Psych Flashcards
(430 cards)
1
Q
Is there life threatening withdrawal for cocaine?
A
No
2
Q
reaction formation
A
a neurotic defense mechanism- doing the opposite of what you think- a man is mean to a wife he loves
3
Q
dissociation
A
defense mechanism- unclear if mature, neurotic, or immature
- dealing with stress by temporarily eliminating a perception of themselves or their environment to avoid a problem- as in amnesia
4
Q
suppression
A
mature defense mechanism that means that you purposely ignore an unacceptable impulse or emotion in order to diminish discomfort and accomplish a task
5
Q
controlling defense mechanism
A
a neurotic defense mechanism in which you regulate situations and events of external environment in order to relieve anxiety
6
Q
intellectualization defense mechanism
A
avoiding negative feelings by excessive use of intellectual functions and focusing on irrelevant details or inanimate objects- eg: man dying of colon cancer explains the pathophysio of the disease to a 12 yo son
- reasoning is used to block confrontation with an unconscious conflict
7
Q
repression vs. suppression
A
suppression= mature defense mechanism- don't think about something in order to get thru a task- *conscious repression= neurotic defense mechanism where you prevent a thought or feeling from entering consciousness- *unconscious
8
Q
acting out
A
immature defense mechanism- giving into an impulse even if socially inappropriate in order to avoid the anxiety of suppressing that impulse
9
Q
denial
A
immature defense mechanism- not accepting reality that is too painful
10
Q
regression
A
immature DM- performing behaviors from an earlier stage of development in order to avoid tension associated with current phase of development
11
Q
projection
A
attributing objectionable thoughts or emotions to others
immature DM
eg- man who is attracted dot other women believes that his wife is having an affair
12
Q
undoing defense mechanism
A
attempting to reverse a situation by adopting a new behavior
eg: man who fantasizes briefly about killing his wife with a car takes the car for a complete checkup
13
Q
what is goal of psychoanalysis
A
resolve unconscious conflicts by bringing repressed experience and feelings in awareness and integrating them into patients conscious experience
14
Q
patient has repressed feelings of abandonment by her father and becomes angry when her therapist is late for the appt- this is an example of which D.M.
A
transference
15
Q
what type of therapy uses free association
A
psychoanalysis- bring unconscious to conscious
16
Q
CBT
A
- 6 wks to 6 mo
- focus on current symptoms by examining the connection between thoughts and behaviors
- identify and challenge maladaptive thoughts like overgeneralization, catastrophizing, etc
17
Q
supportive psychotherapy
A
for lower functioning people- psychotic, cognitively impaired
- work with therapist to build up defense mechanisms and reinforce coping skills
- help make patient feel safe
- not insight oriented
18
Q
psychodynamic psychotherapy
A
in higher functioning people- explore past relationships and conflicts and break down defense mechanisms
19
Q
what type of therapy for borderline
A
DBT- acceptance and change
improve emotional regulation and distress tolerance
component of group therapy
20
Q
drug for hoarding?
A
SSRI
21
Q
adjustment disorder
A
stressful life event-> maladaptive behavioral or emotional symptoms
- symptoms begin within 3 months and end within 6 months
- they must cause significant impairment in daily functioning or interpersonal relationships
22
Q
adjustment disorder vs. PTSD
A
AD: event is not life threatening
PTSD: event is life threatening
23
Q
what therapy is good for adjustment disorder
A
supportive psychotherapy
- pharmacotherapy for associated symptoms like insomnia, anxiety, or depression
24
Q
what drugs can be used for OCD
A
clomipramine (TCA) fluoxetine (SSRI) fluvoxamine (luxov) (SSRI) paroxetine (paxil) (SSRI) sertraline (zoloft) (SSRI)
25
which antipsychotic increases prolactin levels the most. what does this lead to
risperodone
| -> galactorrhea, amenorrhea, breast tenderness
26
schizotypal vs. schizoid
schizoid= social detachment and restricted emotion- do not enjoy close relationships with others, indifferent to praise or criticism
shizotypal= reduced capacity for closed relationships and magical thinking with bizarre fantasies
27
avoidant PD vs. schizoid
avoidant= hypersensitive to criticism. want friendships but stay away bc they fear ridicule
schizoid- don't care about criticism or praise
28
schizophreniform vs. schizophrneia
schizophrenia> 6mo
| schizophreniform: 1-6 mo
29
delusional disorder critera
nonbizzare fixed delusions from >1mo
does not meet criteria for schizophrenia
fucntioning in life not signifciantly impaired
common in >40, immigrants, and hearing impaired
30
persecutory delusional disorder vs. paranoid personality disorder
```
PDD= can still function in life. non bizarre delusions
PPD= pervasive pattern of interpersonal problems but no persistent delusions or other psychotic symptoms
```
31
which antidepressant can help smoking cessation
buproprion
32
adjustment disorder with depressed mood vs. normal stress response
adjustment disorder with depressed mood requires significant functional impairment
33
what do you give to prevent alcohol withdrawal permanent damage
thiamine to prevent wernicke's encephalopathy, which can progress to korsakoff syndrome
34
a patient after days in hospital becomes anxious, diaphoretic, and tachycardic. what do you suspect and what do you give
you suspect alcohol withdrawal
6-24 hrs: anxious, diaphoretic, tachycardic
12-48 hours- you worry about seizures, alcoholic hallucinxsis (vitals stable at this point)
48-96 hrs: DT: confusion, tachycardia, fever, agitation, diaphoresis
give tapered librium (and also phenytoin for seizures)
35
dilsulfiram
drug used to prevent alcohol addiction long term
| - inhibits alcohol dehydrogenase, making patients feel sick when they have alcohol
36
will all people with seizures get delirium tremens
1/3 of them will
37
how many die of DT
15-25% mortality if untreated
38
wernickes vs korsakoff
wernicke first: acute and can be revered with thiamine. ataxia, confusion, ocular abnormalities (nystagmus gaze palsy)
korsakoff: chronic amnestic syndrome
reversible in only 20% of patients
anterograde amnesia
confabulation- making up answers when memory has failed
39
how to treat cocaine withdrawal
its not deadly
| treatment is supportve
40
how does PCP work
antagonize NMDA glutamate receptors
activates dopaminergic neurons
can lead to psychosis
41
conversion disorder
neuro symptoms incompatible with any near disease- often associated with stress
42
factitious disorder vs. malingering
malingering = falsification or exagerating to obtain external incentives
factitious= intenitonal falsification with goal to assume sick role
43
illness anxiety disorder
fear of having a serious illness in spite of no symptoms and consistently negative evaluations
44
somatic symptom disorder
excessive anxiety and preoccupation with 1 or more unexplained symptoms
45
genetics of bipolar
one of strongest genetic components of all psych disorders
- first degree relative: 10%
- both parents: 60%
- monozygotic twin: 70%-90%
- general population: 1%
46
remission vs. response phase
remission: absence of morbid symptoms- return to preillness state of health
response: 50% reduction in baseline level of severity
47
which atypical antipsychotic is most likely to cause EPS? how do you counter them?
risperidone.
