Flashcards in Board Exam Deck (53):
What are the extrapyramidal side effects of neuroleptics?
Parkinsonism; dystonia; akathisia
What is used to treat akathisia?
Benzodiazepines and beta blockers (propranolol)
How is tardive dyskinesia treated?
D/c or lower antipsychotic and switch to a different antipsychotic
What are the typical antipsychotics? High and low potency?
High potency: haldol, fluphenazine, trifluoperazine, pimozide; Low potency: chlorpromazine and thioridazine
How are panic attacks treated?
CBT and pharmacotherapy (SSRIs first-line, can use TCAs if ineffective)
Up to 65% of patients with panic attacks have what comorbid disorder?
Major depression; other comorbid conditions: anxiety disorders (esp agoraphobia), bipolar disorder, alcohol use disorder
What medication is FDA approved for bulimia nervosa?
How is GAD treated?
Psychotherapy (CBT) and pharmacotherapy (SSRI, SNRI)
What is thought to be the cause of tardive dyskinesia?
Increased sensitivity of the dopamine receptors
What is seen on polysomnography in narcolepsy?
Decreased REM latency
What is deficient in the CSF of patients with narcolepsy?
What is the drug of choice in treatment of cataplexy?
Which TCA could be used to treat OCD?
Clomipramine (most serotonin selective)
What factors can increase Lithium levels?
Dehydration, NSAIDs, ASA, decreased kidney function, thiazide diuretics, salt deprivation, sweating (salt loss)
What symptoms are seen in lithium toxicity?
Course tremor, altered mental status, convulsions, delirium, coma, death
What ECG rhythm can be seen in lithium toxicity?
2nd degree AV heart block
What is the treatment for PTSD?
First-line is antidepressant; can us prazosin (alpha 1 antagonist) targets nightmares
What is the most effective treatment for adjustment disorder with depressed mood?
What is the treatment of serotonin syndrome?
Stop offending agent; supportive; benzodiazepines. Can use cyproheptadine (serotonin antagonist)
52 year old homeless man with alcoholism is brought to the emergency departmetn by polic after being found agitated and confused. He feels nervous and could use a drink. Temp 37, HR 120, RR 20, BP 138/86. He is trembling. Hct 30%. Urinalysis shows 7 WBC/hpf and many oxalate crystals. What is the most likely cause?
Ethylene glycol toxicity
How is gambling disorder treated?
CBT and self help groups; SSRIs and naltrexone have been used to help
What is the MOA of buproprion?
Inhibits reuptake of NE and DA
What is buspirone used to treat?
FDA-approved non-benzo anxiolytic; used to treat GAD w/o comorbid depression or panic sxs
What is the first line treatment of GAD?
SSRIs or SNRIs
Patient with new medication to treat asthma develops psychosis, what is the likely cause?
Glucocorticoid-induced psychosis = med-induced psychotic disorder
What is the drug category of clozapine?
Second generation antipsychotic
What drugs can cause lithium toxicity due to drug interaction?
Thiazide diuretics, NSAIDs, ACE inhibitors, tetracyclines, metronidazole
What medications can cause a decrease in serum lithium levels?
Theophylline and potassium sparing diuretics (spironolactone)
If a patient uncharacteristically has a rapid response to venlafaxine, what psychiatric diagnosis should you consider?
Bipolar; typical response to venlafaxine is 2 weeks
What is the treatment of neuroleptic malignant syndrome?
Stop neuroleptics, start fluids, administer dantrolene or bromocriptine if refractory
What is a distinguishing factor between neuroleptic malignant syndrome and serotonin syndrome?
NMS - has lead pipe rigidity; Serotonin syndrome has GI sxs, hyperreflexia and myoclonus
What is the most consistently replicated neuroimaging finding in schizophrenia?
Enlargement of lateral cerebral ventricles
What type of therapy is helpful in borderline PD?
What are the indications for hospitalization in patients with anorexia nervoas?
Dehydration, unstable VS (hypotension, bradycardia HR <40, hypothermia), cardiac dysrhythmias, electrolyte disturbances, organ involvement, very low weight
What is the primary pharmacotherapy treatment of bulimia nervosa?
What is the primary pharmacotherapy treatment for anorexia nervosa?
What is the treatment for anorexia nervosa?
CBT, Nutritional rehab, olanzapine for severe cases
What labs need to be monitored with valproate?
CBC (for platelets) and LFTs
What medication is used to treat PMS/PMDD?
What is the defense mechanism reaction formation?
Responding in a manner opposite to one’s actual feelings
What are non-stimulant options to treat ADHD?
Atomoxetine (NE reuptake inhibitor); buproprion and TCAs
QRS duration of >100 msec in TCA toxicity is an indication for what treatment?
What is the MOA of buproprion?
NE and DA reuptake inhibitor
What are common adverse effects of mirtazapine?
Sedation and weight gain
What antipsychotics have the highest potential for increasing prolactin?
High potency 1st gen (haloperidol and fluphenazine) and risperidone and paliperidone
What are the key features of illness anxiety disorder?
Fear of having a serious illness despite few or no symptoms and consistently negative evaluations
During what phase of sleep do nightmares occur?
What is nightmare disorder?
Recurrent awakenings due to highly disturbing and frightening dream content; patients are able to recall dreams, awaken from dreams, and are able to be consoled (compared to sleep terror disorder)
During what phase of sleep do sleep terrors occur?
How is kleptomania treated?
CBT, SSRIs, opioid antagonist, lithium, anticonvulsants
What is the first line treatment for panic disorder and agoraphobia?
SSRI and CBT
What is the treatment for postpartum depression?
SSRIs (sertraline for breast feeding)