Psychiatry Flashcards Preview

USMLE Step 2 CK > Psychiatry > Flashcards

Flashcards in Psychiatry Deck (75):
1

Selective serotonin reuptake inhibitors (SSRIs)

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)

2

Venlafaxine (Effexor)

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

3

Duloxetine (Cymbalta)

SNRI FDA approved for pain

4

Mirtazapine (Remeron)

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

5

Tricyclic antidepressants (TCAs)

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

6

Monoamine oxidase inhibitors (MAOIs)

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

7

Lithium

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

8

Carbamazepine

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

9

Valproic acid

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

10

Sertraline (Zoloft)

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

11

Citalopram (Celexa)

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

12

Prazosin

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

13

Escitalopram (Lexapro)

SSRI Best tolerated SSRI FDA approved for MDD and GAD

14

Melatonin

Indicated for circadian rhythm sleep disorders

15

Pramipexole

Dopamine agonist Indicated for Parkinson disease and restless leg syndrome

16

Quetiapine (Seroquel)

Atypical antipsychotic SA: sedating Adjunct for depression

17

Modafinil

Nonamphetamine Indicated for narcolepsy

18

Risperidone

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

19

Aripiprazole (Abilify)

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

20

Clozapine (Clozaril)

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

21

Olanzapine

Atypical antipsychotic SA: weight gain

22

Paliperidone (Invega)

Atypical antipsychotic Metabolite of risperidone

23

Lurasidone (Latuda)

Atypical antipsychotic Adjunct for bipolar, minimal effect on QTc

24

Ziprasidone

Atypical antipsychotic SA: prolongs QTc Minimal effect on weight

25

Treatment for acute mania

Antipsychotics (quick onset) Lithium Valproate

26

Lamotrigine

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

27

Treatments for extrapyramidal symptoms

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

28

Neuroleptic malignant syndrome

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

29

Haloperidol

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

30

Serotonin syndrome

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

31

Buspirone

Anxiolytic Indicated for generalized anxiety disorder

32

Clomipramine

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

33

Chlorpromazine

Typical antipsychotic

34

Fluphenazine

Typical antipsychotic, high potentcy

35

Perphenazine

Typical antipsychotic

36

Atypical antipsychotics

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

37

What are the weight neutral atypical antipsychotics?

Aripiprazole Ziprasidone

38

Which antipsychotics are good adjuncts for depression?

Aripiprazole Quetiapine

39

Fluoxetine (Prozac)

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

40

Alprazolam

Short-acting benzodiazepine Can cause seizures following abrupt discontinuation

41

Paroxetine (Paxil)

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

42

Risk factors for obstructive sleep apnea

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

43

Fluvoxamine (Luvox)

SSRI FDA approved for OCD and social phobia Interacts with nicotine

44

Desvenlafaxine (Pristiq)

SNRI Active metabolite of venlafaxine

45

Duloxetine (Cymbalta)

SNRI

46

Serotonin discontinuation syndrome

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

47

What medication is contraindicated in eating disorders?

Bupropion because it lowers the seizure threshold

48

Diagnostic tests for alcohol use disorder?

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

49

Buprenorphine

Opioid receptor partial agonist Used to treat opioid addiction

50

Methadone

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

51

Disulfiram

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

52

Treatment of catatonia

Benzodiazepines and/or ECT Avoid antipsychotics

53

Lorazepam

Benzodiazepine

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Chlordiazepoxide

Very long-acting benzodiazepine Avoid in liver disease

55

Bupropion

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

Nortryptyline

TCA

57

Tranylcypromine

MAOI

58

Flumazenil

Bensodiazepine antagonist Used to treat overdose

59

Amitryptyline (Elavil)

TCA Most anticholinergic

60

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

Atypical antipsychotics quetiapine and lurasidone

61

Treatment for treatment-resistant or severe bipolar?

Lithium or valproate + atypial antipsychotic (quetiapine)

62

Trazodone

Serotonin agonist and reuptake inhibitor Sedating SA: priapism

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Doxepin

TCA

64

Imipramine

TCA

65

Trimipramine

TCA

66

Desipramine

TCA Least antichoinergic

67

Isocaroxazid

MAOI

68

Selegiline

MAOI

69

Moclobemide

MAOI

70

Pirlindole

MAOI

71

Treating an MAOI-induced hypertensive crisis?

Stop medication, IV nitroprusside, clonidine

72

In which psychiatric disorders is pharmacology the first line treatment?

ADHD

Schizophrenia

Bipolar disorder

73

Neuroimaging findings in schizophrenia

Enlargement of lateral ventricles

Decreased volume of hippocampus and amgydala

74

Treatment for social anxiety disorder

SSRI/SNRI

Cognitive-behavioral therapy

Beta-blocker, benzodiazepine for performance-only subtype

75

How to treat specific phobias?

Cognitive-behavioral therapy with exposure

Short-acting benzodiazepines acutely if therapist unavailable or time limited