nervosa 28. Binge Eating Disorder
dissociative identity disorder (DID)
60
Regarding this condition, * more than one distinct personality state results from a fragmented sense of self. 1. Serotonin Syndrome 2. Discontinuation Syndrome 3. Akathisia 4. Benzodiazepine withdrawal 5. Rebound insomnia 6. Anxiety 7. dissociative identity disorder (DID) 8. Depersonalization 9. Derealization 10. Initial/sleep-onset Insomnia 11. Middle/sleep maintenance insomnia 12. Late/sleep offset insomnia 13. Nonrestorative sleep 14. daytime sleepiness associated with obstructive sleep apnea (OSA) 15. Narcolepsy 16. Cataplexy 17. Restless Legs Syndrome (RLS) 18. Periodic Limb Movements of sleep (PLMS) 19. Periodic Limb Movement Disorder (PLMD) 20. Somatic Symptom Disorder 21. Factitious Disorder 22. Conversion Disorder 23. La Bell Indifference 24. Malingering 25. Anorexia and bulimia 26. Anorexia Nervosa 27. Bulimia Nervosa 28. Binge Eating Disorder
dissociative identity disorder (DID)
61
Regarding people with this condition, more than 70% attempt suicide often with frequent attempts and self-mutilation. "dis-" 1. Serotonin Syndrome 2. Discontinuation Syndrome 3. Akathisia 4. Benzodiazepine withdrawal 5. Rebound insomnia 6. Anxiety 7. dissociative identity disorder (DID) 8. Depersonalization 9. Derealization 10. Initial/sleep-onset Insomnia 11. Middle/sleep maintenance insomnia 12. Late/sleep offset insomnia 13. Nonrestorative sleep 14. daytime sleepiness associated with obstructive sleep apnea (OSA) 15. Narcolepsy 16. Cataplexy 17. Restless Legs Syndrome (RLS) 18. Periodic Limb Movements of sleep (PLMS) 19. Periodic Limb Movement Disorder (PLMD) 20. Somatic Symptom Disorder 21. Factitious Disorder 22. Conversion Disorder 23. La Bell Indifference 24. Malingering 25. Anorexia and bulimia 26. Anorexia Nervosa 27. Bulimia Nervosa 28. Binge Eating Disorder
dissociative identity disorder (DID)
62
First-line treatment of which condition is psychotherapy? "dis-" 1. Serotonin Syndrome 2. Discontinuation Syndrome 3. Akathisia 4. Benzodiazepine withdrawal 5. Rebound insomnia 6. Anxiety 7. dissociative identity disorder (DID) 8. Depersonalization 9. Derealization 10. Initial/sleep-onset Insomnia 11. Middle/sleep maintenance insomnia 12. Late/sleep offset insomnia 13. Nonrestorative sleep 14. daytime sleepiness associated with obstructive sleep apnea (OSA) 15. Narcolepsy 16. Cataplexy 17. Restless Legs Syndrome (RLS) 18. Periodic Limb Movements of sleep (PLMS) 19. Periodic Limb Movement Disorder (PLMD) 20. Somatic Symptom Disorder 21. Factitious Disorder 22. Conversion Disorder 23. La Bell Indifference 24. Malingering 25. Anorexia and bulimia 26. Anorexia Nervosa 27. Bulimia Nervosa 28. Binge Eating Disorder
dissociative identity disorder (DID)
63
First-line treatment of dissociative identity disorder (DID) is? 1. can use benzodiazepine short-term in addition to long-term SSRI 2. CBT 3. Meds + CBT 4. SSRI (often need high doses of sertraline, fluoxetine); Luvox 5. SNRI (e.g. venlafaxine) (Clomipramine=Anafranil) 6. Psychotherapy 7. ECT 8. weight loss; avoidance of ETOH; CPAP; Uvulopalatopharyngoplasty 9. Remove offending agent; iron replacement 10. Psychotherapy (CBT, IPT)
Psychotherapy
64
Which drug class is used to target comorbid depressive and/or PTSD symptoms? "S-" 1. SSRIs 2. TCAs 3. β-adrenergic receptor antagonists (beta-blockers) 4. SSRIs, SNRIs 5. SSRIs and TCAs 6. Benzodiazepines 7. Alpha-1 receptor antagonist 8. Non-benzo hypnotics 9. Low Potency Opioids
SSRIs
65
This specific medication is indicated for nightmares pertaining to dissociative identity disorder (DID). "praz-" 1. bupropion (Wellbutrin) 2. venlafaxine (Effexor) 3. trazodone (Desyrel) 4. clomipramine (Anafranil) 5. propranolol (Inderal) 6. alprazolam (Xanax) 7. flumazenil (Romazicon) 8. buspirone (Buspar) 9. prazosin (Minipress) 10. naltrexone (Depade) 11. flurazepam (Dalmane) 12. zolpidem (Ambien) 13. trazodone (Desyrel) 14. ramelteon (Rozerem) 15. triazolam (Halcon) 16. armodafinil (Nuvigil) 17. eszopiclone (Lunesta) 18. sodium oxybate (Xyrem) 19. fluoxetine (Prozac) 20. escitalopram (Lexapro)
prazosin (Minipress)
66
This specific medication is indicated to reduce self-injurious behaviors pertaining to dissociative identity disorder (DID). "na-" 1. bupropion (Wellbutrin) 2. venlafaxine (Effexor) 3. trazodone (Desyrel) 4. clomipramine (Anafranil) 5. propranolol (Inderal) 6. alprazolam (Xanax) 7. flumazenil (Romazicon) 8. buspirone (Buspar) 9. prazosin (Minipress) 10. naltrexone (Depade) 11. flurazepam (Dalmane) 12. zolpidem (Ambien) 13. trazodone (Desyrel) 14. ramelteon (Rozerem) 15. triazolam (Halcon) 16. armodafinil (Nuvigil) 17. eszopiclone (Lunesta) 18. sodium oxybate (Xyrem) 19. fluoxetine (Prozac) 20. escitalopram (Lexapro)
naltrexone (Depade)
67
________ is NOT contraindicated in people with Dissociative Identify Disorder (DID). "E-" 1. can use benzodiazepine short-term in addition to long-term SSRI 2. CBT 3. Meds + CBT 4. SSRI (often need high doses of sertraline, fluoxetine); Luvox 5. SNRI (e.g. venlafaxine) (Clomipramine=Anafranil) 6. Psychotherapy 7. ECT 8. weight loss; avoidance of ETOH; CPAP; Uvulopalatopharyngoplasty 9. Remove offending agent; iron replacement 10. Psychotherapy (CBT, IPT)
ECT
68
Regarding non-pharmacological treatment of dissociative identity disorder (DID). 1. Increased fall risk, hip fracture risk 2. consider nonaddictive anxiolytic alternatives (e.g. gabapentin and antihistamines with anxiolytic properties (e.g. diphenhydramine or hydroxyzine) 3. Benzodiazepines may interfere with the psychological processes needed to benefit from CBT 4. high rate of comorbid substance use disorders and lack of efficacy. 5. note that these patients have depressive symptoms and hence ECT can be considered as a viable option especially in combination with psychotherapy.
note that these patients have depressive symptoms and hence ECT can be considered as a viable option especially in combination with psychotherapy.
