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Third Year Shelf > Psych > Flashcards

Psych Flashcards

1
Q

SSRI

A

Inhibits serotonin reuptake

Fluoxetine (Prozac)
Sertraline ( Zoloft)
Paroxitine (Paxil)
Citalopram (Celexa)
Escitalopram
Vilazadone
Vorioxtine
Fluovoxamine

Weight gain
Abdominal upset
Sexual side effects

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2
Q

SIGECAPS

A 
Sleep
Interest
Guilt
Energy
Concentration
Appetite
Psychomotor
Suicidal thoughts
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3
Q

Depression criteria

A

5/9 x2 weeks consistently

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4
Q

Transmitters involved in depression

A

Serotonin
NE
Dopamine

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5
Q

Eating disorder, anorexia tx

A

CBT, family therapy
Supervised weight gain programs

Fluoxetine (not effective)
(SSRI)

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6
Q

First choice for anxiety in pregnancy

A

Sertraline

SSRI

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7
Q

SNRI

  • types
  • MOA
  • Caution with
  • SE (3)
A

Venlafaxine
Duloxetine
Desvenlafexine

Inhibit NE, Serotonin, dopamine reuptake

Caution in HTN and heart issues increase NE

Weight gain
Sexual side effects
GI upset

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8
Q

Buproprion

  • type
  • MAO
  • SE
  • Helps with
  • CI
A

NDRI
NE and dopamine reuptake inhibitor

No weight gain or sexual side effects

Smoking cessation

CI: eating disorder and seizure disorder

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9
Q

TCA

  • examples
  • MAO
  • Lethal
  • SE (5)
A 
Nortriptyine
Amitriptyline
Dozepin
Imipramine
Clomipramine
Desipramine

Inhibit NE and serotonin

Lethal in overdose due to arrhythmia

Weight gain, drowsiness, hypotension, anticholinergic (red as a beet, dry as a bone, mad as a hatter)

ORTHOSTATIC HYPOTENSION

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10
Q

Atypical antidepressant

A

mirtazapine (Remeron)

  • alpha 2 antagonist
  • Increase NE and 5HT
  • antagonizing 5HT2/3 serotonin receptors
  • Sedation, WEIGHT GAIN, dry mouth

Trazondone

  • priaprism side effect
  • sleep inducing, anti anxiety
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11
Q

2nd gen antipsychotic

A

Abilify

partial agonist/ antagonist at dopamine receptor

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12
Q

DIGFAST

A 
Distractibility
irresponsibility: maxing out cards
Grandiosity
Flight of ideas
Agitation
Sleepless
Thoughtless
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13
Q

Bipolar tx

A

Depakote (irritable mania)
- bad in prego

Lithium (euphoric mania)

  • mood stabilizer
  • bad in prego
  • reduces suicide risk

Carbamazepine and valproic acid (mood stabilizer)

Lamotrigine (mood stabilizer)

Lamictal: maintenance

2nd gen antipsychotic (mania)

  • Latuda (bipolar depression)
  • risperidone
  • aripiprazole
  • olanzapine

Quetiapine [Seroquel] (bipolar depression)

Olanzapine/ Fluoxetine [Symbyax] (SSRI)

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14
Q

Lithium SE

A 
Ebstein abnormality (1st trimester)
- Tricuspid leaflet displaced inferiorly
- RV hypoplasia
- Tricuspid regurgitation or stenosis
- +/- patent foramen ovale
Sedation and dizziness
Tremors
Hypothyroid
Kidney issues
Acne vulgaris
DM insipidus
Sick sinus syndrome
Heart block
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15
Q

High QTC

A

470 or 480

Dont give antipsychotic

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16
Q

First generation antipsychotics

A

First gen

  • Halodol
  • Fluphenazine
  • Perpherazine (mid potency)
  • Chlorpromazine (low) - HAM, cornea deposit
  • Thioridazine (low) - HAM, retina deposit

High potency
- EPS

Low potency
- HAM
Sedation, anticholinergic, metabolic, hot dry, hypotension

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17
Q

Second Generation antipsychotics

A 
Risperdal (IM) (risperidone)
Invega (paliperadone) (IM)
Seroquel (quetiapine) 
Zyprexa (olanzapine) 
Abilify (aripiprazole) 
Geodon (ziprasidone)
Latuda (lurasidone)
Sappharis (asenapine) 
Fanept (Iloperidone) 
Rexalti (brexpiprazole)
Clozaril (clozapine)
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18
Q

Seroquel (quetiapine)

A

Low dose binds H1
300-600 bipolar
600-1200 schizophrenia

Increases QTC
QTC below 450 before prescribe

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19
Q

Olanzapine (zyprexa)

A

2nd most effect antipsycotic after clozaril

Alot of weight gain

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20
Q

Antipsychotic give if over weight

A

Abilify (aripiprazole)

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21
Q

Least metablic side effect of antipsychotic

A

Geodon ( ziprasidone)

prolongs QTC alot

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22
Q

Best antipsychotic for negative symptoms

Suicidality in schizophrenia

A

Clozapine

agranulocytosis, seizures, myocarditis, elderly standard warning, orthostatic hypotension

Excissive salivation most common

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23
Q

Antipsychotics with least side effect

A

Ability (aripiprazole)
Latuda (Lurasidone)
Geodon (ziprasidone)

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24
Q

Cluster A

A

Paranoid
- irrational suspicions and mistrust

Schizoid
- lack of interest in social relationships

Schizotypal
- odd behavior or thinking

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25
Q

CLuster B

A

Antisocial
- pervasive disregard for the law and rights of others

Borderline

  • instability in relationships, self image, identify or behavior
  • cut them selves

Histrionic

  • pervasive attention-seeking behavior, shallow or exaggerated emotions
  • bright colors, flirtatious

Narcissistic

  • pervasive pattern of gradiosity
  • need for admiration and lack of empathy
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26
Q

Cluster C

A

Avoidant
- social inhibition; feelings of inadequacy

Dependent
- pervasive psychological dependence on others

OCD
- rigid conformity to rules and moral codes

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27
Q

Indicated for depressive phase of bipolar

A

Quetiapine
Olanzapine/ fluoxetine
Cariprazine
Lurasidone

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28
Q

Drug recommend for all phase of bipolar

A

Quetiapine

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29
Q

Timeline schizophrenia

A

> 6 months

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30
Q

Timeline delusional disorder

A

> 1 month

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31
Q

Timeline for brief psychotic disorder

A

< 1 month

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32
Q

TImeline for schizophreniform disorder

A

1-6 months

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33
Q

Bugs crawling on you

A

Tactile hallucinations

ALcohol withdrawal or cocaine intoxication

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34
Q

Hallucinations when going to sleep or waking up

A

Narcolepsy

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35
Q

Schizophrenic brain (3)

A

Smaller
Enlarged ventricles
Thin cortex

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36
Q

Physiology of schizophrenia

A

Increased DA in mesolimbic

Decreased DA in mesocortical

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37
Q

Schizophrenia criteria

A

Psychosis

  • disorganized thought
  • disorganized speech
  • delusions (false beliefs, tv talking to you)
  • halluciinations
  • illusions (misinterpret something that is actually there, coat rack is person)

Decline in functioning
> 6 months

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38
Q

Schizoaffective disorder

A

Psychotic symptoms for >2 weeks in absence of mood disorder

Mood disorder later

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39
Q

Neuroleptic malignant syndrome

  • 5 features
  • due to what NT
  • due to what medication
A

** Not this is patient has normal vital signs**

Mental status changes (not psychosis)
- delirium

Muscle rigidity +/- tremor (lead pipe rigidity)

Hyperthermia

Rhabdomyolysis

Autonomic instability
- tachycardia, high blood pressure, tachypnea, diaphoresis

Due to dopamine

Due to antipsychotics (olanzpine)

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40
Q

Tx neuroleptic malignant syndrome

A

Dantrolene

Dopaminergic

  • Bromocriptine
  • Amantadine
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41
Q

Which antipsychotic is most closely associated iwth an increased risk of diabetes

A

Olanzapine

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42
Q

Side effect seen with increasing lithium

A

Tremor

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43
Q

Bipolar I

A

Manic episodes +/- major depression

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44
Q

Bipolar II

A

Hypomania episode

Episode of major depression

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45
Q

Tx postpartum psychosis

A

atypical antipsychotic

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46
Q

Persistent depressive disorder

A

> 2 years in adults
1 year in children

No more than 2 months w/o symptoms in 2 years

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47
Q

Stages of grief

A

DABGA

Denial 
Anger
Bargaining
Grieving (depression)
Acceptance
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48
Q

Tx OCD

A

CBT

Antidepressant
- SSRI
(Fluoxetine, sertraline, paroxetine, citalopram)
- SNRI
( venlafaxine, desvenlafaxine, duloxetine)

Clomipramine (TCA) (not first line)

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49
Q

TX Anxiety

A

Antidepressant

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50
Q

Tx PTSD

A

Antidepressant

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51
Q

SNRI for fibromyalgia

A

Milnacipran

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52
Q

Chronic pain tx

A

Duloxetine

SNRI

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53
Q

Tx generalized anxiety disorder

A 
First line
- CBT
- SSRI
- SNRI
(venlafaxine)
(desvenlafaxine)
(duloxetine

(Increase BP)

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54
Q

Enuresis Tx

A

Imipramine (TCA)

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55
Q

OCD tx

A

CBT
SSRI
Clomipramine (TCA)

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56
Q

Fibromyalgia tx

A

MIlnacipran (SNRI)

Amitriptyline (TCA)

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57
Q

Tx neuropathic pain

A

Amitriptyline

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58
Q

SE TCA

A 
Sedation
Hypotension
Dizziness
Anticholinergic
High dose --> QT prolongation
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59
Q

