Pha 416 Exam 1 (Psychiatric)

Front 1

What is the Axis V?

Back 1

Global assessment of functioning

Front 2

What is a Delusion?

Back 2

fixed false beliefs that are not based in reality, religion, or culture

Front 3

What is an Obsession?

Back 3

unwanted thoughts, ideas, or impulses that intrude into a person’s thinking. (The patient knows that it is not true)

Front 4

What are Hallucinations?

Back 4

false sensory impressions or perceptions that occur in the absence of an external stimulus.

Front 5

What are Illusions?

Back 5

are visual perceptions that are misinterpreted, but have a real sensory stimulus.

Front 6

Define cluster A of personality disorder:

Back 6

paranoid, schizoid, and schizotypal (individuals seem odd or eccentric)

Front 7

Define cluster B of personality disorder:

Back 7

histrionic, narcissistic, antisocial, and borderline

Front 8

Define a borderline personality disorder:

Back 8

individuals are dramatic, erratic, and labile. They like to manipulate others and exhibit childlike attitudes. For the most they are self-cutters but no completely intentionally

Front 9

Define cluster C of personality disorder:

Back 9

– avoidant, dependent (on a person, place, thing. It becomes a problem once the crutch is gone), compulsive (individuals seem fearful, inhibited and anxious)

Front 10

CNS depressant drugs:

Back 10

Opioids (morphine, heroin, methadone)
Alcohol
Gamma hydroxybutyrate (day rape drug)
Sedative hypnotics (benzos, barbiturates)
Inhalants (gasoline, toluene)

Front 11

CNS stimulant drugs:

Back 11

Amphetamines – dextroamphetamine, methamphetamine
Methylphenidate
Cocaine
MDA, MDMA (Ecstasy)
Nicotine
Caffeine

Front 12

Hallucinogen drugs:

Back 12

LSD
Mescaline
Cannabis
PCP

Front 13

Alcohol pharmacotherapy for withdrawal:

Back 13

Benzos (Diazepam or Lorazepam)
Clonidine and BB (palpitations and HR)
Haloperidol (hallucinations, combative pts)
Phenytoin (prevent seizures)
Thiamine (vit. deficiency)
Gabapentine and topiramate (alt. to benzos)

Front 14

Alcohol aversive therapy

Back 14

Disulfiram

Naltrexone (opioid antagonist)

SSRIs??

Acamprosate (to reduce cravings)

Front 15

Antibiotics that cause a disulfiram-like reaction when taken with alcohol:

Back 15

Metronidazole (Flagyl)
Furazolidone (Furoxone)
Ketoconazole (Nizoral)
Cefamandole (IV)
Cefoperazone (IV)
Cefotetan (IV)
Moxalactam (IV)

Front 16

Opioids intoxication drug management:

Back 16

Naloxone (short half life)
Naltrexone (long acting opioids antagonist)
Nalmefene (long half life)

Front 17

Opioids with cross tolerance or partial agonism:

Back 17

clonidine not cross tolerant
Methadone – cross tolerance
Buprenorphine – partial opioid agonist

Front 18

Drugs that are CYP1A2 substrates:

Back 18

*amitriptyline, clomipramine, imipramine
*caffeine
*olanzapine (Zyprexa)
*clozapine
*cyclobenzaprine (Flexeril)
diazepam (minor pathway)
haloperidol
*theophylline
R-warfarin (less active isomer)
zileuton

Front 19

SIGECAPS for diagnose depression:

Back 19

Sleep
Interest
Guilt or worthlessness
Energy loss and fatigue
Concentration or decision making
Appetite and weight loss
Psychomotor agitation or retardation
Suicide or thoughts of death

Front 20

Most used SSRIs:

Back 20

fluoxetine

citalopram

paroxetine

sertraline

fluvoxamine

Front 21

Drugs with mixed serotonin effects:

Back 21

trazodone

nefazodone

Front 22

Mixed NE/DA Reuptake Inhibitors

Back 22

Bupropion

Front 23

Drugs with Mixed 5-HT/NE Effects:

Back 23

Mirtazapine

Front 24

MAOIs drugs

Back 24

Phenelzine

Tranylcypramine

others

Front 25

For how long a depressive patient should be treated in an attempt to avoid relapse?

Back 25

patient would be treat between 6-12mo after achieving remission (no depressive symptoms).

Front 26

For how long a depressive patient with recurrent events should be treated?

