1
Q
Besides increased suicidal ideation, what are some additional early SE associated with SSRIs?
A
Insomnia, anxiety, and headache are common early side effects that patients may experience.
Sexual dysfunction is another common side effect
2
Q
What are the 2 BBW with clozapine?
A
agranulocytosis
myocarditis
3
Q
What is a rare but known SE of trazodone?
A
priapism
4
Q
What SSRI can cause QT prolongation?
A
citalopram and escitalopram
5
Q
What is the BBW when using atypical antipyschotics in geriatric population for dementia?
A
increased risk of mortality in older patients with dementia-related psychosis
6
Q
What 2 antipsychotics are associated with higher frequency of tardive dyskinesia?
A
risperidone and haloperidol
7
Q
What group has the highest suicide rate in the United States?
A
men aged 85 years and older
8
Q
What antiemetic medication is known to cause tardive dyskinesia?
A
metoclopramide
9
Q
What abx needs to be avoided on pts taking SSRIs, SNRIs, TCA?
A
linezolid
10
Q
What 2 atypical antipsychotics are the LEAST associated with weight gain?
A
aripiprazole and ziprasidone
least amount of weight gain
11
Q
_______ is the atypical antipsychotic least associated with increased dyslipidemia
A
aripiprazole
12
Q
What is the first line treatment for major depressive disorder with psychotic features?
A
an antidepressant plus an antipsychotic medication or electroconvulsive therapy, but pharmacotherapy is typically recommended for patients with mild to moderate disease
Studies show that sertraline in combination with olanzapine works more effectively
13
Q
Which of the following medications can be prescribed to assist in weight gain for a patient with anorexia nervosa?
A
Olanzapine
14
Q
What 2 electrolyte abnormalities are typically seen with Bulimia nervosa?
A
hypokalemia and metabolic alkalosis
15
Q
What 2 SSRIs are known for causing QT prolongation?
A
citalopram and escitalopram.
16
Q
Tics associated with ADHD may be treated with _____ or ______-.
A
clonidine
or
guanfacine
17
Q
______ is the medication of choice for patients with Tourette Syndrome and OCD
A
fluoxetine
18
Q
What are the selective norepinephrine reuptake inhibitors that can be used for treatment of attention-deficit/hyperactivity disorder?
A
Atomoxetine and viloxazine.
brand name: Strattera and Qelbree
19
Q
What are the two most common side effects of mirtazapine?
A
weight gain and sedation
20
Q
What is the mechanism of action of buspirone?
A
It affects the serotonergic system by blocking 5HT1A autoreceptors.
21
Q
What 2 antipsychotics SE are strongly associated with increased serum prolactin levels?
A
Risperidone and paliperidone
22
Q
What are the 2 SE of quetiapine?
A
sedation and hyperlipidemia
23
Q
What type of hallucinations are the most common type of hallucinations experienced by patients with schizophrenia?
A
auditory hallucinations
24
Q
What heart valve disease is associated with anorexia?
A
mitral valve prolapse
25
At what BMI should an anorexia nervosa patient be hospitalized for refeeding?
BMI under 14
26
What is typically the mood episode at the onset of bipolar disorder?
major depression
27
What 2 selective serotonin reuptake inhibitors are best to use in breastfeeding women?
paroxetine or sertraline
28
What is the MOA of varenicline?
Varenicline (Chantix) is a smoking cessation medication that agonizes and blocks nicotinic acetylcholine receptors. Varenicline stimulates dopamine activity to a smaller degree than nicotine does, resulting in decreased craving and withdrawal symptoms
29
What is frotteuristic disorder?
paraphilic disorder defined by recurrent and intense sexual arousal from touching or rubbing one’s genitals against a nonconsenting person.
