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IPCS 3 > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

What is a complex heterogenous syndrome of disorganized and bizarre thoughts, delusions, hallucinations, inappropriate affect, and impaired psychosocial functioning?

A

schizophrenia

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2
Q

What neuro pathway is associated with positive symptoms of schizophrenia?

A

Mesolimbic pathway

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3
Q

What neuro pathway is associated with negative symptoms of schizophrenia?

A

Mesocortical Pathway

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4
Q

What dopaminergic pathway, when blocked, results in physical signs and symptoms (EPS)?

A

Nigrostriatal Pathway

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5
Q

What dopaminergic pathway, when blocked, results in prolactin release?

A

Tuberinfundibular Pathway

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6
Q

What is required for the diagnosis of schizophrenia?

A

two or more of the following each present for a significant portion of the time in a 1 month period. One of the symptoms must be 1, 2, or 3.
1. delusions
2. hallucinations
3. disorganized speech
4. disorganized or catatonic behavior
5. negative symptoms

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7
Q

What are the three phases of schizophrenia?

A

prodromal
active
residual

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8
Q

What are examples of positive symptoms in schizophrenia?

A

Suspiciousness
Delusions
Hallucinations
Conceptual disorganization
Ideas of reference
Illusions
Loose associations
Agitation

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9
Q

What are examples of negative symptoms in schizophrenia?

A

Blunted/flat affect
Alogia
Anhedonia
Avolition/amotivation
Poor grooming/hygeine
Poor judgement/insight
Lack of abstract thinking
Social withdrawal

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10
Q

What are examples of cognitive symptoms in schizophrenia?

A

Impaired attention
Impaired working memory
Impaired executive function
Impaired problem solving
Difficulty reading social cues

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11
Q

What is the primary mechanism of first generation antipsychotics?

A

blocks D2 receptors
minimal 5-HT2A receptor blockade

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12
Q

What are examples of EPS?

A

Acute dystonic reaction
Pseudoparkinsonism
Akathisa
Tardive dyskinesia

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13
Q

How is acute dystonic reaction treated?

A

Potent anticholinergic
no PO medications

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14
Q

How is pseudoparkinsonism treated?

A

Benztropine

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15
Q

How is akathisia treated?

A

propranolol

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16
Q

How is tardive dyskinesia treated?

A

PREVENTION!
Valbenazine, Deutetrabenazine

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17
Q

What is the major symptoms of neuroleptic malignant syndrome?

A

extreme muscle rigidity (lead pipe rigidity)

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18
Q

How is NMS treated?

A

quick taper of antipsychotic
supportive care

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19
Q

NMS occurs most commonly with which type of antipsychotics?

A

typical (first generation)

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20
Q

What are lower potency first generation antipsychotics?

A

Chlorpromazine
Thioridazine

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21
Q

What are medium potency first generation antipsychotics?

A

Loxapine
Perphenazine

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22
Q

What are high potency first generation antipsychotics?

A

Trifluoperazine
Thiothixene
Fluphenazine
Haloperidol

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23
Q

QTc prolongation is an adverse effect in which medications?

A

Thioridazine
Haloperidol

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24
Q

What is the primary mechanism of second generation antipsychotics?

A

potent 5-HT2A antagonism
moderate to high D2 antagonism

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25
Q

What are the common adverse effects with atypical antipsychotics?

A

weight gain
lipid changes
diabetes mellitus

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26
Q

Lipid changes are highest risk with which medications?

A

Clozapine
Olanzapine
Quetiapine

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27
Q

EPS are highest risk with which atypical antipsychotics?

A

Risperidone
Paliperidone

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28
Q

What adverse effect is dose-dependent with clozapine?

A

seizures

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29
Q

What are other QTc prolonging agents that should be used with caution with antipsychotics?

A

fluoroquinolones
amitriptyline
citalopram

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30
Q

Smoking can reduce plasma levels of which medications?

A

Olanzapine
Clozapine

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31
Q

Clozapine is the drug of choice for __

A

treatment refractory schizophrenia (failed two antipsychotic trials)

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32
Q

Clozapine is also FDA approved for reducing __ in schizophrenic, violent patients

A

suicidal behavior

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33
Q

What is unique about clozapine dosing?

A

Titrated more slowly due to risk of orthostatic hypotension
If discontinued for more than 48 hours, must restart at initial dose

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34
Q

If a patient experiences __ or __ with clozapine, do not rechallenge

A

myocarditis
cardiomyopathy

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35
Q

Clozapine is part of REMS due to risk of __

A

neutropenia

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36
Q

When should ANC be monitored when a patient is started on clozapine?

A

Week from initiation to 6 months
Then every other week for months 6-12
Monthly monitoring after 12 months

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37
Q

Clozapine is a major substrate of __

A

CYP1A2

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38
Q

Olanzapine IM should not be given with benzodiazepines due to __

A

respiratory depression

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39
Q

What is included in B52?

