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Psychiatry Flashcards

1
Q

Antipsychotic causing loss of night vision & ultimately blindness

A

Thioridazine –> retinitis pigmentosum

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2
Q

Priapism treatment

A

Epinephrine into corpus of penis

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3
Q

MAOI main side effect

A

Hypertensive crisis from tyramine foods (wine, aged cheese, liver, smoked foods)

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4
Q

How much time needed when switching from SSRI to MAOI or vice versa?

A

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

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5
Q

Bupropion contraindications?

A
  • Alcoholics (SEIZURE risk)
  • Eating disorders - bulimia/anorexia (**C/I in anorexic patients b/c of electrolyte imbalances!)
  • Epilepsy

*Low sexual side effects!

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6
Q

Antipsychotic that causes agranulocytosis?

A

Clozapine (can get neutropenic fever)

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7
Q

Drug class famous for QT prolongation, cardiac arrhythmias & coma, leading to death?

A

TCAs –> 3 C’s of overdose (cardiotoxicity, convulsions, coma)

Tx: IV NaHCO3

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8
Q

Treatment for Lithium overdose?

A

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

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9
Q

Benzo/EtOH overdose antidote?

A

Flumazenil –> only if ACUTE intoxication

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10
Q

Chlorpromazine side effects

A

Corneal deposits, blue-green skin discoloration

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11
Q

Neuroleptic Malignant Syndrome signs & antidote

A 
FEVER:
Fever
Encephalopathy
Vitals unstable
Elevated CPK & leukocytosis
Rigidity of muscles & myoglobinuria

Muscle rigidity & fever

Tx: dantrolene

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12
Q

Drugs that cause Serotonin Syndrome

A

Sinners Sell Drugs That MAke ME TRIP

St. John's Wort
SSRI's
Dextromethorphan
TCAs
MAOIs
Meperidine
Triptans
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13
Q

Lithium side effects & factors causing toxicity

A

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
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14
Q

Serotonin Syndrome characteristics

A

In order of appearance: diarrhea, restlessness, extreme agitation, hyperreflexia, autonomic instability, myoclonus, seizures, hyperthermia, rigidity, delirium, coma, death

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15
Q

DOC for anticholinergic (anti-ACh) delirium?

A

Physostigmine

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16
Q

Main side effects of TCA’s?

A
  • 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

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17
Q

2 main types of s/e of SSRI’s?

A

1) GI s/e (especially paroxetine)

2) Sexual dysfunction (impotence, delayed ejaculation, decreased libido, anorgasmia)

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18
Q

Mood stabilizer associated w/ polycystic ovarian disease?

A

Valproic Acid

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19
Q

Side effect of Topiramide?

A

Kidney stones

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20
Q

2 psych drugs that DECREASE suicidal ideations?

A

Lithium, clozapine

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21
Q

Criteria for Substance Abuse?

A

1 criteria for > 1 year:

- Work/school impairment 
- Hazardous situations
- Social problems
- Legal problems
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22
Q

Criteria for Substance Dependence?

A

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
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23
Q

2 screening tests for EtOH abuse/dependence?

A

MAST (michigan alcohol screening test)

AUDIT (alcohol use id test)

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24
Q

EtOH/Benzo’s overdose symptom?

