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Psychiatry > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

Name 4 risks of typical antipsychotics

A
  1. Prolonged QT
  2. Seizure
  3. Anticholinergic effects
  4. NMS!!!!
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2
Q

Which typical antipsychotic has the highest risk of EPS?

A

HALOPERIDOL!
Highest risk of EPS, dystonia, akathisia and NMS :(
Used in ICU delirium (0.5mg bolus and 0.1mg/hr x 12 hr) and in agitation (5mg haloperidol with 2mg ativan)

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3
Q

Best antidepressants to use in geriatric pts?

A

Mirtazapine

Trazodone

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4
Q

Monitoring in mood stabilizers

A 
CBC (incl. plt)
TSH (esp. Lithium and Carbemazepine)
LFTs 
Electrolytes
Drug levels 
Plus ECG, calcium, UA for lithium
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5
Q

What is the difference between somatic symptom d/o and illness anxiety d/o.

A

In illness anxiety there are no actual Sx, just worried about getting sick

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6
Q

How do you differentiate brief psychotic episode, schizophreniform and schizophrenia?

A

Brief psych episode - less than one month, only one of delusions, hall, disorg behav, negative Sx
Schizophreniform - one to six months, need two of the above Sx
Schizophrenia - more than six months, need one or more of delusions, hallucinations, disorganized speech/behav

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7
Q

Disruptive mood dysregulation d/o criteria

A 
Outbursts/temper tantrums (out of proportion) 3x/week 
Irritable and angry between episodes 
Low frustration tolerance 
Onset by age 10
Often co-morbid with ADHD/anxiety
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8
Q

Difference between acute stress d/o and PTSD?

A

Acute stress d/o occurs within one month of the traumatic event, lasts 3 days to one month
PTSD lasts more than one month, need presence of one or more intrusion Sx (dreams, flashbacks, adverse rxn to internal/external stimuli), avoidance Sx, negative alterations in cognition and mood (anhedonia, negative mood, amnesia, distorted cognition about event)

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9
Q

How do you treat NMS?

A

Stop antipsychotic (usually assoc with typical, high potency APs)
Give supportive care (hydration, check vitals regularly)
Cooling blankets
Dantrolene/bromocriptine (dopamine agonist)
Can give benzodiazepines for agitation
Always important to check vitals in ER before giving AP as part of chemical restraint

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10
Q

Name three common and three long term side effects of antidepressants.

A

Common: nausea, sexual changes (long term), h/a, GI upset (diarrhea), GI bleed (beware pts of NSAIDs, heparin), increase in suicidal thoughts in adolescents (

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11
Q

Four features of NMS

A
  1. Fever (>38….even >40)
  2. Rigidity (generalized and extreme, lead pipe rigidity)
  3. Mental status changes (can present as agitated delirium with confusion, catatonia, mutism)
  4. Autonomic instability (tachycardia, labile BP, tachypnea, profuse diaphoresis)
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12
Q

Contraindication to cholinesterase inhibitor use (ex. Donepezil, rivastigmine, galantamine for treatment of dementia)

A

Bradycardia

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13
Q

Name 4 side effects of stimulants (amphetamines, methylphenidate etc)

A

Decreased appetite/weight loss
Insomnia
Anxiety
Decreased growth

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14
Q

Name 6 side effects of lithium

A 
Polyuria/polydipsia
Weight gain
Teratogenicity (epsteins anomaly) 
Thyroid anomalies (hypothyroidism, hyperthyroidism)
Hyperparathyroidism (calcium anomalies) 
Cognitive side effects
Tremor
Arrhythmias
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15
Q

Lab abnormalities in NMS

A 
Increased CK (think rigidity => rhabdomyolysis)
Increased WBC
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16
Q

Which type of dementia has increased sensitivity to neuroleptics?

A 
Lewy body (parkinsonism!) 
Try quetiapine :)
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17
Q

How long does it take for stimulants to take effect?

A

Should see improvement within Approx. 30min-1hour

Wait a week or two to see full effect

18
Q

Which AP has the highest risk of hyperprolactinemia?

A

Risperidone

19
Q

Name 3 typical antipsychotics and their mechanism of action.

