psych Flashcards
1
Q
?? is a serotonin-norepinephrine reuptake inhibitor that can cause dose-dependent hypertension. Blood pressure should be monitored regularly, especially at higher doses
A
Venlafaxine
2
Q
This child’s history of early foster care placement due to parental substance use, social withdrawal, lack of positive response to attempts to comfort, and poor emotional responsiveness is consistent with ??
A
reactive attachment disorder (RAD)
3
Q
Bipolar disorder is a highly recurrent illness. how long is pharm therapy indicated?
A
Maintenance treatment is recommended to decrease the risk of recurrent manic or depressive episodes. Lithium therapy should be maintained in patients whose condition is stable and who are tolerating the medication.
4
Q
Long-standing diabetes mellitus (especially type 1) is a common cause of ???. Patients typically have postprandial vomiting, early satiety, weight loss, and abdominal pain, and many develop food aversion.
A
gastroparesis
5
Q
best diagnosis for gastroparesis
A
The diagnosis is best evaluated with a gastric-emptying scan and an investigation for mechanical obstruction (eg, upper endoscopy ± CT/MR enterography).
6
Q
Active substance use, including alcohol and prescription and/or illicit drugs, is associated with disinhibition and an increased risk of ??.
A
suicide
7
Q
Patients who do not respond to selective serotonin reuptake inhibitors may benefit from switching to another first-line antidepressant medication. The norepinephrine and dopamine reuptake inhibitor ??? is an activating antidepressant with a favorable side effect profile (eg, no weight gain or sexual side effects), making it a good choice for patients with weight gain, hypersomnia, or sexual dysfunction.
A
bupropion
8
Q
When a patient’s family members are reluctant to withdraw care, ??? orders can promote agreement with the care team, minimize futility, and lessen feelings of guilt for hastening the patient’s death.
A
No Escalation of Treatment (NEOT) orders are predetermined limits of care that are not to be exceeded regardless of clinical status.
9
Q
?? is the medication of choice for treatment-resistant schizophrenia and should be considered in patients who have failed ≥2 antipsychotic drug trials.
A
Clozapine
10
Q
Clozapine is the medication of choice for treatment-resistant schizophrenia and should be considered in patients who have failed ≥??? antipsychotic drug trials.
A
2
11
Q
This patient’s depression and sleep disturbances, in the context of centralized obesity, proximal muscle weakness, a ruddy appearance, hypertension, hypokalemia, and hyperglycemia, are suggestive of ??
A
Cushing syndrome
Neuropsychiatric manifestations of Cushing syndrome include depressed or labile mood, anxiety, irritability, insomnia, memory deficits, and fatigue.
12
Q
what to do with an agressive patient in the ED?
A
interview patient with the door open and security personel nearby
13
Q
Antipsychotic medication nonadherence is a common cause of relapse and rehospitalization in patients with schizophrenia. ??? antipsychotics are useful for patients who have responded to oral antipsychotics but relapse frequently due to medication nonadherence.
A
Long-acting injectable
14
Q
patient’s symptoms of insomnia and impaired concentration, developing within 3 months of an identifiable stressor (eg, job loss, moving back in with his parents), are consistent with an ??
A
adjustment disorder
15
Q
Binge eating disorder is characterized by repeated episodes of excessive eating accompanied by a loss of control and subsequent distress. The most effective treatment is psychotherapy. Medication options include (3)
A
Options include selective serotonin reuptake inhibitors such as sertraline, the stimulant lisdexamfetamine, and the antiepileptic agent topiramate.
16
Q
??? is a circadian rhythm disorder characterized by the inability to fall asleep at traditional bedtimes, resulting in sleep-onset insomnia and excessive daytime sleepiness. Patients sleep normally if allowed to follow their internal circadian rhythm and sleep until late morning.
A
Delayed sleep-wake phase disorder
17
Q
Stimulant misuse should be considered in patients with psychomotor agitation and signs of sympathetic hyperactivity. ?? are the treatment of choice
A
Benzodiazepines
18
Q
??? therapy is an effective adjunct to antipsychotic medication in patients with schizophrenia and has been shown to reduce the risk of relapse.
