Shelf Review Anki Deck Unshuffled Flashcards
(371 cards)
1
Q
Key features of adjustment disorder
A
- Sx occur in response tostressor- 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! ]
2
Q
Diagnose a major depressive episode
A
Depressed mood or loss of interest for 2+ weeks5/9 Sleep Interest Guilt Energy Concentration Appetite Psychomotor Suicidality[SIGECAPS ]
3
Q
Diagnosedysthymic disorder in kids
A
Depressed mood1 year <1 month without symptoms2/6 Concentration Hopelessness Appetite Sleep Energy Self-esteem[CHASES ]
4
Q
Diagnose dysthymic disorder in adults
A
Depressed mood for2years
<2 monthwithout symptoms
2/6
Concentration
Hopelessness
Appetite
Sleep
Energy
Self-esteem
[CHASES]
5
Q
Atypical depression can beconfused with ___ .
A
Borderline Personality Disorder (due to seemingly unstable mood + interpersonal sensitivity)Distinguish by TIMELINE
6
Q
Diagnose atypical depression
A
Preserved mood reactivity2/4HyperphagiaHypersomniaLeaden paralysisSensitivity to interpersonal rejection
7
Q
Timeline of a brief psychotic episode
A
1 day -1 month
8
Q
Timeline of schizophreniform
A
1-6 months
9
Q
Diagnose schizophrenia
A
1 monthpsychosis in setting of 6 month of symptoms
2/5 for 1 monthDelusionsHallucinationsDisorganized speechDisorganized/catatonic behaviorNegative symptoms
10
Q
Diagnose acute stress disorder
A
Trauma +(same 4 Sx clusters as PTSD)BUT onset within 4 wkssx last less than 4 wks
11
Q
Reaction to trauma that presagesacute stress disorder
A
numb, detached, dissociated
12
Q
Diagnose PTSD
A
Symptoms > 1 month, onset anytimeTraumatic experience +1) Re-experiencing (flashbacks, nightmares)2) Avoidance3) Hyperarousal4) Mood/Cognitive Sx
13
Q
Diagnose generalized anxiety disorder
A
Anxious about everything for 6 months3/6- Restlessness- Fatigue- Concentrating difficulty- Irritability- Muscle tension- Sleep disturbance
14
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
15
Q
Features of a panic attack
A
- No warning- No specific trigger- Feeling of impending doom
- Autonomic (tachycardia, sweating, SOB)
16
Q
Diagnose bipolar
A
1 manic episode
17
Q
How long does hypomania last?
A
4-7 days
18
Q
How long does manialast?
A
> 7 days or hospitalized
19
Q
Diagnose schizoaffective
A
Majority time =psychosis + moodAnd
Psychosis alone forat least 2weeks
20
Q
Diagnose paranoid personality disorder.
A
- Not psychotic, rathera pattern of relating to others/worldsuch that they always expect others to have bad intentions- “Always been that way”
21
Q
Diagnose delusional disorder.
A
One single non-bizarre delusion(and minor ones related to it)- Functional outside the delusion
22
Q
Describe delusions in schizophrenia.
A
Many bizarre delusions
23
Q
Typical age of onset of schizophrenia?
A
Men: 17-25Women: 25-30Onset after age 40 extremely rare
24
Q
Typical age of onset for delusional disorder?
A
Middle age (40s-50s)
25
Substance-induced depression can be caused by intoxication with ___.
- Alcohol- Benzodiazepines- Barbituates- Opiates
26
Substance-induced depression caused by withdrawal from ___.
- Cocaine- Meth
27
Substance-induced mania can be caused by intoxication with ___.
- Cocaine- Meth
28
Substance-induced psychosis can be caused by intoxication with ___.
PCP, cannabis, LSD
29
Substance-induced mania can be caused by withdrawal from ___.
- Alcohol- Benzodiazepines
30
Which antidepressant is associated with dry mouth, constipation, sedation and weight gain?
TCA's
31
Antidepressants with fewest sexual side effects?
- Buproprion- Mirtazipine
32
What is the washout period to transition from SSRI to MAO-I? And the exception?
2 weeks- Except fluoxetine
33
Antidepressant associated with priapism
Trazodone
34
Antidepressant with dietary restrictions
MAOI: don't eat tyramine
35
Antidepressant that self-tapers when stopped
Fluoxetine
36
Which antidepressant is contraindicated with meperidine (demerol)?
MAOI
37
Antibiotic with serotonin activity
Linezolid
38
Antidepressant that increases seizure risk?
