Shelf Review Anki Deck Flashcards
1
Q
What is nucleus of norepinephrine?
A
Locus ceruleus
2
Q
How does lewy body dementia present?
A
- Hallucinations of little people- Parkinsonism, rapidly progressing
3
Q
Which antipsychotic is also used as amood stabilizer?
A
Quetiapine
4
Q
Antidepressant associated with priapism
A
Trazodone
5
Q
Diagnose schizoaffective
A
Majority time =psychosis + moodAnd
Psychosis alone forat least 2weeks
6
Q
Diagnosis of Panic disorder
A
1) At least 1 panic attack-Sudden onset, no known trigger-Autonomic Sx-Feeling of impending doom
2) Fear of attacks in between
7
Q
What areadvantagesofchlorpromazine?
A
- Low potency- Approved in children
8
Q
What mood stabilizers are associated with SIADH?
A
- Carbamazepine- Oxcarbezipine
9
Q
Typical age of onset of schizophrenia?
A
Men: 17-25Women: 25-30Onset after age 40 extremely rare
10
Q
Diazepam
A
Benzodiazepine- Fast onset- Longt1/2
11
Q
Treatment ofperiodic limb movement disorder
A
Same as restless leg syndrome… (DA agonists, ropinorole/pramipexole) they are highly comorbid
12
Q
What arecommonside effectsof thetypical antipsychotics?
A
- Varying degrees of EPS- Varying degrees of anti-HAMH: sedationA (alpha): orthostatic hypoTNM (muscarinic): dry mouth, tachy, urinary retention, blurry vision, constipation
13
Q
Describe 4 clinical features of narcolepsy
A
- Daytime tiredness2. Hypnopompic/hypnogogic hallucinations
- Sleep paralysis
- Cataplexy
14
Q
Diagnose generalized anxiety disorder
A
Anxious about everything for 6 months3/6- Restlessness- Fatigue- Concentrating difficulty- Irritability- Muscle tension- Sleep disturbance
15
Q
What are symptoms ofalcohol withdrawalat4-5 days?
A
- Delirium tremens- Bad VS instability- Visual hallucinations
- Micropsia (things look small)
16
Q
Diagnose bipolar
A
1 manic episode
17
Q
Low glucose with normal c-protein
A
Factitious disorder: exogenous insulin
18
Q
2 clinical features of sleep terrors
A
- Autonomic activation (breathing heard, tachycardic, sweaty)2. Amnesia
19
Q
What areadvantagesofsertaline?
A
- Few drug-drug interactions- Used in medically ill and elderly
- Used in anxiety disorders (more anxiolytic than activating)
20
Q
Which typical antipsychotic is associated with sedation and weight gain?
A
Chlorpromazine
21
Q
What aredisadvantagesof(es)citalopram?
A
- Prolongs QT- Can’t go above 40
22
Q
Fetal alcohol syndrome
A
- Smooth philtrum- Microcephaly- Micrognathia- Small low set ears- Hypotelorism
23
Q
What is the nucleus of serotonin?
A
Dorsal raphe
24
Q
Tuberous sclerosis
A
- Ashleaf spots- Intractable seizures- Mental retardation
25
What are early symptoms of alcohol withdrawal?
- Tongue tremor (fasciculations)- Tremulous
| - Sweat- Anxiety- Irritable
26
What are the most dangerous side effects of lithium?
- Nephrogenic diabetes insipidus (ADH receptor blocker)- Renal impairment- Hypothyroid
27
How do you treat PCP intoxication?
- Haldol- Minimize stimuli
28
How do you treat opiate withdrawal?
- Clonidine- Immodium- Symptom relief
29
How do MAOI's cause hypertensive crisis?
Tyramine interaction- No aged cheeses or cured meats
30
How do you treat Lewy Body dementia?
Don't give D2 blockers!- Quetiapine is ok though
31
How do you treat alzheimer's dementia?
- Cholinesterase inhibitors: Galantamine, Donepezil, - NMDA antagonist
32
What are disadvantages of risperidone?
- Relatively high incidence of EPS- Hyperprolactinemia
33
What is the washout period to transition from SSRI to MAO-I? And the exception?
2 weeks- Except fluoxetine
34
How do you treat huntington's?
None
35
How do you treat SSRI discontinuation syndrome?
Restart SSRI
36
Which SSRI should be used for anxious depressives?
Paroxetine
37
What are disadvantages of quetiapine?
- Side effects are not dose-dependent- Sedation- Weight gain- Dizziness makes hard to tolerate (CATIE)
38
What are disadvantages of fluvoxamine?
- BID dosing (twice a day)- Very short half life: discontinuation syndrome
39
How long does mania last?
