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Psychiatry > UWORLD pearls > Flashcards

UWORLD pearls Flashcards

1
Q

Treatment duration for first manic episode? After 2nd?

A

First episode: at least 1 year, maybe 2

Two or more: Lifetime

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2
Q

First-line rx for Alzheimer’s dementia?

A

Mild to moderate: Cholinesterase inhibitors (Donepezil, galantamine, rivastigmine, tacrine)
Lead to transient improvement.

DONEPEZIL FOR ALL STAGES

Moderate to severe: Memantine (NMDA receptor antagonist)

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3
Q

Dopamine agonist used in parkinson’s patients that delays the onset and severity of dementia?

A

Amantadine

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4
Q

How to approach an anorexia question?

A

Look for electrolyte imbalanaces, bradycardia, or severe weight loss–> HOSPITALIZE

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5
Q

What to look out for in a hospitalized patient being treated for anorexia

A

Refeeding syndrome- electrolyte depletion, arrythmias, and heart failure that can result from fluid and electrolyte shifts

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6
Q

What medication is contraindicated in eating disorders and why?

A

Bupropion- seizure risk

It’s also not good for anxiety

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7
Q

Rx for remission from binging and purging in bulimia?

A

SSRIs

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8
Q

What can happen to thyroid function in anorexia?

A

Starvation/malnutrition can dec serum thyroxine-binding globulin and albumin concentration

EUTHYROID HYPOTHYROXINEMIA

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9
Q

Guy comes to clinic saying his wife died 4 months ago. He’s super depressed. Thought about going to buy rope to hang himself but didn’t. You tell him he should be admitted to inpatient but he refuses. What do you do?

A

ADMIT involuntarily. He’s at risk for suicide.

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10
Q

If it’s a highly contagious disease like meningococcal meningitis and patient refuses hospital admission?

A

HOSPITALIZE AGAINST WISHES

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11
Q

What receptor does risperidone hit?

A

D2.
Also binds with very high affinity to the serotonin receptors which improves the NEGATIVE sx, reduces extrapyramidal side effects, and treats depression.
THE DOPAMINE ANATAGONISM IS WHAT AFFECTS PSYCHOSIS sx

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12
Q

What does acute mania look like and how do you treat it?

A

Freaking out, getting AGITATED, delusions, etc.

Atypical antipsychotics!!
Lithium, valproate, carbamazepine

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13
Q

When to avoid lithium?

A

Renal disease

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14
Q

When to avoid valproate?

A

Liver disease

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15
Q

When to avoid carbamazepine?

A

When you’re on OCPs it INC DRUG METABOLISM

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16
Q

How to treat severe mania?

A

Antipsychotic + Mood stabilizer

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17
Q

Best treatment for bipolar depressive episodes (rather than mania)? Watch out for what?

A

Lamotrigine (anticonvulsant).

Rash that can become SJS

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18
Q

How long is UDS positive for cocaine?

A

3 days, longer in heavy users

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19
Q

Rx of mild-to-moderate agitation in cocaine intoxication?

A

Benzos

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20
Q

Rx of severe agitation or psychosis in cocaine intoxication?

A

Haloperidol

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21
Q

Rx for cocaine dependence?

A

Psycotherapy, group therapy

TCAs
Dopamine agonists (amantadine, bromocriptine)
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22
Q

Cocaine withdrawal

A

NOT life threatening but causes dysphoric crash:

Malaise/fatigue, depression, hunger, CONSTRICTED PUPILS, vivid dreams, psychomotor agitation

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23
Q

How do amphetamines work?

A

Release dopamine from nerve endings causing a stimulant effect

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24
Q

How do “designer” amphetamines work?

A

Release dopamine and serotonin from nn endings and have stimulant and hallucinogenic properties

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25
Q

How long is UDS positive for amphetamines?

A

1-2 days

Remember, negative UDS never fully rules out bc sensitivity can be lacking

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26
Q

Amphetamine intoxication and withdrawal?

A

Similar to cocaine.

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27
Q

How long is UDS positive for PCP?

A

> 1 week.

CPK and AST often elevated

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28
Q

PCP withdrawal?

A

None, but “flashbacks” can occur

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29
Q

What is one time it’s cool to give activated charcoal?

