Psychiatry Flashcards
(311 cards)
1
Q
generalized anxiety disorder path
A
constant state of worry
2
Q
generalized anxiety disorder pt
A
worry about most things on most days of most months (>/= 6mo)
>/= 3 somatic complaints
3
Q
generalized anxiety disorder dx
A
clinical
4
Q
generalized anxiety disorder tx
A
psychotherapy
SSRI or buspirone adjunct
5
Q
social anxiety disorder path
A
irrational and exaggerated fear related to social performance
egodystonic
6mo+ duration
6
Q
social anxiety disorder pt
A
anxiety and avoidance of stimulus
public speaking or public restrooms
7
Q
social anxiety disorder dx
A
clinical
8
Q
social anxiety disorder tx
A
CBT
ß blockers for public speaking
9
Q
specific phobia path
A
irrational and exaggerated learned fear response to a specific trigger
egodystonic
6mo+ duration
10
Q
specific phobia pt
A
anxiety and avoidance of stimulus
spiders, heights, clowns, etc
11
Q
specific phobia dx
A
clinical
12
Q
specific phobia tx
A
CBT
- desensitization: longer, better
- flooding: faster, not as good
control with SSRI during CBT
13
Q
panic attack path
A
random and unprovoked bouts of intense anxiety without warning
14
Q
panic attack pt
A
STUDENTS PANIC Shortness of breath Trembling Unsteadiness Depersonalization Excessive heart rate Numbness Tingling Sweating Palpations Abdominal distress Nausea Intense fear of losing control/dying Chest pain
15
Q
panic attack dx
A
r/o medical disease:
- EKG + troponins
- asthma
- TSH, toxicology
16
Q
panic attack tx
A
abort - benzo
CBT to abort without meds
control - SSRI
17
Q
panic attack f/u
A
agoraphobia
18
Q
intermittent explosive disorder path
A
trigger = anxiety
violent act = relief
response DISPROPORTIONATE to stressor (verbal, physical, etc)
19
Q
intermittent explosive disorder pt
A
2x/wk in 3 mo without harm OR 3x in a year WITH harm males >> females decrease symptoms with increase age
20
Q
intermittent explosive disorder dx
A
clx
21
Q
intermittent explosive disorder tx
A
drugs (SSRI) = therapy (self-reflection) = drugs + therapy
22
Q
pyromania path
A
setting fire = relief of pleasure
23
Q
pyromania pt
A
more than 1 occasion
fire setting for decrease anxiety, increase sexual arousal, or increase pleasure
men»_space; women
24
Q
pyromania dx
A
r/o arson
25
pyromania tx
none - incarceration
26
pyromania f/u
reaction formation
27
arson
monetary gain
| to cause harm or to destroy
28
pyromania
decrease anxiety
sexual arousal
pleasure
29
kleptomania path
```
trigger = anxiety
theft = relief
```
30
kleptomania pt
steals things
- little to no value
- pt can afford
- to decrease anxiety
- gifts/hides items
- and feels guilt/remorse
- impulsively, alone without external provocation
31
kleptomania dx
r/o pety theft
32
kleptomania tx
none
| SSRI? Therapy?
