High Yield: Psy 1 Flashcards
1
Q
Describe management: Neuroleptic malignant syndrome (2)
A
- Discontinue antipsychotic
- THEN administer Dantrolene
2
Q
What’s the difference between:
- Neuroleptic malignant syndrome
- Seretonin syndrome
A
- Neuroleptic malignant syndrome: no myoclonus
- Seretonin syndrome: myoclonus
3
Q
Name antidotes: Seretonin syndrome (2)
A
Discontinue
- Benzos
- Cyproheptadine
4
Q
What type of antidepressants predisposes to tyramine crisis? (1)
A
- MAOI (ex: phenelzine, isocarboxazid)
5
Q
Tx: Tyramine crisis? (3)
A
Tx: Hypertensive Emergency drugs
- Nitroprusside
- Hydralazine
- Labetalol
6
Q
Name extrapyramidal sx of antipsychotics (4)
A
- Dystonia
- Akathisia
- Parkinsonism
- Tardive dyskonesia
7
Q
Describe: Dystonia in EPS (3)
A
- early, within hours
- usually affects sternocleidomastoid (torticolis) -> neck turned and contracts
- tx: benztropine or benadryl
8
Q
Describe: Akathisia in EPS (3)
A
- restless, keep moving, can’t sit still
- tx: benzos or beta blockers
9
Q
Describe tx: Parkinsonism in EPS (1)
A
- Benztropine (due to antipsychotic drug side effect)
10
Q
Describe: Tardive dyskenisa in EPS (3)
A
- lip smacking
- tx: discontinue
- valbendazine (new)
- switch to clozapine (least risk of causing it)
11
Q
Describe: Clozapine (2)
A
- agranulocytosis
- (low granulocytes, low basophils/eosinophils/neutrophils)
- periodic CBC
- if infx, discontinue clozapine
- decreases suicide risk the most
12
Q
Name mood stabilizer that lowers suicide risk
A
Lithium
13
Q
Describe management: Lithium toxicity (2)
A
- Hydrate
- Hemodyalisis
14
Q
Name indications: Dialysis indications
A
AEIOU
- Acidosis
- Electrolytes (K+)
- Intoxicants (MALE)
- Methanol, Aspirin, Lithium, Ethylene glycol
- Overload
- Uremia
15
Q
Describe management: TCA toxicity (1)
A
- Sodium bicarbonate (flushing out TCA)
16
Q
Describe management: Cocaine overdose (1)
A
- benzo (IV lorazapam + observe)
17
Q
Describe management: Alcohol withdrawal (1)
A
IV benzos
18
Q
Describe management: Delirium tremens (1)
A
- Benzos
19
Q
Describe the difference between alcoholic hallucinosis and delirium tremens
A
Look for timing and vitals
- Alcoholic hallucinosis: vitals stable, within 6-12h
- Delirium tremens: unstable (hypertensive, tachycardia), 2-4 days after stopping
20
Q
Describe: Phencyclidine (PCP) overdose (4)
A
- violent
- psychotic
- nystagmus
- blood test: elevated CPK
21
Q
Describe tx: Phencyclidine (PCP) overdose (1)
A
- tx: benzo
22
Q
What to think of with elevated CPK (2)
A
- PCP
- neuroleptic malignant syndrome
23
Q
Describe management: Benzo overdose (1)
A
- Flumazenil (only in non-dependent user of benzo, if not can get life-threatening withdrawal)
24
Q
Describe management: Chronic Benzo withdrawal (1)
A
- tx = benzo taper
25
Describe management: Opioid overdose (1)
Naloxone
26
Describe management: Opioid withdrawal (1)
Supportive
clonidine
27
Name 4 pathways of antipsychotics
* **Mesolimbic**: positive sx
* **Mesocortical**: negative sx
* **Nigrostriatal**: parkinson sx
* **Tuberoinfundibular**: dopamine prolactin pathway (dopamin suppresses prolactin release) -\> hyperprolactinima, gynecomastia
28
Name antipsychotic famous for hyperprolactimia
Risperidone
29
Name factors for bad prognosis for schizo (3)
* Early onset
* Male
* Slow onset
(best prognosis: female, sudden, late onset)
30
Describe 1st generation antipsychotic (4)
* High Potency = **Haloperidol**, **Fluphenazine**
* More frequent: EPS
* Low Potency = HAM Block
* **antiHistamine**: Drowsiness. Dry mouth, dry eyes. Blurred or double vision. Dizziness and headache. Low blood pressure.