69
Unreality or detachment from one’s body, thoughts, feeling and actions. Which condition is this? 1. Serotonin Syndrome 2. Discontinuation Syndrome 3. Akathisia 4. Benzodiazepine withdrawal 5. Rebound insomnia 6. Anxiety 7. dissociative identity disorder (DID) 8. Depersonalization 9. Derealization 10. Initial/sleep-onset Insomnia 11. Middle/sleep maintenance insomnia 12. Late/sleep offset insomnia 13. Nonrestorative sleep 14. daytime sleepiness associated with obstructive sleep apnea (OSA) 15. Narcolepsy 16. Cataplexy 17. Restless Legs Syndrome (RLS) 18. Periodic Limb Movements of sleep (PLMS) 19. Periodic Limb Movement Disorder (PLMD) 20. Somatic Symptom Disorder 21. Factitious Disorder 22. Conversion Disorder 23. La Bell Indifference 24. Malingering 25. Anorexia and bulimia 26. Anorexia Nervosa 27. Bulimia Nervosa 28. Binge Eating Disorder
Depersonalization
70
Unreality or detachment from one’s surroundings. Which condition is this? 1. Serotonin Syndrome 2. Discontinuation Syndrome 3. Akathisia 4. Benzodiazepine withdrawal 5. Rebound insomnia 6. Anxiety 7. dissociative identity disorder (DID) 8. Depersonalization 9. Derealization 10. Initial/sleep-onset Insomnia 11. Middle/sleep maintenance insomnia 12. Late/sleep offset insomnia 13. Nonrestorative sleep 14. daytime sleepiness associated with obstructive sleep apnea (OSA) 15. Narcolepsy 16. Cataplexy 17. Restless Legs Syndrome (RLS) 18. Periodic Limb Movements of sleep (PLMS) 19. Periodic Limb Movement Disorder (PLMD) 20. Somatic Symptom Disorder 21. Factitious Disorder 22. Conversion Disorder 23. La Bell Indifference 24. Malingering 25. Anorexia and bulimia 26. Anorexia Nervosa 27. Bulimia Nervosa 28. Binge Eating Disorder
Derealization
71
Regarding Depersonalization/Derealization Disorder: 1. Enhance activity of GABA at GABA-A receptor 2. Optimize 3. Increased incidence of comorbid anxiety disorders and major depression 4. severe stress and trauma 5. Tyramine rich foods: red wine, aged cheese, chicken liver, fava beans, cured meats 6. long half-life, increased risk for confusion and falls 7. 10 mg 8. 5 mg 9. binds to melatonin receptors in brain inhibiting neuronal firing 10. cardiac arrhythmias due to electrolyte disturbances (e.g. ↓K+)
Increased incidence of comorbid anxiety disorders and major depression
72
Predisposing factors pertaining to Depersonalization/Derealization Disorder? "sev-" 1. Enhance activity of GABA at GABA-A receptor 2. Optimize 3. Increased incidence of comorbid anxiety disorders and major depression 4. severe stress and trauma 5. Tyramine rich foods: red wine, aged cheese, chicken liver, fava beans, cured meats 6. long half-life, increased risk for confusion and falls 7. 10 mg 8. 5 mg 9. binds to melatonin receptors in brain inhibiting neuronal firing 10. cardiac arrhythmias due to electrolyte disturbances (e.g. ↓K+)
severe stress and trauma
73
What foods should be avoided with MAOIs? 1. Enhance activity of GABA at GABA-A receptor 2. Optimize 3. Increased incidence of comorbid anxiety disorders and major depression 4. severe stress and trauma 5. Tyramine rich foods: red wine, aged cheese, chicken liver, fava beans, cured meats 6. long half-life, increased risk for confusion and falls 7. 10 mg 8. 5 mg 9. binds to melatonin receptors in brain inhibiting neuronal firing 10. cardiac arrhythmias due to electrolyte disturbances (e.g. ↓K+)
Tyramine rich foods: red wine, aged cheese, chicken liver, fava beans, cured meats
74
Difficulty initiating sleep. What condition is this? 1. Serotonin Syndrome 2. Discontinuation Syndrome 3. Akathisia 4. Benzodiazepine withdrawal 5. Rebound insomnia 6. Anxiety 7. dissociative identity disorder (DID) 8. Depersonalization 9. Derealization 10. Initial/sleep-onset Insomnia 11. Middle/sleep maintenance insomnia 12. Late/sleep offset insomnia 13. Nonrestorative sleep 14. daytime sleepiness associated with obstructive sleep apnea (OSA) 15. Narcolepsy 16. Cataplexy 17. Restless Legs Syndrome (RLS) 18. Periodic Limb Movements of sleep (PLMS) 19. Periodic Limb Movement Disorder (PLMD) 20. Somatic Symptom Disorder 21. Factitious Disorder 22. Conversion Disorder 23. La Bell Indifference 24. Malingering 25. Anorexia and bulimia 26. Anorexia Nervosa 27. Bulimia Nervosa 28. Binge Eating Disorder
Initial/sleep-onset Insomnia
75
Frequent nocturnal awakenings What condition is this? 1. Serotonin Syndrome 2. Discontinuation Syndrome 3. Akathisia 4. Benzodiazepine withdrawal 5. Rebound insomnia 6. Anxiety 7. dissociative identity disorder (DID) 8. Depersonalization 9. Derealization 10. Initial/sleep-onset Insomnia 11. Middle/sleep maintenance insomnia 12. Late/sleep offset insomnia 13. Nonrestorative sleep 14. daytime sleepiness associated with obstructive sleep apnea (OSA) 15. Narcolepsy 16. Cataplexy 17. Restless Legs Syndrome (RLS) 18. Periodic Limb Movements of sleep (PLMS) 19. Periodic Limb Movement Disorder (PLMD) 20. Somatic Symptom Disorder 21. Factitious Disorder 22. Conversion Disorder 23. La Bell Indifference 24. Malingering 25. Anorexia and bulimia 26. Anorexia Nervosa 27. Bulimia Nervosa 28. Binge Eating Disorder
Middle/sleep maintenance insomnia
76
Early morning awakenings. What condition is this? 1. Serotonin Syndrome 2. Discontinuation Syndrome 3. Akathisia 4. Benzodiazepine withdrawal 5. Rebound insomnia 6. Anxiety 7. dissociative identity disorder (DID) 8. Depersonalization 9. Derealization 10. Initial/sleep-onset Insomnia 11. Middle/sleep maintenance insomnia 12. Late/sleep offset insomnia 13. Nonrestorative sleep 14. daytime sleepiness associated with obstructive sleep apnea (OSA) 15. Narcolepsy 16. Cataplexy 17. Restless Legs Syndrome (RLS) 18. Periodic Limb Movements of sleep (PLMS) 19. Periodic Limb Movement Disorder (PLMD) 20. Somatic Symptom Disorder 21. Factitious Disorder 22. Conversion Disorder 23. La Bell Indifference 24. Malingering 25. Anorexia and bulimia 26. Anorexia Nervosa 27. Bulimia Nervosa 28. Binge Eating Disorder
Late/sleep offset insomnia
77
Waking up feeling fatiguesd and unrefreshed What condition is this? 1. Serotonin Syndrome 2. Discontinuation Syndrome 3. Akathisia 4. Benzodiazepine withdrawal 5. Rebound insomnia 6. Anxiety 7. dissociative identity disorder (DID) 8. Depersonalization 9. Derealization 10. Initial/sleep-onset Insomnia 11. Middle/sleep maintenance insomnia 12. Late/sleep offset insomnia 13. Nonrestorative sleep 14. daytime sleepiness associated with obstructive sleep apnea (OSA) 15. Narcolepsy 16. Cataplexy 17. Restless Legs Syndrome (RLS) 18. Periodic Limb Movements of sleep (PLMS) 19. Periodic Limb Movement Disorder (PLMD) 20. Somatic Symptom Disorder 21. Factitious Disorder 22. Conversion Disorder 23. La Bell Indifference 24. Malingering 25. Anorexia and bulimia 26. Anorexia Nervosa 27. Bulimia Nervosa 28. Binge Eating Disorder
Nonrestorative sleep
78
Why should flurazepam (Dalmane) be avoided in the elderly? 1. Enhance activity of GABA at GABA-A receptor 2. Optimize 3. Increased incidence of comorbid anxiety disorders and major depression 4. severe stress and trauma 5. Tyramine rich foods: red wine, aged cheese, chicken liver, fava beans, cured meats 6. long half-life, increased risk for confusion and falls 7. 10 mg 8. 5 mg 9. binds to melatonin receptors in brain inhibiting neuronal firing 10. cardiac arrhythmias due to electrolyte disturbances (e.g. ↓K+)
long half-life, increased risk for confusion and falls
79
This medication should be avoided in the elderly due to long half-life, increased risk for confusion, and falls. 1. bupropion (Wellbutrin) 2. venlafaxine (Effexor) 3. trazodone (Desyrel) 4. clomipramine (Anafranil) 5. propranolol (Inderal) 6. alprazolam (Xanax) 7. flumazenil (Romazicon) 8. buspirone (Buspar) 9. prazosin (Minipress) 10. naltrexone (Depade) 11. flurazepam (Dalmane) 12. zolpidem (Ambien) 13. trazodone (Desyrel) 14. ramelteon (Rozerem) 15. triazolam (Halcon) 16. armodafinil (Nuvigil) 17. eszopiclone (Lunesta) 18. sodium oxybate (Xyrem) 19. fluoxetine (Prozac) 20. escitalopram (Lexapro)
