Imp step 3 anki Flashcards
1
Q
while administering Nalaxone, what determines improvement in the patient?
A
Ventilation RR>12/min
2
Q
what class of drugs are methamphetamines?
A
Sympathomemitic amines
3
Q
what 3 neurotransmitters does MDMA act on?
A
Noreepinephrine, serotonin and dopamine
4
Q
SGAs act on which additional receptor as compared to FGA, thus reducing EPS symptoms?
A
antagonsits at the 5HT-2A receptors
5
Q
Cardiac complication of coccaine intoxication?
A
thrombus formation
6
Q
2 complications ingestion of coccain can cause?
A
angioedema and pharyngeal burns
7
Q
eye coplications of coccaine
A
acute angle closure glaucoma
8
Q
prgnancy complication of coccaine?
A
abruptio placenta
9
Q
GI complication of cocaine?
A
perforated gastric ulcers
10
Q
Cocaine blocks ar 2 sites?(mechanism of action)
A
Monoamine reuptake and Na channels are blocked
11
Q
ECG changes with cocaine?
A
QRS prolongation, due to Na channel blockage
Rx:IV sodium bicarbonate
12
Q
while intubating or giving a cocain intoxicated patient a musle relaxant- which drug shod NOT be used, which drug should?
A
Do NOT: succinyl choline- prolonged effect
use: Rocuronium which is a non- depolarizing neuromuscular blocker
13
Q
Managment of cocaine intoxication?
A
1- benzo
2- phentolamine, nitroglycerine, nitroprusside (for CVS complications)
3- correct hypotension with IV isotonic saline, vasopressors
14
Q
which 2 drugs are avoided in cocaine intoxicated patient?
A
beta blockers and succinylcholine
15
Q
HIV associated dementia patients have 3 specific clinical features?
A
- slow movements
- difficulty with smooth limb movements
- memory decline
16
Q
which psychiatric illness do most Wilson disease patients exhibit?
A
depression
17
Q
which 2 benzodiazepines are used to treat alcohol withdrawal?
A
lorazepam (intermediate acting-safe in liver damage pts) and Chlordiazepoxide (long acting benzo- not safe in liver damage patients)
18
Q
2 drugs that can increase or decrease Lithium levels?
A
loop diuretics and CCB
19
Q
4 drugs that increase Lithium levels?
A
- ABX: tetracycline, metronidazole
- Thiazide
- ACE-I and ARBs
- NSAIDs except aspirin
20
Q
2 drugs that reduce Lithium levels?
A
- Theophylline
2. Spirinalactone- loop sparing potassium diuretics
21
Q
Lorazepam challenge test in the diagnosis of catatonia?
A
1-2 mg IV benzodiazapine , shows symptom improvement in 5-10 minutes
22
Q
Panic disorder needs symptoms for how long to be diagnosed?
A
> 1 month
23
Q
hallucinations that require hospital admission?
A
command auditory hallucinations
24
Q
A patient given FGA or SGA is at risk of developing neuroleptic malignant syndrome for how long?
A
2 weeks after starting the drug
25
organophosphate poisoning- mechanism?
inhibit acetylcholinesterase--> reduced Ach breakdown--> Ach buildup--> "Leaky symptoms" with bradycardia, pin point pupils
26
3 OP Poisoning symptoms related to nicotine receptors?
1. Paralysis
2. muscle weakness
3. fasciculations
27
3 CNS complications related to OP poisoning?
seizure (treat with benzos), coma and confusion
28
4 steps management of acute OP poisoning?
1. 100% o2 and endotracheal intubation
2. decontaminate clothes and environment
3. Atropine
4. Pralidoxime (treats both nicotinic and muscarinic symptoms )
29
what does Pralidoxime do?
reactivates acetylcholinesterase
30
what is Organophosphate induced delayed polyneuropathy?
1-5 weeks after OP poisoning, patient may develop painful glove and stocking pins and needles pain
31
what type of CBT is used as first line for specific phobia?
exposure therapy
32
Which dopaminergic pathway accounts for movement disorders such as chorea and tics, EPS symptoms?
Nigrostriatal
33
chronic methaphitamine users develop psychosis. what is the managment?
1- CBT to prevent relapse into using again
| 2- anti psychotics
34
Brain changes seen in panic disorder?
decreased amygdala volume
35
brain changes seen in PTSD?
decreased hipocampal volume
36
conduct disorder symptoms need to be there for how long to make a diagnosis?