Buproprion
39
Which antidepressants have the highest likelihood of withdrawal?
- Paroxetine- Venlafaxine
40
Which antidepressants are more activating?
- Fluoxetine- Buproprion
41
How do you treat OCD?
SSRI's- Sertraline- Fluvoxamine- Clomipramine
42
Adjunct antidepressant to promote sleep and appetite?
Mirtazapine
43
Adjunct antidepressant particularly helpful with anxiety symptoms?
Buspirone
44
Adjunct antidepressant that can help with SSRI-related sexual dysfunction?
- Buproprion- Buspirone
45
What are other adjunct antidepressants?
- Aripiprazole- Lithium
46
Which atypical antipsychotic is also an adjunct antidepressant?
Aripiprazole
47
Which antipsychotic is also used as a mood stabilizer?
Quetiapine
48
Which antipsychotic has the highest likelihood of EPS?
Risperidone
49
Which antipsychotics are weight-neutral?
- Aripiprazole- Ziprasidone
50
Which atypical antipsychotics are the worst for metabolic syndrome?
- Olanzapine- Clozapine
51
Which atypical antipsychotic is associated with hyperprolactinemia?
Risperidone
52
Which atypical antipsychotic increases seizure risk
Clozapine
53
What are 3 life-threatening adverse effects of clozapine?
- Seizure- Agranulocytosis- Cardiomyopathy
54
Which atypical antipsychotic causes prolonged QTc?
Ziprasidone
55
Which medications increase lithium levels?
- OCP's- Thiazides- Spironolactone
56
How does lithium toxicity present?
- Coarse tremor- Altered mental status- Nausea/vomiting/diarrhea
57
What are common lab abnormalities seen with Lithium?
Benign leukocytosis
58
What EKG changes are seen with Lithium?
Flattened T waves (looks like low K)
59
What lab abnormalities can be seen with valproate?
- LFT's- Thrombocytopenia
60
What mood stabilizer lessens efficacy of birth control?
Carbamazepine (dirty, auto-inducer)
61
Which mood stabilizer is associated with SJS?
Lamotrigine
62
What mood stabilizer is associated with weight loss?
Topiramate
63
What fetal abnormality is associated with Lithium?
Ebstein's anomaly: atrialized right ventricle
64
What fetal abnormality is associated with valproate?
Neural tube defects
65
How does valproate toxicity present?
- Nystagmus- Ataxia
66
Which mood stabilizer causes cognitive dulling?
Topiramate
| "dope-amax"
67
What mood stabilizers are associated with SIADH?
- Carbamazepine- Oxcarbezipine
68
What mood stabilizer is associated with nephrogenic DI?
Lithium
69
How do you treat major depressive disorder?
SSRIECT is the last line
70
How do you treat bipolar disorder?
- Acute mania: mood stabilizer + atypical antipsychotic- Maintenance: mood stabilizer only
71
How do you treat panic disorder?
SSRI or CBTAcute relief: benzodiazepine
72
How do you treat OCD refractory to medication?
Deep brain stimulation or cingulotomy
73
How do you treat generalized anxiety disorder?
SSRI
74
How do you treat atypical depression?
MAOI
75
How do you treat catatonia?
- Lorazepam- ECT
76
How do you treat borderline personality disorder?
DBT (dialectical behavior therapy)
77
What are common side effects of MAOI's?
- GI distress- Orthostatic hypotension- Sleep disturbance- Dry mouth- Headache
78
What are dangerous side effects of MAOI's?
- Serotonin syndrome- Hypertensive crisis
79
What are symptoms of serotonin syndrome?
- Flushing- Diaphoreis- Myoclonic jerks
80
How do MAOI's cause hypertensive crisis?
Tyramine interaction- No aged cheeses or cured meats
81
What is the mechanism of action of the MAOI's?
Inhibits the enzyme that metabolizes 5-HT, NE, DA
82
How do you treat hypertensive crisis?
Phentolamine- NOT beta blockers
83
What are advantages of tranylcypromine?
Amphetamine-like properties
84
What are advantages of selegiline?
- Used in Parkinson's disease- Transdermal form available
85
Tyramine found in
- Aged cheeses- Cured meats- Soy sauce- Sauerkraut- Beer
86
Alprazolam
Benzodiazepine- Fast-Intermediate onset- Short-Intermediate T1/2
*Addictive due to fast onset, high seizure risk due to short half life
87
Clonazepam
Benzodiazepine- Slow onset- Intermediate-long t1/2
88
Diazepam
Benzodiazepine- Fast onset- Long t1/2
89
Chlordiazepoxide
Benzodiazepine- Intermediate onset- Longest t1/2
90
How does the time to onset affect benzodiazepine use?
