Rosh Material #2 Flashcards
substanc mc abused by schizophrenic pt’s
tobacco
primary feature of illness anxiety d.o
fear of a serious underlying medical condition
drug that reduces frequency of inappropriate fantasies and sex drive (ex for pedophilic d.)
leuprolide acetate
indications for hospitalization in depressed pt who expresses suicidal ideation (8)
recent suicide attempt
detailed suicide plan
inability to discuss safety planning
comorbid psychiatric d.o
agitation
impulsivity
severe hopelessness
poor social support
3 comorbid psychiatric conditions that indicate hospitalization for depressed suicidal pt
borderline pd
schizophrenia
bipolar
rf for suicide
> 70 yo
male
poor health
hx mental illness
feeling hopeless/helpless
isolation
unemployment/stressful work situation
poor finances
previous suicide attempt
fam hx suicide/attempt
LBGTQ+
what do you think when you see: acute brain syndrome
mc major symptom of PCP
what is acute brain syndrome
disorientation combined w. confusion, lack of judgment, inappropriate affect, or memory loss
common PE finding of acute brain syndrome
nystagmus: horizontal, vertical, or rotary
standard drug urine test can detect (7)
cocaine
amphetamines
benzos
barbs
natural opioids
cannabis
PCP
what are the synthetic opioids (can not be detected on urine drug screen)
fentanyl
methadone
+/- oxycodone (semisynthetic)
3 causes of false positives for opioids on urine drug test
poppy seeds
rifampin
fluoroquinolones
which medications increase lithium levels (5)
ACEI
NSAIDs
thiazides
TCAs
metronidazole
weekly weight gain goal for inpatient anorexia pt
2-3 lb/week
weekly wt gain goal for anorexia pt with partial hospital tx
1-2 lb/week
weekly outpatient weight gain goal for anorexia pt
0.5-1 lb/week
indications for hospitalization for anorexia pt (8)
HR < 40 bpm
bp < 80/60
orthostatic increase in pulse
decrease in SBP
cardiac dysrhythmia
BMI < 15
< 75% IBW
medical complications 2/2 malnutrition
pharm for refractory anorexia that does not respond to 1st line tx
SGA - ex olanzapine
what dietary deficiencies have been linked to ADHD
iron
zinc
omega 3
erections require increased vascular flow into the _ (2)
and reduced _
corpora cavernosa
corpus spongiousum
reduced venous outflow
what intrapenile substance increases during an erection
what substance is produced as a result
nitric oxide promotes generation of cyclic guianosine monophosphate
nitric oxide and cyclic guanosine monophosphate lead to _
which leads to erection
vasodilation
6 classes of medications associated w. decreased libido and sexual dysfxn
SSRIs
antiandrogens
5ARI’s
thiazides
spironolactone
opioids
what personality d.o is mc associated w. anorexia
ocd personality d.o
what lab test is most definitive in determining chronic AUD
carbohydrate deficient transferrin
first line tx for conduct d.o
multisystemic:
family therapy, parent training, CBT, community consultation
besides multisystemic tx, what other non pharm tx are used for conduct d.o (4)
positive parenting program
fast track
therapeutic foster homes
multidimensional foster care
malingering is associated w. _ incentinves
factitious d.o is associated with _ incentives
malingering: external inventives
factitious: non external incentives
what is required for dx of complicated grief rxn
extreme yearning for deceased at 12 mo after their death
what instrument is used to measure severity of GAD
hospital anxiety and dpn scale
t/f: most children w. conduct d.o will later develop antisocial pd
f!
what 3 antiepileptic drugs are associated w. sexual dysfxn
lamotrigine
gabapentin
topiramate
antipsychotic highly associated w. TD
quetiapine
mc manifestations of TD
oral
facial
lingual
2 drugs associated w. TD
antipsychotics
metoclopramide
tx for mild TD
benzo
tx for localized and severe TD
botox
pathology of TD
hyperkinetic movements due to prolonged use of dopamine receptor blocking agents
t/f: TD is irreversible
f!