A

diphenhydramine
haloperidol
ativan

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40
Q

What is an appropriate first-line treatment for a patient with schizophrenia?

A

Aripiprazole
Risperidone
Ziprasidone

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41
Q

Which medication has the lowest risk for EPS (recommended for patients with Parkinsons)?

A

Quetiapine

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42
Q

Which medications has the highest risk for EPS?

A

FGAs
risperidone
paliperidone

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43
Q

Which medications have the highest risk for metabolic side effects?

A

Clozapine
Olanzapine
Quetiapine

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44
Q

Which medications have the lowest risk for metabolic side effects?

A

FGAs
aripiprazole
Ziprasidone
Asenapine

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45
Q

Which medications have the highest risk for QT prolongation?

A

Thioridazine
Haloperidol
Ziprasidone

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46
Q

Which medication has the highest risk for agranulocytosis?

A

Clozapine

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47
Q

Which medications have the highest risk for increased prolactin?

A

Risperidone
Paliperidone

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48
Q

Which medication has the highest risk for seizures?

A

Clozapine

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49
Q

Which long acting injectable antipsychotics are every 2 weeks?

A

Risperidone (Risperdal Consta)
Fluphenazine decanoate

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50
Q

Typical antipsychotics alleviate __ and atypical antipsychotics alleviate __ (pos/neg symptoms)

A

positive symptoms
positive and negative symptoms

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51
Q

What medications are in the class thioxanthenes?

A

thiothixene
loxapine

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52
Q

What medications are in the class butyrophenones?

A

haloperidol

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53
Q

What medications are atypical antipsychotics?

A

clozapine
risperidone
quetiapine
ziprasidone
olanzapine
aripiprazole
cariprazine

54
Q

What is the MOA of clozapine?

A

D4 antagonist, 5-HT2A antagonist

55
Q

What are classes of typical antipsychotics?

A

pheothiazines
thioxanthenes
buterophenones

56
Q

What are classes of atypical antipsychotics?

A

benzodiazepines
benzisoxazoles

57
Q

In the preferred conformation of chlorpromazine, the side chain tilts toward the __

A

chlorine-substituted ring

58
Q

Phenothiazine derivatives without a CL at this position are in most cases __ as neuroleptics

A

inactive

59
Q

Phenothiazines with two carbon sin side chain lack __

A

antipsychotic activity

60
Q

___ attached to fourth carbon of butyrophenone skeleton is essential for antipsychotic activity

A

tertiary amino group

61
Q

__ in para position of phenyl ring on Butyrophenone has the highest potency

A

F substituent

62
Q

Pimozide has a __ duration of action than butyrophenones

A

longer

63
Q

Pimozide may produce potential irreversible __

A

tardive dyskinesia

64
Q

Risperidone has ___ effects similar to benzazepine-type antipsychotics.

A

anti-5HT

65
Q

What is the definition of major depressive disorder?

A

one or more major depressive episodes without a history of mania or hypomania

66
Q

What are the two hypotheses of depression?

A

Monoamine hypothesis
Dysregulation hypothesis

67
Q

What is the DSM-V diagnosis of depression?

A

5 or more symptoms present for 2 weeks
Change from previous functioning
Functional impairment and/or distress
Symptoms not due to another cause

68
Q

What are the eight factors of prognosis?

A

Sleep
Interest
Guilt
Energy
Concentration
Appetite
Psychomotor
Suicide

69
Q

What is the definition of response to treatment?

A

50% reduction in symptoms

70
Q

What is the definition of remission?

A

absence of symptoms, patient is back at baseline

71
Q

What is the definition of recovery?

A

no symptoms/relapse after remission

72
Q

What is the definition of relapse?

A

Return of symptoms within 6 months of remission

73
Q

What is the definition of recurrence?

A

Separate episode of depression

74
Q

How long does an acute phase of depression last?

A

6-12 weeks

75
Q

How long does the continuation phase of depression last?

A

4-9 months

76
Q

What is the time course of improvement on antidepressants?

A

Week 1: improved sleep/appetite, decreased anxiety
Weeks 1-2: increased activity and libido, improved self-care
Weeks 2-4: improvement in mood, less helplessness, decreased suicidal thoughts

77
Q

What are nonpharmacologic treatments for depression?

A

psychotherapy
ECT
vagal nerve stimulation
transcutaneous magnetic stimulation

78
Q

Vagal nerve stimulation is approved in chronic depression lasting more than __ years

A

2

79
Q

What are acceptable first-line drugs for depression?

A

SSRIS
SNRIs
Burpropion
Mirtazapine

80
Q

What are dose-dependent adverse effects associated with SSRIs?

A

nausea
anxiety
fatigue
sexual dysfunction

81
Q

What is the treatment for serotonin syndrome?

A

Mild: drug withdrawal, Ativan for agitation
Moderate to Severe: Cyproheptadine, Chlorpromazine
Propranolol

82
Q

What medications are SSRIs?

A

citalopram
escitalopram
fluoxetine
fluvoxamine
paroxetine
sertraline

83
Q

Which SSRI should be taken in the morning?