1 years, with a symptom at least in the last month
37
medication of ADHD?
methyphenidate(not given for <6), amphetamines
| clonidine, guanfacine(alpha adrenergic antagonists), atomoxetine
38
Medication in tourettes syndrome?
Anti psychotics: Haoperidol, risperidone, PIMOZIDE(QT prologation)
39
how long odes it take for OCD to develop post Touretts syndrome?
3-6 years
40
What kind of (2) kidney injury does chronic lithium therapy cause?
1. Tubulo interstitial Nephritis
| 2. Nephrogenic diabetes insipidus
41
5 tests to do before stating then patient on Lithium?
BUN, creat, TFT, urine analysis, ECG
42
mechanism of Tardative dyskinesia?
Anti psychotics given chronically--> chronic blockage of dopamine receptors--> causes D2 receptor upregulation and supersensitivity.
43
medical managment of PCP?
1. benzodiazepine
| 2. Anti-psychotics- haloperidol
44
why does MDMA cause hyponatremia?
1. excessive water consumption
| 2. MDMA - induced ADH secretion
45
best medication for acute mania managment?
risperidone (quick onset of action)
| FGA or SGA can be used
46
4 side effects immediate to starting an SSRI?
Headache, nausea, anxiety and insomnia
47
Management for conversion disorder?
1. education and self help techniques
| 2. CBT
48
Age group at high risk for opioid use?
less than age 45 years
49
disgnostic criteria for lewy body dementia?
Dementia + 2/4
1. visual hallucinations
2. fluctuating cognition
3. parkinsons symptoms
4. REM sleep behaviour disorder
50
Management of Parkinson dementia disorder?
1- Donepezil
| 2- anti psychotics: Pimavanserin, quetiapine
51
Mechanism of Acamprosate?
Glutamate modulator
52
first sign of aspirin intoxication/overdose?
Hyperventilation leading to respiratory alkalosis
53
5 A.E of aspirin?
1. Tinnitus (even at low doses)
2. Acid base balance changes- initially respiratory alkalosis(because of hyperventilation) later metabolic acidosis(lactic acid build up)
3. N/V
4. Altered mental status
5. Chronic use-Pulmonary edema
54
Medications of narcolepsy?
1- Modafinil
| 2-Amphetamines and methyphenidate
55
Medications for cataplexy?
antidepressants and sodium oxybate
56
Which symptom of TCA overdose is associated with poor prognosis?
QRS >100ms
57
least prolactin producing SGAs?
Aripiprazole, quetiapine
58
2 drugs that cause multi directional nystagmus?
PCP and Ketamine
59
3 tests for salicylate (ASA) intoxication
1. serum salicylate level
2. lactate levels
3. metabolic panel
60
Management of ASA overdose?
1. ABC
2. GI decontamination - Activated charcoal
3. Sodium bicarbonate to alkalinze urine and serum, if it fails- hemodialysis
61
what drug is used to treat aggression symptoms in ASD?
Risperidone
62
6 CNS injury/ conditions to rule out for a patient demonstrating psychosis
1. head Trauma
2. tumours
3. Infection
4. stroke
5. epilepsy
6. cerebral hypoxia
63
6 Metabolic conditions to rule out for a patient demonstrating psychosis?
1. urea cycle disorders
2. acute intermittent porphyria
3. Wilsons disease
4. renal/liver failure- hepatic encephalopathy or urea build up
5. hypoglycemia
6. electrolyte disturbance
64
2 systemic disorders to rule out for a patient demonstrating psychosis?
1. SLE
| 2. Thyroiditis
65
5 stimulant illicit drugs to rule out for a patient demonstrating psychosis?
1. Cocaine, amphetamine
2. LSD, PCP, ketamine
3. weed
4. bath salts
5. Alcohol withdrawal
66
2 drugs that were suddenly discontinued- to rule out for a patient demonstrating psychosis?
1. Benzo
| 2. Baclofen
67
6 drugs if chronically used can cause psychosis?
1. steroids
2. isoniazid
3. anti-convulsants
4. anti- cholinergic: diphenhydramine
5. antibiotics: amox, clarithro, erythro
6. SSRIs- serotonin syndrome
68
5 medications that can induce hyper prolactinemia(25-100nm/ml)
1. risperidone
2. paliperidone
3. methyldopa
4. reserpine
5. verapamil
69
3 drug groups that can cause neuroleptic malignant syndrome?