>7 days or hospitalized
40
Which TCA's can be used for chronic pain and headaches?
ImipramineAmitriptylineDoxepin
41
What is the most dangerous atypical antipsychotic?
Clozapine
42
What lab abnormalities can be seen with valproate?
- LFT's- Thrombocytopenia
43
Diagnose atypical depression
Preserved mood reactivity2/4HyperphagiaHypersomniaLeaden paralysisSensitivity to interpersonal rejection
44
What are advantages of quetiapine?
- Useful as sleep aid- Approved as monotherapy as a mood stabilizer
45
Substance-induced mania can be caused by withdrawal from ___.
- Alcohol- Benzodiazepines
46
Which TCA is the most 5-HT specific?
Clomipramine
47
What is the mechanism of action of aripiprazole?
mixed agonist/antagonist
48
What are disadvantages of topiramate?
- "Dopamax" (makes you slow and tired)- Word finding problems- Kidney stones
49
What is the mechanism of action of clozapine?
D2 and D4 blockade5HT2A receptor antagonist
50
Which atypical antipsychotic increases seizure risk
Clozapine
51
Which antipsychotic has the highest likelihood of EPS?
Risperidone
52
Lesch-Nyhan
- Self-mutilation- Motor degeneration
53
Which benzodiazepine has the least addictive potential?
Clonazepam (slow onset)
54
Causes of increased liver enzymes?
- Alcohol (AST>ALT)- Acetaminophen/valproate overdose- Alcoholic hepatitis
55
Causes of hyponatremia?
- Psychogenic polydipsia- SIADH (carbamazepine)- Ecstasy
56
Which antidepressant is associated with dry mouth, constipation, sedation and weight gain?
TCA's
57
How do you treat generalized anxiety disorder?
SSRI
58
How does t1/2 affect Benzodiazepine use?
- More seizure risk during withdrawal with shorter t1/2
59
How does restless legs syndrome present? (differ from Akathisia)
PHYSICAL feelings of discomfort in legs - creeping, crawling, painAlso relieved by movement(Akathisia is subjective, INNER feeling, not actually physical)
60
Causes of decreased K+?
- Laxatives- Anorexia
61
Which TCA is used for OCD?
Clomipramine
62
What determines seizure risk of benzodiazepines?
Half-life[ short = worse ]
63
What is the difference between drug abuse and dependence
Abuse gets you in trouble (ex. DUI, rob, sex, jail, hospital)
Both have physical sithdrawal symptoms, tolerance, impaired control
64
What is Cotard syndrome?
Nihilistic delusion that he/she is dead- Somatic/physical delusions (rotting, dust)
65
Which antidepressants have the highest likelihood of withdrawal?
- Paroxetine- Venlafaxine
66
How does lithium toxicity present?
- Coarse tremor- Altered mental status- Nausea/vomiting/diarrhea
67
Which mood stabilizer causes cognitive dulling?
Topiramate
| "dope-amax"
68
Alprazolam
Benzodiazepine- Fast-Intermediate onset- Short-Intermediate T1/2
*Addictive due to fast onset, high seizure risk due to short half life
69
What is the most efficacious atypical antipsychotic?
Clozapine
70
What substance causes respiratory alkalosis+metabolic acidosis with tinnitus? How do you treat?
Salicylates- Treat with sodium bicarbonate
71
What substance causes altered mental status, drowsiness, widened QRS on monitor? How do you treat?
TCA - Treat with bicarbonate and magnesium
72
What are advantages of ziprasidone?
#NAME?
73
What are advantages of SNRI's?
- Potentially helps with chronic pain and diabetic neuropathy
74
Encoporesis is normal until age ___.
4
75
Which benzodiazepine is highly addictive? (besides alprazolam)
Diazepam
76
How long does hypomania last?
4-7 days
77
What are symptoms of serotonin syndrome?
- Flushing- Diaphoreis- Myoclonic jerks
78
What are advantages of trazodone?
- Relatively benign- Commonly used on inpatient unit
79
What neuroanatomy is responsible for wernicke korsakoff?
Mamillary bodies
80
When does alcohol withdrawal start?
6-24 hours
81
What are advantages of selegiline?
- Used in Parkinson's disease- Transdermal form available
82
Substance-induced psychosis can be caused by intoxication with ___.
PCP, cannabis, LSD
83
Substance-induced depression caused by withdrawal from ___.
- Cocaine- Meth
84
What will be seen with alzheimer's dementia?
Diffuse cortical atrophy
85
What are common side effects of mirtazapine?
- Appetite stimulation- Sedation (low doses)
86
Which condition is associated with heart block?
Anorexia
87
What are advantages of risperidone?
- High potency- Dissolving form (M tab)- Long-acting consta form
88
Which medications are associated with depression?
