Psychiatric

Question 1

MDD diagnostic criteria

Answer 1

SIGECAPS (5 or more of these for 2 weeks or more)

Question 2

Which labs should be included in a depression evaluation?

Answer 2

CBC, CMP, TSH, folate, drug serum levels

Question 3

What are some common medication causes of depression? (6)

Answer 3

Alpha and beta interferons
levetiracetam
natalizumab
steroids (> 80 mg per day prednisone equivalents)
Progesterone
Efavirenz
Isotretinoin
(Beta-blockers)

Question 4

What is SIGECAPS

Answer 4

Sleep
Interest
Guilt
Energy
Concentration
Appetite
Psychomotor
Suicidal

Question 5

Which 3 SSRIs are preferred in the older adult?

Answer 5

Citalopram, escitalopram, sertraline

Question 6

Which SNRIs are preferred in the older adult?

Answer 6

Venlafaxine, duloxetine

Question 7

Which antidepressants increase the risk of bleeding from warfarin due to decreased platelet aggregation?

Answer 7

SSRI, SNRI, TCAs

Question 8

Which SSRIs increase the risk of bleeding from warfarin by inhibiting CYP2C9?

Answer 8

Fluvoxamine, fluoxetine

Question 9

Which antidepressants are CYP2D6 antagonists?

Answer 9

Duloxetine.
Paroxetine.
Bupropion

Question 10

Which analgesics can be blocked by antidepressant treatment?

Answer 10

Codeine
Tramadol

Question 11

Which Alzheimer’s disease medication’s are substrates for CYP2D6 and CYP3A4, and therefore at risk of antagonism from antidepressants?

Answer 11

Galantamine
Donepezil

Question 12

What should be done when the patient has no response to a therapeutic dose of an antidepressant?

Answer 12

Change to another first line antidepressant

Question 13

What do you do when the patient has a partial response to an antidepressant?

Answer 13

1) switch
2) combination Rx; add bupropion or mirtazapine
3) augmentation: add lithium, aripiprazole (liothyronine, buspirone, quetiapine, brexpiprazole)

Question 14

What labs Should be done to assess for medical or medication causes of anxiety?

Answer 14

TSH, CBC, CMP, urine/serum toxicology screen

Question 15

Which two agents are first line choices for medication therapy of PTSD?

Answer 15

Sertraline and venlafaxine

Question 16

Common medication causes of insomnia

Answer 16

Decongestants, stimulants, Stimulating antidepressants and anticonvulsants (Lamotrigine), alcohol, diuretics

Question 17

What Medications are used for management of excessive daytime sleepiness in OSA consistently using CPAP?

Answer 17

Modafinil, armodafinil, Solriamfetol

Question 18

Rapid eye mouvement sleep behaviour disorder (RBD) treatment medications

Answer 18

Melatonin 3-15 mg, 1 hour before sleep
Clonazepam 0.5 - 2 mg qhs

Question 19

Restless leg syndrome management, first line

Answer 19

Dopamine agonist: pramipexole or rotigotine patch
Gabapentinoids: gabapentin enacarbil (Horizant)
(Cost constraints: pregabalin, plain gabapentin)

Question 20

Restless leg syndrome reduce or eliminate triggers

Answer 20

Serotonergic antidepressant, anti-histamine, Check ferritin level

Question 21

CIWA-Ar At what score is benzodiazepine treatment indicated

Answer 21

> 8

Question 22

Benzodiazepines FDA approved for alcohol withdrawal

Answer 22

Chlordiazepoxide, diazepam, oxazepam

Question 23

Alcohol use disorder management (2)

Answer 23

Naltrexone or acamprosate 

Question 24

Opioid withdrawal symptoms (3 or more of) (10)

Answer 24

Dysphoria
Nausea, vomiting
Myalgias
Lacrimation, rhinorrhea, diarrhea
Mydriasis
Piloerection.
Sweating
Yawning
Fever

Question 25

Alcohol withdrawal symptoms (2 or more of) (7)

Answer 25

Autonomic hyper activity.
Hand tremors.
Insomnia.
Hallucinations, psychomotor agitation
Nervousness
Seizure activity

Question 26

Opioid withdrawal symptom management - diarrhea

Answer 26

Loperamide

Question 27

Opioid withdrawal symptom management - nausea

Answer 27

Ondansetron

Question 28

Opioid withdrawal symptom management - muscle cramping/pain

Answer 28

Ibuprofen (caution in older adults)

Question 29

Opioid withdrawal symptom management - GI cramping

Answer 29

Dicyclomine

Question 30

Buprenorphine drug interaction risks 

Answer 30

QT prolongation, CYP3A4 substrate

Question 31

Which medication for treatment of alcohol use disorder is appropriate in patients with hepatic disease?

Answer 31

Acamprosate