flurazepam (Dalmane)
80
Which two medications are used to treat insomnia? "Tr-" and "mi-" 1. escitalopram, paroxetine, duloxetine, and venlafaxine 2. oxazepam, temazepam, lorazepam 3. midazolam (Versed) and alprazolam (Xanax) 4. lorazepam, oxazepam, temazepam 5. diazepam, clonazepam, chlordiazepoxide, flurazepam 6. sertraline (Zoloft), paroxetine (Paxil), and venlafaxine (Effexor) 7. trazodone (Desyrel) [Mostly prescribed sedating antidepressant], and low doses of mirtazapine (Remeron) 8. amitriptyline (Elavil), doxepin (Sinequan), mirtazapine (Remeron), trazodone (Desyel) 9. fluoxetine (Prozac), duloxetine (Cymbalta), atomoxetine (Strattera), venlafaxine (Effexor) 10. Dopamine agonists: pramipexole (Mirapex), ropinirole (Requip) and Benzos 11. Gabapentin (Neurontin); pregabalin (Lyrica) 12. Alprazolam and Lorazepam
trazodone (Desyrel) [Mostly prescribed sedating antidepressant], and low doses of mirtazapine (Remeron)
81
This medication can be used safely in elderly patients. "zol-" 1. bupropion (Wellbutrin) 2. venlafaxine (Effexor) 3. trazodone (Desyrel) 4. clomipramine (Anafranil) 5. propranolol (Inderal) 6. alprazolam (Xanax) 7. flumazenil (Romazicon) 8. buspirone (Buspar) 9. prazosin (Minipress) 10. naltrexone (Depade) 11. flurazepam (Dalmane) 12. zolpidem (Ambien) 13. trazodone (Desyrel) 14. ramelteon (Rozerem) 15. triazolam (Halcon) 16. armodafinil (Nuvigil) 17. eszopiclone (Lunesta) 18. sodium oxybate (Xyrem) 19. fluoxetine (Prozac) 20. escitalopram (Lexapro)
zolpidem (Ambien)
82
This medication, not zolpidem (Ambien), is an even safer option for the elderly for insomnia. 1. bupropion (Wellbutrin) 2. venlafaxine (Effexor) 3. trazodone (Desyrel) 4. clomipramine (Anafranil) 5. propranolol (Inderal) 6. alprazolam (Xanax) 7. flumazenil (Romazicon) 8. buspirone (Buspar) 9. prazosin (Minipress) 10. naltrexone (Depade) 11. flurazepam (Dalmane) 12. zolpidem (Ambien) 13. trazodone (Desyrel) 14. ramelteon (Rozerem) 15. triazolam (Halcon) 16. armodafinil (Nuvigil) 17. eszopiclone (Lunesta) 18. sodium oxybate (Xyrem) 19. fluoxetine (Prozac) 20. escitalopram (Lexapro)
trazodone (Desyrel)
83
This sleep-related medication should be taken on an empty stomach. "Z-" 1. bupropion (Wellbutrin) 2. venlafaxine (Effexor) 3. trazodone (Desyrel) 4. clomipramine (Anafranil) 5. propranolol (Inderal) 6. alprazolam (Xanax) 7. flumazenil (Romazicon) 8. buspirone (Buspar) 9. prazosin (Minipress) 10. naltrexone (Depade) 11. flurazepam (Dalmane) 12. zolpidem (Ambien) 13. trazodone (Desyrel) 14. ramelteon (Rozerem) 15. triazolam (Halcon) 16. armodafinil (Nuvigil) 17. eszopiclone (Lunesta) 18. sodium oxybate (Xyrem) 19. fluoxetine (Prozac) 20. escitalopram (Lexapro)
zolpidem (Ambien)
84
Recommended zolpidem (Ambien) dose for men? 1. Enhance activity of GABA at GABA-A receptor 2. Optimize 3. Increased incidence of comorbid anxiety disorders and major depression 4. severe stress and trauma 5. Tyramine rich foods: red wine, aged cheese, chicken liver, fava beans, cured meats 6. long half-life, increased risk for confusion and falls 7. 10 mg 8. 5 mg 9. binds to melatonin receptors in brain inhibiting neuronal firing 10. cardiac arrhythmias due to electrolyte disturbances (e.g. ↓K+)
10 mg
85
Recommended zolpidem (Ambien) dose for women? 1. Enhance activity of GABA at GABA-A receptor 2. Optimize 3. Increased incidence of comorbid anxiety disorders and major depression 4. severe stress and trauma 5. Tyramine rich foods: red wine, aged cheese, chicken liver, fava beans, cured meats 6. long half-life, increased risk for confusion and falls 7. 10 mg 8. 5 mg 9. binds to melatonin receptors in brain inhibiting neuronal firing 10. cardiac arrhythmias due to electrolyte disturbances (e.g. ↓K+)
5 mg
86
This medication DOES NOT act on benzodiazepine receptors. "R-" 1. bupropion (Wellbutrin) 2. venlafaxine (Effexor) 3. trazodone (Desyrel) 4. clomipramine (Anafranil) 5. propranolol (Inderal) 6. alprazolam (Xanax) 7. flumazenil (Romazicon) 8. buspirone (Buspar) 9. prazosin (Minipress) 10. naltrexone (Depade) 11. flurazepam (Dalmane) 12. zolpidem (Ambien) 13. trazodone (Desyrel) 14. ramelteon (Rozerem) 15. triazolam (Halcon) 16. armodafinil (Nuvigil) 17. eszopiclone (Lunesta) 18. sodium oxybate (Xyrem) 19. fluoxetine (Prozac) 20. escitalopram (Lexapro)
ramelteon (Rozerem)
87
MOA for ramelteon (Rozerem), of the melatonin agonist drug class? 1. Enhance activity of GABA at GABA-A receptor 2. Optimize 3. Increased incidence of comorbid anxiety disorders and major depression 4. severe stress and trauma 5. Tyramine rich foods: red wine, aged cheese, chicken liver, fava beans, cured meats 6. long half-life, increased risk for confusion and falls 7. 10 mg 8. 5 mg 9. binds to melatonin receptors in brain inhibiting neuronal firing 10. cardiac arrhythmias due to electrolyte disturbances (e.g. ↓K+)
binds to melatonin receptors in brain inhibiting neuronal firing
88
This particular benzodiazepine (BDZ) is a short-acting agent. "tr-" 1. bupropion (Wellbutrin) 2. venlafaxine (Effexor) 3. trazodone (Desyrel) 4. clomipramine (Anafranil) 5. propranolol (Inderal) 6. alprazolam (Xanax) 7. flumazenil (Romazicon) 8. buspirone (Buspar) 9. prazosin (Minipress) 10. naltrexone (Depade) 11. flurazepam (Dalmane) 12. zolpidem (Ambien) 13. trazodone (Desyrel) 14. ramelteon (Rozerem) 15. triazolam (Halcon) 16. armodafinil (Nuvigil) 17. eszopiclone (Lunesta) 18. sodium oxybate (Xyrem) 19. fluoxetine (Prozac) 20. escitalopram (Lexapro)
triazolam (Halcon)
89
These four antidepressants are used for their sedating properties: "admt" 1. escitalopram, paroxetine, duloxetine, and venlafaxine 2. oxazepam, temazepam, lorazepam 3. midazolam (Versed) and alprazolam (Xanax) 4. lorazepam, oxazepam, temazepam 5. diazepam, clonazepam, chlordiazepoxide, flurazepam 6. sertraline (Zoloft), paroxetine (Paxil), and venlafaxine (Effexor) 7. trazodone (Desyrel) [Mostly prescribed sedating antidepressant], and low doses of mirtazapine (Remeron) 8. amitriptyline (Elavil), doxepin (Sinequan), mirtazapine (Remeron), trazodone (Desyel) 9. fluoxetine (Prozac), duloxetine (Cymbalta), atomoxetine (Strattera), venlafaxine (Effexor) 10. Dopamine agonists: pramipexole (Mirapex), ropinirole (Requip) and Benzos 11. Gabapentin (Neurontin); pregabalin (Lyrica) 12. Alprazolam and Lorazepam
amitriptyline (Elavil), doxepin (Sinequan), mirtazapine (Remeron), trazodone (Desyel)
90
This medication is indicated for daytime sleepiness associated with obstructive sleep apnea (OSA). "Ar-" 1. bupropion (Wellbutrin) 2. venlafaxine (Effexor) 3. trazodone (Desyrel) 4. clomipramine (Anafranil) 5. propranolol (Inderal) 6. alprazolam (Xanax) 7. flumazenil (Romazicon) 8. buspirone (Buspar) 9. prazosin (Minipress) 10. naltrexone (Depade) 11. flurazepam (Dalmane) 12. zolpidem (Ambien) 13. trazodone (Desyrel) 14. ramelteon (Rozerem) 15. triazolam (Halcon) 16. armodafinil (Nuvigil) 17. eszopiclone (Lunesta) 18. sodium oxybate (Xyrem) 19. fluoxetine (Prozac) 20. escitalopram (Lexapro)
armodafinil (Nuvigil)
91
This medication, armodafinil (Nuvigil), is indicated for __________________________________. 1. Serotonin Syndrome 2. Discontinuation Syndrome 3. Akathisia 4. Benzodiazepine withdrawal 5. Rebound insomnia 6. Anxiety 7. dissociative identity disorder (DID) 8. Depersonalization 9. Derealization 10. Initial/sleep-onset Insomnia 11. Middle/sleep maintenance insomnia 12. Late/sleep offset insomnia 13. Nonrestorative sleep 14. daytime sleepiness associated with obstructive sleep apnea (OSA) 15. Narcolepsy 16. Cataplexy 17. Restless Legs Syndrome (RLS) 18. Periodic Limb Movements of sleep (PLMS) 19. Periodic Limb Movement Disorder (PLMD) 20. Somatic Symptom Disorder 21. Factitious Disorder 22. Conversion Disorder 23. La Bell Indifference 24. Malingering 25. Anorexia and bulimia 26. Anorexia Nervosa 27. Bulimia Nervosa 28. Binge Eating Disorder
daytime sleepiness associated with obstructive sleep apnea (OSA)
92
