Psychiatry (Boards and Wards) Flashcards
(262 cards)
1
Q
What is a common side effect that SSRIs DONT have?
A
impotence (rare)
2
Q
What are the more severe side efffects of TCAs?
A
confusionsedation (good for people with insomnia at night)
orthostatic hypotension prolonged QRS
3
Q
What are the common side effects with MAOIs
A
Serotonin syndrome (interaction with SSI, meperidine (demerol), pseudoephedrine)--> hyperthermia, muscle rigidity and altered mental status Hypertensive crisis--malignant hyperthermia when ingested with foods rich in tyramine (wine and cheese)
4
Q
What are the SNRIs
A
Mirtazapine and Duloxetine
5
Q
What is a side effect associated with Mirtazapine?
A
agranulocytosis
6
Q
what is required to diagnose MDD?
A
two depressive episodes >2 weeks each, separated by 2 months
7
Q
What is dysthymic disorder?
A
steady depressive sx for at least 2 years (if major depressive episode occurs during the 2 yrs, then the Dx is MDD rather than dysthymic disorder
8
Q
What is the treatment for dysthymic disorder?
A
Same as MDD
9
Q
What drug toxicities should you consider in a patient who may have bipolar disorder?
A
cocaine, amphetamine
10
Q
What is the difference between a manic episode and a hypomanic episode?
A
manic cause significant disability, hypomanic have the same sx but do not cause a significant disability
11
Q
What are the diagnostic clues for bipolar disorder
A
- manic episodes causing significant disability
2. episode lasting at least 1 week, abrupt, not continuous
12
Q
What is the difference between Bipolar I, bipolar II and rapid cycling
A
Bipolar 1 : manic episode with or without depressive episodes (often depression before mania)
Bipolar 2: depressive episodes with hypomanic episodes and NO manic episodes
Rapid cycling: four episodes (depressive, manic or mixed) in 12 months, **can be precipitated by antidepressants
13
Q
What are the first line treatments for bipolar disorder?
A
Valproate and lithium
14
Q
What is a common side effect with Valproate and carbamazepine?
A
blood dyscrasias
15
Q
What are symptoms of lithium toxicity?
A
tremorpolyuria from nephrogenic DI
16
Q
What drugs are commonly the cause of drug induced mania?
A
cocaineamphetamines
17
Q
An ECG arrhytmia or ischemia in a young person should make you suspicious of what?
A
Drug induced mania (also tachy, HTN, dilated pupils)
18
Q
How treat drug-induced mania?
A
Ca-channel blockers for acute autonomic sx (drug programs are better for the long-term)
19
Q
What are the hallmark symptoms of psychosis?
A
hallucinations and delusions
20
Q
How treat someone with psychosis who has compliance issues?
A
depot of Haldol which administers a 1mo supply of drug in a IM injection
21
Q
What are examples of negative symptoms?
A
flat or lack of affect, avolition, alogia (poverty of speech)
22
Q
What are positive symptoms?
A
hallucinations and delusions
23
Q
What are the timelines for schizophrenia vs. schizophreniform vs. brief psychotic disorder?
A
Brief psychotic disorder - 1d to 1mo
Schizophreniform - 1-6mo
Schizophrenia - >6mo continuous
24
Q
What is a delusional disorder?
A
non-bizarre delusion, i.e. things that are possible, like a cheating spouse, etc, WITHOUT hallucinations, disorganized speech or behavior
25
What kind of hallucinations do LSD and PCP cause?
primarily visual, taste, touch or olfactory
26
what drugs cause paranoid delusions and feeling like bugs are crawling on your skin?
cocaine and amphetamines
27
what drug can cause psychosis and mood disturbances early in the course of therapy?
corticosteroids
28
What has a higher potency, chlorpromazine or haloperidol?
haloperidol
29
What are the adverse effects of haldol?
decreased anticholinergic effects, increased movement effects
30
what are the adverse effects of chlorpromazine?
increased anticholinergic effects (ch in this and chlorpromazine), and decreased movement effects
31
What are the adverse effects with Clozapine
1% incidence of agranulocytosis--> weekly CBClowers seizure threshold
32
What are the side effects of Risperidone?
