UL Psych - PassMedicine Flashcards
(188 cards)
1
Q
What is delirium also known as?
A
Acute confusional state or acute organic brain syndrome
2
Q
What percentage of elderly patients admitted to hospital are affected by delirium?
A
Up to 30%
3
Q
List two predisposing factors for delirium.
A
- Age > 65 years
- Background of dementia
4
Q
What are common precipitating events for delirium?
A
- Infection (e.g., urinary tract infections)
- Metabolic issues (e.g., hypercalcaemia, hypoglycaemia, dehydration)
5
Q
What is the first-line sedative recommended for delirium management?
A
Haloperidol 0.5 mg
6
Q
What is the most common cause of dementia in the UK?
A
Alzheimer’s disease
7
Q
What assessment tool is recommended by NICE for non-specialist settings to diagnose dementia?
A
10-point cognitive screener (10-CS)
8
Q
What MMSE score suggests dementia?
A
24 or less out of 30
9
Q
List two common causes of dementia.
A
- Alzheimer’s disease
- Cerebrovascular disease
10
Q
What are important differential diagnoses for dementia that are potentially treatable?
A
- Hypothyroidism
- B12/folate/thiamine deficiency
11
Q
What is the typical memory disturbance pattern in delirium compared to dementia?
A
Delirium has loss of short-term memory > long-term memory
12
Q
According to DSM-V, what characterizes ADHD?
A
Features relating to inattention and/or hyperactivity/impulsivity that are persistent
13
Q
What is the UK prevalence of ADHD?
A
2.4%
14
Q
At what age are most children diagnosed with ADHD?
A
Between the ages of 3 and 7
15
Q
List two management strategies for mild/moderate ADHD symptoms.
A
- Parental education
- Training programmes
16
Q
What is the first-line medication for ADHD in children?
A
Methylphenidate (Ritalin)
17
Q
What are the key symptoms of a depressive episode according to ICD-10?
A
- Persistent sadness or low mood
- Loss of interests or pleasure
18
Q
What is the classification of depression based on severity in ICD-10?
A
- Mild: 2 major + 2 others
- Moderate: ≥2 major + 3-4 others
- Severe: 3 major + ≥4 others
19
Q
What screening question can be used to assess for depression?
A
‘During the last month, have you often been bothered by feeling down, depressed or hopeless?’
20
Q
What is one recommended psychosocial intervention for mild depression?
A
Individual guided self-help based on CBT principles
21
Q
What are the components of the Patient Health Questionnaire (PHQ-9)?
A
- 9 items scored 0-3
- Includes items asking about thoughts of self-harm
22
Q
What is the management strategy for subthreshold depressive symptoms?
A
Active monitoring and considering low-intensity psychosocial interventions
23
Q
What is one feature of atypical grief reactions?
A
Delayed grief
24
Q
What are the five stages of grief according to one popular model?
A
- Denial
- Anger
- Bargaining
- Depression
- Acceptance
25
What is the difference in memory loss between delirium and dementia?
Delirium has memory disturbances with no change in level of consciousness, while dementia shows gradual loss in cognition.
26
What is the recommended approach when switching from one SSRI to another?
The first SSRI should be withdrawn (gradually reduce the dose then stop) before the alternative SSRI is started.
27
What is the protocol for switching from fluoxetine to another SSRI?
Withdraw then leave a gap of 4-7 days before starting a low-dose of the alternative SSRI.
28
What is cross-tapering in the context of antidepressants?
Cross-tapering involves slowly reducing the dose of the current drug while slowly increasing the dose of the new drug.
29
What should be done when switching from a citalopram, escitalopram, sertraline, or paroxetine to venlafaxine?
Cross-taper cautiously. Start venlafaxine at 37.5 mg daily and increase very slowly.
30
What factors suggest a diagnosis of depression rather than dementia?
* Short history
* Rapid onset
* Biological symptoms (e.g. weight loss, sleep disturbance)
* Patient worried about poor memory
* Reluctant to take tests, disappointed with results
* Mini-mental test score: variable
* Global memory loss
31
What is Seasonal Affective Disorder (SAD)?