A
Family therapy
It focuses on educating the family about the symptoms, course, and treatment of the disorder, and it helps to promote a supportive family environment.
19
Q
bupropion is contraindicated with history of bulimia nervosa; the risk of ??? increases in patients with active or historical bulimia or anorexia nervosa because of potential electrolyte disturbances
A
seizures
20
Q
Acute dystonia is a type of extrapyramidal symptom associated with antipsychotic treatment. It is most commonly seen with high-potency first-generation antipsychotics and is best treated with which two drugs??
A
anticholinergics (benztropine) or antihistamines (diphenhydramine).
21
Q
What is most helpful in the early detection of prescription opioid misuse in patients?
A
The prescription drug monitoring program records prescribed controlled substances that the patient received, including quantities, dates the prescriptions were filled, and prescriber information. This database can identify patients who are obtaining opioids from multiple prescribers, thereby raising concern for overuse or diversion.
22
Q
which antipsychotic agent can cause QT-interval prolongation; therefore, an ECG should be obtained prior to administering these agents to avoid causing a life-threatening arrhythmia (ie, torsade de pointes)
A
haloperidol
other antipsych meds do too
23
Q
The antipsychotic clozapine is associated with an increased risk of ???
A
seizure
24
Q
Major depressive disorder is frequently recurrent. Long-term maintenance antidepressant therapy is indicated for patients with ≥?? major depressive episodes
A
2
25
First-line treatment of PTSD includes ??? and/or pharmacotherapy with a serotonergic antidepressant (selective serotonin reuptake inhibitor or serotonin-norepinephrine reuptake inhibitor)
trauma-focused cognitive-behavioral therapy (CBT)
26
?? a rare but potentially lethal adverse reaction to antipsychotic medications (neuroleptics). Its cardinal features include severe hyperthermia, autonomic dysregulation, lead-pipe rigidity, and altered mental status
neuroleptic malignant syndrome (NMS)
27
Treatment of neuroleptic malignant syndrome (NMS) includes the following:
Prompt discontinuation of the offending agent (the antipsychotic)
Supportive care (ie, aggressive cooling, intravenous fluids, and electrolyte repletion).
which three medications???
Benzodiazepines, which can improve agitation and decrease muscle contraction
Bromocriptine or amantadine, dopaminergic medications that can be considered in a patient whose condition does not respond to supportive care and withdrawal of medication.
Dantrolene, a direct-acting muscle relaxant with a rapid onset of action that can reduce heat production and muscle rigidity.
28
Patients with body dysmorphic disorder typically have limited insight into their condition and therefore require a sensitive and tactful assessment approach. The physician should acknowledge their distress and avoid referring to perceived defects as "imagined" or arguing with them about their appearance. Physicians should empathize with patients' efforts to cope with their condition and determine their level of insight by ??
exploring their perceptions of how others see them.
29
what is the management of postpartum psychosis
Postpartum psychosis is a medical emergency characterized by delusions, hallucinations, and disorganized thoughts or behavior often accompanied by mood symptoms. Due to the high risk for suicide/infanticide, most patients require hospitalization to ensure safety.
30
Psychosis is common in Parkinson disease, occurring at a higher rate in those treated with dopamine agonists than in those treated with carbidopa-levodopa. Psychotic symptoms can be treated with antiparkinson medication dose reduction and/or the addition of a low-potency antipsychotic such as ??
quetiapine, clozapine, or pimavanserin
31
?? involves recurrent binge eating and compensatory behaviors
Bulimia nervosa
no compensatory behavior would be binge eating disorder
32
acute stress disorder vs. PTSD
ASD \< 1 month \> PTSD
33
This patient has subjective shortness of breath with good oxygenation, clear lungs, and a deep breathing pattern punctuated by audible sighs. In addition, she has paresthesias of her hands that presented during a time of significant stress. This is consistent with ??
hyperventilation syndrome
Initial treatment is reassurance with breathing retraining
34
associated signs and symptoms of this disease include constipation, cold intolerance, bradycardia, hypotension, which are important diagnostic clues because patients want to hide condition
Anorexia nervosa (AN)
35
The acute onset of headache following a meal in a patient treated with phenelzine raises concern for ??
hypertensive crisis
Patients taking monoamine oxidase inhibitors such as phenelzine should avoid foods rich in tyramine as the interaction of such food-drug combinations can result in hypertensive crisis.