A

**Nystagmus

Slurred speech, ataxia

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25
Classic cocaine scenario?
Person who needs a smoke break every 15-20 minutes
26
Narcotic overdose symptoms?
**Miosis
27
PCP overdose symptom?
Violence
28
Marijuana overdose symptoms?
Slowed time perception Increased appetite Conjunctiva injection
29
DOC for narcotic withdrawal?
Clonidine
30
Narcotic withdrawal s/s?
Mydriasis, gooseflesh, rhinorrhea, muscle aches
31
Amphetamine/cocaine/stimulant withdrawal s/s?
Fatigue, increased appetite, vivid/unpleasant dreams
32
Wernicke's encephalopathy symptoms? Korsakoff's psychosis symptoms?
Wernicke's: confusion, ataxia, intranuclear ophthalmoplegia, delirium Korsakoff's: confabulations
33
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
34
Only time to use benzo's for delirium?
DT's!!!
35
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
36
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)
37
DOC for delirium in elderly patients?
Haloperidol (small dose) | NOT benzo's!!!
38
DOC for peripheral neuropathy?
TCA's
39
TCA for OCD? SSRI for OCD?
Clomipramine Fluvoxamine
40
Increased incidence of OCD in patient's w/ first-degree relatives w/ psychiatric disorder?
Tourette's
41
Anti-emetic with side effects of EPS?
Prochlorperazine *Tx these w/ antiparkinsonian meds (benztropine)
42
Lymphadenopathy + oral thrush + cognitive deficits w/ mood disturbance?
AIDS --> order an ELISA (confirm HIV)
43
Common BP medication that causes depression?
Propranolol
44
Oppositional defiant vs conduct disorder
ODD: NO violation of social norms --> just argue & annoy Conduct d/o: violation of basic rights of others or social norms (physical harm, lying/deceitful, stealing)
45
What is pathognomonic for narcolepsy? DOC?
Cataplexy --> sudden loss of muscle tone (falling down) precipitated by loud noise or intense emotion DOC: modafinil
46
Patient has progressive memory loss, drips urine/can't control his bladder, and can't walk straight/needs assistance walking. What does he have and what diagnostic tests would be warranted?
Normal Pressure Hydrocephalus (NPH) CT w/ Lumbar Puncture --> normal opening pressure & therapeutic for excess CSF. Enlarged ventricles seen on CT
47
What drug is someone taking that has new-onset amenorrhea, infertility, sexual dysfunction (decreased sex drive), galactorrhea, wt gain?
Risperidone --> increases prolactin levels It blocks dopamine from binding to lactotrophs in pituitary & blocking release of prolactin --> uninhibited release of prolactin --> see s/e
48
Neuroleptic Malignant Syndrome (NMS)?
*ANY antipsychotic (typical or atypical) with either: S/S: * *Muscle rigidity * *Fever and/or Increased WBC or CPK Tx: STOP medication - Can give dantrolene/bromocriptine
49
Serotonin Syndrome?
Usually from a result of medications that increase SEROTONIN levels S/S: * *Tremors * *Myoclonus and NO labs needed (unlike NMS)
50
Neuropsychological screening tests?
Halstead-Reitan | Luria-Nebraska
51
Depression rating scales?
Beck Depression Scale | Hamilton Depression Scale
52
Bipolar rating scale?
Youngs Mania Rating Scale
53
What antidepressant is good for helping w/ sleep?
Trazadone
54
At low/medium doses, this drug is sedating. At high doses, it acts as an anti-depressant?
Mirtazapine
55
Treatment of acute dystonia?
Anticholinergic meds/with these s/e --> benztropine, diphenhydramine, trihexyphenidyl
56
Patient presents w/ manic symptoms w/ dilated pupils?
Cocaine
57
Tx of choice for agitation & paranoia in the elderly demented patient?
Low dose atypical antipsychotic
58
2 other psychiatric conditions associated w/ Tourette's?
ADHD | OCD
59
Atypical antipsychotic that does NOT cause weight gain or sedation?
Ziprasidone General rule: "-pine" --> weight gain "-done" --> sedation
60
SSRI that causes withdrawal symptoms if stopped abruptly?
Paroxetine
61
Mood stabilizer that INACTIVATES oral contraceptive pills (OCPs)?
Carbamazepine
62
Difference between sleep terror & nightmare?
do NOT remember sleep terror in morning remember nightmares
63
Side effects of antipsychotics & risperidone?
Increase prolactin levels b/c of decreased dopamine levels --> look for galactorrhea, amenorrhea, impotence, decreased libido
64
Typical presentation of Rett syndrome?
Girl with normal development up until 5 months of age --> then progressive encephalopathy * Small head * Hand-wringing gestures * Loss of speech * Ataxia *ONLY in girls!!!