Depression which occurs predominately around the winter months.
32
What is the initial management approach for mild depression?
Begin with psychological therapies and follow up with the patient in 2 weeks.
33
What should not be given to patients with mild depression?
Sleeping tablets as they can worsen symptoms.
34
What are the first-line treatments for the majority of patients with depression?
Selective serotonin reuptake inhibitors (SSRIs).
35
Which SSRIs are currently preferred?
* Citalopram
* Fluoxetine
36
What is the increased risk associated with SSRIs?
Increased risk of gastrointestinal bleeding in patients taking SSRIs.
37
What are common adverse effects of SSRIs?
* Gastrointestinal symptoms
* Increased anxiety and agitation
38
What warning was released regarding citalopram in 2011?
Citalopram and escitalopram are associated with dose-dependent QT interval prolongation.
39
What is the maximum daily dose of citalopram for adults?
40 mg for adults; 20 mg for patients older than 65 years or those with hepatic impairment.
40
What are the features of discontinuation symptoms from SSRIs?
* Increased mood change
* Restlessness
* Difficulty sleeping
* Unsteadiness
* Sweating
* Gastrointestinal symptoms
* Paraesthesia
41
What is the risk associated with using SSRIs during pregnancy?
Small increased risk of congenital heart defects and persistent pulmonary hypertension of the newborn.
42
What class of antidepressants increases concentrations of serotonin and noradrenaline?
Serotonin and noradrenaline reuptake inhibitors (SNRIs).
43
Which antidepressant is known for blocking alpha-2 adrenergic receptors?
Mirtazapine.
44
What are common side effects of tricyclic antidepressants?
* Drowsiness
* Dry mouth
* Blurred vision
* Constipation
* Urinary retention
* Lengthening of QT interval
45
What is the primary use of lithium?
Mood stabilizer in bipolar disorder and adjunct in refractory depression.
46
What are the monitoring requirements for patients on lithium therapy?
* Weekly checks after starting lithium and after each dose change until stable
* Every 3 months once stable
* Thyroid and renal function every 6 months
47
What is the incidence of suicide in Ireland?
1 in 10,000 commit suicide.
48
What percentage of people with mental illness commit suicide?
50%.
49
What are common symptoms of mania?
* Distractibility
* Insomnia
* Grandiosity
* Flight of Ideas
* Agitation
* Sexual indiscretions
* Talking (pressured speech)
| DIGFAST
50
What differentiates hypomania from mania?
Hypomania lasts < 7 days and does not cause marked impairment or psychotic symptoms.
51
What is the treatment of choice for managing acute mania?
Antipsychotic therapy e.g. olanzapine or haloperidol.
52
What is the potential risk when starting SSRIs in patients misdiagnosed with major depressive disorder?
Induction of mania.
53
What is a common treatment for severe depression refractory to medication?
Electroconvulsive therapy (ECT).
54
What are some short-term side effects of ECT?
* Headache
* Nausea
* Short term memory impairment
* Cardiac arrhythmia
55
What are the two recognized types of bipolar disorder?
* Type I disorder: mania and depression
* Type II disorder: hypomania and depression
56
What is the mechanism of action of lithium?
Not fully understood, but may interfere with inositol triphosphate formation or cAMP formation.
57
What are the signs of lithium toxicity?
* Coarse tremor
* Hyperreflexia
* Acute confusion
* Seizure
* Coma
58
What is Agomelatine and its mechanism?
A novel antidepressant that antagonizes 5HT-2 receptors and agonizes melatonergic receptors.
59
What percentage of suicides occur in patients deemed 'low risk'?
50%
## Footnote
This statistic highlights the limitations of risk assessment tools in predicting suicide.
60
What are the common risk factors for suicide?
* male sex (HR approximately 2.0)
* history of deliberate self-harm (HR 1.7)
* alcohol or drug misuse (HR 1.6)
* history of mental illness
* depression
* schizophrenia (10% will complete suicide)
* history of chronic disease
* advancing age
* unemployment or social isolation/living alone
* being unmarried, divorced, or widowed
## Footnote
HR stands for hazard ratio, indicating the increased risk relative to a baseline.