Addictive potential
91
How does t1/2 affect Benzodiazepine use?
- More seizure risk during withdrawal with shorter t1/2
92
Use of triazolam
Falling asleep
93
What is xanax used for?
- Panic attacks- Highly addictive
94
Which benzodiazepine has the least addictive potential?
Clonazepam (slow onset)
95
Which benzodiazepine is highly addictive? (besides alprazolam)
Diazepam
96
What is chlordiazepoxide used for?
Alcohol withdrawal
97
What determines addictive potential of benzodiazepines?
Onset of action[ faster = worse ]
98
What determines seizure risk of benzodiazepines?
Half-life[ short = worse ]
99
What are advantages of zolpidem?
Widely available
100
What are disadvantages of zolpidem?
- Strange dreams and dissociative symptoms- Less effective after 2 weeks
- Associated with falls in hospital
101
What are advantages of zaleplon?
- Very short acting- May be taken if wide awake in the middle of the night
102
What are disadvantages of zaleplon?
Can be habit forming
103
What are advantages of ramelteon
- Similar to melatonin- Unlikely to be habit forming
104
What are advantages of eszopiclone?
Can be taken for longer periods than other hypnotics
105
What are disadvantages of eszopiclone?
- Expensive- Withdrawal syndrome
106
What are advantages of trazodone?
- Relatively benign- Commonly used on inpatient unit
107
What are common side effects of trazodone?
- Grogginess in am- Priapism (trazoboner)
108
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
109
What is a contraindication to using TCA's?
Contrandicated with pre-existing cardiac conduction abnormalities.- Lethal overdose: widened QRS >> Torsades >> V-Fib
110
How do you treat TCA overdose?
Sodium bicarbonate and magnesium
111
What is the mechanism of action of the TCAs?
5-HT and NE reuptake inhibition
112
What are disadvantages of TCA's?
- "Dirty" drugs -- side effects are common!- Can be lethal in OD
113
Which TCA is the least likely to cause orthostatic hypotension?
Nortriptyline
114
Which TCA is the least sedating with the fewest anticholinergic side effects?
Desipramine
115
Which TCA is the most 5-HT specific?
Clomipramine
116
Which TCA is used for OCD?
Clomipramine
117
Which TCA's can be used for chronic pain and headaches?
ImipramineAmitriptylineDoxepin
118
Which SSRI's are "opposites"?
Prozac vs Paxil- Prozac is activating, long half life- Paxil sedating, short-half life
119
What are common side effects of SSRIs
- Sexual dysfunction- GI upset- Headaches- Low incidence of SE overall
120
What are advantages of fluoxetine
- Relatively activating- Extremely long half-life: no need to taper, use with poor compliance
121
Which SSRI should be used for neurovegetative depressives?
Fluoxetine
122
Which SSRI should be used for anxious depressives?
Paroxetine
123
What are disadvantages of fluoxetine?
Dirtiest SSRI with the most side effects- Sexual dysfunction- Activating properties can worsen anxiety
124
What are advantages of paroxetine?
- Relatively sedating- Used in anxiety disorders
125
What are disadvantages of paroxetine?
Short half life - Significant discontinuation syndrome
| - Can't miss a dose!
126
What are advantages of sertaline?
- Few drug-drug interactions- Used in medically ill and elderly
- Used in anxiety disorders (more anxiolytic than activating)
127
What are disadvantages of sertraline?
- Tends to cause GI upset, particularly when starting- Relatively shorter half-life can lead to discontinuation syndrome
128
What are advantages of (es)citalopram?
- Few drug-drug interactions- Very low incidence of side effects
129
What are disadvantages of (es)citalopram?
- Prolongs QT- Can't go above 40
130
What are advantages of fluvoxamine?
Primarily used in anxiety disorders (OCD, social anxiety, PTSD)
131
What are disadvantages of fluvoxamine?
- BID dosing (twice a day)- Very short half life: discontinuation syndrome
132
What are advantages of SNRI's?
- Potentially helps with chronic pain and diabetic neuropathy
133
What are disadvantages of venlafaxine?
- Contraindicated in pts with poorly controlled HTN- Very short half life: significant withdrawal syndrome
134
What are disadvantages of duloxetine?
- Very expensive- Can cause significant nausea
135
What is the mechanism of action of buproprion?
