Psychiatry Flashcards Preview

FirstAID > Psychiatry > Flashcards

Flashcards in Psychiatry Deck (167):
1

Positive vs Negative Reinforcement:

Positive: desired reward produces action (ie mouse presses button to get food)

Negative: removal of aversive stimulus elicits behavior (ie mouse presses button to avoid shock)

2

Transference:

patient projects feelings about an important person in life onto physician (like saying that the psychiatrist = parent)

3

Counter-transference:

physician projects feelings about important people in life onto patient

4

Acting out:

-immature defense
-->like tantrums; unacceptable feelings and thoughts are expressed through actions

5

Dissociation:

-->seen in Multiple Personality Disorder (Dissociative Identity Disorder)

-->In order to avoid emotional distress, have rapid, temporary, drastic changes in personality, memory, consciousness, behavior...

6

Displacement:

avoided ideas and feelings are transferred to a neutral person or object

--> like a mother placing blame on child, when really she is angry at her husband

7

Projection:

unacceptable personal internal impulse is attributed to an external souce

-->like a man who wants another woman thinks his wife is cheating on him

8

Fixation:

Partially remaining at more childish level of development
-->like a man who fixates on sports games; or maybe a man who fixates on comic books and superhero movies...

9

Identification:

modeling behavior after another person who is more powerful (not necessarily an admired person though)
-->like an abused child identifying as an abuser (abusing others...)

10

Isolation of effect:

separation of feelings from ideas and events

-->like describing murder in detail without an emotional response; or maybe war veterans having no emotions when talking about war

11

Rationalization:

finding logical reasons for actions that were actually performed for other reasons, to avoid self-blame

-->like after getting fired from a job, person claims that job was not important anyway

12

Reaction formation:

-->process where a warded-off idea or feeling is unconsciously replaced by an emphasis on its opposite

-->like a person with lots of sexual drive entering a monastery

13

Regression:

-->turning back maturational clock and dealing with world immaturely

-->like a child bedwetting after previously being toilet-trained, when under stress (like if ill, hospitalized, punished, birth of new sibling...)

14

Repression:

-->involuntary withholding idea/feeling from conscious awareness

-->like not remembering a traumatic/conflictual experience; push bad thoughts in unconscious

15

Splitting:

-->seen in Borderline Personality Disorder
-belief that people are either all-good or all-bad at different times

16

Which immature defense is seen in dissociative identity/multiple personality disorder?

-->Dissociation

17

Which immature defense is seen in Borderline pts?

-->Splitting

18

List the 4 mature defenses:

"a Mature woman wears a SASH"
-Sublimation
-Altruism
-Suppression
-Humor

19

Sublimation:

-->mature ego defense
-replacing an unacceptable wish with actions that are similar to the wish, but don't conflict with values

-->like a person's feelings of aggression redirected to perform well in sports

20

Altruism:

-->a mature ego defense

-guilty feelings alleviated by unsolicited generosity towards others

-->ie mafia boss making large donation to charity; or former alcoholic who got in an accident while drunk-driving going around talking to teens about risks of drinking and driving...

21

Humor:

-->mature ego defense
-finding amusement in anxiety-provoking situations
-->med students joking about the boards

22

Suppression:

-->mature ego defense
-voluntary withholding idea/feeling from conscious awareness (vs repression, which is unconscious)

-->ie choosing not to think about USMLE scores after the exam, b/c nothing you can do about it :)

23

Effects of infant deprivation:

-Weak (decreased muscle tone)
-poor language and socialization skills
-lack of trust
-Anaclitic depression (from separation from caregiver)
-weight loss
-physical illness

24

Consequences of of prolonged infant deprivation:

*Deprivation > 6months --> can be irreversible
*Severe deprivation can result in infant death

25

Who is usually the abuser in:
-physical abuse?
-sexual abuse?

-->physical abuse: abuser is usually female and primary care giver
-->sexual abuse: abuser is usually male and known to victim

26

methylphenidate

=Ritalin
-->treatment of ADHD

27

Atomoxetine

-->non-stimulant SNRI
-->can be used to treat ADHD

28

Treatment options for ADHD:

-methylphenidate (Ritalin)
-amphetamines (ie Dexedrine)
-Atomoxetine (non-stimulant SNRI)

29

Age of onset of ADHD?

onset before age 7

30

Oppositional Defiant Disorder:

-childhood disorder:

-->hostile, defiant behavior towards authority figures, but don't really violate social norms (like disregard authority, but not the rights of others... unlike conduct disorder)

31

Tourette's syndrome:
-Dx criteria (timing)?
-associated with what other condition?
-treatment?