counter with anticholinergic like benztropine
48
how do you treat akathisia from antipsychotics
give propranolol
49
panic disorder
panic attacks with no obvious precipitant
- causes at least of month of persistent concern about attacks, changing behavior based on attacks, and worry about implications of such an attack
comorbid with depression a lot of the time and agoraphobia*
50
what kind of meds to use in depressed terminally ill patients
methylphenidate if short life expectancy
SSRI if longer life expectancy
51
displacement
defense mechanism - immature
dispalce feelings from one thing to another thing
eg: your boss yelling at you- taking it out by yelling at your secretary
52
disociative fugue
sudden unexpected travel away from one's home in addition to an inability to recall things from one's past
- unaware of new identity or amnesia
- seem relatively not stressed
associated with traumatic event, alcohol
53
medication for GAD
SSRI like escitolopram
SNRI like venlafaxine
non benzo anxiolytic like buspirone (slow onset: 1-2 weeks)
54
what is most common side effect o olanzipine
weight gain- because it blocks histaminergics (H1) and 5HT2C receptors.
also diabetes, but not as common as weight gain
55
ODD vs conduct disorder
ODD does not have aggression toward people or animals and conduct disorder does
56
drugs from bipolar 1
mood stabilizer and antipsychotic
57
elderly person with severe depression with psychotic interest, loss of interest, excessive guilt, sleep and appetite disturbance, and auditory hallucinations. SSRI ineffective. Not eating or drinking. What to do?
try ECT. it is an evidence based treatment for treatment refractory MDD. this is an emergency- not eating or drinking. also if pregnant or if suicide risk. it was have a rapid response, unlike drugs. it is safe alone and it can be used in conjunction with other medications.patients are given general anesthesia and an general tonic clonic seizure is induced.
58
what is a mixed episode of bipolar? treatment?
irritability is the predominant mood state. lithium is usually not effective. try an anticonvulsant like depakote (valproic acid)- these also work for rapid cycling mania
59
how long do you give ECT for
discontinued after symptomatic improvement. usually 8-12 sessions given 3 times weekly. monthly maintenance is given to preevent relapse of symptoms.
60
side effects of ECT
muscle soreness, headaches, amnesia, confusion. bilateral electrode placements decrease the number of treatments needed but increase memory impairment and confusion.
61
what drug for manic patient with increased creatinine
check kidney function. if not good, don't give lithium- give valproic acid.
62
time period of adjustment disorder
it is emotional or behavioral symptoms that develop within 3 months of exposure to an identifiable stressor and rarely last more than 6 months after the stressor ends.
63
treatment of choice for adjustment disorder
psychodynamic psychotherapy or brief cognitive psychotherapy. these 2 methods focus on developing coping mechanisms and improving the individuals response to and stated about stressful situations
64
NMS?
NMS is rare but potentially lethal side effect of antipsychotic (Atypical and typical) medications (dopamine antagonists)
- 20% mortality rate if untreated
hyperthermia, autonomic instability, muscular rigidity
rhadbomyolosis-> myoglobinuria- AKI
65
how to treat NMS
take off of neurlopetic
supportive care: aggressive cooling, antipyretics, fluid/electrolyte repletion, alkaline diuresis (in case of rhabdomyolysis)
pharm: dantrolene sodium (muscle relaxant) and/or dopamine agonist bromocriptine
66
can people who get NMS be treated with neuroleptic later on in life
yes
| it is not an allergic rxn
67
side effects of NMS (pnemonic)
```
F: fever
A: autonomic instability (tachycardia, labile HTN, diaphoresis)
L: leukocytosis
T: tremor
E: elevated creatinine phosphokinase (CPK)
R: rigidity (lead pipe rigidity)
E: excessive sweating (diaphoresis)
D: delirium
```
68
lead pipe rigidity
pathological resistance to passive extension of a joint- constant throughout range of motion
69
what is the biggest predictor of suicide
prior suicide attempt
70
PCP intoxication symtpoms
```
RED DANES
R: rage
E: erythema
D: dilated pupils
D: Delusions
A: amnesia
N: Nystagmus
E: excitation
S: skin dryness
```
71
which drug has effect of nystagmus
PCP, sedative hypnotics, inhalants
rotary nystagmus is pathognomonic for PCP
72
PCP vs LSD intoxication
they present similarly
| agitation and aggression more common in PCP
73
which 2 drugs give tactile and visual hallucinations
PCP and cocaine
74
drug to counter acute dystonic rxn
benztropine or diphenhydramine (benadryl)
75
alcohol hallucinosis
12-24 hours after last drink
| auditory, visual, tactile hallucinations with normal vital signs and intact sensorium
76
how to treat social anxiety disorder
Generalized:
SSRI/SNRI, CBT
performance:
benzo or beta blocker
77
schizoaffective disorder vs. bipolar disorder with psychotic features
schizoaffective: lifetime history of delusions or hallucinations for >2 weeks in the absence of major depressive or manic episode (they may also have them concurrently)
major depressive or bipolar with psychotic features: psychotic symptoms occur exclusively during mood episodes
78
persistent depressive disorder (dysthymia)
depressed mood for most days for at least 2 years
79
can dysthymia ever have psychotic features?
no. if a person has delusions or hallucinations with depression, consider another diagnosis like major depression with psychotic features aschizoaffective, etc
80
what is the first line treatment for specific phobia
behavioral treatment
81
bipolar I vs. bipolar II
bipolar I has manic episodes and does not require depressive period.
bipolar II has hypomanic and at least one depressive episode
82
manic versus hypomanic
manic: >7 days unless hospitalized, may have psychotic features
hypomanic: >4 days, no psychotic features
83
what is cyclothymic disorder
at least 2 years of fluctuating mild hypomanic and depressive symptoms that do not meet criteria for hypomanic episodes or major depressive episodes
84
what is the most likely atypical antipsychotic to cause EPS? least likely?
risperidone is most likely. clozapine is least likely.
85
if a person on MAOI eats aged cheese, what should you monitor
blood pressure because they can have a hypertensive crisis
86
what is the most common side effect of MAOi
orthostatic hypertension
87
which 2 drugs have the greatest risk of weight gain and diabetes
clozapine and olanzipine
88
what are signs of amphetamine intoxication
agitiation, irritability, paranoia, or delirium
| can also have cardiac arrhythmia, seizures, hypothermia, and intracerebral hemorrhage
89
can you do a lab test for amphetamine intoxication
no- diagnosis is clinical
90
what medication can cause seizures in withdrawl
xanax
91
how long to continue antidepressant aftera single episode of major depression
treat for 6 months following patients response
92
concordance of depression in twins
50-70% for monozygotic
10-25% for dizygotic
first degree relatives 2-3 x more likely to get it
93
how to treat dysthymic disorder
antidepressants, cognitive therapy, inside oriented psychotherapy
94
medication for a first depressive episode
SSRIs are indicated for 6 mo-year and then can be discontinued as per the patients request
95
risk of depressive episode after first untreated episode? risk of suicide
50% in 2 years
| 15% of depressive patients commit suicide
96
what % of patients with MDD show a response to antidepressants?
50-60%
97
what are medical causes of manic episode?
hyperthyroidism, neuro:seizures, frotno tempoeralsclerosis, neoplasms, HIV infection
98
can you give antidepressants to manic patient
no- they can make mania worse
99
what do you give rapid cycling mania
mood stabilizers like depakote and carbamazapine
100
mixe episode
criteria ar emet for manic and MDD every day for at least a week
101
can you give antipsychotics for mania
yes- they are often give as adjunct to mood stabilizers
| mania can have psychosis (delusions)
102
bipolar I vs. bipolar II
bipolar II cannot have manic phase. it just hypomanic phases and MDE.
bipoalr II- have manic episode. does not need MDE to meet criteria.