61
What factors increase the risk of completed suicide after a suicide attempt?
* efforts to avoid discovery
* planning
* leaving a written note
* final acts such as sorting out finances
* violent method
## Footnote
These factors indicate a higher likelihood of completing suicide in the future.
62
What are some protective factors against suicide?
* family support
* having children at home
* religious belief
* social values
* resilience
* coping skills
* reasons for living
* health treatment
* physical activity and health
* family connectedness
* supportive schools
* religious participation
* employment
* exposure to suicidal behaviour
## Footnote
These factors can help mitigate the risk of suicide.
63
What is a 'contract of safety' in the context of suicide treatment?
An agreement where the patient signs on admission, regardless if they refuse, indicating their commitment to safety measures.
## Footnote
This includes agreements to avoid self-harm and suicidal thoughts.
64
What are the first-line treatments for schizophrenia according to NICE guidelines?
* oral atypical antipsychotics
* cognitive behavioural therapy
## Footnote
These are recommended for effective management of schizophrenia.
65
What are Schneider's first rank symptoms of schizophrenia?
* auditory hallucinations
* thought disorders
* passivity phenomena
* delusional perceptions
## Footnote
These symptoms are considered key indicators of schizophrenia.
66
What is the relative risk of developing schizophrenia if a monozygotic twin has the disorder?
50%
## Footnote
This is the highest genetic risk factor for schizophrenia.
67
What are the features of thought disorders in schizophrenia?
* circumstantiality
* tangentiality
* neologisms
* clang associations
* word salad
* knight's move thinking
* flight of ideas
* perseveration
* echolalia
## Footnote
These features characterize how thought processes may be disorganized in schizophrenia.
68
What constitutes a delusional disorder?
Beliefs lasting > 1 month that are fixed, non-bizarre, with otherwise unimpaired functioning.
## Footnote
These delusions are possible but highly unlikely.
69
What is the primary action of antipsychotics?
They act as dopamine D2 receptor antagonists, blocking dopaminergic transmission in the mesolimbic pathways.
## Footnote
This mechanism is crucial for reducing psychotic symptoms.
70
What are some extrapyramidal side effects (EPSEs) associated with conventional antipsychotics?
* Parkinsonism
* acute dystonia
* akathisia
* tardive dyskinesia
## Footnote
These side effects can significantly affect patient quality of life.
71
What are the adverse effects of clozapine?
* agranulocytosis (1%)
* neutropenia (3%)
* reduced seizure threshold
* constipation
* myocarditis
* hypersalivation
## Footnote
Monitoring of blood counts is essential while on clozapine.
72
What is the clinical definition of Generalised Anxiety Disorder (GAD)?
Excessive, poorly controlled anxiety that tends to occur daily for > 6 months, generalized to most issues.
## Footnote
GAD is characterized by persistent worry and tension.
73
What is the step-wise management approach for GAD according to NICE?
* Step 1: education about GAD + active monitoring
* Step 2: low intensity psychological interventions
* Step 3: high intensity psychological interventions or drug treatment
* Step 4: highly specialist input
## Footnote
This approach helps tailor treatment to patient needs.
74
What are the symptoms of a panic attack?
* sweating
* palpitations
* abdominal distress/nausea
* paresthesias
* lightheadedness
* chest pain
* chills
* choking
* derealization or depersonalization
* fear of dying or losing control
## Footnote
Panic attacks are sudden and intense, often without a clear trigger.
75
What constitutes a specific phobia?
Marked and persistent (> 6 months) fear cued by the presence or anticipation of a specific object or situation.
## Footnote
Common types include animal, environmental, and situational phobias.
76
What is the difference between tangentiality and circumstantiality?
Tangentiality involves wandering from a topic without returning, while circumstantiality eventually returns to the original point after excessive detail.
## Footnote
These are both thought disorder features.
77
What is social phobia (social anxiety disorder)?
