Psych Misc

Question 1

Rx bipolar disorder in children/adolescents

Answer 1

2nd gen antipsychotics: aripiprazole, olanzapine, quetiapine, risperidone, ziprasidone (IF resistant to trials of 2 to 3 2nd gen antipsychotics, THEN try lithium)

Question 2

Parkinson’s Disease and having feelings of depersonalization. Most likely cause?

Answer 2

Amantadine

Question 3

Gene linked to incr risk of smoking & interaction with pharmacotherapy & schizophrenia

Answer 3

CHRNA5

Question 4

Gene involved in amygdala activation & linked to psychiatric issues in alcohol abuse

Answer 4

SLC6A4

Question 5

THC is primarily excreted through

Answer 5

feces; metabolized by CYP450 pathways (2C9, 2C11, 3A pathways)

Question 6

half-life of cannabis

Answer 6

3-4 days; highly fat soluble so rate-limiting part of elimination involves retrieving THC from tissues

Question 7

Which gene + cannabis use incr comorbid mental illness?

Answer 7

COMT = 15% schizophrenia by age 25 vs 2% without COMT

Question 8

Fluoxetine & methadone, why worry?

Answer 8

Fluoxetine inhibits CYP3A4, potentially elevating levels of methadone –> incr risk of respiratory depression

Question 9

venlafaxine & methadone, why worry?

Answer 9

Methadone and venlafaxine both prolong QTc, effects additive

Question 10

How to start buprenorphine for OUD

Answer 10

pt must be in mild to moderate withdrawal state by sudden and full d/c of full agonist 36-72 hours before starting buprenorphine or when methadone dosing is <=30mg/d

Question 11

How to manage opioid withdrawal sx

Answer 11

alpha-2 adrenergic agonist (clonidine) + cox1/cox2 inhibitor (ibuprofen) + centrally acting GABA-B agonist (baclofen) to treat autonomic hyperactivity, myofascial aches, pain of muscle spasms/cramps