- rare movement disorders (though can occur at high doses)
| - new onset diabetes
33
What are the side effects of Olanzapine, quetiapine, ziprasidone and aripiprazole?
- new onset diabetes
| - ziprasidone and aripiprazole can cause LESS weight gain
34
How long does a panic disorder attack usually last?
escalate for 10 mins, remain for ~30 mins (rare to last over an hour)
35
If a young pt with symptoms of an MI presents, what dx should you consider?
panic disorder
36
How dx panic disorder?
dx of exclusion of medical condition and drug abuse
37
Treatment options for panic disorder?
SSRI + benzo, taper benzo after a month
38
What is acute dystonia? How long does it last?
sustained muscle spasm anywhere in body but often in neck (torticollis), jaw or backlasts 4hrs--> 4days
39
Tx for acute dystonia?
immediate IV diphenhydramine
40
What is parkinsonism? Time course?
cogwheel rigidity, shuffling gait, resting tremor4days-->4months
41
what is the tx for parkinsonism?
benztropine (anticholinergic)
42
What is tardive dyskinesia? time course?
involuntary, irregular movements of head, tongue, lips, limbs and trunk4mo-->4yrs
43
Tx for tardive dyskinesia?
immediately change meds or decrease doses b/c effects are often permanent
44
What is akathisia? time course
Subjective sense of discomfort that leads to restlessness (pacing, sitting down and getting up)Any Time
45
Tx for akathisia?
lower medication doses
46
What is neuroleptic malignant syndrome
life threatening muscle rigidity with fever, increase BP and HR, rhabdomyolysis over 1-3 daysLabs: increased WBC, CK, transaminases, myoglobin and myoglobinuria
47
Tx for neuroleptic malignant syndrome?
Supportive, stop drug and give dantrolene (which inhibits calcium release into cells), cool patient to prevent hypoxia
48
What is agoraphobia?
fear of being in situations where escaping would be very difficult should a panic attack arise
49
What is the treatment for phobias?
Beta-blockers for prophylaxisExposure desensitization: exposure to noxious stimulis in increments while undergoing concurrent relaxation
50
What is the difference between obsessions and compulsions?
```
obsessions = recurrent thought
compulsions = recurrent acts
```
obsessive thought causes anxiety and the compulsion is a way of temporarily relieving the anxiety
51
What is the difference between OCD and obsessive-compulsive personality disorder?
OCD - aware/recognize the absurdity
OC personality disorder
- don't see anything wrong with compulsion
52
Treatment for OCD?
SSRIs or clomipramine, CBT in which patient is forced to overcome the behavior
53
What are some of the hallmark symptoms of PTSD?
- reliving initial incident via conscious thoughts or dreams
- avoiding public places and activities
- depression, moodiness, difficulty sleeping and concentrating
54
What is the difference between Acute Stress Disorder and PTSD?
Acute stress disorder also requires a traumatic incident, but sx are more immediate (within 4 wks of event) and last
55
Tx for PTSD?
SSRIs are first line
| **watch out re Benzos b/c there is a high association between substance abuse and PTSD
56
What is Generalized Anxiety Disorder?
worry for most days for at least 6 months
- irritable, inability to concentrate, insomnia, fatigue, restlessness
- need evidence of social dysfunction (ex. poor school grades, mental stagnation, etc.)
57
Tx for GAD?
psychotherapy because problem is chronic
CBT
Biofeedback and relaxation techniques
Pharm: Buspirone, B-blockers for peripheral sx like tachycardia, but doesn't address the worry)
58
What is a general symptom of personality disorders?
pervasive pattern of maladaptive behavior causing functional impairment
consistent behavior often traced to childhood
-pts usually don't see anything wrong with their behavior
59
What are ego defenses?
unconscious mental processes that individuals resort to in order to quell inner conflicts and anxiety that are inacceptable to the ego (ex. denial and projection)
60
What are Cluster A personality disorders?
Paranoid, schizoid and schixotypal (weird or eccentric)
61
What are Cluster B personality disorders?
