Flashcards in High Yield-Emma Holliday Deck (101):
medications to avoid in a manic pt?
-SSRIs and TCAs (can trigger mania)
-Haloperidol or clonazepam for acute agitations or delusions
Lithium, valproic acid or carbamazepine for maintenance
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
major SEs of Lithium? Therapeutic levels? What should you monitor?
-Weigh gain and acne, GI irritation, cramps
-Monitor Li levels q4-8 wks, TFTs q6mo, Cr, UA, CBC, EKG
Teratogenicity of Lithium?
preferred tx for bipolar in preggos?
clonazepam, esp 1st tri
bipolar + elevated LFTs and hepatitis?
Valproate. Also can cause n/v/d, skin rash
bipolar + SJS?
Bipolar + Agranulocytosis?
carbamazepine. Check CBC regularly
Bipolar + increased AFP in a 20 wk preggo?
valproate or carbamazepine
MC complication of carbamazepine? Therapeutic levels?
therapeutic levels of valproate?
most important question to ask for someone with MDD?
assess for SI
RF's for suicide?
> 45 y/o
no support/lack of support
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
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
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
which SSRI do you not have to taper when stopping?
HA, n/v/d, dizziness and fatigue when stopping SSRI suddenly?
5HT discontinuation syndrome. MC with sertraline and fluvoxamine
Myoclonic jerks, tachycardia, high BP, hyperreflexia, n/v/d in pt being tx for MDD?
5HT syndrome. If SSRI + MAOI
Tx for MDD if loss of erection, ejaculation?
switch to bupropion
NET DAT Ball Pro
Tx for MDD and boner for > 3 hrs, what drug?
Tx for MDD for old, skinny, sad ladies?
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
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
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*
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
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
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)
Man is convinced Miley Cyrus is in love with him but otherwise functional
DOC for acute agitation or psychosis?
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
-Purple grey metallic rash over sun-exposed areas and jaundice?
-Prolonged QTc and pigmentary retinopathy?
Pt wakes up with eyes "stuck" looking up or head "stuck" turned to the side?
Acute dystonia (<12 hrs)
tx w/ benztropine or diphenhydramine
pt report feeling like they "always have to move"?
Akathesia (30-90 days)
tx w/propanolol (1st line) or Benzo
Coarse resting tremor, masked facies, unsteady gait, bradykinesia?
Parkinsonism (>6 mo)
tx w/ benztropine/diphenhydramine, amantidine, or bromocriptine. NOT L-DOPA!!
After 10 yrs on fluphenazine, tongue movement, and grimacing?
Tardive dyskinesia (> years)
Tx by stopping antipsychotic and switch to atypical or clozapine
w/in hrs of a haloperidol injx, pt has increased CPK, T=103F, autonomic instability, and delirium?
2nd-Cooling blankets and dantroline
Atypical agent w/ highest risk for EPS and increased prolactin?
Risperidone (depot shot)
atypical agent weight neutral but prolongs QTc? weight neutral but increases akathisia?
atypical agent most assoc with weight gain? orthostasis and cataracts?
atypical agent good for tx-refractory schizophrenia?
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
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*
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
best tx for specific phobia?
Best tx is CBT w/ flooding or exposure/extinction. Can give bzd for situational use
best tx for social phobia or fear of public speaking?
Best tx is propanolol to stop hyperarousal and benzo
Gold standard tx for OCD?
Clomipramine is gold standard
SSRIs are 1st line
tx for PTSD?
Sertraline or paroxetine. Combo w/ CBT. Prazosin for nightmares
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
what lab abnormalities below in anorexia nervosa pt?
Fasting lipid profile?
Long term complications?
MC cause of death?
Complications of tx?
vitals=Hypotension, bradycarida, hypothermia
Chem=High HCO3, low Cl, low K, high carotene, high LFTs and amylase
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
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
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
Tx for narcolepsy?
scheduled naps and modafinil
78 y/o F presents with memory loss...aphasia, apraxia, lost while driving? Pathology? Genes? Tx?
Global brain atrophy. B amyloid plaques or tau tangles
APP (chr 21), ApoE2
Tx with donepezil, rivastigmine, galantine, Memantine
78 y/o F presents with memory loss..becomes more sexually explicit, apathetic? Pathology? Tx?
Lobar atrophy. Intra-neuronal silver staining inclusions
Tx-olanzepine for severe disinhibition
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
78 y/o F presents with memory loss...sudden stepwise decrease in memory/cognition?
78 y/o F presents with memory loss...loss of vibration sense, labile affect. pupils accommodate but don't react? Dx? Tx?