33
theft vs. kleptomania
theft:
- desire, able to resist, HAS value, pt CAN'T afford, planned with help or provoked by external stimuli
- used or kept, NO remorse, NO guilt
kleptomania:
- decrease anxiety, unable to resist, has NO value, pt CAN afford, Unplanned, without help, and not proved by external stimuli
- stashed, gifted, or returned, remorse, guilt
34
obsessive compulsive path
```
obsessions = anxiety-PROVOKING thoughts, unwanted, and intrusive
compulsions = anxiety-REDUCING actions, behaviors, or mental acts
```
35
obsessive compulsive pt
obsessions: contamination, symmetry, safety
compulsions: cleaning, washing, order, counting, lock checking
at least 1hr/d
causes impairment at school, work, socially
36
OCD dx
clx
37
OCD tx
CBT is best
| SSIR or clomipramine (TCA)
38
hoarding path
OCD about throwing things away
39
hoarding pt
obsessions: ridding of possessions
compulsions: retaining useless items like trash or trinkets
unsafe or cluttered home
40
hoarding dx
clx
41
hoarding tx
CBT -> SSRI
42
body dysmorphic path
perceived flaws in physical appearance
43
body dysmorphic pt
obsessions: symmetry of body, hair, skin, nose, breasts, butt
compulsions: appearance, checking, approval-seeking
attempt to have multiple surgeries to correct what isn't broken
44
body dysmorphic dx
clx
45
body dysmorphic tx
CBT -> SSRI
46
body dysmorphic f/u
DO NOT perform surgery as desired
47
muscle dysmorphic disorder path
perceived flaws in physical appearance
48
muscle dysmorphic disorder pt
obsession: muscle size
compulsions: excessive exercise, anabolic steroids
roid rage, rhabdo (renal failure), testicular atrophy, 'copper disorder'
49
muscle dysmorphic disorder dx
clx
50
muscle dysmorphic disorder tx
CBT -> SSRI
51
trichotillomania path
general anxiety with hair pulling
52
trichotillomania pt
obsessions: none in particular
compulsions: pulling out hair items like trash
alopecia with hair in different lengths
53
trichotillomania dx
r/o fungus (KOH prep)
| r/o medical causes for alopecia
54
trichotillomania tx
CBT -> SSRI
55
trichotillomania f/u
small bowel obstruction (trichobezoar)
56
PTSD path
stressor
- actual death, threat death, combat, rape, abuse
exposure
- experienced (self), witnessed (strangers), learned (family), repeated exposure to effects
57
PTSD pt
disorder
- intrusion, neg mood, dissociation, avoidance, arousal
nightmares, flashbacks, memories
depression-like
depersonalization, amnesia
symbols, locations, memories
hypervigilence, irritability, easily startled, CHANGED concentration
58
PTSD dx
>3d and <1 mo = acute stress
| >1 mo = PTSD
59
PTSD tx
group therapy (best)
SSRI/SNRI (adjunct)
benzos (panic attack only)
CBT
60
PTSD f/u
mood disorder
| substance abuse disorder
61
RAD/DESD path
stressor = neglect or abuse in infancy
62
RAD/DESD pt
disorder =
too much attachment (DSED)
too little attachment (RAD)
63
RAD
reactive attachment disorder
64
DESD
disinhibited attachment disorder
65
RAD/DESD dx
<5 y.o
| r/o autism
66
RAD/DESD tx
caregiver - teach how to parent
67
RAD/DESD f/u
mood disorder
| learning disabiliites
68
adjustment disorder path
stressor = non-life threatening event
| - marital strife, loss of job, moving away
69
adjustment disorder pt
disorder = mood changes that don't quite fit another mood disroder
70
adjustment disorder dx
begin <3mo from stressor
| lasts <6mo from stressors
71
adjustment disorder tx
generally not needed
72
MDD path
```
decrease mood OR anhedonia
and
>/= 2wks
AND
5 of SIGECAPS
```
73
MDD pt
```
Sleep incr/decr
Interest decreased
Guilt increased
Energy decreased
Concentration decreased
Appetite incr/decr
Psychomotor decreased
Suicidal increased
```
74
MDD dxc
r/o SI
75
MDD tx
if + SI, + plan => hospital
if + SI, NO plan => safety contract
Combo >> SSRI/SNRI > Psycho therapy
ECT best (refractory only)
76
Bipolar I path
mania = "E" + 3
| duration >/= 1wk
77
Bipolar 1 pt
```
DIG FASTER
Distractibility
Insomnia
Grandiosity
Flight of ideas
Agitation
Sexual exploits
Talkative
Elevated mood
Racing thoughts
```
78
Bipolar 1 dx
r/o Bipolar II
| r/o cyclothymia