-onset before age 18, lasts >1 year
-Coprolalia = obscene speech --> only in about 20% of pts
-associated with OCD
-treat with Haloperidol (anti-pyschotics)

32

Typical age of Separation Anxiety Disorder:

-->common onset = 7-9 years old
-->may lead to factitious physical complaints to avoid going to school

33

Intelligence in Autism disorder:

below normal intelligence; but may rarely be accompanied by unusual abilities

34

girl, a few years old, regresses in development, and constant hand-wringing?

Rett's disoder
-->autosomal dominant X-linked disorder (boys die in utero or shortly after birth)
--> symptoms usually start between 1-4 years old; pt regresses from how was: loss of development, loss of verbal abilities, develops mental retardation, ataxia, and stereotyped hand-wringing

35

Boy, 3-4 years old, after at least 2 years of normal development begins regressing in development/skills:

Childhood Disintegrative Disorder
-->more common in boys; onset 3-4 years old
-->Loss of expressive or receptive language skills, social skills, adaptive behavior, bowel or bladder control, play, motor skills

36

Neurotransmitter changes seen in Anxiety:

-Increased NE
-Decreased GABA
-Decreased Serotonin

37

Neurotransmitter changes seen in Depression:

-Decreased NE
-Decreased Serotonin
-Decreased Dopamine

38

Neurotransmitter changes seen in Alzheimer's?

-Decreased ACh

39

Neurotransmitter changes seen in Huntington's?

-Decreased ACh
-Decreased GABA
-Increased Dopamine

40

Neurotransmitter changes seen in Schizophrenia?

-Increased Dopamine

41

Neurotransmitter changes seen in Parkinson's?

-Decreased Dopamine
-Increased ACh
-Increased Serotonin

42

In terms of a person's orientation to person, time, and place - what is the order of loss (what orientation factors are lost first, if lose orientation)?

First --> lose time
Then --> lose place (where one is)
Last --> lose person (knowing who self is)

43

Korsakoff's amnesia:

-->from Thiamine deficiency and the destruction of mammillary bodies
-->anterograde amnesia (can't form new memories); sometimes may have some retrograde amnesia too (also, associated with personality change and confabulations)

44

Dissociative amnesia:

-->can't remember important personal details; usually after trauma or stress

45

Delirium vs Dementia:
-Onset?
-Consciousness?
-Course?
-Prognosis?
-Type of memory Impairment?
-EEG?
-Common causes?

*Delirium:
-Acute onset
-Impaired consciousness
-Fluctuating symptoms
-Reversible
-Global memory impairment
-Abnormal EEG
-usually secondary to other illnesses (ie UTIs, etc) or Drugs (ie anti-cholinergic side effects)

*Dementia:
-Gradual onset
-Intact consciousness
-Progressive decline in symptoms
-Irreversible
-Remote memory spared (remember certain things)
-Normal EEG
-Common causes: Alzheimer's, cerebral infarcts, HIV, Pick's disease, CJD...

46

Pseudodementia:

-->Elderly pts; depression may present like dementia (pt is aware of memory loss, losing stuff, etc though; whereas in real dementia, pt is unaware of these things)

47

A reversible cause of dementia in elderly (and why it's so important to do a head CT in cases of dementia):

Normal pressure hydrocephalus: "wet, wobbly, and wacky" (incontinence + ataxia + dementia)
-->expansion of ventricles; but, NOT an increase in subarachnoid space

48

Causes of visual Hallucinations:

-->usually associated with medical illnesses (not psychiatric), like d/t drug intoxication
-->see in Lewy Body dementia

49

Cause of auditory hallucinations?

-->usually feature of psychiatric illness, ie schizophrenia

50

Cause of olfactory hallucinations?

-->may be part of aura before seizure
-->brain tumors

51

Causes of tactile hallucinations (feeling something on skin)?

