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USMLE Step 1 > Psychiatry > Flashcards

Psychiatry Flashcards

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USMLE® Step 1 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
Q

Treatment for acute mania

A

Antipsychotics (quick onset) Lithium Valproate

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26
Q

Lamotrigine

A

Anticonvulsant Indicated for bipolar depressive episodes SA: Stevens-Johnson syndrome

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27
Q

fTreatments for extrapyramidal symptoms

A

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

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28
Q

Neuroleptic malignant syndrome

A

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

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29
Q

Haloperidol

A

Typical antipsychotic, high potentcy SA: dystonia, akathisia, parkinsonism, tardive dyskinesia

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30
Q

Serotonin syndrome

A

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)

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31
Q

Buspirone

A

Anxiolytic 5-HT1A agonist

Indicated for generalized anxiety disorder

Not effective in treating acute anxiety due to slow onset of action

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32
Q

Clomipramine

A

TCA (most serotonin selective) Can be used to treat obsessive-compulsive disorder but not first line

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33
Q

Chlorpromazine

A

Typical antipsychotic

SA: corneal deposits

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34
Q

Fluphenazine

A

Typical antipsychotic, high potentcy

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35
Q

Perphenazine

A

Typical antipsychotic

36
Q

Atypical antipsychotics

A

Serotonin (5-HT2) and dopamine (D4 > D2) antagonists SA: HTN, hyperglycemia, weight gain, HLD

37
Q

What are the weight neutral atypical antipsychotics?

A

Aripiprazole Ziprasidone

38
Q

Which antipsychotics are good adjuncts for depression?

A

Aripiprazole Quetiapine

39
Q

Fluoxetine (Prozac)

A

SSRI

Only SSRI FDA approved for bulimia

Indicated for MDD, OCD, bulimia

40
Q

Alprazolam

A

Short-acting benzodiazepine Can cause seizures following abrupt discontinuation

41
Q

Paroxetine (Paxil)

A

SSRI FDA approved for PTSD Inhibits it’s own metabolism Short half-life –> requires taper

42
Q

Risk factors for obstructive sleep apnea

A

STOP BANG Snoring Tiredness during the day Observed apnea Pressure of blood BMI > 35 Age > 50 Neck circumference > 16 Gender of male

43
Q

Fluvoxamine (Luvox)

A

SSRI FDA approved for OCD and social phobia Interacts with nicotine

44
Q

Desvenlafaxine (Pristiq)

A

SNRI Active metabolite of venlafaxine

45
Q

Duloxetine (Cymbalta)

A

SNRI

46
Q

Serotonin discontinuation syndrome

A

S&S: dizziness, fatigue, headache, nausea, “electric like” shocks Highest risk is paroxetine

47
Q

What medication is contraindicated in eating disorders?

A

Bupropion because it lowers the seizure threshold

48
Q

Diagnostic tests for alcohol use disorder?

A

MCV –> macrocytosis GGT AST > ALT (not specific) Blood alcohol level (high levels without evidence of intoxication = tolerance) High HDL, low LDL (not specific)

49
Q

Buprenorphine

A

Opioid receptor partial agonist Used to treat opioid addiction

50
Q

Methadone

A

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
Q

Disulfiram

A

Inhibits aldehyde dehydrogenase –> patient feels ill if ethanol consumed

Used to treat alcoholism in high-functioning alcoholics who desire long-term abstinence

52
Q

Treatment of catatonia

A

Benzodiazepines and/or ECT Avoid antipsychotics

53
Q

Lorazepam

A

Benzodiazepine

54
Q

Chlordiazepoxide

A

Very long-acting benzodiazepine

Avoid in liver disease

55
Q

Bupropion

A

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
Q

Nortryptyline

A

TCA

57
Q

Tranylcypromine

A

MAOI

Indicated for treatment-resistant or atypical depression

58
Q

Flumazenil

A

Bensodiazepine antagonist Used to treat overdose

59
Q

Amitryptyline (Elavil)

A

TCA

Most anticholinergic

60
Q

What medications are good for treating the depressed stage of bipolar disorder?

A

Atypical antipsychotics quetiapine and lurasidone

61
Q

Treatment for treatment-resistant or severe bipolar?

A

Lithium or valproate + atypial antipsychotic (quetiapine)

62
Q

Trazodone

A

Serotonin agonist and reuptake inhibitor Sedating SA: priapism

63
Q

Doxepin

A

TCA

64
Q

Imipramine

A

TCA

65
Q

Trimipramine

A

TCA

66
Q

Desipramine

A

TCA Least antichoinergic

67
Q

Isocaroxazid

A

MAOI

68
Q

Selegiline

A

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
Q

Moclobemide

A

MAOI

70
Q

Pirlindole

A

MAOI

71
Q

Treating an MAOI-induced hypertensive crisis?

A

Stop medication, IV nitroprusside, clonidine

72
Q

In which psychiatric disorders is pharmacology the first line treatment?

A

ADHD Schizophrenia Bipolar disorder

73
Q

Narcolepsy

A

≥ 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
Q

Schizophrenia timeline

A

< 1 month: brief psychotic disorder

1-6 months: schizophreniform disorder

> 6 months: schizophrenia

75
Q

Schizoid vs. schizotypal vs. schizoaffective

A

Schizoid: voluntary social withdrawal, content with isolation

Schizotypal: eccentric, odd/magical beliefs

Schizoaffective: schizophrenia + bipolar or depressive mood disorder

76
Q

Stress disorders timeline

A

3 days - 1 month: acute stress disorder

> 1 month: PTSD

77
Q

Sleep terror disorder vs. nightmares

A

Sleep terror disorder: occur during non-REM sleep, no memory or arousal

Nightmares: occur during REM sleep, memory of scary dream

78
Q

Methylphenidate

A

Increases catecholamines (especially norepinephrine and dopamine) at the synaptic cleft

Indicated for ADHD, narcolepsy, and appetite control

79
Q

Bipolar disorder with psychotic features vs. Schizoaffective disorder

A

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
Q

Bipolar I vs. bipolar II

A

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
Q

Rett syndrome

A

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
Q

Strongest predictive factor for suicide?

A

Previous suicide attempts

83
Q

Phenelzine

A

MAOI

Indicated for treatment-resistant or atypical depression

84
Q

What characterizes atypical depression?

A

Mood reactivity (feeling better in response to positive events)

Leaden paralysis

Reaction sensitivity

85
Q

Tourette disorder vs. tic disorder

A

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
Q

Bulimia nervosa vs. binge-eating disorder

A

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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