79
Bipolar 1 tx
ED = benzos
mood stabilizers = lithium >
- valproate backup = lamotrigine, carbamazapine
anti-psychotics = quetiapine
80
Bipolar II path
hypomania AND major depression
81
Bipolar II pt
hypomania = mania, but less
82
bipolar II dx
r/o bipolar I (catatonia, psychotic)
83
bipolar II tx
bipolar I
84
bipolar II f/u
if major depression, start SSRI, then have mania -> reveals bipolar I
85
dysthymia pt
decreased mood >/= 2yrs
| symptoms not absent 2+ months
86
dysthymia dx
r/o hypothyroid
87
dysthymia tx
SSRI/SNRI
88
cyclothymia pt
mild bipolar II
89
baby blues
```
baby #1, cares about baby
onset and duration within 2wks
dysthymic depression
no psychosis
no tx
```
90
post-partum depression
```
> #1, doesn't care about baby, may hurt baby
onset within 1mo, ongoing
depression MDE
no psychosis
tx antidepressants
```
91
post-partum psychosis
```
> #1, fears the baby, likely to kill it
onset within 1 mo, ongoing
depression MDE
psychosis +
tx mood stabilizers or antipsychotics
```
92
grief
onset: any
duration: <12mo
focus: focused on deceased
when mood symptoms: waxes, wanes, can imagine happy
behaviors: YES insight "psychotic", talking TO deceased, doing things as if they were there
why suicide: to be with deceased
tx: time, counseling
93
PCBD
onset: >/= 6mo
duration: >/= 12mo
focus: on deceased
when mood symptoms: persistent +, cannot imagine being happy
behaviors: NO insight, psychotic features
why suicide:
tx: SSRI
94
depression
onset: any
duration: >/= 12mo
focus: pervasive, global
when mood symptoms: persistent +, cannot imagine being happy
behaviors: NO insight; psychotic (hallucinations, delusions), talking WITH deceased, believing they are there doing things with you
why suicide: to end suffering, despondent
tx: SSRI
95
delusions
fixed false belief without basis in reality
| do NOT confront delusion; it is a glaring truth to the patient, and you will not get anywhere by challenging them
96
schizophrenia path
thought disorder with unknown cause though is certainly a genetic component
receptor pathology
- dopamine (too much) -> + sxs
- serotonin (too much) -> - sxs
97
schizophrenia pt
```
psychotic break = first break occurs in teenager with stressor (college) who then begins behaving bizarrely
positive symptoms (must have 1+)
- bizarre delusions
- hallucinations, usually auditory (voices)
- disorganized speech
- disorganized state/catatonia
Negative symptoms
- anhedonia
- flat affect
- cognitive defects
```
98
schizophrenia dx
clinical
| r/o drug abuse (cocaine)
99
schizophrenia tx
anti-psychotics
- typical controls positive symptoms
- atypical controls negative symptoms
- clozapine when all else fails
100
acute psychotic disorder
duration sxs: < 1 mo
| duration tx: wait (or tx)
101
schizophreniform disorder
duration sxs: < 6 mo
| duration tx: 3-6wks
102
schizophrenia disorder
duration sxs: >/= 6mo
| duration tx: lifetime
103
schizoaffective disorder
duration sxs: any with mood sxs
| duration tx: lifetime; tx delusions first
104
treatment options for psychotic disorders: positive symptoms
typical: haloperidol, thiazide, chlorpromazine
105
treatment options for psychotic disorders: negative symptoms
atypical: risperidone, quetiapine, olanzapine, ziprasidone, aripriprazole
106
treatment options for psychotic disorders: best
clozapine
107
anorexia nervosa path
anxiety induced by fear of being or becoming fat
patient is not fat, but fears fat; sees herself as fat
lacks recognition of how thin she is
108
anorexia nervosa pt
F:M 10:1, teens to 20s
severe:
- hypotension, bradycardia, leukopenia
- CMP abnormalities, electrolytes and albumin
- BMI < 16
non-severe:
- lanugo, cold intolerance, amenorrhea, emaciation
109
anorexia nervosa dx
clinical
110
anorexia nervosa tx
```
hospitalize if severe
- IV nutrtion
- correct electrolytes
- forced feed
outpatient
- antipsychotics and CBT
```
111
anorexia nervosa f/u
if OCD or MDD, add SSRI/SNRI
relapse in 5yrs
death from medical or suicide
112
bulimia nervosa path
anxiety from the binge, then compensates
| normal weight to overweight