-Alcohol withdrawal--> formication = sensation of insects crawling on skin
-Cocaine abusers ("cocaine bugs")

52

What drug use in teens is a risk factor schizophrenia?

Marijuana

53

Timing of:
-Schizophrenia
-Schizophreniform disorder
-Brief psychotic disorder

*Schizophrenia: > 6 months
*Schizophreniform: 1-6 months
*Brief psychotic disorder: < 1 month (usually stress related)

54

Dx criteria of schizophrenia:

> 6 months

*at least 2 of following:
1) Delusions
2) hallucinations (usually auditory)
3) Disorganized speech (loose associations)
4) Disorganized or catatonic behavior (catatonia = either extreme loss of motor skills, like holding a position for a while, or maybe constant hyperactive motor activity)
5) Negative symptoms:
-flat affect (no emotional expression)
-social withdrawal
-lack of motivation
-lack of speech or thought

***Note: increased risk for suicide in schizophrenic pts.

55

5 subtypes of schizophrenia:

1) Paranoid (delusions)
2) Disorganized (speech, behavior, affect)
3) Catatonic (automatisms)
4) Undifferentiated (elements of all types)
5) Residual (positive symptoms present, but at low intensity)

56

Schizoaffective Disorder:

at least 2 weeks of a stable mood (not elevated or depressed), but have psychotic symptoms during those 2 weeks; and,also periods of mood disorder (depressive, manic, or both/mixed) with psychosis (can either be bipolar or depressive = 2 subtypes)

57

How long must a person have delusions in delusional disorder?

at least 1 month
-->pt has strange belief/delusion (ie a woman who thinks she's married to a celebrity, but is not); but, can otherwise function normally

58

Dissociative Identity Disorder: What past history may be common to pts?

This is multiple personality disorder (former name)
-->associated with history of sexual abuse

*pts have at least 2 distinct identities/personality states

59

Dissociative fugue:

Abrupt change in geographic location + inability to remember past, confused about personal identity, assume new identity

-->associated w/traumatic experiences (like war, natural disasters, etc)

60

Dx of a manic episode:

*lasts at least 1 week (note, mood may be elevated, expansive, or irritable)

*at least 3 of following: "DIG FAST"
1) Distractibility
2) Irresponsibility (seeks pleasure, disregard of consequences)
3) Grandiosity (inflated self esteem)
4) Flight of ideas (racing thoughts)
5) increased Activity and Agitation
6) Talkativeness

61

Bipolar disorder:
-Dx criteria?
-Trtmnt?

*at least 1 manic or hypomanic episode and eventually depressive mood; with normal mood in between episodes

*Treatment:
-NOT antidepressants (b/c can lead to increased mania)
-Mood stabilizers (lithium, valproic acid, carbamazepine)
-Atypical antipsychotics

***note: increased risk of suicide in bipolar pts

62

Cyclothymic disorder:

-->milder form of bipolar disorder that lasts at least 2 years
(dysthymia (=mild depression) + hypomania (= mild manic episode))

63

Major Depressive Disorder:
-Dx criteria?

*lasts at least 2 weeks

*Must include patient reported depressed mood or Anhedonia (loss of interest) + at least 5 of following 9 symptoms: "SIG E CAPS"
1) Sleep disturbances
2) loss of Interest in things that used to be pleasurable (anhedonia)
3) Guilt, or feelings of worthlessness
4) loss of Energy
5) loss of Concentration
6) Appetite/weight changes
7) Psychomotor retardation or agitation
8) Suicidal ideations
9) Depressed mood

64

Dysthymia:

--> milder form of depression (like at least 2 of depression criteria); lasts at least 2 years

65

Atypical Depression:

-hypersomnia (sleep lots)
-overeating (weight gain)
-mood reactivity (pt can experience improved mood in response to certain positive events)

66

Pospartum: "blues" vs depression vs psychosis:

* "blues" --> resolve within 10 days (follow up with pt though, to make sure it's not depression); no trtmnt, just supportive

*depression --> lasts at least 2 weeks; treat with anti-depressants, therapy

*psychosis --> rare; lasts days to 4-6 weeks; treat with antipsychotics, antidepressants, possible hospitalization

67

Risk factors for committing suicide (suicide completion):

