Psyc Unfortunately

Question 1

Hyperventilation syndrome - work up?

Answer 1

Common in the setting of panic attacks and anxiety disorders - get a CXR to R/out PE and pneumothorax

Question 2

NMS vs Serotonin Syndrome

Answer 2

NMS has more rigidity while SS has hypereflexia and clonus

Question 3

What is acute dystonia

Answer 3

Sudden muscle spasms - torticollis, retrocollis and trismus - caused by antipsychotics (anticholinergic effect)

Question 4

Akathisia

Answer 4

Restlessness, agitation and inner tension

Question 5

Tardative dyskinesia

Answer 5

Mouth smacking, tongue movements classically - but can be marked by any abnormal movements of the body

Question 6

Side effects of Clozapine

Answer 6

Metabolic - weight gain, diabetes and dyslipidemia EPS effects and myocarditis

Question 7

Medication with highest EPS?

Answer 7

First gens - haloperidol, Risperidone the most of the next gens

Question 8

Non-typable HiB causes

Answer 8

recurrent otitis media

Question 9

First generation antipsychotic action

Answer 9

D2 binding (high potency - haldol, low potency - Chlorpronazine)

Question 10

Second generation (atypical) antipsychotic mechanism of action?

Answer 10

D2 binding - but less strong, also binds 5HT2A

Question 11

Third generation antipsychotics mechanism of action

Answer 11

Partial D2 agonist

Question 12

Biggest SE with atypical antipsychotics?

Answer 12

Weight gain / metabolic syndrome especially clozapine/ olanzapine

Question 13

Dopamine and prolactin relationship

Answer 13

Dopamine inhibits prolactin, so antipsychotics can lead to prolactin hypersecretion, switch med/ reduce the dose

Question 14

Tx for too much prolactin on antipsychotics

Answer 14

Bromocriptine, or amantadine

Question 15

Complication of antipsychotics in young people?

Answer 15

Bone mineral density loss - osteomalacia, give Vit D and encourage good lifestyle

Question 16

Tx of acute motor disorders

Answer 16

Give anticholinergic- benzotropine/procylidine, benzos, Benadryl

Question 17

Mood stabilizers for acute mania

Answer 17

Tegretol/ Epival

Question 18

Monitor for Epival

Answer 18

Liver toxicity / polycystic ovaries - very teratogenic do not give to pts that can get pregnant

Question 19

S/E of lamictol

Answer 19

SJS otherwise not bad

Question 20

Greatest risk from a TCA OD?

Answer 20

QTC prolongation leading to fatal tachycardia

Question 21

Starting a young person on SSRI - what S/E do you need to worry about?

Answer 21

Increased SI - need to monitor closely

Question 22

Wellbutrin for anxiety?

Answer 22

No

Question 23

Mood disorder associated with left anterior stroke

Answer 23

MDD

Question 24

Hep C triple treatment (interferon) watch out for

Answer 24

Depression

Question 25

Propranolol and a vulnerable pt

Answer 25

Depression