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FirstAID > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

Positive vs Negative Reinforcement:

A

Positive: desired reward produces action (ie mouse presses button to get food)

Negative: removal of aversive stimulus elicits behavior (ie mouse presses button to avoid shock)

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2
Q

Transference:

A

patient projects feelings about an important person in life onto physician (like saying that the psychiatrist = parent)

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3
Q

Counter-transference:

A

physician projects feelings about important people in life onto patient

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4
Q

Acting out:

A
  • immature defense

- ->like tantrums; unacceptable feelings and thoughts are expressed through actions

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5
Q

Dissociation:

A

–>seen in Multiple Personality Disorder (Dissociative Identity Disorder)

–>In order to avoid emotional distress, have rapid, temporary, drastic changes in personality, memory, consciousness, behavior…

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6
Q

Displacement:

A

avoided ideas and feelings are transferred to a neutral person or object

–> like a mother placing blame on child, when really she is angry at her husband

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7
Q

Projection:

A

unacceptable personal internal impulse is attributed to an external souce

–>like a man who wants another woman thinks his wife is cheating on him

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8
Q

Fixation:

A

Partially remaining at more childish level of development

–>like a man who fixates on sports games; or maybe a man who fixates on comic books and superhero movies…

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9
Q

Identification:

A

modeling behavior after another person who is more powerful (not necessarily an admired person though)
–>like an abused child identifying as an abuser (abusing others…)

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10
Q

Isolation of effect:

A

separation of feelings from ideas and events

–>like describing murder in detail without an emotional response; or maybe war veterans having no emotions when talking about war

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11
Q

Rationalization:

A

finding logical reasons for actions that were actually performed for other reasons, to avoid self-blame

–>like after getting fired from a job, person claims that job was not important anyway

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12
Q

Reaction formation:

A

–>process where a warded-off idea or feeling is unconsciously replaced by an emphasis on its opposite

–>like a person with lots of sexual drive entering a monastery

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13
Q

Regression:

A

–>turning back maturational clock and dealing with world immaturely

–>like a child bedwetting after previously being toilet-trained, when under stress (like if ill, hospitalized, punished, birth of new sibling…)

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14
Q

Repression:

A

–>involuntary withholding idea/feeling from conscious awareness

–>like not remembering a traumatic/conflictual experience; push bad thoughts in unconscious

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15
Q

Splitting:

A
  • ->seen in Borderline Personality Disorder

- belief that people are either all-good or all-bad at different times

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16
Q

Which immature defense is seen in dissociative identity/multiple personality disorder?

A

–>Dissociation

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17
Q

Which immature defense is seen in Borderline pts?

A

–>Splitting

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18
Q

List the 4 mature defenses:

A

“a Mature woman wears a SASH”

  • Sublimation
  • Altruism
  • Suppression
  • Humor
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19
Q

Sublimation:

A
  • ->mature ego defense
  • replacing an unacceptable wish with actions that are similar to the wish, but don’t conflict with values

–>like a person’s feelings of aggression redirected to perform well in sports

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20
Q

Altruism:

A

–>a mature ego defense

-guilty feelings alleviated by unsolicited generosity towards others

–>ie mafia boss making large donation to charity; or former alcoholic who got in an accident while drunk-driving going around talking to teens about risks of drinking and driving…

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21
Q

Humor:

A
  • ->mature ego defense
  • finding amusement in anxiety-provoking situations
  • ->med students joking about the boards
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22
Q

Suppression:

A
  • ->mature ego defense
  • voluntary withholding idea/feeling from conscious awareness (vs repression, which is unconscious)

–>ie choosing not to think about USMLE scores after the exam, b/c nothing you can do about it :)

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23
Q

Effects of infant deprivation:

A
  • Weak (decreased muscle tone)
  • poor language and socialization skills
  • lack of trust
  • Anaclitic depression (from separation from caregiver)
  • weight loss
  • physical illness
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24
Q

Consequences of of prolonged infant deprivation:

A
  • Deprivation > 6months –> can be irreversible

* Severe deprivation can result in infant death

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25
Q

Who is usually the abuser in:

  • physical abuse?
  • sexual abuse?
A
  • ->physical abuse: abuser is usually female and primary care giver
  • ->sexual abuse: abuser is usually male and known to victim
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26
Q

methylphenidate

A

=Ritalin

–>treatment of ADHD

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27
Q

Atomoxetine

A
  • ->non-stimulant SNRI

- ->can be used to treat ADHD

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28
Q

Treatment options for ADHD:

A
  • methylphenidate (Ritalin)
  • amphetamines (ie Dexedrine)
  • Atomoxetine (non-stimulant SNRI)
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29
Q

Age of onset of ADHD?