36
Tardive dyskinesia occurs after prolonged exposure to antipsychotic drugs and is characterized by abnormal involuntary movements of the mouth, tongue, face, trunk, or extremities. When antipsychotic dose reduction or discontinuation is not feasible, using valbenazine or deutetrabenazine or switching to ??? should be considered.
clozapine
37
Tardive dyskinesia occurs after prolonged exposure to antipsychotic drugs and is characterized by abnormal involuntary movements of the mouth, tongue, face, trunk, or extremities. When antipsychotic dose reduction or discontinuation is not feasible, using ?? or switching to clozapine should be considered.
valbenazine or deutetrabenazine
vesicular monoamine transporter Type 2 (VMAT-2) transports serotonin, norepinephrine, and dopamine for storage and future neurotransmission, the inhibition of VMAT-2 increases cytosolic dopamine levels and decreases synaptic dopamine release and post-synaptic receptor stimulation, thereby decreasing dyskinesia
38
Patients with panic attacks frequently develop ???, which is anxiety and avoidance of ≥2 situations in which it may be difficult to escape or get help (eg, being outside the home or in enclosed spaces, using transportation) in the event of a panic attack.
agoraphobia
39
??? is first-line treatment for major depressive disorder with psychotic features. It is particularly appropriate for severely depressed patients who refuse to eat and drink or are acutely suicidal.
Electroconvulsive therapy
40
Patients with bipolar II disorder experience at least 1 episode of hypomania and ≥1 major depressive episodes. First-line treatment of bipolar depressive episodes includes which two antipsychotics???
lurasidone and quetiapine
41
Adjustment disorder involves symptoms causing marked distress and impairment that develop within ? months in response to a stressor.
3
42
?? is characterized by intrusive, recurrent, and persistent unwanted thoughts and repetitive behaviors or mental acts in response to the obsessions. Patients typically have prominent **anxiety symptoms** that must be differentiated from those of primary anxiety disorders.
Obsessive-compulsive disorder
43
Because of methadone's long half-life, its effects, including respiratory depression, can recur for up to ?? hours following an acute overdose.
24-48
44
??? have amphetamine-like properties that can cause severe agitation, combativeness, psychosis, delirium, myoclonus, and, rarely, seizures. Tachycardia and increased blood pressure are often present. In contrast to other stimulants and hallucinogens, which have a much shorter duration of effect, the **effects of intoxication may take up to a week to subside.**
Synthetic cathinones ("bath salts")
45
Treatment options for Tourette disorder include habit reversal training, and which two types of medication?
**Antidopaminergic** agents are the most effective medications and include the dopamine-depleting agent **tetrabenazine** as well as antipsychotic agents that act as dopamine-receptor blockers (eg, risperidone, haloperidol). **Alpha-2 adrenergic agonists** (eg, **guanfacine**, **clonidine**)
46
Low ??? in cerebrospinal fluid is associated with suicidal behavior.
5-hydroxyindoleacetic acid (5-HIAA) is a metabolite of serotonin.
47
Premature ejaculation is characterized by uncontrolled ejaculation and decreased ejaculatory latency. Most patients respond to which psych drug????, which prolong ejaculatory latency. Patients may also benefit from local anesthetics and/or psychotherapy to address concurrent anxiety, mood disorders, and relational issues.
selective serotonin reuptake inhibitors
48
This patient's retrograde and antegrade amnesia with intact long-term memory, confabulation, apathy, lack of insight, and history of alcohol use disorder are most consistent with a diagnosis of ???
Korsakoff syndrome (KS)
49
???, a tricyclic antidepressant (TCA), and clozapine, a second-generation antipsychotic, along with many other medications, can cause anticholinergic toxicity when taken in combination or in excess.
