Psychiatry

Question 1

What will the vitals look like in a benzo overdose?

Answer 1

Normal or hypotensive

Question 2

Antidote to benzo overdose and mechanism of action

Answer 2

Flumazenil- GABA-A partial agonist and competitive inhibitor to displace benzo

Question 3

Antidote to opioid overdose

Answer 3

Naloxone

Question 4

Antidote to aspirin overdose

Answer 4

Sodium bicarbonate

Question 5

Antidote to ethylene glycol overdose

Answer 5

Fomepizol

Question 6

What are the four key features of methanol poisoning

Answer 6

CNS depression
Blurred vision or blindness
Anion gap acidosis
Elevated osmolar gap

Question 7

What is the treatment of mild methanol poisoning? Symptomatic? Very severe?

Answer 7

Mild – IV fomepizole
Blindness or acidosis – IV sodium bicarb, fomepizole or ethanol, IV folinic acid
Severe – dialysis

Question 8

How do you differentiate between ethanol, methanol and ethylene glycol poisoning?

Answer 8

Ethanol – increased serum levels
Methanol – normal ethanol levels but visual sx
Ethylene glycol – normal ethanol levels but calcium oxalate crystals in urine

Question 9

Photophobia, anion gap acidosis, calcium oxalate crystals in urine

Answer 9

Ethylene glycol poisoning

Question 10

Abdominal pain, N/V, diarrhea, hematemesis, metabolic acidosis

Answer 10

Iron toxicity

Question 11

Tinnitus, tachypnea, metabolic acidosis, respiratory alkalosis

Answer 11

Salicylate overdose

Question 12

Miosis, diarrhea, urination, salivation, elevated troponins, hypomag

Answer 12

Organophosphate poisoning

Question 13

What are some suicide risk factors

Answer 13

Organized plan 
Male sex 
Older age 
Depressed 
Single 
Previous attempt 
Alcohol abuse
Lack of social support 
Chronic illness

Question 14

What overdose results in tinnitus

Answer 14

Aspirin

Question 15

What is the mechanism of action of quetiapine? What are the side effects?

Answer 15

Atypical antipsychotic - antagonist to dopamine, serotonin, NE
Causes sedation, weight gain, constipation, headache

Question 16

How are typical and atypical antipsychotic different in their effectiveness in treating schizophrenia?

Answer 16

Typical antipsychotics are primarily dopamine blockade and reduce positive symptoms but do not affect negative symptoms, whereas atypicals can affect serotonin and NE and can help positive and negative symptoms

Question 17

What causes the tardive dyskinesia seen in patients on typical antipsychotics?

Answer 17

Blockade of D2 receptors

Question 18

Name 5 typical antipsychotics

Answer 18

Haloperidol
Chlorpromazine 
Fluphenazine 
Perphenazine
Thioridazine

Question 19

What is the mechanism of action of typical and atypical antipsychotics?

Answer 19

Typical – block D2 receptors

Atypical – block D2, serotonin, Alpha1, H1 receptors

Question 20

Which atypical antipsychotic is associated with hyperprolactinemia?

Answer 20

Risperidone

Question 21

What is the most dreaded side effect of risperidone?

Answer 21

Hyperprolactinemia

Question 22

What is the mechanism of action and side effects of mirtazapine?

Answer 22

Alpha1 and 5HT2 blocker (antidepressant)

Sedation, weight gain

Question 23

What is the mechanism of action of TCAs?

Answer 23

Inhibition of serotonin and NE reuptake

Question 24

What are the 3 severe side effects of TCAs?

Answer 24

3 Cs– convulsions, coma, cardiotoxicity

Question 25

What are 3 side efffects to lithium?

Answer 25

Tremor Hypothyroidism Nephrogenic DI

Question 26

What are the 3 high potency typical antipsychotics

Answer 26

Trifluoperazine Fluphenazine Haloperidol

Question 27

What are 2 low potency typical antipsychotics?

Answer 27

Chlorpromazine | Thioridazine

Question 28

What are the main differences in side effects between high and low potency typical antipsychotics?

Answer 28

High -- mainly EPS side effects | Low -- less EPS, more anticholinergic, antihistamine, Alpha1 effects

Question 29

What are 3 effects of hyperprolactinemia on antipsychotics?

Answer 29

Galactorrhea Oligomenorrhea Gynecomastia

Question 30

What is the progression of EPS symptoms experienced with typical antipsychotics?

Answer 30

ADAPT: acute dystonia (hrs-days) --> akathisia, Parkinsonism (days-mo) --> tardive dyskinesia (mo-yrs)

Question 31

What is the treatment of EPS symptoms on antipsychotics?

Answer 31

Benztropine Benzos B-blockers for akathisia

Question 32

What are the signs and symptoms of neuroleptic malignant syndrome?

Answer 32

Malignant FEVER -- Myoglobinuria, Fever, Encephalopathy, unstable Vitals, inc Enzymes (CK), muscle Rigidity

Question 33

What is the treatment of neuroleptic malignant syndrome?

Answer 33

Dantrolene | Bromocriptine (D2 agonist)

Question 34

What is the mechanism of action of aripiprazole?

Answer 34

Partial D2 agonist and antagonist

Question 35

What are 6 conditions typical antipsychotics are used for?

Answer 35

``` Delirium Psychosis Bipolar disorder Schizophrenia OCD Tourette's ```

Question 36

Which atypical antipsychotic has evidence of reducing suicidal behavior?

Answer 36

Clozapine

Question 37

What are 7 conditions that atypical antipsychotics are used for?

Answer 37

``` Schizophrenia Bipolar OCD Tourette's Anxiety disorders Depression Mania ```

Question 38

Which has more anticholinergic side effects, typical or atypical antipsychotics

Answer 38

Typical

Question 39

What are the 2 severe side effects of clozapine?

Answer 39

Agranulocytosis | Seizures

Question 40

Benztropine

Answer 40

Anticholinergic drug used to treat Parkinson's disease ad acute dystonia

Question 41

What are the sx of anticholinergic overdose?

Answer 41

Difficulty focusing eyes, flushing, inability to sweat, hyperthermia, Urinary retention, constipation, confusion

Question 42

What are the sx of organophosphate poisoning

Answer 42

Excess cholinergic activity causing urination, salivation, defecation, lacrimation, n/v, diarrhea, wheezing, miosis, blurry vision, bradycardia, HoTN, seizures

Question 43

How do organophosphates cause toxicity?

Answer 43

They irreversibly inhibit acetylcholinesterase therefore blocking metabolism of ACh and causing increased activity

Question 44

What are the steps to treat organophosphate poisoning?

Answer 44

1. Remove clothes and wash patient 2. Administer atropine (competitive inhibitor) 3. Administer pralidoxime (reactives AChE) 4. If seizures, give benzo

Question 45

What are the sx of Serotonin syndrome?

Answer 45

Fever, myoclonus, hyperreflexia, muscle rigidity, tremor, diaphoresis, hyperthermia, diarrhea, AMS

Question 46

What lab test can be ordered to confirm the diagnosis of Serotonin syndrome?

Answer 46

CK

Question 47

What is the treatment of Serotonin Syndrome?

Answer 47

1. Benzos -- muscle relaxant, control seizures 2. O2 and IVF 3. Cyproheptadine -- block serotonin 4. Anti-hypertensives like b-blocker or nitroprusside