TCA overdose signs

Tx

A

Cardiotoxicity
- Tachycardia, hypotension, conduction abnormalities, arrthymias

CNS toxicity
- sedated, coma, seizures

Anticholinergic
- dry mouth, ileus, urinary retention, mydraiasis, blurred vision, hyperpyrexia

Tx: Sodium bicarbonate

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60
Q

SSRI, TCA, MAOI, NDRI, SNRI, Serotonin modulators

Amitriptyline
Bupropion
Citalopram
Clomipramine
Doxepin
Duloxetine
Fluoxetine
Imipramine
Nefazodone
Nortriptyline
Paroxetine
Phenelzine, Sertraline
Tranylcypromine
Trazodone
Venlafaxine
A 
Amitriptyline- TCA
Bupropion- NDRI
Citalopram- SSRI
Clomipramine- TCA
Doxepin- TCA
Duloxetine- SNRI
Fluoxetine- SSRI
Imipramine- TCA
Nefazodone- Serotonin modulators
Nortriptyline- TCA
Paroxetine- SSRI
Phenelzine- MAOI
Sertraline- SSRI
Tranylcypromine- MAOI
Trazodone- Serotonin modulators
Venlafaxine- SNRI
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61
Q

Antidepressant the causes appetite stimulant and weight gain

A

Mirtrazapine

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62
Q

Serotonin syndrome signs

A

Hyperreflexia and clonus
Hyperthermia
Autonomic instability
- Cardiovascular collapse, mental status changes

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63
Q

Priapism

A

pain persistent penile erection

Trazodone, nefazodone
serotonin modulators

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64
Q

Patient has calustrophobia drug to give

A

Benzodiazepine

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65
Q

Antidepressant to not use in over weight

A

Mirtazapine

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66
Q

Women with daily anxiety tx

Panic attack tx

A

Daily= generalized anxiety disorder
give SSRI

Panic attack= benzo

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67
Q

Conversion disorder

tx

A

Unexplained loss of sensory or motor function
(Tests and PE are negative)

Paralysis
Blindness
Mutism
(Following acute stressor)

tx education about illness

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68
Q

Panic disorder tx

A

CBT
SSRI
TCA (amitryptilline
Benzo (acute only)

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69
Q

Specific phobia tx

A

Systemic desensitization

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70
Q

Social anxiety disorder

A 
SSRI
Beta blocker (propranolol)

BEnzodiazepines (lorazepam)

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71
Q

PTSD vs acute stress disorder

Tx

A

PTSD > 1 month

ASD < 1 month

Psychotherapy
SSRI

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72
Q

Adjustment disorder

Tx

A

Identifable psychosocial stressor
< 6 months after stressor is gone

With in 3 months of identifiable stressor but lasting no longer than 6 months once stressor ceases

5/9 SIGECAPS

TX: psychotherapy

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73
Q

Tx generalized anxiety disorder

A

> 6 months

FIrst line:
SSRI
SNRI

Second line
Benzo
Buspirone (not many side effects)

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74
Q

Somatic symptom disorder

tx

A

Complaints in > or = 1 organ system

excessive anxiety and worry
> or = 6 months

regularly scheduled visits with a single primary care physician, who should minimize unnecessary medical workups and tx

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75
Q

Bulimina nervosa labs

A

Hypokalemic
Hypochloremic

Metabolic alkalosis

Non-anion gap metabolic alkalosis w/ respiratory compensation

Metabolic acidosis (laxative abuse)

Elevated bicarbonate
Incrased BUn
Hypernatremia
Increased amylase

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76
Q

Tx Bulimina nervosa

A

SSRI (fluoxetine)

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77
Q

ADHD medications

A

1st line

  • Mehtylphenidate
  • Dexmethylphenidate
  • Mix amphetamines
  • Dextroamphetamine

2nd line

  • atomoxetine (NE reuptake inhibitor)
  • clonidine
  • guanfacine
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78
Q

Hair pulling disorder

A

Trichotillomania

Education –> CBT –> Fluoxetine (SSRI) or Clomipramine (TCA)

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79
Q

Antisocial vs conduct disorder

A

Conduct < 18

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80
Q

Oppositional defiant disorder

A

Pattern of disobeying authority and hostile behavior

No serious violations of social norms
No disregard for rights of others
No destruction of property or cruelty to animals

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81
Q

Fixation

A

partially remaining at childish level of development

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82
Q

Reaction formation

A

Taking unacceptable thoughts and attempting to over exaggerate in opposite action

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83
Q

Projection

A

Taking unacceptable thoughts and believing that someone else has those thoughts

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84
Q

Displacement

A

Substitutes new aim/ object for something that is undesirable

man yells at family for bad day at work

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85
Q

Sublimation

A

unacceptable impulses or feelings transformed into socially acceptable actions

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86
Q

Suppression

A

Voluntarily choosing to not think about something

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87
Q

Medications for alcoholic

A

Naltrexone
Disulfiram (inhibit acetyaldehyde dehyrdogenase –> increase acetylaldehyde)
Topiramate
A camprosate

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88
Q

Reversal agent for benzo

A

Flumazenil
- blockade of GABAergic neurotransmission

Can cause seizure

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89
Q

Reversal agent for opioids

A

Naloxone

Naltrexone

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90
Q

Opioid withdrawal symptoms

A 
Sweating
Dilated pupils
piloerection
yawning
Rhinorrhea
Flu like

Tx:
Moderate: Clonidine (autonomic signs)
Severe: Methadone, suboxone

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91
Q

Amphetamine and cocaine overdose tx

A

Benzodiazepine (agitation)

Haloperiodol ( paranoid idealations)

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92
Q

Tx LSD overdose

Tx LSD reverse effects of drug

A

Overdose: Benzo

Reverse effects: Ziprasidone

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93
Q

Severe depression, HA, fatigue, insomnia/ hypersomnia, hunger

A

Cocaine and amphetamine withdrawal

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94
Q

Pinpoint pupils
N/V
Seizures

A

Opioid overdose

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95
Q

Belligerence, impulsivness, nystagmus, homicidal ideation, psychosis

A

PCP intoxication

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96
Q

HA

Anxiety depression

A

Nicotine or caffeine withdrawal

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97
Q

Anxiety, depression, delusion, hallucinations, flashblacks

A

LSD intoxication

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98
Q

Euphoria, social withdrawal, impaired judgement, hallucinations

A

Marjuana intoxication

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99
Q

Rebound anxiety, tremors, seizures, life thratening

A

WD from alcohol, benzo, or barb

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100
Q

Anxiety, piloerection, yawning, fever, rhinorhea, nausea, diarrhea

A

opioid withdrawal

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101
Q

Identification

A

Acting like the person you have positive thoughts towards (changing where you wear sthetoscope

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102
Q

Intellectualization

A

using logic or fact to emotionally distance onself from stressful situation

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103
Q

Schizophrenia tx first line

  • drug
  • SE of drug (2)
A

Risperidone

Hyperprolactinemia
Can get EPS
Tardive dyskinesia, orofacial chorea

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104
Q

Postpartum depression tx

A

CBT

SSRI

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105
Q

Grief lasts

A

< 6 months –> depression

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106
Q

ECT used in

A 
Treatment refractory depression
Depression with psychotic symptoms
Acutely suicidality
Catatonic
Not eating or drinking
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107
Q

Agoraphobia tx

A

CBT

SSRI

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108
Q

Body dysmorphic disorder tx

A

CBT

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109
Q

Acute stress disorder tx

A

3 days to 1 month

Tx: CBT

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110
Q

Transsexualism

A

Desire to live as opposite sex

Through surgery or hormones

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111
Q

Transvestism

A 
Paraphilia, not genderr dysphoria
Wearing clothing (vest) of the opposite sex (cross dressing)
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112
Q

Sleep terrors

A

Self limited

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113
Q

Narcolepsy tx

A

Daytime stimulants

  • Amphetamines
  • MOdafinil

Nighttime sodium oxybate (GHB)

Tx cataplexy: sodium oxybate

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114
Q

Narcolepsy criteria

A

Recurrent lapses into sleep or naps (>= 3 times/ week for 3 months)

> = 1 of the following:

  • Cataplexy : brief loss of muscle tone precipitated by strong emotions
  • low CSF levels of hypocretin-1
  • shortened REM sleep latency

Associated features

  • Hypnagogic or hypnopompic hallucinations
  • sleep paralysis
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115
Q

Stages of addictions (6)

A
  1. Precontemplation
  2. Contemplation
  3. Preparation
  4. Action
  5. Maintenance
  6. Relapse
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116
Q

Delirium tremens signs

Tx

A

2-4 days after last drink

Tachycardia
Tremors
Anxiety
Seizurs
Electrolyte disturbances
Respiratory alkalosis

Tx: Benzo (chlordiazepoxide, lorazepam, diazepam)

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117
Q

Tourette syndrome tx

A

First line: aripiprazole

Antipsychotics (haloperidol, fluphenazine, pimozide)
Tetraenazine
alpha 2 agonist (guanfacine, clonidine)
Atypical antipsychotics

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118
Q

EPS

  • hours to days
  • days to months
  • months to years
  • tx
A

ADAPT

Hours to days: Acute Dystonia
(Muscle spasm, stiffness, oculogyric grisis) (prolonged involuntary gaze upward)
- Benztropine
- Diphenhydramine

Days to months: Akathiasia, Parkinsonism
(restlessness, bradykinesia)
- Beta blockers
- Benzodiazepine (lorazepam)
- Benztropine
---
-Benztropine
- Amantadine

Months to years: Tardive dyskinesia
(orofacial chorea)
- Valbenazine
- Deutetrabenazine