Doxepin
50
The anticonvulsant mood stabilizer ???? can cause elevated aminotransferases and in rare cases hepatic failure, most commonly in the first 6 months of treatment.
valproate
51
??? in children may come to attention only when social demands reveal their social-emotional deficits during school-age years. Features include social awkwardness, fixated interests, and unusual responses to sensory experiences.
\*\*normal developmental milestones
High functioning autism
52
basic medical workup for new-onset psychosis commonly includes complete physical and mental status examinations, and which 3 labs??
metabolic panel, complete blood cell count, and urine toxicology screen.
53
patient with end-stage malignancy has transitioned to hospice care, in which the focus shifts toward ??? versus extending length of life.
maximizing comfort (eg, pain control)
\*\*increase morphine until adequate pain control is achieved
54
Does diagnosis of bipolar I disorder require a history of major depressive episodes??
no
only bipolar II
55
??? is a first-line pharmacotherapy for alcohol use disorder that decreases craving and heavy drinking. It can be initiated in opioid-free patients without significant liver disease who are still drinking.
Naltrexone
56
Opioid withdrawal should be suspected in a patient who uses opioids and develops signs of noradrenergic hyperactivity within hours of admission. ????, a central alpha-2 adrenergic agonist, is effective in decreasing the autonomic symptoms associated with opioid withdrawal
Clonidine
57
depression has what effect on HPA axis, cortisol, and sleep latency
Hyperactivity of the hypothalamic-pituitary-adrenal axis, resulting in **subclinical increased cortisol levels** (ie, without signs/symptoms of Cushing syndrome)
**decreased** REM sleep latency (ie, decreased time from sleep onset until the start of the first REM sleep period)
58
???is characterized by a long-standing pattern of suspicion and mistrust of others' intentions. In the physician-patient relationship, it may manifest as difficulty establishing rapport and creating a therapeutic alliance.
Paranoid personality disorder
59
sad face on a patient taking antipsychotics is due to
masklike facies (which can be difficult to differentiate from depressed affect) feature of antipsychotic-induced parkinsonism
\*\*add benzotropine
60
Serotonin syndrome is characterized by mental status changes, autonomic dysregulation, and neuromuscular excitability. Management includes discontinuation of serotonergic medications, hydration, cooling, and blood pressure control. ??? are used to decrease agitation and muscle contractions. Cyproheptadine is used to decrease central serotonergic activity.
Benzodiazepines
61
Serotonin syndrome is characterized by mental status changes, autonomic dysregulation, and neuromuscular excitability. Management includes discontinuation of serotonergic medications, hydration, cooling, and blood pressure control. Benzodiazepines are used to decrease agitation and muscle contractions. ??? is used to decrease central serotonergic activity.
Cyproheptadine
62
??? are a common and usually benign parasomnia of childhood. They occur during non-REM sleep and are characterized by fear, crying and/or screaming, and amnesia of the event. The diagnosis is made clinically. Parents should be **reassured** that episodes are self-limited and typically resolve within 1-2 years.
Sleep terrors
63
apriprazole is what type of med??
2nd gen antipsychotic
64
Psychosis may develop in Parkinson disease as a result of the underlying disease process, treatment with anti-Parkinson medications (eg, levodopa, pramipexole), or a combination of the two. In patients treated with anti-Parkinson medications who develop psychotic symptoms, what is the first step in management??
dose reduction
65
Hoarding disorder is characterized by difficulty discarding possessions regardless of their actual value. It is best treated with ??
cognitive-behavioral therapy
66
??? is a preferred initial treatment for children with or without attention deficit hyperactivity disorder who exhibit disruptive behaviors
Parent-child behavioral therapy
67
Pediatric major depression may present with ??? rather than depressed mood.
irritability
If a patient displays irritability along with social withdrawal and academic decline, major depression should be considered.
68
Akathisia should be considered if a patient becomes agitated or restless when an antipsychotic is changed or the dosage is increased. Treatment options include reducing the dose, changing to an antipsychotic with less potential to cause extrapyramidal symptoms, and/or starting treatment with ?? (primary, preffered treatment is?)