Marked and persistent (> 6 months) fear of social or performance situations in which one is exposed to unfamiliar people or to possible scrutiny by others
## Footnote
Fear of acting in a humiliating or embarrassing way, such as public speaking or eating in public.
78
What are the evaluation criteria for social phobia?
Exposure to stimulus provokes immediate anxiety response, may present as panic attack, recognition of fear as excessive, avoidance or endurance with anxiety/distress, significant interference with daily routine
## Footnote
Includes occupational and social functioning.
79
What is the first line treatment for social phobia?
Psychotherapy, specifically cognitive behaviour therapy
## Footnote
More efficacious than medication.
80
What pharmacological options are available for social phobia?
SSRIs/SNRIs, short acting benzodiazepines (e.g., alprazolam), β-blockers for specific performance phobia
## Footnote
β-blockers are indicated for situations such as public speaking.
81
What are the two components of Obsessive Compulsive Disorder (OCD)?
Obsessions and compulsions
## Footnote
Obsessions are intrusive thoughts causing distress; compulsions are repetitive actions to neutralize obsessions.
82
What distinguishes OCD from obsessive-compulsive personality disorder?
OCD is ego-dystonic, meaning behavior is inconsistent with one's beliefs and attitudes
## Footnote
This contrasts with obsessive-compulsive personality disorder.
83
What are common associated conditions with OCD?
Tourette's disorder, depression (30%), schizophrenia (3%), Sydenham's chorea, anorexia nervosa
## Footnote
Tourette's disorder can be treated with risperidone.
84
What is the DSM-V diagnostic criterion for OCD?
Obsessions, compulsions or both must be present, time-consuming (> 1 hour/day) or cause clinically significant distress or social impairment
## Footnote
Symptoms must not be due to substance abuse or medical conditions.
85
What is the first line treatment for OCD?
Cognitive Behavioural Therapy (CBT)
## Footnote
Pharmacotherapy options include SSRIs and clomipramine.
86
What are the main features of Post-Traumatic Stress Disorder (PTSD)?
Re-experiencing, avoidance, hyperarousal, emotional numbing
## Footnote
Symptoms may include flashbacks, nightmares, and difficulty concentrating.
87
What are the ICD-10 criteria for PTSD?
Exposure to a stressful event, persistent remembering or reliving the stressor, avoidance of associated circumstances, and increased psychological sensitivity
## Footnote
Symptoms must not be present before the exposure.
88
What is the recommended management following a traumatic event?
Single-session interventions (debriefing) are not recommended; watchful waiting for mild symptoms
## Footnote
Trauma-focused CBT or EMDR therapy may be used for severe cases.
89
What are the effects of benzodiazepines?
Sedation, hypnotic, anxiolytic, anticonvulsant, muscle relaxant
## Footnote
They enhance the effect of GABA.
90
What is the recommended duration for prescribing benzodiazepines?
Short period of time (2-4 weeks)
## Footnote
Patients may develop tolerance and dependence.
91
What are the effects of rapid withdrawal from benzodiazepines?
Benzodiazepine withdrawal syndrome, similar to alcohol withdrawal syndrome
## Footnote
Features include insomnia, anxiety, irritability, and tremors.
92
What are Z drugs?
Similar effects to benzodiazepines but different structurally, acting on the α2-subunit of the GABA receptor
## Footnote
Examples include zolpidem, zopiclone, and zaleplon.
93
What characterizes antisocial personality disorder?
Failure to conform to social norms, deception, impulsiveness, irritability, lack of remorse
## Footnote
More common in men.
94
What are the features of avoidant personality disorder?
Avoidance of occupational activities, preoccupation with criticism, reluctance to take personal risks
## Footnote
Social isolation accompanied by a craving for contact.
95
What defines borderline personality disorder?
Efforts to avoid abandonment, unstable relationships, impulsivity, chronic feelings of emptiness
## Footnote
May include recurrent suicidal behavior.
96
What are the symptoms of anorexia nervosa?
Reduced body mass index, bradycardia, hypotension, enlarged salivary glands
## Footnote
Physiological abnormalities include hypokalaemia and low sex hormones.
