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Flashcards in High Yield-Emma Holliday Deck (101):
1

medications to avoid in a manic pt?

-SSRIs and TCAs (can trigger mania)

-Haloperidol or clonazepam for acute agitations or delusions
AND
Lithium, valproic acid or carbamazepine for maintenance

2

pt takes Advil and develops n/v/d, coarse tremor, ataxia, confusion, slurred speech. What drug toxicity?

lithium --> precipitated by nsaids. Better pain meds are aspirin or sulindac

3

major SEs of Lithium? Therapeutic levels? What should you monitor?

-Weigh gain and acne, GI irritation, cramps
-0.6-1.2
-Monitor Li levels q4-8 wks, TFTs q6mo, Cr, UA, CBC, EKG

4

Teratogenicity of Lithium?

Ebsteins anomaly

5

preferred tx for bipolar in preggos?

clonazepam, esp 1st tri

6

bipolar + elevated LFTs and hepatitis?

Valproate. Also can cause n/v/d, skin rash

7

bipolar + SJS?

Lamotrigine

8

Bipolar + Agranulocytosis?

carbamazepine. Check CBC regularly

9

Bipolar + increased AFP in a 20 wk preggo?

valproate or carbamazepine

10

MC complication of carbamazepine? Therapeutic levels?

rash

60-120

11

therapeutic levels of valproate?

6-12

12

most important question to ask for someone with MDD?

assess for SI

13

RF's for suicide?

Prior attempt
> 45 y/o
White male
serious illness
detailed plan
no support/lack of support
ethos/drugs

14

Pt who is eating more, gaining weight, sleeping more and has leaden paralysis in the morning?

atypical depression --> hypersensitive to rejection, can affect social fxning
Tx with MAOIs

15

1 mo after death of her child, mom feels guilty, can't sleep, concentrate, eat, or enjoy interests?

uncomplicated bereavement --> No SI, no psychosis, rarely tx w/antidepressants for sxs

16

4 mos after death of her dog, a woman still feels guilt, can't sleep, concentrate, or enjoy her interests?

adjustment d/o --> sxs within 3 mo of stressor out of proportion. can't persist longer than 6 mo. best tx with psychotherapy

17

which SSRI do you not have to taper when stopping?

Fluoxetine

18

HA, n/v/d, dizziness and fatigue when stopping SSRI suddenly?

5HT discontinuation syndrome. MC with sertraline and fluvoxamine

19

Myoclonic jerks, tachycardia, high BP, hyperreflexia, n/v/d in pt being tx for MDD?

5HT syndrome. If SSRI + MAOI

20

Tx for MDD if loss of erection, ejaculation?

switch to bupropion

NET DAT Ball Pro

21

Tx for MDD and boner for > 3 hrs, what drug?

Tx for MDD for old, skinny, sad ladies?

Trazodone

Mirtazepine

22

Pounding head, flushing, nausea, myoclonus after eating cheese, drinking red wine, taking decongestant or meperidine?

Hypertensive crisis w/ MAOI. Tx w/ 5 mg IV phentolamine

23

mc cause of death in someone who ODs on TCAs? Tx for reversal?

Arrhythmia --> torsades, v-fib, death

Activated charcoal if ingested w/in 1-2 hrs

Give IV NaHCO3

24

Patholophys of + sx in schizophrenia?

Pathophys of - sx in schizophrenia?

+ --> Excess DA in limbic area binding D2 receptors

- --> decreased DA in prefrontal cx/mesocortical tract *this is why typical antipsychotics make - sxs worse*

25

Pt has delusions, hallucinations, and flattened affect for 3 wks? for 3 mos?

-Brief psychotic d/o= >1 wk, <1 mo

-Schizophreniform d/o= >1 mo, <6 mo

26

Pt has had persecutory delusions for the past 3 yrs. 6 mo ago he started having sadness, guilt, insomnia, decreased concentration and SI?

Schizoaffective d/o --> hallucinations/delusions for >2 wks in absence of mood sx

Tx with atypical antipsychotics + SSRI if depression and + Lithium if manic

27

a pt has had MDD for 3 yrs and reports hearing voices telling him he is worthless and to kill himself

MDD with psychotic features --> Delusions are typically mood congruent

Tx with atypical antipsychotic + SSRI or ECT (esp preggos)

28

Man is convinced Miley Cyrus is in love with him but otherwise functional

delusional d/o

29

DOC for acute agitation or psychosis?