**propranolol**, benztropine, or a benzodiazepine
\*\*
69
In ???, overwhelming anxiety or tension precedes impulses and is relieved with the theft. Guilt and shame typically follow, so these individuals may return or give away stolen items.
kleptomania
70
In some cases, ??? sx include unwelcome violent urges or images, as seen in this patient who has images of stabbing her mother in the back with a knife, followed by repeatedly counting from 5 to 1 to neutralize the thought.
OCD
intrusive thoughts + compulsive counting
71
Lithium and valproate are first-line options for bipolar disorder maintenance treatment.
when do you choose valproate first?
any patients with renal abnormalities
lithium is excreted by the kidneys
72
?? is effective for treatment of PTSD-related nightmares and is particularly helpful as an adjunct to SSRI or SNRI treatment.
prazosin, an alpha-1 adrenergic receptor antagonist
73
For patients with depression who have had a partial response (generally defined as 25%-50% improvement) to first-line treatment and are tolerating their current medication, major augmentation strategies include ???
adding an antidepressant with a different mechanism of action, a second-generation antipsychotic (eg, aripiprazole), lithium, triiodothyronine, or psychotherapy.
74
??? is a first-line antidepressant medication whose side effects include stimulation of appetite, weight gain, and somnolence
preferred choice for patients with marked insomnia and weight loss due to its side effects of appetite stimulation and sedation.
Mirtazapine
75
Premenstrual syndrome and premenstrual dysphoric disorder are characterized by physical (eg, fatigue, bloating, breast tenderness) and psychological (eg, mood swings, irritability) symptoms that occur in the week prior to menses and resolve during the follicular phase. Assessment should begin with ???
a menstrual diary to determine the relationship of symptoms to menstrual cycle phase.
76
Patients with Tourette syndrome have high rates of comorbid conditions that complicate management and affect quality of life. which 2?? are the most prevalent comorbid conditions.
Attention-deficit hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD)
77
Patients with ??? are frequently seen in the primary care setting for insomnia and/or anxiety. Findings of increased liver enzymes and macrocytosis can also assist in screening.
alcohol abuse disorder
78
??? is the most consistently replicated neuroimaging finding in schizophrenia.
Enlargement of the lateral cerebral ventricles
79
salt craving and reduced body hair are suggestive of ???
primary adrenal insufficiency (PAI) (also known as Addison disease)
80
diagnosis of primary adrenal insufficiency (PAI) is made by stimulation testing with ???, a synthetic form of ACTH. Low production of cortisol is diagnostic of PAI.
cosyntropin
81
The anticonvulsant lamotrigine is used as a mood stabilizer in bipolar disorder and is often used specifically to target bipolar depression. One of the most significant side effects of lamotrigine is a ???
drug rash - a mild form of which occurs in up to 10% of those treated.
rare cases can result in life-threatening Stevens-Johnson syndrome or toxic epidermal necrolysis may occur in 0.1%.
82
Abrupt cessation of ??? is associated with significant withdrawal symptoms, including a risk for generalized seizures and confusion.
alprazolam, a short-acting benzodiazepine
83
??? syndrome is characterized by neuropsychiatric symptoms (eg, developmental delay, **autism**) and dysmorphic features: **elongated face, deep-set eyes, large ears**
Fragile X
Diagnosis is with FMR1 DNA analysis
84
A history of ??? is common in patients with borderline personality disorder
childhood trauma (eg, physical and sexual abuse, neglect)
Insecure attachment to the primary caregiver may underlie the unstable relationships and fears of abandonment commonly seen in the disorder.
85
Lithium is indicated both for the treatment of acute mania and for maintenance therapy in bipolar disorder. Long-term side effects include ???, nephrogenic diabetes insipidus, chronic kidney disease, and thyroid dysfunction, as well as teratogenic effects.
hyperparathyroidism with hypercalcemia
86
Patients with a single episode of major depressive disorder should continue antidepressants for an additional ??? months following acute response to reduce the risk of relapse. Patients with recurrent, chronic, or severe episodes should be considered for maintenance treatment (1-3 years or indefinitely).
