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Peds neuro boards, V2 > Psychiatry / psychology > Flashcards

Psychiatry / psychology Flashcards

1
Q

Antipsychotic most likely to cause weight gain and hyperglycemia

antidepressant most likely to cause weight gain

A

Olanzapine

Mirtazapine

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2
Q

Define Neurasthenia

A

remember “FOG”

Fatigue after mental effort

Overlaps with Chronic fatigue syndrome, depression, and anxiety disorders

General symptoms (dizziness, headache, irritability, insomnia)

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3
Q

SNRI’s

Name 4 and what is unique about them

A

Sven, Du you mind asking milly to Se_ND_ a Fax about how well these work at high doses

Venlefaxine
Desvenlafaxine
Duloxetine
Milnacipran

Low dose: Serotonin
medium dose: Serotonin + norepeniephrine
High dose: Serotonin + norepinephrine + dopamine

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4
Q

Depressed patient complains of sexual side effects on his prozac.

Whad do you screen for, and what class of drug would you prescribe

A

Norepinephrine Dopamine Reuptake inhibitors (buproprion)

Lower seizure threshold, so screen for hx of sz

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5
Q

Name the tricyclic antidepressants (TCA)’s

A

People with rhythm abnormalities CANT DIP into TCA’s due to risk of fatal arrythmias at high doses

Clomipramine
Amitryptiline
Nortriptyline
Trimipramine
Desipramine and Doxepin
Imipramine
Protriptyline

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6
Q

2nd and 3rd generation antipsychotics

A

“Zip up the tent and cloze your LIPs or Risper quietly, Or you’ll be killed by…._A Rip_per!

Ziprasidone
Clozapine
Lurazidone
Iloperidone
Paliperidone
Risperidone
Quetiapine
Olanzapine
Aripirazole (3rd gen)

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7
Q

Low versus high potentency antipsychotics

A

“Dr. Thio Promised (3 times) to Rid us of our psychosis, but when things got too Thix, he Dropped his halo and flu away”

Low Potency

  • ThioRIDazine
  • Chlorphromaxine
  • Prochlorpromazine
  • Promethazine

High potency

  • Thiothixine
  • Droperidol
  • Haloperidol
  • Fluphenazine
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8
Q

Side effects of high potency versus low-potency antipsychotics

A

Low potency

  • Less likely to have
    • EPS
  • MORE likely to have
    • Muscarinic (dry mouth)
    • Adrenergic (orthostasis)
    • Histaminergic (sedation

High potency

  • LESS likely to Musarinic / adrenergic / histaminergic effects
  • MORE likely to have EPS
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9
Q

Mnemonic for antipsychotic adverse effects

A

Does anyone really Think about Psychotic Rabbits?

  • Dystonia
  • Akinesia
  • Rigidity
  • Tremors
  • Akasthesia
  • Pisa Syndrome
    • (Twisting of head and neck to one side + tonic trunk flexion to lean like the tower of Pisa)
  • Rabbit syndrome
    • EPS side effect syndrome by involuntary, fine, rhythmic perioral ~5 Hz tremor (think of a gnawing bunny rabbit)
    • NO tongue envolvement
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10
Q

Key points on antipsychotics:

  1. Most likely to increase prolactin (1)
  2. Most likely to cause weight gain (2)
  3. Most likely to prolong QTC (3)
  4. Most likely to cause orthostatic symptoms (3)
  5. Must take with food (1)
  6. most EPS symptoms (2)
A
  1. Most likely to increase prolactin
    1. risperidone
  2. Most likely to cause weight gain
    1. Olanzapine
    2. Clozapine
  3. Most likely to prolong QTC
    1. All 1st generation
    2. Ziprazidone
    3. Iloperidone
  4. Most likely to cause orthostatic symptoms
    1. Chlorpromazine
    2. Clozapine
    3. Quetiapine
  5. Must take with food
    1. Ziprazidone (if not will decrease bioavailability)
  6. most EPS symptoms
    1. high-potency 1st gen
    2. Risperidol
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11
Q

Patient with treatment resistant depression asks what else can be done about it

What are 3 drugs that are FDA approved and 3 drugs that are NOT for augmentation in depression

A

FDA approved
Quetiapine
Aripiprazole
Brexpiprazole

NOT FDA approved
Lithium
t3 (liothyroxine)
methylphenadate

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12
Q

Patients with depression have increased metabolism in ___ but decreased meabolism in _____

A

Hypermetabolism in Orbitofrontal cortex

Hypometabolic: dorsolateral prefrontal complex

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13
Q

You are starting a patient on Lithium

What drugs should you tell them to avoid because it can increase their levels?