65
What class of drugs (non-psych drugs) can cause depression?
anti-HTN --> B-blockers, reserpine
66
What drug side effect do you suspect with fatigue, slow movements, dry skin, hair loss, voice change?
Lithium --> drug-induced hypothyroidism
67
When is psychiatric consultation the correct answer?
ONLY with overdose from a SUICIDE ATTEMPT
68
Treatment for borderline personality disorder?
Dialectical behavioral therapy (DBT)
69
Most common compulsion in OCD?
Excessive grooming, hand washing, tooth brushing, etc.
70
What medication is used in treatment-resistant schizophrenia? What is the side effect you need to monitor?
Clozapine Agranulocytosis
71
Emotional or behavioral symptoms develop in response to an identifiable stressor that occurs within 3 months of the stressor - what is it? What else is present?
Adjustment disorder Significant impairment of patient's life and disrupts daily activities
72
Person with acute onset psychosis (delusions, hallucinations, disorganized speech) - what is the best initial treatment?
2nd-gen antipsychotics (non-typical) NOT clozapine b/c of agranulocytosis --> used for treatment-resistent psychosis
73
Common side effect of methylphenidate for ADHD treatment?
``` **Decreased appetite Nervousness *Wt loss *Insomnia Abdominal pain ```
74
What pathway is involved in the action of antipsychotics blocking dopamine release?
Tuberoinfundibular pathway *High prolactin (amenorrhea, gynecomastia, sexual dysfunction)
75
What drugs can cause Neuroleptic Malignant Syndrome? S/S? Tx?
Antipsychotics - anything that blocks dopamine S/S: fever, muscle rigidity, confusion, altered mental status Tx: dantrolene, renal diuretics to prevent rhabdo
76
Congenital defect of Lithium?
Ebstein anomaly - atrialization of the R ventricle
77
Treatment of acute panic attacks?
Lorazepam
78
Difference between dependent and avoidant personality disorders?
Dependent = clingy, excessive need to be cared for, submissive Avoidant = shyness (social isolation), lacks self-esteem, fear of embarrassment or rejection, hypersensitive to criticism
79
Lifetime risk for someone to have manic episode with a first-degree relative with bipolar disorder? What if both parents have bipolar disorder?
5-10% 60%
80
Sudden onset confusion and fever in 29 yo male. He was recently admitted to the hospital for hallucinations and was discharged in stable condition. His temp is 101.6 and he is profusely sweating. Abdominal muscles are rigid. Muscle tone is increased and "lead-pipe rigidity" is noted in all 4 extremities. What is the cause?
Drug-induced idiosyncratic reaction * Neuroleptic Malignant Syndrome (NMS) --> look for recent use of antipsychotics * Rigidity and hyperthermia
81
Maintenance therapy for bipolar disorder?
1) Mild-moderate = atypical antipsychotics OR monotherapy with lithium/valproic acid 2) Severe = combination of lithium/valproic acid + atypical antipsychotic
82
How many bipolar episodes (manic) do you need to be on lifetime lithium?
2+
83
DOC for delirium in: Elderly? Younger?
Elderly = Haloperidol *NO benzo's Younger = benzo's
84
What is Delayed Sleep Phase Syndrome?
Sleep-wake disorder characterized by sleep-onset insomnia + excessive morning sleepiness Usually "night owls" and have chronic problems going to sleep before midnight *Sleep is normal when they are allowed to set their own schedule
85
Preferred medical treatment in GAD?
SSRI's
86
Neuroimaging findings in: ``` Autism? OCD? Panic disorder? PTSD? Schizophrenia? ```
Autism = INCREASED total brain volume Ocd = Orbito-frontal cortex + striatum pAnic disorder = decreased volume of Amygdala PTSD = decreased hippocampal volume Schizophrenia = enlargement of cerebral ventricles
87
Characteristic of generalized anxiety disorder?
Excessive anxiety about multiple EVENTS/SITUATIONS
88
Findings in obsessive-compulsive personality disorder?
Perfectionism Carry out activities in extremely methodical way Extremely rigid, meticulous, focused on perfection
89
Child with poor communication and reduced verbal expression in a specific social setting but behaves normally at home?
Selective mutism
90
What medication can predispose to hypothermia?
Fluphenazine ("typical antipsychotic") *Disrupts thermoregulation center and body's shivering mechanism

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