Psychiatry

Question 1

ADHD

Answer 1

Methylphenidate

Question 2

Alcohol withdrawal

Answer 2

Benzodiazepines

Specifically DTs

Question 3

Anxiety

Answer 3

SSRIs, SNRIs, buspirone

Question 4

Bipolar disorder

Answer 4

“Mood stabilizers” = lithium, valproic acid, carbamazepine

Atypical antipsychotics

Question 5

Bulimia

Answer 5

SSRIs

Question 6

Depression

Answer 6

SSRIs, SNRIs, TCAs, bupropion (Wellbutrin; increase NE and Da), mirtazepine (especially with insomnia; a2 antagoinst and potent 5HT2 and 5HT3 receptor antagonist)

Question 7

Obsessive-compulsive disorder

Answer 7

SSRIs, clomipramine (TCA)

Question 8

Panic disorder

Answer 8

SSRIs, venlafaxine (SNRI), benzos

Question 9

PTSD

Answer 9

SSRIs

Question 10

Schizophrenia

Answer 10

Antipsychotics

Question 11

Social phobias

Answer 11

SSRIs, B-blockers

Question 12

Tourette syndrome

Answer 12

Antipsychotics (haloperidol, risperidone)

Question 13

CNS stimulants

Answer 13

Methylphenidate, dextroamphetamine, methamphetamine, phentermine
Increase NE and Da at synaptic cleft
ADHD, narcolepsy, appetite control

Question 14

Typical antipsychotics

Answer 14

Haloperidol
Trifluoperazine
Fluphenazine
Thioridazine
Chlorpromazine
("azines" + Haloperidol)

Block D2 receptors = increase cAMP

Question 15

Typical antipsychotic toxicity/side effects

Answer 15

Extrapyramidal system side effects (dyskinesias)
Endocrine side effects (hyperprolactinemia –> galactorrhea)
Muscarinic, a1, and histamine blockade

Question 16

Evolution of EPS side effects

Answer 16

4 hr acute dystonia = muscle spasm, stiffness, oculogyric crisis
4 day akathisia = restlessness
4 wk bradykinesia = parkinsonism
4 mo tardive dyskinesia

Question 17

Haloperidol side effects

Answer 17

Neuroleptic malignant syndrome

Tardive dyskinesia

Question 18

Neuroleptic malignant syndrome

Treatment?

Answer 18

Rigidity, myoglobinuria, autonomic instability, hyperpyrexia

Treatment = dantrolene, D2 agonists (bromocriptine)

Question 19

Tardive dyskinesia

Answer 19

Stereotypic oral-facial movements as a result of long-term antipsychotic use
Potentially irreversible

Question 20

NMS symptoms

“FEVER”

Answer 20

Fever
Encephalopathy
Vitals unstable
Enzymes increased (CK)
Rigidity of muscles/Rhabdomyolysis

Question 21

Atypical antipsychotics

“Old Closets Quietly Risper from A to Z”

Answer 21

Olanzapine
Clozapine
Quetiapine
Risperidone
Aripiprazole
Ziprasidone

Question 22

Atypical antipsychotics

Answer 22

Varied effects on 5HT2, dopamine, a receptors, H1 preceptors

Fever extrapyramidal and anticholinergic side effects

Question 23

Antipsychotics causing significant weight gain/metabolic syndrome

Answer 23

Olanzapine

Clozapine

Question 24

Antipsychotic causing agranulocytosis (requires weekly WBC monitor) and seizure?

Answer 24

Clozapine

Question 25

Antipsychotic causing gynecomastia (male) and lactation/irregular menstruation (female)?

Answer 25

Risperidone

Question 26

Antipsychotic that prolongs QT interval?

Answer 26

Ziprasidone

Question 27

Lithium toxicity/side effects?