"SAD PERSONS"
-Sex (male)
-Age (teenagers or elderly)
-Depression
-Previous attempts
-Ethanol or drug use
-loss of Rational thinking
-Sickness (medical illness; multiple prescription meds)
-Organized plan how to commit suicide
-No spouse (divorced, widowed, single, childless)
-Social support lacking

***Men commit suicide more often, though women try more.

68

Treatment of social phobia (ie public speaking, using public restrooms...):

SSRIs

69

Agoraphobia:

Anxiety in an environment where person thinks it will be difficult or embarrassing to escape

-->it's a subset of panic disorder

70

Treatment options for Panic Disorder:

-CBT
-SSRIs
-TCAs
-Benzos

71

Treatment for specific phobias?

-->systemic desensitization

72

What other psych disorder is OCD associated with?

-->Tourrettes

73

Treatment for OCD?

-SSRIs
-Clomipramine (TCA)

74

Timing of Acute Stress Disorder vs PTSD?

*Acute Stress Disorder: 2 days to 1 month

*PTSD: lasts at least 1 month; onset of symptoms may begin any time after event

75

Dx criteria of Generalized Anxiety Disorder:

*At least 6 months
*Anxiety is unrelated to specific person, situation or event

76

Adjustment Disorder: Dx criteria?

-->anxiety, depression causing impairment after an identifiable stressor (ie divorce, illness)
-->lasts LESS than 6 months (or more than 6 months if the stressor is chronic)

77

Malingering:

-->pt CONSCIOUSLY fakes or claims to have a disorder in order to get a specific secondary gain (ie skip work, get meds)
-->don't comply with trtment, follow-up with dr, etc
-->complaints stop after get gain

78

Factitious Disorder:

-->Pt CONSCIOUSLY creates physical/psych symptoms in order to be "sick" and get medical attention (motivation is unconscious though)

***unlike Malingering, in Factitious complaints continue even after getting the gain...

***Munchausen's and Munchausen's by proxy are both Factitious disorders

79

Munchausen's syndrome and Munchausen's syndrome by proxy:

-->Both are Factitious Disorders:

*Munchausen's: Chronic factitious disorder; hx of lots of hospital admissions, procedures...

*Munchausen's by proxy: caregiver makes child sick; form of child abuse

80

Somatoform disorders, generally:

physical symptoms but no identifiable physical cause
--> pt UNCONSCIOUSLY produces symptoms and with UNCONSCIOUS motivation

*Includes:
-Somatization disorder
-Conversion
-Hypochondriasis
-Body dysmorphic disorder
-Pain disorder

81

Somatization disorder:

-->type of somatoform disorder
*over several years, pt presents with multiple organ system complaints, but no identifiable physical cause (at least 4 pain, 2 GI, 1 sexual, 1 pseudoneurologic symptoms)

82

Conversion disorder:

-->sudden loss of sensory or motor function (like sudden blindness) after an acute stressor
-->pt is aware, but indifferent to symptoms (la belle indifference)

83

Cluster A Personality Disorders:

--> Weird, odd, eccentric:

-Paranoid
-Schizoid
-Schizotypal

84

Schizoid Personality Disorder:

-->VOLUNTARY social withdrawal; content with social isolation
-a type A PD

85

Cluster B Personality Disorders:

--> Wild, Dramatic, Emotional, Erratic
--> genetic associations with mood disorders and substance abuse

-Antisocial
-Borderline
-Histrionic
-Narcissistic

86

Cluster C Personality Disorders:

-->Worried, anxious, fearful
--> genetic association with anxiety disorders

-Avoidant
-Obsessive-Compulsive
-Dependent

87

Avoidant PD:

-->WANTS relationships with others (as opposed to schizoid PD); but, hypersensitive to rejection, timid, feel inadequate, etc

-a cluster C PD

88

Russel's sign:

seen in Bulemic pts; dorsal hand calluses from inducing vomiting

89

List drugs that are depressants:
-general symptoms of intoxication?
-general withdrawal symptoms?