Inhibits reuptake of norepinephrine and dopamine
136
What is the mechanism of action of mirtazapine?
5-HT2a/c, 5-HT3a antagonist
137
What are common side effects of buproprion?
- Rarely sexual side effects- Can increase anxiety
138
What are common side effects of mirtazapine?
- Appetite stimulation- Sedation (low doses)
139
What are advantages of buproprion?
- Can treat sexual side effects- No weight gain- Activating
| - Helpful in smoking cessation
140
What are disadvantages of buproprion?
- Can worsen anxiety- Lowers seizure threshold: contraindicated in patients with eating disorders and epilepsy
141
What are advantages of mirtazapine?
- Great in patients with poor appetite- Sleep aid at low doses
142
What are disadvantages of mirtazapine?
- Can lead to weight gain
143
What are common side effects of the typical antipsychotics?
- Varying degrees of EPS- Varying degrees of anti-HAMH: sedationA (alpha): orthostatic hypoTNM (muscarinic): dry mouth, tachy, urinary retention, blurry vision, constipation
144
What is the mechanism of action of the typical antipsychotics?
D2 blockade
145
Potency of the typical antipsychotics in increasing order?
Chlorpromazine < Perphenazine < Fluphenazine = Haloperidol
146
Which typical antipsychotics have a high incidence of extrapyramidal symptoms?
- Haloperidol- Fluphenazine
147
Which typical antipsychotic is associated with sedation and weight gain?
Chlorpromazine
148
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)
149
What are disadvantages of haloperidol?
- High incidence of extrapyramidal symptoms
150
What are advantages of fluphenazine?
- Similar to haldol- Long-acting decanoate (2-3w)
151
What are advantages of perphenazine?
- Moderate potency- Lower risk of extrapyramidal symptoms
| evidence from CATIE study
152
What are disadvantages of perphenazine?
BID dosing
153
What are advantages of chlorpromazine?
- Low potency- Approved in children
154
What are disadvantages of chlorpromazine?
- Low potency- Lots of anticholinergic side effects
155
Symptoms of metabolic syndrome
- Hypertension- Insulin resistance- Central obesity- Dyslipidemia (High triglycerides, low HDL)
156
What are common side effects of atypical antipsychotics?
- Metabolic syndrome- Some anti-HAM
157
What is the most efficacious atypical antipsychotic?
Clozapine
158
What is the most dangerous atypical antipsychotic?
Clozapine
159
What is the mechanism of action of risperidone?
D2R blockage5HT2A receptor antagonist
160
What is the mechanism of action of olanzapine?
D2R blockage5HT2A receptor antagonist
161
What is the mechanism of action of aripiprazole?
mixed agonist/antagonist
162
What is the mechanism of action of quetiapine?
D2R blockade5HT2A receptor antagonist
163
What is the mechanism of action of ziprasidone?
D2R blockade5HT2A receptor antagonist
164
What is the mechanism of action of clozapine?
D2 and D4 blockade5HT2A receptor antagonist
165
Which atypical antipsychotic causes hyperprolactinemia?
Risperidone
166
Which atypical antipsychotic causes metabolic syndrome?
Olanzapine
167
Which atypical antipsychotic causes sedation, weight gain and orthostatic hypotension?
Quetiapine
168
Which atypical antipsychotic causes QT prolongation?
Ziprasidone
169
Which atypical antipsychotic causes sedation, weight gain, drooling, cardiomyopathy (reversible) and agranulocytosis?
Clozapine- Require weekly blood draws!
170
What are advantages of risperidone?
- High potency- Dissolving form (M tab)- Long-acting consta form
171
What are disadvantages of risperidone?
- Relatively high incidence of EPS- Hyperprolactinemia
172
What are advantages of olanzapine?
- Effective- Zydis form (dissolving tab)(evidence from CATIE study)
173
What are disadvantages of olanzapine?
- Absolute WORST in terms of metabolic effects
174
What are advantages of aripiprazole?
- Adjunctive antidepressant- Tends to be more activating
| - Theoretically weight neutral
175
What are disadvantages of aripiprazole?
- Can activate a bit too much- Akathisia
176
What are advantages of quetiapine?
- Useful as sleep aid- Approved as monotherapy as a mood stabilizer
177
What are disadvantages of quetiapine?
- Side effects are not dose-dependent- Sedation- Weight gain- Dizziness makes hard to tolerate (CATIE)
178
What are advantages of ziprasidone?
#NAME?
179
What are disadvantages of ziprasidone?
- Prolongs QTc- Must be taken with food
180
What are advantages of clozapine?