- Chronic steroids- Accutane- Interferon- Beta blockers
89
How do you differentiate between somatization and hypochondriasis?
- Somatization: nebulous symptoms- Hypochondriac: fixation on one diagnosis
90
Rett syndrome
In girls
| - Hand wringing- Head stops growing- Regression of language, intellect and motor skills
91
What is a contraindication to lithium?
Renal disease
92
Predominant emotion in anorexia
AnxietyEgo-Syntonic Pathology (exerting CONTROL over weight relieves anxiety)
93
What are advantages of lithium?
- Effective- Not typically associated with weight gain
94
Low TSH leads to ___.
Anxiety[ hyperthyroidism ]
95
How do you treat vascular dementia?
Risk reduction (ASA)
96
What is the mechanism of action of cocaine?
Dopamine, 5-HT, NE reuptake blocker
97
What fetal abnormality is associated with valproate?
Neural tube defects
98
What is the mechanism of action of risperidone?
D2R blockage5HT2A receptor antagonist
99
Describe delusions in schizophrenia.
Many bizarre delusions
100
How do you treat bipolar disorder?
- Acute mania: mood stabilizer + atypical antipsychotic- Maintenance: mood stabilizer only
101
What are common side effects of atypical antipsychotics?
- Metabolic syndrome- Some anti-HAM
102
Antidepressant that increases seizure risk?
Buproprion
103
What is chlordiazepoxide used for?
Alcohol withdrawal
104
What are advantages of olanzapine?
- Effective- Zydis form (dissolving tab)(evidence from CATIE study)
105
How do you treat hypertensive crisis (from MAOI)?
Phentolamine
106
How do you treat catatonia?
- Lorazepam- ECT
107
What is the mechanism of action of mirtazapine?
5-HT2a/c, 5-HT3a antagonist
108
What substance causes anion gap metabolic acidosis and afferent pupillary defect? How do you treat?
Methanol (moonshiners)- Treat with fomepizole
109
What substance causes hyperthermia, dry flushed skin, tachy, agitated, stumbling around? How do you treat?
Diphenhydramine- Treat with physostigmine
110
What is the mechanism of action of buproprion?
Inhibits reuptake of norepinephrine and dopamine
111
Which SSRI should be used for neurovegetative depressives?
Fluoxetine
112
What weight is associated with bulimia?
Normal-high
113
Adjunct antidepressant to promote sleep and appetite?
Mirtazapine
114
What is the mechanism of action of amphetamine?
Reuptake blocker and release increaser
115
How does benzo intoxication present?
Similar to alcohol intoxication, but less active
116
Symptoms of metabolic syndrome
- Hypertension- Insulin resistance- Central obesity- Dyslipidemia (High triglycerides, low HDL)
117
How does the time to onset affect benzodiazepine use?
Addictive potential
118
Which atypical antipsychotic causes sedation, weight gain, drooling, cardiomyopathy (reversible) and agranulocytosis?
Clozapine- Require weekly blood draws!
119
What are disadvantages of carbamazepine?
- Bone marrow suppression- SIADH
| - Many drug-drug interactions!- Deactivates birth control- P450: autoinducer
120
What is the mechanism of action of olanzapine?
D2R blockage5HT2A receptor antagonist
121
Reaction to trauma that presages acute stress disorder
numb, detached, dissociated
122
What is xanax used for?
- Panic attacks- Highly addictive
123
Treatment of cataplexy in narcolepsy
GHB (gamma-hydroxybutyrate)(aka sodium oxybate)(But in real life, Fluoxetine or Venlafaxine)
124
Chlordiazepoxide
Benzodiazepine- Intermediate onset- Longest t1/2
125
How does wernicke korsakoff present?
- Ataxia- Altered mental status- Abnormal eye movement- Confabulation
126
What developmental disorder is only seen in females?
Rett syndrome- Regression of language, intellect and motor skills
127
What substance causes abdominal pain, n/v, jaundice and elevated LFTs? How do you treat?
Acetaminophen- Treat with N-acetylcysteine
128
How do you treat enuresis?
1. Fluid restriction, pee before bed2. Bell and pad (classical conditioning)3. DDAVP (old sources = imipramine)
129
Diagnose a major depressive episode
```
Depressed mood or loss of interest for 2+ weeks5/9
Sleep
Interest
Guilt
Energy
Concentration
Appetite
Psychomotor
Suicidality[ SIGECAPS ]
```
130
What are advantages of buproprion?
- Can treat sexual side effects- No weight gain- Activating
| - Helpful in smoking cessation
131
What is the mechanism of action of ecstasy?
Amphetamines + 5-HT agonist
132
Typical age of onset for delusional disorder?