This medication helps with staying asleep; maintenance sleep onset. 1. bupropion (Wellbutrin) 2. venlafaxine (Effexor) 3. trazodone (Desyrel) 4. clomipramine (Anafranil) 5. propranolol (Inderal) 6. alprazolam (Xanax) 7. flumazenil (Romazicon) 8. buspirone (Buspar) 9. prazosin (Minipress) 10. naltrexone (Depade) 11. flurazepam (Dalmane) 12. zolpidem (Ambien) 13. trazodone (Desyrel) 14. ramelteon (Rozerem) 15. triazolam (Halcon) 16. armodafinil (Nuvigil) 17. eszopiclone (Lunesta) 18. sodium oxybate (Xyrem) 19. fluoxetine (Prozac) 20. escitalopram (Lexapro)
eszopiclone (Lunesta)
93
_________________ do not generally affect REM sleep. "non-" 1. SSRIs 2. TCAs 3. β-adrenergic receptor antagonists (beta-blockers) 4. SSRIs, SNRIs 5. SSRIs and TCAs 6. Benzodiazepines 7. Alpha-1 receptor antagonist 8. Non-benzo hypnotics 9. Low Potency Opioids
Non-benzo hypnotics
94
Excessive daytime sleepiness and falling asleep in inappropriate places. 1. Serotonin Syndrome 2. Discontinuation Syndrome 3. Akathisia 4. Benzodiazepine withdrawal 5. Rebound insomnia 6. Anxiety 7. dissociative identity disorder (DID) 8. Depersonalization 9. Derealization 10. Initial/sleep-onset Insomnia 11. Middle/sleep maintenance insomnia 12. Late/sleep offset insomnia 13. Nonrestorative sleep 14. daytime sleepiness associated with obstructive sleep apnea (OSA) 15. Narcolepsy 16. Cataplexy 17. Restless Legs Syndrome (RLS) 18. Periodic Limb Movements of sleep (PLMS) 19. Periodic Limb Movement Disorder (PLMD) 20. Somatic Symptom Disorder 21. Factitious Disorder 22. Conversion Disorder 23. La Bell Indifference 24. Malingering 25. Anorexia and bulimia 26. Anorexia Nervosa 27. Bulimia Nervosa 28. Binge Eating Disorder
Narcolepsy
95
Brief episodes of sudden bilateral loss of muscle tone. 1. Serotonin Syndrome 2. Discontinuation Syndrome 3. Akathisia 4. Benzodiazepine withdrawal 5. Rebound insomnia 6. Anxiety 7. dissociative identity disorder (DID) 8. Depersonalization 9. Derealization 10. Initial/sleep-onset Insomnia 11. Middle/sleep maintenance insomnia 12. Late/sleep offset insomnia 13. Nonrestorative sleep 14. daytime sleepiness associated with obstructive sleep apnea (OSA) 15. Narcolepsy 16. Cataplexy 17. Restless Legs Syndrome (RLS) 18. Periodic Limb Movements of sleep (PLMS) 19. Periodic Limb Movement Disorder (PLMD) 20. Somatic Symptom Disorder 21. Factitious Disorder 22. Conversion Disorder 23. La Bell Indifference 24. Malingering 25. Anorexia and bulimia 26. Anorexia Nervosa 27. Bulimia Nervosa 28. Binge Eating Disorder
Cataplexy
96
This specific medication is used to treat narcolepsy with cataplexy. "Sod-" 1. bupropion (Wellbutrin) 2. venlafaxine (Effexor) 3. trazodone (Desyrel) 4. clomipramine (Anafranil) 5. propranolol (Inderal) 6. alprazolam (Xanax) 7. flumazenil (Romazicon) 8. buspirone (Buspar) 9. prazosin (Minipress) 10. naltrexone (Depade) 11. flurazepam (Dalmane) 12. zolpidem (Ambien) 13. trazodone (Desyrel) 14. ramelteon (Rozerem) 15. triazolam (Halcon) 16. armodafinil (Nuvigil) 17. eszopiclone (Lunesta) 18. sodium oxybate (Xyrem) 19. fluoxetine (Prozac) 20. escitalopram (Lexapro)
sodium oxybate (Xyrem)
97
This medication, used for narcolepsy with cataplexy, is not to be used with alcohol or other CNS depressants. This is due to increased sedation, CNS depression, loss of consciousness, coma, and death. 1. bupropion (Wellbutrin) 2. venlafaxine (Effexor) 3. trazodone (Desyrel) 4. clomipramine (Anafranil) 5. propranolol (Inderal) 6. alprazolam (Xanax) 7. flumazenil (Romazicon) 8. buspirone (Buspar) 9. prazosin (Minipress) 10. naltrexone (Depade) 11. flurazepam (Dalmane) 12. zolpidem (Ambien) 13. trazodone (Desyrel) 14. ramelteon (Rozerem) 15. triazolam (Halcon) 16. armodafinil (Nuvigil) 17. eszopiclone (Lunesta) 18. sodium oxybate (Xyrem) 19. fluoxetine (Prozac) 20. escitalopram (Lexapro)
sodium oxybate (Xyrem)
98
OTC sedative/hypnotics = tolerance to sedating effects can develop rapidly. True or False?
True
99
Non-pharmacologic sleep Apnea Treatments: 1. can use benzodiazepine short-term in addition to long-term SSRI 2. CBT 3. Meds + CBT 4. SSRI (often need high doses of sertraline, fluoxetine); Luvox 5. SNRI (e.g. venlafaxine) (Clomipramine=Anafranil) 6. Psychotherapy 7. ECT 8. weight loss; avoidance of ETOH; CPAP; Uvulopalatopharyngoplasty 9. Remove offending agent; iron replacement 10. Psychotherapy (CBT, IPT)
weight loss; avoidance of ETOH; CPAP; Uvulopalatopharyngoplasty
100
REM suppression drugs: Which four meds? "fdav" 1. escitalopram, paroxetine, duloxetine, and venlafaxine 2. oxazepam, temazepam, lorazepam 3. midazolam (Versed) and alprazolam (Xanax) 4. lorazepam, oxazepam, temazepam 5. diazepam, clonazepam, chlordiazepoxide, flurazepam 6. sertraline (Zoloft), paroxetine (Paxil), and venlafaxine (Effexor) 7. trazodone (Desyrel) [Mostly prescribed sedating antidepressant], and low doses of mirtazapine (Remeron) 8. amitriptyline (Elavil), doxepin (Sinequan), mirtazapine (Remeron), trazodone (Desyel) 9. fluoxetine (Prozac), duloxetine (Cymbalta), atomoxetine (Strattera), venlafaxine (Effexor) 10. Dopamine agonists: pramipexole (Mirapex), ropinirole (Requip) and Benzos 11. Gabapentin (Neurontin); pregabalin (Lyrica) 12. Alprazolam and Lorazepam
fluoxetine (Prozac), duloxetine (Cymbalta), atomoxetine (Strattera), venlafaxine (Effexor)
101
The urge to move legs accompanied by unpleasant sensation in the legs, characterized by relief with movement, aggravation with inactivity. Which condition is this? 1. Serotonin Syndrome 2. Discontinuation Syndrome 3. Akathisia 4. Benzodiazepine withdrawal 5. Rebound insomnia 6. Anxiety 7. dissociative identity disorder (DID) 8. Depersonalization 9. Derealization 10. Initial/sleep-onset Insomnia 11. Middle/sleep maintenance insomnia 12. Late/sleep offset insomnia 13. Nonrestorative sleep 14. daytime sleepiness associated with obstructive sleep apnea (OSA) 15. Narcolepsy 16. Cataplexy 17. Restless Legs Syndrome (RLS) 18. Periodic Limb Movements of sleep (PLMS) 19. Periodic Limb Movement Disorder (PLMD) 20. Somatic Symptom Disorder 21. Factitious Disorder 22. Conversion Disorder 23. La Bell Indifference 24. Malingering 25. Anorexia and bulimia 26. Anorexia Nervosa 27. Bulimia Nervosa 28. Binge Eating Disorder
Restless Legs Syndrome (RLS)
102
Occurs or worsens in the evening. Which condition is this? "res-" 1. Serotonin Syndrome 2. Discontinuation Syndrome 3. Akathisia 4. Benzodiazepine withdrawal 5. Rebound insomnia 6. Anxiety 7. dissociative identity disorder (DID) 8. Depersonalization 9. Derealization 10. Initial/sleep-onset Insomnia 11. Middle/sleep maintenance insomnia 12. Late/sleep offset insomnia 13. Nonrestorative sleep 14. daytime sleepiness associated with obstructive sleep apnea (OSA) 15. Narcolepsy 16. Cataplexy 17. Restless Legs Syndrome (RLS) 18. Periodic Limb Movements of sleep (PLMS) 19. Periodic Limb Movement Disorder (PLMD) 20. Somatic Symptom Disorder 21. Factitious Disorder 22. Conversion Disorder 23. La Bell Indifference 24. Malingering 25. Anorexia and bulimia 26. Anorexia Nervosa 27. Bulimia Nervosa 28. Binge Eating Disorder
Restless Legs Syndrome (RLS)
103
1.5 -2 times more likely in males Which condition is this? "res-" 1. Serotonin Syndrome 2. Discontinuation Syndrome 3. Akathisia 4. Benzodiazepine withdrawal 5. Rebound insomnia 6. Anxiety 7. dissociative identity disorder (DID) 8. Depersonalization 9. Derealization 10. Initial/sleep-onset Insomnia 11. Middle/sleep maintenance insomnia 12. Late/sleep offset insomnia 13. Nonrestorative sleep 14. daytime sleepiness associated with obstructive sleep apnea (OSA) 15. Narcolepsy 16. Cataplexy 17. Restless Legs Syndrome (RLS) 18. Periodic Limb Movements of sleep (PLMS) 19. Periodic Limb Movement Disorder (PLMD) 20. Somatic Symptom Disorder 21. Factitious Disorder 22. Conversion Disorder 23. La Bell Indifference 24. Malingering 25. Anorexia and bulimia 26. Anorexia Nervosa 27. Bulimia Nervosa 28. Binge Eating Disorder
Restless Legs Syndrome (RLS)
104