IM haloperidol

30

Low potency 1st gen antipsychotics? High potency?

low=Chlorpromazine and Thioridazine --> Less EPS, more Anticholinergic, Antihistamine, and alpha1 antagonism

High=Haloperidol and Fluphenazine --> More EPS

31

Antipsychotic drugs:
-Purple grey metallic rash over sun-exposed areas and jaundice?

-Prolonged QTc and pigmentary retinopathy?

chlorpromazine

thiodridazine

32

Pt wakes up with eyes "stuck" looking up or head "stuck" turned to the side?

Acute dystonia (<12 hrs)

tx w/ benztropine or diphenhydramine

33

pt report feeling like they "always have to move"?

Akathesia (30-90 days)

tx w/propanolol (1st line) or Benzo

34

Coarse resting tremor, masked facies, unsteady gait, bradykinesia?

Parkinsonism (>6 mo)

tx w/ benztropine/diphenhydramine, amantidine, or bromocriptine. NOT L-DOPA!!

35

After 10 yrs on fluphenazine, tongue movement, and grimacing?

Tardive dyskinesia (> years)

Tx by stopping antipsychotic and switch to atypical or clozapine

36

w/in hrs of a haloperidol injx, pt has increased CPK, T=103F, autonomic instability, and delirium?

NMS
1st-D/c med
2nd-Cooling blankets and dantroline

37

Atypical agent w/ highest risk for EPS and increased prolactin?

Risperidone (depot shot)

38

atypical agent weight neutral but prolongs QTc? weight neutral but increases akathisia?

ziprazodone

aripiprazole

39

atypical agent most assoc with weight gain? orthostasis and cataracts?

olanzapine

quetiapine

40

atypical agent good for tx-refractory schizophrenia?

clozapine

41

MC SE of clozapine? Most dangerous? How to monitor?

MC=Sedation, weight gain, increased blood sugar and lipids

Most dangerous=Agranulocytsosis, decrease seizure threshold

Monitor=CBC --> ANC q week for 6 mo and x2 wks for next 6 mo; D/c drug if ANC < 1500

42

drug regimen of choice for panic attacks?

Alprazolam or clonazepam low dose PRN short term, but SSRIs are preferred drug
*dont give benzos to addicts, COPDers, or restrictive lung disease*

43

A pt being tx for panic attack is brought in 3 mo after beginning tx with temp of 101, convulsions, confusion, and HTN. She recently lost her rx drug coverage.

Acute bzd withdrawal rxn. Similar to DTs

Tx w/diazepam or chlordiazepoxide + haloperidol if psychotic

44

best tx for specific phobia?

Best tx is CBT w/ flooding or exposure/extinction. Can give bzd for situational use

45

best tx for social phobia or fear of public speaking?

Best tx is propanolol to stop hyperarousal and benzo

46

Gold standard tx for OCD?

Clomipramine is gold standard
SSRIs are 1st line

47

tx for PTSD?

Sertraline or paroxetine. Combo w/ CBT. Prazosin for nightmares

48

Time frame for PTSD? Acute stress rxn? What if similar sx to ASD but in response to a bad breakup?

PTSD= > 1 mo

ASD= 3 d-1 mo

Bad break up=Adjustment d/o

49

what lab abnormalities below in anorexia nervosa pt?
Vitals?
CBC?
Chemistry?
Fasting lipid profile?
Hormones?
Long term complications?
MC cause of death?
Tx?
Complications of tx?

vitals=Hypotension, bradycarida, hypothermia
CBC=leukopenia
Chem=High HCO3, low Cl, low K, high carotene, high LFTs and amylase
Lipid=High cholesterol
Hormones=High cortisol, low LH/FSH, low estrogen
Long term comp=Osteoporosis
MC cause death=Heart disease then suicide
Tx=Admit them to max nutrition. SSRIs for bulimia but intensive counseling for anorexia
Complications=Re-feeding sx --> low PO4, low Mg, low Ca, and fluid retention

50

what stage of sleep do you find sleep walking/talking/night terrors? Sk m paralysis?

stage 3-sleep walk/talk/night terrors

REM-sk m paralysis

51

daytime sleepiness and depression in a big fat guy with a big neck?

obstructive sleep apnea. Dx with polysomnogram. Tx with CPAP to reduce pulm HTN

52

Tx for narcolepsy?

scheduled naps and modafinil

53

78 y/o F presents with memory loss...aphasia, apraxia, lost while driving? Pathology? Genes? Tx?