113
bulimia nervosa pt
F:M 10:1; teens to 20s
normal appearance except purge signs
purge >/= 1x/wk x3mo
114
bulimia nervosa dx
clinical
115
bulimia nervosa tx
SSRI/SNRI = fluoxetine (best)
| CBT
116
bulimia nervosa f.u
never use bupropion - causes seizures
117
binge-eating disorder path
anxiety from the binge - no compensation
| overweight to obese
118
binge-eating disorder pt
F:M 10:1, teens to 20s
cannot control eating habits
binge >/= 1x/wk x3mo
119
binge eating disorder dx
clinical
120
binge eating disorder tx
topiramate
| CBT
121
methods of eating disorders: restriction
decrease caloric intake (fasting, dieting)
| increase caloric expenditure (exercise)
122
methods of eating disorders: binge purge emesis
eating/binging then induced emesis
dorsal hand scars (from emesis)
dental erosions (from emesis)
metabolic alkalosis, hypoK, hypoMg
123
methods of eating disorders: binge purge laxative
eating/binging then induced diarrhea
metabolic acidosis
diarrhea
124
personality cluster A disorders
paranoid
schizoid
schizotypal
125
paranoid personality disorder description
distrustful, suspicious
| interpret others as malicious
126
paranoid PD examples
'enemy of the state' gene hackman
127
paranoid PD how to handle
clear, honest, nonthreatening
128
schizoid PD description
loners, have no relationships, but are also happy not having any relationships
129
schizoid PD examples
night-shift toll booth
130
schizoid PD how to handle
you won't see them
131
schizotypal description
magical thinking, borders on psychosis
| bizarre thoughts, behavior, and dress
132
schizotypal example
lady gaga
133
schizotypal how to handle
brief psychotic episodes
| clear, honest, nonthreatening
134
cluster B personality disorders
borderline
histrionic
narcissistic
anti-social
135
cluster C personality disorders
avoidant
dependent
obsessive-compulsive
136
borderline PD description
unstable, impulsive, promiscuous, emotional emptiness, unable to control rapid changes in mood, suicidal gestures
137
borderline PD examples
'girl interrupted;
| ' fatal attraction'
138
borderline PD how to handle
suicidal gestures may be successful
| splitting, dialectical behavioral therapy
139
histrionic PD description
theatrical, attention-seeking, hyper sexual, use of physical appearance, dramatic
exaggerated but superfluous emotions
140
histrionic examples
gone with the wind
| Marilyn monroe
141
histrionic how to handle
set rules, insist they are followed
142
narcissistic description
inflated sense of self-worth or taken, self-centered, fragile ego, uses eccentric dress to draw attention, demands special treatment
143
narcissistic example
zoolander
| ron burgundy
144
narcissistic how to handle
set rules, insist they are followed
145
anti-social description
criminal, no regards for rights of others, impulsive, lacks remorse, manipulative
must be >18y/o (conduct disorder)
146
anti-social examples
Tony soprano
| the joker
147
anti-social how to handle
jail, set rules, insist they are followed
148
avoidant description
fears rejection and criticism, wants relationships but does not pursue them
passes on promotions
149
avoidant examples
Napoleon dynamite
| shy hot librarian
150
avoidant how to handle
avoid power struggles, make patients choose
151
dependent description
unable to assume responsibility
| submissive, clingy, fears being alone
152
dependent examples
stay at home mom in an abusive relationship
153
dependent how to handle
give clear advice, patient may try to sabotage their own treatment
154
obsessive compulsive description
rigid, orderly perfectionist
order, control
perfection at the expense of efficacy
155
obsessive compulsive example
monk
156
dissociative disorders path
severe + prolonged stressor causes separation of otherwise intact thought, memory, and identity
157
dissociative disorders pt
stressor proportional to disorder
158
dissociative disorders dx
amytal interview (truth serum)
r/o malingering
r/o substance abuse
159
dissociative disorder tx
psychotherapy
160
dissociative disorder f/u
```
non-severe = recovery
severe = ?
