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1
Q

5 stages of substance abuse

A

1) pre contemplative - denial
2) contemplative - acceptance
3) preparation - committed steps
4) action - actual behavioral change
5) maintenance - sustained behavioral change

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2
Q

populations more susceptible for alcoholism (MC abused substance)

A

native americans
alaska natives
they have increased for suicide

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3
Q

Wernickes

A

reversible cerebellum

tx - thiamine + folate –> D50

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4
Q

korsakoffs

A

irreversible confuabulation

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5
Q

alcoholic found down and out you give what in what order

A

thiamine followed by d50 after otherwise you worsen the hypoglycemia

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6
Q

acute alcohol intoxication symptoms and tx

A

disinhibtion amnesia ataxia
nausea vomiting and death
slurred speech

tx - IVF, time

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7
Q

EtOH withdrawal symptom order

A 
HTN (diastolic) + tachy
tremors, diaphoresis, 
seizures
agitation, confusion 
DTs then death
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8
Q

mechanism and pathway for etoh withdrawal seizures

A

etoh –> increases GABA which blocks brain activity

chronic etoh –> downregulated gaba receptors since they are always blocked by GABAa–> so with etoh stop (no more inhibitor on activity) there leads to overactivity in the muscles (tremors) and the brain (seizures)

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9
Q

treatment of alcohol withdrawal or benzo withdrawal (same thing)

A

long acting benzos + short acting benzos

as they improve you take away short acting

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10
Q

what are long acting benzos

A

chlordiazepoxide

diazepam

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11
Q

what are short acting benzos

A

loreazepam (IV)

alprazolam (PO)

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12
Q

benzo intoxication symtoms

A

delrium in the elderly
resp depression
coma with increased dose
amnesia

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13
Q

benzo withdrawal symptoms

A 
tachy 
tremor 
HTN 
seizures 
psycosis
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14
Q

antidote for benzos

A

flumazenil

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15
Q

opiate intoxication symptoms

A

euphoria
pupil constriction
resp depression
tract marks

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16
Q

opiate withdrawal symptoms

A 
pain 
yawning 
lacrimation 
NVD 
sweating
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17
Q

treatment of opiate abuse/ withdrawal

A 
naloxone 
methadone (long term)
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18
Q

cocaine intoxication symptoms

A 
psychomotor agitation 
HTN 
tachy 
dilated pupils 
psychosis - hallucinations and paranoia  
angina/ HTN crisis
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19
Q

cocaine withdrawal symptoms

A

depression
suicidality
cocaine bugs
crash

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20
Q

treatment of cocaine abuse

A

supp care or benzos
alpha – > then beta blockade

never give beta blockers early on will lead to unopposed alpha action

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21
Q

MDMA intoxication symptoms

A

overheat (fever, tachy)
water intoxication
pupillary dilation
psychosis

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22
Q

PCP intoxication symptoms

A

vertical and horizontal nystagmus
aggressive psychosis
impossible strength
blunted senses

