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68 Cards in this Set
- Front
- Back
TCAs: neurotransmitters affected (2)
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inhibit reuptake of norepi and serotonin
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Name important TCAs (7)
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amitriptyline
nortriptyline doxepin clomipramine desipramine imipramine trimipramine |
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TCA side effects (6)
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"Anti-HAM:"
1. anti-histaminic (sedation) 2. anti-adrenergic (orthostatic hypotension; tachycardia, arrhythmias) 3. anti-muscarinic (dry mouth, constipation, urinary retention, blurred vision, tachycardia) 4. Weight gain 5. Lethal in overdose! 6. 3Cs: convulsions, coma, cardiotoxicity |
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MAOIs: mechanism
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Irreversibly inhibit MAO-A/B, enzymes involved in deactivating biogenic amines
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MAO-A: mechanism
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preferentially deactivates serotonin
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MAO-B: mechanism
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preferentially deactivates norepi/epi
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venlafaxine: use
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refractory depression, CAP
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Side effects of traditional antipsychotics (8)
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1. Antidopaminergic (EPS)
2. Anti-HAM 3. Weight gain 4. LFTs elevated 5. Ophthalmologic problems 6. Dermatologic problems 7. Seizures 8. Tardive Dyskinesia |
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Name one from each class:
1. SNRI 2. NDRI 3. SARI 4. NASA |
1. venlafaxine
2. bupropion 3. trazodone 4. mirtazapine |
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LOW-POTENCY traditional antipsychotics:
1. List two 2. Give ophthalmic side effects for each |
1. chlorpromazine, thioridazine
2. chlorpromazine: corneal, lens deposits thioridazine: irreversible retinal pigmentation |
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Neuroleptic malignant syndrome: signs and symptoms
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"FALTER"
Fever Autonomic instability Leukocytosis Tremor Elevated CPK Rigidity |
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Atypical antipsychotics: how different from typical?
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Block serotonin receptors as well as dopamine receptors
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clozapine: side effects (incidence)
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agranulocytosis (1%)
seizures (2-5%) |
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olanzapine: side effects (4)
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hyperlipidemia
glucose intolerance weight gain liver toxicity (monitor LFTs) |
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mood stabilizers (3)
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lithium
valproic acid carbamazepine latter two are anti-seizure drugs, both with NTDs in pregnancy |
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lithium: side effects (2)
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hypothyroidism
nephrogenic DI |
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carbamazepine: indication, side effects (4)
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indication: mixed and rapid-cycling bipolar disorder
side effects: 1. hyponatremia 2. leukopenia 3. agranulocytosis 4. aplastic anemia NTDs in pregnancy |
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valproic acid: indication, side effects
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indication: mixed and rapid-cycling bipolar disorder
side effects: 1. hepatotoxicity 2. thrombocytopenia NTDs in pregnancy |
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long-acting BZDs, 1-3d
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chlordiazepoxide
diazepam flurazepam |
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intermediate-acting BZDs, 10-20h
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alprazolam
clonazepam lorazepam temazepam |
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short-acting BZDs, 3-8h
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oxazepam
triazolam |
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zolpidem/zaleplon: MOA and features
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selectively bind BZD binding site on GABA receptor
features: no muscle relaxation no withdrawal, minimal rebound insomnia little-no tolerance, dependence |
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buspirone: MOA
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partial agonist at serotonin 5HT-1A receptor
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propanolol: uses in psychiatry (2)
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treatment of:
1. autonomic effects of panic/performance anxiety 2. akathisia |
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Psychiatric symptoms due to general medications (5)
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1. psychosis
2. agitation/confusion/delirium 3. depression 4. anxiety 5. sedation |
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medical causes of psychosis (4)
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1. CNS disease
2. endocrinopathies 3. nutritional/vitamin deficiency 4. other (SLE, GCA, porphyria) |
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schizophreniform v. schizophrenia
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schizophreniform: 1-6 mo
schizophrenia: >6 mo |
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schizoaffective disorder v. mood disorder with psychotic Sx?
