Psych

Question 1

Tx for ADHD?

Answer 1

Stimulants (e.g., methylphenidate) +/– CBT; atomoxetine may be an alternative to stimulants in selected patients.

Question 2

Tx for conduct disorder (18yrs)?

Answer 2

CBT

Question 3

Tx for Tourette Syndrome? For intractable tics?

Answer 3

Psychoeducation, behavioral therapy

Low-dose high-potency antipsychotics (e.g., fluphenazine, pimozide), tetrabenazine, and clonidine may be used.

Question 4

Neurotransmitter changes in Alzheimer disease?

Answer 4

decrease ACh

increase glutamate

Question 5

Neurotransmitter changes in Anxiety?

Answer 5

increase NorEpi

decrease GABA and 5-HT

Question 6

Neurotransmitter changes in Depression?

Answer 6

decrease NorEpi, 5-HT, and dopamine

Question 7

Neurotransmitter changes in Huntington Disease?

Answer 7

decrease GABA and ACh

increase dopamine

Question 8

Neurotransmitter changes in Parkinson Disease?

Answer 8

decrease dopamine

increase ACh

Question 9

Neurotransmitter changes in Schizophrenia?

Answer 9

increase dopamine

Question 10

Tx of bipolar 2?

Answer 10

Mood stabilizers (e.g., lithium, valproic acid, carbamazepine), atypical antipsychotics.

Question 11

Tx for narcolepsy?

Answer 11

Treatment: daytime stimulants (e.g., amphetamines, modafinil) and nighttime sodium oxybate (GHB)

Question 12

Alcohol intoxication sx?

Answer 12

Emotional lability, slurred speech, ataxia, coma, blackouts. Serum γ-glutamyltransferase (GGT)—sensitive indicator of alcohol use. AST value is twice ALT value.

Question 13

Alcohol withdrawal sx?

Answer 13

Mild alcohol withdrawal: symptoms similar to other depressants (anxiety, tremor, seizures). Severe alcohol withdrawal can cause autonomic hyperactivity and DTs (5–15% mortality rate). Treatment for DTs: benzodiazepines.

Question 14

Opioid (morphine, heroin, methadone) intoxication sx?

Answer 14

Euphoria, respiratory and CNS depression, dec. gag reflex, pupillary constriction (pinpoint pupils), seizures (overdose).

Treatment: naloxone, naltrexone.

Question 15

Opioid (morphine, heroin, methadone) withdrawal sx?

Answer 15

Sweating, dilated pupils, piloerection (“cold turkey”), fever, rhinorrhea, yawning, nausea, stomach cramps, diarrhea (“flu-like” symptoms).

Treatment: long-term support, methadone, buprenorphine.

Question 16

Barbiturates intoxication sx?

Answer 16

Low safety margin, marked respiratory depression.

Treatment: symptom management (e.g., assist respiration,inc. BP).

Question 17

Barbiturates withdrawal sx?

Answer 17

Delirium, life-threatening cardiovascular collapse.

Question 18

Benzodiazepines intoxication sx?

Answer 18

Greater safety margin. Ataxia, minor respiratory depression.

Treatment: flumazenil (benzodiazepine receptor antagonist, but rarely used as it can precipitate seizures).

Question 19

Benzodiazepines withdrawal sx?

Answer 19

Sleep disturbance, depression, rebound anxiety, seizure.

Question 20

Amphetamines intoxication sx?

Answer 20

Euphoria, grandiosity, pupillary dilation, prolonged wakefulness and attention, hypertension, tachycardia, anorexia, paranoia, fever.
Severe: cardiac arrest, seizure.

Question 21

Amphetamines withdrawal sx?

Answer 21

Anhedonia, inc. appetite, hypersomnolence, existential crisis.

Question 22

Cocaine intoxication sx?

Answer 22

Impaired judgment, pupillary dilation, hallucinations (including tactile), paranoid ideations, angina, sudden cardiac death.

