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Flashcards in Psychiatry Deck (90):
1

Antipsychotic causing loss of night vision & ultimately blindness

Thioridazine --> retinitis pigmentosum

2

Priapism treatment

Epinephrine into corpus of penis

3

MAOI main side effect

Hypertensive crisis from tyramine foods (wine, aged cheese, liver, smoked foods)

4

How much time needed when switching from SSRI to MAOI or vice versa?

5-6 weeks minimum --> Serotonin Syndrome results if not enough time b/w switching

*If changing to/from Fluoxetine --> need MORE time b/c of it's longest half-life

5

Bupropion contraindications?

*Alcoholics (SEIZURE risk)
*Eating disorders - bulimia/anorexia (**C/I in anorexic patients b/c of electrolyte imbalances!)
*Epilepsy

*Low sexual side effects!

6

Antipsychotic that causes agranulocytosis?

Clozapine (can get neutropenic fever)

7

Drug class famous for QT prolongation, cardiac arrhythmias & coma, leading to death?

TCAs --> 3 C's of overdose (cardiotoxicity, convulsions, coma)

Tx: IV NaHCO3

8

Treatment for Lithium overdose?

It is cleared by the KIDNEY so you need dialysis

If Lithium levels get too high when trying to titrate appropriate dose, simply STOP THE MEDICATION until levels return to therapeutic range

9

Benzo/EtOH overdose antidote?

Flumazenil --> only if ACUTE intoxication

10

Chlorpromazine side effects

Corneal deposits, blue-green skin discoloration

11

Neuroleptic Malignant Syndrome signs & antidote

FEVER:
Fever
Encephalopathy
Vitals unstable
Elevated CPK & leukocytosis
Rigidity of muscles & myoglobinuria

**Muscle rigidity & fever**

Tx: dantrolene

12

Drugs that cause Serotonin Syndrome

Sinners Sell Drugs That MAke ME TRIP

St. John's Wort
SSRI's
Dextromethorphan
TCAs
MAOIs
Meperidine
Triptans

13

Lithium side effects & factors causing toxicity

Side effects --> LMNOP
Lithium causes
Movement disorders (tremor, ataxia)
Nephrogenic diabetes insipidus (polydipsia, polyuria)
hypOthyroidism
Pregnancy problems (Ebstein's anomaly of tricuspid valve)

Causes of increased Li levels:
- Thiazides (increased PCT reabsorption of Na & Li)
- NSAIDs (afferent arteriole vasoconstriction and decreased GFR)
- ACEi
- Dehydration
- Salt depravation
- Impaired renal fxn

14

Serotonin Syndrome characteristics

In order of appearance: diarrhea, restlessness, extreme agitation, hyperreflexia, autonomic instability, myoclonus, seizures, hyperthermia, rigidity, delirium, coma, death

15

DOC for anticholinergic (anti-ACh) delirium?

Physostigmine

16

Main side effects of TCA's?

- Anti-ACh (dry mouth; red as beet, mad as hatter, dry as bone, etc.)
- Cardiotoxicity (increased QT interval)
- LETHAL in overdose --> caution for depressed patients b/c of possible suicidal ideations

**Patient w/ depression presenting w/ anti-cholinergic signs & EKG abnormalities**

17

2 main types of s/e of SSRI's?

1) GI s/e (especially paroxetine)
2) Sexual dysfunction (impotence, delayed ejaculation, decreased libido, anorgasmia)

18

Mood stabilizer associated w/ polycystic ovarian disease?

Valproic Acid

19

Side effect of Topiramide?

Kidney stones

20

2 psych drugs that DECREASE suicidal ideations?

Lithium, clozapine

21

Criteria for Substance Abuse?

1 criteria for > 1 year:
- Work/school impairment
- Hazardous situations
- Social problems
- Legal problems

22

Criteria for Substance Dependence?

3+ criteria for > 1 year:
- TOLERANCE for drug (more needed to achieve same effect as before)
- Withdrawal s/s
- Increased amt consumed
- Increased time spent obtaining substance
- Activities given up b/c of substance
- Can't quit despite knowledge of physical harm

23

2 screening tests for EtOH abuse/dependence?

MAST (michigan alcohol screening test)
AUDIT (alcohol use id test)

24

EtOH/Benzo's overdose symptom?

**Nystagmus

Slurred speech, ataxia

25

Classic cocaine scenario?

Person who needs a smoke break every 15-20 minutes

26

Narcotic overdose symptoms?

**Miosis

27

PCP overdose symptom?

Violence

28

Marijuana overdose symptoms?

Slowed time perception
Increased appetite
Conjunctiva injection

29

DOC for narcotic withdrawal?

Clonidine

30

Narcotic withdrawal s/s?

Mydriasis, gooseflesh, rhinorrhea, muscle aches

31

Amphetamine/cocaine/stimulant withdrawal s/s?