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23
Q

pcp withdrawal symptoms

A

severe random violence

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24
Q

tx of pcp abuse

A

haloperidol to subdue

acidify urine to enhance its excretion

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25
LSD intoxication symptoms
hallucinations flashbacks heightened senses
26
Marijuana intoxications symptoms
``` tired slowed reflexes conjuctivitis munchies overdose brings paranoia ```
27
nicotine overdose
patient goes in to V tach
28
treatment of nicotine abuse
``` bupropion chantix ( varenicline) - adr = suicide ```
29
amphetamine intoxication symptoms
tachy HTN pressured speech flight of ideas
30
generalized anxiety disorder | females 20s
``` constant state of worry about most things that leads to impairment of daily life >6months/years at least 3: -irritability -somatic pain -weight change -sleep change -concentration ```
31
treatment of GAD
psychotherapy SSRIS and buspirone never benzos
32
panic disorders acute without provocation
``` sob trembling unsteadiness depersonalization excessive heart rate numbness tingling sweating ``` ``` palpitations abdominal distrss nausea intense ear of losing control/dying chest pain ```
33
treatment of panic disorder
acute attacks - benzos chronic - SSRIs
34
agoraphobia
fear of going outside, public areas, public transportation , crowds
35
treatment for public speaking phobia
nonselective beta blocker (propanolol, atenolol, nadolol)
36
treatment of phobias 2 types
systemic desensitization - better overalls - slower flooding - better for quick needs (actor - cave scene)
37
benzos are metabolized via
liver - so in patient's with hepatic impairments short acting are preferred
38
MOA of benzos
increased frequency of Cl- channel opens | GABAa antagonist - same as etoh
39
benzos as anesthesia
dose dependent anterograde amnesia
40
paranoid personality disorder
distrustful, suspicious, ppl are out to get them short lived delusions
41
schizoid personality disorder
loners but enjoy being alone
42
schizotypal
weird | bizarre
43
borderline personality disorder
unstable, impulsive, rapid changes in mood promiscuous suicidal gestures spitting behavioral will be seen F>M hx of childhood abuse/ trauma
44
histrionic personality disorder
theatrical use of physical appearance dramatic F>M
45
narcissistic personality disorder
inflated sense of worth | men > women
46
anti-social personality disorder
preceded by conduct disorder criminal lacks any remorse
47
avoidant personality disorder
fears rejection and criticism wants friends and relationships passes on promotions
48
dependent personality disorder
unable to assume responsibility clingy/attached fears being alone abusive husband relationship example
49
Obsessive compulsive
orderliness at the expense of efficiency rewriting notes 100 times
50
SSRIs + MOA
blocsk reuptake of serotonin at the presynaptic nerve terminal citalopram , fluoxetine, paroxetine sertraline , escotalopram
51
SSRIs - side effects
decreased libido delayed ejaculation GI upset, HA, flushing hypernatremia in elderly
52
SnRIs
venlafaxine duloxetine cleaner and more expensive
53
bupropion MOA
atypical antidepressant - increased dopamine activity
54
bupropion
smoking cessation no weight gain no sexual dysfunction C/I - bulimi - lowers seizure threshold
55
TCAs
tryptilines imipramine desipramine doxepin
56
TCAs uses
used for enuresis | 1st line for neuropathic pain
57
Mirtazapine
MOA - Serotonin modulator, alpha 2 adrenergic antagonist, increases NE and fSerotoinin due to dec neg feedback ADR - weight gain, somnolence
58
trazadone
serotonin modulator sleep aid ADR - priaprism
59
MAO-Is
phenelzine tranylcypromine selegiline
60
MAO-Is - ADR
HTN crisis when mixed with tyramine (red wine, cheese)
61
antidepressant tx rules
> 6wk trial >6month treatment >3 week washout period
62
Major Depressive Disorder
``` at least 5 of SIGECAPS: S- sleep I - interest G - guilt E - energy C - concentration A - appetite/weight P - pyschomotor retardation S - suicidal ideation ``` MUST HAVE: depressed mood or ahedonia > 2wks
63
Tx of MDD
SSRIs + psychotherapy | ECT (best but used for refractory MDD or catatonia)
64
Dysthymia (persistent depressive disorder)
at least 2 years but without symptoms for > 2months at a time functioning but will have depressed mood tx = SSRIs after you r/o - hypothyroidism and SI
65
