UWorld Flashcards
(89 cards)
1
Q
What are the commonly used first-line mood stabilizers for bipolar maintenance?
A
- Lithium
- Valproate
2
Q
Long term lithium therapy can adversely affect what organs?
A
- Kidneys
- Thyroid
3
Q
What drug is preferred in bipolar maintenance treatment in patients with renal dysfunction?
A
Valproate due to the potential nephrotoxic effects of lithium
4
Q
Patients with a single episode of major depressive disorder who respond to acute treatment should continue antidepressant treatment for how long?
A
an additional 4-9 months (Continuation phase treatment)
5
Q
Maintenance phase treatment is defined as continuing antidepressant medication past the initial continuation phase treatment. How long is this and who is it appropriate for?
A
- 1-3 years
- Patients with a hx of multiple episodes (recurrent major depressive disorder)
- Chronic episodes (>/= 2 years)
- Strong family history
- or severe episodes (e.g. suicide attempt)
6
Q
Who should continue maintenance therapy with an antidepressant indefinitely?
A
-Pts with a hx of highly recurrent (e.g. >/=3 lifetime episodes) and very severe, chronic major depressive episodes
7
Q
time frame for adjustment disorder
A
-within 3 months of an identifiable stressor and lasting no longer than 6 months once the stressor ceases
8
Q
time frame for generalized anxiety disorder
A
> /= 6 months
9
Q
What is the first line medications treatment for social anxiety disorder
A
SSRIs and SNRIs
10
Q
Contraindications for lithium therapy
A
- Chronic kidney disease
- Heart disease
- Hyponatremia or diuretic use
11
Q
What are the baseline studies that need to be done with Lithium therapy
A
- BUN
- creatinine
- calcium
- urinalysis
- Thyroid function tests
- ECG in patients with coronary risk factors
12
Q
What drugs increase lithium levels?
A
- Thiazide diuretics
- NSAIDs, except aspirin
- ACE inhibitors and angiotensin receptor blockers
- Antibiotics (e.g. tetracycline, metronidazole)
13
Q
What drugs may either increase or decrease lithium levels?
A
- Loop diuretics (e.g. furosemide)
- Calcium channel blockers (e.g. verapamil)
14
Q
What drugs decrease lithium levels
A
- potassium-sparing diuretics
- Theophylline
15
Q
What is first-line treatment for specific phobia
A
Behavioral therapy, which involves exposure to the phobic stimulus in a controlled setting
16
Q
A history of psychosis together with thrombocytopenia, hematuria, and proteinuria is concerning for what?
A
SLE
17
Q
What should be ruled out in sudden onset psychosis in a child or adolescent
A
- SLE
- thyroiditis
- Metabolic or electrolyte disorders
- CNS infection
- Epilepsy
18
Q
What medications are commonly used in the treatment of acute bipolar depression
A
- The 2nd Gen antipsychotics quetiapine and lurasidone
- Lamotrigine
- Lithium, valproate, and a combo of olanzapine and fluoxetine have also demonstrated efficacy
19
Q
Which medication out of Acetaminophen, Lithium, Lorazepam, Risperidone, and Sertraline could cause new onset of severe GI symptoms, confusion, ataxia, and tremor?
A
Lithium
20
Q
What is the greatest risk for suicide
A
history of suicide attempts
21
Q
What is the therapeutic range of Lithium?
A
.6-1.2
22
Q
Common lab findings in NMS
A
- elevated CK
- leukocytosis
23
Q
What is a serotonin antagonist that has been used to treat severe cases of serotonin syndrome
A
-Cyproheptadine
24
Q
what is the treatment for acute dystonia?
A
-Benztropine or diphenhydramine
25
treatment for akathisia
-Beta blocker (propanolol) or Benzodizepine (lorazepam)
26
treatment for parkinsonism
Benztropine or amantadine
27
treatment for tardive dyskinesia
no definitive treatment but clozapine may help
28
The pathophysiology of Tardive Dyskinesia is thought to involve what?
D2 receptor upregulation and supersensitivity
29
Diagnostic criteria for narcolepsy
- Recurrent lapses into sleep or naps (minimum 3 times per week for 3 months)
- At least 1 of the following: 1) Cataplexy: brief loss of muscle tone precipitated by strong emotion (e.g. laughter, excitement). 2) Low CSF levels of hypocretin-1. 3) Shortened REM sleep latency
30
What are the associated features of Narcolepsy
- Hypnagogic or hypnopompic hallucinations
| - Sleep paralysis
31
Describe the management of Gender Dysphoria
- support; psychotherapy (individual, family)
- Hormone therapy
- Gender-reassignment surgery (typically only >/= 18)
32
Abrupt cessation of alprazolam, a short-acting benzodiazepine, is associated with what?
significant withdrawal symptoms, including generalized seizures and confusion
33
What should happen if there is any concern about autism spectrum disorder
Thorough screening and evaluation should be undertaken and educational/behavioral services offered as soon as possible
34
Maintenance treatment of Bipolar disorder typically involves continuation of mood stabilizers used to treat the acute mood episode. What are the evidence based options?
