Psych 9

Question 1

What are anti-histamine side effects

Answer 1

Sedation, weight gain

Question 2

What are anti-adrenergic side effects?

Answer 2

Hypotension

Question 3

What are anti-muscarinic side effects?

Answer 3

Dry mouth, blurred vision, urinary retention, constipation

Question 4

What is hypertensive crisis

Answer 4

Caused by a build up of catecholamines; caused by combo of MAOIs with tyramine-rick foods (e..g red wine, cheese, chicken liver, cured meats)

Question 5

4 components of extra-pyramidal side effects

Answer 5

1. Dystonia
2. Akathisia
3. Parkinsonism
4. Tardive dyskinesia

Question 6

Tx of EPS caused by antipsychotics

Answer 6

Benztropine

Question 7

What psych drugs cause hyperprolactinemia

Answer 7

FGA, Risperidone

Question 8

Inducers of CYP-450

Answer 8

♣	Corona, Guinness, 'N' PBRS induce Chronic alcoholism
•	C - Carbamazepine
•	G - Griseofulvin
•	N - Nevirapine
•	P - Phenytoin
•	B - Barbiturates
•	R - Rifampin
•	S - St. John's Wort
•	Chronic alcoholism

Question 9

Psych meds that inhibits CYP-450

Answer 9

SSRIs (Fluoxetine, Paroxetine, Duloxetine, Sertraline)

Question 10

What is the withdrawal phenomenon associated with antidepressants

Answer 10

Flu-like sx: Dizziness, HA, nausea, insomnia, malaise

Question 11

Side effects of TCAs

Answer 11

THINK: 3 C’s

o Antihistamine = weight gain, sedation
o Antiadrenergic = orthostatic hypotension, arrhythmias (block cardiac sodium channel), ECG changes (widened QRS, QT, and PR intervals)
o Antimuscarinic = dry mouth, constipation, urinary retention, blurred vision, tachycardia
o Serotonergic = erectile/ejaculatory dysfunction, anorgasmia
o Seizures

Question 12

Tx of TCA overdose

Answer 12

IV sodium bicarbonate

Question 13

What are the names of the MAOIs

Answer 13

o Tranylcypromine = “try a sip of wine”
o Phenelzine = funnel
o Isocarboxazid = boxed wine
o Selegiline = sledge hammer

Question 14

Describe how Tyramine toxicity/Hypertensive crisis occurs

Answer 14

• Tyramine is a naturally occurring monoamine compound found in aged meats, alcoholic beverages, and fermented dairy products
• Tyramine acts as a catecholamine releasing agent, but before it gets to the general circulation it is metabolized in the GI tract by MAO-A
• But if you inhibit MAO-A, all the Tyramine flows in the circulation and acts as a sympathomimetic agent, displacing NE from neuronal storage vesicles

Question 15

Tx of hypertensive crisis

Answer 15

Phentolamine (a1 and a2-blocker)

Question 16

What are the low potency FGA

Answer 16

Thioridazine, Chlorpromazine

Question 17

Side effect specific to Chlorpromazine

Answer 17

Blue-gray skin discoloration

Question 18

side effect specific to Thioridazine

Answer 18

Retinal deposits

Question 19

Which antipsychotics are available as long-acting injectables (decanoate)

Answer 19

THINK: How Ridiculous, Paying For A hOle

H = Haloperidol
R = Risperidone
P = Paliperidone
F = Fluphenazine
A = Aripiprazole
O = Olanzapine

Question 20

Is tardive dyskinesia reversible?

Answer 20

50% of cases are permanent

Question 21

What is the only antipsychotic shown to decrease the risk of suicide

Answer 21

Clozapine

Question 22

Side effect of Clozapine

Answer 22

Metabolic syndrome, agranulocytosis, myocarditis, seizures

Question 23

What is the only mood stabilizer shown to decrease the risk of suicide

Answer 23

Lithium

Question 24

What lab levels should be monitored while on Lithium

Answer 24

Lithium levels, creatinine, thyroid function

Question 25

What SSRI is used to treat bulimia

Answer 25

Fluoxetine (Prozac) Super high dose

Question 26

Anorexia is most associated with which personality disorders

Answer 26

OCPD and Dependent

Question 27

Bulimia is most associated with which personality disorder

Answer 27

Borderline

Question 28

What drug can be used to treat anorexia

Answer 28

No FDA approved

Question 29

What SSRI has the longest half life

Answer 29

Fluoxetine

Question 30

What SSRI has the shortest half life

Answer 30

Fluvoxamine (think of the V as a down arrow to remember lowest) Paroxetine/Paxil is the MOST common SSRI with short half life