1. Anti- psychotics: FGA, SGA
2. Anti- emetics: metaclopromide, promethazine
3. discontinuing parkinson medication
all these drug groups focus on messing with the dopamine levels
70
Theophylline mechanism of action?
blocks adenosine
71
5 tests to order for theophylline overdose?
1. ECG (r/o arrythmias)
2. Glucose (hyperglycemia)
3. electrolytes- K+ (hypokalemia)
4. Serum Ca
5. Serum theophylline
72
Adverse effects of theophylline overdose?
1. CNS: seizures
2. CVS: supraventricular arrythmias (children), ventricular arrythmias (adults)
3. GI: vomiting, abd pain
4. MSK: coarse tremors, rhabdomyolysis
5. electrolytes: hypokalemia, hyperglycemia
73
Management of theophylline overdose?
1. ABC and gastric decontamination (activated charcoal),hemolysis
2. symptomatic: K+, ondansetron,isotonic saline or propanolol for hypotension, lorazepam (for seizures)
74
Myoclonic jerks are seen in what drug intoxication?
Anti-cholinergic
75
2 drugs that worsen Manic episodes?
SSRIs and bupropion
76
3 late stage pregnancy complications due to Lithium?
1. Polyhydramnios
2. Diabetes insipidus
3. Floppy infant syndrome
77
Which over the counter cold and cough preparations can cause dissociation and hallucinations?
Dextromethorphan (NMDA antagonist, a cough suppressant)
78
age group that should be given SSRI black box warning?
18-24
79
Mechanism of action of Trazodone and nefazodone
Block 5HT receptors and alpha 1 receptors, reduce 5HT re uptake
80
what labs will be elevated in chronic inhalent abusers
LFTs
81
for Olanzapine, the sedation s due to --- receptor action, and the weight gain is due to -- receptor action?
sedation: Histamine
| Weight gain: histamine and 5HT2c
82
when starting a patient on SGA that cause weight gain, how frequently does the BMI need to be monitored
Monthly--> every 3 months--> annual
83
which SGA does not cause tardative dyskinesia?
Clozapine
84
how often does the WBC counts of a patient on clozapine need to be monitored
every week for the first 6 months
85
ECG changes of ziprasidone?
QT prolongation at high doses
86
GAD second line medication after SSRIs?
2- Benzos, buspirone
87
when can buspirone be given in a GAD patient?
when the patient has no panic, no depression
88
how soon does paradoxical agitation begin after administering benzos?
1 hour
89
treatment of OCD?
1- CBT/ high dose SSRIs
2- clomipramine
3-Deep brain stimulation
90
conditions to be cautious before doing an ECT?
1- recent MI
2- tumor
3-recent stroke
4-unstable aneurysm
91
Valproate A.E?
liver disease, thrombocytopenia
92
Lithium is contraindicated in 3 types of patients?
1-CKD
2- heart disease
3- hyponatremia/ diuretic use
93
how long does a patient need to fulfill bulimia criteria to receive a diagnosis?
3 months
94
which 2 drugs of abuse can result in Myoclonus?
bath salts and MDMA(via serotonin syndrome)
95
refractory alcohol withdrawal, after failure of benzos- next Rx?
phenobarbitol
96
management of neonatal abstinence syndrome?
methadone- to addict mom
| morphine- to neonate to help with withdrawal symptoms
97
What is the mechanism of action of naltrexone?
Mu opioid blocker
98
What is the mechanism of action of Disulfuram?
inhibits aldehyde dehydrogenase
99
Mechanism of prazosin?
alpha-adrenergic receptor blocker
100
3 main features of Shy-Drager syndrome/multiple system atrophy?
Parkinsonism experiences orthostatic hypotension, impotence, incontinence, or other autonomic symptoms
101
managment of Shy- Drager syndrome?
intravascular fluid expansion
102
Mild anti-cholinergic toxicity Mx?
| Severe anti- cholinergic toxicity Mx?
mild- benzo
| sever- physostigmine (contraindicated in TCA receiving patients)
103
what medication causes cataracts and thus requires frequent slit lamp exams?
Quetiapine