Bipolar I
``` function is impaired - needs hospitalization at least (7) days ``` ``` DIGFASTER - (3) + "E" D - distractibility I - insomnia G- grandiosity F- flight of ideas A- agitation S- sexual exploits T-talkative E- elevated mood R- racing thoughts ```
66
bipolar II
``` hypomania and major depression at least (4) days functional ```
67
tx of bipolar I
1) ER - benzo 2) life long - lithium or valproate 3) comorbid = carbamazepine or lamotrigine another drug = quetiapine (seroquel)
68
do you give SSRIs to patients with bipolar I or bipolar II
NO - they will induce mania
69
cyclothymia
roller coaster up and down but failure to meet any of the criteria for bipolar II
70
normal grief
``` < 12 months still functional waxes and wanes praying at them glimpses of deceased talking to them wishing they traded places ``` not to be treated
71
persistent complicated bereavement disorder
> 12 months mostly depression - persistent depressed mood hopelessness hallucinations tx = SSRI or SnRIs
72
post partum depression
> #1 baby doesnt care about baby/ may hurt baby within 1 month onset and duration ongoing tx = antidepressants
73
baby blues
1st baby cares about baby onset and duration within 2 weeks no tx needed
74
post partum psychosis
> #1 baby fears the baby/ likely to kill it onset within 1 month and duration ongoing tx = mood stabilizers or antipsychotics
75
schizophrenia criteria
``` 1 bizarre delusions 2 hallucinations 3 disorganized speech 4 disorganized or catatonic behavior 5 flat affect, cognitive defects, poverty of speech, anhedonia ``` must have any (2) as long as (1) = 1-3
76
schizophrenia other facts
young male in 20s > 6 months overload of dopamine
77
schizophreniform
> 1 month but less than 6 months
78
schizoaffective disorder
``` schizophrenia + mood at least (2) wks of psychosis without the mood ```
79
brief psychotic disorder
>1day and <1 .month
80
delusional disorder
logical thought process functional ex: man believes wife is cheating on him and has someone follow her everyday even tho there is no evidence
81
typical antipyschotics
haloperidol thiazide chlorpromazine good for (+) symptoms
82
atypical antipsychotics
``` risperidone quetiapine olanzapine ziprasidone apriprazole clozapine ``` good for (-) symptoms
83
ADR of Clozapine
agranulocytosis - check ANC >1500 - neutropenia weekly CBCs last line drug to use for refractory schizophrenia
84
DOC for bipolar/mania
lithium
85
ADR of lithium
narrow therapeutic index nephrotoxicity nephrogenic DI ataxia/ tremor/fasciculations N/V/D confusion/ agitation
86
If Lithium cant be used DOC for bipolar =
Valproate
87
valproate ADR
``` teratogen (spina bifida) elevated LFTs -> hepatic failure thrombocytopenia agranulocytosis pancreatitis ```
88
ADR of quetiapine (2nd line bipolar tx)
weight gain | QTc prolongation
89
ADR of lamotrigine (2nd line bipolar tx)
blurred vision | SJS
90
ADR of Carbamazepine (3rd line bipolar tx, trigeminal neuralgia, absence seizures)
teratogen (cleft palate) rash, SJS AV block
91
MOA of Typical antipyschotics
D2 receptor antagonism
92
ADR of typical antipsychotics
EPS side effects | increased prolactin leading to gynecomastia
93
MOA of atypical antipyschotics
D2 and 5HT antagonism
94
ADR of atypical antipyschotics
QTc prolongation less EPS risk gynecomastia sedation DM and weight gain (olanzapine and clozapine)
95
drug with the most potent EPS side effects
haloperidol (typical)
96
antipyschotic for combative ED patient
Haloperidol depot (sedating)
97
Extrapyramidal side effects
akathisia acute dystonia dyskinesia tardive dysinesia
98
akathisia
restlessness tx - decreased dose of antipyschotic + beta blockers tx = benztropine
99
acute dystonia
involuntary muscle contractions hand ringing torticollis oculogyric crisis
100
dyskinesia
parkinsonism tx - benztropine
101
tardive dyskinesia
irreversible hypersensitization of dopamin R oral facial movements tx - stop drug
102
Fluoxetine ADR
decreased libido
103
paroxetine ADR
serotonin syndrome = fever, myoclonus, AMS
104
Citalopram - ADR
GI | Insomnia
105
Bupropion ADR
minimal sex issues | increased risk of seizures (lowers threshold)
106
Mirtazapine ADR
weight gain
107
Trazodone ADR
priapism | sedation
108
ADR of MAO-I
HTN crisis when mixed together with tyramine (wine, cheese)
109
ADR of benzos
addiction | withdrawal seizures - must taper off
110
Intermittent explosive disorder