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119
Q

Typical antipsychotics

A

-azine

High potency: Try to Fly High
Trifluoperazine, Fluphenazine, Haloperiodol,
- EPS

Low potency: Cheating Thieves are low
Chlorpromazine, Thioridazine
- anticholinergic

hyperprolactinemia (amenorreha, galactorreha, gynecomastia)
Weight gain, dyslipidemia, hyperglycemia

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120
Q

Atypical antipsychotics

A

-apine, -peridone, -idone

Aripiprazole, asenapine, clozapine, olanzapine, quetiapine, iloperidone, paliperidone, risperidone, lurasidone, ziprasidone

Prolong QT
Fewer EPS and anticholinergic
"pines"- metabolic syndrome 
(weight gain, diabetes, hyperlipidemia) 
Clozapine: agranulocytosis
Ripseridone: hyperprolactinemia (amenorreha, galactorreha, gynecomastia)

Olanzapine= obesity

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121
Q

LiTHIUM

A

Low Thyroid (hypothyroid)
Heart (Epstein anomaly)
Insipidus (nephrogenic diabetes insipidus)
Unwanted Movements (tremor)

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122
Q

SSRI (6)

A
  • xetine, -alopram
Fluoxetine
Fluvoxamine
Paroxetine
Sertraline
Escitalopram
Citalopram

Depression, anxiety, panic, OCD, bulimia, PTSD, premature ejacuation, premenstrual dysphoric disorder

GI distress, SIADH, sexual dysfunction

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123
Q

SNRI (5)

A 
Venlafaxine
Desvenlafaxine
Duloxetine
Levomilnacipran
Milnacipran

Diabetic neuropathy, depression, anxiety,

Venlafaxine (social anxiety, panic, PTSD, OCD)
Duloxetine (fibromyalgia)

SE: Increase BP

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124
Q

TCA (7)

A 
Amitriptyline
Nortriptyline
Imipramine
Desipramine
Clomipramine
Doxepin
Amoxapine

Depression, OCD (clom), peripheral neuropathy, chronic pain, migrane prophylaxis, Noctural enuresis (imipramine)

SE: sedation, hypotension, anticholinertic like, prolong QT

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125
Q

MAOI

A 
MAO Takes Pride In Shanghai
Tranylcypromine
Phenelzine,
Isocarboxazid
Selegiline

Atypical depression
Anxeity
Parkinson (selegiline)

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126
Q

Clonazepam

A

Benzo

Tx anxiety and panic attacks

Avoid w/ renal dysfunction

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127
Q

Gender dysphoria

A

> 6 months doesnt feel like gender from birth

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128
Q

Flushed, hyperreflexive, diaphoratic, occasional myoclonus, disorientated, seizure

Took pill

A

Ecstasy

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129
Q

Major Depressive disorder TX

A

SSRI

If SSRI doesnt work
SNRI or NDRI (Buproprion)

Last resort: TCA

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130
Q

Patient on risperidone, increased dose now smiles less and slowed down. Mild tremor and doesnt swing arms when walking

TX

A

Continue Risperidone and add benztropine

anti-psychotic induced parkinsonism

Tx anticholinergic antiparkinism benztropine or amantadine

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131
Q

Sudden sustained contraction of neck, mouth, tongue and eye muscles

Tx

A

Acute dystonia

Benztropine
Diphenhydramine

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132
Q

Subjective restlessness, inability to sit still

Tx

A

Akathisia

Beta blocker (propranolol)
Benzodiazepine (lorazepam)
Benztropine

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133
Q

Gradual onset tremor, rigidity and bradykinesia

Tx

A

Parkinsonism

Benztropine
Amantadine

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134
Q

Gradual onset after prolonged therapy (> 6 months). Dyskinesia of the mouth, face, trunk and extremities

A

Tardive dyskinesia

Discontinue medication
Switch to quetiapine or clozapine

Treat with Valbenazine
Deutetrabenazine

Caused by dopamine receptor D2 upregulation and supersensitivity

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135
Q

Zolpidem

A

non-benzodiazepine sleep medication

selective receptor binding to the omega 1 receptor on the GABA-A receptor

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136
Q

Disruptive mood dysregulation disorder

A

Disproportionate verbal or physical outbursts

Onset before age 10

Persistent irritability or anger inbetween episoes

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137
Q

MDD physiology

A

Increased serum cortisol concentration

Hyperactivity of the hypothalamic pituitary adrenal axis results in rising cortisol levels

Hyperactivity of the HPA axis leads to blunted response tot he dexamethasone-suppression test

Also adrenal gland hypertrophy

A blunted response to infusion of thyrotropin release hormone

Elevated levels of thyrotropin releasing hormone in CSF

Sense of well-being and increased relaxation when thyrotropin releasing hormone is administed

Blunted response to serotonin stimulation of prolactin release

Blunted response to sleep induced stimulation of growth hormone release

Decreased amounts of somatostatin in the CSF

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138
Q

Patient with history of bipolar, leaves arm raised and wont talk

A

Catatonia

Benzodiazepines (lorazepam)
ECT

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139
Q

Complex motor behaviors that occur during REM sleep

A

Rapid eye movement behavior disorder (RBD)

Degeneration of the brainstem nuclei responsible for inhibiting spinal motor neurons during normal REM sleep

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140
Q

Insight orientated psychotherapy

A

focuses on uncovering unconscious patterns originating in childhood experiences

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141
Q

What is helpful in schizophrenia patients besides medication

A

Family intervention

CBT

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142
Q

Tx Lithium toxicity

A

Hemodialysis

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143
Q

Benzo overdose tx

A

Flumazenil

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144
Q

CBT treats

A 
Depression
Anxiety
PTSD
Panic
OCD
Eating disorder
Negatie thoughts pattern
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145
Q

Interpersonal psychotherapy treats

A

Depression

Links symptoms to current relationship confilcts and interpersonal skill deficits

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146
Q

Highter functioning

Personality disorders use what treatment

A

Psychodynamic psychotherapy

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147
Q

Motivational interviewing for what

A

Substance use disorders

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148
Q

Use what for borderline personality disorders

A

Dialectical behavioral therapy

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149
Q

What what treatment modality for pain disorders

A

Biofeedback

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150
Q 
Psychological features
Depression
Fatigue
Hypersomnia
Increased dreaming
Hyperphagia
Impaired concentration
A

Cocaine withdrawal

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151
Q 
Anxiety
Insomnia
Tremors
Tachycardia
HTN
A

Alcohol withdrawal

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152
Q

Dysphoria
Myalgia
Yawning
Abdominal cramping

A

Opioid withdrawl

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153
Q 
Dieting
Hallucinations
Abominal pain
Constipation
Tingling sensation in finger tips
A

Acute intermittent porphyria

Elevated urinary porphobilinogen levels

Painful abdomen
Port wine colored urine
Polyneuropathy
Psylogical disturbances
Precipitated by  Drugs, alcohol and starvation
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154
Q

Alcohol withdrawal symptoms (5)

A 
Anxiety
Insomnia
Tremors
Tachycardia
HTN
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155
Q

Opioid withdrawal symptoms (4)

A

Dysphoria (dissatifcation with life)
Myalgia (muscle pain)
Yawning
Abdominal cramping

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156
Q

Bipolar
Fatigue
Constipation
Myalgias

What medication

A

Lithium

Lithium induced hypothyroidism

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157
Q

TCA side effect

A

Constipation
Drowsiness
other anticholinergic

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158
Q

Social anxiety disorder main tx

A

Beta blockers (propranolol)

Before benzo

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159
Q

Gourmet meal with wine and heavy sauces

Headache

A

Phenelzine (MAOI)

HTN crisis

Dont eat foods with tyramine

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160
Q

Patient with retrograde and antegrade amnesia with intact long-term memory, alcohol use history

A

Korsakoff syndrome

Thiamine deficiency

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161
Q

Associated iwth MS

A

Depression

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162
Q

Hoarder treatment

A

CBT

Maybe SSRI

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163
Q

Intense anxiety that the penis will reced into the body, possibly leading to death

A

Koro

Southeast Asia (Singapore)

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164
Q

Sudden unprovoked outbursts of violence, often followed by suicide

A

Amok

Malaysia

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165
Q

Headache, fatigue, eye pain, cognitive difficulties and other somatic disturbances in male students

A

Brain fag

Africa

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166
Q

Mood disorders with mixed features

A

Irritability is predominant mood state

Poor response to lithium

Anticonvulsants such as valproic acid may be more helpful

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167
Q

Substance/ medication- induced depressive disorder (11)

A 
EtOH
Antihypertensives
Barbiturates
Corticosteroids
Levodopa
Sedative-hypnotic
Anticonvulsants
Antipsychotics
Diuretics
Sulfonamides
Withdrawal from stimulants (cocaine, amphetamines)
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168
Q

Substance/ medications- induced bipolar disorder (8)

A 
Antidepressants
Sympathomimetics
Dopamine
Corticosteroids
Levodopa
Bronchodilators
Cocaine
Amphetamines
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169
Q

Tx MDD with atypical features

A

SSRI first line

MAOIs (phenelzine)

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170
Q

Anhedonia

A

inability to experience pleasure

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171
Q

Physiology in depressed patient

A

Decrease in CSF levels of 5-hydroxyindolacetic acid (5-HIAA) the main metabolite of serotonin

High cortisol due to hyperactivity of HPA axis

Abnormal thyroid axis

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172
Q

MAOI Side effect

A

Hypertensive crisis w/ tyramine rich foods

Serotonin syndrome when mixed with SSRI

Orthostatic hypotension

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173
Q

Triad for seasonal affective disorder

A

Irritability
Carbohydrate craving
Hypersomnia

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174
Q

MDD atypical features (5)

A 
Hypersomnia
Hyperphagia
Reactive mood
Leaded paralysis
Hypersensitivity to Interpersonal rejection
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175
Q