Back 26

It may require significant long treatment (more than 2yrs)

Front 27

Presentation of atypical depression:

Back 27

• gain a lot of weight
• they sleep a lot
• tendency to be quick in emotional responses
• lead pipe paralysis or heavy limb syndrome

Front 28

Treatment for atypical depression:

Back 28

MAOIs:
Phenelzine
Tranylcypromine

Selegiline transderma (Emsam) = very expensive

Front 29

Main line of txt for Depression with Psychotic Features:

Back 29

• Anti depressives are the main treatment
• Anti psychotic can be used for short time (max. 6 weeks)

Front 30

What could be add ons in the treat depression with psychotic features?

Back 30

aripiprazole
buspar
anti-thyroids meds
lithium
etc.

Front 31

Time frame of action of anti depressive meds:

Back 31

- Response approx. 4 weeks

- Once stabilized, txt is suggested for 6-9 months

recurrent or chronic depression may require 2 or more yrs to prevent relapses

Front 32

Considerations for the use of wellbutrin:

Back 32

not usually given after 4pm even in split doses due to stimulatory effects that interfere with sleep

Front 33

Considerations for the use of Remeron:

Back 33

usually taken at bedtime.

Front 34

SE of SSRIs:

Back 34

Insomnia (should be taken AM)
Weight changes
sedation
Sexual dysfunction
initial increased anxiety

Front 35

SE of wellbutrin:

Back 35

Agitation
Tremor
insomnia

Front 36

SE of effexor (SNRI):

Back 36

Agitation, Insomnia,
Sexual dysfunction
Increase in diastolic BP (avoid in pts with uncontrolled HTN)

Front 37

SE of Mirtazepine (Remeron):

Back 37

sedation, weight gain, dry mouth, constipation, increased appetite, orthostasis

Front 38

Serious SE of nefazodone (Serzone):

Back 38

Liver failure

Front 39

SSRI with the most potential of anticholinergic effects:

Back 39

Paroxetine (Paxil)

Front 40

SSRI with more GI distress (diarrhea) and insomnia (activation):

Back 40

Sertraline (zoloft)

Front 41

Short acting SSRIs that require tapering for discontinuation:

Back 41

Paroxetine
sertraline
citalopram

venlafaxine (SNRI)

Front 42

Signs of discontinuation syndrome:

Back 42

vivid dreams
nightmares
tremor
dizziness
crying spells
nausea and
poor concentration

Front 43

MoA of wellbutrin

Back 43

- antidepressant effect primarily through inhibition of NE and DA reuptake with no direct effect on serotonin

Front 44

What SE is lesser and what is higher with the use of wellbutrin?

Back 44

Lesser: Sexual dysfunction

Higher: Seizure potential (dose dependent)

Front 45

What patients should avoid using wellbutrin?

Back 45

o should be avoided in patients with a pre-existing seizure condition, bulimia or anorexia nervosa, or alcohol withdrawal

Front 46

What side effect is seen at low doses of Mirtazepine?

Back 46

Increased sedation

Front 47

what pts may specially benefit from the use of mirtazapine?

Back 47

- patients with a decreased appetite or body weight

Front 48

Mirtazapine has the potential to increase and dysregulate...

Back 48

Increase: total cholesterol and triglycerides

Dysregulate: glucose

Front 49

Typical SE of TCAs:

Back 49

anticholinergic

antihistamine (sedation = HS)

hypotensive effects

Decrease in the seizure threshold

Front 50

TCAs should be avoid in patients with...

Back 50

Suicide history or ideation

Front 51

Bipolar diagnose:

Back 51

• Distract
• Insomnia: not sleeping for several days
• Grandiosity
• Flight of ideas (easy to confused with psychosis)
• Activities: not done under normal circumstances.
• Speech (very rapid)
• Thoughtlessness “Risk taking” not thinking on consequences.

Front 52

Treatment options for Bipolar disorders:

Back 52

Lithium (bipolar I and mixed) - fast response

Valproic Acid (Mixed bipolar and others)

Carbamazepine (bipolar I, II, and mixed)

Front 53

Adverse effects of lithium:

Back 53

- GI and weight gain
- thirst and urination
- Neurological = slows down
- hypothyroidism
- Leucosytosis - Increase WBC by 30-45%
- exacerbation of psoriasis - it is CI in pts with psoriasis
- Cardiovascular

Front 54

What signs of lithium toxicity are seen at <1.5mWq/L?