103
what treatment for refractory life threatening acute mania
ECT may be indicated
104
how long do untreated manic episodes last
3 months
105
what percent of people with bipolar commit/die from suicide? compared to MDD
more than MDD> 25% commit and 15% die
106
how common is relapse in bipolar? how to prevent it
90% of people with one manic episode will have another within 5 years
treat by interim lithiumprophylaxis
107
which gender has earlier onset of bipolar? outcome
men. worse outcome when earlier onset
108
what drug OD would present with confused, agitated, delirious, obtunded, low BP, regular HR, warm dry flushed skin, dllated pupils, distended bladder
anticholinergic- high potency neuroleptics (antipsychotics), antihistamines, mostly TCA*
109
what are TCAs used for
depression, neuropathic pain, migraines
110
what do you give for lithium toxicity
kayexalate chelator
| cant use lavage to treat it
111
what should you give delirious patient
only give benzo if delirious from alcohol withdrawal
| otherwise NEVER because it can make it worse. give a low dose of an antipsychotic like haldol.
112
SSRi side effects due to 5HT3 receptor
GI system. over stimualtion -> diarrhea, nausea, and vomiting
113
SSRI side effects due to 5HT2C
CNS- overstim-> anxety and mental agitation
114
SSRi side effects due to 5HT2A
CNS, spinal cord, over stimualton-> anxiety, mental agitation, akathisia, insomnia, myoclonus, sexual dysfunction
115
what does demerol do to pupils
it is an exception to opioids producing miosis. demerol dilates pupils.
116
how to stop sexual disfunction from risperdal
give a little bit of ability with it- binds to D2 more strongly?
117
how can mood and psychosis congruency help diagnosis
mood congruent- bipolar
| mood incongruent- psychosis
118
can benadryl cause anticholinergic?
yes. it is mostly antihistamine but it can also cause anti-cholinergic
119
what can you give in anticholingeric OD
physostigmine- cholinesterase inhibitor
120
why are TCA OD so lethal
1. anticholinergic-> prolong qtc-> torsade
2. antiarrythmic-> mess up rhythm
3. anti-a-adrenergic-> drop BP
also other effects like serotonin syndrome
anticholinergic-> slows down its own absorption-> makes you think that patient is better, but then another bolus gets absorped
121
columbia suicide severity screen test
wish to be dead, suicidal thoughts, suicidal thoughts with method, SI, SI with specific plan
tests history of attempts
122
how long to keep on antidepressant after suicide attempt? after 2?
1 attempt: >1 year
| more than 1 attempt: even longer, bc it icnreases risk
123
how do SSRIs work
block uptake->
| more serotonin binds to 5ht1a receptor
124
what serotonin receptors do atypical antipsychotics block
5HT2a (and 2c)
125
5Ht2 blockade -> dopamine?
increases dopamine
126
SSRI and akathisia?
can cause it
| increase action 5HT2 receptor-> decrease dopamine-> increase receptors for dopamine-> akathisia (?)
127
what do you use if SSRI isn't effective
try SNRI like effexor
128
risk of effexor
increase mania
129
MAOi process of working
look up
also in gut- processes tyramine- over tyramne-> tyramine
also can't take anything sympathomimetic- sudafed, etc
130
treatment refractory depression highly atypical (and def not bipolar variant) what drug?
MAOI is a good variant
| eg: selegiline
131
buproprion mechanism
antagonism of presynaptic norepinephrine and dopamine reuptake pumps
weight gain, no sexual side effects
less likely to flip people into mania
132
trazadone mechansims
serotonin antagonism and reuptake inhibitor
| no weight gain even though 5HT2 blocker
133
mirtazapine mechanism
alpha 2 blocker-> disinhibition of NE and SE.
also stimulate alpha 1 somatodendritic receptors on serotonin neurons.
can cause weight gain and sedation
works in a diff way than ssri and snri- can add to them and i can be synergistic
134
serotonin and platelet
need serotonin for platelets
anything that inhibits serotonin messes up platelets-> increases bleeding like GI bleeding or surgical bleeding
wan people, if on aspirin
remeron (mirtazapine) does not have that problem
135
rational approach to ssri
start ssri.
if partial response -> increase dose
if still partial-> augmentation strategies based on side effects and anticipated response. welbutrin, buspar, remora, lamictal, lithium, atypical antipsychotic. thyroid hormone.
136
what antidepressants do not cause mania
ECT and thyroid hormone
137
what is most common substance and psych comorbidity
nicotine and schizophrenia
138
which personality disorder is most likely to have substance abuse
antisocial
139
what test allows you to monitor depressive symptoms with the greatest validity
beck depression inventory
140
what test would you use to assess for memory impairments in the setting of ECT
Brown-Peterson task- evaluates short term memory
141
what test would you use to test in schizophrenic ability to organize and correctly process information
wisconsin card sorting test- sort cards of pictures and symbols according to a variety of different criteria that change over time without the patient knowing. tests a patients ability to switch sets, reason abstractly, and solve problems.
executive functions-frontal lobes (dorsolateral frontal lobes)
142
MMPI-2
most widely used test in evaluation of personality structure. evaluates attitudes about the test which helps determne validity of test. must be scored by experienced evaluator.
143
how to calculate IQ
divide mental age by chronological age and then multiply by 100
144
patient with damage to right parietal lobe. which test to assess damage?
rey-osterrieth test. assess visual nonverbal memory. people with right parietal lesions show abnormalities in copying the figure by neglecting the items int he left visual field.
145
deja entendu vs deja vu
deja entendu= feeling that one is hearing something one has heard before
deja vu= sensation that one is seeing something one has not seen before
146
transference vs. countertransference
```
transference= feelings patient has about therapist (based on past)
countertrasnference= therapists feelings about patient (based on past)
```
147
how to interpret rorsach test?
exner comprehensive system- limited in validity and requires highly trained examiners
148
test to ask friends or family of the patient to assess the ability of the patient to function in his or her usual environemnt
blessed rating scale
149
how to preoperatively test hemispheric dominance in an 18 year old left handed woman with a history of seizure disorder who is about to undergo surgery to remove a seizure focus in th let hemishere
wada test-
150
what stage of sleep do night terrors occur
deep sleep: stage 3-4
151
separation anxiety disorder versus reactive attachment disorder
sep. anx.: usually after 7- maybe after a stressful event; reactive attachment disorder: experience marked lack of social relatedness, usually before age 5
152
copralalia
excessive repetition of obscene words, often seen in tourettes
153
how to treat enurisis
DDAVP or TCA like imipramine
DDAVP stop neurosis for 7ish hours- can cause headache and slight hyponatremia
154
approximate comorbidity of childhood anxiety disorders and MDD
50%
155
most common side effect of fluoxetien
GI- nausea
156
what is first line treatment for Tourette's
clonidine (intermediate acting benzo) (first line)
| used to be high potency antipsychotics (these are more effective but have worse side effects)
157
what is the most common initial symptoms of tourettes? what is necessary to diagnose tourettes?
eye tics such as blinking. need multiple motor tics and one or more vocal tics at some point. onset before 18. tics must be present almost every day for a year with no tic free period greater than 3 months.
158
what is most common predisposing factor for MR?
early altercations in embryonic development (chromosomes, alcohol)
159
what type of medication is most likely to unmask an underlying predisposition to developing tics?
stimulants
160
what blood abnromality do you see in anorexia nervosa
hypercholesterolemia.
161
are there brain changes in anorexia nervosa?
yes- increased ventricular- brain ratio on imaging
162
what criteria to meet paranoid schizophrenia
highest functioning type. oldest age of onset.
