10

Question 1

buspirone MOA

Answer 1

MOA: 5HT1A agonist

Good for GAD but takes 4-6 week for effect

Question 2

mirtazepine MOAs

Answer 2

*Alpha2 blockade and NaSSA
 5HT1A agonist: antidepressant/anxiolytic benefit
 5HT2A antagonist: sleep
 5HT2C antagonist: wt gain
 H1 antag: sedation, wt gain, anxiolytic
 Less antihistamine and more NE effect at higher doses

Question 3

trazodone MOA

Answer 3

Inhibits presynaptic 5HT reuptake and blocks postsynaptic 5HT2

Question 4

valproate Rx

Answer 4

Acute Mania, mixed mania (Better with Rapid cycling and dysphoric mania)
epilepsy
migraine prophalyxis

Question 5

carbamazepine Rx

Answer 5

Acute mania, maintenance, rapid cycling, mixed episodes

Question 6

creutzfeld-jacob

Answer 6

Rapidly progressive dementia

Often with movement disorder (Parkinsonism, cerebellar signs)

Question 7

non-pharm treatments of delirium

Answer 7

• Orientation techniques
• Familiarizing patient with environment
• Natural lighting and diurnal cues
• Avoid restraints
• Caregiver support and education
• Reduce/discontinue unnecessary medications, opiates, anticholinergics, benzos

Question 8

pharm treatments of delirum

Answer 8

• antipsychotics- *haldol, atypicals (TBI)
• benzos (etoh withdrawal)
• anticonvulsants (ictal)

Question 9

delirium symptoms

Answer 9

• Background slowing on EEG
• Sleep-wake disturbance
• psych: hallucinations, delusions, affect lability, anxiety
• Movement alterations: hyperactive or hypo or mixed
• cognitive: attention, memory deficits, disoriented

FLUCTUATES, ACUTE

Question 10

Confusion Assessment Method (CAM)

Answer 10

1. History of acute onset of change in patient’s normal mental status & fluctuating course?
AND
2.Lack of attention? AND EITHER
3. Disorganized thinking?
4. Altered Level of Consciousness

Question 11

delirium differential

Answer 11

VITAMINS

Vascular
Infectious
Toxic (OD, withdrawal)
Trauma (concussion)
Autoimmune
Metabolic (electrolytes, liver)
Iatrogenic
Neoplasms
Seizures

Question 12

iatrogenic causes of delirum

Answer 12

Restraints
 Urinary catheters
 Multiple procedures
 Sleep deprivation
 Untreated pain
 Variety of medications(refer to handout)  Surgery

Question 13

Best established neurotransmitter dysfunction in delirium

Answer 13

reduced cholinergic activity

Question 14

MMSE interpretation of score

Answer 14

A score of less than 24 points is suggestive of dementia or delirium