Psyche Flashcards
What is the name of the defense mechanism where the target of emotion of drive changes but the person having the feeling remains the same?
ex: man is fired from job, and beats his wife or children
Displacement
How does Antisocial personality disorder differ from Conduct disorder?
Antisocial personality disorder is not diagnosed in pts under 18
What is the best treatment for Borderline personality disorder?
Dialectical Behavior therapy
Determine Age:
Infant can look at mom and say “mama”
patient is seated at table, gets in prone position and crawls, uses wall for support to stand
walks but falls when not holding wall for support
10 months
What is Schizoaffective Disorder
Major depressive or Manic episode
with sx of schizophrenia
Lifetime history of delusions or hallucinations for > 2 weeks in the absence of major depressive or manic episode
13 month girl
normal development until now
loss of speech and motor skills, deceleration of head growth, stereotypic hand movements
identify dz + defective gene
Rett Syndrome
MECP2 gene mutations
What is a comorbidity a/w Tourette’s syndrome?
OCD
What stage of sleep do Sleep terrors occur?
stage 3/4 = Non-rapid eye movement (NREM)
What is the EEG finding of sleep terrors?
slow (delta) waves
What stage of sleep should have the large percent of sleep time on a normal EEG?
Stage 2
A pt with generalized anxiety reports not being able to experience orgasm after being prescribed new medication. what is the drug?
SSRI (sertraline)
What is the treatment of mild to moderate pyelonephritis in the outpatient setting?
Oral fluoroquinolone (ciprofloxacin or levofloxacin)
if there is resistant: us TMP-SMX
If hexagonal crystals are seen in evaluation of kidney stones, what is the dz? what other lab finding is there?
Cysteine Kidney stone
- defect in renal transport of certain amino acids (COLA - Cysteine, ornithine, lysine, arginine)
- Positive urinary cyanide nitroprusside test
How do you calculate RBF from eRPF when you are given Urine PAH concentration, Urine flow rate, Plasma PAH concentration, hematocrit
eRPF = (Urine PAH)(Urine flow rate)/(Plasma PAH)
RBF = eRP/(1-hematocrit)
Pt acts out dreams with jerking movements while sleeping. He is started on a TCA, and this behavior decreases. why? (what is this behavior called)
REM sleep behavior disorder
- -retain muscle tone during REM
- -Antidepressants reduce symptoms because they suppress total quantity of REM sleep/change sleep architecture
A depressed patient on Fluoxetine is still depressed. the doctor prescribes Phenelzine. Why? what is the mechanism of this drug?
Phenelzine - more efficacious for atypical, treatment-resistant depression
-nonselective, irreversible MAOI
Which anxiolytic drug has the lowest risk of dependence?
Buspirone - relatively weak inhibitor of the neuronal uptake of NE, DA
A pregnant pt is evaluated for depression. which drug is she able to be continued on?
Fluoxetine - SSRI
teratogens: valproic acid, warfarin, phenytoin
A patient on Valproic Acid for tonic-clonic seizure is prescribed an antibiotic that decreases the serum concentration of valproic acid. what is the medication?
Imipenem
(also ertapenem, meropenem)
Carbapenems are also known to cause seizures and other CNS toxicity
An elderly patient is being chronically treated for bipolar I disorder with lithium. she needs to have her dose reduced. why?
Age-related changes in GFR
**lithium is excreted unchanged (not liver metabolized) by the kidneys
A pt with trouble falling asleep and waking up in the morning is prescribed Ramelteon. what is the mechanism of action?
Selective melatonin receptor agonist which binds to MT1, MT2 located in SUPRACHIASMATIC NUCLEUS
–helps regulate circadian rhythm
What stage of sleep does bed wetting occur? what is pharm management if voiding diary or bed wetting alarm doesnt work
what EEG waveforms are likely to be found during an episode?
Stage N3 - Delta waves
-Desmopressin (preferred) then Imipramine
What are the 3 most efficacious medications for treating acute mania?
Olanzapine
Risperidone
Haloperidol
What is a schizophrenic drug that can cause galactorrhea?
Haloperidol and other typical antipsychotics
–gynecomastia and/or lactation
A patient treated with antipsychotics develop torticollis, and eyes are stuck in upward deviation? what is happening and what is most appropriate pharmacologic treatment?
Extrapyrmidal symptoms (from inhibition of dopamine receptors in basal ganglia)
–Tx = Diphenhydramine, Benztropine (anticholinergic agents)
What is the use/mechanism and possible adverse effect of phenelzine?
Monoamine oxidase inhibitor (MAO-I)
-used for severe or atypical depressive disorders and severe anxiety disorders (increased NE, DA)
How does narcolepsy affect REM sleep?
decreased REM latency = enter REM sleep within few minutes of falling asleep (normally 80-100 minutes)
How is a hypomanic episode distinguished from a manic episode?
Hypomanic - lasts 4 days, Sx does not impair fxnality
Manic - lasts at least a weeks
What is the difference between:
- Bipolar disorder type I
- Bipolar disorder type II
- present of at least one manic episode
2. at least one HYPOmanic episode and at least one major depressive episode
What is the pharm therapy for severe night terrors?