A

For sedative-hypnotic intoxication to prevent further GI absorption

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30
Q

Rx for barbiturate intoxication?

A

Alkalinize urine with sodium bicarb to promote renal excretion

BARB IS A BASIC BITCH

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31
Q

Rx for benzo overdose and what to look out for with it?

A

Flumazenil (short acting BDZ antagonist)

CAN PRECIPITATE SEIZURES

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32
Q

General rule about which drugs are life threatening with withdrawal?

A

Sedating drugs are

Stimulants and hallucinogens not

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33
Q

Rx for sedative-hypnotic withdrawal?

A

Long-acting benzos (chlordiazepoxide or diazepam with taper)

Tegretol or VPA for seizure control

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34
Q

What receptors do opiates hit?

A

Opioid receptors mu kappa delta AND dopaminergic system

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35
Q

Which opiate can cause serotonin syndrome and with what?

A

Meperidine + MAOIs

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36
Q

Serotonin syndrome

A

Hyperthermia
Confusion
HYPER OR HYPOtension
Muscular rigidity

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37
Q

How long does UDS stay positive for opiates?

A

12-36 hours

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38
Q

Treating opiate OD?

A

Naloxone or naltrexone

Reverse respiratory depression but may cause severe withdrawal in opiate dependent ppl

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39
Q

Opiate withdrawal symptoms?

A

dysphoria, insomnia, lacrimation, RHINORRHEA, yawning, muscle weakness, sweating, PILOERECTION, n/v, fever, dilated pupils, muscle ache

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40
Q

Rx for moderate sx of opiate withdrawal?

A

Clonidine, buprenorphine

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41
Q

Rx for severe opiate withdrawal?

A

Detox with methadone taper over 7 days

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42
Q

PCP mech?

A

NMDA antagonist; activates dopaminergic neurons

Developed as anesthetic agent, like ketamine which is similar

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43
Q

Rx of PCP intoxication?

A

Acidify urine with ammonium chloride or ascorbic acid

Benzos or dopamine antagonists to control agitation/anxiety

Diazepam for muscle spasms/seizures

Haloperidol for severe agitation or psychosis

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44
Q

Hallucinogen intoxication

A

Perceptual changes (duh), pupil dilation, tachycardia, palpitations, tremors, incoordination, sweating

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45
Q

Is withdrawal from opiates life-threatening?

A

NO!

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46
Q

Hallucinogen withdrawal?

A

None, but may have “flashbacks” later (due to reabsorption from lipid stores)

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47
Q

How long is UDS positive in habitual marijuana user?

A

Up to 4 weeks

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48
Q

How long is UDS positive with inhalant use?

A

4-10 hours

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49
Q

Phenothiazines?

A

The 1st generation antipsychotics

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50
Q

Hypothyroidism can cause dementia or delirium!!!

A

Know that…

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51
Q

pyramidal signs

A

The pyramidal system controls all of our voluntary movements; it is made up of two systems: upper motor neurons in the primary motor cortex and lower motor neurons in the anterior horn of the spinal cord; the axons of the corticospinal tract the condense to form the pyramids—giving the system its name; injuries to this system can cause paralysis

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52
Q

Sleep changes in elderly?

A

TOTAL amount of REM is about the same as younger, but

  • Inc # of REMs throughout night
  • Shorter than normal
  • Redistributed throughout sleep cycle

More stage 1 and 2, less stage 3 and 4 (deep sleep)
More awakenings

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53
Q

Sedative hypnotics in elderly?

A

More likely to cause side effects.
Memory impairment, ataxia, PARADOXICAL EXCITEMENT, rebound insomnia

If you must prescribe, use hydroxyzine or zolpidem (safer then benzos)
FLUMAZENIL STILL REVERSES zolpidem EVEN THOUGH THEY’RE NOT BENZOS!

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54
Q

KEY TO REMEMBER ABOUT TOURETTE’S

A

BOTH vocal and motor tics needed to diagnose Tourette’s

ONLY MOTOR or ONLY VOCAL tics suggests either MOTOR TIC DISORDER or VOCAL TIC DISORDER

Tics many times a day nearly daily for > 1 year. NO TIC-FREE PERIOD > 3 MONTHS.

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55
Q

Rx for Tourette’s?