Risk factors: age, iron deficiency, antidepressants, antipsychotics, dopamine blocking antiemetic, antihistamines; strong familial component Which condition do these risk factors pertain to? 1. Serotonin Syndrome 2. Discontinuation Syndrome 3. Akathisia 4. Benzodiazepine withdrawal 5. Rebound insomnia 6. Anxiety 7. dissociative identity disorder (DID) 8. Depersonalization 9. Derealization 10. Initial/sleep-onset Insomnia 11. Middle/sleep maintenance insomnia 12. Late/sleep offset insomnia 13. Nonrestorative sleep 14. daytime sleepiness associated with obstructive sleep apnea (OSA) 15. Narcolepsy 16. Cataplexy 17. Restless Legs Syndrome (RLS) 18. Periodic Limb Movements of sleep (PLMS) 19. Periodic Limb Movement Disorder (PLMD) 20. Somatic Symptom Disorder 21. Factitious Disorder 22. Conversion Disorder 23. La Bell Indifference 24. Malingering 25. Anorexia and bulimia 26. Anorexia Nervosa 27. Bulimia Nervosa 28. Binge Eating Disorder
Restless Legs Syndrome (RLS)
105
Treatment for Restless Legs Syndrome (RLS)? 1. can use benzodiazepine short-term in addition to long-term SSRI 2. CBT 3. Meds + CBT 4. SSRI (often need high doses of sertraline, fluoxetine); Luvox 5. SNRI (e.g. venlafaxine) (Clomipramine=Anafranil) 6. Psychotherapy 7. ECT 8. weight loss; avoidance of ETOH; CPAP; Uvulopalatopharyngoplasty 9. Remove offending agent; iron replacement 10. Psychotherapy (CBT, IPT)
Remove offending agent; iron replacement
106
First-line medication treatments for Restless Legs Syndrome (RLS)? "Pr-," "Ro-" 1. escitalopram, paroxetine, duloxetine, and venlafaxine 2. oxazepam, temazepam, lorazepam 3. midazolam (Versed) and alprazolam (Xanax) 4. lorazepam, oxazepam, temazepam 5. diazepam, clonazepam, chlordiazepoxide, flurazepam 6. sertraline (Zoloft), paroxetine (Paxil), and venlafaxine (Effexor) 7. trazodone (Desyrel) [Mostly prescribed sedating antidepressant], and low doses of mirtazapine (Remeron) 8. amitriptyline (Elavil), doxepin (Sinequan), mirtazapine (Remeron), trazodone (Desyel) 9. fluoxetine (Prozac), duloxetine (Cymbalta), atomoxetine (Strattera), venlafaxine (Effexor) 10. Dopamine agonists: pramipexole (Mirapex), ropinirole (Requip) and Benzos 11. Gabapentin (Neurontin); pregabalin (Lyrica) 12. Alprazolam and Lorazepam
Dopamine agonists: pramipexole (Mirapex), ropinirole (Requip) and Benzos
107
Two other medications useful in treating Restless Legs Syndrome (RLS)? "gab-"and "pre-" 1. escitalopram, paroxetine, duloxetine, and venlafaxine 2. oxazepam, temazepam, lorazepam 3. midazolam (Versed) and alprazolam (Xanax) 4. lorazepam, oxazepam, temazepam 5. diazepam, clonazepam, chlordiazepoxide, flurazepam 6. sertraline (Zoloft), paroxetine (Paxil), and venlafaxine (Effexor) 7. trazodone (Desyrel) [Mostly prescribed sedating antidepressant], and low doses of mirtazapine (Remeron) 8. amitriptyline (Elavil), doxepin (Sinequan), mirtazapine (Remeron), trazodone (Desyel) 9. fluoxetine (Prozac), duloxetine (Cymbalta), atomoxetine (Strattera), venlafaxine (Effexor) 10. Dopamine agonists: pramipexole (Mirapex), ropinirole (Requip) and Benzos 11. Gabapentin (Neurontin); pregabalin (Lyrica) 12. Alprazolam and Lorazepam
Gabapentin (Neurontin); pregabalin (Lyrica)
108
Which specific drug class should be used in patients with refractory Restless Legs Syndrome (RLS)? "op-" 1. SSRIs 2. TCAs 3. β-adrenergic receptor antagonists (beta-blockers) 4. SSRIs, SNRIs 5. SSRIs and TCAs 6. Benzodiazepines 7. Alpha-1 receptor antagonist 8. Non-benzo hypnotics 9. Low Potency Opioids
Low Potency Opioids
109
RLS associated with involuntary, jerking movements of limbs during sleep. Which condition is this? 1. Serotonin Syndrome 2. Discontinuation Syndrome 3. Akathisia 4. Benzodiazepine withdrawal 5. Rebound insomnia 6. Anxiety 7. dissociative identity disorder (DID) 8. Depersonalization 9. Derealization 10. Initial/sleep-onset Insomnia 11. Middle/sleep maintenance insomnia 12. Late/sleep offset insomnia 13. Nonrestorative sleep 14. daytime sleepiness associated with obstructive sleep apnea (OSA) 15. Narcolepsy 16. Cataplexy 17. Restless Legs Syndrome (RLS) 18. Periodic Limb Movements of sleep (PLMS) 19. Periodic Limb Movement Disorder (PLMD) 20. Somatic Symptom Disorder 21. Factitious Disorder 22. Conversion Disorder 23. La Bell Indifference 24. Malingering 25. Anorexia and bulimia 26. Anorexia Nervosa 27. Bulimia Nervosa 28. Binge Eating Disorder
Periodic Limb Movements of sleep (PLMS)
110
Impaired sleep and daytime functioning + PLMS in the absence of RLS. Which condition is this? 1. Serotonin Syndrome 2. Discontinuation Syndrome 3. Akathisia 4. Benzodiazepine withdrawal 5. Rebound insomnia 6. Anxiety 7. dissociative identity disorder (DID) 8. Depersonalization 9. Derealization 10. Initial/sleep-onset Insomnia 11. Middle/sleep maintenance insomnia 12. Late/sleep offset insomnia 13. Nonrestorative sleep 14. daytime sleepiness associated with obstructive sleep apnea (OSA) 15. Narcolepsy 16. Cataplexy 17. Restless Legs Syndrome (RLS) 18. Periodic Limb Movements of sleep (PLMS) 19. Periodic Limb Movement Disorder (PLMD) 20. Somatic Symptom Disorder 21. Factitious Disorder 22. Conversion Disorder 23. La Bell Indifference 24. Malingering 25. Anorexia and bulimia 26. Anorexia Nervosa 27. Bulimia Nervosa 28. Binge Eating Disorder
Periodic Limb Movement Disorder (PLMD)
111
Patient believes they are ill and do not intentionally produce symptoms. Which condition is this? 1. Serotonin Syndrome 2. Discontinuation Syndrome 3. Akathisia 4. Benzodiazepine withdrawal 5. Rebound insomnia 6. Anxiety 7. dissociative identity disorder (DID) 8. Depersonalization 9. Derealization 10. Initial/sleep-onset Insomnia 11. Middle/sleep maintenance insomnia 12. Late/sleep offset insomnia 13. Nonrestorative sleep 14. daytime sleepiness associated with obstructive sleep apnea (OSA) 15. Narcolepsy 16. Cataplexy 17. Restless Legs Syndrome (RLS) 18. Periodic Limb Movements of sleep (PLMS) 19. Periodic Limb Movement Disorder (PLMD) 20. Somatic Symptom Disorder 21. Factitious Disorder 22. Conversion Disorder 23. La Bell Indifference 24. Malingering 25. Anorexia and bulimia 26. Anorexia Nervosa 27. Bulimia Nervosa 28. Binge Eating Disorder
Somatic Symptom Disorder
112
Present with at least 1 neurological symptom – sensory/motor which cannot be fully explained by a neurological condition Which condition is this? "Con-" 1. Serotonin Syndrome 2. Discontinuation Syndrome 3. Akathisia 4. Benzodiazepine withdrawal 5. Rebound insomnia 6. Anxiety 7. dissociative identity disorder (DID) 8. Depersonalization 9. Derealization 10. Initial/sleep-onset Insomnia 11. Middle/sleep maintenance insomnia 12. Late/sleep offset insomnia 13. Nonrestorative sleep 14. daytime sleepiness associated with obstructive sleep apnea (OSA) 15. Narcolepsy 16. Cataplexy 17. Restless Legs Syndrome (RLS) 18. Periodic Limb Movements of sleep (PLMS) 19. Periodic Limb Movement Disorder (PLMD) 20. Somatic Symptom Disorder 21. Factitious Disorder 22. Conversion Disorder 23. La Bell Indifference 24. Malingering 25. Anorexia and bulimia 26. Anorexia Nervosa 27. Bulimia Nervosa 28. Binge Eating Disorder
Conversion Disorder
113
* Falsifying physical (e.g. seizures/ infection, abdominal pain) and/or psychological (hallucinations, depression, fever, infection) signs and symptoms to assume a sick role * Absence of obvious external reward * Repeated & long hospitalizations are common Which condition is this? 1. Serotonin Syndrome 2. Discontinuation Syndrome 3. Akathisia 4. Benzodiazepine withdrawal 5. Rebound insomnia 6. Anxiety 7. dissociative identity disorder (DID) 8. Depersonalization 9. Derealization 10. Initial/sleep-onset Insomnia 11. Middle/sleep maintenance insomnia 12. Late/sleep offset insomnia 13. Nonrestorative sleep 14. daytime sleepiness associated with obstructive sleep apnea (OSA) 15. Narcolepsy 16. Cataplexy 17. Restless Legs Syndrome (RLS) 18. Periodic Limb Movements of sleep (PLMS) 19. Periodic Limb Movement Disorder (PLMD) 20. Somatic Symptom Disorder 21. Factitious Disorder 22. Conversion Disorder 23. La Bell Indifference 24. Malingering 25. Anorexia and bulimia 26. Anorexia Nervosa 27. Bulimia Nervosa 28. Binge Eating Disorder