remission may occur months-years later
first line tx for ADHD in peds:
first line tx for ADHD in adults:
peds: behavior mods
adults: stimulants
life threatening adverse effect of methadone
qt prolongation
3 features associated w. paranoid pd
feeling of exploitation/deception
holding grudges
interpret benign remarks as threatening
risk of lamotrigine if it is titrated up rapidly
SJS
moa for first gen antipsychotics
D2 antagonists
also antagonists of M1, H1, and alpha 1 receptors
moa for second gen antipsychotics
5HT2a an D2 antagonists
rapid D2 dissociation
5H1a agonists
also antagonists of M1, H1, and alpha 1 receptors
mc type of hallucination in schizophrenia pt
auditory
3 red flags for factitious d.o
hx of multiple hospital admits
willingness to undergo procedures
deceptive behavior: ex forging/falsifying /exaggerating
spectrum of postpartum dpn
blues: 2-3 days postpartum
dpn: first few months
psychosis: days to 4-6 weeks
tx for postpartum blues
reassurance
watchful waiting for dpn
pharm for postpartum dpn
sertraline
paroxetine
tx for postpartum psychosis
antipsychotics
inpatient
brief psychotic episode involves one or more psychotic symptoms that have a sudden onset and last at least _
and resolve within _
1 day
1 month
first line tx for brief psychotic episode
SGAs
gs assessment tool used for panic d.o
panic disorder severity scale
what classes of meds are associated w. neuroleptic malignant syndrome
FGA: haldol, fluphenazine - mc
SGA: clozapine, risperidone, olanzapine
antiemetics:metocopramide, promethazine
withdrawal of dopamine agonists
quadrad of neuroleptic malignant syndrome
AMS
hyperthermia
lead pipe rigidity
autonomic instability
lab finding of neuroleptic malignant syndrome
elevated CK
pharm for neuroleptic malignant syndrome
benzos
neuroleptic malignant syndrome rarely presents with _
which is one way it can be distinguished from serotonin syndrome
hyperreflexia
EKG finding of neuroleptic malignant syndrome
generalized slow wave activity
disorders of arousal from NREM sleep in peds
confusional arousals
sleep walking
sleep terrors
parasomnias associated w. REM sleep in peds
nightmares
sleep paralysis
REM sleep behavior d.o
parasomnia overlap d.o
what insomnia drug is best for sleep maintenance
what is its MOA
doxepin
H1 receptor antagonist
what insomnia drug is best for sleep onset
what is its MOA
ramelteon
melatonin agonist
what insomnia drugs are used for sleep onset AND sleep maintenance
what are their MOAs
lemborexant - orexin antagonist
suvorexant - orexin antagonist
trazadone - 5HT, alpha-1, H1 antagonist
what OTC supplement is used to induce vomiting
what complication is associated w. it
syrup of ipecac
ipecac induced myopathy/cardiomyopathy
long tangent of unrelated conversation before arriving at an answer
circumstantial speech
long tangent of unrelated conversation without arriving at an answer
tangential speech
disorganized speech with repetitive words
verbigeration
words strung together without making sense
word salad
rapidly shifting between topics that have no connection
loose association
gad typically begins in what age group
early adulthood
pharm for binge eating d.o (3)
lisdexamfetamine
topiramate
SSRIs
what phobia is mc associated w. binge eating d.o
specific phobia
major differentiation btw somatic sx d.o and illness anxiety d.o
somatic sx d.o: genuine sx w.o an identifiable cause
illness anxiety d.o: obsession w. illness +/- somatic sx
what 2 antipsychotics are mc associated w. weight gain
SGAs:
clozapine
olanzapine
SGA’s have fewer EPS s.e, but higher incidence of (4)
wt gain -> metabolic syndrome
qt prolongation
hyperprolactinemia
drowsy
3 subgroups of sx associated w. schizotypal pd
cognitive-perceptual
odd/disorganized
interpersonal
cognitive perceptual sx associated w. schizotypal pd
odd beliefs
unusual perceptual experiences
ideas of reference
paranoia
what odd beliefs are associated w. schizotypal pd
magical thinking
mind reading
thought transfer
how long shold women w. postpartum dpn continue medication after sx resolution
6-9 months
_ are associated w. poor prognosis in schizophrenia
negative sx
< 20 yo at onset
coexisting OCD
unstable employment
insidious onset
slow rate of dz progression
male
SUD
low socioeconomic status
fam hx schizophrenia
factors associated w. better prognosis in schizophrenia
dx > 20 yo
catatonic
paranoid
stable employment
acute onset
rapid progression
female
no SUD
middle/high socioeconomic status
early intervention
order of tx for serotonin syndrome
- benzos
- cryptoheptadine
what do you think when you see a pt who smoked something bad at a party and presents w.: paranoia, avoidance of eye contact, sedation, diahoresis, vomiting, bradycardia, hypotn, and extreme muscle pain
UA is negative
synthetic cannabinoids
street names for synthetic cannabinoids
K2/K3
spice
crazy clown
krypton
aztec fire
happy tiger incense
first and 2nd line tx for bipolar 1 mania
- lithium PLUS antipsychotic
- valproate PLUS antipsychotic - if contraindication for lithium
black box warning for valproate
hepatotoxicity
rf for PTSD
young age at time of trauma
adverse childhood events
female
widowed/separated/divorced
lower socioeconomic status/education
fam hx
poor social support
severe stress rxn to event
rf for schizophrenia
brith during late winter/spring
living further from the equator
living in an urban area/industrialized country
immigration
advanced paternal age
perinatal obstetric complications
childhood trauma
CNS infxns
cannabis use
female athlete triad
low energy availability
low bone mineral density
amenorrhea
pathophys behind dystonias related to first gen antipsychotics
dopamine receptor blockade
tx for acute dystonic rxn related to first gen antipsychotics
anticholinergics:
diphenhydramine
benztropine
what pharm is first line tx for adult pt w. ADHD who has a hx of substance use disorder
atomoxetine
piloerection, diaphoresis, yawning restlessness, dysphoria, myalgia, arthralgia, rhinorrhea, lacrimation, n/v, diarrhea, palpitations
acute opioid withdrawal
acute opioid withdrawal is associated w. _
abrupt cessation of short acting opioids
heroin
tx for acute opioid withdrawal
opioid agonists:
methadone
buprenorphine
6 specifiers for delusional d.o
ertomanic
grandiose
jealous
persecutory
somatic
bizarre content
tx for schizotypal pd
quetapine
+/- stimulants
belief that irrelevant and innocuous things in teh world have great personal significance
ideas of reference
