Psychiatry Flashcards
Antipsychotic causing loss of night vision & ultimately blindness
Thioridazine –> retinitis pigmentosum
Priapism treatment
Epinephrine into corpus of penis
MAOI main side effect
Hypertensive crisis from tyramine foods (wine, aged cheese, liver, smoked foods)
How much time needed when switching from SSRI to MAOI or vice versa?
5-6 weeks minimum –> Serotonin Syndrome results if not enough time b/w switching
*If changing to/from Fluoxetine –> need MORE time b/c of it’s longest half-life
Bupropion contraindications?
- Alcoholics (SEIZURE risk)
- Eating disorders - bulimia/anorexia (**C/I in anorexic patients b/c of electrolyte imbalances!)
- Epilepsy
*Low sexual side effects!
Antipsychotic that causes agranulocytosis?
Clozapine (can get neutropenic fever)
Drug class famous for QT prolongation, cardiac arrhythmias & coma, leading to death?
TCAs –> 3 C’s of overdose (cardiotoxicity, convulsions, coma)
Tx: IV NaHCO3
Treatment for Lithium overdose?
It is cleared by the KIDNEY so you need dialysis
If Lithium levels get too high when trying to titrate appropriate dose, simply STOP THE MEDICATION until levels return to therapeutic range
Benzo/EtOH overdose antidote?
Flumazenil –> only if ACUTE intoxication
Chlorpromazine side effects
Corneal deposits, blue-green skin discoloration
Neuroleptic Malignant Syndrome signs & antidote
FEVER: Fever Encephalopathy Vitals unstable Elevated CPK & leukocytosis Rigidity of muscles & myoglobinuria
Muscle rigidity & fever
Tx: dantrolene
Drugs that cause Serotonin Syndrome
Sinners Sell Drugs That MAke ME TRIP
St. John's Wort SSRI's Dextromethorphan TCAs MAOIs Meperidine Triptans
Lithium side effects & factors causing toxicity
Side effects –> LMNOP
Lithium causes
Movement disorders (tremor, ataxia)
Nephrogenic diabetes insipidus (polydipsia, polyuria)
hypOthyroidism
Pregnancy problems (Ebstein’s anomaly of tricuspid valve)
Causes of increased Li levels:
- Thiazides (increased PCT reabsorption of Na & Li) - NSAIDs (afferent arteriole vasoconstriction and decreased GFR) - ACEi - Dehydration - Salt depravation - Impaired renal fxn
Serotonin Syndrome characteristics
In order of appearance: diarrhea, restlessness, extreme agitation, hyperreflexia, autonomic instability, myoclonus, seizures, hyperthermia, rigidity, delirium, coma, death
DOC for anticholinergic (anti-ACh) delirium?
Physostigmine
Main side effects of TCA’s?
- Anti-ACh (dry mouth; red as beet, mad as hatter, dry as bone, etc.)
- Cardiotoxicity (increased QT interval)
- LETHAL in overdose –> caution for depressed patients b/c of possible suicidal ideations
Patient w/ depression presenting w/ anti-cholinergic signs & EKG abnormalities
2 main types of s/e of SSRI’s?
1) GI s/e (especially paroxetine)
2) Sexual dysfunction (impotence, delayed ejaculation, decreased libido, anorgasmia)
Mood stabilizer associated w/ polycystic ovarian disease?
Valproic Acid
Side effect of Topiramide?
Kidney stones
2 psych drugs that DECREASE suicidal ideations?
Lithium, clozapine
Criteria for Substance Abuse?
1 criteria for > 1 year:
- Work/school impairment - Hazardous situations - Social problems - Legal problems
Criteria for Substance Dependence?
3+ criteria for > 1 year:
- TOLERANCE for drug (more needed to achieve same effect as before) - Withdrawal s/s - Increased amt consumed - Increased time spent obtaining substance - Activities given up b/c of substance - Can't quit despite knowledge of physical harm
2 screening tests for EtOH abuse/dependence?
MAST (michigan alcohol screening test)
AUDIT (alcohol use id test)
EtOH/Benzo’s overdose symptom?
**Nystagmus
Slurred speech, ataxia
Classic cocaine scenario?
Person who needs a smoke break every 15-20 minutes
Narcotic overdose symptoms?
**Miosis
PCP overdose symptom?
Violence
Marijuana overdose symptoms?
Slowed time perception
Increased appetite
Conjunctiva injection
DOC for narcotic withdrawal?
Clonidine
Narcotic withdrawal s/s?
Mydriasis, gooseflesh, rhinorrhea, muscle aches
Amphetamine/cocaine/stimulant withdrawal s/s?
Fatigue, increased appetite, vivid/unpleasant dreams
Wernicke’s encephalopathy symptoms?
Korsakoff’s psychosis symptoms?
Wernicke’s: confusion, ataxia, intranuclear ophthalmoplegia, delirium
Korsakoff’s: confabulations
Type of eating disorder where patient is a “perfectionist”
“Young patient who is extremely competitive and high-achieving with a low BMI (< 18.5)
Anorexia Nervosa
Only time to use benzo’s for delirium?
DT’s!!!
Side effects of atypical antipsychotics?
Method of administration for non-complaint patients?
- Olanzapine & Clozapine: hyperlipidemia, increased blood glucose
- Clozapine: agranulocytosis (neutropenic fever)
- Quetiapine: cataracts
- Risperidone: increased prolactin (amenorrhea, decreased sex drive, galactorrhea), akathisia (high doses)
- Ziprasidone: increased QT interval
*Can be given in IM injections that last 2 weeks (depot form) for non-complaint patients
Impotence?
Inability to attain an erection - caused by organic, psychogenic, substance use
In questions, look for a temporal (what recently happened) relationship to the impotence –> diabetic w/ depression recently consumed EtOH (all 3 of these can relate to the impotence)