PreTest Psychiatry: Psychopharmacology and Other Somatic Therapies Flashcards
How should leukopenia in a patient taking clozapine be addressed?
- If it is mild (WBC 3,000 - 4,000), then switch to twice-weekly CBCs and continue the clozapine.
- If it is severe (WBC less than 3,000), then discontinue the clozapine and do daily CBCs.
How should lithium toxicity be treated?
First, draw a serum lithium level.
• If it is less than 2.5 nM, then administer IV saline and monitor closely.
• If it is greater than 2.5 nM, then emergency dialysis is indicated.
Ramelteon should not be used in those with _____________.
- Severe hepatic impairment
- COPD
- Sleep apnea
When starting a patient on carbamazepine, you need to tell them to come in if they develop ____________.
a rash (which could progress to SJS)
How should acute dystonia be treated?
Intramuscular diphenhydramine or benztropine for acute relief followed by PO versions of the same to avoid recurrence
When they say “patient has tardive dyskinesia but can’t tolerate lowering dose of atypical antipsychotic,” you say ____________________.
“give clozapine!”
_______________ is the most commonly used anesthetic for electroconvulsive therapy.
Methohexital
Ritalin (methylphenidate) should not be taken ________________.
after noon (because of insomnia)
If a patient with Parkinson’s demonstrates psychotic symptoms, then you should initially treat with _____________.
quetiapine; if that doesn’t work, then give clozapine
How long does lithium take to become effective?
One week
A patient is taking a high dose of clozapine and has a seizure. What should you do?
First, discontinue the clozapine and start valproate. Next, restart the clozapine at a lower dose.
When they say “a patient has orthostatic hypotension and BPH,” they really mean _________________.
“DO NOT GIVE THIS PATIENT DRUGS WITH ANTI-ALPHA-1 PROPERTIES”
Which antipsychotics have the lowest risk of anticholinergic symptoms?
The high-potency first-generation antipsychotics (haloperidol and fluphenazine)
How soon can SSRI discontinuation syndrome start?
In the case of paroxetine and sertraline –which have the shortest half-lives of the SSRIs –discontinuation symptoms can start in as little as 1 or 2 days without taking the medication.
A patient is taking phenelzine. She tells you she’s scrupulously avoided meat, cheese, and all tyramine-containing products, yet she comes in with hypertension, sweating, and a headache. What over-the-counter medication might she have taken?
Pseudoephedrine