Borderline, antisocial, histrionic and narcissistic (dramatic, wild and aggressive)
62
What are Cluster C personality disorders?
Avoidant, dependent, and obsessive compulsive (shy and nervous)
63
What is acting out
transforming unacceptable feeling into actions, ex. tantrum
64
What is displacement?
redirection of some emotion from a real source to a substitute person or object
65
What is introjection?
identifying with some idea or object so deeply that it becomes a part of that person
66
What is projection?
attributing unacceptable thoughts, feelings, behaviors and motives to others
67
Paranoid personality disorder characteristics?
- negatively interpret actions and words of others
- often use projection as ego defense (attribute to other people impulses and thoughts that are unacceptable to self)
- do not hold fixed delusions or have hallucinations
68
Schizoid personality disorder
- socially withdrawn, introverted
- don't feel need to form close emotional ties with others
- can recognize reality(D for distant)
69
Schizotypal personality disorder
```
Believe in concepts not considered real by rest of society/culture (magiv, vlairvoyance
)-Ego defense: fantasy
-no necessarily psychotic
-usually socially isolated
-often related to schizophrenics
```
70
Antisocial personality disorder
violate rights of others, break lawDx: have to have exhibited behavior BY age 15, BUT have to BE at least 18 for DxDDx = conduct disorder which is bad behavior dx in kids
71
Borderline
- volatile emotionally
- Ego defense: splitting
- self-destructive behavior
- can disassociate: forget negative experiences by covering them up with overly exuberant positive behavior
72
Histrionic
- require everyone's attention
| - use disassociation and repression (block feelings unconsciously)
73
Narcissistic
feeling entitled, because they are the best ande veryone else in inferiorhandle criticism poorly
74
Dependent personality disorder
can't do much on own, can't be alone
75
Avoidant personality disorder
Feel inadequate, very sensitive to negative comments
| Reluctant to try new things for fear of embarassment
76
Obsessive Compulsive Personality Disorder
preoccupied with detail Isolation is a common ego defense
77
What is rationalization?
making the unreasonable seem acceptable (ex. if you get fired, saying that you wanted to quit anyway)
78
What is Reaction formation
setting aside unconscious feelings and expressing the exact opposite feelings (showing extra affection for someone you hate)
79
What is Sublimation?
taking instinctual drives (ex. sex) and funneling that energy into a socially acceptable action (studying) behavior or emotion
80
What is the difference between factitious disorder and malingering?
Factitious disorder = consciously faking or manipulating sx to 'assume the sick role' but not for material gainMalingering = consciously faking sx for material gain
81
Munchhausen is an example of what kind of disorder?
Factitious Disorder
82
What is somatoform Disorder?
ex. female pt with problems starting before age 30 w/history of frequent visits to the doctor for countless procedures and operations (often exploratory) and h/o abusive or failed relationships
83
treatment for somatoform disorder
continuity of care, regular appointments so pt can express sx, perform phys exam but don't order labs, eventually suggest psych
84
What is conversion disorder?
neuro sx, not consciously fakedsensory defecits usually fail to correspond to a known pathwayDx: identify a stressor that preciptated the sx and exclude an adequate medical illness**some of these patients may be found to have a non-psychiatric cause of illness
85
Hypochondriasis
preocupation with dz, misinterprets sx as suggestive of something serious
86
Body dysmorphic disorder definition? Tx?
concern with body, usually 1 feature, imagines defecits that other people don't see, exagerrate any slight imperfections if presentTx = SSRIs
87
Autism
pervasive developmental disorder that covers many areas of development from language, social interaction to emotional reactivity
-child is 'living in own world
'-sx begin by age 3
88
Aspergers
autism without language impairment
89
Depression in kids and teens
kids: can be hyperactive and aggressiveteens: can show boredom, irritability, openly antisocial behavior+ adult sx
90
Sx of Separation anxiety and Tx
sleep disturbance and somatic sx during times of separation (headache, upset stomach)Tx: desensitizing, imipramine sometimes used
91
Tx for ADHD?