Middle age (40s-50s)
133
Which medications can cause psychosis/delirium?
- Steroids- Levodopa- Benzos- Anticholinergics
134
How does amphetamine intoxication compare to cocaine?
No coronary symptoms with meth
135
Causes of hypernatremia?
- Dehydration- Diabetes Insipidus (Lithium)- Alcohol
136
Which benzos bypass liver metabolism
LorazepamOxazepamTemazepam
137
How does opiate intoxication present?
- Pinpoint pupils- Decreased RR
138
What mood stabilizer is associated with weight loss?
Topiramate
139
Diagnose acute stress disorder
Trauma +(same 4 Sx clusters as PTSD) BUT onset within 4 wkssx last less than 4 wks
140
How do you treat OCD refractory to medication?
Deep brain stimulation or cingulotomy
141
Cause of low Ca++?
Anorexia
142
Diagnosis of bulimia
Binging (central pathology)With consequent compensatory behavior (eg, purging)
143
How does cocaine intoxication present?
Angina/MI
144
First line treatment for anorexia?
None
145
What are disadvantages of zaleplon?
Can be habit forming
146
Diagnose PTSD
Symptoms > 1 month, onset anytimeTraumatic experience +1) Re-experiencing (flashbacks, nightmares)2) Avoidance3) Hyperarousal4) Mood/Cognitive Sx
147
Which antidepressant is contraindicated with meperidine (demerol)?
MAOI
148
What are disadvantages of olanzapine?
- Absolute WORST in terms of metabolic effects
149
What are advantages of eszopiclone?
Can be taken for longer periods than other hypnotics
150
What substance causes anion gap metabolic acidosis and calcium oxalate crystals? How do you treat?
Ethylene glycol- Treat with fomepizole
151
What is the advantage of valproate?
Slightly wider therapeutic window
152
Causes of increased H&H
Polycythemia vera
153
What are 3 life-threatening adverse effects of clozapine?
- Seizure- Agranulocytosis- Cardiomyopathy
154
Which atypical antipsychotics are the worst for metabolic syndrome?
- Olanzapine- Clozapine
155
Atypical depression can be confused with ___ .
Borderline Personality Disorder (due to seemingly unstable mood + interpersonal sensitivity)Distinguish by TIMELINE
156
Which atypical antipsychotic causes QT prolongation?
Ziprasidone
157
What are advantages of (es)citalopram?
- Few drug-drug interactions- Very low incidence of side effects
158
What are common side effects of valproate?
- Sedation- Weight gain- Alopecia
159
Liver cirrhosis + psychiatric symptoms?
Wilson's
160
What are disadvantages of fluoxetine?
Dirtiest SSRI with the most side effects- Sexual dysfunction- Activating properties can worsen anxiety
161
Potency of the typical antipsychotics in increasing order?
Chlorpromazine < Perphenazine < Fluphenazine = Haloperidol
162
What is the most dangerous effect of valproate overdose?
Fulminant hepatic failure
163
Clinical features of REM sleep behavior disorder
Lack of atonia during REM: they act out dreams
164
Which atypical antipsychotic is also an adjunct antidepressant?
Aripiprazole
165
What are common side effects of MAOI's?
- GI distress- Orthostatic hypotension- Sleep disturbance- Dry mouth- Headache
166
What is most often found on CBC with lithium?
Benign leukocytosis
167
How do you treat OCD?
SSRI's- Sertraline- Fluvoxamine- Clomipramine
168
What fetal abnormality is associated with Lithium?
Ebstein's anomaly: atrialized right ventricle
169
What are disadvantages of eszopiclone?
- Expensive- Withdrawal syndrome
170
How do you treat neuroleptic malignant syndrome?
- Cooling- Fluids- Dantrolene/bromocriptine
171
What are symptoms of temporal lobe seizures?
- Olfactatory/gustatory hallucinations (auras)- Auditory hallucinations
- Hyperemotional -- fight or flight (amygdala)- Hyperreligious
- Intermittent aphasia
172
Which mood stabilizer is associated with SJS?
Lamotrigine
173
Very high glucose with altered mental status?
- DKA- HONK (HyperOsmolar Non-Ketotic state)
174
What are common lab abnormalities seen with Lithium?
Benign leukocytosis
175
How do amphetamines compare to cocaine?
Amphetamines last longer
176
ADHD Timeline: symptoms before age ___.
DSM IV: 7 years oldDSM 5: 12 years old
177
Adjunct antidepressant that can help with SSRI-related sexual dysfunction?
- Buproprion- Buspirone
178
Which atypical antipsychotic causes hyperprolactinemia?
Risperidone
179
What mood stabilizer lessens efficacy of birth control?