6
87
??? is the preferred drug for reducing cravings for alcohol use disorder in patients with liver disease or opioid use
Acamprosate
Acamprosate, a glutamate modulator at metabotropic glutamate receptor 5, is a first-line treatment that would help reduce this patient's risk of relapse. It is excreted mostly unchanged by the kidneys, and can be used safely in patients with liver disease, but requires dosage adjustment in patients with renal failure.
88
Individuals with performance-only social anxiety disorder do not fear nonperformance social situations and are not socially avoidant in general.
The pharmacologic treatment of performance-only social anxiety disorder includes
**as-needed** beta blockers or benzodiazepines rather than maintenance medication.
89
male patient's unstable moods, recurrent suicidal behaviors, impulsivity, intense anger, and chaotic interpersonal relationships are consistent with ??
borderline personality disorder
90
mood shifts in ?? occur in response to situational stressors and typically last minutes to hours as opposed to the days or weeks required to diagnose manic and depressive episodes.
borderline personality disorder
91
Treatment of body dysmorphic disorder consists of ???
selective serotonin reuptake inhibitors and/or cognitive-behavioral therapy.
92
with mild cognitive impairment (MCI), there is a objective evidence of impairment = MoCA score ???/30) and modest but notable decline in cognitive function (eg, complex attention, executive function, learning and memory, language). Although independence is generally preserved, ADLs take greater effort, time, and/or compensatory strategies.
26
93
which mood stabilizer has the most favorable pregnancy safety profile
lamotrigine
an appropriate treatment option for euthymic patients who do not wish to continue valproate during pregnancy.
94
?? is an evidence-based, first-line treatment for major depression with psychotic features and appropriate for severely depressed elderly patients who are not eating or drinking and require rapid intervention.
Electroconvulsive therapy
95
management of acute mania: Because this patient exhibits acute psychosis (eg, grandiose delusions) and escalating agitation (eg, shouting, banging on the door, throwing a cup of water), an antipsychotic such as ??? would be the next step in management because it can be administered intramuscularly and has a rapid onset of action.
olanzapine
First-line treatments for mania include antipsychotics (eg, olanzapine), lithium, and anticonvulsant mood stabilizers (eg, valproate).
96
negative symptoms of schizophrenia include apathy, avolition (meaning ???), affective flattening (lack of facial expression), alogia (very brief answers), and asociality (social withdrawal and diminished interest in relationships).
avolition is a total lack of motivation that makes it hard to get anything done
97
??? antipsychotic is associated with the highest risk of weight gain and metabolic side effects (eg, insulin resistance, hyperlipidemia) and should be avoided in this patient due to his history of type 2 diabetes
olanzapine
98
When hyperactivity and impulsivity concerns are limited to the home setting ??? should be suspected
ineffective parenting methods should be suspected, with parent management training being the treatment of choice.
99
Among SSRIs, ??? is preferred for depression post MI because it carries a very low risk of adverse drug interactions, especially with cardiac medications.
sertraline
100
??? toxicity causes new onset of severe gastrointestinal symptoms, confusion, ataxia, tremor, and other signs of neuromuscular irritability such as fasciculations and seizures.
lithium
101
The risk of ?? toxicity is higher in patients with dehydration from any cause (eg, vomiting, diarrhea, fever, diuresis) and in elderly patients due to a lower glomerular filtration rate and reduced volume of distribution
which psych drug
lithium
102
Concurrent use of ???—as well as ACE inhibitors, tetracyclines, metronidazole, and nonsteroidal anti-inflammatory drugs—and lithium can increase serum lithium levels and lead to symptoms of lithium toxicity
thiazide diuretics
103
findings of hypokalemic, hypochloremic metabolic alkalosis are a classic sign of ???
self-induced vomiting, one of the most common methods of purging in bulimia nervosa
104
Clozapine is indicated for the treatment of psychotic patients who do not respond to other antipsychotics. Patients must undergo regular monitoring due to the risk of ?
neutropenia and agranulocytosis (complete absence of neutrophils)
105
Serotonin syndrome is caused by excess serotonin levels and is characterized by a triad of mental status changes, autonomic dysregulation, and what change in neuro system???