30
What is yoyeuristic disorder?
is a paraphilic disorder characterized by recurrent and intense sexual arousal from observing an unsuspecting person who is naked, disrobing, or involved in sexual activity
31
What is exhibitionistic disorder?
is paraphilic disorder characterized by an individual becoming aroused from exposing their genitals to an unsuspecting person
32
What 2 personality disorders carry an increased risk for sucide?
borderline and antisocial
33
_____ and ____ must be present for a diagnosis of oppositional defiant disorder but are NOT necessary for a diagnosis of conduct disorder.
Irritability and anger
34
Which one of the following features of a major depressive disorder is most predictive of a positive response to electroconvulsive therapy?
psychotic
34
What are the 2 MC comorbid disorders likely to be present in a pt with ODD?
ADHD and bipolar
35
How is FNSD (Functional neurologic symptom disorder) distinguished from factitious disorder and malingering?
symptoms of FNSD are considered unintentionally produced
36
What is the difference between malingering and factitous disorder?
malingering -> s/sx are motivated by an external reward
factitious disorder -> s/sx are motivated by an underlying desire to play the role of the patient
37
_______ is an SSRI antidepressant primarily FDA-approved to treat obsessive-compulsive disorder (OCD) in adults and children (8+).
fluvoxamine (Luvox)
38
What is pagophagia?
is a specific type of pica defined as a craving for ice
39
What demographic is at greatest risk for completed suicide?
older men (>75 years old)
40
What anti-HTN medication should NOT be used in cocaine or amphetamine intoxication?
Beta- blockers
because of the risk for unopposed alpha-agonist stimulation
41
Which antidepressant medication can cause a false positive for amphetamines on a urine drug assay?
bupropion
42
What 3 SE should all pt on an atypical antipsychotic be monitored for?
weight gain
new-onset diabetes mellitus
hyperlipidemia
43
Typical antipsychotics (e.g., haloperidol, loxapine, thioridazine) generally alleviate only (positive/negative) symptoms and are usually more useful in situations of ????
typical antipsychotics are generally used to target POSITIVE symptoms
acute psychosis than long-term schizophrenia management.
44
What 2 typical antipsychotics are associated with an increased risk of retinopathy and should get regular ophthalmology exams?
chlorpromazine and thioridazine
45
What pregnancy category is clozapine?
cat B
46
What is the MOA of ondansetron?
It works centrally in the chemoreceptor trigger zone and peripherally in the gastrointestinal tract by **antagonizing serotonin 3 (5HT3) receptors**
47
Which BZD is preferred in alcoholic patients with liver failure?
lorazepam
48
What is the difference between a panic attack and panic disorder?
panic attacks occur when there is an intense, spontaneous fear along with cardiorespiratory, gastrointestinal, or neurologic changes of chest pain, shortness of breath, nausea, vomiting, dizziness, or headache. When an isolated episode of these changes occurs, it is considered a panic attack. **When there is fear of future attacks or a change in behavior in an attempt to try to prevent future attacks, it is then considered panic disorder**
49
In patients with anorexia nervosa what is the BMI cutoff for hospitalization?
BMI less than 15 is an indication for admission
50
In patients with anorexia nervosa, what are the orthostatic vitals indicated for admission?
An orthostatic increase in pulse of at least 20 bpm or decrease in systolic blood pressure of at least 20 mm Hg is considered unstable and is an indication for admission.
51
What medication should be monitored to identify low serum bicarbonate levels?
topiramate
52
Which drugs can be used for the treatment of bulimia nervosa in patients who cannot tolerate or do not respond to selective serotonin reuptake inhibitors?
Topiramate, tricyclic antidepressants, monoamine oxidase inhibitors, and trazodone.
53
What is the BBW of atomoxetine in children and adults?
increased risk of suicidal thoughts
54
Why should propranolol be avoided in the treatment of tachycardia resulting from serotonin syndrome?
