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USMLE Step 1 > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

Selective serotonin reuptake inhibitors (SSRIs)

A

An adequate trial is considered 4-6 weeks SA: headache, GI disturbance, sexual dysfunction, increased bleeding (2/2 platelet dysfunction), increased risk of peptic ulcers (avoid NSAIDs)

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2
Q

Venlafaxine (Effexor)

A

SNRI SA: diaphoresis, increased BP Not the best for hypertensive patients

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3
Q

Duloxetine (Cymbalta)

A

SNRI FDA approved for pain

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4
Q

Mirtazapine (Remeron)

A

Alpha2-adrenergic receptor antagonist Good for the elderly, increases appetite, sedating

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5
Q

Tricyclic antidepressants (TCAs)

A

SA: sedation, weight gain, orthostatic hypotension, anticholinergic effects, prolonged QT interval Most lethal in overdose –> arrythmias

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6
Q

Monoamine oxidase inhibitors (MAOIs)

A

Used for refractory depression SA: hypertensive crisis when used with sympathomimetics or ingestion of tyramine-rich foods (wine, beer, aged cheeses, liver, smoked meats), orthostatic hypotension, serotonin syndrome if combined with other serotonergic drugs

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7
Q

Lithium

A

Mood stabilizer

Indicated for bipolar I

Reduces suicide risk

SA: weight gain, tremor, GI disturbance, fatigue, arrhythmias, seizures, goiter/hypothyroidism, leukocytosis, nephrogenic DI, polydipsia, alopecia, metallic taste

Avoid in renal disease, heart disease, hyponatremia, diuretic use, pregnancy (a/w Ebstein anomaly)

Check creatinine and TFTs before starting

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8
Q

Carbamazepine

A

Sodium channel blocker

Indicated for bipolar I, esp. rapid cycling or mixed features

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9
Q

Valproic acid

A

Sodium channel blocker, inhibits GABA transaminase increaseing GABA concentration

Indicated for bipolar I, esp. rapid cycling or mixed features

Avoid in liver disease

Monitor for thrombocytopenia

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10
Q

Sertraline (Zoloft)

A

SSRI Good for atypical depression and MDD with psychotic features FDA approved for PTSD

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11
Q

Citalopram (Celexa)

A

SSRI FDA approved for MDD Good for depression in the elderly and for behavioral issues related to dementia Prolongs QTc

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12
Q

Prazosin

A

Alpha1-receptor antagonist Indicated for nightmares and hypervigilance a/w PTSD

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13
Q

Escitalopram (Lexapro)

A

SSRI Best tolerated SSRI FDA approved for MDD and GAD

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14
Q

Melatonin

A

Indicated for circadian rhythm sleep disorders

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15
Q

Pramipexole

A

Dopamine agonist Indicated for Parkinson disease and restless leg syndrome

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16
Q

Quetiapine (Seroquel)

A

Atypical antipsychotic SA: sedating Adjunct for depression

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17
Q

Modafinil

A

Nonamphetamine Indicated for narcolepsy

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18
Q

Risperidone

A

Atypical antipsychotic

SA: hyperprolactinemia (sexual dysfunction, gynecomastia in men, amenorrhea, glactorrhea)

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19
Q

Aripiprazole (Abilify)

A

Atypical antipsychotic

More weight neutral

Good adjunct for depression

SA: akathisia

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20
Q

Clozapine (Clozaril)

A

Atypical antipsychotic

SA: agranulocytosis, seizures, myocarditis, orthostatic hypotension

Very effective but reserved for patients who have failed at least 2 antipsychotic trials as need to regularly monitor CBC

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21
Q

Olanzapine

A

Atypical antipsychotic

SA: weight gain

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22
Q

Paliperidone (Invega)

A

Atypical antipsychotic Metabolite of risperidone

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23
Q

Lurasidone (Latuda)

