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MS3 > Psych 9 > Flashcards

Psych 9 Flashcards

1
Q

What are anti-histamine side effects

A

Sedation, weight gain

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2
Q

What are anti-adrenergic side effects?

A

Hypotension

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3
Q

What are anti-muscarinic side effects?

A

Dry mouth, blurred vision, urinary retention, constipation

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4
Q

What is hypertensive crisis

A

Caused by a build up of catecholamines; caused by combo of MAOIs with tyramine-rick foods (e..g red wine, cheese, chicken liver, cured meats)

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5
Q

4 components of extra-pyramidal side effects

A
  1. Dystonia
  2. Akathisia
  3. Parkinsonism
  4. Tardive dyskinesia
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6
Q

Tx of EPS caused by antipsychotics

A

Benztropine

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7
Q

What psych drugs cause hyperprolactinemia

A

FGA, Risperidone

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8
Q

Inducers of CYP-450

A 
♣	Corona, Guinness, 'N' PBRS induce Chronic alcoholism
•	C - Carbamazepine
•	G - Griseofulvin
•	N - Nevirapine
•	P - Phenytoin
•	B - Barbiturates
•	R - Rifampin
•	S - St. John's Wort
•	Chronic alcoholism
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9
Q

Psych meds that inhibits CYP-450

A

SSRIs (Fluoxetine, Paroxetine, Duloxetine, Sertraline)

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10
Q

What is the withdrawal phenomenon associated with antidepressants

A

Flu-like sx: Dizziness, HA, nausea, insomnia, malaise

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11
Q

Side effects of TCAs

A

THINK: 3 C’s

o Antihistamine = weight gain, sedation
o Antiadrenergic = orthostatic hypotension, arrhythmias (block cardiac sodium channel), ECG changes (widened QRS, QT, and PR intervals)
o Antimuscarinic = dry mouth, constipation, urinary retention, blurred vision, tachycardia
o Serotonergic = erectile/ejaculatory dysfunction, anorgasmia
o Seizures

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12
Q

Tx of TCA overdose

A

IV sodium bicarbonate

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13
Q

What are the names of the MAOIs

A

o Tranylcypromine = “try a sip of wine”
o Phenelzine = funnel
o Isocarboxazid = boxed wine
o Selegiline = sledge hammer

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14
Q

Describe how Tyramine toxicity/Hypertensive crisis occurs

A
  • Tyramine is a naturally occurring monoamine compound found in aged meats, alcoholic beverages, and fermented dairy products
  • Tyramine acts as a catecholamine releasing agent, but before it gets to the general circulation it is metabolized in the GI tract by MAO-A
  • But if you inhibit MAO-A, all the Tyramine flows in the circulation and acts as a sympathomimetic agent, displacing NE from neuronal storage vesicles
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15
Q

Tx of hypertensive crisis

A

Phentolamine (a1 and a2-blocker)

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16
Q

What are the low potency FGA

A

Thioridazine, Chlorpromazine

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17
Q

Side effect specific to Chlorpromazine

A

Blue-gray skin discoloration

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18
Q

side effect specific to Thioridazine

A

Retinal deposits

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19
Q

Which antipsychotics are available as long-acting injectables (decanoate)

A

THINK: How Ridiculous, Paying For A hOle

H = Haloperidol
R = Risperidone
P = Paliperidone
F = Fluphenazine
A = Aripiprazole
O = Olanzapine
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20
Q

Is tardive dyskinesia reversible?

A

50% of cases are permanent

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21
Q

What is the only antipsychotic shown to decrease the risk of suicide

A

Clozapine

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22
Q

Side effect of Clozapine

A

Metabolic syndrome, agranulocytosis, myocarditis, seizures

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23
Q

What is the only mood stabilizer shown to decrease the risk of suicide

A

Lithium

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24
Q

What lab levels should be monitored while on Lithium

A

Lithium levels, creatinine, thyroid function

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25
Q

What SSRI is used to treat bulimia

A

Fluoxetine (Prozac)

Super high dose

26
Q

Anorexia is most associated with which personality disorders

A

OCPD and Dependent

27
Q

Bulimia is most associated with which personality disorder

A

Borderline

28
Q

What drug can be used to treat anorexia

A

No FDA approved

29
Q

What SSRI has the longest half life

A

Fluoxetine

30
Q

What SSRI has the shortest half life

A

Fluvoxamine (think of the V as a down arrow to remember lowest)