The hypotensive effects are long-lasting and may mask treatment ineffectiveness
55
What is first line therapy for serotonin syndrome?
lorazepam 2mg IV q 4 hours
56
What is the MOA of flumazenil?
antagonist of GABA receptor
57
What timeframe is delirium tremens most likely to start?
48-96 hours after the patient's last alcoholic drink
58
To be diagnosed with antisocial personality disorder, the individual must be at least _____ years of age with evidence of conduct disorder before the age of ____ years.
18 years old
with conduct disorder before 15 years old
59
define persistent depressive disorder?
s defined by depressed mood for at **least 2 consecutive years** with at least two of the following symptoms: decreased or increased appetite, insomnia or hypersomnia, low energy or fatigue, low self-esteem, impaired concentration or decision making, and hopelessness.
60
What is the most efficacious treatment for severe major depression?
ECT
61
What stage of sleep comprises the largest percentage of total sleep time?
Stage N2 of NREM sleep
62
Which neurons are inhibited during rapid eye movement (REM) sleep resulting in atonia?
alpha motor neurons
63
Pt with panic disorder is most likely to have what other psych dx?
major depressive disorder
64
What are the BMI cutoffs for mild, moderate, severe and extreme anorexia nervosa?
mild: BMI >17
moderate: 16- 16.9
Severe: 15-15.9
Extreme: less than 15
65
What is first line treatment for delusional disorder?
antipsychotic medications (aripiprazole)
66
What is the timeframe associated with brief psychotic disorder?
is marked by hallucinations or delusions that last more than a day but less than a month.
67
What is the first line treatment for a severe manic episodes in patients with bipolar I?
combination of either lithium or valproate and an antipsychotic
68
What 2 things do you need to think about before prescribing valproate?
hepatotoxicity and pregnancy status??
need to preg test at the minimum but should avoid use in females of reproductive age
69
What 2 things do you need to think about when starting a pt on lithium?
known to cause a declined in kidney function over time
and known to cause hypothyroidism
70
What are the kidney monitoring requirements for lithium?
Patients who are treated with lithium should have their blood urea nitrogen and creatinine checked every 2 months for the first 6 months and then every 6–12 months thereafter.
71
What second gen antipsychotic is known to cause sedation and should be avoided in patient with schizoprenia who have a hx of substance abuse?
quetiapine
72
What 2 psych meds are known to cause neural tube defects?
carbamazepine
valproate
73
What 2 SSRIs are preferred in nursing mothers?
sertraline and paroxetine
74
What is the mechanism of action of methylphenidate?
blocks reuptake of dopamine and norephinephrine
75
What is the classic electrolyte abnormality associated with refeeding syndrome?
hypophosphatemia
76
What is the strongest predictor of future suicide?
hx of previous suicide attempt
77
what drug class is guanfacine and clonidine?
centrally acting alpha-2A adrenergic receptor agonist
78
Prenatal exposure to what agent is consistently associated with the development of attention-deficit/hyperactivity disorder?
nicotine
79
What is the MC type of delusional disorders?
persecutory
80
define circumstantiality
when the patient responds to a question in a roundabout way
81
What is the MOA of stimulants?
works by blocking the reuptake of norepinephrine and dopamine into presynaptic neurons
82
What is the BBW for stimulants?
abuse and dependence
83
When should fasting blood glucose be checked after starting second-gen antipsychotics?
Fasting blood glucose should be checked at the 6-week, 3-month, and 12-month marks after starting a second-generation antipsychotic and then annually.
84
What age is the MC for bipolar I to begin?
between 18 and 20 years old
85
What 4 serious SE are specific to clozapine?
myocarditis, cardiomyopathy, pulmonary embolism, and agranulocytosis
86
Which medication for treating bipolar disorder is associated with an increased risk of Ebstein anomaly following in utero exposure?
lithium
87
Which laboratory test is the most definitive in determining chronic alcohol use?
Phosphatidylethanol
88
What are the three clinical findings that comprise the triad associated with Wernicke encephalopathy?
