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USMLE Step 2 CK > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

Selective serotonin reuptake inhibitors (SSRIs)

A

An adequate trial is considered 4-6 weeks SA: headache, GI disturbance, sexual dysfunction, increased bleeding (2/2 platelet dysfunction), increased risk of peptic ulcers (avoid NSAIDs)

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2
Q

Venlafaxine (Effexor)

A

SNRI SA: diaphoresis, increased BP Not the best for hypertensive patients

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3
Q

Duloxetine (Cymbalta)

A

SNRI FDA approved for pain

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4
Q

Mirtazapine (Remeron)

A

Alpha2-adrenergic receptor antagonist Good for the elderly, increases appetite, sedating

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5
Q

Tricyclic antidepressants (TCAs)

A

SA: sedation, weight gain, orthostatic hypotension, anticholinergic effects, prolonged QT interval Most lethal in overdose –> arrythmias

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6
Q

Monoamine oxidase inhibitors (MAOIs)

A

Used for refractory depression SA: hypertensive crisis when used with sympathomimetics or ingestion of tyramine-rich foods (wine, beer, aged cheeses, liver, smoked meats), orthostatic hypotension, serotonin syndrome if combined with other serotonergic drugs

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7
Q

Lithium

A

Mood stabilizer Indicated for bipolar I Reduces suicide risk SA: weight gain, tremor, GI disturbance, fatigue, arrhythmias, seizures, goiter/hypothyroidism, leukocytosis, nephrogenic DI, polydipsia, alopecia, metallic taste Avoid in renal disease, heart disease, hyponatremia or diuretic use Check creatinine and TFTs before starting

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8
Q

Carbamazepine

A

Anticonvulsants Indicated for bipolar I, esp. rapid cycling or mixed features

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9
Q

Valproic acid

A

Anticonvulsants Indicated for bipolar I, esp. rapid cycling or mixed features Avoid in liver disease Monitor for thrombocytopenia

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10
Q

Sertraline (Zoloft)

A

SSRI Good for atypical depression and MDD with psychotic features FDA approved for PTSD

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11
Q

Citalopram (Celexa)

A

SSRI FDA approved for MDD Good for depression in the elderly and for behavioral issues related to dementia Prolongs QTc

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12
Q

Prazosin

A

Alpha1-receptor antagonist Indicated for nightmares and hypervigilance a/w PTSD

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13
Q

Escitalopram (Lexapro)

A

SSRI Best tolerated SSRI FDA approved for MDD and GAD

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14
Q

Melatonin

A

Indicated for circadian rhythm sleep disorders

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15
Q

Pramipexole

A

Dopamine agonist Indicated for Parkinson disease and restless leg syndrome

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16
Q

Quetiapine (Seroquel)

A

Atypical antipsychotic SA: sedating Adjunct for depression

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17
Q

Modafinil

A

Nonamphetamine Indicated for narcolepsy

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18
Q

Risperidone

A

Atypical antipsychotic SA: hyperprolactinemia (sexual dysfunction, gynecomastia in men, amenorrhea, glactorrhea)

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19
Q

Aripiprazole (Abilify)

A

Atypical antipsychotic More weight neutral Good adjunct for depression SA: akathisia

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20
Q

Clozapine (Clozaril)

A

Atypical antipsychotic SA: agranulocytosis, seizures, myocarditis, orthostatic hypotension Very effective but reserved for patients who have failed at least 2 antipsychotic trials as need to regularly monitor CBC

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21
Q

Olanzapine

A

Atypical antipsychotic SA: weight gain

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22
Q

Paliperidone (Invega)

A

Atypical antipsychotic Metabolite of risperidone

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23
Q

Lurasidone (Latuda)

A

Atypical antipsychotic Adjunct for bipolar, minimal effect on QTc

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24
Q

Ziprasidone

A

Atypical antipsychotic SA: prolongs QTc Minimal effect on weight

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25
Q

Treatment for acute mania

A

Antipsychotics (quick onset) Lithium Valproate

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26
Q

Lamotrigine

A

Anticonvulsant Indicated for bipolar depressive episodes SA: Stevens-Johnson syndrome

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27
Q

Treatments for extrapyramidal symptoms

A

Acute dystonia –> benzotropine or diphenhydramine (IM)

Akathisia –> reduction of antipsychotic dose + beta-blocker or benzodiazepine

Parkinsonism –> benzotropine or amantadine

Tardive dyskinesia –> no definitely treatment but clozapine may help

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28
Q

Neuroleptic malignant syndrome

A

S&S: fever/hyperthermia, autonomic instability (tachycardia, labile BP, tachypnea, diaphoresis), muscle rigidity (lead-pipe), AMS, elevated CK

Causes: antipsychotics, antiemetics, antiparkinson medication withdrawal

Tx: stop the antipsychotic, supportive care (hydration, cooling), dantrolene or bromocriptine

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29
Q

Haloperidol

A

Typical antipsychotic, high potentcy SA: dystonia, akathisia, parkinsonism, tardive dyskinesia