1. preoccupation with one or more delusions or frequent auditory hallucinations
2. no predominance of disorganized speech, disorganized or catatonic behavior, or inappropriate affect
163
how to best differentiate between mania and ADHD in children
low self esteem in ADHD, euphoria in mania
164
when can children conceptualize death
between 7 and 10
165
what medication for panic disorder?
SSRI
166
when is rubella-> physical/mental defects in fetus
first trimester
167
what do you think if you see an 8 yo boy with erythematous chapped hands and otherwise normal phsycial
OCD- from excessive washing
168
twin concordance of schizophrenia
50%
169
belief that people have been replaced by imposters
capgras
170
postpartum depression with depression, mood lability, delusions, hallucinations is usually a result of
bipolar
171
what characterizes shizophrenia catatonic type
must meet 2 of the following
- motor immobility
- excessive purposeless motor activity
- ectreme negativism or mutism
peculiar voluntary movements or posturing
- echolalia or echopraxia
--it has been going down in recent years and it is the least common of all of them.
172
what has the strongest genetic link in all the psych illnesses
bipolar 1
carries a worse prognosis than unipolar depression but a higher percentage of patients with bipolar are eventually treated
173
woman with terrible anxiety, diaphoretic, tachycrdic, dialed pupils, stomach pain
think porphyra
174
lab findings in anorexia
```
increase BUN
hyperkalemic alkalosis
hypercholesterolemia
leukopenia
ostoeposrosis
```
175
what are chances that a person with MDD will fail to suppress cortisol levels in a dexamethasone suppression test
50%
176
person getting a pill for a chronic mood disorder. side effects of dry mouth, trouble urinating, occasional dizziness when she gets out of bed
TCA ike imipramine
| not prozac
177
clinical triad of normal pressure hydrocephalus
1. gait disturbance
2. urinary inontinence
3. dementia, mild, with insidious onset.
this is reversible cause of dementia
178
GGT in alcoholism? AST and ALT? anemia?
increased GGT;
| AST/ALT increase; macrocytic anemia
179
can delusional in delusional disorder be bizarre
no
180
acute stress disorder versus PTSD
ASD= trauma 4 weeks ago
181
old lady coming from hospital with fluctuating results on MSE
delirium not dementia. dementia is more stable. dementia= memory impairment, delirium= sensorium impairment
182
SSRI at 5HT3 receptor side effect
GI system. overstimulation leads to diarrhea, nausea, and vomiting
most common side effect of SSRI
183
SSRI at 5HT2C receptor side effect
CNS. overstimulation leads to anxiety and and mental agitation
184
SSRI at 5HT2A side effect
CNS: spinal cord; overstimulation-> anxiety and mental agitation, akathisia, akathisia, insomnia, myoclonus, and sexual disfunction
185
how to treat panic disorder? prognosis?
start SSRIs slowly- sertraline(Zoloft) and paroxetine (Paxil). . they are more prone to get panic symptoms from activation of 5HT2A/C. ultimately need higher doses than you do for depression
- relapses common with discontinuation of therapy.
- 10-20% have signifiant symptoms that inferrer with fair functioning
- 50% have mild infrequent symptoms
- 30-40% remain symptom free after treatment
186
How to qualify for GAD
- excessive worry and anxiety that is difficult to control for >6 months
- must include 3 of the following- restlessness, fatigue, difficulty concentrating, irritability, muscle tension, sleep disturbance
- very common- 45% lifetime prevalence
- 50-90 % have coexisting disorder
187
patient is in an acute manic episode. what should you give? (no counter indications here)
lithium + anticonvuslant (carbamazepime or valproic acid). maybe add an atypical antipsychotic (olanzipine, quietiapine, ziprasidone (Geodon)) as adjunct for acute mania
don't give benzo bc they are addicting
188
side effects of lithium for
1. pregnant women
2. person with CHF
3. person with pain
4. person with kidney disease, heart disease, thyroid disease
1. ebstein's abnormality-abnormal parts of tricuspid valve, abnormality of great vessels
2. caution with thiazide diuretics, ACE inhibitors
3. caution with NSAIDS
4. prob bad idea-> causes long term nephrotoxicity, cardiac arrhythmia and T wave flattening, thyrotoxcity
189
monitoring for lithium?
YES. levels should be obtained twice weekly until stable. then they should be obtained once every 1-3 months.
therapeutic levels for acute mania are: 0.6-1.2 mEq/L
>1.5: toxic
>2.0: lethal
190
how can carbamazepine (tegretol) cause toxicity and death
- it inhibits neuron depolarization (by binding to Na/K channel) and decreases glutamate release and is anticholinergic
- toxicity: prolong QRS-> predispose patients to ventricular arrythmias and hypotension
- OD: antagonizes adenosine receptors-> proconvulsant
- OD: acute liver failure
191
what is mechanism of valproic acid
inhibits Na/Ca channels-> boost GABA-> decrease glutamate
192
what percent of depressed patients respond to placebo? what percent respond (within 2-4 weeks) to SSRI
- 30%
| - 70%
193
disorganzied schizophrenia? how does it respond to treatment?
it is pronounced and severe through disorder that is relatively unresponsive to neuroleptics
194
how to treat narcolepsy?
methylphenidate-> inhibit REM sleep cycles
| - TCAs as adjunctive are sometimes shown to be good adjuncts with methylphenidate
195
infarct of right vs. left hemisphere vs diffuse bilateral frontal injury
left infarct: depression;
right infarct: euphoria, inappropriate indifference, mania;
diffuse bilateral frontal injury: OCD
196
what are sleep changes seen in depressed patients
- increased sleep latency (difficulty falling asleep), early morning awakening, less REM sleep latency (REM sleep occurs earlier in the night)
197
cotard syndrome
delusion that nothing exists (nihilism) or that the patient hissed does not exist. the person may believe her body is dead.
198
what is fomication? who has it?
tactile hallucintion in which one has the sensation of bugs crawling on or under the skin. it can be seen in cocaine intoxication or alcohol withdrawal. `
199
neurovegetative signs
physiological signs of depression such as changes in sleep, bowel habits, and weight
200
brain of schizophrenic
shrunken hippocampus, parahippocampal gyrus, amygdala
201
ideas of reference
idea that others are focusing on you in some positive or negative way- seen in paranoid schizophrenia
202
TCA OD-> hallucinations, pulling out IV lines
gives benzo like lorazepam (short half life);
| NOT neuroleptic- more hypotensions;
203
person with weight gain,hypersomnia, and mood reactivity and depression. what do you give?
this is atypical depression. give phenelzine (MAO).
204
patient with alcohol withdrawal and elevated transaminases
normally you would give long acting like chlordiazepoxide (librium). however, that is metabolized in the liver. use something like oxazepam or lorezapam or temezepam (LOT) which undergo glucuronidation before the liver
205
what is the most likely mechanism for the delayed therapeutic response of SSRI
still not really known for sure- maybe down regulation of postsynaptic 5HT2 binding sites
206
what is the most common serious side effect of NMS
rhabdomyologsis-> renal failure
207
long term consequence of high dose thioridazine (mellaril) (unique)
retinal pigmentation-> blindness
208
what is the most potent anxiolytic benzo
clonazepam (klonopin) long half life and high potency
209
what should you target in children suffering from tourette disorder
dopamine D2 receptor (halloo) anatognism; also maybe alpha2agonist
210
what is the only medication that may improve symptoms of TD
clozapine
211
how to best treat borderline (drugs)?