Back 54

- Fine hand tremor
- GI upset: N/V, diarrhea, anorexia
- Mild polyuria, polydipsia
- Muscle weakness

Front 55

What signs of lithium toxicity are seen at 1.5-2.5mEq/L?

Back 55

- Course tremor, twitching
- GI upset
- Slurred speech, vertigo
- Confusion, sedation
- Lethargy, hyperreflexia

Front 56

What signs of lithium toxicity are seen at <2.5mEq/L?

Back 56

- Seizures
- Stupor
- Coma
- Cardiovascular collapse
- Death

Front 57

DDI of lithium?

Back 57

Diuretics (loops are OK)

NSAIDs

Theophylline (reduce lithium plasma levels and increase tremors)

Front 58

Lithium contraindications:

Back 58

- Psoriasis
- Significant renal disease
- Immune issues (high WBC count)
- 1st trimester of pregnancy

Front 59

Adverse effects of Valproic Acid:

Back 59

GI: specially weight gain
SEDATION
Thrombocytopenia
Neurologic: lethargy, sedation, reversible dementia, tremor.
Liver dysfunction
Menstrual disturbances
hair loss

Front 60

How to prevent hair loss caused by Valproic Acid?

Back 60

use zinc and selenium orally supplements (better to start early or before treatment)

Front 61

What drugs increase Valproic Acid levels?:

Back 61

Cimetidine
Erythromycin
phenothiazides
gluvoxamine
SSRIs
Aspirin
NSAIDs
Lamotrigine

Front 62

What drugs decrease Valproic Acid levels?

Back 62

Rifampin
Carbamazepine
Phenobarbital

Front 63

What two mood stabilizers cannot be used together due to risk of toxicity?

Back 63

Valproic Acid and Lamotrigine (Seizures and Severe skin rash reaction )

Front 64

Contraindications for Valproic Acid:

Back 64

• Pre existing liver disease
• Heavy drinkers or have cirrhosis
• Platelets and WBC problems
- First trimester of pregnancy

Front 65

Loading dose calculation of valproic acid:

Back 65

weight in lbs + zero = round to dosage form.
i.e. = 150lbs = 1500mg

Front 66

Response rate of Carbamazepine:

Back 66

Slow: 5-7 days due to titration of dose

Front 67

Major AE of carbamazepine:

Back 67

Hemotologic:
- Aplastic anemia
- agranulocytosis
- thrombocytopenia
- leucopenia

Front 68

Other Mood stabilizers:

Back 68

Gabapentin (probably not effective)
Lamotrigine (useful for maintenance of disease)
- Topiramate
- Oxcarbazepine (causes hyponatremia)
- Antispyschotics: seroquel, zyprexa, risperdal.

Front 69

Signs of carbamazepine toxicity:

Back 69

Ataxia
Seizure
Coma

Front 70

SE of carbamazepine:

Back 70

CNS: dizziness, drowsiness, blurry or double vision, and confusion.
Increases in LFT's
Potential rash

Front 71

Most widely used medications to treat anxiety:

Back 71

Benzodiazepine: lorazepam, diazepam, clonazepam, alprazolam

Front 72

Advantages of benzos over non-benzos (barbiturates and meprobamate) to treat anxiety:

Back 72

– lower fatalities due to overdose, toxicities
- better side effect profiles
- lower abuse potential
- less drug-drug interactions.

Front 73

The four effects of benzos are:

Back 73

Anxiolytics

Anticonvulsants

Muscle relaxants

Sedative Hypnotics

Front 74

MoA of Buspirone to treat anxiety:

Back 74

doesn’t bind to benzodiazepine receptors or interact with GABA – works as a partial agonist of serotonin type 1A receptor (binds to receptor but works poorer than a full agonist)

Front 75

How long takes buspirone to work?

Back 75

6 weeks
(Patients need to be educated on this)

Front 76

Antidepressants in the treatment of anxiety:

Back 76

TCAs, SSRIs, and MAOIs

They can make feel worse before starting to help (up to 4 weeks)

Front 77

Beta blocker in the treatment of anxiety

Back 77

Add on med.

Work on the physical response of the fight or flight reaction to fear.

Propranolol

Front 78

Clonidine in the treatment of anxiety:

Back 78

decreases noradrenergic activity

side effects include: dry mouth, drowsiness, dizziness, nausea and hypotension, very sedating

Front 79

What antihistamines are used in the treatment of anxiety?

Back 79

hydroxyzine and diphenhydramine

Not first line txt

Anticholinergic SE

Not used for long period of time.