- Lithium
- Valproate
- Quetiapine
- Lamotrigine
35
Describe the sleep pattern consistent with normal aging
- decreased total sleep time
- peak sleepiness earlier in evening
- nocturnal awakenings
- reduced sleep during early morning hours
- daytime napping/reduced daytime sleep latency
36
What is the BMI cutoff for Anorexia Nervosa
<18.5
37
Treatment for Anorexia nervosa
- CBT
- nutritional rehabilitation
- Olanzapine for severe cases
38
What effect of TCA overdose is the best predictor of complications?
QRS duration
39
What QRS duration in TCA overdose has been associated with an increased risk of arrhythmias and/or seizures ad is an indication for treatment with sodium bicarb?
> 100 msec
40
Survivors of sexual assault are at high risk for developing what?
- PTSD
- depression
- suicidality
41
onset and duration of postpartum blues
- onset 2-3 days after birth
| - resolves within 14 days
42
onset of postpartum depression
within 4 weeks
43
What is the treatment of catatonia
-Benzodiazepines and/or ECT
44
The acute onset of headache following a meal in a pt treated with phenelzine raises concern for what
hypertensive crisis
45
Several biomarkers used in screening for unhealthy alcohol use include what?
- AST:ALT ratio of at least 2:1
- elevated GGT
- macrocytosis
- pancytopenia
- increased carbohydrate-deficient transferrin
46
Neuroimaging of the brain in a schizophrenic typically shows what?
-loss of cortical tissue volume with ventricular enlargement with lateral ventricular enlargement being the most widely replicated finding
47
Describe the difference between naltrexone and Acamprosate
- Naltrexone can be initiated while the patient is still drinking
- Acamprosate, a glutamate modulator, is another first-line medication for alcohol dependence. It is initiated once abstinence is achieved and is used to maintain abstinence rather than to reduce drinking in nonabstinent patients
48
Treatment for Hoarding disorder
CBT
49
What is first line treatment for obsessive compulsive disorder
-exposure and response prevention (a type of CBT) and/or an SSRI
50
If signs such as bradycardia, hypotension, respiratory depression and hyporeflexia are seen, co-ingestion of what with benzos should be suspected
other sedative hypnotics, the most common being alcohol
51
what is first line pharmacotherapy for narcolepsy
-Modafinil, a nonamphetamine medication that promotes wakefulness
52
When antipsychotic dose reduction is not possible due to risk of worsening psychosis, how is Tardive Dyskinesia best managed?
switching to clozapine
53
Time frame for acute stress disorder
from 3 days to 1 month
54
If a patient presents with acute mania and is exhibiting acute psychosis and escalating agitation what would be the preferred treatment
Risperidone due to more rapid onset of actions
| -Lithium, Valproate, and carbamazepine would be ineffective in managing the patient's psychosis and agitation acutely
55
Augmentation with this drug is an option for treatment of patients with depression with partial response to selective SSRIs. It has activating effects and a favorable side effect profile (no weight gain or sexual side effects), making it a good choice for patients who are on SSRI therapy but have fatigue, weight gain, or a hx or sexual side effect
Bupropion
56
MOS of Bupropion
norepinephrine-dopamine reuptake inhibitor
57
This is a first-line treatment for panic disorder and agoraphobia. It can be used alone or in combo with antidepressants (SSRIs) to help target avoidance behavior
CBT
58
Most antidepressants should be discontinued 2 weeks before beginning an MAOI to avoid serotonin syndrome or hypertensive crisis. However, which SSRI has a relatively longer half-life than other antidepressant and must be stopped 5 weeks before initiating an MAOI
Fluoxetine
59
A hypertensive crisis may occur in patients who consume foods rich in the sympathomimetic substance tyramine while taking an MAOI. What are the prohibited foods
- Aged cheeses
| - Aged, smoked, pickled, or cured meats/fish/poultry
60
What symptoms of Serotonin syndrome are unlikely to be seen in Hypertensive crisis from a food-drug interaction
- Dilated pupils
- Hyperreflexia
- Hyperthermia
61
What are signs of anorexia nervosa other than BMI < 18.5 and distorted body image
- dry skin
- brittle hair and nails
- cold intolerance
- bradycardia
- Patients who induce vomiting may have haypokalemia and/or calluses on dorsum of their hands
62
What are the indications for hospitalization in Anorexia nervosa
- Bradycardia (< 40/min), dysrhythmia
- Hypotension (< 80/60) orthostasis
- Hypothermia (< 35C)
- Electrolyte disturbance, marked dehydration
- Organ compromise (renal, hepatic, cardiac)
- < 70% expected weight (BMI < 15)
63
bupropion is contraindicated for use in eating disorders due to an increased risk of what?