Bereavement

A

Simple grief
Reaction to major loss

Self limiting

Last several months

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176
Q

Pregnant patient with manic episode tx

A

ECT

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177
Q

Patient with history of postpartum mania tx

A

Mood stabilizers prophylaxis

Lamotrigine

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178
Q

Persistent depressive disorder

A

Dysthymia

Two of more of:
CHASES
Poor Concentration or difficulty making decisions
Feelings of Hopelessness
Poor Appetite or overeating
InSomnia or hypersomnia
Low Energy or fatigue
Low Self-esteem

2 years of depression

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179
Q

Premenstrual dysphoric disorder tx

A

SSRI first line daily or lutela phase tx

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180
Q

Delirium tremens use what

A

Lorazepam

Dont use Diazepam or chlordiazpoxide in patient with possible liver damage

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181
Q

Fetal alcohol vs downs syndrome

A

Fetal alcohol

  • heart murmer
  • low IQ
  • Low height and weight
  • thin upper lip
  • short palpebral fissures
  • smooth philtrum
  • Emotional reactivity

Downs syndrome

  • epicanthal folds
  • upslanting palpebral fissures
  • flat nasal bridge
  • protruding tongue
  • intellectual disability
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182
Q

Seizure with eyes closed, absence of self-injury, incontinence or confusion

A

Psychogenic nonepileptic seizure
- conversion disorder

Tx videoelectroencephalogram monitoring

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183
Q

Generalized tonic clonic seizures characterized by

A

Abrupt loss of consciousness followed by stiffening of muscles throughout the body

Rhythmic jerking of extremities

Eyes are open

Postictal confusion upon awakening

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184
Q

Insomnia causing significant functional impairment

Tx

A

Short term pharmacotherapy

Lorazepam

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185
Q

Anorexia criteria for hospitalization

A

Pulse < 40/min
BP < 80/60
hypokalemia
hypophosphatemia

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186
Q

Hospitalized 12 hrs afterwards psychosis and paranoid

A

Alcoholic hallucinosis

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187
Q 
Depression 
Anxiety
recent onset diabetes
Decreased appetite
Smoker
A

Pancreatic cancer

CT of abdomen

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188
Q

Normal aging

A

Word-finding aphasia
Sleep disturbance
Forgetting to take medication

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189
Q

ADHA treatment thats non-addictive

A

Atomoxetine

Clonidine and guanfacine tx ADHD in children but not adults

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190
Q

Manic episode treatment

A

Lithium

If level of creatinine high then valproate (renal failure)

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191
Q

Low blood pressure

2 mm pupils

A

constricted pupils (miosis)

Opioid intoxication

Naloxone

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192
Q

Naltrexone

A

Maintenance treatment for opioid use disorder
-blockade of opioid receptors in the endorphin system

Slower onset

Not for acute opioid intoxication

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193
Q

Bipolar tx with rash

A

Lamotrigine

mood stabilizer

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194
Q

Normal pupil size

A

2-4 mm

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195
Q

Specific phobia tx

A

CBT exposure therapy
(first line)

Benzo

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196
Q

Ziprasidone

A

Geodon

No side effects

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197
Q

MDD Sleep traits

A

Decreased REM sleep latency (the time from sleep onset until the start of the first REM sleep period

Decreased slow wave sleep

Increased total REM sleep duration

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198
Q

Hyperprolactinemia

A

Risperidone

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199
Q

Clozapine causes

A

agranulocytosis

Check for neutropenia

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200
Q

Risperidone MOA

A

Serotonin 2A and dopamine D2 receptor blockade

All second gen antipsychotics

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201
Q

Dopamine reuptake inhibition and stimulation of dopamine release

A

Stimulants for ADHD

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202
Q

Norepinephrine and dopamine reuptake inhibition

A

Antidepressant bupropion

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203
Q

Serotonin and norepinephrine reuptake inhibition

A

Venlafaxine

SNRI and TCA

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204
Q

Neuroleptic malignant syndrome

A

FEver > 40 (104)
Confusion
Muscle rigidity (generalized)
Autonomic instability (sweating, abnormal vital signs)

Elevated creatine kinase

Tx Dantrolene, bromocriptine

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205
Q

Physiology associated with suicidal behavior

A

Low levels of 5-hydroxyindoleacetic acid (5-HIAA) in CSF

Metabolite of serotonin

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206
Q

Hydrocephalus ex vacuo on CT

A

Neurodegenerative conditions (Alzheimer disease) leads to cortical atrophy

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207
Q

How long to take antidepressant

A

additional 6 months in patients with single episode of depression

Maintain at level of remission

Then taper

If patient at high risk for recurrence (>2 episodes) then maintenance for 3 years

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208
Q

Medication that causes seizures after abruptly stopping

A

Benzo

Alprazolam

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209
Q

Hepatotoxicity medication

A

Valproate (mood stabilizer)

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210
Q

False positive for Phencyclidine

A 
Dextromethorphan (cough suppressant) 
Diphenhydramine
Ketamine
Tramadol
Venlafaxine
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211
Q

False positive for Amphetamine

A

Atenolol
Propranolol
Bupropion
Nasal decongestants

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212
Q

Excessive anxiety and preoccupation with >1 unexplained symptoms

A

Somatic symptom disorder

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213
Q

Postpartum psychosis tx

A

Hospitalization

Anti-psychotic (2nd gen)

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214
Q

Delusional disorder

A

Does not include mood symptoms or they are brief

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215
Q

Avoidant personality disorder

A

Avoidance due to fear of criticism and rejection

216
Q

Patient see repeat images of stabbing her mother

Count downs to eliminate images

A

OCD

Tx: SSRI

217
Q

Patient with repeat abdominal pain. Negative abdodminal CT

A

Somatic symptom disorder

Tx: Regular scheduled visits with same provider

218
Q

Alzheimer characteristics

A

Early short term memory loss
Language deficits
Later personality changes

219
Q

Vascular dementia characteristics

A

Stepwise decline
Early executive dysfunction
Cerebral infarct/ deep white matter changes on neuroimaging

220
Q

Frontotemporal dementia characteristics

A

Early personality changes
Apathy, disinhibition and compulsive behavior
Frontotemporal atrophy on imaging

221
Q

Dementia with Lewy bodies characteristics

A

Visual hallucinations
Spontaneous parkinsonism
Fluctuating cognition

222
Q

Normal pressure hydrocephalus characteristics

A

Ataxia early in disease
Urinary incontinence
Dilated ventricles on neuroimaging

223
Q

Prior disease characteristics

A

Behavioral changes
Rapid progression
Myoclonus and or seizures

224
Q

Patients of traumatic events are at risk for

225
Q

How to reduce long term misuse of opioids in patient

A

Query the prescription drug- monitoring database at each visit

Random drug urine screen

Follow up visit every 3 MONTHS

226
Q

Diabetic neuropathy SSRI

A

Duloxetine

227
Q

Neuropathic pain SSRI

228
Q

Bipolar plus hypercalcemia medication

229
Q

Antipsychotic medication effects

- Antipsychotic efficacy the pathway effected

A

Decreased Dopamine in mesolimbic

230
Q

Antipsychotic medication effects

- EPS pathways

A

Decrease in Dopamine in nigrostriatal

231
Q

Antipsychotic medication effects

- Hyperprolactinemia pathway

A

Decrease Dopamine in tuberoinfundibular

232
Q

Increased dopamine in mesolimbic

A

Euphoric and psychotic symptoms

233
Q

Rapidly progessive dementia what is seen with labs/ imaging

A

Creutzfeldt-Jakob disease

Periodic sharp wave complexes on EEG
Positive 14-3-3 CSF assay
Caudate nucleus/putamen MRI findings

Spongiform changes
Neuronal loss without inflammation

234
Q

Creutzfeldt Jakob disease characteristics

Tx

A

Rapidly progressive dementia

> 2/4

  • Myoclonus (startle-induced arm jerking)
  • Akinetic mutism
  • Cerebellar or visual disturbances
  • Pyramidal/ extrapyramidal dysfunction (hypokinesia)

Tx: None

235
Q

Low alpha-synuclein

A

Parkinson disease

Dementia with Lewy bodies

236
Q

Tx Absence seizures

A

Ethosuximide

237
Q

Asain with facial flushing

A

Polymorphisms in acetaldehydre dehydrogenase, commonly found in asian populations

238
Q

Early manifestations of word finding difficulties

A

Dominant temporal lobe

Frontotemporal dementia (FTD)

239
Q

2nd generation antipsyhotic iwth QT prolongation

A

Ziprasidone

240
Q

Ziprasidone SE

A

Neutral weight

QT prolongation

241
Q

Quetiapine SE

A 
Cataracts
Orthostatic hypotension (Beware in elderly)
Prolongation of QT
242
Q

Olanzapine SE

A

Weight gain

Metabolic syndrome

243
Q

Thiamine deficiency in alcoholics progression

A

Confusion, ataxia, ophthalmoplegia

–> Amnestic disorder (retrograde and anterograde)

Cant learn new information

244
Q

Rationialization

A

Patient excusing or justifying an attitude or event by developing an alternate explanation or shifting the blame

Man speed who crashes into other drive. Other drives fault for not paying attention

245
Q

Antipsychotic not working now smoking cigarettes

A

Hydrocarbon-induced induction of antipsychotic drug metabolism

P450 system

Olanzapine
Clozapine

246
Q

Dissociative fugue

A

Abrupt travel or wondering associated with traumatic event

247
Q

Involuntary contraction of small muscles groups like repeated contraction of fingers in one hand

A

Tardive dyskinesia

248
Q

Increased thirst in bipolar patient

A

Primary polydipsia

Increase thirst
Normal serum electrolytes
Dilute urine

249
Q

Drugs that induce schizophrenia

A

Marijuana
PCP
Ketamine

250
Q

Lamotrigine SE

A

Mood stabilizer for bipolar

Stevens Johnson syndrome (10% of body rash)
Toxic epidermal necrosis (30% of body w/ rash)
(Rash of mucous membranes)