Question 31

What SSRI has the highest rate of QTc prolongation

Answer 31

Citalopram/Celexa But Escitalopram is an isomer of Citalopram that works almost exactly the same but you can use half the dose and still be as effective

Question 32

What does withdrawal from SSRI feel like

Answer 32

Flu-like symptoms + ZAPS (feeling of an electric shock starting at some part of the body and radiating)

Question 33

Which SSRIs are most associated with discontinuation/withdrawal syndrom

Answer 33

Paroxetine/Paxil and Fluvoxamine Because these are the ones with the shortest half life

Question 34

Put these SSRI cards in study guide

Answer 34

Maybe. Hi!

Question 35

How long should you wait for SSRIs to kick in

Answer 35

6-8 weeks

Question 36

How long should you wait after patient has reached expected dose before you up-titrate SSRI

Answer 36

1 week

Question 37

Most common side effect of SSRI

Answer 37

GI distress

Question 38

How long does it take for GI effects of SSRI to go away

Answer 38

3-5 days (80% of patients) 3 weeks (90% of patients)

Question 39

What do you give to a male patient on an effective SSRI but with erectile dysfunction

Answer 39

Add Bupropion/Wellbutrin

Question 40

Time frame for mania

Answer 40

7 days Or hospitalization Or mania + psychosis

Question 41

Time frame for hypomania

Answer 41

4 days

Question 42

What SSRI should you give to non-compliant patients

Answer 42

Fluoxetine (because it has the longest half-life)

Question 43

What effect does SSRI have on suicide?

Answer 43

Can increase suicidal thought in teens and young adults But no known increase in suicide completion

Question 44

What classifies as an "adequate" trial of SSRI

Answer 44

Lasting 6-8 weeks at the dose you expect to work (not the starting dose, because you always titrate up)

Question 45

When should PCP consult psychiatry for SSRI

Answer 45

1. Failed 2 adequate trials of SSRI 2. High severity 3. Many medications 4. Co-morbid psychiatric disorders

Question 46

Effects in adulthood of untreated ADHD

Answer 46

Higher rate of substance use, depression, anxiety disorders, oppositional defiant disorder

Question 47

What is an appropriate age to start ADHD kids on stimulants

Answer 47

Usually 5-6

Question 48

How many inattentive symptoms must a patient have to classify as ADHD, inattentive type

Answer 48

6/9

Question 49

How many hyperactive symptoms must a patient have to classify as ADHD, hyperactive type

Answer 49

6/9

Question 50

What are the criteria for combined type ADHD

Answer 50

6/9 inattentive + 6/9 hyperactive type

Question 51

On Vanderbilt ADHD scale, what numbers count as yes and what as no

Answer 51

``` 0-1 = no 2-3 = yes ```

Question 52

What drugs are used to treat ADHD

Answer 52

Amphetamines/Adderall | Methylphenidates/Ritalin

Question 53

Most common side effect of stimulants

Answer 53

Appetite suppression

Question 54

Do you start with short or long-acting stimulants in ADHD

Answer 54

Long-acting (XR)

Question 55

Why do drug-reps say that Vyvanse cannot be abused

Answer 55

Because Vyvanse is a pro-drug - needs to be processed by the liver before it becomes active drug

Question 56

What is the biggest risk factor for development of ADHD

Answer 56

Genetics - highest genetic association of any psych disorder

Question 57

Treatment options for ADHD

Answer 57

First line = stimulants (methylphenidate, dextroamphetamines) Second line = Atomoxetine or Bupropion Alpha-2 agonists (Clonidine, Guanfacine) can be used instead of or as adjunctive therapy to stimulants

Question 58

Other risk factors for ADHD

Answer 58

In utero exposure to alcohol or nicotine, low birth weight

Question 59

Describe sx of prion disease

Answer 59

* Insidious onset with rapidly progressive cognitive decline * Difficulties with concentration, memory, and judgment occur early * More than 90% of patients experience myoclonus * Depression, apathy and hypersomnia are also common * Basal ganglia and cerebellar dysfunction, manifesting as ataxia, nystagmus, and hypokinesia, are present in a majority of individuals

Question 60

Presentation of Huntington's Disease

Answer 60

* Triad of motor, cognitive, and psychiatric symptoms * Cognitive decline and behavioral changes can precede onset of motor signs by up to 15 years * Executive function is the primary cognitive domain affected * Psychiatric manifestations include depression, apathy, irritability, obsessions, and impulsivity * Patients are often aware of deteriorating mentation * Movement disorders include chorea and bradykinesia