SSRI and antipsychotics
212
mechanism of action of trazodone and nefazadone
selective antagonism as 4HT reuptake pumps PLUS 5HT2A blockade. the blockade at 5HT2A prevents side effects of overstimulating 5HT2A (anxiety, mental agitation, akathisia, insomnia, myoclonus, sexual disfunction). questionably treats severe illness BUT it can be used as an adjunct to help with sleep in severely depressed patients
213
how can lithium in normal doses affect EKG
it can flatten the T wave. not clinically signficant. lithium toxicity can cause sinus node disfunction and AV block
214
clozapine is efficacious because of its action at which recpeotr
D4, especially in limbic system. D4 receptors may mediate psychotic symptoms and may also potentiate NMDA receptor. it also has activity at 5HT2 receptor (other neuroleptics lack this). it also works at D1, D2, histamine 1, alpha 1.
215
which antidepressant causes orthostatic hyotension?
TCA- like imipramine. notriptyline has the least orthostatic hypertension of the TCAs
216
what to give an 85 year old patient who has become combative, yelling, punching staff, and pulling out IVs. what to give her
low dose antipsychotic like risperidone are very effective at reducing agitation in delirious patients. benzos can be used for agitation in delirium but they can overly sedate or conversely disinhibit the patient further
217
mechanism of mirtazapine
- antagonism of central alpha-2 auoreceptors and subsequent disinhibition of NE and SE
- stimulation of alpha 1 receptors on serotonin neurons-> boost 5HT release
218
what is counterindication to TCA use
ECG changes. it slows cardiac conduction like prolonged QT, winding of QRS, bundle branch block,
219
what can you give for PTSD
SSRI; clonidine (alpha 2 adrenergic agonist) for symptoms of fear and palpitations
220
what can you give to help with sialorrhea from clozaril
anticholinergic like propylthiouracil
221
what is flumazanil
benzo antagonist. should not be given until you get history because it can decrease seizure threshold.
222
how do you medically detox from heroin
clonidine. central alpha 2 antagonist. suppressed sympathetic response to heroin withdrawal and helps to control agitation and autonomic instability (elevated BP and HR). DOES NOT take away craving.
223
what should you monitor for in low dose risperidone
orthostatic hypotension
224
how to treat impotence? who can't get this drug? what is opposite of this drug
yohimbine (central alpha 2 antagonist). should not be used in patients with cardiac or renal disease bc it can cause elevated BP and HR. opposite of this is clonidine (central acting alpha2 agonist)
225
dopamine and prolactin? impact of antipsychotics
dopamine inhibits prolactin. antipsychotics inhibit dopamine-> increase prolactin.
226
what type of drug is most dangerous when it is abruptly withdrawn
sedative hypnotics
227
which bipolar drug can cause pancreatitis
valproic acid
228
which antidepressant can cause serotonin discontinuation syndrome
only paxil really has a short enough half life to cause serotonin discontinuation syndrome
229
which antipsychotics are available in a depot injection
risperdal and haldol
230
which drug can cause a lot of peeing
lithium can cause nephrogenic diabetes insidious-> lots of peeing
231
someone on clozaril gets increase in resting HR and a sinus tachycardia. do you need to stop medication?
no. give propranolol
232
what are the least likely antipsychotics to cause weight gain and diabetes?
least likely= aripiprazole and ziprasadone. next likely= risperidone and quetiapine. most likely=olanzipine and clozapine.
233
which mood stabilizer doesnt cause weight gain
lamictal
234
what do you see in brain scan of panic dsorder
overactive locus coerulus and amygdala
235
time course of dysthymia vs. GAD
GAD: >6 months
dysthymia: 2 yrs
236
what medicine to use for bipolar with substance abuse
depakote. works faster. can do IV. anti-epileptic. wider therapeutic window. treats mixed and rapid cycling (common with SUD). it also helps with impulsivity. but not good bc its metabolized by the liver.
237
methadone vs heroin
opiate agonist. much slower acting. not as likely to cause addiction. not in withdrawal and you don't experience cravings. just need to take it once a day. need to use in clinic.
238
suboxone
buprenorphine + naloxone. buprenorphine- partial agonist- risk of OD is decreased- less use of OD and less use of misuse. can give prescription. naloxone- can't do anything unless injected, but if you try to inject something, it will be safety measure.
239
naltrexone
orally bioavailable versus of naloxone. blocks opiate receptors. use in alcohol addiction, opiate addition. more long term.
240
4 drugs for alcohol withdrawal
acamprosate (regualtes GABA and glutamate- works in someone who is newly sober), disulfiram (blocks enzymes that metabolize alcohol- make you feel sick), naltrexone (alcohol also works at opiod receptors). topamax- potentiates GABA and inhibits glutamate.
241
what is contraindication for ECT
history of MI, history of intracranial space occupying lesion
242
what would you use to treat depression in a patient with diabetes and a lot pain
dulexetine (cymbalta). SNRI. Serotonin and Norepinephrine reuptake inhibitor. treats depression and also approved for diabetic neuropathy.
243
which 3 antidepressants do not cause sexual disfunction
buproprion, mirtazapine, nefazadone
244
what lab changes do you see in bulimia
hypokalemic, hypochloremic alkalosis, high serum amylase, hypo magnesia. normal thyroid function.
245
what are symptoms of opiate withdrawal
yawning, muscle aches, diarrhea, laceration, rhinorea, fever, mildly elevated vital signs
246
how does cocaine work
blocks dopamine reuptake
247
patient complains of diffuse muscle pain and vague abdominal ramps she continually yawns, blows her nose, and has goose bumps.
opiate withdrawal
248
patient with increased tactile perceptions, diaphoretic, high bp, trismus, bruxism, hyperthermia and diaphoreses and sucking a pacifier
MDMA intoxication, drug paraphernalia include pacifiers, popsicle sticks, candy necklaces, to help avoid bruxism (grinding of teeth)
249
what is classical presentation of Wernicke
ACE. A- ataxia, C- confusion, E- eye movement
250
how to treat schizotypal that is affecting life negatively
low dose neuroleptic
251
a woman being treated for major depression is brought to the ED unconscious after drinking wine with BP=220/110. how to treat?
hypertensive crisis from MAOI+wine. give iV alpha blocking agent. can also be seen with occipital headache, stiff neck, nausea, vomiting, sweating
252
does clozapine affect prolactin
no- unlike typical antipsychotics
253
what are medical causes of mania
thyrotoxicosis (hyperthyroidism), cushing disease, hypoglycemia, electrolyte disorders, substance abuse and withdrawal, nutritional deficinies, steroid use, anticholinergic agents, CNS insults
254
what tests attention in the MSE
perform digit recall
255
amok
culture bound syndrome of malayan origin in which there is a violent or furious outburst of homicidal intent. prodromal brooding, a homicidal outburst, persistence in reckless killing without apparent motive, claim of amnesia. common in young men whose selfesteen has been injured. person often commits suicide afterward.
256
what are 4 types of EPS? how to treat?
1. acute dystonic rxn. (4 hr) 2. akathisia.(4 day) 3. pseudoprkinsonism. (4 week) 4. tardive dyskinesia (4 mo)
treat with anticholinergic like benztropine, antihistamine, benzodiazepine, dopamine agonist
do not give parkinsonism l dopa! that will make psychosis worse.