action is violent and out of proportion to the initial stressor 2/week for 3 months without harm = mild 3/ever for 12 months with harm = severe tx - SSRIs or group therpy
111
pyromania
deliberate fire setting on >1 occasion decreases their anxiety sexual arousal pleasure vs arson - for monetary gain
112
kleptomania
decreases anxiety unable to resist item has NO value remorse and guilt after event F>M
113
OCD
persistent, intrusive, unwanted thoughts - obsessions that provoke anxiety obsessions - contamination, symmetry safety compulsion - cleaning, order/counting, checking tx - CBT and SSRIs
114
body dysmorphic disorder
perceived defects in physical appearance appearance checking excessive unneeded cosmetic surgeries F>M
115
muscle dysmoprhia
M>F preoccupation with muscle size anabolic steroids excessive exercise rhabdo roid rage copper - small testicles
116
trichotillomania
pulling out there hair to reduce anxiety greater on dominant hand side hair in different lengths small bowel obstruction - from hair ball (trichobezoar)
117
acute stress disorder
timeline <1 month
118
PTSD
>1 month exposure to some extreme emotional event group therapy SSRIs benzos - only for panic attacks
119
reactive attachment disorder
<5 years old stressor is neglect or abuse during infancy and chilhood kid fails to attach to anyone
120
disinhibited socia engagement disorder
<5 years old | kid is way too friendly with strangers
121
adjustment disorder
start within 3 months of the stressor and duration should be less than 6 months after event
122
binge purge emesis
``` dorsal hand scars dental erosion metabolic alkalosis low - K low - Mg ```
123
binge purge laxative
metabolic acidosis | diarrhea
124
anorexia
``` F>M 10:1, BMI < 15 fears she is going to be fat lacks recognition of a problem malnourished may require hosptialization ``` tx - group therapy and SSRIs
125
bulimia nervosa
binge, feeling ashamed nml weight hypokalemia hypochloremia metabolic alkalosis Tx - SSRI (fluoxetine) CBT
126
binge eating disorder
its bulimia but without the purge | patients are overweight
127
dissociative identity disorder
> 2 distinct identity states most severe and prolonged trauma ``` memory gaps paradoxical behaviors (doing things you wouldnt normally do) appearance changes ``` tx - pyschotherapy and hypnosis
128
dissociative amnesia
stressors induce memory loss memory loss of event -> regular everyday routine --> complete idea of self
129
dissociative amnesia with fugue
= dissociative amnesia + travel
130
depersonalization derealization disorder
adolescent with non severe trauma feels like a dream feels detached from own thoughts
131
Catatonia
``` 3 of the following: stupor catalepsy waxy flexibility mutism negativsm stereotypy agitation or grimacing echolalia echopraxia ```
132
stupor
decreased alertness and decrease response to stimuli
133
catalepsy
patient can be put in any position
134
waxy flexibility
slight to no resistance to positioning and will hold new position
135
mutsim
no verbal response when there once was
136
negativism
motiveless resistance to instructions
137
stereotypy
repetitive non goal directed movements
138
echolalia
mimicking speech
139
echopraxia
mimicking movements
140
tx of catatonia
lorazepam ECT
141
Retarded catatonia
mutism posturing negativism staring
142
excited catatonia
hyperkinesis frenzy combativeness restless
143
malignant catatonia
``` rigidity autonomic instability high HTN high HR high Temp ``` caused by NO MEDS
144
neuroleptic malignant syndorme
rigidity - lead pipe autonomic instability increased CK patient is ON antipsychotic meds
145
serotonin syndrome
``` myoclonus hyperreflexia lead pipe rigidity increased Temp increased CK ``` patient is ON SSRIs
146
malignant hyperthermia
halothane anesthesia rxn rigidity autonomic instability increased CK
147
tic disorders
associated with OCD and ADHD tx - dopamine antagonists
148
MOA of benzos
increased frequency of Cl- channel opening | GABAa
149
ADR of benzos
dose dependent anterograde amnesia - especially in the elderly
150
quetiapine is effective in the
depressed phase of bipolar
151
acute dystonia tx
benadryl
152
tx of tardive dyskinesia
valbenzine
153
naltrexone
1st line tx for alcohol use disorder that decreases cravings and heavy drinking
154
somatic symptoms disorder
> 1somatic symptom causing distress and functional impairment excessive thoughts or behavior related to somatic symptoms > 6 months in duration tx - regularly scheduled visits