97
What is the DSM-V diagnostic criterion for anorexia nervosa?
Restriction of energy intake leading to significantly low body weight, intense fear of gaining weight, disturbance in body image
## Footnote
BMI and amenorrhoea are no longer specifically mentioned.
98
What is the management for bulimia nervosa?
Referral for specialist care, bulimia-nervosa-focused guided self-help, individual CBT-ED, family therapy for children
## Footnote
Pharmacological treatments have a limited role.
99
What is Tourette Syndrome?
A chronic neurologic disorder that manifests with motor and vocal tics
## Footnote
Variable incidence, more common in males.
100
What is the recommended therapy for children with bulimia nervosa?
Bulimia-nervosa-focused family therapy (FT-BN)
## Footnote
This therapy is specifically tailored for children suffering from bulimia nervosa.
101
What is the role of pharmacological treatments in bulimia nervosa?
Limited role; high-dose fluoxetine is licensed but lacks long-term data
## Footnote
Fluoxetine is the only medication currently licensed for use in bulimia nervosa.
102
Define Tourette Syndrome.
A chronic neurologic disorder that manifests with motor and vocal tics
## Footnote
Tourette Syndrome is characterized by both motor and vocal tics.
103
What is the mean age of tic onset in Tourette Syndrome?
Approximately 5.6 years of age
104
What is the gender ratio of Tourette Syndrome prevalence?
More common in males (4:1)
105
What is the pathogenesis of Tourette Syndrome?
Believed to be due to a complex interaction between genetic, environmental, and social factors
## Footnote
The exact mechanism of disease remains unclear.
106
What psychiatric disorders are commonly comorbid with Tourette Syndrome?
* ADHD (~60% of cases)
* OCD (~27% of cases)
107
What are the hallmark symptoms of Tourette Syndrome?
Tics with sudden onset, brief duration, and can be motor or vocal
## Footnote
Examples include eye blinking and simple noises.
108
What are the DSM-V diagnostic criteria for Tourette Syndrome?
* Multiple motor and ≥ 1 vocal tic
* Tics persist ≥ 1 year
* Tics begin at < 18 years of age
* Tics are not due to other causes
109
What is the differential diagnosis for Tourette Syndrome?
* Transient motor and phonic tics (lasting < 1 year)
* Myoclonus
* Dystonia
* Chorea
* Stereotypies
110
List the treatment modalities for Tourette Syndrome.
* Conservative
* Medical/Pharmacologic
* Operative
* Behavioural therapy
111
What is the first-line treatment for moderate tics in Tourette Syndrome?
Behavioural therapy, such as habit reversal training
112
Name some pharmacological treatments for Tourette Syndrome.
* Clonidine
* Guanfacine
* Atypical antipsychotics (e.g., risperidone, olanzapine)
113
What is the prognosis for Tourette Syndrome?
Tics typically decline during adolescence and may resolve around 18 years of age
114
What is pathologic gambling classified as in DSM-V?
A substance-related disorder
115
What is the prevalence of pathologic gambling in adults?
1-3% of adults
116
What are common symptoms of pathologic gambling?
* Preoccupation with gambling
* Need to gamble with increasing amounts
* Irritability when attempting to stop
117
What is the most effective treatment for pathologic gambling?
Participation in Gamblers Anonymous (12-step program)
118
What is kleptomania?
Inability to resist uncontrollable urges to steal objects not needed for personal use
119
What are some treatment options for kleptomania?
* Psychotherapy
* 12-step program
* SSRIs and naltrexone
120
What is trichotillomania also known as?
Hair pulling disorder
121
What is the prevalence of trichotillomania in the population?
1-3%
122
What are the symptoms of trichotillomania?
* Recurrent pulling out of hair
* Tension before pulling and relief afterwards
* Significant distress in daily functioning
123
What is the first-line treatment for trichotillomania?
Cognitive behavioural therapy
124
What defines insomnia according to DSM-V?
Difficulty initiating or maintaining sleep, or early-morning awakening leading to dissatisfaction with sleep quantity or quality
125
What is considered acute insomnia?