Valproate inhibits metabolism of lamotrigine –> accumulation

251
Q

Channeling uncomfortable thoughts or emotions into more acceptable behavior

A

Sublimation

Acting out is always a negative reaction

252
Q

Celecoxib

A

NSAID COX2 selective

Doesnt cause GI effects

Not for psychiatric and/or neuropathic pain

Used for inflammatory pain and osteoarthritis

253
Q

Chronic alcohol use physiology

A

Enhancement of GABAergic neurotransmission –> downregulation of GABA RECEPTOR activity

254
Q 
Constipation
Dry skin
Weight gain
Sleepiness
Decrease appetite
Trouble concentrating
A

Hypothyroidism

Brittle hair*

255
Q

Addison disease characteristics

A 
Hypotension*
Weight loss
Fatigue
Anhedonia (inability to feel pressure) 
GI symptoms
Hypoglycemia
256
Q

Cushing syndrome characteristics

A

Depressed mood
Weight gain
Moon facies
Buffalo hump

257
Q

Poor prognosis in schizophrenia

A 
Onset before 25
Negative features
Family hx of schizophrenia (not mood disorders) 
Poor social/ family support
Male sex
Poor functioning before onset
258
Q

Opioid withdrawal 2 hrs after oral intake of drug

A

Buprenorphine

  • partial opioid agonist
  • trigger withdrawal

(Naloxone injection works 20-30 min)

259
Q

Clonidine

A

Treat autonomic symptoms of opioid withdrawal

No role in precipitating a withdrawal syndrome

260
Q

Methadone

A

Long acting opioid receptor agonist

Opioid maintenance therapy

Traditional opioid agonist

Doesnt cause withdrawal syndrome

Can cause QTC prolongation
- get ECG

261
Q

Naloxone

A

Rapid acting opioid antagonist

20-30 min effect

Tx opioid overdose

IV or intranasally

262
Q

Naltrexone

A

Competitive Opioid antagonist

Longer half-life than naloxone

Oral and IM

Precipitates withdrawal if used within 7 days of heroin use

263
Q

Buprenorphine

A

Partial opioid agonist

Sublingual

Used in a taper dose to prevent withdrawal symptoms in opioid users

If taken after significant opioid dose can precipitate withdrawal by displacing the drug from mu opioid receptors

Can precipitate withdrawal if used too soon after full opioid agonists

264
Q

Serotonin syndrome caused by

A

SSRI and MAOIs

St John’s wort

Meperidine

Myoclonus
Hyperreflexia
Rigidity
Termor
Seizures
Flushing
Hyperthermia
Dilated pupils
Tachycardia
HTN
265
Q

Night blindness

A

Thiordazine (retina deposit)

More common than cornea deposit in chlorpromaxine

266
Q

Unconscious and repressed drives and emotions from childhood are brought to consciousness

A

Psychoanalysis

3x per week
for 5 years

267
Q

Brief dynamic psychotherapy

A

High functioning patient with a focal and circumscribed area of conflict

Addressed in 10-20 sessions

High level of motivation

268
Q

Cognitive therapy

A

Depression

Panic, OCD, somatoform

Take maladaptive and faulty views of oneself and world are source of affects and behaviors

Identify and modify cognitions

269
Q

Interpersonal psychotherapy

A

short term tx for MDD

Depressive symptoms are interpersonal conflicts

Patients problems categorized into four areas: unresolved grief, social role disputes, social role transitions, interpersonal deficits

270
Q

Focus is on the here and now. Focus on patients current dynamic conflicts rather than on childhood conflict.

A

Psychodynamic psychotherapy

271
Q

Avoiding social situations with panic attacks

A

General social phobia

Avoidant personality disorder dont have panic attacks

272
Q

Memantine

A

NMDA antagonist

Slowing down disease progression with dementia

Antagonist at NDMA receptors with pupose of reducing NMDA-medicated neurotoxicity

273
Q

Donepezil

A

Cholinesterase inhibitors

Rivastigmine
Galantamine

Reducing destruction of ACh in synaptic cleft

Can lead to bradycardia and hypotension

274
Q

Tx Dementia

A

Donepezil
Rivastigmine
Galantamine
(Cholinesterase inhibitors)

Memantine (NMDA antagonists)

275
Q

Alprazolam

276
Q

Taper of benzo

A

Chlordiazepoxide

- long acting benzodiazepine to manage withdrawal

277
Q 
Irritability
Anxiety
Depression
Mood lability
Impair concentration/ cognition
A

Hypercalcemia

278
Q

Hyponatremia is psychiatry

A

Syndrome of SIADH

SE of carbamazepine and rare SSRI

279
Q

Bed wetting normal until age

280
Q

Man who like risky behavior becomes stunt man

A

Sublimation

281
Q

Labile affect and mood
Interpersonal difficulties

Session focus on life threatening behaviors

Therapy interfering and quality of life interfering behaviors

Weekly group for skills training in emotional regulation, distress tolerance, interpersonal effectivenss and Zen-like mindfulness

1 year commitment

A

Dialectical behavior therapy (DBT)

Borderline personality disorder

282
Q

Interpersonal difficulties and excessive emotionality or expansive cognitive styles

A

Histrionic PD or narcissistic PD

Tx Psychoanalytic psychotherapy
- focus on current conflicts and dynamic patterns

283
Q

Increased seizure activity w/o epileptic stressor is concern for

A

Psychogenic non-epileptic seizures (PNES)

Related to emotional stress

Prolactin distinguish between epileptic and psychogenic seizures
(Elevated prolactin level found in genuine seizure)

284
Q

Haloperiodol
Citalopram
Methadone

A

Prolonged QT

Antidepressants

  • Citalopram
  • Escitalopram
  • TCA

Antipsychotics

  • Haloperiodol (highest when IV)
  • Ziprasidone
  • Thioridazine

Opiates
- Methadone

285
Q

Anticholinergic intoxication drugs

A

TCA
Paroxetine
Sleep aids

Vasodilation
Anhidrosis (dry)
Hyperthermia (hot)
Mydriasis (blind) 
Delirium
286
Q

Increased cytochrome P450 mediated metabolism drug

A

Carbamazepine

287
Q

Neuroleptic malignant syndrome drugs

A

Haloperidol
Metoclopramide

Rigidity
Fever
autonomic instability
delirium

288
Q

Serotonin syndrome drugs

A 
Dextromethorphan
Tramadol
Meperidine
Amphetamines
linezolid
SSRI
289
Q

Sleep techniques (10)

A

Avoid bed unless sleep and sex

Go to bed quickly upon experiencing sleepiness

Only go to bed when sleepy

Cant sleep in 20 min, lead bed and do relaxing activity

Avoid daytime nap

Eat at regular intervals throughout day

NO caffeine after lunch

Exercise

Wind down by reading book

Wake up same time every day

290
Q

Drug for nightmares w/ SSRI

291
Q

Nicotine withdrawal symptoms

A

Constipation
Irritable
Headache
Fatigue

292
Q

Depression cant use SSRI, SNRI, Bupropion

A

Trazodone

- insomnia

293
Q

First line for hypersomnia

294
Q

Hallucinogens work on what system

295
Q

Cocaine work on what system

A

Dopamine receptors

296
Q

PCP works on what system

A

NMDA receptors

Glutamate

297
Q

Amphetamines work on what system

A

Dopamine receptors

298
Q

Ketamine works on what system

A

NMDA receptors

299
Q

Capgras syndrome

A

delusional syndrome characterized by belief that a familar person is replaced by imposter

Schizophrenia

300
Q

belief that the patient is entirely dead or putrefying or that parts of them (Blood, organs ) are missing or dying

Believes nothing exists

A

Cotard syndrome/ delusion

301
Q

Shared psychotic disorder/ delusion.

A

Folie a deux

302
Q

delusional syndrome characterized by belief that a familar person is replaced by imposter

A

Capgras syndrome

303
Q

Belief that several different people/ strangers are actually one person

Usually familiar individual or persecutor who is in disguise or can change his/her appearance

A

Fregoli syndrome

304
Q

Cotard syndrome/ delusion

A

belief that the patient is entirely dead or putrefying or that parts of them (Blood, organs ) are missing or dying

Believes nothing exists

305
Q

Folie a deux

A

Shared delusion

306
Q

Fregoli syndrome

A

Belief that several different people/ strangers are actually one person

Usually familiar individual or persecutor who is in disguise or can change his/her appearance

307
Q

Refeeding syndrome

A

Food intake insulin Ž hypophosphatemia, hypokalemia, hypomagnesemia Ž

cardiac complications, rhabdomyolysis, seizures.