methylphenidate, amphetamine (Ritalin, Concerta, Adderal)
92
Tourette's Dx
require a motor tic and vocal tic for >1yr
| vocal tics are usually obscene
93
Tx for Tourette's
Haldol
94
Bulemia
binge eating and purging
more common than anorexia
can have nml appearance
Abrasion over knuckles and dental erosion
95
Cocaine/amphetamine withdrawal sx
hypersomnolence, dysphoria, increased appetite
96
Tx for Cocaine and amphetamines
Beta blockers for seizures and BP HR control
| Ca channel blockers for ischemia
97
Heroin intoxication sx
decreased consciousness
| pinpoint pupilsrespiratory depression
98
Heroin withdrawal sx
nausea/vomiting
| pupillary dilationinsomnia
99
Tx for Heroin
Naloxone to reverse acute intoxication
| Withdrawal tx with a methadone taper
100
Benzo and Barbiturates intox sx
respiratory and cardiac depression
101
Benzo and Barbiturates withdrawal
agitationanxietydelerium
102
Tx for Barb/Benzo intox
ABCscharcoal to reduce absorptionFlumazenil to reverse benzos acutely (but can cause seizures)
103
Sx and Tx for PCP intoxication
Intense psychosis, violence, rhabdo, hyperthermia
| Tx: supportive, benzos or haldol for psychosisacidify urine with ammonium chloride and ascorbic acid
104
Sx of LSD intox
enhanced sensation: richer colors, music more profound, tastes heightened
tx = supportive
105
What is Dissociative disorder? What are the main symptoms?
possess different personalities that can each take control at a given time (key is shifting identities)
106
What is adjustment disorder? What are the main symptoms?
behavioral or emotional sx that occurs in response to stressful life events in excess of what is normal-has a catch-all quality
Sx within 3 months of stressor and has to disappear within 6 months of disappearance of stressor
(bereavement is not adjustment disorder, they are separate)
107
What is the hallmark of impulse control disorders?
cannot resist certain actions, feel anxiety before action and gratification afterwards
108
do kleptomaniacs feel guilty about stealing?
Yes!
109
Tx for Narcolepsy?
stimulants like methylphenidate or pemoline
110
What are associations and complications of sleep apnea?
assoc: hyperthyroidismcomplications: pulmonary HTN
111
Sx of pickwickian syndrome
somnolence, obesity and erythrocytosis
| pathophys: weight of adipose on lungs and abdomen cause chronic alveolar hypoventilation
112
What are night terrors? When do they occur during sleep?
not fully awake, sit up suddenly in bed with sweating, tachycardia, feeling frightened
-arises during NREM sleep
113
When do nightmares occur?
REM sleepusually after an emotional eventfully awake and can recall nightmare eventsassoc with drugs
114
When does sleepwalking occur?
during NREM sleep
115
Sx of restless leg syndrome
irresistible urge to move limbs, commonly causes limb jerking movements during sleep that disrupts sleep stages
Tx: dopamine agonist and tx of underlying causes, like thyroid replacement
116
What test is important to do 3 months after starting Olanzapine?
Fasting glucose and lipids
117
Dx of delusional disorder?
non-bizarre fixed delusions for at least 1 month
doesn't meet schizophrenia criteria
functioning in life not significantly impaired
118
What drug is used to treat social anxiety disorder?
Paroxetine (Paxil)
119
What medication can lead to seizures if it is stopped too abruptly?
Xanax aka Alprazolam
120
Treatment for performance social anxiety?
Propranolol
121
What blood tests should be done before lithium is started?
- creatinine
| - thyroid function tests
122
What is the most common side effect of methylphenidate?
Decreased appetite
123
What is the mechanism of acamprosate?
increases GABA, decreases glutamate--> decreased cravings
124
What are the symptoms of Wernicke encephalopathy?
```
Acute thiamine deficiency leads to:
C: reversible Confusion
O: Ophthalmoplegia (CN6 palsy)
A: Ataxia
T: Thought disturbances
Tx = IV Thiamine
```
125
What is Korsakoff psychosis?
chronic thiamine deficiency
- irreversible retrograde/anterograde amnesia
- confabulations
126
What is the treatment for delusional disorder?