155
inhalant disorder
14-17 y/o boys common houselhold products perioral skin changes = glue sniffers rash rapid onset and relatively short duration
156
tx of specific phobias
tx exposure CT therapy
157
buspirone
tx of anxiety disorders
158
neuroleptic malignant disorder
``` F > 104 confusion sweating muscle rigidity abnormal vital signs ```
159
tx of neurolpetic malignant disorder
stop medications --> bromocriptine or dantrolene if necessary
160
tx of serotonin syndrome
cyproheptadine
161
tx of bulimia nervosa
CBT and fluoxetine
162
tx of anorexia nervosa
CBT and olanzapine if refractory
163
complications of anorexia nervosa
myocardial atrophy, bradycardia, low BP, arrthymias dry skin, lanugo, dehydration, seizures cognitive impairment, amenorrhea, infertility ostepenia, cytopenia, constipation hypercholesteremia, hypercarotenemia
164
factitious disorder
intentional falsification or inducement of symptoms with goal to assume sick role
165
malingering
falsification or exaggeration of symptoms to obtain external incentives
166
conversion disorder
neurological symptom incompatible with any known neurological disease acute onset associated with stress
167
illness anxiety disorder
fear of having serious illness despite few or no symptoms and consistently negative evaluations
168
antidepressant discontinuation syndrome
abrupt discontinuation or rapid taper of short half life serotonergic antidepressants tx - restart meds and slow slow taper
169
MOA of 2nd gen antipsychotic
serotonin 2A and dopamine D2 antagonists
170
Bupropion MOA
NE and dopamine re-uptake inhibitor
171
neuro-imaging finding associated with schizophrenia
enlargement of the lateral cerebral ventricles
172
medication induced psychotic disorder
acute onset of delusions and/or hallucinations that are temporarily associated with use of a new med (common = high dose glucocorticoids)
173
sleep latency
time from going to bed to falling asleep its elevated in insomnia decreased in sleep deprivation
174
REM latency
time from falling asleep to REM avg 40 min shortened by depression or narcolepsy
175
REM Rebound
occurs when the body has been deprived of REM | its easier to get REM AND you get more of it
176
Nightmares
during REM | remember everything
177
night terrors
during N3 doesnt remember anything in a child - parents will complain
178
some causes of REM deprivation
etoh abuse | sleep apnea
179
obstructive sleep apnea
obese snores daytime somnolence dx - polysomnography - 15 obstructive apneas/ hr or 5 per hour with snoring tx - lose weight and/or CPAP
180
central sleep apnea
tx - with bipap lost their intrinsic drive to breathe cheynes strokes breathing - no chest rise
181
narcolepsy
rapidly plunged into REM sleep 3x/week for 3 months cataplexy - is the loss of muscle tone while conscious hypnagogic and hypnopompic hallucinations tx - schedule naps and stimulants (modafinil, provigil)
182
insomnia
difficulty falling asleep 3x/week for 3 months sleep hygiene
183
sleep medication
benadryl - dont give to elderly quetiapine - off label - prolonged QTc trazadone - strong - erections, nasal congestion zolpidem - strong - benzo derivative not as addicting
184
enuresis
>2/wk for 3 months > 5 years up to 7 = nml avoid negative reinforcement nighttime fluid restriction water alarm blankets desmopressin oxybutynin watch out for regression = child abuse or new stressor
185
conduct disorder
``` criminal harms animals harms friends lies steals and cheats defiant towards authority ```
186
oppositional defiant disorder
defiant towards authority does not break the law does NOT hurt friends
187
paranoid
MC delusion | delusion of grandeur and persecution
188
infertility due to what psych meds
antipsychotics due to dopamine antagonism --> hyperprolactinemia --> galactorrhea, amenorrhea, infertility esp in 2nd gen = risperidone
189
ADR of carbamazepine
aplastic anemia
190
transient global amnesia
anterograde amnesia | resolves within 24 hrs
191
acting out
expressing unacceptable feelings through actions
192
denial
behaving as if an aspect of reality does not exist
193
displacement
transferring feelings to less threatening object or person
194
intellectualization
focusing on nonemotional aspects to avoid distressing feelings
195
projection
attributing ones own feelings to others
196
rationalization
justifying behavior to avoid difficult truths
197
rxn formation
