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Step 2 > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

What will the vitals look like in a benzo overdose?

A

Normal or hypotensive

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2
Q

Antidote to benzo overdose and mechanism of action

A

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

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3
Q

Antidote to opioid overdose

A

Naloxone

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4
Q

Antidote to aspirin overdose

A

Sodium bicarbonate

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5
Q

Antidote to ethylene glycol overdose

A

Fomepizol

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6
Q

What are the four key features of methanol poisoning

A

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

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7
Q

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

A

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

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8
Q

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

A

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

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9
Q

Photophobia, anion gap acidosis, calcium oxalate crystals in urine

A

Ethylene glycol poisoning

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10
Q

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

A

Iron toxicity

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11
Q

Tinnitus, tachypnea, metabolic acidosis, respiratory alkalosis

A

Salicylate overdose

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12
Q

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

A

Organophosphate poisoning

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13
Q

What are some suicide risk factors

A 
Organized plan 
Male sex 
Older age 
Depressed 
Single 
Previous attempt 
Alcohol abuse
Lack of social support 
Chronic illness
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14
Q

What overdose results in tinnitus

A

Aspirin

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15
Q

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

A

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

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16
Q

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

A

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

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17
Q

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

A

Blockade of D2 receptors

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18
Q

Name 5 typical antipsychotics

A 
Haloperidol
Chlorpromazine 
Fluphenazine 
Perphenazine
Thioridazine
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19
Q

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

A

Typical – block D2 receptors

Atypical – block D2, serotonin, Alpha1, H1 receptors

20
Q

Which atypical antipsychotic is associated with hyperprolactinemia?

A

Risperidone

21
Q

What is the most dreaded side effect of risperidone?

A

Hyperprolactinemia

22
Q

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

A

Alpha1 and 5HT2 blocker (antidepressant)

Sedation, weight gain

23
Q

What is the mechanism of action of TCAs?

A

Inhibition of serotonin and NE reuptake

24
Q

What are the 3 severe side effects of TCAs?

A

3 Cs– convulsions, coma, cardiotoxicity

25
Q

What are 3 side efffects to lithium?

A

Tremor
Hypothyroidism
Nephrogenic DI

26
Q

What are the 3 high potency typical antipsychotics

A

Trifluoperazine
Fluphenazine
Haloperidol

27
Q

What are 2 low potency typical antipsychotics?

A

Chlorpromazine

Thioridazine

28
Q

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

A

High – mainly EPS side effects

Low – less EPS, more anticholinergic, antihistamine, Alpha1 effects

29
Q

What are 3 effects of hyperprolactinemia on antipsychotics?

A

Galactorrhea
Oligomenorrhea
Gynecomastia

30
Q

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

A

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

31
Q

What is the treatment of EPS symptoms on antipsychotics?

A

Benztropine
Benzos
B-blockers for akathisia

32
Q

What are the signs and symptoms of neuroleptic malignant syndrome?

A

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

33
Q

What is the treatment of neuroleptic malignant syndrome?

A

Dantrolene

Bromocriptine (D2 agonist)

34
Q

What is the mechanism of action of aripiprazole?

A

Partial D2 agonist and antagonist

35
Q

What are 6 conditions typical antipsychotics are used for?

A 
Delirium
Psychosis
Bipolar disorder
Schizophrenia 
OCD 
Tourette's
36
Q

Which atypical antipsychotic has evidence of reducing suicidal behavior?

A

Clozapine

37
Q

What are 7 conditions that atypical antipsychotics are used for?

A 
Schizophrenia 
Bipolar 
OCD 
Tourette's 
Anxiety disorders 
Depression 
Mania
38
Q

Which has more anticholinergic side effects, typical or atypical antipsychotics

A

Typical

39
Q

What are the 2 severe side effects of clozapine?

A

Agranulocytosis

Seizures

40
Q

Benztropine

A

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

41
Q

What are the sx of anticholinergic overdose?

A

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

42
Q

What are the sx of organophosphate poisoning

A

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

43
Q

How do organophosphates cause toxicity?

A

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

44
Q

What are the steps to treat organophosphate poisoning?

A
  1. Remove clothes and wash patient
  2. Administer atropine (competitive inhibitor)
  3. Administer pralidoxime (reactives AChE)
  4. If seizures, give benzo
45
Q

What are the sx of Serotonin syndrome?

A

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

46
Q

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

A

CK

47
Q

What is the treatment of Serotonin Syndrome?

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

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