Medications

Question 1

What SSRI has been shown to be the best choice for pediatric patients?

Answer 1

fluoxetine

UWorld

Question 2

NMS is more commonly associated with ___ antipsychotics.

Answer 2

first-generation

Question 3

When is electroconvulsive therapy preferred?

Answer 3

elderly patients unable to eat/drink, psychotic or actively suicidal

Question 4

What is the treatment for NMS?

Answer 4

bromocriptine or dantrolene

supportive care - hydration andcooling

Question 5

What is the MOA of bromocriptine or amantadine?

Answer 5

dopaminergic agonists

Question 6

What is the MOA of dantrolene?

Answer 6

direct-acting muscle relaxant

Ryanodine-Receptor agonist

Question 7

What is the best medication for treatment resistant schizophrenia?

Answer 7

clozapine

ONLY medication that has evidence that it is superior to others

Question 8

Which benzodiazepine is safe to use in alcohol withdrawal?

Answer 8

lorazepam

no liver metabolism

Question 9

Which benzos are long-acting? Are they metabolized by the liver or not?

Answer 9

chlordiazepoxide and diazepam

YES - not safe in pts with possible liver disease

Question 10

What is benztropine used for?

Answer 10

acute dystonic reaction to antipsychotic EPS
AND
parkinsonism effects of antipsychotic meds

Question 11

How do you treat parkinsonism effects of antipsychotic medications?

Answer 11

benztropine OR amantadine

Question 12

What is the MOA of benztropine?

Answer 12

muscarinic agonist

Mercedes-Benz car in Sketchy

Question 13

How do you treat tardive dyskinesia?

Answer 13

valbenazine

Question 14

What is the MOA of valbenazine?

Answer 14

monamine transporter 2 inhibitor

Question 15

A patient on antipsychotic medication is experiencing restlessness and inability to stay still. Treatment?

Answer 15

(Akathisia)
beta blocker
benzo
benztropine

Question 16

Which second generation antipsychotic is most likely to cause EPS?

Answer 16

risperidone

Question 17

Which SGA has the highest association with weight gain and metabolic side effects?

Answer 17

olanzapine

vs ziprasidone has low risk profile

Question 18

What type of therapy is found to be high-yield intervention for schizophrenia?

Answer 18

family therapy and psychoeducation

Question 19

What is the goal of psychodynamic psychotherapy?

Answer 19

unconver unconscious patterns originating in childhood experiences

Question 20

Sx: low GFR, nausea, vomiting, diarrhea, confusion agitation, ataxia, tremors/fasciculations

Dx: intoxication of ____

Answer 20

lithium

Question 21

Treatment for lithium intoxication?

Answer 21

hemodialysis in severe cases

Question 22

What other medications may increase risk of lithium toxicity?

Answer 22

NSAIDs, thiazide diuretics, ACE-I, tetracyclines, metronidazole

Question 23

What medication must be prescribed with caution in patients with dementia with lewy bodies?

Answer 23

antipsychotic meds

can cause extreme antipsychotic hypersensitivity

Question 24

What are major adverse effects of lithium therapy?

Answer 24

tremor, ataxia, polyuria/polydipsia, vomiting, diarrhea

(chronic) - nephrogenic DI, CKD, thyroid dysfunction, hyperparathyroid

Question 25

Sx: mental status change, seizures, tachycardia, hypotension, cardiac conduction delay, anticholinergic effects Dx: toxicity of ____

Answer 25

tricyclic antidepressants

Question 26

What is the treatment for catatonia?

Answer 26

benzos - lorazepam OR ECT

Question 27

What are side effects of bupropion?

Answer 27

weight LOSS insomnia dizziness tremor

Question 28

What is first line treatment for acute bipolar depression?

Answer 28

SGA = quetiapine or lurasidone OR lamotrigine

Question 29

For a single-episode, unipolar major depression, what is the time frame for continuation-phase treatment?

Answer 29

additional 6 months after achieving level for remission

Question 30

What is the definition of "maintenance-phase treatment"?

Answer 30

continuing antidepressant meds past the initial continuation-phase treatment

Question 31

When is maintenance for 1-3 years of antidepressive therapy appropriate?

Answer 31

chronic episodes >2 years, recurrent MDD, strong family hx, suicide attempt

Question 32

Fluoxetine has a (long/short) half-life with long-term use?

Answer 32

LONG 4-6 days

Question 33

Paroxetine has a (long/short) half-life?

Answer 33

SHORT

Question 34

What is the best treatment for antipsychotic induced acute dystonia?

Answer 34

diphenhydramine OR benztropine

Question 35

Performance-only social anxiety disorder should be treated with ___.

Answer 35

beta blockers or benzos

Question 36

What Parkinson medications are associated with greater risk of psychosis?

Answer 36

dopamine agonists - pramipexole or ropinirole

Question 37

What is the best treatment of Parkinson Disorder psychosis?

Answer 37

1 - reduction of antiparkinson meds 2 - med substitution 3 - addition of low-potency antipsychotic meds

Question 38

Alpha-adrenergic agonists (clonidine, guanfacine) are more useful in treating ADHD in (KIDS/ADULTS)

Answer 38

KIDS and adolescents

Question 39

Dicontinuation of ___ medications may lead to dysphoria, fatigue, insomnia, myalgias

Answer 39

antidepressants (SSRIs)

Question 40

What are evidence-based therapy options for bipolar I maintenance therapy?

Answer 40

lithium, valproate, quetiapine, lamotrigine

Question 41

What is first line combination therapy for Bipolar I?

Answer 41

lithium OR valproate PLUS SGA

Question 42

How do you treat tardive dyskinesia?

Answer 42

- Discontinue med if possible - Switch to SGA like quetiapine, clozapine - treat with valbenazine

Question 43

Which mood stabilizer can be associated with hepatotoxicity?

Answer 43

Valproate

Question 44

____ antidepressant therapy is associated with dose-dependent HTN, especially at doses above 300 mg daily

Answer 44

venlafaxine

Question 45

What is the difference in MOA between risperidone and quetiapine?

Answer 45

risperidone = Dopamine-2 receptor antagonist Quetiapine = low-potency D2R antagonist (less dopamine side effects)

Question 46

What medications can increase lithium levels in the blood?

Answer 46

``` thiazide diuretics ACE-i NSAIDs TCAs metronidazole ```

Question 47

Which SSRI is generally avoided in post-MI patients because of risk for QT prolongation?

Answer 47

Citalopram

Question 48

What are the preferred SSRIs for patients post-MI?

Answer 48

sertraline and escitalopram | -least drug interactions with cardiac meds

Question 49

What are cardiac side effects of venlafaxine?

Answer 49

tachycardia | increased BP

Question 50

What are the two first-line mood stabilizers for biploar disorder? And when would you choose one over the other?

Answer 50

lithium and valproate if baseline creatinine elevation --> valproat>Lithium

Question 51

What is a renal side effect of lithium use?

Answer 51

nephrogenic DI | Chronic tubulointerstitial nephropathy

Question 52

What are first line medications for bipolar disorder?

Answer 52

lithium, valproate, quetiapine, lamotrigine

Question 53

Treatment for acute dystonia?

Answer 53

benztropine or diphenhydramine

Question 54

Treatment for akathisia

Answer 54

beta-blocker benzodiazepine benztropine

Question 55

Treatment for parkinsonism

Answer 55

benztropine or amantadine

Question 56

Phenytoin --> megaloblastic anemia from ____ deficiency

Answer 56

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