Alzheimers dementia
Global brain atrophy. B amyloid plaques or tau tangles
APP (chr 21), ApoE2
Tx with donepezil, rivastigmine, galantine, Memantine

54

78 y/o F presents with memory loss..becomes more sexually explicit, apathetic? Pathology? Tx?

Frontotemporal dementia
Lobar atrophy. Intra-neuronal silver staining inclusions
Tx-olanzepine for severe disinhibition

55

78 y/o F with memory loss...fluctuation in consciousness, visual hallucinations, and shuffling gait? Pathology? Tx?

lewy body dementia
Intra cytoplasmic a-synuclein inclusions in neocortex
Tx-AchEsterase inhibitors, not L-Dopa, avoid neuroleptics

56

78 y/o F presents with memory loss...sudden stepwise decrease in memory/cognition?

vascular dementia

57

78 y/o F presents with memory loss...loss of vibration sense, labile affect. pupils accommodate but don't react? Dx? Tx?

tertiary syphilis

Dx=+ RPR, VDRL. Do spinal tap to look for spirochetes

Tx=IV penicillin

58

78 y/o F with memory loss...myoclonus, startle response, seizures. Recently had a corneal transplant? Pathology? EEG findings?

CJD

Path-Spongiform encephalopathy

EEG-Triphasic bursts

59

78 y/o F with memory loss...incontinence, gait disturbance/frequent falls, and rapidly developing dementia? Dx? Tx?

Normal pressure hydrocephalus

dx-CT/MRI shows hydrocephalus, spinal tap shows nl opening pressure

tx-Ventriculoperitoneal shunt improves cognitive fxn in 50-67% of pts

60

best initial tx for etoh withdrawal pt?

diazepam or chlordiazepoxide b/c they have 80 and 120 hr 1/2 lives, respectively

61

best tx for etoh witihdrawal in a pt wiho is cirrhotic?

Lorazepam, Oxazepam, or Temazepam (LOT)

62

tx for wernicke encephalopathy?

thiamine 1st then glucose containing fluids

63

best 1st step to tx a pt with heroin OD?

intubate pt. then give IV or IM naloxone

64

What sxs in a pt withdrawing from heroin?

joint and muscle pain, photophobia, goosebumps, diarrhea, tachycardia, HTN, GI cramps, dilated pupils, anxiety/depression

65

Pt presents with horizontal nystagmus, dilated pupils, ataxia, and acute psychosis?

PCP intoxication. Can use haloperidol for acute psychosis

66

pt presents s/p MVC with injected conjunctiva, sedation, and asking for Doritos?

cannabis intox

67

Pt presents with SI, hypersomnia, depression, and anergia (abnormal lack of energy)? Best 1st test? Tx of HTN and tachycardia?

cocaine/amphetamine intoxication

EKG then urine tox screen. Tx seizure with lorazepam

HTN and tachy-tx with CCB; B blockers contraindicated

68

11 y/o boy with developmental delay, poor school and social performance, iq of 50, macrocephaly and macroorchidism?

Fragile X syndrom
X linked dominant
CGG repeats w/ anticipation
Cx=seizures, MVP, dilation of aorta, tremors, ataxia, ADHD-like behavior

MC cause of inherited MR

69

Newborn baby with decreased tone, oblique palpebral fissures, simian crease, big tongue, white spots on iris? MC med complications?

Downs syndrome

Heart-VSD, endocardial cushion defects
GI-Hirschsprungs, intestinal atresia, imperforate anus, annular pancreas
Endocrine-Hypothyroidism
MSK-AA instability
Neuro-Incr risk of Alzheimers by 30-35 (APP on Chr 21)
Cancer-Incr risk of ALL

70

Cafe au last spots, seizures, large head, AD?

neurofibromatosis

71

Coarse facies, short stature, cloudy cornea. AR?