neuromuscular hyperactivity (3+ deep tendon reflexes)
106
Depression, weight loss, and new-onset diabetes mellitus may occur as early manifestations of ???. CT of the abdomen is indicated as part of the initial diagnostic evaluation.
pancreatic cancer
107
Unilateral foot drop is characterized by a "steppage" gait: exaggerated hip and knee flexion while walking. Common causes include L5 radiculopathy and compression of ??
peroneal nerve at lateral aspect of fibula
108
??? can cause anticholinergic symptoms, central nervous system toxicity (eg, seizures), and cardiac toxicity (eg, hypotension, QRS prolongation). Patients with QRS prolongation should receive sodium bicarbonate to narrow the QRS interval, prevent ventricular arrhythmia, and improve hypotension
Tricyclic antidepressant
109
hyperthermia, flushed skin, dilated pupils, decreased bowel sounds
which overdose
TCA overdose can cause anticholinergic effects (eg, hyperthermia, flushed skin, dilated pupils, decreased bowel sounds), seizures, and cardiac toxicity (eg, prolonged QRS interval, hypotension).
110
Cardiac toxicity is caused by TCA inhibition of fast sodium channels in the His-Purkinje system and myocardium. This decreases conduction velocity, increases the duration of repolarization, and prolongs absolute refractory periods. QRS prolongation and ventricular arrhythmias (eg, ventricular tachycardia, ventricular fibrillation) may result.
treatment??
Sodium bicarbonate
Increases serum pH makes the TCA less pharmacologically active, decreasing its avidity for sodium channels.
Increasing extracellular sodium concentration raises the electrochemical gradient across cardiac cell membranes, decreasing the impact of the TCA-induced sodium channel blockade
111
patient who has urinary retention likley overdosed on ???
anticholinergic like diphenhydramine (antihistamine with anticholinergic effects)
112
This patient's fatigue, constipation, myalgias, and bradycardia are most consistent with lithium-induced ???
hypothyroidism
113
?? are the preferred initial treatment for an agitated and combative patient with acute mania. Their rapid onset and the possibility of intramuscular administration will allow for rapid sedation.
Antipsychotics, e.g., haloperidol or risperidone
A mood stabilizer should eventually be initiated and titrated for long-term maintenance therapy, but this will take a few days to take effect and she is in need of rapid stabilization at this time.
114
?? is the recommended initial treatment for patients with genito-pelvic pain disorder, which is often associated with increased pelvic floor muscle tension. Sharp vaginal pain on attempted penetration (e.g., sexual intercourse, tampon insertion) in an otherwise healthy young woman suggests genito-pelvic pain disorder.
Pelvic floor physical therapy
115
This patient has generalized anxiety disorder (GAD), which is characterized by excessive worrying about various aspects of daily life, causing significant social or occupational dysfunction for \> 6 months. She was prescribed ????, a 5-HT1A receptor agonist.
buspirone
116
??? intoxication manifests with a combination of CNS depression and fairly normal vital signs called sedative‑hypnotic toxidrome. In this patient, CNS depression manifests as somnolence, ataxia, diminished deep tendon reflexes, and slurred speech.
Benzodiazepine
117
??? often manifests with microcephaly, flat philtrum, short palpebral fissures, hypertelorism, depressed nasal bridge, and micrognathia. This patient's difficulties at school are due to the behavioral problems (e.g., hyperactivity and inattention) and intellectual disability (e.g., learning disabilities, memory and reasoning deficits, impaired language development). This patient's pansystolic murmur heard best along the left lower sternal border is caused by a ventricular septal defect, which is often seen in patients
Prenatal alcohol exposure results in fetal alcohol syndrome (FAS),
118
Bipolar ??? disorder is a subtype of bipolar disorder that is characterized by at least one manic episode lasting ≥ 1 week with or without major depressive episodes.
I (1)
119
??? is the strongest predisposing factor for bipolar disorder.
Genetic predisposition
120
??? is the preferred medication for opioid use disorder in pregnancy and has been associated with less severe neonatal abstinence syndrome compared to methadone, which can also be used in pregnancy.
Buprenorphine
121