A

think LIthium

DIuretics
Ace Inhibitors
NSAIDs
Angiotencin II inhibitors

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14
Q

Things to keep in mind when starting antidepressants in Patient’s with:

Hypertension (3)

A
  1. Hypertension: avoid
    1. venlafaxine
    2. buproprion
    3. maoi’s (if consuming tyramine containing compounds)
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15
Q

Mechanism of action: Selegiline

A

Inhibition of MAO-B isoform

Note: majority of serotonin is metabolized through MAO-A isoform

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16
Q

Patient with Depression and Gastric ulcers develops anemia

What is likely causing it?

What would change if patient was on warfarin?

A

SSRI’s (decreased platelet activation and aggregation due to reduction of serotonin in platelets

Fluvoxamine (also an SSRI) can incraese levels of Warfarin and lead to increased bleeding risk

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17
Q

How do neurotransmitter levels change in delirium?

Dopamine
Acetylcholine
Glutamate
Gaba
Serotonin
Melatonin

A
  1. Dopamine = Increases nearly 500 fold
  2. Acetylcholine = Decreased
  3. Glutamate = increased (less compared to dopamine)
  4. Gaba increased (only roughly 5 fold)
  5. Serotonin increased (less compared to dopamine)
  6. Melatonin: Decreases
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18
Q

Patient prescribes disulfram stopps taking the medicaiton.

What is the half-life of the drug and how long before patient will not have a reaction from drinking?

A

Half-life 60-120 hours

Time before safe to drink: roughly 2 weeks

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19
Q

Patient with depression is being prescribed pain medication after surgery.

What medications do you want to screen for, and what would it increase risk for?

A

SSRI’s (combo with Tramadol can result in decreased seizure threshold and increased risk of serotonin syndrome)

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20
Q

Patient with early parkinons disease comes to you because he failed a drug test.

What was he on?

A

Selegiline (can give false-positive result for methanephetamine)

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21
Q

Depressed patient presents to ED with small laceration needing stitches, ultimately goes into hypertensive crisis

What happened?

What medication was he on?

what other drugs should he avoid (4)

A

Hypertensive crisis from interaction with MAO-I’s

Avoid:
Meperedine
epinepherine
Local anesthetics (with sympathomimetics; I.e. lidocaine with epi)
Decongestants

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22
Q

how do you treat a constipated patient with anorexia nervosa?

A

Surfactants (such as docusate)

Stool sofeners

AVOID:

Laxatives, osmotic agents

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23
Q

Patient with bipolar disorder develops mania after starting herbal supplement.

what was it?

A

St. John’s Wort

24
Q

patient with bipolar disorder tells you she is pregnant. What is the safest medication to treat her mania?

A

Haloperidol and other 1st generation antipsychotics

25
Q

obese patient wants to be started on an antidepressant.

What medication could serve double purpose?

What medication should you avoid?

A

Buproprion is associated with weight loss

Mirtazepine is most associated with weight gain.

26
Q

What SSRI class is safe to disconitinue abruptly?

A

Long-acting SSRIs (like fluoxetine)

27
Q

You are considering diagnosing a patient with major depression with atypical features:

What is the criteria (5)
How many do you need?
what one is required for diagnosis?

A

Need 3+

  • mood reactivity toward positive stimuli (required for diagnosis)
  • Increased food consumption and/or significant weight gain
  • increased sleep
  • Heaviness of limbs
  • HIstory of significant fear or rejection form others
28
Q

Erikson’s stages (8)

A
  1. Trust versus mistrust (0-1 year)
  2. Autonomy versus shame/doubt (1-3 years)
  3. Initiative vs guilt (3-6 years)
  4. Industry vs inferiority (6-12 years)
  5. Identiy vs role confusion (12-18 years)
  6. Intimacy versus isolation (20’s - 40’s)
  7. Generativity vs stagnation (40’s)
  8. Integrity vs dispair (60’s - end of life)
29
Q

Most effective treatments for Conduct disorder (2)

A

Multisystemic therapy

Parent management training

30
Q

Mechanism of action: Methadone

A

U-receptor agonist

NMDA receptor ANTagonist

31
Q

Population studies with depression:

  • Relative prevalence in developed versus developing countries
  • Relative rates in rural versus urban settings
  • Relative rates in high versus low income
  • Obestity rates with versus without depression
  • Highest rates of depression (age group)
32
Q

Patient with rapid-cycling bipolar comes in with Ataxia, , dizziness, and opthalmoplegia

What was he taking?

A

Carbamazepine

33
Q

Mechanism of action: Mirtazapine

A

Presynaptic alpha-2 antagonist

Post-synaptic 5-HT2, 5-HT3, amd H1 antagonist

34
Q

How often should you check lithium levels in patients?