Effective
181
What are disadvantages of clozapine?
- Weekly blood monitoring- Significantly lowers seizure threshold
- Potentially dangerous side effects
182
What are common side effects of lithium?
- Polyuria- Polydipsia- Sedation- Tremor (fine)
183
What are the most dangerous side effects of lithium?
- Nephrogenic diabetes insipidus (ADH receptor blocker)- Renal impairment- Hypothyroid
184
What are advantages of lithium?
- Effective- Not typically associated with weight gain
185
Which labs should be monitored with lithium?
Blood draws: - Lithium levels- BUN/Creatinine
| - T4/TSH
186
What is the therapeutic window of lithium?
Narrow- Therapeutic 0.7-1.2
| - Toxic >1.2
187
What are the signs and symptoms of lithium toxicity?
- Nausea/Vomiting/Diarrhea- Coarse tremor- Ataxia- Altered mental status- Renal failure- Convulsions- Coma
188
What is a contraindication to lithium?
Renal disease
189
What drug-drug interactions should be considered with lithium?
- Diuretics- NSAIDs- Thiazides- Spironolactone
190
What skin change does lithium cause?
Acne
191
What is most often found on CBC with lithium?
Benign leukocytosis
192
What can be seen on EKG with lithium?
- Flattened T-waves- U waves
193
What are common side effects of valproate?
- Sedation- Weight gain- Alopecia
194
What are the most dangerous side effects of valproate?
- Hepatotoxiciity- Thrombocytopenia- Pancreatitis
195
What is the advantage of valproate?
Slightly wider therapeutic window
196
What labs must be monitored with valproate?
- Platelets: <50 bad! >150 OK- LFT's: 3x ok
197
What drug-drug interactions should be considered with valproate?
p450
198
What are teratogenic side effects of valproate?
Neural tube defects
199
What is the most dangerous effect of valproate overdose?
Fulminant hepatic failure
200
What symptoms are associated with valproate toxicity?
- Nausea/Vomiting- Ataxia- Nystagmus- Lethargy- Coma
201
What are disadvantages of carbamazepine?
- Bone marrow suppression- SIADH
| - Many drug-drug interactions!- Deactivates birth control- P450: autoinducer
202
Which mood stabilizer is a p450 inducer?
carbamazepine
203
Which mood stabilizer deactivates birth control?
Carbamazepine
204
What are advantages of lamotrigine?
Useful in bipolar depression
205
What are disadvantages of lamotrigine?
- Must titrate very slowly (every 2 weeks)- Risk of SJS
206
What are advantages of topiramate?
- Can promote weight loss- Can treat headaches- Impulse control in bipolar disorder
207
What are disadvantages of topiramate?
- "Dopamax" (makes you slow and tired)- Word finding problems- Kidney stones
208
Which drugs can be given with topiramate to minimize metabolic syndrome?
- Metformin- Antipsychotic
209
How do you treat akathisia?
Propranolol
210
How do you treat dystonia (including acute)?
- Benztropine- Diphenhydramine
211
How do you treat tardive dyskinesia?
- Discontinue drug- Clozapine
212
How do you treat hypertensive crisis (from MAOI)?
Phentolamine
213
How do you treat SSRI discontinuation syndrome?
Restart SSRI
214
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
215
SSRI + ecstasy
Serotonin syndrome
216
What neurotransmitter is affected by hallucinogens?
5-HT agonism
217
What is the mechanism of action of alcohol?
GABA
218
What is the mechanism of action of benzos
GABA
219
What is the mechanism of action of opiates?
Opioid mu receptor
220
What is the mechanism of action of cocaine?
Dopamine, 5-HT, NE reuptake blocker
221
What is the mechanism of action of amphetamine?
Reuptake blocker and release increaser
222
How do amphetamines compare to cocaine?
Amphetamines last longer
223
What is the mechanism of action of ecstasy?
Amphetamines + 5-HT agonist
224
How does alcohol intoxication present?
- Altered mental status- Slurred words- Ataxia
| - Decreased respiratory rate- Sluggish pupils- Active (to a point)
225
How do you treat alcohol intoxication?
- Thiamine- Hydration
226
How do you treat alcohol withdrawal?
Benzodiazepine taper
227
How does benzo intoxication present?
Similar to alcohol intoxication, but less active
228
How do you treat benzo intoxication?
Flumazenil
229
How does benzo withdrawal compare to alcohol withdrawal?
More rebound anxiety in benzos
230
How do you treat benzo withdrawal?