-Alcohol
-Opiods (morphine, heroin, methadone...)
-Barbiturates
-Benzodiazepines

*Nonspecific intoxication symptoms: elevated mood, decreased anxiety, sedation, behavior disinhibition, respi depression
*Nonspecific withdrawal: anxiety, tremors, seizures, insomnia

90

List drugs that are stimulants:
-nonspecific intoxication symptoms:
-nonspecific withdrawal symptoms:

-Amphetamines
-Cocaine
-Caffeine
-Nicotine

*nonspecific intoxication: elevated mood, psychomotor agitation, insomnia, cardiac arrhythmias, tachycardia, anxiety
*nonspecific withdrawal: post-use "crash" with depression, lethargy, weight gain, headache

91

List drugs that are hallucinogens:

-PCP = Phenylcyclidine
-LSD
-Marijauna

92

Constipation, pupillary constriction (pinpoint pupils), seizures, CNS depression, nausea, vomiting:

-->Opioid intoxication (morphine, heroin, methadone, etc...)

***overdose can be fatal (treat OD with Naloxone, Naltrexone)

93

Flumazenil

-->Treatment for Benzo overdose (competitive GABA antagonist --> blocks GABA!)

94

Pupillary dilation, tactile hallucinations (or other hallucinations), paranoid thoughts, angina, sudden cardiac death

Cocaine intoxication
-->treat cocaine OD with Benzos

95

Pupillary dilation, prolonged wakefullness and attention, delusions, hallucinations, fever:

Amphetamine intoxication

96

Belligerence (violent!!), impulsiveness, vertical and horizontal nystagmus, delirium, psychosis, homicidality, tachycardia:

PCP (Phenylcyclidine) intoxication
-->PCP inhibits the NMDA receptor (glutamate receptor)

97

Pupillary dilation, flashbacks (perhaps long after drug use), visual hallucinations, anxiety or depression:

LSD intoxication

98

Conjunctival injection, rapid HR, dry mouth, increased appetite, paranoia

Marijuana intoxication

99

Treatment for Cocaine OD?

-->Benzos

100

Treatment for Benzo OD?

Flumazenil

101

Treatment for Opioid (ie heroin) OD?

-->Naloxone or Naltrexone

102

Dilated pupils, sweating, piloerection (if quit "cold turkey"), rhinorrhea, flu-like symptoms: d/t withdrawal from which drug?

-->Opioids withdrawal (ie heroin, methadone, morphine; can also get these symptoms from chronic prescription narcotics, like in cancer pts)

103

Methadone:

->long-acting oral opiate; used for heroin detox and long-term maintenance; but, can have opioid withdrawal symptoms.

104

Intoxication with which drugs will cause pupillary dilation?

-Amphetamines
-Cocaine
-LSD

--> Also: anti-cholinergics (ie Atropine) causes midriasis

105

Intoxication with which drugs will causes pupillary constriction?

-Opioids (ie heroin)

--> Also: cholinergic-agonists (ie organophosphates) cause miosis!

106

Intoxication with which drug may cause violence/belligerence?

-->PCP (phenylcyclidine)

107

Sublaxone:

= Naloxone + Buprenorphine (partial opioid agonist) --> can be used to treat heroin addiction; long-acting and fewer withdrawal symptoms than Methadone (b/c Naloxone is not active when taken orally, so only get withdrawal symptoms if it's injected; so has a lower abuse potential)

108

Treatment of Wernicke-Korsakoff syndrome:

IV vitamin B1 (Thiamine)

109

Treatment of Alcoholism:

-Disulfiram (so pt feels sick when drinks alcohol)
-supportive care, AA, etc

110

Alcohol withdrawal symptoms?
-->treatment?

*Delirium Tremens --> get it 2-5 days after last drink:
-tachycardia, tremors, anxiety, seizures
-hallucinations, delusions
-confusion

*note: alcohol withdrawal can be fatal!

***Treat with Benzos!

111

Treatment for Bulimia?

SSRIs

112

Treatment for Atypical depression:

-MAO inhibitors
-SSRIs

113

Treatment for Depression:

-SSRIs, SNRIs
-TCAs

114

Treatment for Depression with Insomnia?

Mirtazapine
-->alpha-2-blocker (increases release of NE and serotonin) and serotonin receptor-blocker

115

Clomipramine

TCA used to treat OCD (along with SSRIs)

116

Treatment for Panic Disorder:

-SSRIs
-TCAs
-Benzos

117

Treatment for PTSD:

-SSRIs

118

Treatment for Tourette's:

-antipsychotics (haloperidol, respiridone)

119

Treatment for scoial phobias:

-SSRIs

120

Methylphenidate and amphetamines:
-clinical uses?
-mechanism?