Carbamazepine (dirty, auto-inducer)
180
What imaging is associated with huntington's?
Caudate atrophy
181
What are hypnogogic / hypnopompic hallucinations?
Hypnogogic: hallucinate when going to sleepHypnopompic: hallucinate when waking up
182
Timeline of a brief psychotic episode
1 day - 1 month
183
What are advantages of zolpidem?
Widely available
184
How does separation anxiety present?
Scared of something happening to parent- Can happen at any age
185
Clinical features of periodic limb movement disorder
ASLEEP: Middle insomnia woken up with rhythmic leg movements
186
How do you treat panic disorder?
SSRI or CBTAcute relief: benzodiazepine
187
What is a contraindication to using TCA's?
Contrandicated with pre-existing cardiac conduction abnormalities.- Lethal overdose: widened QRS >> Torsades >> V-Fib
188
Which TCA is the least sedating with the fewest anticholinergic side effects?
Desipramine
189
What are disadvantages of paroxetine?
Short half life - Significant discontinuation syndrome
| - Can't miss a dose!
190
4 types of REVERSIBLE dementia
- NPH- B12- depression- hypothyroidism
191
What are advantages of zaleplon?
- Very short acting- May be taken if wide awake in the middle of the night
192
How do you treat alcohol intoxication?
- Thiamine- Hydration
193
Which drugs prolong QT?
- Ziprasidone- Methadone
194
Which mood stabilizer deactivates birth control?
Carbamazepine
195
How do you treat tic disorder and related disorders?
Clonidine: for tourette's + ADHD
| Risperidone, haldol, pimizide (D2 blockers): for tourette's
196
How do you treat opiate intoxication?
Naloxone
197
Which atypical antipsychotic is associated with hyperprolactinemia?
Risperidone
198
Causes of HCO3- changes?
Poison with metabolic acid-base disturbances
199
Causes of decreased K+/Cl-?
Bulimia (metabolic alkalosis)
200
What drug causes ST elevations?
Cocaine
201
Which SSRI's are "opposites"?
Prozac vs Paxil- Prozac is activating, long half life- Paxil sedating, short-half life
202
Causes of macrocytic anemia?
- B12 deficiency- Folate deficiency (think alcoholics)
203
What mood stabilizer is associated with nephrogenic DI?
Lithium
204
What imaging is associated with vascular dementia?
Multiple infarcts of varying ages
205
What are symptoms of alcohol withdrawal at 36 hours?
- Vital signs instability- Seizure
206
Diagnose dysthymic disorder in adults
Depressed mood for 2 years
<2 month without symptoms
2/6
Concentration
Hopelessness
Appetite
Sleep
Energy
Self-esteem
[ CHASES ]
207
What are disadvantages of aripiprazole?
- Can activate a bit too much- Akathisia
208
How does alcohol hallucinosis compare to delirium tremens?
VS instability with delirium tremens
209
What is the mechanism of action of opiates?
Opioid mu receptor
210
When do sleep terrors happen?
- First 1/3 of night- During N3 (stage 3 sleep)
211
Which typical antipsychotics have a high incidence of extrapyramidal symptoms?
- Haloperidol- Fluphenazine
212
High TSH leads to ___.
Depression[ hypothyroidism ]
213
How do you differentiate between factitious disorder and malingering?
- Primary gain (factitious): internal conflict- Secondary gain (malingering): external benefits, ex. attention, escape from law
214
PKU phenotype
Mousy smellPale skin/hair
215
What determines addictive potential of benzodiazepines?
Onset of action[ faster = worse ]
216
Features of a panic attack
- No warning- No specific trigger- Feeling of impending doom
| - Autonomic (tachycardia, sweating, SOB)
217
What skin change does lithium cause?
Acne
218
Causes of increased albumin/protein?
- Acute HIV- Multiple myeloma
219
What imaging is associated with frontotemporal dementia?
Preferential atrophy
220
When does alcohol withdrawal end?
5-7 days
221
What is the mechanism of action of alcohol?
GABA
222
What are disadvantages of clozapine?
- Weekly blood monitoring- Significantly lowers seizure threshold
- Potentially dangerous side effects
223
Causes of decreased albumin?
CirrhosisAnorexia
224
What are symptoms of frontal lobe seizures?
- Personality change- Disinhibition- Hemiballismus
225
REM sleep behavior disorder highly associated with ___ .
Lewy body dementia and Parkinson's
226
SSRI + ecstasy
Serotonin syndrome
227
What is the mechanism of action of the MAOI's?
Inhibits the enzyme that metabolizes 5-HT, NE, DA
228
What is the most common genetic cause of mental retardation in US
Down syndrome
229
What is the difference between oppositional defiant disorder and conduct disorder?