```
161
dissociative identity disorder path
>/= 2 distinct identity states
| most severe and prolonged trauma
162
dissociative identity disorder pt
```
self experiences
- memory gaps (blackouts)
- other dissociation symptoms
others witness
- paradoxical behaviors
- appearance changes
```
163
dissociative identity disorder f/u
fight club, sybil
164
dissociative amnesia path
stressors include loss of memory
165
dissociative amnesia pt
memory loss of
- the event
- regular everyday occurrences/routine
- complete autobiographical self
166
dissociative amnesia f/u
law and order, SVU
167
dissociative amnesia with fugue path
stressors induce loss of memory WITH travel
168
dissociative amnesia with fugue pt
memory loss of
- the event
- regular everyday occurrences/routine
- complete autobiographical self
169
dissociative amnesia with fugue f/u
Jason Bourne, archer from FX
170
depersonalization derealization disorder path
adolescent with minor stressor (though stressor is relatively major for demographic)
171
depersonalization derealization disorder pt
seeing a video or dream of self, out of body experience (depersonalization)
detached from reality, as though in a dream
reality testing INTACT
172
catatonia path
not a disease state
modifier to another disease
psych - bipolar, depression >> schizophrenia
heart - autoimmune, paraneoplastic, nutritional
173
catatonia pt
```
must have 3 or more:
- retarded catatonia
-- stupor
-- cata-LEPSY
-- waxy flexibility
-- mutism
-- negativism
- excited catatonia
-- stereotypy
-- agitation or grimace
-- echolalia
-- echopraxia
retarded and excited symptoms may occur together
```
174
catatonia dx
clinical
| lorazepam
175
catatonia tx
lorazepam (diagnostic and therapeutic)
176
malignant catatonia meds/hx
no meds, lorazepam corrects
177
malignant catatonia sxs
```
rigidity
autonomic dysfunction (increase BP, HR, temp)
muscle breakdown (increase CK)
```
178
neuroleptic malignant hyperthermia meds/hx
atypical antipsychotics/ lead-pipe rigidity
179
neuroleptic malignant hyperthermia sxs
```
rigidity
autonomic dysfunction (increase BP, HR, temp)
muscle breakdown (increase CK)
```
180
serotonin syndrome meds/hx
SSRI's and hypertonicity/hyperreflexia
181
serotonin syndrome sxs
```
rigidity
autonomic dysfunction (increase BP, HR, temp)
muscle breakdown (increase CK)
```
182
malignant hyperthermia meds/hx
halothane anesthesia, family history
183
malignant hyperthermia sxs
```
rigidity
autonomic dysfunction (increase BP, HR, temp)
muscle breakdown (increase CK)
```
184
intellectual disability disorder path - chromosomal
down syndrome
fragile x
cri-du-chat
185
intellectual disability disorder path - maternal acquired
EtOH in utero
| hypothyroid in utero
186
intellectual disability disorder path - child acquired
lead poisoning
| head trauma
187
intellectual disability disorder pt
decrease cognitive skill
decrease adaptive functioning
+/- syndromic physical features
188
intellectual disability disorder dx
clx; severity on adaptive functioning
189
intellectual disability disorder tx
assess social, conceptual (speak, read, write), and practical (self mgmt)
special education, supervision
50-70 = group home, work and ADLs alone
25-49 = group home, ADLs alone
20-34 = institutionalized, supervised ADLs
<20 = institutionalized, total care
190
tic disorder (Tourette's) path
essentially OCD
191
tic disorder (Tourette's) pt
```
onset < 18
"obsession" = impulse to perform tic
"compulsion" = the tic itself