A

FIRST LINE IS CLONIDINE AND GUANFACINE

Haloperidol or pimozide or the atypicals (dopamine receptor antagonists)

SUPPORTIVE psychotherapy

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56
Q

Encopresis vs. enuresis age criteria?

A

Encopresis is after 4 YO
(At least 2x/wk for 3 months OR with marked impairment)

Enuresis after 5 YO
(At least 1x/mo for 3 months)

(kids learn not to go #2 before they learn not to go #1)

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57
Q

What is encopresis associated with?

A

ADHD and conduct disorder (DSM criteria is involuntary OR VOLUNTARY passage…little shit heads)

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58
Q

Rx for separation anxiety disorder?

A

Family, supportive psychotherapy

Low-dose antidepressants

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59
Q

Requirement for the diagnosis of schizoaffective disorder?

A

Delusions or hallucinations for > or equal to 2 wks IN THE ABSENCE OF A MAJOR MOOD EPISODE (depressive or manic)

In bipolar or depression w/ psychotic features, psychotic sx occur EXCLUSIVELY DURING THE MOOD EPISODES
When the patient is euthymic, there are NO psychotic symptoms

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60
Q

Decreased volume of the amygdala and L temporal lobe?

A

MRI of panic disorder

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61
Q

Decreased volume of the hippocampus

A

PTSD

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62
Q

Accelerated head growth during infancy and increased total brain volume?

A

Autism

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63
Q

Structural abnormalities in the orbitofrontal cortex and basal ganglia?

A

OCD

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64
Q

Enlargement of the lateral cerebral ventricles?

A

Schizophrenia

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65
Q

How to differentiate adjustment disorder from acute stress disorder?

A

Adjustment is sx begin within 3 months of the event and end within 6 months. Stressful life event…the form with anxiety is ONE SUBTYPE and looks like acute stress disorder but:

Acute stress disorder is an event < 1 month ago and symptoms last < 1 month. Super short!!

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66
Q

Tourette’s comorbidities?

A

ADHD (60%), OCD (27%)

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67
Q

Comorbidity of trichotillomania?

A

OCD (family or personal)

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68
Q

Simplest explanation of depression?

A

4 SIGECAPS PLUS depressed mood or anhedonia for at least 2 weeks

69
Q

In assessing capacity in a paranoid schizophrenic with a ruptured ectopic pregnancy….

A

If they’re compliant with meds and reasoning well then they’re competent. Get their consent before proceeding with what mom, husband, etc want.

70
Q

Comorbidities with panic disorder?

A

Major depression (>60% have had an MD episode)
Bipolar disorder
Agoraphobia
Substance abuse

71
Q

Rx for delusional disorder?

A

Psychotherapy.

Antipsychotics often ineffective but a course of them should be tried

72
Q

Delusional disorder subtype that will eff you up on tests?

A

Somatic.

Physical delusion focusing on one thing being wrong and freaked out about it. Not body dysmorphic disorder when they think it looks ugly.

73
Q

Risks of sexual assault victims?

A

PTSD, Major depression, suicidal ideation or attempts

STDs, fibromylagia, pelvic pain, functional GI disorders

74
Q

Rx for the first episode of major depressive episode?

A

SSRI for 6 months

75
Q

If patient gives verbal authorization to discuss situation with employer and employer calls, what do you do?

A

Tell them what’s going on. Verbal or written consent is acceptable. (Written obvi preferable.)

76
Q

Important to remember about dysthymia?

A

It’s really not as severe as MDD. Only 2 “criteria” need to be met during their low-grade depression; low self-esteem counts

77
Q

Lifetime risk of first-degree relative of someone with bipolar?

A

5-10%

General population is 1%

78
Q

Why is clozapine good and bad?

A

Least likely atypical antipsychotic to cause EPS BUT it’s a last resort bc of the agranulocytosis

79
Q

Amnesia of ECT?

A

Anterograde amnesia tends to resolve rapidly, retrograde amnesia may last longer

80
Q

Antipsychotics causing greatest weight gain?

A

Olanzapine, clozapine

81
Q

Hospice referral requirement?

A

Prognosis of </= 6 months

82
Q

Tangentiality vs. loose associations?

A

Loose associations tend to be a more severe form of tangentiality

83
Q

How to treat body dysmorphic disorder?