A
  1. Chloropromazine
  2. Zuclopenthixol (accuphase)
  3. Loxapine
  4. Haloperidol

Act by dopamine D2 blockade (haloperidol also has D1blockade)

20
Q

Name 7 signs of serotonin syndrome (think: SHIVERS)

A

Shivers (unique to SS)
Hyperreflexic
Increased temperature
Vital sign instability (tachycardia, tachypnea, labile BP)
Encephalopathy (agitation, delirium, confusion)
Restlessness
Sweating

21
Q

Four major dopaminergic pathways

A
  1. Mesocortical
  2. Mesolimbic
  3. Nigrostriatal (parkinsonism)
  4. Tuberoinfundibular (hyperprolactinemia)
22
Q

Name one anticonvulsant that is safe in pregnancy

A

Lamotrigine

23
Q

Name two treatments for severe dementia

A

Mementine (NMDA antagonist) => for cognition

Donepezil (cholinesterase inhibitor => increase ACh!)

24
Q

Name 3 Contraindications for stimulant use in ADHD and one alternative Tx

A

Cardiac Hx => syncope, sudden cardiac death in family
Do an ECG before starting stimulant
Try non-stimulant such as strattera (SNRI) or bupropion (NDRI)

25
Q

How to treat co-morbid anxiety in Bipolar 1?

A

Do NOT given antidepressants

Try: seroquel (low dose) or gabapentin

26
Q

Name three situations in which ECT would be indicated

A

Depression with psychotic features
Catatonia
Depression and not eating
Depression in pregnant woman

27
Q

Name three major risks of taking clozapine

A

AGRANULOCYTOSIS
myocarditis
Decreased seizure threshold

28
Q

Name two things to monitor in a patient on valproic acid

A

Increasing LFTs

Decreasing platelets

29
Q

What is the best SSRI to use in children?

A

Fluoxetine (“Prozac” => most studied)

30
Q

Name two SSRIs to use in pregnancy and/or medical co-morbidities

A

Sertraline

Citalopram

31
Q

How long does a MDE last with and without Tx?

A

With Tx: ~3 months, high probability of relapse if Rx D/C’ed before 3 months, usually treat for a total of 9-12months
Without Tx: 6-12 months

32
Q

What to do if a patient has sexual side effects while on an SSRI?

A 
Try wellbutrin (bupropion) 
Try adding viagra
33
Q

What to do if improvement on antidepressants is stalling?

A

Consider compliance, substance use and social stressors
Do NOT add another AD => consider switching (taper old med, start new med slowly)
Consider adding an antipsychotic such as aripiprazole, olanzapine or lithium to augment
If somnolence, get them to take the Rx at night

34
Q

How long to treat with antidepressants?

A

Usually 9-12 months

Treat longer/lifetime if: older age, recurrent episodes (>3), chronic depression, psychotic features

35
Q

Name 4 activating antidepressants (useful for pt with slowed thinking/moving, low energy)

A

Paroxetine
Fluoxetine
Bupropion
Venlafaxine

36
Q

Name two sedating/calming SSRIs (good if pt is agitated or anxious)

A

Sertraline
Mirtazapine
Trazodone

37
Q

Name two antidepressants used for insomnia and chronic pain

A

Duloxetine

Amitriptyline

38
Q

Name an antidepressant that is also used for OCD (good for ruminative, obsessive thoughts)

A

Fluvoxamine

39
Q

Which antidepressants should you avoid in impulsive pts?

A

Avoid TCAs, activating ADs (paroxetine, fluoxetine, bupropion, venlafaxine)
Try neutal ADs such as citalopram, sertraline or mirtazapine

40
Q

Neuro adaptation in alcohol use disorder

A

Decrease NMDA receptor activity

Increase GABA receptor activity => feel calmer

41
Q

Alcohol withdrawal Sx

A

Tremors, tachycardia, hypertension, GI disturbances, dysphoria, sleep disturbances
Seizures
Delirium tremens (fluctuating sensorium, agitation,
Alcoholic halluncinosis
Tx: given benzos for a few days

42
Q

What does CAGE stand for?

A

Cut down
Annoyed (by criticism of your drinking)
Guilty
Eye opener (to prevent shakes)

Psychiatry (1 decks)

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