257
how to treat NMSMS
1. STOP medication 2. D2 agonist like bromocriptine, dantrolene sodium
258
which antipsychotic can cause jaundice and purple gray rash over sun exposed areas?
chlorpromazine
259
which atypical is weight neutral but prlongs QTC? which atypical is weight neutral but causes akathisia?
QTC prolongation: ziprazadone; akathisia: arapriprazole
260
which atypical is most likely to cause orthostatic hypotension? what else can it cause.
quietiapine. it has alpha blocking properties. also cataracts.
261
polysomnogram of depressed patient
decreased REM latency and more REM overall
262
which medications might cause depression
beta blockers, IFN, amethyldopa, OCPs, ETOH, cocaine/amp withdrawal, opiates
263
medical causes of depression
HIV, hypothyroidism, porphyra, uremia, lyme, cushings, liver dz, huntingtons, MS, lupus, L-MCA stroke
264
which SSRI has the most drug-drug interactions? which has fewest?
most: paroxetine (p450 metabolism in liver). least: citalopram.
265
which SSRI is most likely to cause headache, dizziness, irritability, and fatigue upon abrupt dicontinuation
sertaline and fluvox have shortest half lives and are most likely to cause serotonin discontinuation syndrome
266
what SSRI should you avoid in hypertensive patients? what homeopathic med can't you take this srug with?
venlafaxine. also can't take it with st. johns wort.
267
how do you treat hypertensive crisis from MAO and bad diet
discontinue. treat with IV alpha blocker like phentolamine
268
75 yo patient with symptoms of mania. what is it likely?
not bipolar- too late. in older patients, think medical causes. right MCA stroke.
269
how do you treat lithium overdose.
fluid rescusitation. dialysis if levels are >4 or if kidney disease
270
bipolar- taking meds. gets agranulocytosis. which drug was taken?
carbamazepime.
271
bipolar in preggos? how to treat?
ECT and benzos
272
bipolar + increase AFP in a 20 week preggo. what drug were they taking?
valproic acid or carbamazepime. they cause neural tube defects-> increased AFP. repro age female should eat 4g folate daily
273
what s the most common side effect of carbamezpime
rash (can progress to stevens johnson syndrome)
274
therapeutic levels of valpric acid and carbamzepime
VP: 6-12
Carb: 60-120
275
who can't you give benzos to
drug addiction history, COPD, restrictive lung disease
276
somatization disorder criteria
onset before age 30. 4 pain sxs, 1 GI sx, 1 sexual sx, 1 pseudoneuro sx
277
how does dantrolene sodium work
dissociates excitation-contraction coupling in skeletal muscle by decreasing intracellular calcium, inducing skeletal muscle contraction. used for rigidity from NMS
278
how does bromocriptine work
stimulates dopamine receptors, inhibits anterior pituitary prolactin secretion (dopamine agonist). used for NMS. also for hyperprolactinemia.
279
dyssomnia vs. parasomnia
dyssomnia: disturbance in amount, quality, or timing of sleep
parasomnia: abnormal events in behavior or physiology during sleep
280
how long is REM cycle? how often does it happen? REM as you get older? REM after sleep deprivation?
REM cycle is 10-40 minutes every 90 minutes. amount of REM decreases with age. REM rebound is an increase in the amount of REM after sleep deprivation
281
what labs do check in restless leg syndrome
iron level. creatinine. treat with dopamine agonist
282
treatment for narcissistic PD
indiviudal therapy- they don't do well in group therapy. kind of have to buy into narcissism in treatment.
283
social phobia vs. avoidant personality disorder
avoidant PD is more pervasive. social phobia is fear of embarrassment. avoidant is fear of rejection and a sense of inadequacy.
284
antisocial PD vs narcissitic PD
both exploit others. antisocial PD wants material gain or subjugation of others. Narcissistic PD become depressed when they don't receive the recognition they think they deserve.
285
EEG findings of delirium and psychosis.
psychosis EEG is normal. delirium is diffuse background slowing of background rhythm
286
alzheimers on MMSE
can't remember 3 words, even with promptin
287
genes of alzheimers
APP (on chr 21- thats why people with down syndrome get more alzheimers) and Apo E E2
288
treatment of alzheimers
donazepil, memantidine (NMDA receptor antagonist- second line- add as an adjunctive), rivastigmine, galantamine (diarrhea). acetylcholinesterase inhibitors-> give more acetylcholine in synapse.
289
what are the three most common causes of dementia
alzheimers (50-60%); vascular dementia (10-20%), major depression (pseudo dementia)
290
minimum workup to exclude reversible causes of dementia
CBC, electrolytes, TFTs, VDRL/RPR, B12 and folate levels, brain CT or MRI
291
dementia + stepwise increase in severity + focal neurologic signs
multi-infarct dementia. do CT/MRI
292
dementia + cogwheel rigidity+ resting tremor
lewy body dementia or parkinsons. tests= clinical
293
dementia+ obesity+ coarse hair + constiption+ cold intolerance
hypothyroidism. test T4, TSH.
294
dementia + diminished position/vibratory sense + megaloblasts on CBC
vitamin B12 deficinecy. test b12
295
dementia + tremor + abnormal LFT + kayser fleischer rings
wilsons disease. test for ceruloplasmin
296
dementia + diminished position and vibration senses + Argyll Robertson Pupils
(argyll robinson pupils: accommodation response present, response to light absent)- neurosyphilis. test cerebrospinal fluid fluorescent treponemal antibody absorption test (CSF FTA-ABS) or CSF VDRL
297
alzheimers criteria
memory impairment plus at least one of the following. aphasia, apraxia, agnosia (can't recognize things that were previously known), diminished executive function (plan, organize, abstract)
298
alzheimers physiology
loss of noradrenergic neurons in locus coerulus-> decreased acetylcholine.
loss of cholinergic neurons in basal nucleus of meynert of midbrain-> decreased norepinephrine
299
path of alzheimers
gross: diffuse atrophy with enlarged ventricles and flattened sulci. microscopic: senile plaques of amyloid protein, neurofibrillary tangles from Tau proteins, neuronal and synaptic loss
300
picks disease/frontotemporal dementia vs alzheimers
very similar. FTD has more personality and behavioral changes. intraneuronal inclusion bodies (Pick bodies).
301
dementia vs. pseudodementia sympotms
sundowning common in dementia but not in pseudo (more confusion at night). dementia- guess at answers (confabulate), pseudo- answers i don't know. pseudo- aware of problems
302
how to treat picks disease/FTD
treat behavioral problems with olanzipine
303
lewy body dementia symptoms.
hard to tell form parkinsons. shuffling gait. key= fluctuations in consciousness and visual hallucinations
304
what do you give lewy body dementia
not antipsychotics or benzos- paradoxical rxn occurs.
305
pristiq
desvenlafaxine. good at menopause. snri
306
wellbutrin side effects besides seizures
anxiety bc its activating
307
how does mirtazapine work
block alpha 2 receptor- disinihibit SE and NE. same effect as SNRI but diff function (SNRI blocks repute of SE and NE)
308
which antidepressant if nauseous on chemo
mirtazapine. blocks 2a nd 2c and 3. doesnt block 1a. get all therapeutic effects of antidepressant but without sexual disfunction an nausea. you also histamine receptor.
309
what is the therapeutic level of nortryptiline
50-150
310
which MAOI is similar to buproprion
tranylcipramine
311
can you use trazadone with a MAOi
yes- they work at diff receptors
312
why does eating tyramine with MAOI bad
MAO blocks MAOa (degrade monoamines) and MAOb ( degrade tyramine)
313
what if you see triphasic bursts on eeg
CJD
314
how long since last drink do you see tonic clonic seizures
avg 12-48 hours. bimodal peak at 8 and 48.