Fatigue, increased appetite, vivid/unpleasant dreams

32

Wernicke's encephalopathy symptoms?

Korsakoff's psychosis symptoms?

Wernicke's: confusion, ataxia, intranuclear ophthalmoplegia, delirium

Korsakoff's: confabulations

33

Type of eating disorder where patient is a "perfectionist"

"Young patient who is extremely competitive and high-achieving with a low BMI (< 18.5)

Anorexia Nervosa

34

Only time to use benzo's for delirium?

DT's!!!

35

Side effects of atypical antipsychotics?



Method of administration for non-complaint patients?

- Olanzapine & Clozapine: hyperlipidemia, increased blood glucose
- Clozapine: agranulocytosis (neutropenic fever)
- Quetiapine: cataracts
- Risperidone: increased prolactin (amenorrhea, decreased sex drive, galactorrhea), akathisia (high doses)
- Ziprasidone: increased QT interval

*Can be given in IM injections that last 2 weeks (depot form) for non-complaint patients

36

Impotence?

Inability to attain an erection - caused by organic, psychogenic, substance use

In questions, look for a temporal (what recently happened) relationship to the impotence --> diabetic w/ depression recently consumed EtOH (all 3 of these can relate to the impotence)

37

DOC for delirium in elderly patients?

Haloperidol (small dose)
NOT benzo's!!!

38

DOC for peripheral neuropathy?

TCA's

39

TCA for OCD?

SSRI for OCD?

Clomipramine

Fluvoxamine

40

Increased incidence of OCD in patient's w/ first-degree relatives w/ psychiatric disorder?

Tourette's

41

Anti-emetic with side effects of EPS?

Prochlorperazine

*Tx these w/ antiparkinsonian meds (benztropine)

42

Lymphadenopathy + oral thrush + cognitive deficits w/ mood disturbance?

AIDS --> order an ELISA (confirm HIV)

43

Common BP medication that causes depression?

Propranolol

44

Oppositional defiant vs conduct disorder

ODD: NO violation of social norms --> just argue & annoy

Conduct d/o: violation of basic rights of others or social norms (physical harm, lying/deceitful, stealing)

45

What is pathognomonic for narcolepsy?

DOC?

Cataplexy --> sudden loss of muscle tone (falling down) precipitated by loud noise or intense emotion

DOC: modafinil

46

Patient has progressive memory loss, drips urine/can't control his bladder, and can't walk straight/needs assistance walking. What does he have and what diagnostic tests would be warranted?

Normal Pressure Hydrocephalus (NPH)

CT w/ Lumbar Puncture --> normal opening pressure & therapeutic for excess CSF. Enlarged ventricles seen on CT

47

What drug is someone taking that has new-onset amenorrhea, infertility, sexual dysfunction (decreased sex drive), galactorrhea, wt gain?

Risperidone --> increases prolactin levels

It blocks dopamine from binding to lactotrophs in pituitary & blocking release of prolactin --> uninhibited release of prolactin --> see s/e

48

Neuroleptic Malignant Syndrome (NMS)?

*ANY antipsychotic (typical or atypical) with either:

S/S:
**Muscle rigidity
**Fever

and/or
Increased WBC or CPK

Tx: STOP medication
- Can give dantrolene/bromocriptine

49

Serotonin Syndrome?

Usually from a result of medications that increase SEROTONIN levels

S/S:
**Tremors
**Myoclonus

and NO labs needed (unlike NMS)

50

Neuropsychological screening tests?

Halstead-Reitan
Luria-Nebraska

51

Depression rating scales?

Beck Depression Scale
Hamilton Depression Scale

52

Bipolar rating scale?

Youngs Mania Rating Scale

53

What antidepressant is good for helping w/ sleep?

Trazadone

54

At low/medium doses, this drug is sedating. At high doses, it acts as an anti-depressant?

Mirtazapine

55

Treatment of acute dystonia?

Anticholinergic meds/with these s/e --> benztropine, diphenhydramine, trihexyphenidyl

56

Patient presents w/ manic symptoms w/ dilated pupils?

Cocaine

57

Tx of choice for agitation & paranoia in the elderly demented patient?

Low dose atypical antipsychotic

58

2 other psychiatric conditions associated w/ Tourette's?

ADHD
OCD

59

Atypical antipsychotic that does NOT cause weight gain or sedation?

Ziprasidone

General rule:
"-pine" --> weight gain
"-done" --> sedation

60

SSRI that causes withdrawal symptoms if stopped abruptly?

Paroxetine

61

Mood stabilizer that INACTIVATES oral contraceptive pills (OCPs)?

Carbamazepine

62

Difference between sleep terror & nightmare?

do NOT remember sleep terror in morning

remember nightmares

63

Side effects of antipsychotics & risperidone?