Front 80

Primary drug treatment of anxiety:

Back 80

Benzodiazepines

Buspirone

Front 81

Counseling point in the use of benzos:

Back 81

Sedation
Cognitive impairment
anterograde amnesia
paradoxical effect

Front 82

In what type of patients is buspirone a particular good option?

Back 82

for those with drug abuse history or potential

Front 83

Drugs most effective in the txt of Panic Disorder:

Back 83

SSRIs
Benzos
TCAs
MAOIs

Front 84

Target symptoms of panic disorder:

Back 84

chest pain, SOB, dizziness, abdominal distress, and depersonalization

Front 85

Benzos in the txt of panic disorder:

Back 85

- rapid onset of action
- better tolerated than TCAs
- Higher doses than in the txt of GAD
- Longer acting agent (clonazepam) used for break through anxiety.

Front 86

Duration of treatment of benzos in panic disorder:

Back 86

6-12 months beyond acute stabilization

Front 87

Antidepressants in the txt of panic disorder:

Back 87

- Activation syndrome (they are stimulants)
- May need benzos adjuctively for the first few weeks
- It may take 12 weeks to see positive results.

Front 88

Drugs to treat phobic disorders:

Back 88

- MAOI and SSRIs to treat chronic condition)
- Benzos for incidental situations
- Beta blockers for incidental situations (test dose may be necessary)

Front 89

What is the only TCA effective in OCD?

Back 89

Clomipramine:
- LFTs on baseline
- long half life (QD after titration)

Front 90

SSRIs in treatment of OCD:

Back 90

higher doses than used to treat depression.
Use the lowest effective dose.
high relapse rate off drug

Front 91

What antiadrenergics are used in PTSD treatment?

Back 91

Prazosin for vivid dreams and flash back or re-experiencing

Front 92

What drugs have FDA indication for PTSD:

Back 92

SSRIs

Front 93

Why benzos are not used in the treatment of PTSD?

Back 93

due to use of other substances with addiction potential

Front 94

What off label drugs are useful in the treatment of PTSD?

Back 94

antisychotics

Front 95

TCAs drugs:

Back 95

Clomiprmine
Desipramine
Imipramine

Front 96

Non-drug treatment for anorexia nervosa:

Back 96

Nutritional counseling
Behavioral management
Set eating and weight gain goals
Cognitive-behavioral therapy
Interpersonal psychotherapy
Group and family therapy

Front 97

What SSRI is the most studied in the treatment of AN?

Back 97

Fluoxetine
(higher doses necessary)

Front 98

What exam is required at baseline when TCAs are used to treat AN?

Back 98

ECG due to risk for arrhythmias

Front 99

Miscellaneous agents in the txt of AN:

Back 99

Metoclopramide (for gastric emptying)
Short acting benzos (risk of abuse)
estrogen replacement
TPN (very challenging - last resort)

Front 100

What personality disorders have increased incidence in BN pts?

Back 100

dependence
border line personality
kleptomania

Front 101

Role of antidepressants in BN:

Back 101

reduce binge eating, vomiting, anxiety, obsessions, impulsivity, and depression and improve eating habits

Front 102

What drug treatment for BN requires restriction of calorie intake?

Back 102

Phenelzine (MAOI)

Front 103

First line treatment for BN:

Back 103

SSRIs
(require prior evaluation for medical conditions, electrolyte disturbances, and seizure potential).

Front 104

Close to ideal hypnotic drugs for sleep disorders:

Back 104

Benzos

Zolpidem

Front 105

Antidepressants to treat insomnia:

Back 105

Amitriptyline (TCA)
doxepin (TCA)
trazadone

Front 106

Zolpidem to treat insomnia:

Back 106

- as effective as benzos
- Little effect on sleep stages
- No next day psychomotor SE

Front 107

Zaleplon to treat insomnia:

Back 107

Rapid onset
duration of action: 2-5 hrs
No significant SE

Front 108

Eszopiclone (lunesta) to treat insomnia:

Back 108

- No time limit for treatment
- helps fall asleep and maintain sleep
- Schedule IV prescription med.