Conduct disorder: breaks law
| ODD doesn't: okay if behavior is only in one setting
230
What are disadvantages of ziprasidone?
- Prolongs QTc- Must be taken with food
231
What are advantages of ramelteon
- Similar to melatonin- Unlikely to be habit forming
232
What is the mechanism of action of benzos
GABA
233
What labs must be monitored with valproate?
- Platelets: <50 bad! >150 OK- LFT's: 3x ok
234
What are disadvantages of haloperidol?
- High incidence of extrapyramidal symptoms
235
What are advantages of clozapine?
Effective
236
What symptoms are associated with neurosyphilis?
- Dementia- Intermittent psychosis(irreversible)
237
What are other adjunct antidepressants?
- Aripiprazole- Lithium
238
How do you treat amphetamine intoxication?
Haldol
239
Diagnose dysthymic disorder in kids
```
Depressed mood 1 year
<1 month without symptoms2/6
Concentration
Hopelessness
Appetite
Sleep
Energy
Self-esteem[ CHASES ]
```
240
What can be seen on labs/imaging with Lewy Body dementia?
Not much atrophy on imaging
241
What is a dangerous side effect of methadone?
Increases QT
242
How does valproate toxicity present?
- Nystagmus- Ataxia
243
What are advantages of lamotrigine?
Useful in bipolar depression
244
How do you treat PCP withdrawal?
None, supportive
245
How do you treat TCA overdose?
Sodium bicarbonate and magnesium
246
What are disadvantages of mirtazapine?
- Can lead to weight gain
247
How does huntington's present?
- Depression (endogenous)- Personality changes- Dementia
248
What symptoms are associated with valproate toxicity?
- Nausea/Vomiting- Ataxia- Nystagmus- Lethargy- Coma
249
What are advantages of paroxetine?
- Relatively sedating- Used in anxiety disorders
250
How do you treat amphetamine withdrawal?
None, supportive
251
How does PCP intoxication present?
- Aggression- Rrotary/vertical nystagmus
252
Cause of decreased platelet count?
Valproate
253
Enuresis is normal before age ___.
5 years old
254
How do you treat cocaine withdrawal?
None, supportive
255
How do you treat akathisia?
Propranolol
256
What are disadvantages of duloxetine?
- Very expensive- Can cause significant nausea
257
What is the most common cause of inherited mental retardation?
Fragile X
258
Cause of decreased liver enzymes?
Cirrhosis - Encephalopathy and altered mental status
259
What are 4 effects of benzodiazepines on sleep?
1. Decreased time to sleep onset2. Prolong stage 2 (worthless sleep)3. Prolong total sleep time4. Decrease REM
260
What are advantages of haloperidol?
- High efficacy- Widely available and cheap
| - Fewer anticholinergic side effects- Short-acting injectable for PRN use- Long-acting decanoate (4w)
261
How do you treat REM sleep behavior disorder?
Clonazepam - to decrease relative amount of REM sleep
262
What are advantages of fluoxetine
- Relatively activating- Extremely long half-life: no need to taper, use with poor compliance
263
How do you treat benzo withdrawal?
Benzo taper
264
How do you differentiate between factitious and conversion disorder?
- Conscious production of symptoms (factitious)- Unconscious production of symptoms (conversion)
265
Which psych drug causes an increased WBC?
Lithium
266
Down syndrome are predisposed to ____ later in life?
Alzheimer's
267
How do you treat atypical depression?
MAOI
268
What are common side effects of SSRIs
- Sexual dysfunction- GI upset- Headaches- Low incidence of SE overall
269
How do you treat somatization and hypochondriasis?
Regularly scheduled visits
270
How do you treat alcohol withdrawal?
Benzodiazepine taper
271
How do you treat frontotemporal dementia?
None- Try to limit things that make it worse
272
How does Creutzfeldt Jacob's disease present?
Rapidly progressive dementia (3 months)
273
How does alcohol intoxication present?
- Altered mental status- Slurred words- Ataxia
| - Decreased respiratory rate- Sluggish pupils- Active (to a point)
274
Diagnose delusional disorder.
One single non-bizarre delusion (and minor ones related to it)- Functional outside the delusion
275
How does serotonin syndrome present?
- Flushing- Hyperreflexia- VS instability
276
Which antidepressants are more activating?
- Fluoxetine- Buproprion
277
How do you treat borderline personality disorder?
DBT (dialectical behavior therapy)
278
What are the nuclei of dopamine?
- VTA- Substantia nigra
279
What drug class causes a widened QRS?
TCA's
280
What are common side effects of trazodone?
- Grogginess in am- Priapism (trazoboner)
281
Which atypical antipsychotic causes prolonged QTc?