A

Atypical antipsychotic Adjunct for bipolar, minimal effect on QTc

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24
Q

Ziprasidone

A

Atypical antipsychotic

SA: prolongs QTc

Minimal effect on weight

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25
Treatment for acute mania
Antipsychotics (quick onset) Lithium Valproate
26
Lamotrigine
Anticonvulsant Indicated for bipolar depressive episodes SA: Stevens-Johnson syndrome
27
fTreatments for extrapyramidal symptoms
Acute dystonia --\> benzotropine or diphenhydramine (IM) Akathisia --\> reduction of antipsychotic dose + beta-blocker or benzodiazepine Parkinsonism --\> benzotropine or amantadine Tardive dyskinesia --\> no definitely treatment but clozapine may help The first three are caused by acute D2 blockade but tardive dyskinesia is associted with chronic antipsychotic use which causes upregulation of dopamine receptors
28
Neuroleptic malignant syndrome
Characterized by fever/hyperthermia, autonomic instability (tachycardia, labile BP, tachypnea, diaphoresis), muscle rigidity (lead-pipe), AMS, elevated CK Causes: antipsychotics, antiemetics, antiparkinson medication withdrawal Tx: stop the antipsychotic, supportive care (hydration, cooling), dantrolene or bromocriptine
29
Haloperidol
Typical antipsychotic, high potentcy SA: dystonia, akathisia, parkinsonism, tardive dyskinesia
30
Serotonin syndrome
S&S: autonomic instability, AMS, hyperreflexia, myoclonus, increased bowel sounds Tx: stop medication, benzos for clonus, CCB for HTN, _cyproheptadine_ Associated with drug-drug interactions with serotonergic activity (e.g. SSRIs, MAOIs, linezolid)
31
Buspirone
Anxiolytic 5-HT1A agonist Indicated for generalized anxiety disorder Not effective in treating acute anxiety due to slow onset of action
32
Clomipramine
TCA (most serotonin selective) Can be used to treat obsessive-compulsive disorder but not first line
33
Chlorpromazine
Typical antipsychotic SA: corneal deposits
34
Fluphenazine
Typical antipsychotic, high potentcy
35
Perphenazine
Typical antipsychotic
36
Atypical antipsychotics
Serotonin (5-HT2) and dopamine (D4 \> D2) antagonists SA: HTN, hyperglycemia, weight gain, HLD
37
What are the weight neutral atypical antipsychotics?
Aripiprazole Ziprasidone
38
Which antipsychotics are good adjuncts for depression?
Aripiprazole Quetiapine
39
Fluoxetine (Prozac)
SSRI _Only SSRI FDA approved for bulimia_ Indicated for MDD, OCD, bulimia
40
Alprazolam
Short-acting benzodiazepine Can cause seizures following abrupt discontinuation
41
Paroxetine (Paxil)
SSRI FDA approved for PTSD Inhibits it's own metabolism Short half-life --\> requires taper
42
Risk factors for obstructive sleep apnea
STOP BANG Snoring Tiredness during the day Observed apnea Pressure of blood BMI \> 35 Age \> 50 Neck circumference \> 16 Gender of male
43
Fluvoxamine (Luvox)
SSRI FDA approved for OCD and social phobia Interacts with nicotine
44
Desvenlafaxine (Pristiq)
SNRI Active metabolite of venlafaxine
45
Duloxetine (Cymbalta)
SNRI
46
Serotonin discontinuation syndrome
S&S: dizziness, fatigue, headache, nausea, "electric like" shocks Highest risk is paroxetine
47
What medication is contraindicated in eating disorders?
Bupropion because it lowers the seizure threshold
48
Diagnostic tests for alcohol use disorder?
MCV --\> macrocytosis GGT AST \> ALT (not specific) Blood alcohol level (high levels without evidence of intoxication = tolerance) High HDL, low LDL (not specific)
49
Buprenorphine
Opioid receptor partial agonist Used to treat opioid addiction
50
Methadone
Mu-opioid agonist Used to help with opioid detox in people with opioid dependence (has a long half-life so suppresses cravings and withdrawal symptoms ≥ 24 hours)
51
Disulfiram
Inhibits aldehyde dehydrogenase --\> patient feels ill if ethanol consumed Used to treat alcoholism in high-functioning alcoholics who desire long-term abstinence
52
Treatment of catatonia
Benzodiazepines and/or ECT Avoid antipsychotics
53
Lorazepam
Benzodiazepine
54
Chlordiazepoxide
Very long-acting benzodiazepine Avoid in liver disease
55
Bupropion