Increase prolactin levels b/c of decreased dopamine levels --> look for galactorrhea, amenorrhea, impotence, decreased libido

64

Typical presentation of Rett syndrome?

Girl with normal development up until 5 months of age --> then progressive encephalopathy

*Small head
*Hand-wringing gestures
*Loss of speech
*Ataxia

*ONLY in girls!!!

65

What class of drugs (non-psych drugs) can cause depression?

anti-HTN --> B-blockers, reserpine

66

What drug side effect do you suspect with fatigue, slow movements, dry skin, hair loss, voice change?

Lithium --> drug-induced hypothyroidism

67

When is psychiatric consultation the correct answer?

ONLY with overdose from a SUICIDE ATTEMPT

68

Treatment for borderline personality disorder?

Dialectical behavioral therapy (DBT)

69

Most common compulsion in OCD?

Excessive grooming, hand washing, tooth brushing, etc.

70

What medication is used in treatment-resistant schizophrenia?

What is the side effect you need to monitor?

Clozapine

Agranulocytosis

71

Emotional or behavioral symptoms develop in response to an identifiable stressor that occurs within 3 months of the stressor - what is it? What else is present?

Adjustment disorder

Significant impairment of patient's life and disrupts daily activities

72

Person with acute onset psychosis (delusions, hallucinations, disorganized speech) - what is the best initial treatment?

2nd-gen antipsychotics (non-typical)

NOT clozapine b/c of agranulocytosis --> used for treatment-resistent psychosis

73

Common side effect of methylphenidate for ADHD treatment?

**Decreased appetite
Nervousness
*Wt loss
*Insomnia
Abdominal pain

74

What pathway is involved in the action of antipsychotics blocking dopamine release?

Tuberoinfundibular pathway

*High prolactin (amenorrhea, gynecomastia, sexual dysfunction)

75

What drugs can cause Neuroleptic Malignant Syndrome?

S/S?

Tx?

Antipsychotics - anything that blocks dopamine

S/S: fever, muscle rigidity, confusion, altered mental status

Tx: dantrolene, renal diuretics to prevent rhabdo

76

Congenital defect of Lithium?

Ebstein anomaly - atrialization of the R ventricle

77

Treatment of acute panic attacks?

Lorazepam

78

Difference between dependent and avoidant personality disorders?

Dependent = clingy, excessive need to be cared for, submissive

Avoidant = shyness (social isolation), lacks self-esteem, fear of embarrassment or rejection, hypersensitive to criticism

79

Lifetime risk for someone to have manic episode with a first-degree relative with bipolar disorder?

What if both parents have bipolar disorder?

5-10%

60%

80

Sudden onset confusion and fever in 29 yo male. He was recently admitted to the hospital for hallucinations and was discharged in stable condition. His temp is 101.6 and he is profusely sweating. Abdominal muscles are rigid. Muscle tone is increased and "lead-pipe rigidity" is noted in all 4 extremities. What is the cause?

Drug-induced idiosyncratic reaction

*Neuroleptic Malignant Syndrome (NMS) --> look for recent use of antipsychotics

*Rigidity and hyperthermia

81

Maintenance therapy for bipolar disorder?

1) Mild-moderate = atypical antipsychotics OR monotherapy with lithium/valproic acid

2) Severe = combination of lithium/valproic acid + atypical antipsychotic

82

How many bipolar episodes (manic) do you need to be on lifetime lithium?

2+

83

DOC for delirium in:

Elderly?
Younger?

Elderly = Haloperidol
*NO benzo's

Younger = benzo's

84

What is Delayed Sleep Phase Syndrome?

Sleep-wake disorder characterized by sleep-onset insomnia + excessive morning sleepiness

Usually "night owls" and have chronic problems going to sleep before midnight

*Sleep is normal when they are allowed to set their own schedule

85

Preferred medical treatment in GAD?

SSRI's

86

Neuroimaging findings in:

Autism?
OCD?
Panic disorder?
PTSD?
Schizophrenia?

Autism = INCREASED total brain volume

Ocd = Orbito-frontal cortex + striatum

pAnic disorder = decreased volume of Amygdala

PTSD = decreased hippocampal volume

Schizophrenia = enlargement of cerebral ventricles

87

Characteristic of generalized anxiety disorder?

Excessive anxiety about multiple EVENTS/SITUATIONS

88

Findings in obsessive-compulsive personality disorder?

Perfectionism
Carry out activities in extremely methodical way
Extremely rigid, meticulous, focused on perfection

89

Child with poor communication and reduced verbal expression in a specific social setting but behaves normally at home?

Selective mutism

90

What medication can predispose to hypothermia?

Fluphenazine ("typical antipsychotic")

*Disrupts thermoregulation center and body's shivering mechanism