Psychotherapy
127
If a patient with MDD fails a SSRI, what is the next drug treatment?
a different SSRI, then switch to a different drug class
128
What is trazodone primarily used for?
insomnia related to depression
129
What defecits can lithium cause in the 2nd and 3rd trimesters?
Goiter
| Transient neonatal neuromuscular dysfunction
130
What is the treatment for alcohol withdrawal?
Lorazepam
131
What is the treatment for GAD?
SSRI (escitalopram) + CBT
132
what is the difference between childhood disintegrative disorder and Rett syndrome?
Rett girls> boys, CDD boys> girls
| CDD has similar loss of previously acquired skills, but CDD has no decreased head growth or hand wringing
133
Treatment for rapid cyclers?
Carbamazepine
134
Treatment for Panic Disorder?
high dose SSRI for 8-12 months + CBTShort term Benzos for immediate relief from attacks
135
Treatment for social phobia
SSRI (paroxetine) + CBT
136
How distinguish normal stress reaction?
may be stressed and have decreased sleep, but does not cause any functional impairment
137
What is a requirement for hospice?
prognosis of
138
treatment for hoarding?
CBT and SSRI
139
difference between somatization and conversion patients?
somatization patients are concerned about their condition, conversion pts don't care
140
Hypochondriasis time frame?
> 6 months
141
Ddx Somatization from Hypochondriasis?
Hypochondriacs are worried about ONE thing, specific disease
142
Treatment for body dysmorphic disorder
CBT + SSRI
143
brain fag
headache, fatigue, and visual disturbances in African male student
144
How dx delerium?
abnormal EEG
145
if parents refuse therapy for their child that is non-emergent but potentially fatal what is the next step?
court orderif emergent, proceed with tx
146
teen with behavioral changes, next step?
utox
147
Anti H2
sedation and weight gain
148
Anti A1
orthostatic hypotensionsexual dysfunction
149
Anti muscarinic
dry mouth, blurry vision, constipation, urinary retention, exacerbates Alzheimers
150
anti D2
anti psychosis, EPS, increased prolactin
151
Anti 5-HT1c
weight gain
152
5-HT2
agitation, akathisia
153
5-HT3
diarrhea, nausea + vomiting
154
What are drugs that when combined with SSRIs can cause Serotonin syndrome?
MAOi, OTC cough meds, Linezolid
155
What are drugs that when combined with MAOis can cause Serotonin syndrome
meperidine
| MDMA/MDEA
156
treatment for serotonin syndrome?
cyproheptadine or BDZ
157
EPS Tx?
acute dystonia--> benztropine or diphenhydramine
akathisia--> B blockers or BDZ
Parkinsonism--> levodopa or amantadine
158
What are the teratogenic defects caused by TCAs and BDZs?
TCAs: limb defects
BDZ: cleft palate and FAS facies
159
which SSRI has the fewest withdrawal sx?
Fluoxetine (Prozac) bc has the longest half life
160
Which SSRI has the most withdrawal sx?
Paroxetine (Paxil) due to shortest half life and most anticholinergic side effects
161
Fluvoxamine is used to treat what?
OCD
162
what is the treatment for TCA OD?
NaHCo3
163
what is the only antidepressant that can cause EPS?
Amoxapine (Asendin)
164
Clomipramine major side effect?
very sedating, tx for OCD
165
What are MAOis primarily used to treat?
atypical depression
166
which type of antipsychotics are better for negative sx
atypicals (2nd gen) are better for negative psychotic sx
167
which antipsychotic most likely causes increased prolactin and dystonic reactions
Risperidone (Risperdal)
168
Likely cause if patient says Ziprasidone isn't working?
patient wasn't eating, food is required to activate Geodon in the body
169
if someone on lithium has a blood level > 4.0, what is the next step?
hemodialysis
170
Treatment for someone on lithium with HTN?
Ca channel blocker
171
treatment for barbiturate overdose
IV NaHCO3
172
Benadryl has what kind of side effects?
anti-cholinergic
173
What is Propranolol used to treat?
panic attacks, performance anxiety and akathisia
174
patient has sx of schizophrenia, depression and bipolar 1 disease and is older, think...?
vascular dementia x frontal lobe infarct
175
How does DA and 5-HT relate to libido?