Benzodiazepine meds (Clonazepam)
what is the order of orientation loss?
1st: Time
2nd: Place`
3rd: Person
What distinguishes:
- Brief psychotic disorder
- Schizophreniform disorder
- Schizoaffective disorder
?
- lasting < 1 month - stress
- 1-6 months
- > 2weeks of hallucinations/delusions w/o major mood episode
pt w depressed mood is prescribed doxepin. Sx improve, but he notices that whenever he stands up he becomes very dizzy and lightheaded.
What is the classification/mechanism of doxepin? what is its best use?
Doxepin = TCA
main mech: blocks NE reuptake
side fx: inhibits alpha1-adrenergic receptors
best used for Depression with insomnia (drug can cause sedation)
What is the use and mechanism of venlafaxine?
used for Major depressive disorder
SNRI - increases the levels of serotonin in the raphe nucleus
What is the mechanism of action of Ethosuximide?
What is the most serious side effect of Ethosuximide?
Decreases T-type calcium currents in thalamic neurons
Steven-Johnson Syndrome
What is the first line pharmacological treatment for schizophrenia?
Atypical Antipsychotics:
- Olanzapine - weight gain, diabetes
- Quetiapine
- Risperidone
- Aripiprazole
- Clozapine - agranulocytosis
A schizophrenic pt that is resistant to first and second generation antipsychotics it prescribed a drug effective for treating antipsychotic RESISTANT schizophrenia?
what is the this drug what is the most dangerous side effect?
Clozapine - agranulocytosis
What type of antipsychotic are better at treating:
1. negative symptoms: flat affect, alogia, avolition, anhedonia
- positive symptoms: delusions, hallucinations, tanentiality
- Atypical (risperidone, olanzapine, clozapine)
2. Typical (ie haloperidol)
25 year old presents after recovering from a seizure. Hx reveals major depressive disorder treated by unknown med. Pt has dilated pupils, tachycardia, dry mucous membranes
ECG: tachycardia w 122 msec QRS. what the overdosing agent (and mechanism of action) and what is the pharm therapy?
Tricyclic antidepressant overdose
- -mechanism =
1. inhibition of presynaptic neurotransmitter reuptake of NE, serotonin,
2. antagonism of GABAA receptors, Histamine 1 receptors, peripheral alpha-1 adrenergic recetpros, Central + peripheral muscarinic acetylcholine receptors, blockage of cardiac fast Na channels - —-antagonism of GABA caused seizures.
- —-antagonism of Na channels cause widened QRS
pharm therapy for overdose = Sodium bicarb
3 year old female presents w frequent inappropriate laughter, hyperactivity. Maxillary hypoplasia, deep-set eyes, large mouth with tongue protrusion. Gait is jerky and puppet-like
What is underlying disorder
Angelman syndrome - Maternally-derived microdeletion on chromosome 15
(if paternally derived or maternal uniparental disomy = Prader-Willi)
pt presents with episodes of severe anxiety when riding on trains, sitting in crowded movie theaters, standing in line. accompanied by chest pain, palpitations, difficulty breathing.
What is the most appropriate agent to prevent future episodes?
SSRI (ie paroxetine)
What is the pharm therapy for tourettes/tics?
antipsychotics (ie aripiprazole, quetiapine, risperidone, olanzapine, clozapine)
Child can sit with some support, begun to jabber and make significant sounds, started to feed herself appropriate finger foods.
what is age of child?
6 months
What is age of child:
grasps stethoscope, laughs
infant in prone position - can roll to supine, and back to prone.
able to sit without support and responds to her name and babbles`
7 months
identify dz: pt started on haloperidol 3 days ago presents with: oculogyric crisis protrusion of the tongue trismus (locked jaw) torticollis
Acute dystonia
–starts HOURS to DAYS after initiation of antipsychotics
what is age of child:
infant smiles when mother laughs, makes cooing counds
prone on exam table, lifts up head and shoulders. infant swipes hands at stethoscop. requires support when he is seated on exam table
3 months
What is the age of the child?
Child runs around office and says “I like doctors”. He can walk up and down stairs but only when he is supported by the railing
2 years
–should begin to run, stand on tip toes, walk up and down stairs with support, kick a ball, turn over containers (pour out contents), build a tower of 4 or more blocks. 2-4 word sentences, sort by shapes/colors, toilet training
What is the pharm therapy of Tourettes?
Risperidone - D2 receptor antagonist
severe cases: fluphenazine, haloperidol, alpha agonists (clonidine, guanfacine)
which phase of sleep has the appearance of sleep spindles and prominent K complexes?
Stage N2
What is the mechanism of action of Phenytoin?
Inhibits glutamate release from excitatory presynaptic neurons
What is the use and mechanism of Isocarboxazid
MAO-i
-prevents breakdown of dopamine, serotonin, epinephrine, norepinephrine
–never combo with SSRIs (will cause serotonin syndrome)
What is a side effect of Tricyclicantidepressants at non-toxic levels?
Amitriptyline - strong muscarinic blocking properties =
urinary retention
tachycardia