Seizures
64
Describe antidepressant discontinuation syndrome
- sudden onset of dysphoria
- fatigue
- insomnia
- myalgia
- dizziness
- flu-like and GI symptoms
- tremor
- neurosensory disturbances
65
Symptoms of antidepressant discontinuation syndrome begin within 2-4 days of medication being abruptly stopped or rapidly tapered. What factors are associated with more severe symptoms
- Shorter half life (eg, paroxetine, venlafaxine)
- higher doses
- longer duration
66
What is the best approach to manage antidepressant discontinuation syndrome
re-institute the same antidepressant and taper the dose gradually over 2-4 weeks
-or substitute fluoxetine, which is more easily tapered due to its long half-life
67
The anticonvulsant lamotrigine is used as a mood stabilizer in bipolar disorder and is often used specifically to targer bipolar depression. One of the most significant side effects of lamotrigine is waht?
- drug rash, a mild form of which occurs in up to 10% of those treated
- The more severe mucocutaneous rashes of Stevens-Johsons syndrome and TEN are more rare
68
Management of lamotrigine induced rash
Because of the challenge of predicting the eventual severity, it should be discontinued at the first sign of rash and substituted with another agents
69
Describe the relationship of Major depressive disorder to cortisol levels
-Hyperactivity of the hypothalamic-pituitary-adrenal axis, results in increased cortisol levels
70
Hippocampal and frontal lobe volumes in Depression
decreased
71
REM sleep latency and slow wave sleep in depression
decreased
72
What psych dx? abnormalities in cortico-striato-thalamo-cortical circuits
Obsessive compulsive disorder
73
What psych dx? Increased sensitivity to lactate infusion
panic attacks
74
Hypothalamic-pituitary-ovarian axis in Anorexia nervosa
Suppression leads to decreased GnRH and LH, with resultant amenorrhea and infertility
75
physical heart finding in anorexia nervosa
Cardiac hypertrophy
76
bone finding in anorexia nervosa
Osteopenia
77
When prescribing opioids, what measures can be taken to reduce the risk of opioid misuse
- Checking the prescription drug-monitoring program data for undisclosed co-prescriptions
- Performing RANDOM urine drug screens
- scheduling frequent follow up visit . . .at least every 3 months
78
Treatment of dissociative identity disorder
long-term, trauma-focused psychotherapy
79
Treatment of Oppositional defiant disorder
- Parent management training
- Psychotherapy (anger management, social skills training)
- No pharmacotherapy for ODD but assess for comorbid ADHD & treat if present
80
Abrupt discontinuation of a benzo can results in a petentially life-threatening withdrawal syndrome, characterized by what?
Related this to patients who also have anxiety disorders?
- anxiety, insomnia, tremors, psychosis, seizures
| - Mild withdrawal may be difficult to distinguish from reemergence of the underlying disorder
81
Stimulant medication is a first line treatment for most adults with ADHD. What is preferred in patients with a hx of substance use disorder to avoid the risks of drug misuse and addiction
Nonstimulant Atomoxetine
82
Dementia with Lewy bodies prestns with dementia plus 2 or more of the following features: visual hallucinations, parkinsonism, fluctuating cognition, and REM sleep behavior disorder. Parkinson disease dementia and Dementia with lewy bodies share similar pathology and clinical features. Howevere, they can be differentiated based on course. Describe this
- PDD is diagnosed when parkinsonism predates cognitive impairment by > 1 year
- DLB: cognitive impairment would develop before or at the same time as parkinsonism
83
Patients with bulimia nervosa have some symptoms consistent with hypothyroidism (eg, weight gain, low energy, dry skin) but lack what other signs of the disorder?
- Bradycardia
- Slowed deep tendon relaxation
- Diastolic HTN
84
Most healthy adults can safely consume how much caffeine daily?
<400 mg
85
Pediatric depression often presents with symptoms of what rather than depressed mood
irritability
86
Pharmacotherapy is effective for pediatric depression, and evidence shows that SSRIs are most effects. Among the SSRIs, what is considered the medication of choice based on several meta-analysis
Fluoxetine
87
Among the psychotropic med, what is most commonly associated with hepatotoxicity
Valproate
88
In addition to hepatotoxicity, Valproate is also associated with what side effects?
- tremor
- thrombocytopenia
- alopecia
89
This low-potency antipsychotic has been associated with cholestatic jaundice
Chlorpomazine