transferring unacceptable feelings/impulse into the opposite
198
regression
reverting to earlier developmental stage
199
splitting
experiencing a pressure/situation as either all positive or all negative
200
sublimation
channeling impulses into socially acceptable behavior
201
suppression
putting unwanted feelings aside to cope with reality
202
acute mania with non compliant patient tx =
olanzapine since it can be given IM
203
hallucinations in kids can be caused by
over the counter cold medications
204
HIV associated dementia
early sign = subcortical symptoms
205
management of PCP agitation and aggression
benzos
206
DOC for ADHD
always stimulants unless parents dont want stimulants
207
First line tx for bipolar disorder
lithium valproate quetiapine lamotrigine
208
doc for social anxiety disorder
SSRIs/SNRIs such as sertraline
209
REM sleep behavior disorder
dream enactment that occurs during REM sleep if muscle atonia is absent - more common in the elderly
210
drug that is associated with dose dependent HTN
venlafaxine - SNRI
211
drugs that are associated with hypotension
MAO-Is | TCA
212
bipolar pts not adequately controlled with monotherapy should be treated with what med
lithium or valproate + 2nd gen antipsychotic
213
unexplained abd pain new onset neuropsych symptoms (anxiety, mood changes psychosis) dx =
AIP
214
``` overdose patient - seizures - mental changes tachy hypotension cardiac conduction delay anticholinergic (dilated pupils, flushed, dry skin) ```
TCA overdose
215
first line tx for major depressive disorder with psychotic features
ECT
216
pathology behind tardive dyskinesia
dopamine receptor hypersentivity
217
which 2nd gen antipsychotic has less metabolic risk
ziprasidone has the least vs olanzapine | 2nd gen has less EPS risk then 1st gen
218
tx of choice for adjustment disorder
psychotherapy
219
After SSRIs what are the next tx options for depression
``` (1) SNRIs then (2) buproprion mitrazapine serotonin modulators then (3)TCAs ```
220
baseline studies needed before intiating lithium
``` BMP calcium thyroid UA ECG ```
221
what drug has a high frequency of prolactin elevation
respiridone
222
tx of acute dystonia
benadryl | diphenhydramine
223
what sign is associated with dementia and not normal aging
getting lost in familiar territory
224
sexual assault increases risk for
suicidal ideation and attempts
225
caffeine intoxication
sympathetic hyperactivity - anxiety, jitteriness, insomnia palpitations
226
nightmare disorder
child remembers the disorder and can be consoled
227
alzheimer basics
early insidious short term memory loss | later personality changes
228
vascular dementia basics
stepwise decline | cerebral infarctions and/o deep white matter changes on neuroimaging.
229
frontotemporal dementia basics
early personality changes apathy disinhibition compulsive behavior frontaltemporal atrophy on neuroimaging
230
dementia with lewy bodies bascis
visual hallucinations spontaneous parkinonism fluctuating cognition
231
normal pressure hydrocephalus
wet wobbly weird dilated ventricles on neuroimaging
232
prior disease
behavioral changes | rapid progression myoclonus and/or seizures
233
side effects of ECT and safety in pregnancy
anterograde and retrograde amnesia safe during all terms of pregnancy
234
tx of choice for borderline personality disorder
dialectical behavioral therapy
235
example of reaction formation
you hate someone but when you see them you act super nice to them
236
presentation of acute dystonia
sudden sustained contraction of the neck, mouth, tongue and eye muscles tx - benadryl and/or benztropine
237
increased serum cortisol is associated with what disorder
MDD
238
depression and sleep
decreased REM latency and increased overall REM
239
decreased concentration of 5-hydroxyindoleacetic acid in CSF analysis is associated with
depression 5-HIAA metabolite of serotonin (5-HT)
240
increased sensitivity to lactate infusion is associated with
panic disorder
241
serology positive for HLA-DR2 is associated with
narcolepsy
242
oxalate crystals are associated with
ethylene glycol toxicity
243
somatization disorder timeline
>6months and they dont blame themselves
244
nucleus accumbens associated with
cannaboids - increased food intake
245
mamillary bodies are associated with
wernickes and krosakoff syndromes in alcoholics
246
area of the brain associated with drug induced parksonism
substantia niagra