Hurler syndrome

72

Broad, square face, short stature, self-injurious behavior. Deletion on Chr 17?

Smith Magenis

73

Hypotonia, hypogonadism, hyperphagia, skin picking, aggression, Deletion on paternal Chr 15?

Prader-willi

74

Seizures, strabismus, sociable w/episodic laughter, deletion on maternal chr 15?

Angelman

75

Elfin-appearance, friendly, increased empathy and verbal reasoning ability, deletion on Chr 7

Williams

76

ADHD-like sxs, microcephaly, smooth philtrum. MC cause of MR?

Fetal alcohol syndrome

77

Seizures, chorioretinits, hearing impairments, periventricular calcifications, petechiae at birth, hepatitis?

Congenital CMV infx

78

Seizures, hearing impairments, cloudy cornea/retinitis, heart defects, low birth weight?

congenital rubella syndrome

79

abnormal muscle tone, unsteady gait, seizures, MR or learning disability

cerebral palsy from birth asphyxia

80

IUGR, hypertonia, distinctive facies, limb malformation, self-injurious behavior, hyperactive?

Cornelia de lange

81

Coloboma, heart defects, choanal atresia, growth retardation, GU anomalies, ear deformity and deafness, Chr 8?

CHARGE

82

autism spectrum sxs, heart disease, palate defects, hypo plastic thymus, hypo-Ca, Chr 22 deletion?

DiGeorge

83

Vomiting, seizures, lethargy, coma. Acidosis w/stress, illness. Causes neurological damage?

Maple syrup urine disease

84

Exclusively in girls, normal development for 6-8 pos, then regression, handwringing, loss of speech and use of hands. X-linked dominant deletion of MECP2?

Rett syndrome

85

Normal development until age 2 then major loss of verbal, social skills w/autistic-like behavior

Childhood disintegrative behavior

86

lack of mother-child eye contact, language delay/repetitive language, preoccupation with "parts of toys" before age 3?

Autism

87

Problems with social skills (usually recognized in preschool) w/reserved verbal ability?

aspergers

88

risk factors for ADHD? comorbid conditions?

Low birth weight, tobacco/etoh exposure

OCD/tic disorder

89

MOA of methylphenidate?

Blocks DA reuptake

90

MOA of amphetamine?

Blocks DA/NE reuptake and stimulates release

91

MOA of atomoxetine?

NE reuptake inhibitor. Non stimulant

92

MOA of clonidine, guanfacine?

a2 agonists, reduce peripheral SNS

93

14 y/o boy sent for court mandated counseling. Stole neighbors lawn more and then set fire to his tool shed. has a 5 y hx of truancy from school and assaulted a 13 y/o school mate?

conduct d/o

Need sxs for 6 mo
Comorbid substance abuse
May progress to anti social PD

94

14 y/o boy brought in by mom. For past year, getting in trouble at school for being argumentative and disrespectful to teachers. he defies rules she sets for house and often deliberately annoys her?

ODD
Need sxs for 12 mos

Stops just short of breaking the law or physically harming others

95

Timeline for dx tourettes?

tics must occur at least 1x/day for 1 yr w/o a tic-free period longer than 3 mo

96

comorbid conditions for Tourettes?

Look for the compulsions of OCD. Can have ADHD as well

97

1st line tx for Tourettes? Most effective?

Clonidine

Haloperidol or pimozide --> DA receptor antagonists

98

7 y/o boy complains of frequent abdominal pain resulting in many missed school days. He never gets the pain on the weekends or in the summer?

Separation anxiety d/o

99

6 y/o adopted child brought in b.c she has not formed a relationship with her adoptive parents. She is inhibited and hypervigilant?

Reactive attachment d/o

100

18 mo old baby has recently been regurgitating and re-chewing her food. She had previously been eating normally?

Rumination d/o
Check Pb levels

Next best test=Check for fecal retention

Tx=Behavior modification that only rewards

101

6 y/o urinates in her clothes once a day. Next best test? Tx?

UA and urine culture

Alarm and pad for 6 wks. TCAs reduce bed wetting but relapse is common. DDAVP has same prob + S/E=HA's, nausea, hyponatremia