A

fluoxetine

84
Q

Which SSRI should be taken at night?

A

Paroxetine

85
Q

Which SSRI is preferred in patients with cardiac risk?

A

sertraline

86
Q

What ADE is unique to duloxetine?

A

urinary difficulty/hesitancy

87
Q

What medications are SNRIs?

A

desvenlafaxine
duloxetine
venlafaxine
levomilnacipran

88
Q

What medication is reasonable to dispense in 1 week supplies?

A

TCAs

89
Q

What medications are tertiary TCAs?

A

amitriptyline
doxepin
imipramine

90
Q

What medications are secondary TCAs?

A

desipramine
nortriptyline

91
Q

Bupropion has no __ effect

A

serotonergic

92
Q

Bupropion XL is the preferred formulation due to __

A

seizure risk

93
Q

What is the MOA of mirtazapine?

A

pre-synaptic alpha2 antagonist

94
Q

What are ADEs of mirtazapine?

A

somnolence
dry mouth
increased appetite
weight gain

95
Q

What medications are serotonin modulators?

A

trazodone
vilazodone
vortioxetine

96
Q

What are adverse effects of MAOIs?

A

hypotension
sedation
insomnia
weight gain
sexual dysfunction

97
Q

MAOIs interact with __ in food?

A

tyramine

98
Q

What medications are MAOIs?

A

phenelzine
selefiline TD patch
tranylcypromine

99
Q

What medications are potent CYP2D6 inhibitors?

A

Fluoxetine
paroxetine
bupropion

100
Q

What medication is a moderate CYP2D6 inhibitor?

A

Duloxetine

101
Q

NSAIDs, Aspirin, and Anticoagulants interact with __

A

SSRIs
SNRIs
TCAs
Trazodone
Vilazodone
Vortioxetine

102
Q

Triptans interact with __

A

MAOIs
SSRIs
SNRIs

103
Q

Linezolid interacts with __

A

all serotonergic antidepressants

104
Q

Tramadol interacts with __

A

bupropion
duloxetine
fluoxetine
paroxetine

105
Q

antiarrhythmics, antipsychotics, and fluoroquinolone interact with __

A

citalopram
escitalopram
venlafaxine
TCAs

106
Q

What are two alternative pharmacotherapy options for depression?

A

St John’s Wort
Omega-3 Fatty Acids

107
Q

What is the MOA of esketamine?

A

NMDA receptor antagonist

108
Q

What antidepressants are FDA approved for pediatrics?

A

fluoxetine and escitalopram

109
Q

What is the most widely used antidepressant class used in pregnancy?

A

SSRIs

110
Q

What is brexanolone used for?

A

post-partum depression

111
Q

What antidepressant should be avoided in patient who is trying to avoid weight gain?

A

mirtazapine

112
Q

What antidepressant should be considered in a patient trying to avoid weight gain?

A

buproprion

113
Q

What antidepressant should be avoided in patients with cardiac issues?

A

citalopram
escitalopram

114
Q

What antidepressant is contraindicated in patients with seizures?

A

bupropion

115
Q

What antidepressant is indicated in both depression and pain?

A

duloxetine

116
Q

What antidepressants should be avoided in patients trying to avoid sexual dysfunction?

A

SSRIs and SNRIs

117
Q

What antidepressants should be used in patients trying to avoid sexual dysfunction?

A

bupropion
mirtazapine

118
Q

A 5 week wash out period is required when switching from __ to another antidepressant

A

fluoxetine

119
Q

A __ washout period is required when switching between MAOIs and SSRIs, SNRIs, TCAs, and bupropion.

A

2 week

120
Q

What are neurotransmitters involved in depression?

A

serotonin
norepinephrine
peptides
growth factors

121
Q

What activates TrkB receptor?

A

BDNF

122
Q

What are anti-histamine side effects of TCAs?

A

sedation and weight gain

123
Q

What are anticholinergic side effects of TCAs?

A

dry mouth
constipation
cycloplegia

124
Q

What are side effects of TCAs associated with increased 5HT and NE?

A

increased appetite

125
Q

What side effects of TCAs are related to alpha1 blockade?

A

sedation
postural hypotension

126
Q

Stress increases cortisol and inhibits __

A

BDNF

127
Q

What are symptoms of serotonin syndrome?

A

confusion, agitation, hypomania
sweating, hypertension, hyperthermia, nausea, diarrhea
tremor, rigidity, herreflexia, restlessness, myoclonus

128
Q

Which TCA has N and O in its 7 membered ring?

A

amoxapine

129
Q

Which TCA has highest selectivity for NE transporter?

A

maprotiline

130
Q

Maclobemide is a selective __ MAO-A inhibitor

A

reversible

131
Q

Which enantiomer is paroxetine?

A

3S,4R

132
Q

In dose-in the Cis inhibits __ and trans inhibits __

A

5HT reuptake
NE reuptake

IPCS 3 (4 decks)

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