Paroxetine/Paxil is the MOST common SSRI with short half life

31
Q

What SSRI has the highest rate of QTc prolongation

A

Citalopram/Celexa

But Escitalopram is an isomer of Citalopram that works almost exactly the same but you can use half the dose and still be as effective

32
Q

What does withdrawal from SSRI feel like

A

Flu-like symptoms + ZAPS (feeling of an electric shock starting at some part of the body and radiating)

33
Q

Which SSRIs are most associated with discontinuation/withdrawal syndrom

A

Paroxetine/Paxil and Fluvoxamine

Because these are the ones with the shortest half life

34
Q

Put these SSRI cards in study guide

A

Maybe. Hi!

35
Q

How long should you wait for SSRIs to kick in

A

6-8 weeks

36
Q

How long should you wait after patient has reached expected dose before you up-titrate SSRI

A

1 week

37
Q

Most common side effect of SSRI

A

GI distress

38
Q

How long does it take for GI effects of SSRI to go away

A

3-5 days (80% of patients)

3 weeks (90% of patients)

39
Q

What do you give to a male patient on an effective SSRI but with erectile dysfunction

A

Add Bupropion/Wellbutrin

40
Q

Time frame for mania

A

7 days
Or hospitalization
Or mania + psychosis

41
Q

Time frame for hypomania

A

4 days

42
Q

What SSRI should you give to non-compliant patients

A

Fluoxetine (because it has the longest half-life)

43
Q

What effect does SSRI have on suicide?

A

Can increase suicidal thought in teens and young adults

But no known increase in suicide completion

44
Q

What classifies as an “adequate” trial of SSRI

A

Lasting 6-8 weeks at the dose you expect to work (not the starting dose, because you always titrate up)

45
Q

When should PCP consult psychiatry for SSRI

A
  1. Failed 2 adequate trials of SSRI
  2. High severity
  3. Many medications
  4. Co-morbid psychiatric disorders
46
Q

Effects in adulthood of untreated ADHD

A

Higher rate of substance use, depression, anxiety disorders, oppositional defiant disorder

47
Q

What is an appropriate age to start ADHD kids on stimulants

A

Usually 5-6

48
Q

How many inattentive symptoms must a patient have to classify as ADHD, inattentive type

A

6/9

49
Q

How many hyperactive symptoms must a patient have to classify as ADHD, hyperactive type

A

6/9

50
Q

What are the criteria for combined type ADHD

A

6/9 inattentive + 6/9 hyperactive type

51
Q

On Vanderbilt ADHD scale, what numbers count as yes and what as no

A 
0-1 = no
2-3 = yes
52
Q

What drugs are used to treat ADHD

A

Amphetamines/Adderall

Methylphenidates/Ritalin

53
Q

Most common side effect of stimulants

A

Appetite suppression

54
Q

Do you start with short or long-acting stimulants in ADHD

A

Long-acting (XR)

55
Q

Why do drug-reps say that Vyvanse cannot be abused

A

Because Vyvanse is a pro-drug - needs to be processed by the liver before it becomes active drug

56
Q

What is the biggest risk factor for development of ADHD

A

Genetics - highest genetic association of any psych disorder

57
Q

Treatment options for ADHD

A

First line = stimulants (methylphenidate, dextroamphetamines)

Second line = Atomoxetine or Bupropion

Alpha-2 agonists (Clonidine, Guanfacine) can be used instead of or as adjunctive therapy to stimulants

58
Q

Other risk factors for ADHD

A

In utero exposure to alcohol or nicotine, low birth weight

59
Q

Describe sx of prion disease

A
  • Insidious onset with rapidly progressive cognitive decline
  • Difficulties with concentration, memory, and judgment occur early
  • More than 90% of patients experience myoclonus
  • Depression, apathy and hypersomnia are also common
  • Basal ganglia and cerebellar dysfunction, manifesting as ataxia, nystagmus, and hypokinesia, are present in a majority of individuals
60
Q

Presentation of Huntington’s Disease

A
  • Triad of motor, cognitive, and psychiatric symptoms
  • Cognitive decline and behavioral changes can precede onset of motor signs by up to 15 years
  • Executive function is the primary cognitive domain affected
  • Psychiatric manifestations include depression, apathy, irritability, obsessions, and impulsivity
  • Patients are often aware of deteriorating mentation
  • Movement disorders include chorea and bradykinesia

MS3 (88 decks)

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