315
reflexes in alcohol withdrawal?
there is hyperreflexia
316
what is the most specific test for ETOH consumption in the past 10 days
carbohydrate deficient transferin. also increased GGT. AST/ALK>2
317
what symptoms do you expect in opiate withdrawal
joint and muscle pain, photophobia, goosebumps, diarrhea, tachycardia, HTN, GI cramps, dilated pupils, anxiety/depression (Juicy- things get wet)
318
how to treat opiate withdrawal.
treat symptoms. clonidine for autonomic sxs. ibuprofen for muscle cramps. loperamide for diarrhea,
319
when do kids begin to think abstractly
around 11. formal operational starts.
320
what is the most common cause of inherited MR
fragile X
321
methylphenidate vs. amphetamine
methylphenidate blocks DA reuptake. amhetamine (adderall) blocks DA/NE reuptake and stimualtes release. both have side effects of anorexia, nausea, increased HR and BP, stunted growth
322
how long do you need sxs for conduct disorder? for ODD?
CD: 6 mo. ODD:1 yr
323
normal grief vs. abnormal grief in bereavement
normal: 1 year. Normal: hallucinations. abnormal: hallucinations or delusions. no attempt to return to life, significant sleep disturbance or weight loss
324
after administering an anti cholinesterase, patient gets nausea, vomiting, and seizure. what to give?
atropine= anticholinergic
325
patient with HIV is depressed, low energy and hopeless. what to give?
medically ill patients with depressive disorders may respond to psychostimulants- rapid onset of action and rapid clearance are beneficial
326
signs of inhalant intoxication? OD?
intoxication- impaired judgment, belligerence, impulsivity, perceptual disturbance, lethargy, dizziness, nystagmus, tremor, muscle weakness, hyporeflexia, ataxia, slurred speech, euphoria, stupor, or coma. OD may be fatal secondary to respiratory depression or arrythmias. Long term use may cause permanent damage to CNS, PNS, liver, kidney, and muscle.
327
staring into space and euphoria. which drug?
PCP
328
what bipolar treatment can cause hair loss
divalproex sodium
329
a woman in labor with schizophrenia is acutely psychotic. what medicine is pretty safe?
haldol. high dose antipsychotic (typical)
330
A 16 year old girl with abdominal cramps, confusion, palpitations, and muscle twitching
nicotine intoxication
331
which SSRI may increase blood pressure at higher doses. what is its mechanism of action?
SNRI like venlafaxine. It inhibits the repute of serotonin and at higher doses, inhibits norepinephrine.
332
which SSRi inhibits the repute of serotonin most specifically
citalopram
333
what is called when one thinks that others can hear his thoughts
thought broadcasting. in schizophrenia
334
nymphomania vs satyriasis
nymphomania in women and satyriasis in men. both mean insatiable sexual desire.
335
competence vs. capacity
competence= legal term and can only be decided by a judge. capacity= clinical term assessed by physicians
336
criteria for capacity
1. can communicate a choice or preference. 2. understands the relevant info regarding treatment-purpose, risks, benefits, and alternatives- can explain this info to you. 3. appreciates the situation and potential consequences 4. can logically manipulate info and reach logical communication
337
tangential vs flight of ideas
flight of ideas is a very fast stream of tangential thoughts
338
delusions are in which part of MSE
they are a disturbance in thought content
339
childhood disintegrative disorder
normal development first 2 years of life. then loss of previously acquires skill sin language, social skills, etc. onset age 2-10. cause unknown. B:F 4:1.
340
physiology of most delirium in elderly from medicines
delirium related to blockage of acetylcholinergic receptors. Ach is related to memory processes in the brain.
341
what percent of patients with complex partial epilepsy experience psychotic symptoms at some time
20%
342
blockade of which NT in an elderly person would most likely result in a cognitive decline
ACH
343
which sign is most closely associated with lithium toxicity
abdominal pain
344
can you take antipsychotics during ECT
yes. they lower seizure threshold which can even make the ECT more effectvie
345
how does clozapine affect glucose
it increases liver gluconeognesis.
346
do you need weight gain to get diabetes after taking zyprexa or clozapine?
no- some just get diabetes without weight gain
347
should you put patient on clozapine or zyprexa on prophylactic metformin
yes you can. studies show that it does work- but it might not work in real life as much as in studies
348
how do we augment antidepressant when it doesnt work
add a little antipsychotic. we don't know how effective this is but its standard practice and its public health issue- both cause weight gain
349
which antidepressants are more weight gaining
the ones that are more anti-histaminic (maybe)
350
what medications can offset weight gain
amphetamines (but cause tarry stools), topamax,
351
weight loss with welbutrin?
avg weight loss is about 4 lbs
352
benzo withdrawal?
not necessarily autonomic sxs. can feel sxs of anxiety
353
can you use SNRI for anxiety?
yes- even though its activating, they've been shown to be very effective
354
which benzo for prophylaxis of panic attacks an anxiety
klonopin
355
what determines how quickly a benzo takes effect
lipid solubility. doesnt have to do with how quickly metabolized
356
is benzo OD (w/o comorbidities) lethal?
yes. just do supportive treatment. could use flumzenil but usually just use that for benzo users in ECT
357
what is mechanism of buspar
serotinin 1A partial antagonist. some dopamine properties as well.
358
what is tourettes comorbid with
OCD
359
child with ADHD and OCD and a tic- what meds
not stimulant- that can make tics worse.
360
- atomexetine (strattera)
norepinephrine reuptake inhibitor used to treat ADHD
361
what type of dementia looks like delirium
vascular- it gets worse very quickly
362
downside of depot antipsychotics
if they have NMS- you can't get rid of it quickly
363
lithium OD
not thyrotox, kidney tox (thats long term side effects). tremors, stomach pain
364
name five high potency antipsychotics
halopridol, fluphanezine, pimozide, thithixene, trifluoperazine
365
name five mid potency antipsychotics
perphanazine, molindine, loxapine
366
name three low potency antipsychotics
chlorpromazine, mesoridazine, thioridazine
367
what typical antipsychotics have IM forms available? depot?
IM: haloperidol, fluphanezine, perphanizine. depot: haloperidol, fluphanezine.
368
what parts of body can tradeoff dyskinesia be
involuntary choreoathetoid movements of face, neck, trunk, and extremities
369
how can parkinsonism be treated from antipsychotics (4)
anticholinergics, dopaminergric agents (amantidine) or beta blockers
370
seizures and antipsychotics
typical antipsychotics lower seizure threshold
371
can antipsychotics affect skin?
yes. dermatitis and photosensitivity
372
which pathways do atypicals affect
block D2 in mesolimbic: efficacious against positive symptoms. block D2 in mesocortical tract-> worsen negative sxs. block D2 in nigrostriatal->EPS, block D2 in tuberoinfundibulnar-> hyperprolactinemia
373
what is mechanism of action of atypical antipsychotics (exact receptors).
D2 blockade and serotonin 2A blockade. also block muscarinic, alpha-adrenergic, and histamine-1 to varying degrees.
374
atypicals and mania
atypicals (with the exception of clozapine) have recently won indications for acute mania. olanzipine and arapiprazole are indicated for prophylaxis of recurrent mania or bipolar maintenance.