A

onset before age 7

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30
Q

Oppositional Defiant Disorder:

A

-childhood disorder:

–>hostile, defiant behavior towards authority figures, but don’t really violate social norms (like disregard authority, but not the rights of others… unlike conduct disorder)

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31
Q

Tourette’s syndrome:

  • Dx criteria (timing)?
  • associated with what other condition?
  • treatment?
A
  • onset before age 18, lasts >1 year
  • Coprolalia = obscene speech –> only in about 20% of pts
  • associated with OCD
  • treat with Haloperidol (anti-pyschotics)
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32
Q

Typical age of Separation Anxiety Disorder:

A
  • ->common onset = 7-9 years old

- ->may lead to factitious physical complaints to avoid going to school

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33
Q

Intelligence in Autism disorder:

A

below normal intelligence; but may rarely be accompanied by unusual abilities

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34
Q

girl, a few years old, regresses in development, and constant hand-wringing?

A

Rett’s disoder

  • ->autosomal dominant X-linked disorder (boys die in utero or shortly after birth)
  • -> symptoms usually start between 1-4 years old; pt regresses from how was: loss of development, loss of verbal abilities, develops mental retardation, ataxia, and stereotyped hand-wringing
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35
Q

Boy, 3-4 years old, after at least 2 years of normal development begins regressing in development/skills:

A

Childhood Disintegrative Disorder

  • ->more common in boys; onset 3-4 years old
  • ->Loss of expressive or receptive language skills, social skills, adaptive behavior, bowel or bladder control, play, motor skills
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36
Q

Neurotransmitter changes seen in Anxiety:

A
  • Increased NE
  • Decreased GABA
  • Decreased Serotonin
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37
Q

Neurotransmitter changes seen in Depression:

A
  • Decreased NE
  • Decreased Serotonin
  • Decreased Dopamine
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38
Q

Neurotransmitter changes seen in Alzheimer’s?

A

-Decreased ACh

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39
Q

Neurotransmitter changes seen in Huntington’s?

A
  • Decreased ACh
  • Decreased GABA
  • Increased Dopamine
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40
Q

Neurotransmitter changes seen in Schizophrenia?

A

-Increased Dopamine

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41
Q

Neurotransmitter changes seen in Parkinson’s?

A
  • Decreased Dopamine
  • Increased ACh
  • Increased Serotonin
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42
Q

In terms of a person’s orientation to person, time, and place - what is the order of loss (what orientation factors are lost first, if lose orientation)?

A

First –> lose time
Then –> lose place (where one is)
Last –> lose person (knowing who self is)

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43
Q

Korsakoff’s amnesia:

A
  • ->from Thiamine deficiency and the destruction of mammillary bodies
  • ->anterograde amnesia (can’t form new memories); sometimes may have some retrograde amnesia too (also, associated with personality change and confabulations)
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44
Q

Dissociative amnesia:

A

–>can’t remember important personal details; usually after trauma or stress

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45
Q

Delirium vs Dementia:

  • Onset?
  • Consciousness?
  • Course?
  • Prognosis?
  • Type of memory Impairment?
  • EEG?
  • Common causes?
A
  • Delirium:
  • Acute onset
  • Impaired consciousness
  • Fluctuating symptoms
  • Reversible
  • Global memory impairment
  • Abnormal EEG
  • usually secondary to other illnesses (ie UTIs, etc) or Drugs (ie anti-cholinergic side effects)
  • Dementia:
  • Gradual onset
  • Intact consciousness
  • Progressive decline in symptoms
  • Irreversible
  • Remote memory spared (remember certain things)
  • Normal EEG
  • Common causes: Alzheimer’s, cerebral infarcts, HIV, Pick’s disease, CJD…
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46
Q