Typically related to a life event and resolves without treatment
126
List some risk factors associated with insomnia.
* Female gender
* Increased age
* Unemployment
* Chronic illness
127
What is the recommended short-term management for insomnia?
* Identify potential causes
* Advise good sleep hygiene
* Consider hypnotics if daytime impairment is severe
128
What is sleep paralysis?
Transient paralysis of skeletal muscles occurring when awakening or falling asleep
129
What are the subtypes of circadian rhythm sleep disorder?
* Advanced sleep-wake phase disorder
* Delayed sleep-wake phase disorder
* Irregular sleep-wake type
* Non-24-hour sleep-wake type
130
What is narcolepsy characterized by?
Disordered regulation of sleep cycles due to hypocretin deficiency
131
What are common symptoms of narcolepsy?
* Excessive daytime sleepiness
* Cataplexy
* Sleep paralysis
132
What is the first-line pharmacologic treatment for narcolepsy?
Modafinil
133
What is the mechanism of action for most addictive drugs?
Act on the dopamine mesolimbic-reward pathway
134
What are common symptoms of opioid withdrawal?
* Anxiety
* Insomnia
* Sweating
* Dilated pupils
135
What is the treatment for opioid withdrawal?
Clonidine, a2 agonist that decreases NE and sympathetic output
136
What is the common presentation of cocaine withdrawal?
Severe depression and suicidality, hyperphagia, hypersomnolence
137
What is the treatment for alcohol withdrawal?
Long-acting benzodiazepines with taper
138
What is the first-line treatment for alcohol withdrawal?
Benzodiazepines e.g. chlordiazepoxide
## Footnote
Lorazepam may be preferable in patients with hepatic failure.
139
What are the symptoms of cocaine withdrawal?
Severe depression and suicidality, hyperphagia, hypersomnolence, fatigue, malaise, severe psychological craving
## Footnote
Treatment includes pharmacologic options like bupropion and bromocriptine.
140
What is the mechanism of action of alcohol in the CNS?
Enhances GABA mediated inhibition and inhibits NMDA-type glutamate receptors
## Footnote
Alcohol withdrawal leads to decreased inhibitory GABA and increased NMDA glutamate transmission.
141
When do symptoms of alcohol withdrawal typically start?
6-12 hours after last drink
## Footnote
Symptoms include tremor, sweating, tachycardia, anxiety.
142
What is the peak incidence time for seizures during alcohol withdrawal?
36 hours
## Footnote
Delirium tremens peaks at 48-72 hours.
143
What is a key feature of delirium tremens?
Coarse tremor, confusion, delusions, auditory and visual hallucinations, fever, tachycardia
## Footnote
It typically peaks at 48-72 hours after last drink.
144
Which drug is used as an opioid receptor antagonist?
Naloxone
## Footnote
It is used in cases of opioid overdose.
145
What are some symptoms of opioid intoxication?
Constipation, respiratory depression, pinpoint pupils, seizures
## Footnote
Overdose can be life-threatening.
146
What distinguishes barbiturates from benzodiazepines in terms of depression?
Barbiturates do not have a depression 'ceiling'
## Footnote
Benzodiazepines have a ceiling effect.
147
What is the treatment for amphetamine intoxication?
Antipsychotics (haloperidol), benzodiazepines, antihypertensives, vitamin C
## Footnote
Do not restrain patients to avoid complications like rhabdomyolysis.
148
What syndrome is characterized by persistent visual or auditory hallucinations in clear consciousness?
Charles-Bonnet Syndrome
## Footnote
Commonly associated with visual impairment.
149
What is Cotard Syndrome?
A rare mental disorder where the patient believes they are dead or non-existent
## Footnote
Often associated with severe depression and psychotic disorders.
150
Define De Clerambault's Syndrome.
A form of paranoid delusion where a patient believes a famous person is in love with them
## Footnote
Often affects single women.
151
What is Othello's syndrome?
Pathological jealousy where a person is convinced their partner is cheating without proof
## Footnote
This is accompanied by socially unacceptable behavior.
152
What are immature defenses in psychology?