hidden: hair flicks, blinking, rubbing
vocal: grunt, cough, yell
NEVER a swear word
```
192
tic disorder (Tourette's) dx
clx
193
tic disorder (Tourette's) tx
dopamine antagonists
| - fluphenazine, tetrabenazine
194
tic disorder (Tourette's) f/u
ADHD on stimulants who gets worse is Tic disorder
195
autism spectrum path
```
impaired social communication
- social reciprocity
- social relationships
- nonverbal communication
- joint attending
restrictive/repetitive behavior
- stereotypy
- sameness
- restricted interests
- change in perception
```
196
autism spectrum pt
young child, 1-4y/o
no social smile or eye contact
repetitive useless behaviors
insistence on consistency
197
autism spectrum dx
clx; severity based on progress
198
autism spectrum tx
supportive
199
ADHD path - impulsivity
blurts out answers
interrupts
fidgets a lot
cannot wait turn
200
ADHD path - inattention
talks fast
easily distracted
fails to complete tasks
201
ADHD path - timing and situation
>/= 2 settings
onset 7-12
duration >/= 6mo
202
ADHD pt
```
the 'ad kid' who is male, disrupts class and moves all over the place, fails to wait his turn, whose parents have a tough time controlling behaviorally, and whose like this in every setting
ensure there are no absence seizures
```
203
ADHD dx
clx
204
ADHD tx
stimulants (avoid at night d/t insomnia)
- methylphenidate
- dextroamphetamine
205
ADHD f/u
special ed classes, parent education
| if absence seizures, carbamazepine (ethosuximide)
206
learning disabilities path
performing substantially below expected for age and grade
207
learning disabilities pt
medical conditions
- deaf, blind, non-native speaker
poor education to date
- low socioeconomic class, home schooled
208
learning disabilities dx
audiology test
vision testing
language assessment
209
learning disabilities tx
remediate, fix the medical problem (glasses, hearing aids), fix the teacher to student ratio
210
conduct disorder path
antisocial personality disorder but <18
211
conduct disorder pt
bullying - hurts animals/people, uses torture/cruelty, forced sex
destruction - fire starting, lies, cheats, steals, breaks into property
rules violation - truancy, run away at least twice, staying gout at night before 13
212
conduct disorder dx
clx
213
conduct disorder tx
juvenile detention
214
conduct disorder f/u
fights authority
| HARMS peers
215
oppositional defiant disorder path
incongruent parenting
| teen acting out
216
oppositional defiant disorder pt
NO bullying - does NOT hurt animals/people, does NOT use torture/cruelty, no forced sex
destruction - lies, cheats, steals, breaks into property
rules violation - truancy, run away at least twice, staying out at night before 13
217
ODD dx
clx
218
ODD tx
improved parenting
219
ODD f/u
fights authority
| COOPERATES with peers
220
enuresis - never been dry path
normal toilet training takes up to 7 years old
221
enuresis never been dry pt
if < 7 and still wets bed, NORMAL
222
enuresis never been dry dx
clx
223
enuresis never been dry tx
POSITIVE reinforcement
alarm blankets
water restriction before bed
DDAVP as last resort
224
enuresis never been dry f/u
TCAs may also be used
225
enuresis - was once dry path
regression, abuse, infection, anatomic
226
enuresis - was once dry pt
was once dry, now is not
227
enuresis - was once dry dx
u/a, u/s, clx
228
enuresis - was once dry tx
infection (abx); if STI then abuse
anatomic (resection)
regression (identify stressor)
abuse
229