Pseudodementia:

A

–>Elderly pts; depression may present like dementia (pt is aware of memory loss, losing stuff, etc though; whereas in real dementia, pt is unaware of these things)

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47
Q

A reversible cause of dementia in elderly (and why it’s so important to do a head CT in cases of dementia):

A

Normal pressure hydrocephalus: “wet, wobbly, and wacky” (incontinence + ataxia + dementia)
–>expansion of ventricles; but, NOT an increase in subarachnoid space

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48
Q

Causes of visual Hallucinations:

A
  • ->usually associated with medical illnesses (not psychiatric), like d/t drug intoxication
  • ->see in Lewy Body dementia
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49
Q

Cause of auditory hallucinations?

A

–>usually feature of psychiatric illness, ie schizophrenia

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50
Q

Cause of olfactory hallucinations?

A
  • ->may be part of aura before seizure

- ->brain tumors

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51
Q

Causes of tactile hallucinations (feeling something on skin)?

A
  • Alcohol withdrawal–> formication = sensation of insects crawling on skin
  • Cocaine abusers (“cocaine bugs”)
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52
Q

What drug use in teens is a risk factor schizophrenia?

A

Marijuana

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53
Q

Timing of:

  • Schizophrenia
  • Schizophreniform disorder
  • Brief psychotic disorder
A
  • Schizophrenia: > 6 months
  • Schizophreniform: 1-6 months
  • Brief psychotic disorder: < 1 month (usually stress related)
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54
Q

Dx criteria of schizophrenia:

A

> 6 months

  • at least 2 of following:
    1) Delusions
    2) hallucinations (usually auditory)
    3) Disorganized speech (loose associations)
    4) Disorganized or catatonic behavior (catatonia = either extreme loss of motor skills, like holding a position for a while, or maybe constant hyperactive motor activity)
    5) Negative symptoms:
  • flat affect (no emotional expression)
  • social withdrawal
  • lack of motivation
  • lack of speech or thought

***Note: increased risk for suicide in schizophrenic pts.

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55
Q

5 subtypes of schizophrenia:

A

1) Paranoid (delusions)
2) Disorganized (speech, behavior, affect)
3) Catatonic (automatisms)
4) Undifferentiated (elements of all types)
5) Residual (positive symptoms present, but at low intensity)

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56
Q

Schizoaffective Disorder:

A

at least 2 weeks of a stable mood (not elevated or depressed), but have psychotic symptoms during those 2 weeks; and,also periods of mood disorder (depressive, manic, or both/mixed) with psychosis (can either be bipolar or depressive = 2 subtypes)

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57
Q

How long must a person have delusions in delusional disorder?

A

at least 1 month
–>pt has strange belief/delusion (ie a woman who thinks she’s married to a celebrity, but is not); but, can otherwise function normally

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58
Q

Dissociative Identity Disorder: What past history may be common to pts?

A

This is multiple personality disorder (former name)
–>associated with history of sexual abuse

*pts have at least 2 distinct identities/personality states

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59
Q

Dissociative fugue:

A

Abrupt change in geographic location + inability to remember past, confused about personal identity, assume new identity

–>associated w/traumatic experiences (like war, natural disasters, etc)

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60
Q

Dx of a manic episode:

A

*lasts at least 1 week (note, mood may be elevated, expansive, or irritable)

  • at least 3 of following: “DIG FAST”
    1) Distractibility
    2) Irresponsibility (seeks pleasure, disregard of consequences)
    3) Grandiosity (inflated self esteem)
    4) Flight of ideas (racing thoughts)
    5) increased Activity and Agitation
    6) Talkativeness
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61
Q

Bipolar disorder:

  • Dx criteria?
  • Trtmnt?
A

*at least 1 manic or hypomanic episode and eventually depressive mood; with normal mood in between episodes

  • Treatment:
  • NOT antidepressants (b/c can lead to increased mania)
  • Mood stabilizers (lithium, valproic acid, carbamazepine)
  • Atypical antipsychotics

***note: increased risk of suicide in bipolar pts

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62
Q

Cyclothymic disorder:

A

–>milder form of bipolar disorder that lasts at least 2 years
(dysthymia (=mild depression) + hypomania (= mild manic episode))

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63
Q

Major Depressive Disorder:

-Dx criteria?