247
locus cereulus is associated with
increased NE = anxiety decreased NE = depression
248
cerebellar vermis associated with
truncal ataxia
249
tx of tyramine hypertensive crisis
nitroprusside or phentolamine
250
dx test for kids with seizures
EEG
251
tramadol when combined with an SSRI can lead to what
serotonin syndrome
252
beta blockers can induce what type of moods
depressed moods that mimic MDD
253
smelling rubber -
temporal lobe seizure - focal spikes on EEG
254
only TCA approved for OCD
clomipramine
255
caudate atrophy =
huntingtons dz
256
ADR of metoclompramide or prochlorperazine
akithesia - tx beta blockers | EPS
257
Contraindication for beta blockers
asthma
258
marker of malnutrition
albumin - low in anorexia
259
part of the brain of affected by alzheimers
nucleus basalis of meynert
260
ADR of IV methylprednisolone therapy
corticosteroid psychotic disorder
261
closed fracture in kid
abuse
262
drug for anxiety that is safe during pregnancy
buspirone
263
tx of tourette syndrome
antipyschotics 2nd gen Respiridone is an option
264
illness anxiety disorder vs somatic disorder
illness anxiety disorder - more concerned with being sick rather then about their actual symptoms like somatic syndrome which are concurrent
265
serotonin syndrome is typically caused by
drug drug interaction between SSRIs and MAO Is
266
signs of pyschomotor retardation
quiet | rocking back and forth
267
dx of narcolepsy
plysomnography
268
tx of choice for OCD if no SSRI
TCA such as clomipramine
269
OCD affect on brain
increased size of caudate nucleus and increased frontal lobe metabolism
270
PET scan shows hypoactivity in the frontal lobs and hyperactivity in the basal ganglia - disorder = ?
schizophrenia
271
positive symptoms - neuro trans and receptor negative symptoms - neuro trans and receptor
pos = dopamine receptors neg = muscarinic receptors
272
bipolar is associated with increased levels of
NE and serotonin
273
MDD is associated with
decreased NE, serotonin dopamin and REM latency increased REM
274
ADHD is associated with lower levels of
dopamine
275
first symptom to disappear after treatment of ADHD is
hyperactivity
276
tx of nightmares
prazosin
277
inhalants effect on the brain
white matter changes | diffuse brain atrophy
278
alcoholic withdrawal delusions tend to be more
visual than auditory
279
tx of essential tremor secondary to lithium
propanolol
280
increased amylase is found in what type of patient
purging vomiting patient alcoholic with pancreatitis
281
benztropine MOA
anticholinergic effect - restores ACh/Dopamine balance used for EPS tx
282
hydroxyzine
MOA - antihistamine - tx of anxiety and pruritus
283
use for buprenorphine
tx of opioid dependence
284
acetylcholinesterase inhibitors
donepezil and rivastigmine tx of mild to mod dementia
285
Memantine
NMDA antagonist - reduces glutamate tx of mod to severe dementia
286
conditons that mimic depression
``` anemia b12/folate def hypothyroidism hypoglycemia hypercalcemia/hypocalcemia cushings/addisons parkinons alzheimers ```
287
before starting an SSRI what labs do you need to check
platelets - since SSRIs decrease platelet adhesion Na - since SSRIs can decrease Na
288
SSRIs with shortest half life
paroxtine | fluvoxamine
289
longest half life SSRI
Fluoxetine
290
which SSRI has the least drug drug interaction
citalopram
291
ADR of venlafaxine
risk of increased BP - C/I in patients with untreated HTN
292
tx of lewy body dementia
quetiapine
293
atypical antipsychotics least associated with metabolic syndrome
ziprasidone | aripriprazole
294
dielectival behavioral therapy is indicated for the tx of
borderline personality disorder to prevent splitting
295
tourette syndrome brain involvement
basal ganglia involvment | impaired regualtion of dopamine in caudate
296
loss of hypocretin
narcolepsy
297
insomnia has a decrease in what receptor
GABA
298
lithium drug drug interactions
``` thiazides nsaids ace inh tetracyclines metronidazole ```
299
why are TCAs C/I in elderly
confusion halucinations irritability
300
in a TCA overdose what determines the severity of the outcome
QRS prolongation length
301
primary cause of NMS
dsyregulation of dopamine
302
what type of psychotherapy is for PTSD pts
prolonged exposure | eye movement desensitization and reprocessing
303
pancreatitis is an ADR to what drug
depakote
304
DOC for atypical depression
MAO-Is
305
DOC for melacholic depression
TCAs
306