encopresis and enuresis path
encopresis (stool) or enuresis (urine) repeatedly on clothes or bed
- intentional (acting out)
- incontinent (cognitive impairment)
- medication side effect
- anatomic (fistula)
- regression (abuse, stressor)
230
encopresis and enuresis pt
dependent on patients. look for new sibling, new step parent, or new house
231
antidepressants
```
SSRIs
SNRIs
atypical
SM
TCAs
MAOIs
```
232
SSRIs
```
escitalopram
citalopram
fluoxetine
paroxetine
sertraline
```
233
SSRI side effects
decrease libido
delayed ejaculation
serotonin syndrome
GI, insomnia
234
SNRI side effects
cleaner, better version of SSRI, more expensive
235
SNRIs
venlafaxine
| duloxetine
236
bupropion
smoking cessation
no weight gain
NEVER in bulimia (increase seizures)
237
mirtazapine, trazodone
appetite stimulant
| sleep aid, caution priapism
238
TCAs
'-tryptylines'
- imipramine
- desipramine
- doxepin
239
TCAs extra info
used for enuresis (anti-ash)
1st line use is neuropathic pain
can be lethal because of CCC (convulsions, coma, cardiac) so get EKG
has anti-ash properties (Dry mouth, sedation, urinary retention, constipation)
240
MAOIs
phenelzine
tranylcypromine
selegiline
241
MAOIs info
HTN crisis when mixed together, lack of washout, or eating of tyramine (red wine/cheese)
distinguish from other hypertensive-hyperthermia disorders in psych by the ABSENCE of lead-pipe rigidity and fever
242
mood stabilizers
```
lithium
valproate
quetiapine
lamotrigine
carbamazepine
```
243
lithium indications
first line, drug of choice for bipolar
| bipolar, acute mania, depression augmentation
244
lithium side effects
teratogen
nephrotoxic > 1.5 - causes neph DI
narrow TI
245
valproate indications
first line in bipolar if Li cannot be used
| also tx seizures
246
valproate side effects
teratogen (spina bifida)
thrombocytopenia
agranulocytosis
pancreatitis
247
quetiapine indications
second line bipolar
| all phases of treatment
248
quetiapine side effects
weight gain, QTc prolongation
249
lamotrigine indications
second line bipolar
| newer anticonvulsant
250
lamotrigine side effects
blurred vision
| SJS
251
carbamazepine indications
third line bipolar
trigeminal neuralgia
absence seizures
252
carbamazepine side effects
teratogen (cleft palate)
rash, SJS
AV block
253
anti anxiety
benzos
SSRIs
ß blockers
254
benzos indications
abort panic attack, treats EtOH withdrawal
255
benzos side effects
dependence
| withdrawal seizures
256
SSRIs indications
first line long term medication for tx of chronic anxiety; OCD, PTSD, GAD
257
SSRI side effects
not useful in acute attack
258
ß blockers indications
performance anxiety
259
ß blockers side effects
bradycardia, asthma
260
typical antipsychotics
haloperidol
fluphenazine
thioridazine
chlorpromazine
261
typical antipsychotics action
mesolimbic D2C-R-i
- treats + symptoms
nigrostriatal antagonism -> EPS side effects
tuberoinfundibulnar antagonism causes increase prolactin, gynecomastia
262
typical antipsychotics side effects
potency of drug proportional to EPS
| potency inversely proportional to anti-ACh
263
atypical antipsychotics
```
risperidone
quetiapine
olanzapine
aripiprazole
ziprasidone
```
264
atypical antipsychotics mechanism
both D2c and 5HT1 so work on + and - sx
more selective to lower risk of EPS
currently 'first line' for psychosis
265
atypical antipsychotics side effects
QTc prolongation
EPS, gynecomastia, sedation, anti-ACh (small risk)
DM and weight gain
266
clozapine