A

*lasts at least 2 weeks

  • Must include patient reported depressed mood or Anhedonia (loss of interest) + at least 5 of following 9 symptoms: “SIG E CAPS”
    1) Sleep disturbances
    2) loss of Interest in things that used to be pleasurable (anhedonia)
    3) Guilt, or feelings of worthlessness
    4) loss of Energy
    5) loss of Concentration
    6) Appetite/weight changes
    7) Psychomotor retardation or agitation
    8) Suicidal ideations
    9) Depressed mood
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64
Q

Dysthymia:

A

–> milder form of depression (like at least 2 of depression criteria); lasts at least 2 years

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65
Q

Atypical Depression:

A
  • hypersomnia (sleep lots)
  • overeating (weight gain)
  • mood reactivity (pt can experience improved mood in response to certain positive events)
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66
Q

Pospartum: “blues” vs depression vs psychosis:

A
  • “blues” –> resolve within 10 days (follow up with pt though, to make sure it’s not depression); no trtmnt, just supportive
  • depression –> lasts at least 2 weeks; treat with anti-depressants, therapy
  • psychosis –> rare; lasts days to 4-6 weeks; treat with antipsychotics, antidepressants, possible hospitalization
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67
Q

Risk factors for committing suicide (suicide completion):

A

“SAD PERSONS”

  • Sex (male)
  • Age (teenagers or elderly)
  • Depression
  • Previous attempts
  • Ethanol or drug use
  • loss of Rational thinking
  • Sickness (medical illness; multiple prescription meds)
  • Organized plan how to commit suicide
  • No spouse (divorced, widowed, single, childless)
  • Social support lacking

***Men commit suicide more often, though women try more.

68
Q

Treatment of social phobia (ie public speaking, using public restrooms…):

A

SSRIs

69
Q

Agoraphobia:

A

Anxiety in an environment where person thinks it will be difficult or embarrassing to escape

–>it’s a subset of panic disorder

70
Q

Treatment options for Panic Disorder:

A
  • CBT
  • SSRIs
  • TCAs
  • Benzos
71
Q

Treatment for specific phobias?

A

–>systemic desensitization

72
Q

What other psych disorder is OCD associated with?

A

–>Tourrettes

73
Q

Treatment for OCD?

A
  • SSRIs

- Clomipramine (TCA)

74
Q

Timing of Acute Stress Disorder vs PTSD?

A
  • Acute Stress Disorder: 2 days to 1 month

* PTSD: lasts at least 1 month; onset of symptoms may begin any time after event

75
Q

Dx criteria of Generalized Anxiety Disorder:

A
  • At least 6 months

* Anxiety is unrelated to specific person, situation or event

76
Q

Adjustment Disorder: Dx criteria?

A
  • ->anxiety, depression causing impairment after an identifiable stressor (ie divorce, illness)
  • ->lasts LESS than 6 months (or more than 6 months if the stressor is chronic)
77
Q

Malingering:

A
  • ->pt CONSCIOUSLY fakes or claims to have a disorder in order to get a specific secondary gain (ie skip work, get meds)
  • ->don’t comply with trtment, follow-up with dr, etc
  • ->complaints stop after get gain
78
Q

Factitious Disorder:

A

–>Pt CONSCIOUSLY creates physical/psych symptoms in order to be “sick” and get medical attention (motivation is unconscious though)

***unlike Malingering, in Factitious complaints continue even after getting the gain…

***Munchausen’s and Munchausen’s by proxy are both Factitious disorders

79
Q

Munchausen’s syndrome and Munchausen’s syndrome by proxy:

A

–>Both are Factitious Disorders:

  • Munchausen’s: Chronic factitious disorder; hx of lots of hospital admissions, procedures…
  • Munchausen’s by proxy: caregiver makes child sick; form of child abuse
80
Q