Factitious Disorder
114
Patients surprisingly calm and unconcerned when describing symptoms Connected to Conversion Disorder. Which condition is this? 1. Serotonin Syndrome 2. Discontinuation Syndrome 3. Akathisia 4. Benzodiazepine withdrawal 5. Rebound insomnia 6. Anxiety 7. dissociative identity disorder (DID) 8. Depersonalization 9. Derealization 10. Initial/sleep-onset Insomnia 11. Middle/sleep maintenance insomnia 12. Late/sleep offset insomnia 13. Nonrestorative sleep 14. daytime sleepiness associated with obstructive sleep apnea (OSA) 15. Narcolepsy 16. Cataplexy 17. Restless Legs Syndrome (RLS) 18. Periodic Limb Movements of sleep (PLMS) 19. Periodic Limb Movement Disorder (PLMD) 20. Somatic Symptom Disorder 21. Factitious Disorder 22. Conversion Disorder 23. La Bell Indifference 24. Malingering 25. Anorexia and bulimia 26. Anorexia Nervosa 27. Bulimia Nervosa 28. Binge Eating Disorder
La Bell Indifference
115
* External rewards present * Intentional reporting of physical or psychological symptoms * Goal: To achieve personal gain/secondary gain/ external reward (i.e. avoiding police/incarceration, room & board, narcotics, monetary compensation) * Not considered a mental illness Which condition is this? 1. Serotonin Syndrome 2. Discontinuation Syndrome 3. Akathisia 4. Benzodiazepine withdrawal 5. Rebound insomnia 6. Anxiety 7. dissociative identity disorder (DID) 8. Depersonalization 9. Derealization 10. Initial/sleep-onset Insomnia 11. Middle/sleep maintenance insomnia 12. Late/sleep offset insomnia 13. Nonrestorative sleep 14. daytime sleepiness associated with obstructive sleep apnea (OSA) 15. Narcolepsy 16. Cataplexy 17. Restless Legs Syndrome (RLS) 18. Periodic Limb Movements of sleep (PLMS) 19. Periodic Limb Movement Disorder (PLMD) 20. Somatic Symptom Disorder 21. Factitious Disorder 22. Conversion Disorder 23. La Bell Indifference 24. Malingering 25. Anorexia and bulimia 26. Anorexia Nervosa 27. Bulimia Nervosa 28. Binge Eating Disorder
Malingering
116
______ and ______ are risk factors for developing cardiac arrhythmias due to electrolyte disturbances (e.g. ↓K+). 1. Serotonin Syndrome 2. Discontinuation Syndrome 3. Akathisia 4. Benzodiazepine withdrawal 5. Rebound insomnia 6. Anxiety 7. dissociative identity disorder (DID) 8. Depersonalization 9. Derealization 10. Initial/sleep-onset Insomnia 11. Middle/sleep maintenance insomnia 12. Late/sleep offset insomnia 13. Nonrestorative sleep 14. daytime sleepiness associated with obstructive sleep apnea (OSA) 15. Narcolepsy 16. Cataplexy 17. Restless Legs Syndrome (RLS) 18. Periodic Limb Movements of sleep (PLMS) 19. Periodic Limb Movement Disorder (PLMD) 20. Somatic Symptom Disorder 21. Factitious Disorder 22. Conversion Disorder 23. La Bell Indifference 24. Malingering 25. Anorexia and bulimia 26. Anorexia Nervosa 27. Bulimia Nervosa 28. Binge Eating Disorder
Anorexia and bulimia
117
Anorexia and bulimia are risk factors for developing: 1. Enhance activity of GABA at GABA-A receptor 2. Optimize 3. Increased incidence of comorbid anxiety disorders and major depression 4. severe stress and trauma 5. Tyramine rich foods: red wine, aged cheese, chicken liver, fava beans, cured meats 6. long half-life, increased risk for confusion and falls 7. 10 mg 8. 5 mg 9. binds to melatonin receptors in brain inhibiting neuronal firing 10. cardiac arrhythmias due to electrolyte disturbances (e.g. ↓K+)
cardiac arrhythmias due to electrolyte disturbances (e.g. ↓K+)
118
Avoid this medication in all eating disorder patients because it lowers the seizure threshold. 1. bupropion (Wellbutrin) 2. venlafaxine (Effexor) 3. trazodone (Desyrel) 4. clomipramine (Anafranil) 5. propranolol (Inderal) 6. alprazolam (Xanax) 7. flumazenil (Romazicon) 8. buspirone (Buspar) 9. prazosin (Minipress) 10. naltrexone (Depade) 11. flurazepam (Dalmane) 12. zolpidem (Ambien) 13. trazodone (Desyrel) 14. ramelteon (Rozerem) 15. triazolam (Halcon) 16. armodafinil (Nuvigil) 17. eszopiclone (Lunesta) 18. sodium oxybate (Xyrem) 19. fluoxetine (Prozac) 20. escitalopram (Lexapro)
bupropion (Wellbutrin)
119
* Preoccupation with their weight, body image and being thin * Types (Restricting type & Binge-eating/purging type) * Intense fear of gaining weight or becoming fat * Restriction of calorie intake * Low body weight Which condition is this? 1. Serotonin Syndrome 2. Discontinuation Syndrome 3. Akathisia 4. Benzodiazepine withdrawal 5. Rebound insomnia 6. Anxiety 7. dissociative identity disorder (DID) 8. Depersonalization 9. Derealization 10. Initial/sleep-onset Insomnia 11. Middle/sleep maintenance insomnia 12. Late/sleep offset insomnia 13. Nonrestorative sleep 14. daytime sleepiness associated with obstructive sleep apnea (OSA) 15. Narcolepsy 16. Cataplexy 17. Restless Legs Syndrome (RLS) 18. Periodic Limb Movements of sleep (PLMS) 19. Periodic Limb Movement Disorder (PLMD) 20. Somatic Symptom Disorder 21. Factitious Disorder 22. Conversion Disorder 23. La Bell Indifference 24. Malingering 25. Anorexia and bulimia 26. Anorexia Nervosa 27. Bulimia Nervosa 28. Binge Eating Disorder
Anorexia Nervosa
120
* Binge eating with behaviors intended to counteract weight gain (e.g. vomiting, laxative use, enemas/diuretics, fasting, excessive exercise) * Embarrassed by their binge eating and are overly concerned with body weight * Usually maintain normal body weight (may be overweight) * Tx: o Antidepressant + therapy (CBT, IPT, group therapy) o First line= SSRIs o fluoxetine (Prozac) 60-80mg /day is the only FDA approved med Which condition is this? "bul-" 1. Serotonin Syndrome 2. Discontinuation Syndrome 3. Akathisia 4. Benzodiazepine withdrawal 5. Rebound insomnia 6. Anxiety 7. dissociative identity disorder (DID) 8. Depersonalization 9. Derealization 10. Initial/sleep-onset Insomnia 11. Middle/sleep maintenance insomnia 12. Late/sleep offset insomnia 13. Nonrestorative sleep 14. daytime sleepiness associated with obstructive sleep apnea (OSA) 15. Narcolepsy 16. Cataplexy 17. Restless Legs Syndrome (RLS) 18. Periodic Limb Movements of sleep (PLMS) 19. Periodic Limb Movement Disorder (PLMD) 20. Somatic Symptom Disorder 21. Factitious Disorder 22. Conversion Disorder 23. La Bell Indifference 24. Malingering 25. Anorexia and bulimia 26. Anorexia Nervosa 27. Bulimia Nervosa 28. Binge Eating Disorder
Bulimia Nervosa
121
* Not fixated on their body shape and weight * Recurrent episodes of binge eating * No compensatory behaviors (i.e. vomiting and laxative use) * Usually, obese * Tx: o First line= SSRIs – escitalopram (Lexapro) o Psychotherapy (CBT, IPT) Which condition is this? "Bi-" 1. Serotonin Syndrome 2. Discontinuation Syndrome 3. Akathisia 4. Benzodiazepine withdrawal 5. Rebound insomnia 6. Anxiety 7. dissociative identity disorder (DID) 8. Depersonalization 9. Derealization 10. Initial/sleep-onset Insomnia 11. Middle/sleep maintenance insomnia 12. Late/sleep offset insomnia 13. Nonrestorative sleep 14. daytime sleepiness associated with obstructive sleep apnea (OSA) 15. Narcolepsy 16. Cataplexy 17. Restless Legs Syndrome (RLS) 18. Periodic Limb Movements of sleep (PLMS) 19. Periodic Limb Movement Disorder (PLMD) 20. Somatic Symptom Disorder 21. Factitious Disorder 22. Conversion Disorder 23. La Bell Indifference 24. Malingering 25. Anorexia and bulimia 26. Anorexia Nervosa 27. Bulimia Nervosa 28. Binge Eating Disorder
Binge Eating Disorder
122
This medication is the only FDA-approved treatment for Bulimia Nervosa. "Fl-" 1. bupropion (Wellbutrin) 2. venlafaxine (Effexor) 3. trazodone (Desyrel) 4. clomipramine (Anafranil) 5. propranolol (Inderal) 6. alprazolam (Xanax) 7. flumazenil (Romazicon) 8. buspirone (Buspar) 9. prazosin (Minipress) 10. naltrexone (Depade) 11. flurazepam (Dalmane) 12. zolpidem (Ambien) 13. trazodone (Desyrel) 14. ramelteon (Rozerem) 15. triazolam (Halcon) 16. armodafinil (Nuvigil) 17. eszopiclone (Lunesta) 18. sodium oxybate (Xyrem) 19. fluoxetine (Prozac) 20. escitalopram (Lexapro)