A

Therapeutic alliance: “lets meet regularly to discuss your concerns”
Psychotherapy
SSRIs
More than 90% have coexisting depression

84
Q

Akathisia rx?

A

Propranolol

or benzo

85
Q

Exactly what is Ebstein’s anomaly?

A

Malformed tricuspid valve, atrialized R venricle, ASD

Risk with taking lithium during 1st trimester (duh which is when cardiac development is)

86
Q

Confusing point about social anxiety disorder?

A

May present with physical sx suggestive of a PANIC ATTACK when the patient is confronted with the feared social situation

Panic disorder is UNEXPECTED panic attacks

87
Q

What can happen with sudden cessation of a short-acting benzo?

A

(Alprazolam)

Seizures!!

88
Q

Rx for hoarding disorder?

A

SSRI, CBT

89
Q

What is delayed sleep phase syndrome?

A

Circadian rhythm disorder. Inability to fall asleep at “normal” times like 10pm-midnight and stay awake till 4-5AM BUT sleep is NORMAL IF ALLOWED TO SLEEP UNTIL LATE MORNING

90
Q

Antipsychotic a/w cataracts?

A

Quetiapine

91
Q

Hypochondriasis (aka. illness anxiety disorder) vs. somatic symptom disorder?

A

Hypochondriasis has MINIMAL OR NO ACTUAL PHYSICAL SX. Scary things they feel are just normal. Present for at least 6 months.

Hypochondriacs worried about DISEASE, somatization ppl worried about SYMPTOMS

92
Q

Rx of anorexia? Rx of bulimia?

A

Both: CBT, nutritional rehabilitation

For weight gain in anorexia: paroxetine or mirtazapine

Olanzapine if no response for anorexia

SSRIs often in combo with the therapy in bulimia
TCAs second-line

93
Q

Binge eating disorder therapy?

A

CBT, behavioral weight loss therapy, SSRI

94
Q

“Surgery” q on every psych test?

A

Just had surgery, starts having seizures or shaking. Alcoholic! Duh. Give benzo taper.

95
Q

Best rx for treatment-resistant schizophrenia AND schizophrenia a/w persistent suicidality?

A

Clozapine

Look out for agranulocytosis, seizures, MYOCARDITIS, and metabolic syndrome

96
Q

Panic attack immediate rx? Long-term?

A

Immediate: benzos

Long-term: SSRIs or SNRIs + CBT

97
Q

OCD rx? If failure to respond?

A

SSRI

Switch to a DIFFERENT SSRI if not responding (not diff class!!)

CLOMIPRAMINE and TCAs also effective

98
Q

Hypochondriasis tricky point?

A

They will storm out like malingering people when they’re told they’re well

99
Q

Facts about body dysmorphic disorder?

A

90% MD
70% anxiety
30% psychosis

100
Q

Pain disorder facts?

A

Abrupt onset and inc in intensity for first several months.
Prolonged severe discomfort, may co-exist with medical disorder but not directly caused by it

SSRIs, biofeedback, hypnosis, psychotherapy…NOT NSAIDs :(

101
Q

Impulse control disorders underlying theme?

A

Inability to resist behaviors that may bring harm to self or others
LOW LEVELS OF SEROTONIN assoc with impulsiveness/aggression

GIVE SSRIs + therapy

102
Q

Intermittent explosive disorder?

A

Can’t resist aggressive impulses that damage; level of aggression is out of proportion to trigger.

Individual episodes often remit quickly/spontaneously; remorse usually

Hx of child abuse, head trauma, seizures
Late teens and may get worse until middle age

Rx: SSRIs, anticonvulsants, lithium, propranolol; group/familly therapy NOT INDIVIDUAL

103
Q

Klepto comorbidities?

A

1/4 of bulimics have it!! Eating disorders,
Mood disorders, OCD

Rx: SSRIs, insight-oriented psychotherapy, systematic desensitization and aversive conditioning

104
Q

Pyromania rx?

A

Behavior therapy, SSRIs

Supervision LOL

105
Q

Pathologic gambling risk factors?

A

Loss of parent during childhood, inappropriate parental discipline during childhood, ADHD, family not emphasizing saving

106
Q

Trichotillomania comorbidities?