Somatoform disorders, generally:

A

physical symptoms but no identifiable physical cause
–> pt UNCONSCIOUSLY produces symptoms and with UNCONSCIOUS motivation

  • Includes:
  • Somatization disorder
  • Conversion
  • Hypochondriasis
  • Body dysmorphic disorder
  • Pain disorder
81
Q

Somatization disorder:

A
  • ->type of somatoform disorder
  • over several years, pt presents with multiple organ system complaints, but no identifiable physical cause (at least 4 pain, 2 GI, 1 sexual, 1 pseudoneurologic symptoms)
82
Q

Conversion disorder:

A
  • ->sudden loss of sensory or motor function (like sudden blindness) after an acute stressor
  • ->pt is aware, but indifferent to symptoms (la belle indifference)
83
Q

Cluster A Personality Disorders:

A

–> Weird, odd, eccentric:

  • Paranoid
  • Schizoid
  • Schizotypal
84
Q

Schizoid Personality Disorder:

A
  • ->VOLUNTARY social withdrawal; content with social isolation
  • a type A PD
85
Q

Cluster B Personality Disorders:

A
  • -> Wild, Dramatic, Emotional, Erratic
  • -> genetic associations with mood disorders and substance abuse
  • Antisocial
  • Borderline
  • Histrionic
  • Narcissistic
86
Q

Cluster C Personality Disorders:

A
  • ->Worried, anxious, fearful
  • -> genetic association with anxiety disorders
  • Avoidant
  • Obsessive-Compulsive
  • Dependent
87
Q

Avoidant PD:

A

–>WANTS relationships with others (as opposed to schizoid PD); but, hypersensitive to rejection, timid, feel inadequate, etc

-a cluster C PD

88
Q

Russel’s sign:

A

seen in Bulemic pts; dorsal hand calluses from inducing vomiting

89
Q

List drugs that are depressants:

  • general symptoms of intoxication?
  • general withdrawal symptoms?
A
  • Alcohol
  • Opiods (morphine, heroin, methadone…)
  • Barbiturates
  • Benzodiazepines
  • Nonspecific intoxication symptoms: elevated mood, decreased anxiety, sedation, behavior disinhibition, respi depression
  • Nonspecific withdrawal: anxiety, tremors, seizures, insomnia
90
Q

List drugs that are stimulants:

  • nonspecific intoxication symptoms:
  • nonspecific withdrawal symptoms:
A
  • Amphetamines
  • Cocaine
  • Caffeine
  • Nicotine
  • nonspecific intoxication: elevated mood, psychomotor agitation, insomnia, cardiac arrhythmias, tachycardia, anxiety
  • nonspecific withdrawal: post-use “crash” with depression, lethargy, weight gain, headache
91
Q

List drugs that are hallucinogens:

A
  • PCP = Phenylcyclidine
  • LSD
  • Marijauna
92
Q

Constipation, pupillary constriction (pinpoint pupils), seizures, CNS depression, nausea, vomiting:

A

–>Opioid intoxication (morphine, heroin, methadone, etc…)

***overdose can be fatal (treat OD with Naloxone, Naltrexone)

93
Q

Flumazenil

A

–>Treatment for Benzo overdose (competitive GABA antagonist –> blocks GABA!)

94
Q

Pupillary dilation, tactile hallucinations (or other hallucinations), paranoid thoughts, angina, sudden cardiac death

A

Cocaine intoxication

–>treat cocaine OD with Benzos

95
Q

Pupillary dilation, prolonged wakefullness and attention, delusions, hallucinations, fever:

A

Amphetamine intoxication

96
Q

Belligerence (violent!!), impulsiveness, vertical and horizontal nystagmus, delirium, psychosis, homicidality, tachycardia:

A

PCP (Phenylcyclidine) intoxication

–>PCP inhibits the NMDA receptor (glutamate receptor)

97
Q

Pupillary dilation, flashbacks (perhaps long after drug use), visual hallucinations, anxiety or depression:

A

LSD intoxication

98
Q

Conjunctival injection, rapid HR, dry mouth, increased appetite, paranoia

A

Marijuana intoxication

99
Q

Treatment for Cocaine OD?

