Psychiatry Flashcards
MOA of risperidone?
Side effect?
It is a dopamine antagonist
meaning that it will cause galactorrhea (due to non-inhibition of prolactin)
MOA of primidone?
Side effect?
Anticonvulsant
can cause acute intermittent porphyria
What is the side effect of the SSRI Imiprimine?
It causes increased prolactin, so it can cause infertility and galactorrhea!
What is a long term side effect of buspirone?
Seizures
Ppl mainly take this for GAD, OCD, PTSD
OCD vs OC personality disorder?
OCD = the pts know that what they are doing is crazy and want to get rid of their behaviors
OCPD = pts think their actions are ok
Panic Disorder
Pt has panic attacks, avoids areas that may make them panic, fear of public areas (agoraphobia) and has concern (>1 month) about having additional attacks
Differentiate:
MDD Atypical Depression Double Depression Adjustment Disorder Dysthymia
MDD = 2 weeks of 7 SIGECAPs
Atypical = weight gain, hypersomnia, and rejection sensitivity
Double = major depressive episode w/ dysthymia (2 years of depressed mood.)
Adjustment = Some SIGECAPs but not all, occurs 3 months after an identifiable stressor
Dysthymia = milder, chronic depression for most of the time for 2 years. Resistant to tx.
TCA toxicity?
3 C’s
Convulsions
Coma
Cardiac Arrythmias (long QTc)
MUST BE OFF SSRI’S FOR 2 WEEKS BEFORE STARTING AN MAOI
MUST BE OFF FLUOXETINE FOR 5 WEEKS
Differentiate:
Postpartum blues
Postpartum psychosis
Postpartum depression
blues = 2 weeks PP, sad, no thoughts of harm psychosis = 2-3 weeks PP, delusions, thoughts of harm depression = 1-3 months PP, all of the above + sleep issues and anxiety. Thoughts of harm!
Differentiate: BP 1 BP 2 Cyclothymic Rapid Cycling
BP1 - at least 1 manic or mixed episode (at least 1 week long)
BP2 - at least 1 major depressive episode AND 1 HYPOmanic episode
Cyclothymic - chronic, less severe alternating periods of hypomania and moderate depression for >2 years
Rapid Cycling - 4+ episodes of depression or mania in 1 year!
Antidepressants in a BP patient can cause them to go into mania
Always start your mood stabilizers first
Serotonin syndrome
fever, myoclonus, mental status changes
Paroxetine can cause what in fetus?
Pulmonary HTN, avoid in pregnant pts
Side effects of mirtazepine?
Venlafaxine?
MAOi?
Weight gain and sedation
Ven = diastolic HTN
MAOi = HTN crisis if taken w/ tyramine foods. also causes weight gain and ortho hypotension
Avoid lithium in RF pts
It has a narrow TI and can cause decreased renal function if levels are too high
Side effects of carbamaxepine?
Valproate
Lamotrigine
carb = nausea, rash, aplastic anemia, SJS
Valproate = GI side effects, agranulocytosis
Lamotrigine = blurry vision, SJS (increase dose slowly!)
Schizoid vs anti social vs avoidant
schizoid = avoid. No emotions. loners
anti-social = break laws, impulsive. in child hood this is called Conduct Disorder
avoidant = rejection sensitive and fear of being disliked so thats why they avoid
Schizoaffective vs Schizophreniform
Affective = symptoms of schizophrenia and either depression or BP
Schizophreniform = schizophrenia symptoms for
MOA of typical antipsychotics (haldol, chlorpromazine etc.)
Side effects?
MOA = D blockers (treats + symptoms)
can cause EPS or hyperprolactinemia
can cause anticholinergic effects
QTc elongation
NMS
THORIDAZINE CAUSES IRREVERSIBLE RETINAL PIGMENTATION
MOA of atypical antipsychotics (clozapine, risperidone, aripiprazole, olanzapine, quetiapine)
Side effects?
dont know MOA. dont use clozapine unless everything else fails (it causes agranulocytosis and needs to have a weekly CBC.)
Can all cause weight gain and t2DM, but less EPS symptoms!
EPS side effects?
4 hours - acute dystonia (twisted neck) tx = anticholinergics
4 days - akinesia. (pseudo parkinsons) tx = anticholinergics
4 weeks - akathesia. (restlessness) tx = BBs and antichol
4 months - TD. d/t chronic D blockade. tx = anticholinergics (although these may worsen the symptoms at first!) and change drug to clozapine or risperidone (atypicals)
Differentiate:
Aspergers
Rett
Childhood disintegrative disorder
Aspergers = autism but w.o the language or cognitive delays
Rett = neurodegenerative disorder in girls (impairment in language, head growth, and coordination after 5 months of normal development.)
Childhood dis = developmental regression > after 2 years of normal development (language, bowel control, motor skills etc..)
Mild, moderate, or profound Mental Retardation
mild = IQ of 50-70 mod = IQ of 35-49 profound = IQ
What do pupils look like in these abuses: opioids amphetamines cocaine PCP
opioids - constriction
amphetamines - dilation
cocaine - dilation
PCP - vertical/horizontal nystagmus
People with anorexia nervosa may still binge/purge
differentiate it from bulemia if they are underweight and dont see anything wrong with what they are doing
DONT GIVE BUPROPRION TO EATING DISORDER PTS B/C IT CAN LOWER THE SEIZURE THRESHOLD!
lanugo
soft fine hairs that grow on pts with eating disorders
Tx for narcolepsy?
Naps, benzos (stimulants) and/or SSRI’s if they have cataplexy (sudden loss of muscle tone)
How are factitious disorders and malingering different from somatoform disorders?
Somatoform disorders have no conscious control or intentional process!
malingering = they are pretending to be sick for a tangible gain
Conversion vs Somatoform?
somatoform - multiple symptoms in different organ systems
conversion - motor/sensory function disorders linked to a relationship of stress