defense mechanism most commonly used by paranoid ppl
projection
307
defense mechanism most commonly used by OCD ppl
undoing
308
C/I to 4 pt restraints
pregnant women
309
most common type of anxiety disorder
phobias
310
most common comorbid condition with depression
anxiety
311
GAD req in kids vs adults
kids - 1/6 adults 3/6
312
first SSRI created
fluxoetine
313
cotard syndrome
belief that one has lost their soul or is dead
314
capgreass syndrome
family or ppl they know have been replaced by imposters
315
fregoli syndrome
shapeshifter belief someone keeps changing into different ppl
316
koro
south and east asia syndrome - anxiety that their penis will recede into the body leading to death
317
what is the only relative C/I to ECT
recent acute MI
318
mesocortical pathway
cognition | reward
319
meslombic pathway
+ symptoms of schizophrenia
320
nigostriatal pathway
EPS | parkinson symptoms
321
tuberoinfundibular
sexual side effects | amenorrhea issues
322
typical antipsychotic with the ADR of photosynesitivity
chlorpromazine
323
typical antipsychotic with ADR of pigment retinopathy
thioridazine
324
what are the only 2 drugs that reduce suicide
clozapine and lithium
325
ADR of Ziprasidone
prolonged QT interval
326
Lurisidone
atypical antipsychotic >13 y/o schizophrenia adr - renal dsyfunction
327
clonidine moa
alpha 2 antagonist
328
RETT syndrome
deceleration of head growth and small hands and feet seizures normal function up to 5 months than regression begins
329
uses for clonidine
ADHD tourrette opiod withdrawal
330
risk factors for suicide
``` white old man jew divorced/single ```
331
atrophy of cingulate gyrus seen in
schizophrenia
332
bupropion MOA
NE and dopamine reuptake inhibitor
333
major tool of tx for psychoanalysis
interpretation of transferrence
334
TCA - MOA
blok 5-ht and NE alpha adrenergic blockade antihistaminic anticholinergic
335
SSRI --> MSO-I washout period
2wks unless fluoxtine washout takes 5-6 weeks
336
washout period from MAO-I to SSRI
2 weeks
337
uses for duloxetine
diabetic neuropathy | fibromyalgia
338
nefazodone
blackboxed | liver toxicity
339
MC - ADR of buproprion
nervousness HA Insomnia
340
normal lithium levels
0.8 -1.2
341
how many days until you measure lithium levels or depakote levels
3 - for lithium 5- for depakote
342
stroke patients are at highest risk for developing what mood disroder
depression along with pancreatic cancer patients
343
what drugs are C/I in breast feeding
antidepressants | lithium
344
defense mechanism that histrionic patients use
regression
345
methadone
long acting opioid receptor agonist ADR - prolonged QT
346
most common finding in derlium aptients
impairment with recent memory visual hallucinations and short attention spans are 2 other very common symptoms
347
lithium reversible vs irreversible damage
thyroid damage = reversible renal damage = irreversible
348
stage I sleep EEG
theta waves | absent alpha waves
349
stage 2 sleep EEG
k complexes | sleep spindles
350
stage 3 sleep EEG
delta waves
351
increased ACH associated with what sleep function
increased dreams
352
increased serotonin = what sleep effect
increased sleep
353
increased dopamine = what sleep effect
increased awakeness
354
increased NE = what sleep effect
increased arousal
355
increased GABA =
decreased sleep latency | decreased NREM 3
356
zolpidems increase what
sleep walking
357
over oxygenation of COPD patients can lead to
central sleep apnea
358
OSA tx vs CSA tx
OSA tx = cpap CSA tx = bipap
359
abnormal labs seen in refeeding syndrome
fluid retention | decreased phosphorus Mg Ca
360
complications of refeeding syndrome
arrhythmias resp failure delirium seizures
361
cortisol in anorexia nervosa
increased like depression
362
dopamine does what to sexual function
increases libido
363
serotonin does what to libido
inhibits sexual function
364
tx of TCA overdose
sodium bicarbonate
365
complications involved with catatonia
malnutrition - check albumin DVT - tx with low molecular weight heparin rhabdo - check cpk
366
busprione is for buproprion is for
buspirone is for --> anxiety buproprion is for --> depression add on
367
criteria for hospitlization for anorexia nervosa
BMI < 15 | vital sign abnormalities
368
first line tx of anorexia nervosa that doesnt require hosptilization
CBT
369
tx for social anxiety disorder
SSRI/SNRI

Step 2 Rotation Cards (14 decks)

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