A

–>Benzos

100
Q

Treatment for Benzo OD?

A

Flumazenil

101
Q

Treatment for Opioid (ie heroin) OD?

A

–>Naloxone or Naltrexone

102
Q

Dilated pupils, sweating, piloerection (if quit “cold turkey”), rhinorrhea, flu-like symptoms: d/t withdrawal from which drug?

A

–>Opioids withdrawal (ie heroin, methadone, morphine; can also get these symptoms from chronic prescription narcotics, like in cancer pts)

103
Q

Methadone:

A

->long-acting oral opiate; used for heroin detox and long-term maintenance; but, can have opioid withdrawal symptoms.

104
Q

Intoxication with which drugs will cause pupillary dilation?

A
  • Amphetamines
  • Cocaine
  • LSD

–> Also: anti-cholinergics (ie Atropine) causes midriasis

105
Q

Intoxication with which drugs will causes pupillary constriction?

A

-Opioids (ie heroin)

–> Also: cholinergic-agonists (ie organophosphates) cause miosis!

106
Q

Intoxication with which drug may cause violence/belligerence?

A

–>PCP (phenylcyclidine)

107
Q

Sublaxone:

A

= Naloxone + Buprenorphine (partial opioid agonist) –> can be used to treat heroin addiction; long-acting and fewer withdrawal symptoms than Methadone (b/c Naloxone is not active when taken orally, so only get withdrawal symptoms if it’s injected; so has a lower abuse potential)

108
Q

Treatment of Wernicke-Korsakoff syndrome:

A

IV vitamin B1 (Thiamine)

109
Q

Treatment of Alcoholism:

A
  • Disulfiram (so pt feels sick when drinks alcohol)

- supportive care, AA, etc

110
Q

Alcohol withdrawal symptoms?

–>treatment?

A
  • Delirium Tremens –> get it 2-5 days after last drink:
  • tachycardia, tremors, anxiety, seizures
  • hallucinations, delusions
  • confusion

*note: alcohol withdrawal can be fatal!

***Treat with Benzos!

111
Q

Treatment for Bulimia?

A

SSRIs

112
Q

Treatment for Atypical depression:

A
  • MAO inhibitors

- SSRIs

113
Q

Treatment for Depression:

A
  • SSRIs, SNRIs

- TCAs

114
Q

Treatment for Depression with Insomnia?

A

Mirtazapine

–>alpha-2-blocker (increases release of NE and serotonin) and serotonin receptor-blocker

115
Q

Clomipramine

A

TCA used to treat OCD (along with SSRIs)

116
Q

Treatment for Panic Disorder:

A
  • SSRIs
  • TCAs
  • Benzos
117
Q

Treatment for PTSD:

A

-SSRIs

118
Q

Treatment for Tourette’s:

A

-antipsychotics (haloperidol, respiridone)

119
Q

Treatment for scoial phobias:

A

-SSRIs

120
Q

Methylphenidate and amphetamines:

  • clinical uses?
  • mechanism?
A
  • ->used to treat Narcolepsy, ADHD…

- ->increase catecholamines (esp NE and Dopamine) at synaptic cleft

121
Q

Mechanism of typical antipsychotics:

A

–>block D2 receptors (get increased cAMP)

122
Q

List the typical antipsychotics:

A
  • Haloperidol + drugs ending in “-azine”
  • Trifluoperazine
  • Fluphenazine
  • Thioridazine
  • Chlorpromazine
123
Q

Which typical antipsychotics cause neurological/extrapyramidal side effects?

A
  • ->High potency antipyschotics: “Try to Fly High”
  • Trifluoperazine
  • Fluphenazine
  • Haloperidol
124
Q

Which typical antipsychotics cause not neurological, but anti-cholinergic, anti-histamine, and anti-alpha side effects? What are these side effects?

A
  • Low potency antipsychotics: “Cheating Thieves are low”
  • Chlorpromazine
  • Thioridazine

*blurred vision, constipation, hypotension, sedation

125
Q

Which antipsychotic may cause corneal deposits? Retinal deposits?