Look for fluid retention and decreased levels

  • phosphorus
  • magnesium
  • calcium
308
Q

Buspirone

A

Generalized anxiety disorder

Anxiolytic

Partial agonism of serotonin receptors

Doesnt caused sedation, addiction or tolerance

Doesnt not interact w/ alcohol

309
Q

ADHD neurotransmitters

A

Dopamine

Norepinephrine

310
Q

Tetrabenazine

A

Huntington disease

Inhibit vesicular monoamine transporter (VMAT)

Decrease dopamine vesicle packaging and release

311
Q

Riluzole

A

ALS

Decrease glutamate excitotoxicity

312
Q

Blockade of postsynaptic dopamine receptors

A

Antipsychotics

313
Q

Global impairment of serotonergic neurotransmission

A

Pathophysiology of MDD

314
Q

Localized loss of neurons in the caudate nucleus

A

Movement symptoms in Huntington’s disease

315
Q

Localized loss of neurons in substantia nigra

A

Decrease in dopaminergic neurotransmission that causes movement symptoms of Parkinson’s disease

316
Q

Drug of choice for supervised heroin withdrawal inpatient

A

Buprenorphine

317
Q

Drug of choice for supervised opioid withdrawal taken at home

A

Buprenorphine/ naloxone

Nloxone component prevents abuse of buprenorphine

318
Q

Heroin withdrawal acute setting

319
Q

Heroin withdrawal med in prison

A

Clonidine (alpha 2 adrenergic agonist)

Lofexidine

320
Q

Chlordiazepoxide

A

Reduce anxiety and agitation due to sedative GABAergic effects

Alcohol withdrawal

321
Q

Chlorpromazine

A

Dopamine antagonist

Originally antipsychotic no longer used dues to EPS

Reduce vomiting and diarrhea

Orthostatic hypotension
Blue gray skin discoloration
Corneal and lens deposits
Photosensitivity
Intractable hiccups
322
Q

Diphenhydramine in withdrawal

A

Antihistamine used to manage pruritus in opioid withdrawal

Causes sedation

323
Q

Ketorolac

A

Pain management

Potent NSAID

324
Q

First line tx for tics in Tourette syndrome

A

Aripiprazole
(partial agonist at D2 dopamine receptors)

FDA approved: Haloperidol and pimozide

Pimozide is often correct answer on test

Habit reversal training

[Guanfacine first choice according to book?]

325
Q

Patient with bipolar on lithium that wants to get pregnant

A

Continue medication at current dose

326
Q

Labs seen with chronic alcohol abuse

A

Macrocytic anemia

Due to dietary folate deficiency and alcoholic effect on gastric synthesis of intrinsic factor causing deficiency in Vit B 12

327
Q

Alcoholic liver enzymes

A

AST x2 to ALT

328
Q

Diffuse cerebral atrophy

A

Alzheimers dementia
Lewy body dementia
Some cases of vascular dementia

329
Q

Delusions of reference

A

Type of delusion in which the patient believes that he/she is receiving special coded message via the media

Mania
Psychotic depression
Primary psychosis

330
Q

Panic disorder with agoraphobia

A

Avoid places from which it would be difficult to escape in the event of panic attack

331
Q

MAOI

A

Isocarboxazid
Tranylcypromine
Phenelzine
Selegiline (selective MAO-B inhibitor)

332
Q

Isocarboxazid

333
Q

HTN crisis

Tx

A

MAOI
Pseudoephedrine (sympathomimetics)
Tyramine

Tx: Phentolamine

Sympathomimetics

  • albuterol
  • terbutaline
  • dobutamine
  • dopamine
  • epinephrine
  • midodrine
  • amphetamine
  • cocaine
  • ephedrine
334
Q

SSRI discontinuation syndrome

A

Seen most commonly in antidepressants with shorter half lives

Fluvoxamine
Paroxetine
Venlafaxine

“Electric shocks”

Fluoxetine

  • half life 4-6 days
  • tx of choice
335
Q

Delusion disorder

A

Delusions in absence of other psychiatric symptoms or functional impairment

No history of mental illness

336
Q

Grandiose delusion

A

“grand role”
Special abilities

Mania
Schizophrenia

337
Q

Belief that the patient is the subject of malice perpetrated by others

A

Persecutory delusions

Schizophrenia
Primary psychotic disorders

338
Q

Alprazolam

Diazepam

A

Oral outpatient tx

Alprazolam: acute anxiety

Diazepam: alcohol withdrawal

339
Q

Midazolam

A

Fastest acting benzo

Reduce anxiety prior to anesthesia

Emergency setting as a rapid abortive tx for status epilepticus

340
Q

Temazepam

A

Slower onset and long duration of action

Intermittent insomnia

341
Q

Tx individual episodes of panic attacks

A

Alprazolam

342
Q

Depression NT

  • Other feature
A

Decreased amount of Serotonin
Decreased Norepinephrine
Decrease Dopamine

Hypothalamic dysfunction

343
Q

Mania NT

A

Increased Dopamine

344
Q

Schizophrenia NT

A

Increased Dopamine in prefrontal cortex

345
Q

OCD NT

A

Low Serotonin

346
Q

Anxiety disorder NT

A

Low Serotonin

Low GABA

347
Q

Benzodiazepines target

348
Q

Benztropine

A

Improve tremor

349
Q

St. Johns wort

A

Antidepressatn due to SSRI like effect

350
Q

Bipolar I w/ rapid cycling

A

1 episode of mania in addition to three other mood disturbances within 1 year

Mania
Hypomania
Major depression
Mixed episode

351
Q

Mania

A

DIGFAST

Distractibility
Impulsive behavior
Grandiosity
Flight of ideas
Activity/ agitation
Sleep disturbance
Talkativeness (pressured speech)

3 symptoms for 1 week or any duration if hospitalized

352
Q

Bulimia labs

A

Decreased potassium
Elevated BUN
Normal creatinine
Increased amylase (parotid gland stimulation)

Low albumin

353
Q

Dementia vs MDD

A

MDD
- recognize deficit

Dementia
- Poor insight

354
Q

Defense mechanism which you consciously choose to not think about anxiety provoking thought

A

Suppression

355
Q

Delusion vs illusion

A

Delusion

  • sensory perception correct
  • knew it was smoke
  • belief of demons

Illusion
- subconscious misinterpretation of sensory perception

356
Q

Delirum tremens characteristics

A

Disorientation
Memory deficits
Perceptual and language disturbances

Rapidly fluctuating symptoms

Disturbance of consciousness

(No dreams)

357
Q

Muscle aches part of what withdrawal

358
Q

Vivid of unpleasent dreams part of what withdrawal

359
Q

Cognitive triad of depression

A

1) Negative views about oneself
2) Negative views about the world
3) Expectation of future failure

360
Q

Gambling disorder

A

Impulse control disorder

Tx Group psychotherapy or CBT

361
Q

Inhibition of monoamine reuptake

A

SNRI

Bupropion

362
Q

What release to feel no pain after severe injury

A

Endorphins

363
Q

Substance P

A

NT that is associated w/ pain

364
Q

Endocannabinoids

A

Provide sense of euphoria in certain situations

365
Q

Tourette tx

A

Only tx if causing distress to child of decline in academic funcitoning

366
Q

Alzheimers in brain

A

Neurofibrillary tangles

367
Q

Alpha synuclein inclusions in neurons

A

Lewy dementia

Parkinson

368
Q

Neurofibrillary tangles

A

Alzheimers

369
Q

SSRI most likely to cause SSRI discontinuation syndrome

A

Paroxetine

370
Q

Signs of schizophrenia

A

Delusions of thought insertion

Thought withdrawal

Thought broadcasting

Voices in discussion

Voice commentary

Audible thoughts
-hallucination in which patients thoughts are relayed back as audible voices

371
Q

Schizophrenia voices

A

Clearly audible voices

Attempt to resist command hallucinations

372
Q

Lab to check neuroleptic malignant syndrome

A

High levels of creatinine phosphokinase

373
Q

Anticholinergic symptoms

  • blurry vision
  • agitation
  • fever
  • constipation
  • urinary retention

What type of medication

A

TCA

- amitriptyline

374
Q

Antihypertensive that can cause depression

A

Clonidine
Propranolol
Methyldopa
Reserpine

375
Q

Antipsychotic which doesnt cause hyperprolactinemia in preexisting hyperprolactinemia

376
Q 
Slurred speech
Unsteady gait
Nystagmus
Memory impairment
Stupor
Seizures
A

Ethanol withdrawal

Ethanol intoxication w/o seizure

377
Q

Dementia
Pupillary changes (anisocoria different sized pupils)
Ataxia
Urinary incontinence
Impaired peripheral vibratory and proprioceptive sensation

A

Neurosyphilis

378
Q

Patient w/ psychosis that recovers quickly in hospital

379
Q

Acute alcohol intoxication features

A

Lack of coordination
Impairment of cognition
NYSTAGMUS

380
Q

Risperidone causes orthostatic hypotension by

A

Cross reactivity as an alpha 1 adrenergic antagonist impairing binding of norepinephrine to alpha 1 receptor

381
Q

Schizophrenia brain changes

A

Deterioration of Hippocampus

382
Q

Nefazodone

A

Antidepressant

SE: hepatotoxicity

383
Q

MDD w/ sexual side effects and generalized anxiety

A

Dont use Bupropion

Nefazodone

384
Q

MDD that develops psychotic features such as auditory hallucinations

Tx

A

Risperidone (due to high potency)

385
Q

Auditory hallucination are from what part of the brain

A

Temporal lobe

386
Q

Generalized anxiety disorder lab level

A

Elevated cortisol

387
Q

OCD due to what part of brain

A

Cerebral cortex or basal ganglia

388
Q

clonus=

A

serotonin syndrome

389
Q

Lorazepam vs other benzo

A

Lorazepam is not metabolized by liver

390
Q

Patient abruptly stops talking

A

Thought blocking

Person stealing thoughts

391
Q

Wandering off topic during regular conversations

A

Derailment

392
Q

Wandering off topic during an explanation or while responding to a question

A

Tangentiality

393
Q

Rapid cycling between different ideas without direct relationship with one another

A

Flight of ideas

394
Q

Losing track of the intended purpose of a sentence

A

Loss of a goal

395
Q

Decreased speech, but complete sentences present

A

Poverty of speech

396
Q

Adequate amount of speech with very little actual content

A

Poverty of thought

397
Q

Illness anxiety disorder

A

Focus on obtaining a diagnosis for mild complaints that are genuine not pathological