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30
Q

Serotonin syndrome

A

S&S: autonomic instability, AMS, hyperreflexia, myoclonus, increased bowel sounds Tx: stop medication, benzos for clonus, CCB for HTN, cyproheptadine

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31
Q

Buspirone

A

Anxiolytic Indicated for generalized anxiety disorder

32
Q

Clomipramine

A

TCA (most serotonin selective) Can be used to treat obsessive-compulsive disorder but not first line

33
Q

Chlorpromazine

A

Typical antipsychotic

34
Q

Fluphenazine

A

Typical antipsychotic, high potentcy

35
Q

Perphenazine

A

Typical antipsychotic

36
Q

Atypical antipsychotics

A

Serotonin (5-HT2) and dopamine (D4 > D2) antagonists SA: HTN, hyperglycemia, weight gain, HLD

37
Q

What are the weight neutral atypical antipsychotics?

A

Aripiprazole Ziprasidone

38
Q

Which antipsychotics are good adjuncts for depression?

A

Aripiprazole Quetiapine

39
Q

Fluoxetine (Prozac)

A

SSRI Only SSRI FDA approved for bulimia Indicated for MDD, OCD, bulimia

40
Q

Alprazolam

A

Short-acting benzodiazepine Can cause seizures following abrupt discontinuation

41
Q

Paroxetine (Paxil)

A

SSRI FDA approved for PTSD Inhibits it’s own metabolism Short half-life –> requires taper

42
Q

Risk factors for obstructive sleep apnea

A

STOP BANG Snoring Tiredness during the day Observed apnea Pressure of blood BMI > 35 Age > 50 Neck circumference > 16 Gender of male

43
Q

Fluvoxamine (Luvox)

A

SSRI FDA approved for OCD and social phobia Interacts with nicotine

44
Q

Desvenlafaxine (Pristiq)

A

SNRI Active metabolite of venlafaxine

45
Q

Duloxetine (Cymbalta)

A

SNRI

46
Q

Serotonin discontinuation syndrome

A

S&S: dizziness, fatigue, headache, nausea, “electric like” shocks Highest risk is paroxetine

47
Q

What medication is contraindicated in eating disorders?

A

Bupropion because it lowers the seizure threshold

48
Q

Diagnostic tests for alcohol use disorder?

A

MCV –> macrocytosis GGT AST > ALT (not specific) Blood alcohol level (high levels without evidence of intoxication = tolerance) High HDL, low LDL (not specific)

49
Q

Buprenorphine

A

Opioid receptor partial agonist Used to treat opioid addiction

50
Q

Methadone

A

Opioid Used to help with opioid detox in people with opioid dependence

51
Q

Disulfiram

A

Inhibits aldehyde dehydrogenase –> patient feels ill if ethanol consumed Used to treat alcoholism in high-functioning alcoholics who desire long-term abstinence

52
Q

Treatment of catatonia

A

Benzodiazepines and/or ECT Avoid antipsychotics

53
Q

Lorazepam

A

Benzodiazepine

54
Q

Chlordiazepoxide

A

Very long-acting benzodiazepine Avoid in liver disease

55
Q

Bupropion

A

Norepinephrine and dopamine reuptake inhibitor (NDRI) Often added when partial response to SSRI or sexual side effects from SSRIs Can also aid in smoking cessation Avoid in patients with bulimia or seizures

56
Q

Nortryptyline

A

TCA

57
Q

Tranylcypromine

A

MAOI

58
Q

Flumazenil

A

Bensodiazepine antagonist Used to treat overdose

59
Q

Amitryptyline (Elavil)

A

TCA Most anticholinergic

60
Q

What medications are good for treating the depressed stage of bipolar disorder?

A

Atypical antipsychotics quetiapine and lurasidone

61
Q

Treatment for treatment-resistant or severe bipolar?

A

Lithium or valproate + atypial antipsychotic (quetiapine)

62
Q

Trazodone

A

Serotonin agonist and reuptake inhibitor Sedating SA: priapism

63
Q

Doxepin

A

TCA

64
Q

Imipramine

A

TCA

65
Q

Trimipramine

A

TCA

66
Q

Desipramine

A

TCA Least antichoinergic

67
Q

Isocaroxazid

A

MAOI

68
Q

Selegiline

A

MAOI

69
Q

Moclobemide

A

MAOI

70
Q

Pirlindole

A

MAOI

71
Q

Treating an MAOI-induced hypertensive crisis?

A

Stop medication, IV nitroprusside, clonidine

72
Q

In which psychiatric disorders is pharmacology the first line treatment?

A

ADHD

Schizophrenia

Bipolar disorder

73
Q

Neuroimaging findings in schizophrenia

A

Enlargement of lateral ventricles

Decreased volume of hippocampus and amgydala

74
Q

Treatment for social anxiety disorder

A

SSRI/SNRI

Cognitive-behavioral therapy

Beta-blocker, benzodiazepine for performance-only subtype

75
Q

How to treat specific phobias?

A

Cognitive-behavioral therapy with exposure

Short-acting benzodiazepines acutely if therapist unavailable or time limited

USMLE Step 2 CK (7 decks)

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