A

Corneal deposits–> Chlorpromazine
ReTinal deposits –> Thioridazine

–>both of these are low-potency atypical antipsychotics; have anti-cholinergic, anti-histamine, and alpha-blockade side effects (dry mouth, constipation, hypotension, sedation)

126
Q

Neuroleptic Malignant Syndrome:

  • cause?
  • presentation?
  • treatment?
A
  • toxicity of typical antipsychotic meds; starts a few days after begin meds
  • presentation = excess muscle contraction:
  • rigidity
  • myoglobinuria
  • hyperpyrexia (very high temp)
  • treatment:
  • Dantrolene (prevents Ca release from sarcoplasmic reticulum)
  • Bromocriptine (D2-receptor-blocker; used in Parkinson’s)
127
Q

Tardive dyskinesia:

  • cause?
  • presentation?
A
  • ->result of lont-term typical antipsychotic use
  • ->stereotypical facial movements
  • ->often irreversible
128
Q

Atypical antipsychotics: list them!

A

“it’s Atypical for Old Closets to Quietly Risper from A to Z”

  • Olanzapine
  • Clozapine
  • Quetiapine
  • Risperidone
  • Apiprazole
  • Ziprasidone
129
Q

Mechanism of atypical antispychotics:

A

–>not fully understood; effects on serotonin, dopamine, alpha, and histamine receptors

130
Q

Olanzapine:

A

atypical antipsychotic that can be used to treat OCD, anxiety, depression, mania, Tourrette’s

131
Q

Which class of anti-psychotic meds can treat both positive and negative symptoms of schizophrenia?

A

–>Atypical antipsychotics (typical primarily just treats positive symptoms)

132
Q

Which antipsychotic may cause agranulocytosis?

A

–>Clozapine (atypical antipsychotic); must monitor WBC weekly in these pts

133
Q

Which antipsychotics may cause significant weight gain?

A
  • ->Olanzapine and Clozapine (both are atypical antipsychotics)
  • so increased risk of developing DM
134
Q

Which antipsychotic may prolong the QT interval?

A

(like Class IA and III antiarrhythmics!)

–>Ziprasidone

135
Q

Apiprazole:

A

Atypical antipsychotic

136
Q

Why may antipsychotics cause galactorrhea?

A

–>b/c block dopamine –> so less inhibition of prolactin by dopamine –> increased prolactin –> galactorrhea and amenorrhea (amenorrhea b/c prolactin inhibits GnRH, so get decreased LH and FSH –> decreased spermatogenesis and ovulation)

137
Q

Risperidone:

A

atypical antipsychotic

138
Q

Affect of lithium in bipolar disorder?

A

–>blocks relapse and acute manic attacks; stabilizes mood (so, acts on the mania, not the depression)

139
Q

Lithium Toxicity:

A

“LMNOP”

  • Lithium
  • Movement (tremor)
  • Nephrogenic DI (it’s an ADH-blocker, so causes polyuria; so, can be used to treat SIADH!)
  • hypOthyroidism
  • Pregnancy problems (teratogenic–> Ebstein anomaly and malformation of great vessels)

***Narrow Therapeutic Index, so must monitor pts closely!

140
Q

Buspirone:

  • mechanism?
  • clinical use?
A
  • ->stimulates serotonin receptors

- ->used to treat GAD (no addiction, sedation, tolerance)

141
Q

TCA:

  • Mechanism?
  • Toxicity?
A
  • Mechanism: block reuptake of NE and Serotonin
  • Toxicity = Tri-C’s:
  • Convulsions
  • Coma
  • Cardiotoxicity (arrhythmias)
  • ->Also:
  • anticholinergic side effects; can lead to confusion and hallucinations in elderly
  • Sedation
142
Q

Treatment for CV toxicity from TCAs?

A

–>NaHCO3

143
Q

Which TCA should be used in elderly pts?

A

–>Nortryptiline (has fewer anti-cholinergic side effects, so better in elderly)

144
Q

Imipramine:

A

–>TCA that is used to treat bedwetting

145
Q

Clomipramine:

A

TCA used to treat OCD

146
Q

Doxepin

A

TCA (that doesn’t end in -typtyline or -ipramine!