A

OCD, OCPD, mood disorders, borderline PD

107
Q

Trichotillomania risks? Rx?

A

After stressful life event in 1/4; problems with mom, recent loss of important person or object, etc.

SSRIs, antipsychotics, lithium
Positive reinforcement with something else

108
Q

Laxative abuse?

A

Melanosis coli

109
Q

Hospitalization in anorexia?

A

If more than 20% below ideal body weight

110
Q

Pharm for binge eating disorder?

A

Stimulants (phentermine, amphetamine) to suppress appetite

Orlistat (less fat absorbed from GI tract)

Sibutramine (inhibits reuptake of norepi, serotonin, dopamine)

111
Q

Neurotransmitter abnormalities in sleep disorders?

A

Elevated acetylcholine- inc in total sleep time, inc proportion of REM

Elevated serotonin- inc total sleep time, inc proportion of delta wave

112
Q

After night of sleep deprivation?

A

REM rebound; slow-wave sleep made up first

113
Q

Primary hypersomnia rx?

A

Amphetamines

SSRIs #2

114
Q

If you MUST treat night terror disorder…

A

Diazepam tiny dose at bedtime

115
Q

Neurotransmitters and libido?

A

Dopamine enhances libido

Serotonin inhibits it

116
Q

Most common rx for paraphilias?

A

Insight-oriented psychotherapy

117
Q

Which TCA is least likely to cause orthostatic hypotension?

A

Nortriptyline

118
Q

Which TCA is least sedating/least anticholinergic side effects?

A

Desipramine

119
Q

Which TCA is most serotonin specific and useful in treating OCD?

A

Clomipramine

120
Q

TCA overdose rx?

A

IV sodium bicarb

121
Q

When would you ever give MAOIs?

A

Refractory depression or refractory panic disorder

122
Q

Most stimulating SSRI?

A

Paroxetine bc most serotonin specific

123
Q

Only thing fluvoxamine is approved for?

A

OCD

124
Q

What antidepressant can cause withdrawal sx? Other things to look out for?

A

Venlafaxine
Causes flulike sx and electric-like shocks or zaps

Can inc BP so don’t use in ppl with unstable BP or htn

125
Q

What is bupropion used for?

A

NDRI

SAD, adult ADHD, smoking cessation

NO SEXUAL SIDE EFFECTS :)

126
Q

High dose of bupropion can cause?

A

Risk of seizures and psychosis (dopaminergic effect)

127
Q

What is trazodone? Use?

A

Serotonin antagonist and reuptake inhibitor (SARI)

Refractory depression, major depression w/ anxiety, insomnia

128
Q

Side effects of trazodone?

A

SEDATION, priapism, dizziness, nausea, orthostatic hypotension, arrythmias

129
Q

What is mirtazepine?

A

A norepi and serotonin antagonist (NASA)

Sedation, wt gain, dizziness, agranulocytosis, tremor

Higher doses inc norepi reputake and is therefore less sedating

130
Q

High potency antipyschotics meaning?

A

Greater affinity for dopamine receptors, so lower dose needed

131
Q

Hypothesis of tardive dyskinesia pathophys?

A

Caused by inc # of dopamine receptors which causes lower levels of acetylcholine

132
Q

Seizures and antipsychotics?

A

They LOWER seizure threshold (low potency more likely)

133
Q

Mnemonic for NMS?

A 
Fever
Autonomic instability
Leukocytosis
Tremor
Elevated CPK
Rigidity (lead pipe)

NOT AN ALLERGIC REACTION

HYDRATION, COOLING, maaaybe dantrolene, bromocriptine, or amantadine

134
Q

Clozapine side effects

A

Agranulocytosis, seizures

135
Q

Olanzapine side effects?

A

HLD, metabolic syndrome, LIVER TOXICITY

Monitor LFTs

136
Q

Quetiapine side effects?

A

Orthostasis (alpha-blocking properties)

Do slit lamp exam every 6 months…causes cataracts in beagles

137
Q

When would you use mood stabilizers other than mania?

A

Potentiation of antidepressants in refractory

Potentiation of antipsychotics in schizophrenia

For enhanced abstinence in alcoholism

For aggression and impusivity (dementia, intoxiaction, mental retardation, personality disorders, general medical)

138
Q

Factors that affect lithium levels?