fluoxetine (Prozac)
123
First-line drug class treatment for Bulimia Nervosa? 1. SSRIs 2. TCAs 3. β-adrenergic receptor antagonists (beta-blockers) 4. SSRIs, SNRIs 5. SSRIs and TCAs 6. Benzodiazepines 7. Alpha-1 receptor antagonist 8. Non-benzo hypnotics 9. Low Potency Opioids
SSRIs
124
First-line medication, an SSRI, used to treat Binge Eating Disorder? "esc-" 1. bupropion (Wellbutrin) 2. venlafaxine (Effexor) 3. trazodone (Desyrel) 4. clomipramine (Anafranil) 5. propranolol (Inderal) 6. alprazolam (Xanax) 7. flumazenil (Romazicon) 8. buspirone (Buspar) 9. prazosin (Minipress) 10. naltrexone (Depade) 11. flurazepam (Dalmane) 12. zolpidem (Ambien) 13. trazodone (Desyrel) 14. ramelteon (Rozerem) 15. triazolam (Halcon) 16. armodafinil (Nuvigil) 17. eszopiclone (Lunesta) 18. sodium oxybate (Xyrem) 19. fluoxetine (Prozac) 20. escitalopram (Lexapro)
escitalopram (Lexapro)
125
Non-pharm treatment for Binge Eating Disorder? 1. can use benzodiazepine short-term in addition to long-term SSRI 2. CBT 3. Meds + CBT 4. SSRI (often need high doses of sertraline, fluoxetine); Luvox 5. SNRI (e.g. venlafaxine) (Clomipramine=Anafranil) 6. Psychotherapy 7. ECT 8. weight loss; avoidance of ETOH; CPAP; Uvulopalatopharyngoplasty 9. Remove offending agent; iron replacement 10. Psychotherapy (CBT, IPT)
Psychotherapy (CBT, IPT)
126
A defense mechanism that protects a person from overwhelming anxiety by emotionally separating. A disruption in the integrated sense of self.
Dissociation
127
Lapses in autobiographical memory
Amnesia
128
unreality or detachment from one’s body, thoughts, feeling and actions
Depersonalization
129
unreality or detachment from one’s surroundings
Derealization
130
Unable to remember important personal information or history often traumatic in nature Inconsistent with ordinary forgetfulness. "Dis- am-"
Dissociative Amnesia
131
- sudden expected travel away from home accompanied by amnesia for identity or other autobiographical information.
Dissociative fugue
132
ECT is NOT contraindicated in people with ___________________ – note that these patients have depressive symptoms and hence ECT can be considered as a viable option especially in combination with psychotherapy. "Dis-"
Dissociative Identify Disorder (DID)
133
Recurrent pulling out one’s hair despite repeated attempts to stop. Txt: SSRI, Clomipramine; atypical antipsychotics, lithium or N-acetylcysteine (NAC) "Tri-"
Trichotillomania
134
Recurrent skin picking that results in lesions despite attempts to stop. Cognitive-behavioral therapies may be beneficial for patients accepting psychiatric referral Txt: SSRIs, antipsychotics, anxiolytics
Excoriation disorder
135
Persistent difficulty discarding possessions regardless of actual value Results in accumulation of possessions that compromise living space or inability to function Patients who remain resistant to psychosocial interventions, or who lack access to them, can be provided a trial of a serotonin-reuptake inhibitor, particularly if they have a comorbid affective or anxiety disorder; Txt: Difficult; Specialized CBT for hoarding; SSRI may be used.
Hoarding disorder
136
Preoccupation with one or more perceived defects or flaws in physical appearance Spends significant time trying to correct perceived flaw with makeup, dermatological procedures or plastic surgery Txt: SSRI and or CBT – to reduce obsessive and compulsive symptoms "Bod-"
Body dysmorphic disorder
137
Occurs when behavioral or emotional symptoms develop after a non-life threatening, stressful life events (e.g. divorce, death of a loved one, loss of job) Symptoms are not those of normal bereavement Symptoms resolve within 6 months after the stressor has terminated Txt: Supportive psychotherapy, group therapy Pharmacotherapy- to target associated symptoms (e.g. anxiety, depression, insomnia) "Adj-"
Adjustment Disorders
138
Development of multiple symptoms after exposure to one or more traumatic events Re-experiencing of an extremely traumatic event accompanied by symptoms of intrusive symptoms (nightmares, flashbacks), avoidance of stimuli associate with the trauma, alterations in thought and mood and arousal. Treatment: 1st line: SSRIs (Zoloft, Celexa) or SNRIs (Venlafaxine) FDA approved meds: Sertraline (Zoloft) and Paroxetine (Paxil) SSRIs ameliorate core PTSD and other associated symptoms. Alpha-1 receptor antagonist (Prazosin)= targets flashbacks; nightmares and hypervigilance Augment with Atypical antipsychotic in severe or treatment resistant cases. Psychotherapy (CBT- exposure therapy etc.) NOTE: Avoid addictive medications (e.g., Benzodiazepines) = high rate of comorbid substance use disorders and lack of efficacy.
Posttraumatic Stress Disorder (PTSD)
139
- GABA-PAM (Positive Allosteric Modulator) - Does not appear to cause significant tolerance or dependence over time, though it is a controlled substance. Can be used long-term. - Onset within an hour but high fat meals may slow absorption. Which med is this? "eszo-"
eszoplicone (Lunesta)
140
- GABA-PAM, alpha 1 agonist GABA-A - Approved for short-term insomnia - Onset less than 1 hour but short half-life - Dependence with longer term treatment. Not intended for longer-term use. "Zal-"
zaleplon (Sonata)
141
Antihistamine with moderate anticholinergic effects. Most-sedating antihistamine. Avoid with elderly. "diph-"
diphenhydramine (Benadryl)
142
Only tricyclic antidepressant (TCA) thought to be effective in the treatment of obsessive compulsive disorder (OCD) "clom-"
clomipramine
143
Abrupt abstinence after chronic use of this drug class can be life threatening. "ben-"
benzodiazepines
144
Benzodiazepine Overdose: Give this med to reverse effects "flum-"
Flumazenil
145
* Partial agonist at 5HT-1A = ↓serotonergic activity * Low potential for abuse/addiction Which med? "bus-"
buspirone
146
Regarding drugs pertaining to treating DID: * Use this drug class to target comorbid depressive and or PTSD symptoms "SS-"
SSRIs
147
Regarding drugs pertaining to treating DID: * This med for nightmares "mini-"
minipress (Prazosin)
148
Regarding drugs pertaining to treating DID: Use this med to reduce self-injurious behaviors "Nal-"
Naltrexone
149
Take this med on an empty stomach "zolp-"
zolpidem (Ambien)
150
This med DOES NOT Act on benzodiazepine receptors. "rame-"
ramelteon
151
indicated for daytime sleepiness associated with OSA "armo-"
armodafinil (Nuvigil)
152
helps with staying asleep; maintenance sleep onset "eszo-"
eszoplicone (Lunesta)
153
* Patient believes they are ill and do not intentionally produce symptoms "soma-"
somatic symptom disorder
154
* No external rewards present for this disorder "fact-"
factitious disorder
155
Avoid this med in all eating disorder patients = lowers seizure threshold "well-"
Bupropion (Wellbutrin)
156
o this med, 60-80mg /day is the only FDA approved medication for bulimia nervosa "fluo-"
fluoxetine (Prozac)
157
Pamela, a 26-year-old college student presents today with symptoms of anxiety attacks lasting 10-20 min w/ symptoms of diaphoresis, palpitations, tremor, dizziness and inability to concentrate at school. The PMHNP has diagnosed her w/ panic disorder without agoraphobia. What medication will the PMHNP consider for Pamela? A.Clonazepam B.Bupropion C.Lithium D. Fluoxetine
D. Fluoxetine
158
George, a patient with PTSD presents to the outpatient clinic today w/ reports of middle insomnia secondary to increased nightmares. The PMHNP knows that this class of medication is used specifically to treat these symptoms. A. Benzodiazepines B. Beta blockers C. SSRIs D. Alpha blockers
D. Alpha blockers
159
What class of drugs are commonly used in OTC sleep aids? A. Antihistamine B. Beta blockers C. Benzodiazepines D. NMDA antagonists
A. Antihistamine
160
30 yo male with OCD, MDD started on fluoxetine low dose and does not feel meds are working. what do you do?