147
Q

Amoxapine

A

TCA (that doesn’t end in -typtyline or -ipramine!

148
Q

SSRI that can be used to treat premature ejaculation?

A

Paroxetine

149
Q

List the SSRIs:

A
  • Fluoxetines
  • Paroxetine
  • Sertraline
  • Citalopram
150
Q

Toxicity of SSRIs:

A
  • sexual dysfunction –> anorgasmia (although Paroxetine can be used to treat premature ejaculation)
  • GI distress
  • Serotonin syndrome (hyperthermia, myoclonus, CV collapse, flushing, diarrhea, seizures)
151
Q

Serotonin syndrome:

  • cause?
  • presenation?
  • treatment?
A
  • ->When have too much serotonin; like if combine an SSRI and an MAO, so get lots of serotonin!
  • Presentation (think: lots of serotonin):
  • diarrhea
  • flushing
  • seizures
  • hyperthermia
  • myoclonus
  • CV collapse

*Treat with Cyproheptadine (an anti-histamine that is also a serotonin receptor blocker)

152
Q

Venlafaxine

A

SNRI

–>can be used to treat depression, GAD

153
Q

Duloxetine

A

SNRI
= “cimbalta”
–>treatment of depression, also can be used to treat diabetic peripheral neuropathy

154
Q

Tanylcypromaine

A

MAO inhibitor

155
Q

Phenelzine

A

MAO inhibitor

156
Q

Mechanism of MAO inhibitors:

A

–>increased levels of NE, Serotonin, Dopamine

157
Q

Selegiline

A

MAO inhibitor that is NOT used for depression; used to treat Parkinson’s

158
Q

Isocarboxazid

A

MAO inhibitor

159
Q

MAO inhibitors are contraindicated with:

A
  • foods with high tyramine content (wine, cheese, etc) –> b/c can get hypertensive crisis (b/c tyramine can act as a catecholamine, so get a whole ton of catecholamine release –> INCREASED BP!!!!)
  • Beta-agonists (can also lead to hypertensive crisis, b/c increased catecholamine action)
  • SSRIs (can lead to serotonin syndrome)
  • Meperidine (Opioid; can lead to serotonin syndrome)
160
Q

Buproprion:

A
  • atypical antidepressant
  • no sexual side effects
  • lowers seizure threshold (especially in bulemics, anorexics)
  • unknown mechanism, but leads to increased NE and dopamine
  • can be used for depression and also for smoking cessation
161
Q

Mirtazapine:

A
  • atypical antidepressant; good for depression with insomnia (b/c sedation = toxicity)
  • alpha -2-antagonist (so increases release of NE and serotonin) and serotonin-receptor antagonist
162
Q

Maprotiline:

A
  • atypical antidepressant
  • ->blocks NE reuptake
  • ->may cause orthostatic hypotension
163
Q

Trazodone:

A
  • atypical antidepressant
  • ->inhibits serotonin reuptake
  • ->used for insomnia (not really for depression, b/c need high doses for depression treatment)
  • toxicities:
  • postural hypotension
  • sedation (so can use for insomnia)
  • priapism –> “trazaBONE!”
164
Q

Buproprion:

A
  • atypical antidepressant
  • no sexual side effects
  • lowers seizure threshold (especially in bulemics, anorexics)
  • unknown mechanism, but leads to increased NE and dopamine
  • can be used for depression and also for smoking cessation
165
Q

Mirtazapine:

A
  • atypical antidepressant; good for depression with insomnia (b/c sedation = toxicity)
  • alpha -2-antagonist (so increases release of NE and serotonin) and serotonin-receptor antagonist
166
Q

Maprotiline:

A
  • atypical antidepressant
  • ->blocks NE reuptake
  • ->may cause orthostatic hypotension
167
Q

Trazodone:

A
  • atypical antidepressant
  • ->inhibits serotonin reuptake
  • ->used for insomnia (not really for depression, b/c need high doses for depression treatment)
  • toxicities:
  • postural hypotension
  • sedation (so can use for insomnia)
  • priapism –> “trazaBONE!”

FirstAID (24 decks)

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