Ziprasidone
282
What are disadvantages of venlafaxine?
- Contraindicated in pts with poorly controlled HTN- Very short half life: significant withdrawal syndrome
283
What are common side effects of TCA's?
H: sedation
A: orthostatic hypotension, tachycardia, arrhythmias
M: dry mouth, constipation, urinary retention, blurred vision, tachycardia
+ Weight gain
284
How odes vascular dementia present?
Step wise decline
285
What are advantages of topiramate?
- Can promote weight loss- Can treat headaches- Impulse control in bipolar disorder
286
Antidepressant that self-tapers when stopped
Fluoxetine
287
Key features of adjustment disorder
- Sx occur in response to stressor- Resolves within 6 months of end of stressor- Symptoms directly relate to stressor- Does NOT meet criteria for MDD[ If they meet criteria for MDD, it is MDD! ]
288
Which medications increase lithium levels?
- OCP's- Thiazides- Spironolactone
289
What are teratogenic side effects of valproate?
Neural tube defects
290
Use of triazolam
Falling asleep
291
What are advantages of fluvoxamine?
Primarily used in anxiety disorders (OCD, social anxiety, PTSD)
292
Substance-induced depression can be caused by intoxication with ___.
- Alcohol- Benzodiazepines- Barbituates- Opiates
293
Diagnose anorexia
BMI 18.5Adolescents: 85% expected body weight (EBW)Fear of weight gainDistorted body image
294
What is the mechanism of action of PCP?
NMDA antagonist
295
What are disadvantages of chlorpromazine?
- Low potency- Lots of anticholinergic side effects
296
What imaging and labs are seen with Creutzfeldt Jacob disease?
- Spongiform encephalopathy- EEG: periodic sharp wave complexes
- LP: high 14-3-3 protein
297
What is the mechanism of action of the TCAs?
5-HT and NE reuptake inhibition
298
How does acute intermittent porphyria present?
- Intermittent psychosis
- Microcytic anemia
- Multiple abdominal scars from ex-laps
299
What is the leading non-genetic cause of mental retardation?
Fetal alcohol syndrome
300
What are disadvantages of lamotrigine?
- Must titrate very slowly (every 2 weeks)- Risk of SJS
301
Which atypical antipsychotic causes sedation, weight gain and orthostatic hypotension?
Quetiapine
302
How does frontotemporal dementia present?
Early onset- Selective language devolvement- Personality change- Parkinsonism
303
What is the therapeutic window of lithium?
Narrow- Therapeutic 0.7-1.2
| - Toxic >1.2
304
What drug-drug interactions should be considered with lithium?
- Diuretics- NSAIDs- Thiazides- Spironolactone
305
How do you treat bulimia?
1. Fluoxetine
| 2. Topiramate
306
Timeline of schizophreniform
1-6 months
307
How does benzo withdrawal compare to alcohol withdrawal?
More rebound anxiety in benzos
308
What neurotransmitter is affected by hallucinogens?
5-HT agonism
309
Feature of cocaine withdrawal NOT typicall seen with amphetamine withdrawal
Acute suicidality
310
Which drugs can be given with topiramate to minimize metabolic syndrome?
- Metformin- Antipsychotic
311
What are dangerous side effects of MAOI's?
- Serotonin syndrome- Hypertensive crisis
312
What are the most dangerous side effects of valproate?
- Hepatotoxiciity- Thrombocytopenia- Pancreatitis
313
How do you treat major depressive disorder?
SSRIECT is the last line
314
Causes of increased platelet count?
Autoimmune diseases- Lupus- Sjogrens- Sarcoidosis
315
What are advantages of tranylcypromine?
Amphetamine-like properties
316
How do you treat cocaine intoxication?
Haldol
317
What is capgras syndrome?
Delusion that a familiar person has been replaced by an imposter
318
What are the signs and symptoms of lithium toxicity?
- Nausea/Vomiting/Diarrhea- Coarse tremor- Ataxia- Altered mental status- Renal failure- Convulsions- Coma
319
When does alcohol withdrawal peak?
24-48 hour"POD 1"
320
Substance-induced mania can be caused by intoxication with ___.
- Cocaine- Meth
321
What are advantages of mirtazapine?
- Great in patients with poor appetite- Sleep aid at low doses
322
Causes of increased Ca++?
- Multiple myeloma
| - Hyperparathyroidism (secondary to Lithium)[ Hypercalcemia gives you "psychiatric overtones" ]
323
What are advantages of aripiprazole?
- Adjunctive antidepressant- Tends to be more activating
| - Theoretically weight neutral
324
Antidepressants with fewest sexual side effects?
- Buproprion- Mirtazipine
325
How does neuroleptic malignant syndrome present?