DA increases libido5-HT decreases libido
176
sildafenil is what kind of drug?
PDE5-inhibitor
177
During what stage of sleep does sleepwalking, bedwetting and sleep terrors occur?
delta, stage 3-4
178
What is the difference between acute and chronic insomnia?
acute is less than a month, chronic is more than a month
179
What is Keine-Levin syndrome?
excess daytime sleepiness, aggression, hyperphagia, hypersexuality
180
What is the treatment for cataplexy?
Oxybate
181
What is delayed sleep phase disorder? tx?
sleep onset and awakening are delayed, nml duration/qualitytx: bright light phototherapy in AM, melatonin in evening
182
What is advanced sleep phase disorder?
sleep onset and awakening are early, normal duration and qualitytx: bright light therapy in the evening
183
tx for nightmares
image rehearsal therapyif severe, antidepressants
184
REM sleep disorder: sx and tx
Sx: dream enactment (talking, yelling, etc) that often presents as injury to pt or bed partertx: clonazepam
185
Restless leg syndromecausesSx
irresistible urge to move one's legs while going to sleepCause: pregnancy, anemia, renal failure, metabolic disturbances
186
What is the treatment for pseudodementia?
supportive psychotherapy + low dose antidepressantsdepression + low appetite + insomnia--> mirtazapine
187
How long does normal grief last?
188
what side effects of anti-depressants are more commonly seen in elderly?
anticholinergic
189
What kind of drug is meperedine?
opioid
190
Tx for opiate OD?
naloxone
191
Tx for opiate withdrawal
Clonidine
192
what is the best treatment for heroin addiction?
methadone
193
Teeth grinding is associated with what drug?
Ecstasy/MDMA
194
what is dissociative amnesia?
1+ episode of inability to recall personal information ,not due to tTBI, medication condition, substance abuse or ordinary amneisa
195
Tx for dissociative amenisa?
psychotherapy, most acute cases return to normal after min-dayslorazepam or amobarbital often used to help pt talk freely during interview
196
What is dissociative fugue?
sudden, unexpected travel away from home and inability to recall one's past
197
Dissociative fugue vs. amnesia?
DA pts are aware of what they can't seem to remember, DF don't acknowledge the amnesia
198
Dissociative fugue vs. transient global amnesia
DA pts show loss of identity, global amnesia have difficulty with more recent events but identity remains intact
199
Delirium cause: focal neuro sx
CVA/Mass lesiondx brain CT/MRI
200
Delirium cause? increased BP and papilledema
HTN encephalopathy dx brain CT/MRI
201
Delirium cause? increased HR and dilated pupils
drug intox
| dx: utox
202
Delirium cause? increased HR, tremor and thyromegaly
Thyrotoxicosis
| Dx TSH and t4 levels
203
Delirium cause? increased ammonia?
Hepatic encephalopathy
| tx lactulose adn neomycin
204
Dementia cause: obesity, coarse hair, constipation and cold intolerance?
Hypothyroidism, reversibleDx: TSH and T4 levels
205
Dementia cause: diminished position and vibration sense?
decreased B12
| Dx: B12 levels
206
Dementia cause: diminished position and vibration sense, pupil accommodates but doesn't respond to light
Neurosyphilis
| Dx: CSF FTA-ABs or VDRL levels
207
Dementia cause: tremor, increased LFTs, corneal rings?
Wilson dz
| dx: decreased serum ceruloplasmin levels
208
Diagnosis? waxing and waning Parkinsonism, VH, and antipsychotic sensitivity?
Lew Body dementia
209
treatment for adjustment disorder?
psychotherapy
210
side effect of Lamotrigine?
stevens-johnson
211
side effect of nefazodone?
hepatotoxicity
212
side effect of carbamazepine?
anemia, thrombocytopenia, leukopenia
213
symptoms of myocarditis?
eosinophilia, fever, tachycardia fatigue
| decreased EF, increased cardiac enzymes, eKG changes
214
myoclonus is associated with what adverse drug reaction?
serotonin syndrome
215
lihtium toxicity symptoms usually begin above what level?