Encephalopathy
oculomotor dysfunction
gait ataxia.
89
What is the first line treatment for malingering?
subtle confrontation
90
What is the medication used for pts who are withdrawing from cannabis and their symptoms begin to affect their work or school negatively?
dronabinol
gabapentin is an alternative option
91
Which antidepressant requires discontinuation for 5 weeks prior to initiating a monoamine oxidase inhibitor?
fluoxetine
92
What is the MOA for first gen antipsychotics?
Blockage of dopamine D2 receptors at the postsynaptic membrane
93
What is the The hallmark clinical tetrad of neuroleptic malignant syndrome?
mental status changes
rigidity
fever
dysautonomia
94
What is a classic PE finding in neuroleptic malignant syndrome?
lead pipe rigidity
95
What are 2 common lab findings associated with neuroleptic malignant syndrome?
elevated CK and leukocytosis
96
What illicit substance, metabolite benzoylecgonine.
cocaine
97
What are the 3 MOA of cocaine?
blocking the reuptake of biogenic amines, sodium channel blockade, and excitatory amino acid stimulation
98
What are the 3 biogenic amines?
dopamine
norepinephrine
epinephrine
99
What are the 5 As (must be in order) to eval someone to quit smoking?
ask
advise
assess
assist
arrange
100
How are schizoaffective disorder distinguished from schizophrenia?
by the presence of manic episodes or a significant depressive episode in addition to the symptoms listed above. Delusions or hallucinations must be present for at least 2 weeks during which a major mood episode is not present
101
What is the associated timeframe to dx schizoaffective disorder?
Diagnosis is made when two or more of the characteristic symptoms are present for at least 1 month and significant impairment is present for at least 6 months
102
What is the difference between schizoaffective disorder and schizophreniform disorder?
The total duration of the disorder is < 6 months and there is no mania associated with schizophreniform disorder.
103
What is the term for the creation of new, idiosyncratic words associated with schizoaffective disorder?
neologisms
104
What is the MOA of an amphetamine?
Increased release of catecholamines through inhibition of monoamine oxidase
105
What is the MOA of an antipsychotic?
Inhibition of dopamine receptors
106
What SSRI is more likely to cause sedation?
paroxetine
107
Which personality disorder is associated with anorexia nervosa?
obsessive compulsive personality disorder
108
What are the 3 categories of extrapyramidal symptoms?
akathisia
dystonia
parkinsonian syndromes.
109
What are the 2 SEs of bupropion that you should remember?
insomnia
and
psychomotor agitation
110
What are the 2 SEs you should remember about mirtazapine?
drowsiness and weight gain
111
Which anticonvulsant used as a mood stabilizer is associated with SJS and TEN?
carbamazepine
112
HLA-B*1502 allele, which occurs nearly exclusively in patients of Asian ancestry has a higher likelihood of SJS and TEN. What anticonvulsant used as a mood stablizer?
carbamazepine
113
Which SSRI has the longest half life?
fluoxetine
between 1-3 days
114
What is one of the drawbacks of flibanserin if it is used daily? What is it indicated for?
it cannot be taken within hours of drinking alcohol
female sexual interest/arousal disorder
115
Mood disorder questionnaire, is a SCREENING tool for what dx? Minimum age to use?
bipolar
12 years old and older
116
What area of the brain is likely responsible for OCD?
hyperactivity of the orbitofrontal cortex
117
What is the MOA of lysergic acid diethylamide (LSD)?
increased activity in serotonin receptors
118
What is the maintenance treatment range for lithium?
0.6-1.2 mEq/L
119
auditory hallucinations in schizophrenia are associated with _______(what part of the brain)?
decreased size of the temporal lobe
120
What is the MOA when consuming alcohol?
alcohol agonizes GABA receptors which causes central nervous system depression
121
What part of the brain is most closely associated with the rush of fear a pt feels when they are surrounded by their phobia trigger?
amygdala
amygdala is associated with fear and anxiety pathways
122
What comprehensive intelligence test would be most approperiate for evaluating the boy's intelligence and to assist with possible placement in special classes in school?