Benzo taper
231
How does opiate intoxication present?
- Pinpoint pupils- Decreased RR
232
How do you treat opiate intoxication?
Naloxone
233
How do you treat opiate withdrawal?
- Clonidine- Immodium- Symptom relief
234
What is a dangerous side effect of methadone?
Increases QT
235
What is suboxone?
Buprenorphine + naloxone- Precipitates withdrawal in heavy users- Give methadone
236
How does cocaine intoxication present?
Angina/MI
237
How do you treat cocaine intoxication?
Haldol
238
Feature of cocaine withdrawal NOT typicall seen with amphetamine withdrawal
Acute suicidality
239
How do you treat cocaine withdrawal?
None, supportive
240
How do you treat amphetamine withdrawal?
None, supportive
241
How does amphetamine intoxication compare to cocaine?
No coronary symptoms with meth
242
How do you treat amphetamine intoxication?
Haldol
243
How does PCP intoxication present?
- Aggression- Rrotary/vertical nystagmus
244
What is the mechanism of action of PCP?
NMDA antagonist
245
How do you treat PCP intoxication?
- Haldol- Minimize stimuli
246
How do you treat PCP withdrawal?
None, supportive
247
When does alcohol withdrawal start?
6-24 hours
248
When does alcohol withdrawal peak?
24-48 hour"POD 1"
249
When does alcohol withdrawal end?
5-7 days
250
What are early symptoms of alcohol withdrawal?
- Tongue tremor (fasciculations)- Tremulous
| - Sweat- Anxiety- Irritable
251
What are symptoms of alcohol withdrawal at 36 hours?
- Vital signs instability- Seizure
252
What are symptoms of alcohol withdrawal at 4-5 days?
- Delirium tremens- Bad VS instability- Visual hallucinations
- Micropsia (things look small)
253
Which benzos bypass liver metabolism
LorazepamOxazepamTemazepam
254
How does alcohol hallucinosis compare to delirium tremens?
VS instability with delirium tremens
255
How does wernicke korsakoff present?
- Ataxia- Altered mental status- Abnormal eye movement- Confabulation
256
What neuroanatomy is responsible for wernicke korsakoff?
Mamillary bodies
257
How do you treat / prevent wernicke korsakoff?
Thiamine
258
What substance causes anion gap metabolic acidosis and afferent pupillary defect? How do you treat?
Methanol (moonshiners)- Treat with fomepizole
259
What substance causes anion gap metabolic acidosis and calcium oxalate crystals? How do you treat?
Ethylene glycol- Treat with fomepizole
260
What substance causes respiratory alkalosis+metabolic acidosis with tinnitus? How do you treat?
Salicylates- Treat with sodium bicarbonate
261
What substance causes hyperthermia, dry flushed skin, tachy, agitated, stumbling around? How do you treat?
Diphenhydramine- Treat with physostigmine
262
What substance causes altered mental status, drowsiness, widened QRS on monitor? How do you treat?
TCA - Treat with bicarbonate and magnesium
263
What substance causes abdominal pain, n/v, jaundice and elevated LFTs? How do you treat?
Acetaminophen- Treat with N-acetylcysteine
264
How does neuroleptic malignant syndrome present?
- Lead-pipe rigidity- High CPK
| - Fever
265
How do you treat neuroleptic malignant syndrome?
- Cooling- Fluids- Dantrolene/bromocriptine
266
How does serotonin syndrome present?
- Flushing- Hyperreflexia- VS instability
267
How do you treat serotonin syndrome?
- Cooling- Fluids- Cyproheptadine
268
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
269
Describe 4 clinical features of narcolepsy
1. Daytime tiredness2. Hypnopompic/hypnogogic hallucinations
3. Sleep paralysis
4. Cataplexy
270
What are hypnogogic / hypnopompic hallucinations?
Hypnogogic: hallucinate when going to sleepHypnopompic: hallucinate when waking up
271
Treatment of cataplexy in narcolepsy
GHB (gamma-hydroxybutyrate)(aka sodium oxybate)(But in real life, Fluoxetine or Venlafaxine)
272
2 clinical features of sleep terrors
1. Autonomic activation (breathing heard, tachycardic, sweaty)2. Amnesia
273
When do sleep terrors happen?
- First 1/3 of night- During N3 (stage 3 sleep)
274
Clinical features of REM sleep behavior disorder
Lack of atonia during REM: they act out dreams
275
How do you treat REM sleep behavior disorder?
Clonazepam - to decrease relative amount of REM sleep
276
REM sleep behavior disorder highly associated with ___ .