-->used to treat Narcolepsy, ADHD...
-->increase catecholamines (esp NE and Dopamine) at synaptic cleft

121

Mechanism of typical antipsychotics:

-->block D2 receptors (get increased cAMP)

122

List the typical antipsychotics:

-Haloperidol + drugs ending in "-azine"
-Trifluoperazine
-Fluphenazine
-Thioridazine
-Chlorpromazine

123

Which typical antipsychotics cause neurological/extrapyramidal side effects?

-->High potency antipyschotics: "Try to Fly High"
-Trifluoperazine
-Fluphenazine
-Haloperidol

124

Which typical antipsychotics cause not neurological, but anti-cholinergic, anti-histamine, and anti-alpha side effects? What are these side effects?

-Low potency antipsychotics: "Cheating Thieves are low"
-Chlorpromazine
-Thioridazine

*blurred vision, constipation, hypotension, sedation

125

Which antipsychotic may cause corneal deposits? Retinal deposits?

Corneal deposits--> Chlorpromazine
ReTinal deposits --> Thioridazine

-->both of these are low-potency atypical antipsychotics; have anti-cholinergic, anti-histamine, and alpha-blockade side effects (dry mouth, constipation, hypotension, sedation)

126

Neuroleptic Malignant Syndrome:
-cause?
-presentation?
-treatment?

-toxicity of typical antipsychotic meds; starts a few days after begin meds
*presentation = excess muscle contraction:
-rigidity
-myoglobinuria
-hyperpyrexia (very high temp)

*treatment:
-Dantrolene (prevents Ca release from sarcoplasmic reticulum)
-Bromocriptine (D2-receptor-blocker; used in Parkinson's)

127

Tardive dyskinesia:
-cause?
-presentation?

-->result of lont-term typical antipsychotic use
-->stereotypical facial movements
-->often irreversible

128

Atypical antipsychotics: list them!

"it's Atypical for Old Closets to Quietly Risper from A to Z"
-Olanzapine
-Clozapine
-Quetiapine
-Risperidone
-Apiprazole
-Ziprasidone

129

Mechanism of atypical antispychotics:

-->not fully understood; effects on serotonin, dopamine, alpha, and histamine receptors

130

Olanzapine:

atypical antipsychotic that can be used to treat OCD, anxiety, depression, mania, Tourrette's

131

Which class of anti-psychotic meds can treat both positive and negative symptoms of schizophrenia?

-->Atypical antipsychotics (typical primarily just treats positive symptoms)

132

Which antipsychotic may cause agranulocytosis?

-->Clozapine (atypical antipsychotic); must monitor WBC weekly in these pts

133

Which antipsychotics may cause significant weight gain?

-->Olanzapine and Clozapine (both are atypical antipsychotics)
-so increased risk of developing DM

134

Which antipsychotic may prolong the QT interval?

(like Class IA and III antiarrhythmics!)

-->Ziprasidone

135

Apiprazole:

Atypical antipsychotic

136

Why may antipsychotics cause galactorrhea?

-->b/c block dopamine --> so less inhibition of prolactin by dopamine --> increased prolactin --> galactorrhea and amenorrhea (amenorrhea b/c prolactin inhibits GnRH, so get decreased LH and FSH --> decreased spermatogenesis and ovulation)

137

Risperidone:

atypical antipsychotic

138

Affect of lithium in bipolar disorder?

-->blocks relapse and acute manic attacks; stabilizes mood (so, acts on the mania, not the depression)

139

Lithium Toxicity:

"LMNOP"
-Lithium
-Movement (tremor)
-Nephrogenic DI (it's an ADH-blocker, so causes polyuria; so, can be used to treat SIADH!)
-hypOthyroidism
-Pregnancy problems (teratogenic--> Ebstein anomaly and malformation of great vessels)

***Narrow Therapeutic Index, so must monitor pts closely!

140

Buspirone:
-mechanism?
-clinical use?

-->stimulates serotonin receptors
-->used to treat GAD (no addiction, sedation, tolerance)

141

TCA:
-Mechanism?
-Toxicity?