- Lead-pipe rigidity- High CPK
| - Fever
326
What drug-drug interactions should be considered with valproate?
p450
327
What are disadvantages of zolpidem?
- Strange dreams and dissociative symptoms- Less effective after 2 weeks
- Associated with falls in hospital
328
Treatment of restless legs syndrome
- Mild: Clonazepam- More severe = DA agonists like ropinorole/pramipexole
329
How do you treat serotonin syndrome?
- Cooling- Fluids- Cyproheptadine
330
How does alzheimer's dementia present?
- Gradual memory decline- Working memory goes first (set switching)- Paranoia
331
Tyramine found in
- Aged cheeses- Cured meats- Soy sauce- Sauerkraut- Beer
332
What can be seen on EKG with lithium?
- Flattened T-waves- U waves
333
What EKG changes are seen with Lithium?
Flattened T waves (looks like low K)
334
Which drugs cause decreased WBC?
- Clozapine- Carbamazepine- HIV
335
Causes of microcytic anemia
- Iron deficiency (restless legs)- Anorexia- Lead poisoning- Porphyria
336
Prader-Willi
- Obese - Hyerphagia- Hypogonadism[ paternal gene deleted ]
337
What are common side effects of buproprion?
- Rarely sexual side effects- Can increase anxiety
338
Which labs should be monitored with lithium?
Blood draws: - Lithium levels- BUN/Creatinine
| - T4/TSH
339
Which antipsychotics are weight-neutral?
- Aripiprazole- Ziprasidone
340
Fragile X phenotype
Marfanoid + big balls
341
How do you treat benzo intoxication?
Flumazenil
342
What is fregoli syndrome?
Delusion that strangers are people you know in disguise
343
Diagnose paranoid personality disorder.
- Not psychotic, rather a pattern of relating to others/world such that they always expect others to have bad intentions- "Always been that way"
344
How do you treat dystonia (including acute)?
- Benztropine- Diphenhydramine
345
What are disadvantages of buproprion?
- Can worsen anxiety- Lowers seizure threshold: contraindicated in patients with eating disorders and epilepsy
346
Antibiotic with serotonin activity
Linezolid
347
Adjunct antidepressant particularly helpful with anxiety symptoms?
Buspirone
348
What are disadvantages of TCA's?
- "Dirty" drugs -- side effects are common!- Can be lethal in OD
349
Antidepressant with dietary restrictions
MAOI: don't eat tyramine
350
What are disadvantages of sertraline?
- Tends to cause GI upset, particularly when starting- Relatively shorter half-life can lead to discontinuation syndrome
351
What is the mechanism of action of ziprasidone?
D2R blockade5HT2A receptor antagonist
352
Clonazepam
Benzodiazepine- Slow onset- Intermediate-long t1/2
353
Causes of increased K+/Cl-?
Renal failure (Lithium)
354
What psychiatric symptoms are seen with Huntington's?
- Depression- Later personality changes
355
Which mood stabilizer is a p450 inducer?
carbamazepine
356
How does child depression differ from adult symptoms?
- Irritability- Psychomotor agitation- Somatic complaints
357
What is the mechanism of action of quetiapine?
D2R blockade5HT2A receptor antagonist
358
How do you treat tardive dyskinesia?
- Discontinue drug- Clozapine
359
What is the mechanism of action of the typical antipsychotics?
D2 blockade
360
What are advantages of fluphenazine?
- Similar to haldol- Long-acting decanoate (2-3w)
361
How do you treat hypertensive crisis?
Phentolamine- NOT beta blockers
362
Which atypical antipsychotic causes metabolic syndrome?
Olanzapine
363
Which TCA is the least likely to cause orthostatic hypotension?
Nortriptyline
364
Congenital hypothyroid
PalePuffy facedProtuberant tonguePot belliedProtruding umbilicusPoor brain development
365
What are common side effects of lithium?
- Polyuria- Polydipsia- Sedation- Tremor (fine)
366
What are advantages of perphenazine?
- Moderate potency- Lower risk of extrapyramidal symptoms
| evidence from CATIE study
367
Causes of increased BUN/Cr-?
- Uremic encephalopathy- Lithium toxicity- Rhabdomyolysis from neuroleptic malignant syndrome
368
What is suboxone?
Buprenorphine + naloxone- Precipitates withdrawal in heavy users- Give methadone
369
How do you treat / prevent wernicke korsakoff?
Thiamine
370
Diagnose schizophrenia
1 month psychosis in setting of 6 month of symptoms
| 2/5 for 1 monthDelusionsHallucinationsDisorganized speechDisorganized/catatonic behaviorNegative symptoms
371
What are disadvantages of perphenazine?
BID dosing
