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Flashcards in Ethics/Radiology/Psychiatry Deck (59):
1

What is one exception to partial emancipation of minors to make their own medical decisions (e.g. sex, reproductive health, substance abuse)?

Abortion needs to be disclosed to parents in 36 states

2

If the parents of a child are Jehoviah's Witness can they deny life-saving therapy for their child?

No

3

Can a pregnant women refuse therapies which would assist the fetus while pregnant?

Yes. But once the fetus is out then she can't refuse life-sustaining treatment for it

4

True/False

To be useful a living will needs to be clear and precise

True

5

When is a court order an acceptable tool?

After all other options have been exhausted, including an ethics consultation

6

Is physician-assisted suicide and euthanasia ever the right answer (that is the intent to end life)?

No

7

Do you need the consent of the father for an abortion?

No

8

When can you break patient confidentiality?

When there is direct harm to others (e.g. physical harm in setting of psychiatric patient or communicable diseases like HIV)

9

Can physicians refuse to treat certain patients?

It is legal for them to do so but not always ethical

10

Lytic bone lesions may be caused by what cancer?

Multiple myeloma
Primary bone cancer
Lung, renal, thyroid, or breast mets

11

Blastic bone lesions may be caused by what cancer?

Breast, prostate, or lymphoma mets
Paget's Disease
Medulloblastoma in peds

12

What is the preferred therapy for delusional disorders and personality disorders?

Psychotherapy

13

What are other tests which should be included your diagnostic work-up to rule out non-psych related diagnoses?

TSH
VDRL/RPR
HIV
BMP (Calcium and other metabolic disorders)
Temporal lobe epilepsy hx

14

Besides psychosis, what are two other indications for the use of antipsychotics?

1) Sedating effect when BZDs contra-indicated
2) Huntington's Disease or Tourette's

15

Major side effect of clozapine

Agranulocytosis (Check a CBC once/week)

16

What are adverse effects seen with low-potency antipsychotics?

Orthostatic hypotension (from alpha blockade effect)
Dry mouth, urinary retention, blurry vision, delirium (anticholinergic effect)

17

Adverse effects of thioridazine

Prolongs QT and arrhythmias
Abnormal retinal pigmentation

18

What are adverse effects of some antipsychotics which are a major reason for male non-compliance?

Impotence and inhibition of ejaculation

19

What is the major advantage and disadvantage of use of typical high-potency antipsychotics (e.g. haloperidol and fluphenazine)?

Advantage: fewer side effects related to alpha blockade and anticholinergic effect; higher potency

Disadvantage: higher association with EPS symptoms

20

What is the major advantage and disadvantage of low-potency typical antipsychotics (e.g. thioridazine, chlorpromazine)?

Advantage: Less likely to cause EPS symptoms

Disadvantage: Greater sedating effect and risk of orthostatic hypotension and anticholinergic effects

21

What is the major benefit of atypical antipsychotics such as risperidone, quetiapine, olanzapine, and clozapiine?

Greater effect on negative symptoms and has less risk of EPS

22

Which antipsychotic has the greatest risk of weight gain?

Olanzapine

23

How do you treat acute dystonic reactions or bradykinesia which occurs while on antipsychotics?

Reduce dose
Anticholinergics (i.e. benztropine, diphenhydramine, trihexyphenidyl)

24

How do you manage akathisia which may result from antipsychotics?

Reduce dose
BZD may help
Switch to a newer antispsychotic (e.g. risperidone)

25

How do you manage tardive dyskinesia?

Stop the old antipsychotic and start a new one

26

T/F

After discontinuing an old antipsychotic symptoms of tardive dyskinesia improve

False

Symptoms worsen first

27

What are non-antipsychotic meds which may also cause EPS symptoms?

Metoclopramide and prochlorperazine (antiemetics)

28

Mgmt of panic disorder

Cognitive behavioral therapy and relaxation training
SSRIs, BZD, imipramine, MAOI

29

Treatment of phobia disorders

Exposure therapy
BZD and Beta Blockers may be helpful when given prior to the exposure

30

Place these benzodiazepines in order of shortest to longest half-life:

Diazepam (Valium)
Alprazolam (Xanax)
Lorazepam (Ativan)

Alprazolam (Xanax)

31

What is a major benefit of buspirone compared to other anxiolytic effects?

No sedating effects

32

Major depressive disorder requires symptoms to last for how long?

2 weeks

33

In patients with newly diagnosed depression who are acutely suicidal what is an appropriate therapy?

ECT, which reduces risk of suicidality quicker than antidepressants would

34

Describe dysthymic disorder. What is mgmt?

Low level depression symptoms lasting 2 yrs
Individual psychotherapy is the best initial treatment, SSRIs can be used if that doesn't help

35

How is seasonal affective disorder managed?

Phototherapy and sleep deprivation

36

What is rapidly cycling bipolar disorder?

Greater than 4 manic episodes per year

37

How do you managed a bipolar patient who is well maintained on Li but becomes pregnant?

Stop Li

Use ECT in first trimester and Lamictal in 2nd and 3rd trimester

38

What is appropriate management of acute mania?

1) Mood stabilizing medicine to induce remission (e.g. Lithium)
2) Antipsychotic to control the acute mania (e.g. Risperidone)
3) IM Depot Phenothiazine in noncompliant and severely manic patients

39

What are second-line options for treatment of bipolar disorder?

Aripiprazole, quetiapine, olanzapine, divalproex

40

Describe cyclothymia and its mgmt

Recurrent episodes of depressed mood and hypomania over 2 years.

Psychotherapy is first and then if patients still need assistance may give Divalproex

41

What is appropriate treatment for a grief reaction?

Supportive therapy

42

What type of depression are MAOIs useful for?

Atypical Depression

43

How long should you keep a pt on an antidepressant before considering switching if it doesn't work?

8 weeks

44

Mirtazapine is a good antidepressant to use if patients have what additional symptoms to their depression?

Poor appetite, insomnia, weight loss

45

In which situations is trazodone a helpful antidepressant?

Patients with severe insomnia because of its sedating effect

46

What is the one SSRI not safe in pregnancy?

Paroxetine

47

Which antidepressive medication should be avoided in patients with history of seizures?

Bupropion

48

What is the first line choice for rapidly cycling bipolar disorder?

Divalproex

49

What are serious side effects of carbamazepine?

Agranulocytosis and sedation
*CYP450 Inducer so increases clearance of warfarin, phenytoin, theophyllilne, valproic acid

50

What should you always discuss with a patient prior to starting an antidepressant medication?

If they have had suicidal ideations because some patients have increases thoughts of over the first 2 weeks

51

What medications assist with anorexia and bulimia?

Olanzapine (promotes weight gain)
SSRI antidepressants

52

What is appropriate treatment of body dysmorphic disorder?

SSRI

53

How is intermittent explosive disorder managed?

Aggression out of proportion to stressor

54

Do you have to report spousal abuse?

No, its not indicated

55

Which is the one with weird thoughts and magical thinking, schizoid or schizotypal personality disorder?

Schizotypal

56

What are characteristics of histrionic PD?

Exaggerated behaviors to draw attention to oneself, often through sexual means

57

What are characteristics of borderline PD?

Unstable affect with mood swings. Often can be suicidal and have chronic feelings of emptiness, identity disturbance, and inappropriate anger

58

What are potential treatments for opiate withdrawal?

Clonidine and/or methadone

59

What is appropriate management of paraphillic disorders (recurrent, sexually arousing preoccupations)?

Individual psychotherapy and aversive conditioning