*Mechanism: block reuptake of NE and Serotonin
*Toxicity = Tri-C's:
-Convulsions
-Coma
-Cardiotoxicity (arrhythmias)
-->Also:
-anticholinergic side effects; can lead to confusion and hallucinations in elderly
-Sedation

142

Treatment for CV toxicity from TCAs?

-->NaHCO3

143

Which TCA should be used in elderly pts?

-->Nortryptiline (has fewer anti-cholinergic side effects, so better in elderly)

144

Imipramine:

-->TCA that is used to treat bedwetting

145

Clomipramine:

TCA used to treat OCD

146

Doxepin

TCA (that doesn't end in -typtyline or -ipramine!

147

Amoxapine

TCA (that doesn't end in -typtyline or -ipramine!

148

SSRI that can be used to treat premature ejaculation?

Paroxetine

149

List the SSRIs:

-Fluoxetines
-Paroxetine
-Sertraline
-Citalopram

150

Toxicity of SSRIs:

-sexual dysfunction --> anorgasmia (although Paroxetine can be used to treat premature ejaculation)
-GI distress
-Serotonin syndrome (hyperthermia, myoclonus, CV collapse, flushing, diarrhea, seizures)

151

Serotonin syndrome:
-cause?
-presenation?
-treatment?

-->When have too much serotonin; like if combine an SSRI and an MAO, so get lots of serotonin!
*Presentation (think: lots of serotonin):
-diarrhea
-flushing
-seizures
-hyperthermia
-myoclonus
-CV collapse

*Treat with Cyproheptadine (an anti-histamine that is also a serotonin receptor blocker)

152

Venlafaxine

SNRI
-->can be used to treat depression, GAD

153

Duloxetine

SNRI
= "cimbalta"
-->treatment of depression, also can be used to treat diabetic peripheral neuropathy

154

Tanylcypromaine

MAO inhibitor

155

Phenelzine

MAO inhibitor

156

Mechanism of MAO inhibitors:

-->increased levels of NE, Serotonin, Dopamine

157

Selegiline

MAO inhibitor that is NOT used for depression; used to treat Parkinson's

158

Isocarboxazid

MAO inhibitor

159

MAO inhibitors are contraindicated with:

-foods with high tyramine content (wine, cheese, etc) --> b/c can get hypertensive crisis (b/c tyramine can act as a catecholamine, so get a whole ton of catecholamine release --> INCREASED BP!!!!)

-Beta-agonists (can also lead to hypertensive crisis, b/c increased catecholamine action)

-SSRIs (can lead to serotonin syndrome)

-Meperidine (Opioid; can lead to serotonin syndrome)

160

Buproprion:

-atypical antidepressant
-no sexual side effects
-lowers seizure threshold (especially in bulemics, anorexics)
-unknown mechanism, but leads to increased NE and dopamine
-can be used for depression and also for smoking cessation

161

Mirtazapine:

-atypical antidepressant; good for depression with insomnia (b/c sedation = toxicity)
-alpha -2-antagonist (so increases release of NE and serotonin) and serotonin-receptor antagonist

162

Maprotiline:

-atypical antidepressant
-->blocks NE reuptake
-->may cause orthostatic hypotension

163

Trazodone:

-atypical antidepressant
-->inhibits serotonin reuptake
-->used for insomnia (not really for depression, b/c need high doses for depression treatment)
*toxicities:
-postural hypotension
-sedation (so can use for insomnia)
-priapism --> "trazaBONE!"

164

Buproprion:

-atypical antidepressant
-no sexual side effects
-lowers seizure threshold (especially in bulemics, anorexics)
-unknown mechanism, but leads to increased NE and dopamine
-can be used for depression and also for smoking cessation

165

Mirtazapine:

-atypical antidepressant; good for depression with insomnia (b/c sedation = toxicity)
-alpha -2-antagonist (so increases release of NE and serotonin) and serotonin-receptor antagonist

166

Maprotiline:

-atypical antidepressant
-->blocks NE reuptake
-->may cause orthostatic hypotension

167

Trazodone:

-atypical antidepressant
-->inhibits serotonin reuptake
-->used for insomnia (not really for depression, b/c need high doses for depression treatment)
*toxicities:
-postural hypotension
-sedation (so can use for insomnia)
-priapism --> "trazaBONE!"