1.5
216
what is a distinctive feature of acute stress disorder?
dissociation aka losing track of time
217
low iron and magnesium are associated with what disorder?
restless leg syndrome
218
night terrors vs. nightmares
NTs: first 1/3 of night, shout/paralysis, no memory in AM
219
Enuresis nml until what age?
5yo
220
Encopresis nml until what age?
4yo
221
refeeding syndrome is associated with what metabolic abnormality?
decreased phosphorus
222
Dx: confusion/delirium, lethargy, constipation, abdominal pain, polyuria
hypercalcemia
223
what psych drugs can cause hyponatremia?
SSRIs and carbamazepine
224
lesions in what part of the brain can cause hypomania or mania?
R frontal lobe lesions
225
olfactory hallucinations are associated with what illness?
temporal lobe epilepsy
226
What psych sx? interferon
depression
227
What psych sx? Beta-blockers
depression
228
What psych sx? Corticosteroids
hypomania, depression, psychosis and mania *not associated with 'roid rage which is from anabolic steroids
229
What psych sx? Dopaminergic antiparkinson meds
psychosis
230
What psych sx? Dopaminergic antiemetics like prochlorperazinea and metoclopramide
psychosis
231
What psych sx? Anticholinergic meds like diphenhydramine, benztropine
precipitate or worsen delirium
232
What psych sx? Meperidine
precipitate or worsen delirium
233
What psych condition is prazosin used for?
at bedtime for PTSD related nightares
234
What is buproprion used for?
- depressed pts who need to quit smoking
| - depressed pts thought to have bipolar disorder-sexual s/e from SSRIs
235
what med for patients with neurovegetative sx of depression (decreased sleep and appetitie)?
Mirtazapine
236
Contraindications: Buproprion
pts with seizure disorders and eating disorders
237
Contraindications: Valproic acid
pregnant women (neural tube defects)
238
Contraindications: Carbamazepine
pregnant women (neural tube defects)
239
Delusional disorder: time frame? functional impairment?
>1 month, withOUT functional impairment
240
treatment for cocaine withdrawal
Buproprion
241
characteristics of insomnia?
decreased sleep duration or quality
242
what drug decreases alcohol cravings?
naltrexone
243
When do you NOT want to give Haldol?
alcohol withdrawal, can decrease seizure threshold
244
tx for acute mania in a pt with bipolar disorder
haldol or clonazepam
245
tx for bipolar dz in preggos
Clonazepam
246
bipolar and agranulocytosis: what drug? when d/c?
Carbamazepine, d/c if ANC
247
HA, N/V, dizziness and fatigue when stop what drug suddenly?
5HT discontinuation syndrome, most common with sertraline and fluvoxamine
248
contraindications to buproprion
bulemia, alcoholics, epileptics
249
Tx fo HTN crisis
5mg IV phentolamine
250
tx for TCA OD in a kid?
Charcoal if within 1-2 hours
| IV Na-Bicarb helps met acidosis and cardioprotective
251
purple grey metallic rash over sun-exposed areas and jaundice, what drug?
chlorpromazine
252
prolonged qTc and pigment retinopathy, what drug?
thioridazine
253
When d/c clonzapine?
Clozapine, d/c if ANC
254
how long have anxiety to diagnose GAD?
> 6 months
255
first step in mgmt of restless leg syndrome
rule out iron deficiency anemia or CKD
tx ropinirole or pramipexole
256
EEG shows diffuse background slowing, dx?
delirium
257
most specific test for EtOH consumption in past 10 days
carb-deficient transferrin
less specific is elevated GGT and AST 2x ALT
258
tx for PCP intox
haldol for acute psychosis
259
pt with SI, hypersomnia, depression adn anergia: dx?
cocaine/amph withdrawal
260
pt presents with dilated pupils, seizure, tachycardia and HTN, dx? best first test?
cocaine/amphetamine intox
EKG then utox, tx seizure with lorazepam
tx HTN with CCB, BB are contraindicated!
261
tourettes tx
clonidine, haldol or pimozide
262
suppression vs. repression?
suppression is conscious
repression is unconscious
