Psych

Question 1

Schizophrenia Negative symptoms

Answer 1

loss of interest, lack of emotion/apathy, inability to plan/do daily activities, poor hygiene, social withdrawal, loss of motivation, lack of speech

Question 2

Schizophrenia positive symptoms

Answer 2

hallucinations, delusions, disorganized thinking, difficulty paying attention

Question 3

First generation antipsychotics

Answer 3

chlorpromazine
haloperidol (Haldol)
s/e: sedation, EPS, akathisia, parkinsonism, tardive dyskinesia

Question 4

Second generation antipsychotics

Answer 4

aripiprazole (Abilify), clozapine (Clozaril), olanzapine (Zyprexa), lurasidone (Latuda), paliperidone (Invega), quetiapine (Seroquel), risperidone (Risperdal), ziprasidone (Geodon)
s/e: akathisia, anxiety, insomnia
less EPS than 1st gen antipsychotics

Question 5

Psychosis in Parkinson’s disease

Answer 5

pimavanserin (Nuplazid)

doesn’t worsen motor symptoms of Parkinson’s

Question 6

Tardive Dyskinesia

Answer 6

complication d/t dopamine blockade
uncontrollable movements in tongue, face, trunk, extremities
valbenzine (Ingrezza) - s/e somnolence

Question 7

Bipolar 1

Answer 7

severe mania and bouts of intense depression

can be psychotic/delusional or require hospitalization

Question 8

Bipolar 2

Answer 8

hypomania and bouts of intense depression
hypomania does not affect work/social functioning
no psychosis or hospitalization

Question 9

Bipolar treatment

Answer 9

goal to stabilize mood w/o inducing depression
acute mania tx: valproate or lithium + antipsychotic
acute bipolar depression tx: lamotrigine or lithium

Question 10

Bipolar + pregnancy

Answer 10

use 2nd gen antipsychotic

avoid valproate, carbamazepine, and lithium d/t fetotoxicity

Question 11

Bipolar + epilepsy

Answer 11

lamotrigine (Lamictal)
valproate (Depakote)
carbamazepine (Equetro)

Question 12

Parkinson’s Background

Answer 12

neurons in substantia nigra damaged/impaired, unable to produce dopamine - less dopamine = more movement problems
s/sx: TRAP - tremor, rigidity, akinesia, postural instability

Question 13

Parkinson’s treatment

Answer 13

levodopa - prodrug of dopamine, converted in CNS
carbidopa/levodopa (Sinemet) - most effective, carbidopa prevents peripheral metabolism of levodopa
dopamine agonists mimic dopamine - pramipexole (Mirapex), ropinirole (Requip), rotigotine patch
rescue agent during off peiods: apomorphine
others: amantadine, safinamide (Xadago), bentropine (Cogentin)

Question 14

Alzheimer’s Background

Answer 14

s/sx: memory loss, getting lost, difficulty communicating, repeating words, inability to remember new info, difficulty planning/organizing, poor coordination, personality change, agitation, paranoia, hallucinations
dx: mini mental state exam score <24 = memory impairment

Question 15

Alzheimer’s Treatment

Answer 15

acetylcholinesterase inhibitors - increases Ach levels
donepezil (Aricept)
rivastigmine
s/e: nausea, insomnia
other: memantidine (Namenda) inhibits glutamate binding to NMDA receptors

Question 16

ADHD medications

Answer 16

CBT and stimulants 1st line
atomoxetine (Strattera) is non-stimulant
guanfacine (Intuiv), clonidine (Kapvay), benadryl added to stimulants, help with sleep
s/e: tachycardia, HTN, CVE, less appetite, weight loss
guanfacine and clonidine decrease BP, sedating

Question 17

Insomnia

Answer 17

CBT, sleep hygiene 1st line
do not use melatonin, benadryl, trazadone chronically
non-benzos: zolpidem (Ambien, Edular, Intermezzo), zaleplon (Sonata), eszopiclone (Lunesta) - s/e unusual actions while sleeping
orexin antagonist: suvorexant (Belsomra) - s/e abnormal dreams, sleep driving when not fully awake
melatonin agonists: ramelteon (Rozerem), tasimelteon (Hetlioz
antidepressants: doxepin (Silenor)
benzos: do not use age 65+ - beers list
antihistamines: Benadryl, doxylamine (Unisom) - avoid w/ BPH or glaucoma

Question 18

Restless Leg Syndrome

Answer 18

treat w/ dopamine agonist or gabapentin
pramipexole (Mirapex)
ropinirole (Requip)
rotigotine (Neupro patch)
dopamine s/e: orthostasis, somnolence, psych concerns
gabapentin encarbil (Horizant)

Question 19

Narcolepsy

Answer 19

Stimulants: modafinil (Provigil), armodafinil (Nuvigil)
sodium oxybate (Xyrem)