Lange Q&A Somatic Treatment and Psychopharmacology Flashcards Preview

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Flashcards in Lange Q&A Somatic Treatment and Psychopharmacology Deck (65)
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1

Symptoms of phenelzine and tranylcypromine overdose?

These are the only two MAO-I approved for use in the U.S. Overdose can result in 12-24 hour asymptomatic period followed by hyperpyrexia, autonomic instability and ultimately rhabdomyolysis.

2

Treatment of MAO-I overdose?

Lorazepam

3

How long should you wait before starting a patient on an antidepressant if they just came off of a MAO-I?

SSRIs, TCAs, buspirone and SNRIs can cause serotonin syndrome if started within 14 days of discontinuing a MAO-I.

4

Atypical features of depression? How should you treat?

Weight gain, hypersomnia and mood reactivity. Treat with SSRIs even though MAO-Is are more effective in atypical depression.

5

Effect of eating tyramine-rich foods in a patient taking MAO-I?

Fatal hypertensive crisis

6

Drugs for alcohol withdrawal in a patient with normal liver function? What if his liver function is decreased?

Normal = chlordiazepoxide or diazepam because they have long half lives. Decreased = "LOT" lorazepam, oxazepam or temazepam.

7

Most common side effect in women taking SSRIs?

Anorgasmia

8

Management of akathisia in a patient recently started on an antipsychotic?

1) Lower the dose 2) Add benztropine for EPS 3) Add propranolol for symptomatic treatment

9

Management of acute dystonia in a patient recently started on an antipsychotic?

Diphenhydramine

10

Most common serious complication of NMS?

Rhabdomyolysis occurs in 25% of cases of NMS

11

Drug with side effect of retinal pigmentation at doses greater than 1000mg per day?

Thioridazine, this may result in blindness and does not typically reverse after stopping the medication.

12

Most to least potent benzodiazepines

1) clonazepam 2) triazolam 3) alprazolam 4) diazepam 5) clorazepate 6) chlordiazepoxide 6) flurazepam

13

Labs to order before starting lithium

BMP and UA to check kidney function. TSH to assess for pre-existing hypothyroidism and WBC to check baseline level.

14

Drugs that can make a patient on lithium supratherapeutic?

NSAIDs (except ASA and sulindac), thiazides, spironolactone, triampterene, metronidazole, tetracycline and ACE-I.

15

Most common side effects of methylphenidate?

Decreased appetitie and difficulty falling asleep

16

Treatment of Tourette's with comorbid ADHD?

Still with a D2-antagonist like pimozide or haloperidol. Clonidine is less effective, but can be used because it lacks EPS. Don't treat with a stimulant because these worsen the tics.

17

Only medication that my improve tardive dyskinesia?

Clozapine

18

Treatment of borderline personality disorder

SSRI for impulsivity and affective instability. Aripiprazole for impulsivity and psychotic thinking.

19

Treatment for bulemia nervosa?

Fluoxetine

20

Treatment of anorexia nervosa?

No great treatment exists. Avoid pro-arrhythmic drugs.

21

SSRI discontinuation syndrome

Begins 1-3 days after stopping, especially with paroxetine due to its short half life. Symptoms are flu-like with anxiety, irritability and crying spells.

22

SSRI to use if patient is on carbamazepine?

Paroxetine has not been reported to raise levels, so it is preferred.

23

How does trazodone work?

Weak SSRI and alpha-1, 5-HT1a, 5-HT1c and 5-HT2 receptor antagonist. It isn't really used for depression, just sleep. Look out for orthostasis in the elderly!

24

Activating SSRI?

Fluoxetine

25

A patient overdosed on a medication that resulted in ECG changes of T-wave flattening, SA node dysfunction and first-degree AV block. What drug was it?

Lithium

26

1st line drug for OCD?

Clomipramine (TCA)

27

Mirtazapine mechanism. How does this contribute to its side effect profile?

Central alpha-2 antagonist and H1, 5-HT2/5-HT3 antagonist. Blocking 5-HT2 and 5-HT3 leads to increased 5-HT1 stimulation, leading to increased appetite and weight gain. H1 antagonism causes sedation, but this may be counteracted by alpha-2 blockade and increased NE.

28

Typical neuroleptics

Haloperidol, chlorpromazine, fluphenazine, perphenazine, thioridazine and perphenazine.

29

Clozapine mechanism

D1, D2, D4, H1, muscarinic, alpha-1 adrenergic, 5-HT2, 5-HT2c and 5-HT3. Effectiveness compared to other antipsychotics is thought to be due to D4 and 5-HT2 action.

30

Why prefer nortriptyline over other TCAs in the elderly?

It has less alpha-1 blocking activity than other TCAs and less orthostatic hypotension.