Answer 27

Movement (tremor) Nephrogenic diabetes insipidus Hypothyroidism Pregnancy problems Tremor, sedation, edema, heart block, hypothyroidism, polyuria (ADH antag causing nephrogenic DI) Narrow therapeutic window = excreted by kidneys Most reabsorbed at PCT following Na reabsorption

Question 28

Fetal cardiac defects due to lithium use?

Answer 28

Ebstein anomaly and malformation of the great vessels

Question 29

Buspirone

Answer 29

Stimulates 5HT1A receptors (partial agonist) GAD Does not cause sedation, addiction, or tolerance Does not interact with alcohol

Question 30

SSRIs

Answer 30

``` Fluoxetine = Prozac Paroxetine = Paxil Sertraline = Zoloft Citalopram = Celexa ``` 5HT reuptake inhibitors

Question 31

SSRI side effects

Answer 31

GI distress SEXUAL DYSFUNCTION (anorgasmia and decreased libido) Serotonin syndrome with any drug that increases 5HT

Question 32

Serotonin syndrome sx

Answer 32

Hyperthermia, confusion, myoclonus, CV collapse, flushing, diarrhea, seizures Treatment = cyproheptadine (5HT2 receptor antagonist)

Question 33

Serotonin syndrome antidote?

Answer 33

Cyproheptadine = 5HT2 receptor antagonist

Question 34

SNRIs

Answer 34

Tx depression Venlafaxine = GAD, panic Duloxetine = diabetic peripheral neuropathy Inhibit 5HT and NE reuptake

Question 35

SNRI toxicity

Answer 35

Increased BP Stimulant effects Sedation Nausea

Question 36

TCAs

Answer 36

``` Amitriptyline Nortriptyline Imipramine Desipramine Clomipramine (OCD) Doxepin Amoxapine (depression in elderly with psychotic features) ``` Block reuptake of NE and 5HT Major depression, OCD, fibromyalgia

Question 37

TCA toxicity

Answer 37

Sedation, a1 blocking (postural hypotension), anticholinergic (tachycardia, urinary retention, dry mouth) Desipramine = less sedating but higher incidence seizures Tri-C's: ---Convulsions ---Coma ---Cardiotoxicity (arrhythmias) = tx with NaHCO3 Respiratory depression, hyperpyrexia Confusion, hallucination

Question 38

Tri-C's

Answer 38

Convulsions Coma Cardiotoxicity

Question 39

Treatment for TCA induced cardiotoxicity?

Answer 39

NaHCO3

Question 40

MAOIs

Answer 40

Tranylcypromine Phenelzine Isocarboxazid Selegiline (selective MAO-B inhibitor) Increase levels of amine neurotransmitters (NE, 5HT, Da) Atypical depression, anxiety, hypochondriasis

Question 41

MAOI toxicity

Answer 41

``` HTN crisis (with ingestion of tyramine = wine and cheese) CNS stimulation ```

Question 42

MAOI contraindications

Answer 42

``` SSRIs TCAs St. John's wort Meperidine Dextromethorphan (To prevent serotonin syndrome) ```

Question 43

Atypical antidepressants (3)

Answer 43

Bupropion (Wellbutrin) Mirtazapine Trazodone

Question 44

Bupropion (Wellbutrin) | MOA? Toxicity?

Answer 44

Increased NE and 5HT via unknown MOA | Toxicity = stimulant effects (tachycardia, insomnia), headache, seizure in bulimics

Question 45

Mirtazapine | MOA? Toxicity?

Answer 45

``` a2 antagonist (increase release of NE and 5HT) and potent 5HT2 and 5HT3 receptor antagonist Toxicity = sedation (desirable with concurrent insomnia), increased appetite, weight gain (desirable in anorexic patients), dry mouth ```

Question 46

Trazodone | MOA? Toxicity?

Answer 46

Blocks 5HT2 and a1 adrenergic receptors Uses = insomnia (high doses needed for antidepressant effects) Toxicity = sedation, nausea, PRIAPISM, postural hypotension "TrazoBONE"