Lewy body dementia and Parkinson's
277
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)
278
Treatment of restless legs syndrome
- Mild: Clonazepam- More severe = DA agonists like ropinorole/pramipexole
279
Clinical features of periodic limb movement disorder
ASLEEP: Middle insomnia woken up with rhythmic leg movements
280
Treatment of periodic limb movement disorder
Same as restless leg syndrome... (DA agonists, ropinorole/pramipexole) they are highly comorbid
281
Diagnose anorexia
BMI 18.5Adolescents: 85% expected body weight (EBW)Fear of weight gainDistorted body image
282
Predominant emotion in anorexia
AnxietyEgo-Syntonic Pathology (exerting CONTROL over weight relieves anxiety)
283
Diagnosis of bulimia
Binging (central pathology)With consequent compensatory behavior (eg, purging)
284
What weight is associated with bulimia?
Normal-high
285
ADHD Timeline: symptoms before age ___.
DSM IV: 7 years oldDSM 5: 12 years old
286
Enuresis is normal before age ___.
5 years old
287
Encoporesis is normal until age ___.
4
288
First line treatment for anorexia?
None
289
How do you treat bulimia?
1. Fluoxetine
| 2. Topiramate
290
Which psych drug causes an increased WBC?
Lithium
291
Which drugs cause decreased WBC?
- Clozapine- Carbamazepine- HIV
292
Causes of increased H&H
Polycythemia vera
293
Causes of macrocytic anemia?
- B12 deficiency- Folate deficiency (think alcoholics)
294
Causes of microcytic anemia
- Iron deficiency (restless legs)- Anorexia- Lead poisoning- Porphyria
295
Causes of increased platelet count?
Autoimmune diseases- Lupus- Sjogrens- Sarcoidosis
296
Cause of decreased platelet count?
Valproate
297
Causes of hypernatremia?
- Dehydration- Diabetes Insipidus (Lithium)- Alcohol
298
Causes of hyponatremia?
- Psychogenic polydipsia- SIADH (carbamazepine)- Ecstasy
299
Causes of increased K+/Cl-?
Renal failure (Lithium)
300
Causes of decreased K+/Cl-?
Bulimia (metabolic alkalosis)
301
Causes of decreased K+?
- Laxatives- Anorexia
302
Causes of HCO3- changes?
Poison with metabolic acid-base disturbances
303
Causes of increased BUN/Cr-?
- Uremic encephalopathy- Lithium toxicity- Rhabdomyolysis from neuroleptic malignant syndrome
304
Very high glucose with altered mental status?
- DKA- HONK (HyperOsmolar Non-Ketotic state)
305
Low glucose with normal c-protein
Factitious disorder: exogenous insulin
306
Causes of increased Ca++?
- Multiple myeloma
| - Hyperparathyroidism (secondary to Lithium)[ Hypercalcemia gives you "psychiatric overtones" ]
307
Cause of low Ca++?
Anorexia
308
Causes of increased liver enzymes?
- Alcohol (AST>ALT)- Acetaminophen/valproate overdose- Alcoholic hepatitis
309
Cause of decreased liver enzymes?
Cirrhosis - Encephalopathy and altered mental status
310
Causes of increased albumin/protein?
- Acute HIV- Multiple myeloma
311
Causes of decreased albumin?
CirrhosisAnorexia
312
High TSH leads to ___.
Depression[ hypothyroidism ]
313
Low TSH leads to ___.
Anxiety[ hyperthyroidism ]
314
What symptoms are associated with neurosyphilis?
- Dementia- Intermittent psychosis(irreversible)
315
What drug class causes a widened QRS?
TCA's
316
What drug causes ST elevations?
Cocaine
317
Which drugs prolong QT?
- Ziprasidone- Methadone
318
Which condition is associated with heart block?
Anorexia
319
How does acute intermittent porphyria present?
- Intermittent psychosis
- Microcytic anemia
- Multiple abdominal scars from ex-laps
320
Liver cirrhosis + psychiatric symptoms?
Wilson's
321
What psychiatric symptoms are seen with Huntington's?
- Depression- Later personality changes
322
Which medications are associated with depression?
- Chronic steroids- Accutane- Interferon- Beta blockers
323
Which medications can cause psychosis/delirium?
- Steroids- Levodopa- Benzos- Anticholinergics
324
How do you differentiate between factitious disorder and malingering?
- Primary gain (factitious): internal conflict- Secondary gain (malingering): external benefits, ex. attention, escape from law
325
How do you differentiate between factitious and conversion disorder?