Dx=+ RPR, VDRL. Do spinal tap to look for spirochetes
78 y/o F with memory loss...myoclonus, startle response, seizures. Recently had a corneal transplant? Pathology? EEG findings?
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
best initial tx for etoh withdrawal pt?
diazepam or chlordiazepoxide b/c they have 80 and 120 hr 1/2 lives, respectively
best tx for etoh witihdrawal in a pt wiho is cirrhotic?
Lorazepam, Oxazepam, or Temazepam (LOT)
tx for wernicke encephalopathy?
thiamine 1st then glucose containing fluids
best 1st step to tx a pt with heroin OD?
intubate pt. then give IV or IM naloxone
What sxs in a pt withdrawing from heroin?
joint and muscle pain, photophobia, goosebumps, diarrhea, tachycardia, HTN, GI cramps, dilated pupils, anxiety/depression
Pt presents with horizontal nystagmus, dilated pupils, ataxia, and acute psychosis?
PCP intoxication. Can use haloperidol for acute psychosis
pt presents s/p MVC with injected conjunctiva, sedation, and asking for Doritos?
Pt presents with SI, hypersomnia, depression, and anergia (abnormal lack of energy)? Best 1st test? Tx of HTN and tachycardia?
EKG then urine tox screen. Tx seizure with lorazepam
HTN and tachy-tx with CCB; B blockers contraindicated
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
Newborn baby with decreased tone, oblique palpebral fissures, simian crease, big tongue, white spots on iris? MC med complications?
Heart-VSD, endocardial cushion defects
GI-Hirschsprungs, intestinal atresia, imperforate anus, annular pancreas
Neuro-Incr risk of Alzheimers by 30-35 (APP on Chr 21)
Cancer-Incr risk of ALL
Cafe au last spots, seizures, large head, AD?
Coarse facies, short stature, cloudy cornea. AR?
Broad, square face, short stature, self-injurious behavior. Deletion on Chr 17?
Hypotonia, hypogonadism, hyperphagia, skin picking, aggression, Deletion on paternal Chr 15?
Seizures, strabismus, sociable w/episodic laughter, deletion on maternal chr 15?
Elfin-appearance, friendly, increased empathy and verbal reasoning ability, deletion on Chr 7
ADHD-like sxs, microcephaly, smooth philtrum. MC cause of MR?
Fetal alcohol syndrome
Seizures, chorioretinits, hearing impairments, periventricular calcifications, petechiae at birth, hepatitis?
Congenital CMV infx
Seizures, hearing impairments, cloudy cornea/retinitis, heart defects, low birth weight?
congenital rubella syndrome
abnormal muscle tone, unsteady gait, seizures, MR or learning disability
cerebral palsy from birth asphyxia
IUGR, hypertonia, distinctive facies, limb malformation, self-injurious behavior, hyperactive?
Cornelia de lange
Coloboma, heart defects, choanal atresia, growth retardation, GU anomalies, ear deformity and deafness, Chr 8?
autism spectrum sxs, heart disease, palate defects, hypo plastic thymus, hypo-Ca, Chr 22 deletion?
Vomiting, seizures, lethargy, coma. Acidosis w/stress, illness. Causes neurological damage?
Maple syrup urine disease
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?
Normal development until age 2 then major loss of verbal, social skills w/autistic-like behavior
Childhood disintegrative behavior
lack of mother-child eye contact, language delay/repetitive language, preoccupation with "parts of toys" before age 3?
Problems with social skills (usually recognized in preschool) w/reserved verbal ability?
risk factors for ADHD? comorbid conditions?
Low birth weight, tobacco/etoh exposure
MOA of methylphenidate?
Blocks DA reuptake
MOA of amphetamine?
Blocks DA/NE reuptake and stimulates release
MOA of atomoxetine?
NE reuptake inhibitor. Non stimulant
MOA of clonidine, guanfacine?
a2 agonists, reduce peripheral SNS
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?
Need sxs for 6 mo
Comorbid substance abuse
May progress to anti social PD
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?
Need sxs for 12 mos
Stops just short of breaking the law or physically harming others
Timeline for dx tourettes?
tics must occur at least 1x/day for 1 yr w/o a tic-free period longer than 3 mo
comorbid conditions for Tourettes?
Look for the compulsions of OCD. Can have ADHD as well
1st line tx for Tourettes? Most effective?
Haloperidol or pimozide --> DA receptor antagonists
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
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
18 mo old baby has recently been regurgitating and re-chewing her food. She had previously been eating normally?
Check Pb levels
Next best test=Check for fecal retention
Tx=Behavior modification that only rewards