Treatment: α-blockers, benzodiazepines. β-blockers not recommended.

Question 23

Cocaine withdrawal sx?

Answer 23

Hypersomnolence, malaise, severe psychological craving, depression/suicidality.

Question 24

Caffeine intoxication sx?

Answer 24

Restlessness, inc. diuresis, muscle twitching.

Question 25

Caffeine withdrawal sx?

Answer 25

Lack of concentration, headache.

Question 26

Nicotine intoxication sx?

Answer 26

Restlessness

Question 27

Nicotine withdrawal sx?

Answer 27

Irritability, anxiety, craving. Treatment: nicotine patch, gum, or lozenges; bupropion/ varenicline

Question 28

PCP intoxication sx?

Answer 28

Belligerence, impulsivity, fever, psychomotor agitation, analgesia, vertical and horizontal nystagmus, tachycardia, homicidality, psychosis, delirium, seizures. Treatment: benzodiazepines, rapid-acting antipsychotic.

Question 29

PCP withdrawal sx?

Answer 29

Depression, anxiety, irritability, restlessness, anergia, disturbances of thought and sleep.

Question 30

LSD intoxication sx?

Answer 30

Perceptual distortion (visual, auditory), depersonalization, anxiety, paranoia, psychosis, possible flashbacks.

Question 31

Marijuana (cannabinoid) | intoxication sx?

Answer 31

Euphoria, anxiety, paranoid delusions, perception of slowed time, impaired judgment, social withdrawal, inc. appetite, dry mouth, conjunctival injection, hallucinations. Pharmaceutical form is dronabinol (tetrahydrocannabinol isomer): used as antiemetic (chemotherapy) and appetite stimulant (in AIDS).

Question 32

Marijuana (cannabinoid) | withdrawal sx?

Answer 32

Irritability, depression, insomnia, nausea, anorexia. Most symptoms peak in 48 hours and last for 5–7 days. Generally detectable in urine for up to 1 month.

Question 33

Methadone

Answer 33

LONG ACTING | Oral opiate used for heroin detoxification or long-term maintenance.

Question 34

Naloxone + buprenorphine

Answer 34

Antagonist + partial agonist. | Naloxone is not orally bioavailable, so withdrawal symptoms occur only if injected (lower abuse potential)

Question 35

Naltrexone

Answer 35

Long-acting opioid antagonist used for relapse prevention once detoxified.

Question 36

Mechanism of Antipsychotics (typical)?

Answer 36

Block dopamine D2 receptors (increase cAMP)

Question 37

Use of Antipsychotics (typical)?

Answer 37

Schizophrenia (+ symptoms) psychosis acute mania Tourette syndrome

Question 38

Antipsychotics (typical) are very ___ soluble and are removed ___ from the body.

Answer 38

Lipid, slowly

Question 39

``` Antipsychotics (typical) toxicities: Neuro = ____; Tx= ____ Endo=____ From receptors (3) binding= ____ ```

Answer 39

Extrapyramidal (dyskinesia); benzotropine Galactorrhea (from dopamine receptor antagonism -->hyperprolactinemia) Dry mouth and constipation (from muscarinic block); hypotension (from a1 block); sedation (from histamine block)

Question 40

Other potential Antipsychotic (typical) toxicities (2)

Answer 40

Neuroleptic malignant syndrome-- Fever Encephalopathy Vitals unstable Enzymes inc. Rigid muscles (tx with dantrolene or D2 agonists (bromocriptine)) Tardive Dyskinesia (oral facial movements from long term use -- irreversible)

Question 41

Which atypical antipsychotics cause significant weight gain?

Answer 41

Olanzapine and clozapine

Question 42

Which atypical antipsych. causes agranulocytosis and seizure?

Answer 42

Clozapine

Question 43

Which atypical antipsych. causes increased prolactin and fertility issues?

Answer 43

Risperidone

Question 44

Which atypical antipsych. causes QT prolongation?

Answer 44

Ziprasidone