* **Alpha 1 blockade**: HTO, dizziness, headache, tachycardia, nasal stuffiness
* **antiMuscarinic**: dry mouth, constipation, blurred vision, drowsiness, no/vo, abdominal discomfort, difficulty micturating, palpitations, skin reactions.
31
Name 2nd generation antipsychotic (4)
* risperidone
* olanzapine
* aripiprazole
* ziprazadone
32
Describe 2nd generation antipsychotic (2)
* ex: clozapine, risperidone, olanzapine, aripiprazole, ziprazadone
* side effects: metabolic syndrome (hyperlipidemia, hyperglycemia, obecity)
* check BMI, blood pressure, glucose, lipids
* most common: olanzapine (trick: O for obesity)
33
Name adverse effect of thioridazine (1st gen)
Retinal pigmentation
34
Name adverse effect of chlorpromazine
Corneal deposits
| (chlo \> corneal)
35
Describe: Schizoaffective disorder (2)
* Baseline schizo + (depressive or manic episodes)
* tx: 2nd gen antipsychotics or mood stabilizer (lithium)
36
What's the timeline for:
* brief psychotic disorder
* schizophreniform
* schizophrenia
* brief psychotic disorder:
* schizophreniform: 1-6 months
* schizophrenia: \> 6 months
37
Describe sx: Bipolar Disorder (7)
3+ DIGFAST
* Distracted
* Insomnia
* Grandiosity
* Flight of ideas
* Activity
* Pressured Speech
* Thoughtlessness
38
What's the difference mania and hypomania (3)
* Mania Type 1
* Requires hospitalisation
* At least 3 sx of DIGFAST for **ONE WEEK + social dysfunction**
* Hypomania Type 2
* At least 3 sx of DIGFAST for **FOUR DAYS + no social dysfunction**
39
Name effects: Tricyclic antidepressants (4)
* HAM block
* Tri Cs:
* Cardiac: Long QT, arythmia
* Convulsions
* Coma
40
Describe: Serotonin syndrome (2)
* Look for someone that was started with SSRI, discontinued and started another too quickly in another class
* When you stop SSRI, it takes a few week before washing out all serotonin
41
How long does antidepressant takes to start working
4-6 wks
42
Describe: Electroconvulsive Therapy (ECT) (3)
* For emergencies, need rapid chances
* Classic scenarios:
* refusal eat or drink
* high suicide risk
* Side effect: Amnesia for 6 months that will resolve
43
Describe tx of catatonia 2e to antipsychotics
Lorazepam
44
Describe the difference between grieving and depression (2)
* Grieving: good and bad days
* normal to have guilt, wished they died instead, see the dead person
* Depression: more bad days
* feelings worthlessness
45
46
Describe 2ed effects of lithium (5)
LMNOP
* **l**ithium
* **m**ovement problems
* **ne**phrogenic diabetes insipidus
* hyp**O**t4
* **p**regnant defects (Ebstein's anomaly: your tricuspid valve is in the wrong position and the valve's flaps (leaflets) are malformed)
47
How long for persistent depressive disorder?
2 years
48
Describe: Cyclothymic disorder (3)
* not quite bipolar
* mild, not exactly hypomania or depression
* 2 years
49
Describe: Premenstrual dysphoric disorder (2)
* keep menstrual diary
* first-line tx: SSRI
50
Describe tx: Acute panic attack
* Acute: Benzo
* Panic disorder: SSRI (4-6 wks to work)
51
What's the difference between acute panic attack and pheochromocytoma?
pheo: high TA
52
What's the tx: Public speaking phobia (2)
* BBloquer (not benzo, bc sedating)
* Only give benzo if asthma + public speaking phobia
53
What's the difference: Social anxiety disorder vs avoidant personality disorder (2)
* Social anxiety disorder: fear of embaresement public
* Avoidant personality disorder: fear of rejection, but want to make friends but don't know what
tx: CBT
54
What's 1st line tx: OCD
* Exposure response control
55
What's the therapy of borderline personality disorder?
Dialectical Behavioral Therapy
56
What's tx of adjustment disorder (1)
supportive
57
