SAS/Review Flashcards

(40 cards)

1
Q

Which opioids affect serotonin levels?

Why is this important?

A

Tramadol, fentanyl

Patients on serotoninergic agents should not take!

Can lead to serotonin syndrome

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2
Q

What kind of defense mechanism:

A person is angry at their phsysician for cancelling their appointment. They end up cleaning their entire department to avoid thinking about being angry

A

Sublimation

Channeling anger, discomfort, unpleasant thoughts at productive activities

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3
Q

Which side effect of first-generation antipsychotics is likely to present after decades of use?

A

Tardive dyskinesia

Due to long term dopamine blockade

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4
Q

Describe the general timeline of symptoms onset during alcohol withdrawal

A
  • 6-48h: ANS hyperactivity
  • 12-48h: Seizures
  • 12-24h: Hallucinations
  • 3-5+ days: Delirium Tremens
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5
Q

What are the risks associated with MAO inhibitors?

A
  • Serotonin Syndrome
  • Hypertensive crisis
    • Must avoid tyramine-rich foods
  • Severe interaction with meperidine
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6
Q

Which drugs increase serum Lithium levels?

A
  • NSAIDs
  • Diuretics
    • Thiazides, spironalactone, triamterene
  • ACE inhibitors
  • Ca2+ channel blockers
  • Metronidazole
  • Tetracycline
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7
Q

What factors might precipitate delerium?

A

I-WATCH-DEATH

The slides specifically highlight factors in bold

  • Infection - pneumonia
  • Withdrawal
  • Acute metabolic
  • Trauma
  • CNS pathology
  • Hypoxia/hypercarbia - hypoxia
  • Deficiencies
  • Endocrine
  • Acute vascular
  • Toxins - diphenhydramine
  • Heavy metal
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8
Q

What is the difference between schizoaffective disorder and schizophrenia?

A
  • Schizoaffective disorder:
    • Mood symptoms regardless of whether psychotic symptoms are present or absent
  • Schizophrenia:
    • Mood symptoms only present when psychotic symptoms are present

(Thank you @Nathan Shlobin!)

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9
Q

Abnormal eye movements (nystagmus) are characteristic of which drug intoxication?

A

Phencyclidine (PCP)

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10
Q

Which antidepressants are contraindicated in patients with current or history of anorexia nervosa or bulimia nervosa?

A

Bupropion

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11
Q

Is this neurotransmitter associated with wakefullness or sleep?

Where is it secreted?

Serotonin

A

Wakefullness

Raphe nuclei (pons)

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12
Q

Which antipsychotics are most likely to have side effects of involuntary facial movements, restlessness, and dystonia?

A

High-potency first-generation antipsychotics

  • Haloperidol
  • Fluphenazine
  • Trifluoperazine
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13
Q

Hoover’s sign provides evidence for which disorder?

A

Functional Neurological Disorder (aka conversion disorder)

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14
Q

Is this neurotransmitter associated with wakefullness or sleep?

Where is it secreted?

Orexin

A

Wakefulness

Lateral hypothalamus

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15
Q

Is this neurotransmitter associated with wakefullness or sleep?

Where is it secreted?

Histamine

A

Wakefulness

Tuberomamillary nucleus (hypothalamus)

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16
Q

What differentiates Bipolar I from Bipolar II?

A
  • Bipolar I
    • At least 1 manic episode lasting 1+ weeks
  • Bioplar II
    • Hypomania
      • Different from mania b/c does not cause marked impairment in social/occupational functioning, does not require hospitalization
    • No manic episodes
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17
Q
A

E - All of the above

  • Bupropion = atypical antidepressant (NE and DA reuptake inhibitor)
  • Clonidine, guanfacine = alpha-2 blockers
  • Atomoxetine = selective NE reuptake inhibitor
18
Q

Rapid withdrawal of what hormone can trigger migraine?

A

Estrogen

  • Rapid withdrawal occurs during the following times:
    • Perimenopause
    • Post-partum
    • Perimenstruation
19
Q

What is the most consistent but non-specific neuroimaging finding in schizophrenia?

A

Enlarged ventricles

  • Almost always found in patients with schizophrenia
  • Not specific for schizophrenia
20
Q

Which seizure medications are prefered in women of childbearing age?