D. maximize dose
161
Demenia pt. – increase bx at night, wandering, poor sleep, sleeps during day. Prescribe this med: "traz-"
D. trazodone
162
26 yo college student - PD without agoraphobia Give which med? "fluo-"
D. fluoxetine – SSRI/SNRI first line (might have hydroxyzine in between)
163
OCD class of medications for high doses "SS-"
SSRIs
164
33 yo male with GAD, started on Prozac 1 week ago complaining of worsening symptoms. No sign. hx and denies SA
A. continue fluoxetine and start alprazolam because of initial activating impact of fluoxetine and no hx of SA
165
initial tx plan for PD prescribe what? "cita-"
C. citalopram (Celexa) – SSRI first line
166
buproprion contraindicated in pts. with "se-"
seizures
167
binge eating d/o and MDD, what to prescribe for binge eating, requesting medication to lose weight. "esci-"
escitalopram (Lexapro)
168
30 yo female with SAD, failed paroxetine and willing to try another medication, no comorbid, no SA "venl-"
venlafaxine (Effexor)
169
Regarding hypertensive crisis – always have this on them "nife-"
nifedipine (Procardia)
170
This drug class is lethal in overdose (give 1-week prescription especially in high-risk patients) "T-"
TCAs
171
quicker onset, hard to get off, dependence, no daily dose, give only a week’s worth; worry about withdrawal so wean off Note: Treatment for acute panic attacks = can use this drug class short term in addition to. Long-term SSRI "ben-"
benzodiazepines
172
Current data indicate that onset or exacerbation of restless legs syndrome and rise in frequency of periodic limb movements are uncommon following the initiation of an _____________. "anti-"
antidepressant
173
Among the various antidepressants, this med may be associated with higher rates of restless legs syndrome and periodic limb movements. "mirt-"
mirtazapine
174
One small study of normal volunteers suggested that this med may be associated with an increase in restless legs syndrome symptoms and periodic limb movements. "venl-"
venlafaxine
175
These 3 meds appear to increase periodic limb movements that do not disrupt sleep and are thus unlikely to be clinically significant. "sfa"
Sertraline, fluoxetine, and amitriptyline
176
This med may reduce restless legs syndrome symptoms, at least in the short term. "bup-"
bupropion
177
RLS can be difficult to treat and may not respond to the dopamine agonists. As you mentioned, only secondary causes can be "cured". One of the secondary causes that we will see in psych is after a patient has started an antidepressant like ______________. Although we may see this specializing in psych, it is not all that common in general. "venl-"
venlafaxine
178
This med is an excellent choice for narcolepsy although often other stimulants are chosen first. "moda-"
Modafinil
179
While stimulants such as dextroamphetamine are effective in treating ___________, they can produce more side effects such as insomnia, tremulousness, or irritability. "narc-"
narcolepsy
180
While stimulants such as dextroamphetamine are effective, they can produce more side effects such as insomnia, tremulousness, or irritability. This med is a good option to switch to if this happens. "moda-"
Modafinil
181
This med, also known as gamma hydroxybutyrate (GBH), binds to GABAβ and acts as a central nervous system depressant. It has been abused as a club drug and date rape drug. "sod-"
Sodium oxybate
182
This med is quite cumbersome to use requiring mixing and taking twice at night and is reserved for refractory narcolepsy or narcolepsy with cataplexy. Because it is a central nervous system depressant it should not be taken before driving or with alcohol. "sod-"
Sodium oxybate
183
This med has a rapid onset but only lasts about 3 hours so would be good for initial insomnia. "zolp-"
Zolpidem (Ambien)
184
Benzodiazepines and non-benzodiazepine “Z” drugs can be helpful for sleep but carry risks. They each have particular usefulness with regard to their particular properties such as half life and mode of metabolism. You should be familiar with the half-lives and metabolism so that you can make the best choice when dealing with different types of insomnia such as initial, middle, and terminal. For instance, for initial insomnia, a drug with _____ _____ would be more helpful than a med that has more latency with onset but has longer half life. "rap-"
rapid onset
185
This med has longer onset but lasts about 6 hours so would be better for sleep maintenance.
Eszopiclone (lunesta)
186
Remember some of the drawbacks when using this drug class such as dependence, tolerance, cognitive impairment, rebound insomnia, withdrawal, REM rebound, and increased falls in the elderly. "benz-"
benzodiazepines
187
Benzodiazepines and non-benzodiazepine “Z” drugs are actually very similar and possess many of the same risks. One difference is the non-benzodiazepines do not generally affect ___ _____. "RE-"
REM sleep
188
Treatment for narcolepsy including cataplexy can include stimulants such as dextroamphetamine, although this med is FDA approved for narcolepsy, sleep apnea, and shift-work sleep disorder. "moda-"
modafinil
189
These do reduce appetite but they also increase dopamine getting the frontal lobe to kick in a bit more thereby theoretically reducing impulsivity and the compulsion to binge. "stim-"
Stimulants
190
We are really trying to reduce the behavior of binging, not prescribe an appetite suppressant, so understanding that the pharmacotherapy is aimed at this rather than the appetite suppression is important. Some medications do have anorexia (loss of appetite, not the disorder, anorexia nervosa) as a side effect. You may be tempted to prescribe one of these to capitalize on that side effect (such as this med). There is some evidence that show it can be helpful in weight loss, however, it is best to prescribe medications that are aimed at reducing the behaviors by reducing compulsions such as SSRIs. "topir-"
topiramate [Topamax]
191
Pharmacological options are few for eating disorders. In the case of anorexia nervosa, pharmacotherapy is not really that helpful at all. These can be helpful in reducing the compulsivity of the eating disorders. Consideration of which one to use can be helped by considering psychiatric co-morbidities such as depression, OCD, chronic pain and other psychosomatic complaints. Be sure to review the existing indications for these so you will be skilled in choosing which one of these might be best for someone with an eating disorder and a comorbidity such as OCD. "antid-"
Antidepressants
192
This med is an SSRI that is widely used for eating disorders and actually has an indication for bulimia nervosa, but not anorexia nervosa. "fluox-"
Fluoxetine
193
Fluoxetine is an SSRI that is widely used for eating disorders and actually has an indication for bulimia nervosa, but not anorexia nervosa. This med would be another that is generally well tolerated and efficacious. "cital-"
Citalopram
194
This med is contra-indicated in people who have current or historical anorexia or bulimia nervosa due to the reduced seizure threshold and subsequent increased risk for seizures. "bupr-"
Bupropion
195
This drug class can be helpful for reducing the obsessive thoughts and preoccupation related to psychosomatic symptoms. "anti-"
Antidepressants
196
Antidepressants can be helpful for reducing the obsessive thoughts and preoccupation related to psychosomatic symptoms. For those who experience chronic pain, this drug class can be helpful for reducing discomfort. "SN-"
SNRIs
197
This med has an indication for both chronic musculoskeletal pain and for diabetic peripheral neuropathic pain. Although it does not have the indication, venlafaxine (Effexor) can also be helpful. "dulox-"
Duloxetine (Cymbalta)
198
FDA approved meds for PTSD: "ser-" and "par-"
Sertraline (Zoloft) and Paroxetine (Paxil)
199
Part of the brain implicated in PTSD that is responsible for memory and learning: "hip-"
hippocampus
200
Fluoxetine is used to treat which disorder? 1. Bulimia nervosa 2. Anorexia nervosa
Bulimia nervosa
201
Txt: This drug class and or CBT – to reduce obsessive and compulsive symptoms pertaining to body dysmorphic disorder.
SSRI and or CBT
202
FDA-approved meds for PTSD (2 of them). "ser-" and "par-"
Sertraline (Zoloft) and Paroxetine (Paxil)
203
FDA Black Box Warning nighttime complex behaviors "zolp-"
zolpidem (Ambien)
204
Needs to be tapered if using longer term (risk of seizures), not very suitable for long term use, dependence, tolerance issues, dangerous interactions (e.g. ETOH) "tria-"
triazolam (Halcion)
205
Regarding _______ _______ use in the elderly, always consider sleep hygiene as first-line treatment "sed-" "hy-"
sedative hypnotics
206
Activating serotonergic agents e.g. this med may trigger symptoms consistent with Restless Leg Syndrome (RLS) "venl-"
venlafaxine (Effexor)
207
Believe they are ill and do not intentionally produce symptoms. "soma-"
somatic symptom disorder
208
Treatment for which disease? - Visits with a single PCP (regularly scheduled visits) - Slowly address psychological issues - Patients are likely to resist referral to a mental health professional
somatic symptom disorder
209
FDA-approved for GAD. Which med? "busp-"
buspirone (Buspar)
210
You want the patient to wean off this medication in order to prevent discontinuation symptoms. "Pax-"
paroxetine (Paxil)

Psychopharmacology 552 (7 decks)

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