UWorld Drugs Flashcards
What med class give for:
Woman wandering streets, disheveled, malodorous, malnourished. Smiles pleasantly, difficult to hold her attention.
She stares at A/C unit and said “jingle jangle, doctor, jingle jangle.”
Urine tox and blood alcohol level negative.
She agrees to admission to psych unit.
Psychosis:
- give 2nd generation antipsychotic
Risperidone / Ziprasidone
Aripiprazole
Quietiapine / Olanzapine
Clozapine can be used to treat psychosis. Why is it not a 1st line agent? When use?
Clozapine: 2nd gen antipsychotic
- SE = agranulocytosis
What med give for treatment-resistant schizophrenia?
Clozapine
- use when pt failed at least 2 trials of antipsychotics
What class of meds is discouraged in elderly due to risk of adverse effects? What kind of adverse effect?
Benzodiazepines
SE: paradoxical agitation (usually w/in one hour of administration). Confusion + falls.
Alprazolam
What is paradoxical agitation? What drug class?
Increased agitation, confusion, aggression, disinhibition
Benzodiazepines: elderly metabolize it more slowly.
If give risperidone for schizophrenia, what two sexual side effects from DECREASED dopamine in ______ area of brain?
Tuberoinfundibular pathway
- decreased dopamine = increased prolactin = breast enlargement (gynecomastia, galactorrhea)
- decreased libido
Pt very sleepy
Hears voices when falling asleep
Feels temporarily frozen, unable to move on awakening
How treat including Med to give?
Narcolepsy
(cataplexy = emotionally triggered loss of muscle tone)
Sleep hygiene
Scheduled naps
Modafinil: promotes wakefulness = 1st line
78yo problem sleeping past few months. Wife died 1 year ago. Takes 45-60 minutes to fall asleep. Frequent waking during night. Wakes at 430am and can’t return to sleep.
Mild forgetfulness; appetite not what it once was. Weight loss past 6 months.
No longer golfs as tired and no longer enjoys.
Think major depressive disorder more than just a sleep disorder.
Treat w/ antidepressants + cognitive-behavioral therapy
Frantic effort avoid abandonment Unstable & intense relationships Unstable self-image Impulsivity (possible Suicide attempt) Feeling empty, intense anger 1st Line treatment? Dx?
Borderline personality disorder
1st line = psychotherapy
dialectical behavioral therapy
Molly, aka?, main drug class?
Ecstasy
- amphetamine
Hypertension
Tachycardia
Hyperthermia
Serotonin syndrome with what drug?
MDMA = Molly = Ecstasy
- autonomic dysregulation
- altered mental status
- seizures
What make you suspect delirium?
- how test?
Acute confusion + chronic memory impairment
- after surgery or other stressor
Get EEG: see diffuse slowing
Failed SSRI (fluoxetine) with continues depression. What next to try?
SNRI - venlafaxine
could augment, switch to another SSRI or switch class of antidepressant, as above
Brief euphoria + loss of consciousness
Class of drug?
Inhalants
- glue, toluene
- Nitrous oxide, amyl nitrate
- spray paint
Boys age 14-17
1st Line Bipolar?
Two others you could use?
Lithium + 2nd gen antipsychotic
(quietiapine, lurasidone)
Other high yield: valproate, lamotrigine
2nd Generation Antipsychotic mech of action?
- risperidone
Serotonin-dopamine antagonist
- serotonin 2A
- dopamine D2
…receptor blockade
Haloperidol can produce ____ a subset of EPS (extrapyramidal symptom).
Acute dystonic reaction
- sustained contraction of neck, mouth, tongue, eye
Often seen w/ high-potency first generation antipsychotics
How treat acute dystonic reaction?
Benztropine
Diphenhydramine
Everyone knows _____ can cause agranulocytosis. What other adverse effects are possible?
Clozapine
- metabolic syndrome
- seizures
- myocarditis
Chlorpromazine is?
Low potency, first-generation antipsychotic
What meds avoid in bipolar I and why?
Avoid antidepressant mono therapy
- risk of precipitating mania
Contraindications to Bupropion?
Bupropion = Ne + D reuptake inhibitor
- can’t use in pt w/ seizures
- can’t use in pt w/ eating disorders
Amantadine
Dopaminergic agonist, treat:
- parkinsonism: bradykinesia
- cogwheel rigidity
- pill-rolling tremor
- masked facies
- shuffling gait
Alprazolam
Short-acting BDZ
- seizure, tremor, anxiety after cessation
- perceptual disturbances, psychosis after cessation
Phenelzine + dinner with heavy sauces and wine, what exam finding expected?
Hypertensive crisis: MAOI + tyramine
- increases release of adrenaline b/c…
- tyramine metabolism inhibited by MAOI
Headache is early sign of hypertensive crisis.
What are 3 other signs?
Intracranial bleed
Stroke
Death