375
which receptors does olanzipine work at
like clozapine, wide antagonism at 5HT2A, D1, D2, D4, H1, muscarinic, and alpha 1
376
which atypicals have an IM form? dissolvable tab? depot?
IM: risperidone, olanzipine, ziprasadone. depot: risperidone. dissolavable tab: risperidone, olanzapine
377
which receptors does quietiapine work at
antagonist at 5HT2A, D2, Alpha-1, alpha-2, H1.
378
which receptors does ziprasadone work at
antagonist at 5HT1A, 5HT2A, D2, D3, monoamine reuptake pumps (NE, 5HT, DA)
379
which receptors does aripiparzole work at
antagonist at 5HT2A, partial agonist at D2 and 5HT1A.
380
which atypical is a metabolite of risperidone?
paliperidone (Invega). possibly less EPS than risperidone.
381
Which atypical antipsychotic can be given for depression?
Aripiprazole. It is antagonist at 5HT2A AND partial agonist at D2 and 5HT1A.
382
mechanism of action of typical CNS stimulants vs. novel ones
typical: stimulate alpha and beta adrenergic receptors-> release dopamine and norepinephrine from presynaptic terminals. novel: mechanism not clear for monadical. atomoxetine is related to selective inhibition of repute of norepinephrine.
383
side effects of novel vs. typical CNS stimulants
both have anxiety, anorexia, insomnia
typical: tachycardia, drug dependence, HTN, cardiac arrhythmia, cardiovascular collapse.
novel: dizziness, rhinitis, sexual dysfunctions. atomocetine: suicidal ideation and severe liver injury
384
which stimulants can be given or narcolepsy
typical CNS stimulants. modanifil (provigil). not atomoxetine.
385
ADHD with narrow angle glaucoma. what to give?
modanifil (provigil). not atomoxetine or typical.
386
which stimulant can you coadminister with MAOI
NONE
387
what is pemoline
CNS stimulant.
388
can you give lamotrigine with valproic acid
not really- there are boosted blood levels
389
which two mood stabilizers are ineffective as mono therapy for mania
gabapentin and topiramate
390
do you need blood monitoring for oxcarbazepine (trileptal)
no- compared to carbamexepine, it has much less potential for hematologic, dermatologic, and hepatotoxicity
391
which mood stabilizer can cause nephrolithiasis
topiramate
392
what do you need to monitor on valproic acid? for carbamezpine? lithium?
all: therapeutic blood monitoring
VP: blood count, liver, and pancreatic function testing.
carb: blood count, liver, metabolic function testing.
lithium: thyroid and kidney monitoring
393
how does gabapentin work? where is it excreted
GABAergic. excreted renally so caution in renal disease.
394
which mood stabilizer can be rapidly loaded for quicker therapeutic effect
valproic acid
395
adverse effects of valproic acid versus carbamazepine
both: nausea, vomiting, diarrhea, sedation, lightheadedess, tremor, cognitive blunting, weight gain.
carb: electrolyte abnormalities (hyponatremia), anticholinergic, .
VP: hair loss
396
serious adverse effects of carbamazepine vs. VP
both: thrombocytopenia.
Carb:blood dycrasias (aplastic anemia, agranulocytosis,), hepatotox.
VP: hemorrhagic pancreatitis hepatotoxicity polycystic ovaries
397
OD for carbazempine for VP
both: tremor, coma, and death
398
Adverse effects of MAOi vs TCA
Both: orthostatic hypotension, sexual dysfunction, weight gain, mania in bipolar
TCA: anticholinergic (dry mouth, constipation, blurry vision, urinary retention, confusion, ECG changes), seizures, sedation
MAOI: myoclonus, muscle pains, parasthesias, insomnia
399
Serious side effects in TCA vs MAOI
TCA: cardio toxicity (slow cardiac conduction-> arrhythmia, AV block), neurotox (tremor and ataxia; in OD, agitation, delirium, coma, death)
MAOI: tyramine induced HTN crisis
400
Mechanism of action of TCA
Antagonism at 5HT and NE pre synaptic re-uptake pumps. Also block muscarinic, alpha adrenergic, and histamine 1 receptors
401
Tertiary amines vs secondary amines
Tertiary amines have greater HAM blockade. Newer secondary amines have fewer side effects and are less sedating, and are safer in OD
402
What are 5 tertiary amines
Amitryptiline (elavil), clomipramine (anafranil), doxepin (sinequan), trimipramine (surmontil), imipramine(tofranil)
403
Which atypicals can be used for adjunctive treatment for depression
Aripiprazole and quitiapine
404
Which two atypicals can be used for bipolar depression
Latuda and quetiapine
405
What is side effect of ziprasadone to worry about
Possible increased risk of QT prolongation
406
What are 3 secondary amines
Desipramine (norpramin), nortryptyline (Pamelor), protryptiline (vivactil)
407
Which TCA is least anticholinergic
Desipramine (norpramin)- secondary TCA
408
Which TCA causes least orthostatic hypotension
Nortyptiline (Pamelor)
| This is the demethylated version of amitryptaline (elavil)
409
Uses for amitryptaline vs doxepin
Both are for pain and insomnia. Amytryptiline is for headache. Doxepin is for anxiety.
410
Which MAOI has fewer dietary restrictions s
Transdermal selegeline
411
What are three MAOIs
Phenylzine, tranylcypramine, transdermal selegeline
412
How long do you have to wait after MAOI before starting ssri
2 weeks
413
Mechanism of action of SNRI
Selective antagonism of NE and 5HT reuptake pumps. No HAM- kosher
414
What happens when you discontinue SNRI
You can get headache, dizziness, irritability, and fatigue (just like with discontinuation of SSRI)
415
What are serious side effects of mirtazapine
Agranulocytosis and other blood dyscrasias
416
mechanism of action of benzos
binding site on GABA(A) receptor-> potentiates GABA by causing increased FREQUENCY of chloride channel openings
417
what are three long half life benzos
clonazepam, diazepam (valium), chlordiazepoxide (librium)
418
what are three nonbenzo anxiolytics
buspirone, hydrozyzine (sedating antihistamine), propranolol (beta blocker)
419
how do nonbenzo hypnotics work
all but diphenhydramine and ramelteon are GABAergic
420
which nonbenzo hypnotic leads to progressive tolerance and dependence
zolpidem (ambien) and zaleplon (sonata)
421
which nonbenzo hypnotic can you dose in the middle of the night
zalpeplon (sonata)- it is short acting
422
which GABAergic nonbenzo hypnotic does not yield tolerance
eszopiclone (Lunesta)
423
ramelteon?
agonist at melatonin MT-1 and MT-2 receptors, thought to normalize circadian rhythms
424
which nonbenzo hypnotics cause GI probs
zolpidem: nausea, vomiting, GI distress.
zaleplon: dizziness and dyspepsia
425
hydrozyzine versus diphenhydramine
hydrozyzine is more for situational anxiety, diphenydramine is more for sleep
426
what non chart drugs for ADHD
guanfacine and clonidine
427
what drugs cause QT prolongation
typicals, TCAs, ziprasadone,
428
which mood stabilizers treat mania
lithium, carbamazepine, VP
429
how is clozapine dosed and monitored
12.5 mg daily BID + 25/50mg daily-> target to 200-450 mg daily-> + 100 mg/day-> max is 900 mg/day
430
how often do you monitor clozapine
first 6 months: weekly monitoring.
months 6-12: monitor every 2 weeks.
after 12 months, you monitor every 4 weeks