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schizoaffective disorder: delusions or hallucinations in the ABSENCE of mood disorder symptoms
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in the listed disorder, mood Sx must last at least:
1. Major depressive episode 2. Manic episode 3. Mixed episode 4. Hypomanic episode |
1. 2 weeks
2. 1 week 3. 1 week 4. 4 days |
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PTSD: criteria (6)
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1. experience (of a traumatic event)
2. re-experience (of same event) 3. avoidance (of stimuli associated with event) 4. numbing (of affect, social relatedness) 5. increased arousal (insomnia, anger bursts) 6. Sx present for at least 1 month |
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PTSD v. Acute Stress Disorder
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PTSD: any time in the past, Sx for >1 month
Acute Stress Disorder: within 1 month of trauma, Sx for <1 month |
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GAD: criteria (3)
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1. anxiety about daily activities for >6 months
2. difficult to control the worry 3. associated with at least 3 of the following: restlessness, fatigue, concentration difficulty, irritability, muscle tension, sleep disturbance |
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Adjustment Disorder: criteria (3)
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1. Sx (emotional/behavioral) begin within 3 months of stressful life event
2. Sx are not those of bereavement 3. Sx resolve within 6 months after stressor has terminated |
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Personality Disorders: Sx manifestations (4)
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Two or more of "CAPRI" for Dx:
Cognition Affect Personal Relations Impulse control |
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Cluster A disorders (3)
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Paranoid
Schizoid Schizotypal |
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Avoidant v. Schizoid personality disorders
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Avoidant: desires relationships but hides in corner
Schizoid: no desire for close relationships |
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Schizotypal: criteria (9)
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Five or more of these:
1. ideas of reference (but not delusions) 2. odd beliefs, magical thinking 3. unusual perceptual experiences 4. suspiciousness 5. inappropriate/restricted affect 6. odd/eccentric appearance/behavior 7. few close friends 8. odd thinking or speech 9. excessive social anxiety |
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Antisocial Personality Disorder: minimum age for diagnosis
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18
Hx of childhood behavior consistent with conduct disorder |
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Borderline Personality Disorder: features (9)
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"IMPULSIVE"
Impulsive Moody Paranoid under stress Unstable self-image Labile, intense relationships Suicidal Inappropriate anger Vulnerable to abandonment Emptiness |
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Social Phobia v. Avoidant Personality Disorder
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Social Phobia: fear of embarrassment in a particular setting
Avoidant Personality Disorder: fear of rejection and sense of inadequacy |
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OCD v. OCPD
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OCPD: perfectionist, miserly, stubborn; ego-syntonic
OCD: obsessions, compulsions; ego-dystonic |
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Substance Abuse: criteria (4)
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At least one of the following for at least 1 year:
1. failure to fulfill work/school obligations 2. use in dangerous situations 3. recurrent substance-related legal problems 4. continued use despite social/interpersonal problems due to use |
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Substance Dependence: criteria (7)
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At least three within a 12-month period
1. tolerance 2. withdrawal 3. more use than intended 4. persistent desire to cut down/quit 5. significant time spent obtaining, using, or recovering 6. decreased social/occupational/recreational activities due to use 7. continued use despite physical/psychological problem |
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Incute EtOH intoxication: treatment (3)
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1. ABCs, monitor lytes and acid-base
2. Finger-stick glucose to r/o hypoglycemia 3. Give thiamine, naloxone, folate |
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EtOH withdrawal: treatment (3)
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1. tapering doses of BDZs (chlordiazepoxide, lorazepam)
2. thiamine, folate, multivitamin 3. Magnesium sulfate for postwithdrawal seizures |
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Cocaine: MOA
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blocks dopamine reuptake from synaptic cleft
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Wernicke encephalopathy v. Korsakoff syndrome
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Both due to thiamine (B1) deficiency. Korsakoff syndrome develops from untreated Wernicke encephalopathy.
Wernicke encephalopathy: 1. Ataxia 2. Confusion 3. Ocular abnormalities Korsakoff syndrome: 1. Impaired recent memory 2. Anterograde amnesia 3. +/- Confabulation |
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Therapy of Wernicke-Korsakoff
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thiamine BEFORE glucose
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Tx of cocaine intoxication
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1. BDZ for mild/mod agitation
2. haloperidol for severe agitation/psychosis 3. Sx support (labetalol, anti-arrhythmics) |
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PCP intoxication: pathognomonic finding
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rotatory nystagmus
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BDZs v. barbiturates: MOA
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BDZs: potentiate GABA by increasing *frequency* of Cl- channel opening
barbiturates: potentiate GABA by increasing *duration* of Cl- channel opening |
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Tx of acute sedative-hypnotic intoxication (4)
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1. ABCs
2. Activated charcoal 3. BDZs: flumazenil; barbiturates: alkalinize urine with sodium bicarb 4. supportive care |
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Triad of opiate overdose:
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"Rebels Admire Morphine"
Respiratory depression Altered mental status Miosis |
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Opiate that causes mydriasis rather than miosis?
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meperidine (Demerol)
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Smoking cessation Tx (4)
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1. Behavioral counseling
2. Nicotine replacement therapy 3. Zyban 4. clonidine |
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B12 deficiency: cognitive findings (3)
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1. dementia
2. decreased position/vibration sense 3. megaloblasts on CBC |
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Neurosyphillis: cognitive features (3)
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1. dementia
2. decreased position/vibration sense 3. Argyll-Robertson pupil's (AKA whore's pupils: accomodate but do not react) |
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Alzheimer's: classic features (4)
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aphasia
apraxia agnosia diminished executive function personality/mood changes also common |
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Alzheimer's: Tx and MOAs (3)
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1. NMDA receptor anatogonists (memantine)
2. Cholinesterase inhibitors (tacrine, donepezil, rivastigmine) 3. BDZs, antidepressants, antipsychotics as indicated |
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How do Sx of vascular dementia differ from Alzheimer's?
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In etiology and presentation (insidious and gradual in Alzheimer's, *stepwise* in vascular/multi-infarct dementia)
Sx otherwise the same: aphasia, apraxia, agnosia, decreased executive function. Vascular dementia may also present with focal neurologic findings. |
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amatadine: MOA
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unknown, but drug used for Parkinson's
"aMANtadINE eMANcipates dopamINE" |
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EEG in CJD
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periodic sharp waves/spikes
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Normal pressure hydrocephalus: features (3)
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"Wacky, wobbly, and wet"
1. dementia (mild, insidious) 2. gait disturbance (often first to appear) 3. urinary incontinence |
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Treatment of delirium (4)
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"You may start a FEUD by treating your delirious patients"
Fluids/nutrition Environment Underlying cause Drug withdrawal |
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General Tx strategies for dissociative disorders (3)
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1. hypnosis
2. drug-assisted interviewing (amobarbital or Ativan) 3. insight-oriented psychotherapy |
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primary v. secondary gain
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primary gain: expression of unacceptable feelings as physical Sx in order to avoid facing feelings
secondary gain: use of Sx to benefit patient (attention, running from law) |
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Onset before what age for Somatization Disorder?
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30
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Findings associated with Anorexia Nervosa (9)
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amenorrhea
lytes abnormalities hypercholesterolemia arrhythmias cardiac arrest LANUGO MELANOSIS COLI leukopenia osteoporosis |