A

Lamotrigine, levetiracetam

Sometimes carbamazepine

Avoid valproate!!

21
Q

What is the most effective treatment for insomnia?

A

Cognitive behavioral therapy

Focuses on:

  • Sleep hygeine
  • Sleep restriction
    • Bed is for sleeping and sex only!
    • Wake up at the same time every day
  • Stimulus control
    • Don’t sleep until you’re tired
    • If you can’t fall asleep in 20 min, get out of bed and read
      • Avoid screens
22
Q

What is the difference between schizotypal and schizoid personality disorders?

A
  • Schizoid
    • Socially withdrawn
    • Desire to be left alone
    • Limited emotional expression
  • Schizotypal
    • Also socially withdrawn
    • Interpersonal awkwardness
    • Magical thinking, eccentricity
23
Q

A set of sidely scattered but orchestrated crerebral areas that are activated by a specific task observed on neuroimaging is a…

  1. State network
  2. Attention network
  3. Channel network
  4. Default mode network
A

c. Channel network

24
Q

Schizophrenia is a [developmental/degenerative] disorder

What is the brain pathology?

A

Schizophrenia is a developmental disorder

Results from abnormal neuronal migration during development

25
What are the classic features of MDD, melancholic subtype?
* Anhedonia and/or lack of reactivity * Early morning awakening * Significant anorexia or weight loss * Excessive or inappropriate guilt
26
A - Methylphenidate * Bupropion can also be used for ADHD, but not first line * Guanfacine is an alpha-2 agonist that is 2nd line or ad-junct to the stimulants * Tranylcypromine is a MAO inibitor - not indicated for ADHD
27
Which antipsychotic may cause neutropenia?
Clozapine * Atypical anti-psychotic * Blocks serotonin and norepinephrine * Used as a 3rd line agent * But must register in database * Track any neutropenia resulting so it is not prescribed in the future
28
What time period constitutes persistent depressive disorder?
2+ years of depressed mood for most of the day, more days than not
29
Which antipsychotics are likely to cause abnormal lactation?
* Low-potency first-generation * Chlorpromazine * Thioridazine * Second-generation - lower risk than FGA, but can still happen * Quetiapine * Olanzapine * Risperidone * Aripiprazole * Ziprasodone * Clozapine
30
What kind of medication is cyclobenzaprine?
Muscle relaxant
31
What kind of defense mechanism: ## Footnote **A person is angry at their psysician for cancelling their appointment. Next time they see their physician, they compliment the physician on their shirt**
Reaction formation | (Doing the opposite of what you feel)
32
Which class of antidepressants is most likely to have cardiac effects? What are the effects?
TCAs Long QT -\> Torsades (potentially fatal arrhythmia) * Amitriptyline * Nortriptilyine * Desipraime * Amoxapine * Imipramine * Clomipramine * Doxepin Citalopram (SSRI) also can cause long QT
33
How is lithium metabolized?
Excreted unchanged by the kidney (No hepatic metabolism)
34
What are the indications for haloperidol in a patient with delerium?
* Psychosis * Hallucinations * Agitation But remember, the focus of the treatment should always be the underlying cause!!
35
What further testing is indicated when a child presents with signs and symptoms of autism spectrum disorder?
* **Genetic testing** * **Lead levels (if reasonable environmental risk)** * **EEG** * Hearing and vision * Wood's lamp (for Tuberous Sclerosis)
36
According to Robins and Guze (1970), what 5 steps can help achieve diagnostic validity for psychiatric disorders?
1. Clinical description 2. Delimitation from other disorders 3. Follow-up study (including treatment response) 4. Family study 5. Laboratory studies
37
What are the classic features of MDD, atypical subtype?
* Mood reactivity * Significant weight gain * Hypersomnia * Leaden paralysis
38
Is this neurotransmitter associated with wakefullness or sleep? Where is it secreted? **Norepinephrine**
Wakefulness Locus ceruleus (pons)
39
Which medication can be used to augment the effects of SSRIs and is known for reducing the risk of suicide?
Lithium
40
Is this neurotransmitter associated with wakefullness or sleep? Where is it secreted? **GABA**
Sleep Ventrolateral peroptic nucleus (VLPO)