Stanford-Binet test
123
What are the diagnostic criteria different in ADHD for a pt who is less than 17 vs older than 17?
17 and younger: 6 symptoms of hyperactivity or inattentiveness
older than 17: 5 symptoms of hyperactivity or inattentiveness
6+ months and occur in more than 1 setting
124
question mentions drug intoxication and mentions vertical or horizontal nystagmus. What drug?
PCP intoxication
125
Why should propranolol be avoided in the treatment of tachycardia resulting from serotonin syndrome?
The hypotensive effects are long-lasting and may mask treatment ineffectiveness.
126
question mentions drug intoxication and mentions a music festival and drinking lots of water. What drug?
Ecstasy or MDMA
MDMA increases in serotonin, dopamine, norepinephrine and antidiuretic hormone
127
What is avolition?
a severe, persistent lack of motivation or willpower that makes it difficult to initiate or complete goal-directed activities, such as showering, working, or socializing. It is not laziness, but rather a symptom of mental health conditions like schizophrenia, depression, or bipolar disorder
aka a negative symptom
128
Define klismaphilia
arousal by introducing fluids into the rectum, such as enemas
129
What common peds illness is associated with sudden onset OCD in children?
recent strep infection
130
What is the MC neuroimaging finding in 2 year olds with autism?
increase in total brain volume
131
What is the major difference between acute stress disorder and PTSD?
acute stress: between 3 and 30 days (1 month)
PTSD: 1 month or more
132
Psilocybin is the active ingredient in what illicit drug?
mushrooms
133
What type of therapy is preferred for pt with autism?
applied behavioral analysis
134
What is the MOA of nicotine?
nicotine binds to nicotinic acetylcholine receptors which causes release of dopamine, but also norepi, serotonin, endorphins and acetylcholine
135
What is the MOA that is going on during an acute dystonic reaction?
The underlying mechanism involves an imbalance between dopaminergic and cholinergic neurotransmission in the basal ganglia. Dopamine receptor antagonism results in reduced dopamine activity, which disinhibits acetylcholine release, leading to excessive cholinergic activity and resulting motor symptoms.
136
What are 2 common SEs of bupropion?
insomnia or psychomotor agitation
137
What are 2 common SEs of mirtazapine?
drowsiness and weight gain
138
What 2 antipsychotics are known to cause increase prolactin?
risperidone and paliperidone
139
What personality disorder is MC in pts with anorexia nervosa?
obsessive-compulsive personality disorder
140
What is important to remember with regards to timeframe with acetaminophen overdose?
Risk of severe hepatotoxicity increases if the patient is not treated with N-acetylcysteine (NAC) within the **first 8 hours** after ingestion
An acetaminophen level and transaminases must be determined, but therapy should not be delayed while awaiting the results of the laboratory studies
141
What type of hallucinations are associated with attempted suicide?
command
142
PANCE prep
flashcards
Decks in class (32)
# Cards
-
MC90
-
Things I Want to Remember200
-
Cardio105
-
Heart Murmurs Sounds26
-
Pulm42
-
Things -part 257
-
Peds193
-
ER201
-
Derm28
-
MSK79
-
Endo26
-
EENT47
-
Women's Health129
-
Psych143
-
GI51
-
Hem41
-
Pulm3
-
Urology21
-
Nephro29
-
Neuro38
-
ER- Part 2191
-
Antibody, labs test, etc key associations79
-
High yield questions23
-
Surgery EOR101
-
Infectious Disease38
-
Surgery EOR part 2106
-
Surgery EOR part 329
-
Professionalism12
-
Preventative screening guidelines6
-
Internal Med EOR100
-
Cardio- Part 228
-
Peds - part 29