A

NSAIDs
Dehydration, salt deprivation, impaired renal fn increases

Aspirin, diuretics

139
Q

Lithium therapeutic range

A

0.7-1.2

Toxic >1.5

140
Q

Toxic levels of lithium effects?

A

AMS, coarse tremors, convulsions, death

141
Q

Carbamazepine onset? Mech?

A

5-7 days

Blocks sodium channels, inhibits APs

142
Q

Carbamazepine side effects?

A

Skin rash, drowsiness, ataxia, slurred speech, leukopenia, hyponatremia, aplastic anemia/agranulocytosis, NTDs

CBC and LFTs regularly

143
Q

Valproic acid mech? Side effects?

A

Inc CNS levels of GABA

Sedation, wt gain, alopecia, hemorrhagic pancreatitis, HEPATOTOXICITY, THROMBOCYTOPENIA

144
Q

Anxiolytics

A

Benzos, barbs, buspirone

145
Q

Long acting bdz’s?

A

Chlordiazepoxide, diazepam, flurazepam

146
Q

Chlordiazepoxide use?

A

Alcohol detox, pre-surgery anxiety

147
Q

Diazepam use?

A

RAPID onset. Anxiety, seizure control.

148
Q

Flurazepam use?

A

RAPID. Insomnia.

149
Q

Panic attack rx?

A

Alprazolam, clonazepam (intermediate acting)

150
Q

Zolpidem/Zaleplon?

A

Bind to bdz site on GABA receptor (but chemically not a BDZ)

No anticonvulsant or muscle relaxant properties

No withdrawal

Minimal rebound insomnia

LITTLE OR NO TOLDERANCE

151
Q

What is buspirone used for?

A

Alternative to BDZ or venlafaxine in GAD rx

Slower onset (1-2 wks for effect)

Doesn’t potentiate CNS depression in alcohol

152
Q

IV Heroin withdrawal sx peak when?

A

48 hours

153
Q

Meperidine intoxication esp with chronic use can cause…

A

Seizures

154
Q

LSD-induced PSYCHOSIS should wear off by…

A

2 weeks! Long!

155
Q

Marijuana smoking can significantly decrease ability to drive for up to…

A

6 hours later

156
Q

Ecstasy does NOT CAUSE

A

Hallucinations

157
Q

Treatment for delirium?

A

Quetiapine first line

Don’t use haloperidol unless on a cardiac monitor bc it can cause torsades

Benzos only good for alcohol or benzo withdrawal delirium.

158
Q

Delirium EEG

A

Fast waves or generalized slowing

159
Q

Alzheimers neurotransmitters

A

Dec acetylcholine from loss of cholinergic neurons in nucleus basalis of Meynert in midbrain

Dec NE from loss of noradrenergic neurons in locus ceruleus

Tau is tangles
Amyloid is plaques
SEEN IN NORMAL AGING

160
Q

EEG in CJD

A

Periodic sharp waves/spikes

161
Q

Treating conduct disorder?

A

Structure the environment, psychotherapy

If drugs needed…
Antipsychotics or lithium for aggression
SSRIS for impulsivity, irritability, mood lability

162
Q

Do you treat autism with drugs

A

You can.

Neuroleptics for aggression
SSRIs for mood lability

163
Q

Amnestic disorders

A

ALWAYS caused by an underlying medical problem

Memory impairment without any other cognitive problems or altered consciousness

164
Q

Meds to help dissociative amnesia ppl remember?

A

Sodium amobarbital OR LORAZEPAM

165
Q

Two presentations of conversion disorder you forget?

A

Mutism and globus hystericus (lump in throat)

166
Q

Cataplexy rx in narcolepsy?

A

SSRIs or sodium oxalate

Give amphetamines for general narcolepsy rx

167
Q

Minimum time for insomnia? Narcolepsy?

A

1 month insomnia, 3 months narcolepsy

168
Q

Restless leg syndrome rx?

A

Evidence supports the use dopamine agonists including: pramipexole, ropinirole, rotigotine, and cabergoline

169
Q

Lewy body dementia sx? Rx?

A

Dementia, visual hallucinations, shuffling gait

Acetylcholinesterase inhibitors

Psychiatry (5 decks)

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