- Conscious production of symptoms (factitious)- Unconscious production of symptoms (conversion)
326
How do you differentiate between somatization and hypochondriasis?
- Somatization: nebulous symptoms- Hypochondriac: fixation on one diagnosis
327
How do you treat somatization and hypochondriasis?
Regularly scheduled visits
328
What is the nucleus of serotonin?
Dorsal raphe
329
What is nucleus of norepinephrine?
Locus ceruleus
330
What are the nuclei of dopamine?
- VTA- Substantia nigra
331
What is capgras syndrome?
Delusion that a familiar person has been replaced by an imposter
332
What is fregoli syndrome?
Delusion that strangers are people you know in disguise
333
What is Cotard syndrome?
Nihilistic delusion that he/she is dead- Somatic/physical delusions (rotting, dust)
334
What are symptoms of frontal lobe seizures?
- Personality change- Disinhibition- Hemiballismus
335
What are symptoms of temporal lobe seizures?
- Olfactatory/gustatory hallucinations (auras)- Auditory hallucinations
- Hyperemotional -- fight or flight (amygdala)- Hyperreligious
- Intermittent aphasia
336
What is the most common cause of inherited mental retardation?
Fragile X
337
What is the most common genetic cause of mental retardation in US
Down syndrome
338
Down syndrome are predisposed to ____ later in life?
Alzheimer's
339
What is the leading non-genetic cause of mental retardation?
Fetal alcohol syndrome
340
What developmental disorder is only seen in females?
Rett syndrome- Regression of language, intellect and motor skills
341
Fragile X phenotype
Marfanoid + big balls
342
Prader-Willi
- Obese - Hyerphagia- Hypogonadism[ paternal gene deleted ]
343
Lesch-Nyhan
- Self-mutilation- Motor degeneration
344
PKU phenotype
Mousy smellPale skin/hair
345
Congenital hypothyroid
PalePuffy facedProtuberant tonguePot belliedProtruding umbilicusPoor brain development
346
Fetal alcohol syndrome
- Smooth philtrum- Microcephaly- Micrognathia- Small low set ears- Hypotelorism
347
Tuberous sclerosis
- Ashleaf spots- Intractable seizures- Mental retardation
348
Rett syndrome
In girls
| - Hand wringing- Head stops growing- Regression of language, intellect and motor skills
349
How does child depression differ from adult symptoms?
- Irritability- Psychomotor agitation- Somatic complaints
350
How do you treat enuresis?
1. Fluid restriction, pee before bed2. Bell and pad (classical conditioning)3. DDAVP (old sources = imipramine)
351
How does separation anxiety present?
Scared of something happening to parent- Can happen at any age
352
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
353
How do you treat tic disorder and related disorders?
Clonidine: for tourette's + ADHD
| Risperidone, haldol, pimizide (D2 blockers): for tourette's
354
How does alzheimer's dementia present?
- Gradual memory decline- Working memory goes first (set switching)- Paranoia
355
What will be seen with alzheimer's dementia?
Diffuse cortical atrophy
356
How do you treat alzheimer's dementia?
- Cholinesterase inhibitors: Galantamine, Donepezil, - NMDA antagonist
357
How does lewy body dementia present?
- Hallucinations of little people- Parkinsonism, rapidly progressing
358
What can be seen on labs/imaging with Lewy Body dementia?
Not much atrophy on imaging
359
How do you treat Lewy Body dementia?
Don't give D2 blockers!- Quetiapine is ok though
360
How odes vascular dementia present?
Step wise decline
361
What imaging is associated with vascular dementia?
Multiple infarcts of varying ages
362
How do you treat vascular dementia?
Risk reduction (ASA)
363
How does frontotemporal dementia present?
Early onset- Selective language devolvement- Personality change- Parkinsonism
364
What imaging is associated with frontotemporal dementia?
Preferential atrophy
365
How do you treat frontotemporal dementia?
None- Try to limit things that make it worse
366
How does huntington's present?
- Depression (endogenous)- Personality changes- Dementia
367
How do you treat huntington's?
None
368
What imaging is associated with huntington's?
Caudate atrophy
369
How does Creutzfeldt Jacob's disease present?
Rapidly progressive dementia (3 months)
370
What imaging and labs are seen with Creutzfeldt Jacob disease?
- Spongiform encephalopathy- EEG: periodic sharp wave complexes
- LP: high 14-3-3 protein
371
4 types of REVERSIBLE dementia
- NPH- B12- depression- hypothyroidism