Preoccupation with having or acquiring a serious illness

persists 6 months

tx: regular visits with one primary care physician

398
Q

Delirium tx

A

Haloperidol

399
Q

NT responsible for patients sexual dysfunction on clozapine

A

Anticholinergic activity

Parasympathetic

400
Q

Several unrelated physical symptoms in several different systems

A

Somatic symptom disorder

401
Q

Other features of PTSD

A

Sense of foreshortened future

402
Q

Breathing techniques target what NT

A

Norepinephrine

403
Q

Girl 1-4 y.o
Wringing hands
Delay in intellectual development

A

Rett syndrome

404
Q

Alcohol changes on sleep

A

Decreased REM sleep

Decreased sleep latency (shorter time to fall asleep)

Increased sleep fragmentation (increased nighttime awakenings)

405
Q

Pain relief tx in heroin use disorder

A

Ketorolac

  • NSAID
  • Potent
406
Q

Hear colors

See tastes

A

Synesthesia

407
Q

Visual hallucinations in those that are blind

A

Charles Bonnet syndrome

408
Q

Neutropenia in patient

A

Clozapine

Carbamazepine

409
Q

Carbamazepine SE

A

Agraulocytosis
Stevens-Johnson syndrome
Teratogenic in pregnancy

Cytochrome P450 induction

Hyponatremia

Hepatotoxicity

410
Q

Drugs that induce mania or psychosis is patients with previous history of disease (6)

A

Corticosteriods

Thyroxine
Dopaminergic anti-parkinsonian drugs
Amphetamines
Cocaine
PCP
411
Q

Drugs that induce depression in already depressed patient (8)

A 
Corticosteriods
Lidocaine
Procainamide
Beta blockers
Reserpine
Antimalarials
- chloroquine
- mefloquine
Levetiracetam
412
Q

Anticonvulsant that can exacerbate depression and anxiety

A

Levetiracetam

413
Q

Topiramate

  • what is it
  • SE (2)
  • Used in (2)
A

Mood stabilizer

Significant cognitive suppression and sedation

Useful in migraine prophylaxis and weight loss

414
Q

Valproic acid

  • what is it
  • use in (2)
  • SE (5)
A

Mood stablizer

Use for seizure disorder, migraine prophylaxis

Sedation, hepatotoxicity, teratogenesis, weight gain and hair loss

415
Q

Epilepsy associated with psychosis

A

Temporal lobe epilepsy (TLE)

416
Q

Major NTs in anxiety

A

NE
Serotonin 5HT
GABA

417
Q

Most common form of psychopathology

418
Q

If patient has a comorbid depressive disorder dont use what medications

A

Benzodiazepines, as they will worsen depression

419
Q

Anxiety with comorbid substance abuse consider using

A

non-addictive anxiolytic alternatives prn such as diphenhyramine, hydroxyzine, and gagapentin

420
Q

Busprione MOA

A

NOn-benzodiazepine anxiolytic which has partial agonist activity at serotonin receptor

421
Q

Panic disorder tx

A

Combination of CBT and pharmacotherapy most effective

First line: SSRI

422
Q

Agoraphobia duration and tx

A

> 6 months

CBT and SSRI

423
Q

Specific phobias duration and tx

A

> 6 months

CBT

424
Q

Selective mutism

Tx

A

Rare
Failure to speak in specific situations for a least 1 month

Consistent failure to speak in select social situations (school) despite speech ability in other scenarios

Tx: CBT, family therapy
SSRI

425
Q

Separation anxiety disorders

  • duration
  • tx
A

Excessive and developmentally inappropriate fear/anxiety regarding separation from attachment figures

> 4 weeks in children/ adolescents
6 months in adults

TX: CBT, family therapy

426
Q

Characteristics of generalized anxiety disorder (6)

A

associated >=3 symptoms:

Restlessness
Fatigue
Impaired concentration
Irritability
Muscle tension
Insomnia
427
Q

OCD tx

A

CBT

  • exposure and response prevention
  • SSRI

Second line:

  • SNRI
  • TCA
  • Clomipramine
428
Q

Hoarding tx

A

CBT for hoarding

SSRI can be used

429
Q

Hair pulling disorder tx

A

SSRI
Second gen antipsychotics
Lithium
N-acetylcysteine

Specialized CBT
- Habit reversal training

430
Q

Medication to stop nightmares

431
Q

Medication to avoid in PTSD

432
Q

Tx PTSD

A

SSRI
Prazosin (alpha 1 antagonist)

CBT

  • exposure therpy
  • cognitive processing therapy
433
Q

Adjustment disorder

  • is what
  • timeline
  • tx
A

Non lifethreatening, stressful life event

Symptoms resolve within 6 months after stressor has terminated

Tx: Supportive psychotherapy
Group therapy

434
Q

Group therapy should be avoid in what personality disorder

A

Paranoid personality disorder

435
Q

Pharmacotherapy and tx that is useful in borderline personality disorder

A

Dialectical behavior therapy

  • cognitive behavioral therapy
  • mindful skills
  • group therapy

Mood stabilizers
Antipsychotics
Antidepressants

436
Q

Alcohol intoxication tx

A

Thiamine before glucose

437
Q

Alcohol withdrawal what predisoses to seizures

A

Hypomagnesemia

438
Q

Confabulation is part of what

A

Inventing stories

Korsakoff’s psychosis

Patients unaware they are making things up

439
Q

Alcoholic ketoacidosis

  • tx
A

Ketosis without hyperglycemia and a negative alcohol level

High anion gap metabolic acidosis, ketonemia, and low level of potassium, magnesium and phosphorus

Tx: Hydration with D5N5 and replacing electrolytes

440
Q

Tx alcohol use disorder

A

First line:
Naltrexone
- Opioid receptor antagonist
- Reduces desire/ craving and the “high” associated with alcohol
- will precipitate withdrawal in patient with physical opioid dependence

Acamprosate

  • modulate glutamate transmission
  • used for relapse prevention in patients who have stopped drinking (post-detoxification)
  • advantage is liver disease
  • CI if renal disease

Second line:
Disulfiram
-blocks aldehyde dehydrogenase in liver

Topiramate

  • anticonvulsant that potentiates GABA and inhibits glutamate receptors
  • reduces cravings for alcohol and decreases alcohol use
441
Q

Naltrexone

A
  • Opioid receptor antagonist
  • Reduces desire/ craving and the “high” associated with alcohol
  • will precipitate withdrawal in patient with physical opioid dependence
442
Q

Acamprosate

A
  • modulate glutamate transmission
  • used for relapse prevention in patients who have stopped drinking (post-detoxification)
  • advantage is liver disease
  • CI if renal disease
443
Q

Topiramate

A
  • anticonvulsant that potentiates GABA and inhibits glutamate receptors
  • reduces cravings for alcohol and decreases alcohol use
444
Q

Alcohol can cause what changes in labs

A

increased LFTs

Macrocytosis (increased in MCV)

445
Q

Cocaine MOA

A

blocks the reuptake of dopamine, epinephrine and norepinephrine

446
Q

What labs to check in PCP and amphetamine

A

Elevated creatine kinase.

Rhabdomyolysis

447
Q

Amphetamines MOA

A

Release dopamine, NE and serotonin from nerve endings

448
Q

Synesthesia

seen with what drug

A

One sensory stimulation evokes another

hearing a sound causes one to see a color

PCP

449
Q

Tx barbiturates overdose

A

Alkalinize urine with sodium bicarbonate to promote renal excretion

450
Q

Tx benzodiazpine overdose

A

Flumazenil

451
Q

Marijuana MOA

A

Cannabinoid receptors in brain inhibit adenylate cyclase

452
Q

Marijuana withdrawal

A 
Irritability
Anxiety
Restlessness
Aggression
STRANGE DREAMS
Depression
HA
Sweating
Chills
453
Q

Dronabinol

A

FDA approved form of THC

454
Q

Caffeine MOA

A

Increasing in cyclic adenosine monophosphate (cAMP) and stimulating the release of excitatory NT

455
Q

Nicoteine dependce tx

A

Varenicline

  • alpha4beta2 nicotinic cholinergic receptor partial agonist
  • mimics action of nicotine
  • reduces rewarding aspects and prevents withdrawal

Bupropion
- antidepressant inhibits reuptake of dopamine and NE helps reduce cravings and withdrawal symptoms

456
Q

Common causes of medication induced delirium

A 
TCA
Anticholinergics
Benzo
Nonbenzo hypnotics
Corticosteriods
H2 blockers
Opioids (esp meperidine)
457
Q

Opioid that doesnt cause miosis

A

Meperidine

458
Q

Delirium on EEG

A

Diffuse background slowing

Delirium tremens opposite: fast EEG activity

459
Q

Tool for assessing delirium

A

Confusion assessment method (CAM)

460
Q

Medication to avoid in delirium

A

Benzo

Worsen delirium by causing paradoxical disinhibition or oversedation

461
Q

Alzheimers disease in brain

  • accumulation
  • genes
A

Accumulation of extraneuronal beta- amyloid plaques and intraneuronal tau protein tangles assocaited iwth progressive brain atrophy

Mutation
- Amyloid precursor protein
- Presenilin 1
- Presenilin 2 
(early onset)

Epsilon-4 variant of the apolipoprotein gene is a risk factor for developoing early onset AD

462
Q

Alzheimers tx

A

No cure

Cholinesterase inhibitors
- donepezil
- rivastigmine
- galantamine
(may slow clinical deterioration by 6-12 months)

NMDA receptor antagonist
- memantine

Antipsychotics for agitation and aggression
- low doses

463
Q

Increased difficulty in planning and decision making

A

Complex attention and executive functioning

Vascular disease

464
Q

Lewy body disease

  • brain
  • features (3)
  • suggesive features (3)
  • biomarkers (3)
A

brain
- lewy bodies (alpha synuclein) and lewy neurites in the brain, primarily basal ganglia

Progressive cognitive delcine
WAXING AND WANING

Visual hallucinations

Rapid eye movement sleep behavior disorder (REM)