Norepinephrine and dopamine reuptake inhibitor (NDRI) Often added when partial response to SSRI or sexual side effects from SSRIs Can also aid in smoking cessation _Avoid in patients with bulimia or seizures_
56
Nortryptyline
TCA
57
Tranylcypromine
MAOI Indicated for treatment-resistant or atypical depression
58
Flumazenil
Bensodiazepine antagonist Used to treat overdose
59
Amitryptyline (Elavil)
TCA Most anticholinergic
60
What medications are good for treating the depressed stage of bipolar disorder?
Atypical antipsychotics quetiapine and lurasidone
61
Treatment for treatment-resistant or severe bipolar?
Lithium or valproate + atypial antipsychotic (quetiapine)
62
Trazodone
Serotonin agonist and reuptake inhibitor Sedating SA: priapism
63
Doxepin
TCA
64
Imipramine
TCA
65
Trimipramine
TCA
66
Desipramine
TCA Least antichoinergic
67
Isocaroxazid
MAOI
68
Selegiline
MAOI, selectively MAO-B MAO-B preferentially metabolizes dopamine over norepinephrine and serotoin so inhibition increases the availability of dopamine Indicated for treatment-resistant or atypical depression, Parkinsons
69
Moclobemide
MAOI
70
Pirlindole
MAOI
71
Treating an MAOI-induced hypertensive crisis?
Stop medication, IV nitroprusside, clonidine
72
In which psychiatric disorders is pharmacology the first line treatment?
ADHD Schizophrenia Bipolar disorder
73
Narcolepsy
≥ 3x/week for 3 months of excessive daytime sleepiness, hypnagogic hallucinations (on falling asleep), sleep paralysis, cataplexy (emotionally triggered loss of muscle tone) _May see decreased hypocretin-1 (orexin) in CSF_ Tx: stimulants in the daytime (amphetamines, modafinil), sodium oxybate (GHB) at night
74
Schizophrenia timeline
\< 1 month: brief psychotic disorder 1-6 months: schizophreniform disorder \> 6 months: schizophrenia
75
Schizoid vs. schizotypal vs. schizoaffective
Schizoid: voluntary social withdrawal, content with isolation Schizotypal: eccentric, odd/magical beliefs Schizoaffective: schizophrenia + bipolar or depressive mood disorder
76
Stress disorders timeline
3 days - 1 month: acute stress disorder \> 1 month: PTSD
77
Sleep terror disorder vs. nightmares
Sleep terror disorder: occur during non-REM sleep, no memory or arousal Nightmares: occur during REM sleep, memory of scary dream
78
Methylphenidate
Increases catecholamines (especially norepinephrine and dopamine) at the synaptic cleft Indicated for ADHD, narcolepsy, and appetite control
79
Bipolar disorder with psychotic features vs. Schizoaffective disorder
In bipolar disorder with psychotic features, psychotic symptoms occur exclusively during mood episodes In schizoaffective disorder, delusions or hallucinations are present in the absense of major depressive or manic episodes
80
Bipolar I vs. bipolar II
Bipolar I: at least one manic episode, depressive episode not required Bipolar II: at least one hypomanic episode + at least one major depressive episode Manic episode: symptoms more severe, last at least 1 week or required hospitalization, marked impairement, may have psychotic features Hypomanic episode: less severe symptoms, ≥ 4 consecutive days, less severe impairement, no psychotic features
81
Rett syndrome
X-linked disorder (MECP2 gene) seen almost exclusively in girls _Regression_ characterized by loss of development, loss of verbal abilities, intellectual disability, ataxia, _stereotyped hand-wringing, deceleration of head growth_ Apparent around ages 1-4
82
Strongest predictive factor for suicide?
Previous suicide attempts
83
Phenelzine
MAOI Indicated for treatment-resistant or atypical depression
84
What characterizes atypical depression?
Mood reactivity (feeling better in response to positive events) Leaden paralysis Reaction sensitivity
85
Tourette disorder vs. tic disorder
Tourette disorder: ≥ 1 year of motor + vocal tics (don't have to be concurrent) Tic disorder: ≥ 1 year of motor or vocal tics but not both
86
Bulimia nervosa vs. binge-eating disorder
Bulimia nervosa: compensatory behaviors, excessive worry about body shape and weight Binge-eating disorder: no compensatory behaviors

USMLE Step 1 (20 decks)

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