A

Every 2-3 months for the first 6 months

Afterward every 6-12 months

35
Q

Receptor Targets:

Buspirone

A

Buspirone: 5-HT1A

36
Q

Treatment for alcohol withdrawl in patients WITH and WITHOUT liver disease

A

With liver disease: Lorazepam

Without: DIazepam / chlordiazepoxide

37
Q

Drugs you should NOT use with MAOI’s

(4)

A

“Avoid wine, cheeze, and MEAD with MAOI’s”

Meperidine

Epinepherine

local Anesthetics (with sympathomimetics)

Decongestants

(risk of hypertensive crisis)

38
Q

Contraindications to venlafaxine

A

“venHAAfaxine”

Hypertension

anticoagulants

acute-closure glaucoma

39
Q

Antibiotic which could potentiate serotonin syndrome

A

Linezolid (has some serotonergic activity; stop 5 weeks before starting prozac)

40
Q

MRI changes in schizophrenia

Increased (2)
Decreased (3)

A

​Increased

  • Lateral and third ventricule volume
  • basal ganglia volume

Decreased

  • blood flow and metabolism in frontal lobes
  • volume in prefrontal, thalamic, hippocampal, and superior temporal gyrus
  • (histology) neuronal density in prefrontal, thalamic, and cingulate areas
41
Q

Antidepressant most likely to cause weight gain (3)

A

Mirtazapine

TCA’s

MAOIs

42
Q

Best acute trement for delirium in geriatric population

A

Haloperidol

43
Q

Key difference between Malignant hyperthermia vs neuroleptic malignant syndrome vs acute dystonia

A

Malignant hyperthermia = in the setting of sedation
treated with dantroline

Neuroleptic malignant syndrome = due to antipsychotics

acute dystonia can also be due to antipsychotics, treated with Benztropine

44
Q

You want to test a patient for ASD, but he’s a young adult.

Which two tests are you thinking of and what is the age cutoff?

A

Social Responsiveness scale for adults (SRS-A) for people 18+

Autism spectrum Screening Questionnaire (ASSQ): for 7-16 years

45
Q

Seizure disorder associated with circumstantiality, hypergraphic, hyposexusality, and intense hyperreligiolsity

A

Focal seizures (MC left temporal)

Gastaut-geshwind syndrome

46
Q

Antidepressants most likely to cause:

GI side effects (2)
Restlessness (1)
Sedation (1)
SIADH (3)

A
  1. GI side effects (Stomach Flu)
    1. Sertraline
    2. Fluvoxamine
  2. Restlessness
    1. Fluoxetine
  3. Sedation
    1. Paroxetine
  4. SIADH
    1. Fluoxetine
    2. escitalopram
    3. citalopram
47
Q

TCA to consider for BPH and why

A

Desipramine

fused 3-ring moity

(tertiary Amine TCA’s more likely to show anticholinergic effects)

48
Q

Patient on warfarin wants to be started on an antidepressant

what drugs should you avoid?

A

Fluvoxamine (many drug-drug interactions that can increase levels of warfarin)

Venlafaxine (increased risk of bleeding when on anticoagulants (NOS)

49
Q

Mirtazapine:

mechanism of action

A

Mechanism of action:

  1. Presynaptic alpha-2-antagonist
  2. Postynaptic 5HT2, 5HT3, and H1 antagonist
50
Q 
Antidepressants to avoid in:
Hepatic disease (5)
A

(same as renal disease)
Decrease dose of Citalopram
Decrease dose of Escitalopram
Decrease dose of Paroxetine
Avoid Duloxetine entirely

ALSO
decrease dose of fluoxetine

51
Q

Antidepressants to avoid in renal disease

Decrease dose (3)

Avoid entirely (1)

A

Decrease dose:
Citalopram
Escitalopram
Paroxetine

Avoid entirely:
Duloxetine

52
Q

Antidepressant to avoid with prolonged QTC’s

(2)

A

Avoid TCA’s

+/- fluoxetine

53
Q

Antidepressant to avoid in alzheimers

(1)

A

paroxetine (most activating)

54
Q

Antidepressant to avoid in Bulemia

A

Welbutrin

(decreased seizure threshold)

55
Q

Notes on antidepressants and breastfeeding (2)

A

20% of fluoxetine makes it into breast milk (no clear relationship on long-term behavioral effects)

If starting on antidepressant, consider sertraline

56
Q

Antidepressant to avoid with glaucoma

A

Venlafaxine (at least prescribe cautiously)

Peds neuro boards, V2 (29 decks)

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