Psych Flashcards
All of the following are common side effects of antipsychotics except:
a. Sedation
b. Weiht loss
c. Prolonged QTc
d. Movement disorder
b. Weight loss
Weight gain is more likely to occur
Using best practices, when is a follow-up visit scheduled after the initial use/prescription for an anti-psychotic?
a. 4 weeks
b. 6 weeks
c. 12 weeks
d. 2 weeks
d. 2 weeks
Antipsychotics cure psychoses
a. True
b. False
b. False
Which of the following are first line interventions appropriate for patients suffering from behavioral and psycholigical symptoms of dementia (BPSD)? Select all that apply.
a. Music therapy
b. Aromatherapy
c. Additional diagnostic testing including CBC, CMP, TSH, B12, folate
d. Massage
e. Fluoxetine (Prozac)
a. Music therapy
b. Aromatherapy
c. Additional diagnostic testing including CBC, CMP, TSH, B12, folate
While not all patients with demential will be agitated, it is important to first investigate concomitant disease that may be related to behaviors (hence labs) and to try non-pharmacologic interventions
A 52-yo male is being seen for tinnitus and is evaluated and confirmed for bilateral sensorineural hearing loss. His symptoms have become more severe, and you decide to prescribe medication. In 2 weeks, he returns for a follow-up, and his EKG reveals Torsades de Pointes. Which medication was he likely started on?
a. Paroxetine
b. Diltiazem
c. Melatonin
d. Nortriptyline
d. Nortriptyline
All of these medications can be used to treat tinnitus. Nortriptyline is a Tricyclic antidepressant, and a known side effect of this medication is prolonged QT. Torsades de Pointes develops from a prolonged QT.
Long-term administration of drugs that selectively block postsynaptic receptors in the CNS will most likely cause:
a. Drug tolerance
b. Down-regulation of presynaptic receptors
c. Down-regulation of postsynaptic receptors
d. Up-regulation of postsynaptic receptors
d. Up-regulation of postsynaptic receptors
This is why patients “recover” from the initial beta blockade feeling of being extremely fatigued. It may also explain how some psychotropic drugs take a while to work.
Many psychotherapeutic drugs have alpha blocking and anti-cholinergic effects. Which of the following statements addresses at least some of these potential effects leading to ADRs?
a. Anticholinergic effects can be especially problematic in the elderly, with autonomic effects of hypotension and tachycardia leading to falls or heart attack
b. Anticholinergic effects are beneficial particularly with urinary urgency and the clinician should seek drugs with high anticholingergic effects
c. Anticholinergic effects result in extrapyridamal effects like tardive dyskinesia that can be permanent in elders
d. The anticholinergic effects lead to marked sedation in some patients, especially those with dementias
Typical antipsychotics work therapeutically on which of the following receptors?
a. Serotonin-2 (5HT-2)
b. Extrapyridamal pathways
c. Dopamine-2
d. Norepineperine in the CNS
c. Dopamine-2
Extrapyridamil effects are not therapeutic, although these drugs to work on these pathways.
Drugs used to treat ADHD typically target the neurotransmitter GABA.
a. True
b. False
b. False
Benzodiazepines incrase GABA (through increased release or decreased breakdown), the patient with anxiety has increased muslce relaxation and decreased attentiveness/memory.
ADD stimulant generally act on norepinephrine (also dopamine).
Sedative-hypnotics affect sensory processing, typically at the level of the reticular activating system (RAS).
a. True
b. False
a. True
Current clinical trials have too few enrollees to detect worrying levels of adverse drug effects.
a. True
b. False
a. True
To detect adverse effects that occur at a rate of 1/1000 drug users, a clinical trial would need to enroll 8 million participants. Most clinical trials involve fewer than 1000 patients - a sufficient number to show a drug’s effectiveness. But a trial of that size may fail to detect side effects when occuring as frequently as 1 in 10!
How are stimulants dosed for ADHD?
a. First obtain an ECG, then dose based on cardiac risk factors
b. Generally weight-based for pediatric patients, then a standard dose for adults
c. Begin with a drug in one class, then if symptoms do not improve, add a drug in another class/category
d. Start at a low dose, then slowly titrate upwards until desired effects occur
b. Generally weight-based for pediatric patients, then a standard dose for adults
ECGs are not recommended routinely and cardiac risk does not dictate dose.
Generally, one starts with a single stimulant. The only add-on is a non-stimulant and that can be controversial.
Generally, one starts at the recommended dose for adults, or a weight-based dose for children. The frequency of dosing may vary - for example, use a long-acting formulation to get through the school or work day, then a short-acting formulation to get through the evening without carry-over into the night.
Vitamine B6, used in GABA synthesis, may reduce feelings of anxiety and depression.
a. True
b. False
a. True
A study supported this statement. Something to consider when both diagnosing (vit B6 deficiency- may add to symptom burden) and prescribing.
Psychedelic research has provided moderate evidence for resolving symptoms of severe depression or selected psychoses.
a. True
b. False
b. False
Psychedelic research is getting its moment in the press and on social media.
These drugs provide significant, established risks such as confusional states, abuse potential, and precipitation of enduring psychiatric conditions, especially in people with pre-existing vulnerabilities like psychotic disorders.
However, meaningful short-term benefits are established in replicated studies for some people. The quality of evidence is not yet moderate or strong.
Similar investigations and results were reported in the 1950s and 1960s.
The best advice for clinicians is that further study is indicated. Do not trivialize harm.
Current meta-analyses indicate that in-utero exposure to antipsychotic drugs is not meaningfully associated with an increased risk for fetal malformations in most situations.
a. True
b. False
a. True
While there are concerning reports, they require confirmation.
Concerning reports that need additional conformation include:
- Oral clefts with olanzapine
- Gastroschisis and brain anomalies with atypical antipsychotics
- Cardiac malformations with chlorprothixone