best antipsychotic
most selective for D2c and 5HT1
drug of last resort
267
clozapine side effects
agranulocytosis
| requiring CBC q week
268
extrapyramidal side effects
akathisia
acute dystonia
dyskinesia
tardive dyskinesia
269
akathisia
feeling of restlessness
| decrease dose, ß blockers, anti-ACh (benztropine)
270
acute dystonia
involuntary muscle contractions, hand wringing, torticollis, and oculogyric crisis
anti-ACh (benztropine)
271
dyskinesia
parkinsonism - dyskinesia = bradykinesia
| anti-ACh (benztropine)
272
tardive dyskinesia
irreversible hypersensitization of dopamine-R = suppressible oral-facial movements
stop drug, sxs initially worsen
273
choosing a medication: compliant young adult without complications
any atypical po
| decreased SE profile
274
choosing a medication: combative ER pt
haloperidol depot
| dedating
275
choosing a medication: noncompliant psychotic
olanzapine depot, risperidone depot, haloperidol dept
| q 1wk
276
choosing a medication: dysphagia or IM not availabl
olanzapine ODT, risperidone ODT
| oral dissolving tablet
277
choosing a medication: everything else has failed
clozapine
| best, most dangerous
278
choosing a medication: hospitalized and off their meds
atypical, increase dose q day until maxed, then try another
279
EtOH intox
slurred speech, disinhibition, ataxia, blackouts, memory loss, impaired judgment
280
EtOH withdrawal
tachycardia and HTN, tremor, perspiration, hallucinations, and eventual seizures
281
EtOH drug/antidote
```
benzo taper (withdrawal)
disulfiram (long term)
```
282
benzos intox
delirium in elderly
| respiratory depression and coma (with increase dose), amnesia
283
benzos withdrawal
tremor, tachycardia, HTN, seizures, psychosis
284
benzos drug/antidote
flumazenil
285
opiate intox
euphoria, pupil constriction, respiratory depression, and potential track marks
286
opiate withdrawal
yawning, lacrimation, n/v, hurts everywhere, sweating
287
opiate drug/antidote
```
naloxone
methadone (long term)
```
288
cocaine intox
psychomotor agitation, HTN, tachycardia, dilated pupils, psychosis
angina, HTN crisis
289
cocaine withdrawal
depression, suicidality, irritability, 'cocaine bugs'
290
cocaine drug/antitode
supportive care
benzos/antipsychotics for agitation
HTN treated with α, then ß blockade
291
MDMA intox
overheat (fever, tachycardia), water intoxication, pupillary dilation, psychosis
292
MDMA withdrawal
crash
293
MDMA drug/antidote
supportive
294
PCP intox
aggressive psychosis, vertical, lateral, or rotary nystagmus, impossible strength, blunted senses
295
PCP withdrawal
severe random violence
296
PCP drug/antidote
haloperidol to subdue
| acidify urine to enhance excretion (sodium bicarb)
297
LSD intox
hallucinations, flashbacks, heightened senses, dissociative symptoms
298
LSD withdrawal
flashbacks
299
LSD drug/antidote
supportive
300
THC intox
tiredness, slowed reflexes, conjunctivitis, munchies, OD brings paranoia
301
THC withdrawal
none
302
THC antidote/drug
supportive (often nothing required)
303
barbs intox
low safety margins, benzos safer
304
barbs withdrawal
redistribute into fat
305
barbs drugs/antidote
none
306
nicotine intox
none - just jittery and stimulated
| pt has to overdose a lot -> VFib
307
nicotine withdrawal
cravings
308
nicotine drug/antidote
```
bupropion
chant (varencicline)
```
309
amphetamines intox
tachycardia, HTN, pressured speech, flight of ideas
310
amphetamines withdrawal
crash
311
amphetamines drug/antidote
none