Suggestive features

  • antipsychotic sensitivity (EPS)
  • postural instability and recurrent falls
  • diminished sense of smell

Biomarkers

  • REM sleep without atonia
  • decreased 123iodine-MIBG uptake on myocardial scintigraphy
  • Reuced dopamine receptor uptake in basal ganglia vis PET or SPECT
465
Q

Lewy body tx

A

Cholinesterase inhibitors
Quetiapine or clozapine for psychotic symptoms
Levodopa carbidopa for parkinsonism
Melatonin or clonazepam for REM sleep disorder

466
Q

Tx Huntingtons

A

Symtoms directed tx
Tetrabenazine
Atypical (second gen) antipsychotic

467
Q

Rapidly progressive cognitive decline with myoclonus

A

Creutzfeldt jakob disease

468
Q

Features of creutzfeldt jakob disease

A

Ataxia
Nystagmus
Hypokinesia

469
Q

Features of creutzfeldt jakob disease labs

A

Periodic sharp wave complexes of EEG
CSF positive for 14-3-3 protins
Lesions in the putamen or caudate nucleus on MRI

470
Q

Normal aging of brain

A

Decreased brain weight/ enlarged ventricles and sulci

471
Q

Pseudodementia tx

A

SSRI

If have to use TCA use nortriptyine less anticholinergic side effects

Mirtazapine can increase appetite and is also sedating (dose at bed time)

472
Q

Restless leg movements due to

A

Dopamine imbalance

473
Q

Sleep changes in elderly

A

Decreased REM latency
Decreased total REM

Increased amount stage 1 and 2
Decreased stage 3 and 4

Decrease sleep efficiency
(frequent nocturnal awakenings)

Decreased total sleep amount

474
Q

If elderly need sedative hypnotics then use

475
Q

K-ABC

A

Kaufman assessment battery for children

Intelligence test comparing intellectual capacity with acquired knowledge of patients between 2-12

476
Q

WISC-R

A

Wechsler intelligence scale for children revised

Assesses verbal, performance and full scale IQ of patients between 6-16 years old

477
Q

Difficulty acquiring and using language
Reduced vocab
Limited sentence structure

A

Language disorder

478
Q

Difficulty producing articulate intelligible speech

A

Speech sound disorder

479
Q

Stuttering

A

Childhood onset fluency disorder

480
Q

ADHD

  • onset
  • duration
  • associated with
  • tx
A

> 6 months
Prior to age 12

Comorbid

  • oppositional defiant disorder
  • conduct disorder
  • specific learning disorder

Methylphenidate, amphetamines

Second line:
Atomoxetine (NE reuptake inhibitor)
Alpha 2 agonist (clonidine, guanfacine)

481
Q

Coprolalia

A

Utterance of obscene, taboo words in abrupt sharp bark or grunt

482
Q

Enuresis

A

Recurrent bed wetting
At least 5 years old
3 months

Spontaneous remission

Psychoeducation

Limit fluid intake and caffeine at night
Urine alarm
Desmopressin (DDAVP) antidiuretic
Imipramine (TCA)

483
Q

Encopresis

A

Recurrent defecation
3 months
4 years old

484
Q

Depersonalization

tx

A

out of body experience

cbt

485
Q

Derealization

tx

A

experiencing world around them in a dream or movie

Tx CBT

486
Q

Medication to reduce self mutilation

A

Naltrexone

487
Q

Intermittent explosive disorder

  • criteria
  • lab finding
  • tx
A

outbursts twice weekly for 3 months

CSF shows low 5-hydroxyindoleacetic acid (5-HIAA) concentration

SSRI (fluoxetine)
Anticonvulsants
lithium

488
Q

What is associated with aggressive and impulsiveness lab

A

Low levels of serotonin in CSF

489
Q

Kleptomania comorbid with

A

Bulimia nervosa

490
Q

Kleptomania tx

A

CBT
- systematic desensitization and aversive conditioning

SSRI

Naltrexone maybe

491
Q

Anorexia nervousa comorbid with

492
Q

Physical findings in Anorexia nervousa

A 
Bradycardia
Orthostatic hypotension
Arrhythmias
QTC prlongation
ST-T wave changes
Anemia (normocytic normochromic) 
Leukopenia

Enlarged ventricles and neuropathy

Muscle wasting

Amenorrhea and loss of libido

Parotid enlargement
Increased amylase levels

Hypokalemia
Elevated BUN
Increase GH
Increased CORTISOL

Lanugo (fine soft hair on body)

Hypochloremic hypokalemic alkalosis (if vomiting)

493
Q

REM sleep is characterized by

A

Increase in

  • blood pressure
  • heart rate
  • respiratory rate
494
Q

Insomnia disorder

  • criteria
  • tx
A

3 days a week for at least 3 months

Sleep hygiene measures
CBT (first line)
Chronotherapy (bright light therapy)
Benzo (redue sleep latencya nd nocturnal awakening)

495
Q

Insomnia medication with increased risk of falls in elderly

A

zolpidem (ambien)

Also causes cognitive impairment

496
Q

Tx Sleep related hypoventilation

A

CPAP

Medications to stimulate/ promote breathing

  • bronchodilators
  • theophylline
497
Q

Nightmare disorder

A

Recurrent frightening dreams
Vivid recall
No confusion or disorientation upon awakening

Tx: Densensitization/ imagery rehearsal therapy (IRT)

498
Q

REM sleep behavior disorder tx

A

Clonazepam

499
Q

Dopamine and serotonin effect on sex

A

Dopamine enhances libido

Serotonin inhibits sexual function

500
Q

Tx premature ejactulation

501
Q

Frotteuristic disorder

A

Sexual arousal from touching or rubbing against a nonconsenting person

502
Q

Voyeuristic disorder

A

Sexual arousal from observing an unsuspecting nude, or disrobing individual (binoculars)

503
Q

Exhibitionistic disorder

A

Sexual arousal from exposure of one’s genitals to an unsuspecting person

504
Q

Sexual masochism disorder

A

Sexual arousal from the act of being humiliated beaten bound or made to suffer

505
Q

Sexual sadism disorder

A

Sexual arousal from the physical or psychological suffering of another person

506
Q

Isolation of affect

A

Unconsciously limiting the experience of feelings or emotions associated with stressful life event in order to avoid anxiety

507
Q

Undoing

A

Attempting to reverse a situation by adopting a new behavior

Man had fantasy of killing wift by sabotaging her car takes the car for complete check up

508
Q

Homework assignments between therapy session
Set agenda
Review homework
challenge cognitive distortions

6 weeks to 6 months

A

CBT

Current symptoms

509
Q

Dialectical behavioral therapy

A

once weekly individual and group tx

Reduce urges to engage in self harm behavior

510
Q

Duty of warn

A

Tarasoff duty

511
Q

Dont require consent (3)

A

Life saving medical emergency
Prevention of suicide or homicidal behavior
Unemancipated minor (require consent from parent)

512
Q

Emanciapted minor (4)

A

Self supporting
In the military
Married
Have children or pregnant

513
Q

Capacity vs competence

A

Capacity
- clinical term by physician

Competence
- legal term by judge

514
Q

Parens patriae

A

Protecting citizens who cant care for themselves

515
Q

Sixth amendment

A

right to counsel, a speedy trial and to confront witnesses

516
Q

Fourteenth amendment

A

right to due process by law

517
Q

M’Naghten insanity defense

A

Person did not understand what he/she was doing was wrong

518
Q

Durham insanity defense

A

Criminal act resulted from mental illness

519
Q

OTC drugs that can cause serotonin syndrome

A

St. John’s wort

dextromethorphan

520
Q

CYP 450 inducers

A

Tobacco
Carbamazepine
Barbiturates
St. John’s wort

521
Q

CYP450 inhibitors

A 
Fluvoxamine
Fluoxetine
Paroxetine
Duloxetine
Sertraline
522
Q

SSRI most associated with weight gain

A

Paroxetine

523
Q

SSRI and MAOI

A

SSRI should not be used for at least 2 weeks before or after use of an MAOI

524
Q

Fluvoxamine

A

SSRI

only for OCD

525
Q

Citalopram

Escitalopram

A

SSRI

Dose dependent QTC prolongation

526
Q

Trazodone

Nefazodone

A

Serotonin receptor antagonists

Tx

  • MDD
  • MDD w/ anxiety
  • Insomnia

SE

  • orthostatic hypotension
  • arrhythmias
  • sedation
  • priapism

Nefazodone
- black box warning for liver failure

527
Q

Mirtazapine

A

Alpha 2 adrenergic receptor antagonists

Tx MDD
Patients with weight loss and or insomnia

SE
weight gain
sedation

528
Q

TCA

A

Tertiary amines

  • Amitriptyline: chronic pain, migraines, insomnia
  • Imipramine: enuresis and panic disorder
  • Clomipramine: OCD
  • Doxepin: Chronic pain

Secondary amines
- Nortriptyline: least likely to cause orthostatic hypotension
Desipramine

529
Q

TCA overdose

A

Sodium bicarbonate

530
Q

Factors that increase Li levels

A

NSAIDS
Aspirin
Thiazide diuretics

531
Q

Carbamazepine

A

Especially useful in treating mania with mixed features and rapid-cycling bipolar disorder

Acts by blocking sodium channels and inhibiting action potentials

532
Q

Valproic acid

A

acute mania
acute mania with mixed features
rapid cycling

Blocks sodium channels and increases GABA concentration in the brain

533
Q

Lamotrigine

A

Bipolar depression

Steven johnson syndrome

534
Q

Anxiety inducing

A

Sympathomimetics

Antiasthmatics

535
Q

Miosis pupil size

Mydrasis pupil size

A

Miosis less than 2 mm

Mydrasis larger than 4 mm

536
Q

What inhibits lamotrigine

A

Valproic acid

Third Year Shelf (7 decks)

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