Unconscious processes that prevent undesirable feelings, such as acting out, denial, and displacement
## Footnote
They are more primitive compared to mature defenses.
153
What is the definition of regression in psychological defenses?
Reversion to more childlike behavior
## Footnote
Commonly seen in children under stress.
154
What does sublimation refer to in mature defenses?
Replacing an unacceptable action with a similar acceptable action
## Footnote
An example includes an artist expressing inner angst through art.
155
What are tricyclic antidepressants primarily used for?
Major depression and enuresis
## Footnote
Imipramine is a second-line agent for enuresis.
156
What is the mechanism of action for tricyclic antidepressants?
Block NE and serotonin transporters, inhibiting reuptake
## Footnote
They have negligible affinity for DA transporter except amineptine.
157
What are the two categories of tricyclic antidepressants?
3° TCAs and 2° TCAs
## Footnote
Examples include imipramine and nortriptyline.
158
What is the best tolerated TCA used in geriatric populations?
Nortriptyline
159
Which TCA has the least anticholinergic and antihistaminic effects?
Desipramine
160
What is the mechanism of action for TCAs?
Block NE and serotonin transporters; negligible affinity for DA transporter except amineptine
161
Name a second-line agent used for the treatment of enuresis.
Imipramine
162
Which TCA is primarily used for OCD?
Clomipramine
163
List common side effects of TCAs.
* Anticholinergic
* Tachycardia
* Urinary retention
* Anti-α-adrenergic effects
* Sedation
* ↓ Seizure threshold
164
What are the 3 C's of TCA overdose?
* Convulsions
* Coma
* Cardiotoxicity (arrhythmias)
165
What is the best indicator of TCA overdose?
QRS prolongation
166
What is the treatment for TCA overdose?
NaHCO3 for cardiovascular toxicity
167
What are SSRIs commonly considered for?
First-line treatment for depression
168
How long does it usually take for SSRIs to show therapeutic effects?
3-8 weeks
169
Name two SSRIs of choice if concerned about drug-to-drug interactions.
Citalopram and Escitalopram
170
What is a common side effect of SSRIs?
Sexual dysfunction (anorgasmia)
171
What syndrome can occur with abrupt discontinuation of SSRIs?
SSRI discontinuation syndrome
172
What is the mechanism of action for SNRIs?
Inhibits 5-HT and NE reuptake
173
What is a common toxicity associated with SNRIs?
Increased blood pressure
174
Name a class of antidepressants that includes phenelzine and tranylcypromine.
Monoamine Oxidase Inhibitors (MAOIs)
175
What clinical use are MAOIs particularly suited for?
Atypical depression that is refractory to other medications
176
What dietary substance can cause a hypertensive crisis when ingested with MAOIs?
Tyramine
177
What is a common side effect of bupropion?
Stimulant effects (tachycardia and insomnia)
178
What is the mechanism of action for buspirone?
Partial agonist of 5-HT1A receptor
179
What is the primary clinical use of buspirone?
Generalized anxiety disorder
180
What are the two classes of antipsychotics?
* Typical
* Atypical
181
What is a major advantage of atypical antipsychotics over typical ones?
Less EPS and anticholinergic side effects
182
What is the characteristic time course for EPS side effects from high potency D2 blockers?
* 4 hours: Acute dystonia
* 4 days: Parkinsonism
* 4 days to 4 weeks: Akathisia
* 4 months: Tardive dyskinesia
183
What is Neuroleptic Malignant Syndrome (NMS)?
High fever, hypertension, tachycardia, muscle rigidity, elevated CPK
184
What is the treatment for Neuroleptic Malignant Syndrome?
Discontinue offending agent, muscle relaxant (e.g., dantrolene)
185
Which atypical antipsychotic is known for causing significant weight gain?
Olanzapine
186
What unique feature does clozapine have?
Requires weekly WBC monitoring due to agranulocytosis risk
187
What is the mechanism of Methylphenidate (Ritalin)?
Increases presynaptic NE release from vesicles
188
What is the clinical use of Methylphenidate?
ADHD and narcolepsy
