Master Review Section Flashcards
1
Q
ADR of thioridazine
A
- abnormal retinal pigmentation after years of use
2
Q
What are some common noncompliance issues for antipsychotics in males?
A
- impotence and inhibition of ejaculation due to alpha blocker effect
3
Q
What is a common noncompliance issue for antipsychotics in females?
A
- weight gain due to hyperprolactinemia
4
Q
What is the first choice medication for treating schizophrenia when sedation is a problem?
A
- risperidone (minimal sedation effects)
5
Q
Risperidone affects which receptors?
A
- 5HT
- D1
- D2
- alpha 1
- alpha 2
- H1
6
Q
Tx for tardive dyskinesia
A
- valbenazine
7
Q
MOA of valbenazine
A
- reversible reduction of dopamine release by selectively inhibiting presynaptic human vesicula rmonoamine transporter type 2
- VMAT2
- ultimately reduces the levels of dopamine available
8
Q
What are some EPS that can occur in the first week of using an antipsychotic?
A
- muscle spasms
- difficulty swallowing
9
Q
What are some EPS that can occur with using antipsychotics within weeks?
A
- bradykinesia
- rigidity
- tremors
10
Q
Weeks to chronic use of antipsychotics can lead to what specific EPS?
A
- akathisia aka motor restlessness
11
Q
Why are anticholinergics first line for EPS?
A
- blocking D2 receptors increases cholinergic activity in the nigrostriatal.
12
Q
What is the main difference between BZDs and barbiturates?
A
- BZDs work by increasing the frequency of chloride ions via GABA
- Barbiturates potentiate GABA by increasing the duration of chloride ions
13
Q
Why is buspirone more favorably used people who have to operate heavy machinery for a living?
A
- there is no additive effect when used with other sedative-hypnotics
14
Q
Tx for hoarding disorder
A
- CBT with clomipramine or SSRIs
15
Q
In pregnant women who have severe depression, if ECT fails, what is the next line of treatment?
A
- esketamine
16
Q
Tx for seasonal affective disorder
A
- phototherapy or sleep deprivation
17
Q
Rapid cycling bipolar is indicated by?
A
> 4 episodes of mania per year
18
Q
How long do the symptoms of mania need to be present in order to diagnose bipolar disorder?
A
- 1 week
19
Q
What is the most common ADRs of lurasidone?
A
- weight gain
- sedation
20
Q
In severely manic patients who are noncompliant, what would be the treatment?
A
- IM depot phenothiazine
21
Q
What is the most common cause of progression to rapid cycling bipolar?
A
- use of antidepressants
22
Q
How should you manage rapid cycling bipolar?
A
- gradually stop all antidepressants, stimulants, caffeine, benzos, and alcohol
23
Q
What other medical conditions predispose a patient to rapid cycling bipolar?
A
- hypothyroidism
24
Q
What drug has been shown to prevent suicidal ideation in bipolar disorder?
A
- lithium
25
A known patient on lithium is now pregnant. How will you manage her?
- discontinue the lithium; choose ECT therapy for the first trimester patients with manic episodes
- use lamotrigine in 2nd or 3rd trimester
26
What is the preferred tx in cyclothymic disorder?
- divalproex
27
Patient with hallucinations who has recently had a baby and is depressed. What should be treated for first?
- always treat the more dangerous symptoms first. This patient has hallucinations, which can be treated with antipsychotics.
28
What is the biggest complication of ECT?
- transient memory loss, which worsens with prolonged therapy and resolves after several weeks
29
Why wouldn't you want to preform ECT on a patient with a brain tumor or space occupying intracranial lesion?
- ECT induces transient intracranial pressure
30
Which SSRI is not safe in pregnancy?
- paroxetine
31
Patient has attempted suicide by overdosing on TCAs. What is the next step?
- give sodium bicarbonate; it alkalines the blood to remove TCAs from the myocardial sodium channels
32
Second line therapy for rapid cycling bipolar disorder when lithium fails?
- divalproex
33
What is third line if lithium and divalproex fail for rapid cycling bipolar?
- carbamazepine
34
What is important to note about carbamazepine?
- It's a CYP450 induces, so it increases the clearance of warfarin, phenytoin, theophylline, and valproic acid
35
Tx for illness anxiety disorder
- CBT
36
Besides giving olanzapine to help an anorexic patient gain weight, what should also be prescribed?
- fluoxetine because it helps prevent relapses
37
Define disruptive mood dysregulation disorder
- children with a pervasively angry or irritable mood involving frequent aggressive outbursts that are out of proportion to the stressor
38
In terns of mood presentation, what is the main difference between intermittent explosive disorder and disruptive mood dysregulation disorder?
- A patient with intermittent explosive disorder will return to normal mood after the explosive episode
- A patient with disruptive mood dysregulation disorder will not return to normal mood after the outburst.
39
Tx for gambling disorder
- group psychotherapy
40
Brain bleeds in a small infant due to abuse is called?
- shaken baby syndrome
41
Vitamin C helps to promote excretion of what type of drug intoxication?
- cocaine/amphetamines
42
MOA of cocaine
- blocks the reuptake of NE, serotonin, and dopamine
43
MOA of amphetamines
- induces the release of dopamine
44
If a patient has track marks on their arms, what should you order to look for?
- HIV serology
- hep B antigen
- hep C antigen
- PPD
45
Most effective tx for alcoholics?
- group psychotherapy aka AA
46
Disulfiram inhibits acetaldehyde dehydrogenase. As a result acetaldehyde builds up and causes?
- vomiting
- headache
- tachycardia
- sweating
47
Inpatient management of those withdrawing from alcohol should have what given to them?
- thiamine
- magnesium
- B12
- folate
- BZD
48
K2 is what type of drug?
- synthetic cannabinoid
49
Symptoms of caffeine withdrawal?
- headache
- depression
- anxiety
- fatigue
- difficulty concentrating
50
Tx for the various paraphilic disorders?
- mild--> psychotherapy and aversive conditioning
| - severe--> antiandrogens or SSRIs
51
recurrent urges to observe an unsuspecting person who is engaging in sexual activity or disrobing
- voyeurism
52
recurrent urges or arousal toward prepubescent children
- pedophilia
53
recurrent urge to expose oneself to strangers
- exhibitionism
54
involves the use of nonliving objects usually associated with the human body
- fetishism
55
recurrent urge or behavior involving touching or rubbing against a nonconsenting partner
- frotteurism
56
recurrent urge or behavior involving the act of humiliation
- masochism
57
recurrent urge or behavior involving acts in which physical or psychological suffering of a victim is exciting to the patient
- sadism
58
Which two antipsychotics can lead to QT prolongation and therefore are at higher rate of mortality in an overdose?
- quetiapine (seroquel)
| - ziprasidone (geodon)
59
Cogentin aka benztropine MOA
- AcH antagonist
60
What is the therapeutic range for lithium?
0.6 to 1.2 mmol/L
61
Which antidepressant is safe while being on heparin or warfarin?
- mirtazapine
62
Before prescribing olanzapine, what things should be checked?
- glucose
- TGs and cholesterol
*olanzapine aka zyprexa causes weight gain (metabolic syndrome)
63
Vistaril is the brand name for?
- hydroxyzine
64
Vyvanse is the brand name for?
- Lisdexamfetamine
65
Nuplazid is the brand name for ?
- pimavanserin
66
Lithium and depakote need to be checked for how long when a patient first starts them?
- 4-5 days