Front 109

Possible SE of Zaleplon, Eszopiclone, and Zolpidem:

Back 109

Sleep walking, driving, or other activities while asleep

Front 110

Ramelteon (Rozerem) for the treatment of insomnia:

Back 110

- Only useful to induce sleep

Front 111

Adverse effects of Ramelteon (Rozerem):

Back 111

Somnolence
dizziness
fatigue
decreased testosterone levels
and
increased prolactin levels

Front 112

Characteristics of Benzos for insomnia treatment:

Back 112

- help onset sleep and increase total sleep time.
- Affect stages of sleep (not useful for sleep problem)
- Side effects: performance impairment, daytime sedation
- use lowest possible dose and for the shortest possible time

Front 113

What benzos have indications for sleep problems?

Back 113

estazolam, flurazepam, quazepam, temazepam, triazolam (short acting).

Front 114

Pharmacological therapy for sleep apnea:

Back 114

- Avoid all CNS depressants
- Protriptyline (TCA) is useful but anticholinergic SEs are problematic.
- Fluoxetine
- Theophylline
- Clonidine

Front 115

Drug treatment for cataplexy related to narcolepsy:

Back 115

antidepressants
Modafinil
TCAs
Sodium oxybate (Xyrem) = active ingredient is Gamma-hydroxybutyrate (GHB)

Front 116

Drugs to treat Restless leg syndrome:

Back 116

- Ropinirole (AE: somnlence, hypotension, dizziness, fatigue, hallucinations, etc.)

- Pramipexole dihydrochloride (mirapex) (similar SE)

Front 117

Drugs to treat nocturnal myoclonus:

Back 117

clonazepam
baclofen
opiates
lamotrigine
levodopa or dopamine agonist if severe

Front 118

What dopamine receptors correlate with antpsychotic efficacy?

Back 118

D1 and D2
D1 probably modulate intensity

Front 119

What dopamine receptor produced antipsychotic induced movement disorders?

Back 119

D2

Front 120

Where do atypical antipsychotics affect dopamine receptors?

Back 120

In the limbic system (emotion)

Front 121

Where do the typical antipsychotic agent work?

Back 121

In the basal ganglia (movement)

Front 122

What are the positive symptoms of schizophrenia?

Back 122

hallucinations
delusions
thought disorder
combativeness
hostility

Front 123

What are the negative effects of schizophrenia?

Back 123

social and emotional withdrawal
apathy
blunted affect
poor insight and judgment

Front 124

Drugs with depot formulations in the treatment of Schizophrenia:

Back 124

fluphenazine, haloperidol, and risperidone (atypical), olanzapine.

Front 125

Treatment of pseudoparkinsonism due to antipsychotics:

Back 125

- reduce dose of Antipsychotic(s), add
- anticholinergics (benzatropine or dyphenhydramine)

Front 126

Use of anticholinergics to treat SE of antispychotics:

Back 126

- Short term (3 mo)
- Reduce dose or discontinue if symptoms disappear
- Be aware of SE

Front 127

What symptom of dystonia is especially serious for the risk of death?

Back 127

Laryngospasm

Front 128

Treatment of dystonias cause for antipsychotic use:

Back 128

diphenhydramine IV

Benztropin IV

Front 129

Symptoms of akathesia:

Back 129

restlessness, agitation, pacing, tapping feet, shifting of legs, subjective feeling of being “driven to move” (I have to move to feel better).

Front 130

What drugs besides antipsychotic can cause akathesias?

Back 130

SSRIs

Front 131

Treatment of akathesias:

Back 131

- lower the antipsychotic dose
- switch antipsychotics
- anticholinergics are NOT very useful
- Benzos maybe helpful

Front 132

Cardinal features of neuroleptic malignant syndrome:

Back 132

Muscular rigidity
Hyperthermia as high as 41C or 106F
Rigidity

Front 133

Drugs useful to treat NMS:

Back 133

amantadine 100-200mg po bid or tid or
bromocriptine po 2.5-15mg tid
- Anticholinergics for rigidity
- Dantrolin - muscle relaxant - Check LFTs

Front 134

Symptoms of tardive dyskinesias:

Back 134

facial tics, blinking, grimacing; tongue – chewing, protrusion, tremor, writhing; lips – smacking, pursing, puckering; neck and trunk – torsion and torticollis; limbs – toe tapping, pill rolling, and writhing

Front 135

What antipsychotic has a low risk to generate tardive dyskenesias?

Back 135

Clozapine

Front 136

Treatment for tardive dyskinesias:

Back 136

- Prevention: antipsychotic smallest effective dose.
- Try anticholinergics, clonidine,BB, and benzos BUT they are not very useful

Front 137

How to treat agranulocytosis generated by antipsychotic use?

Back 137

- Prevention: blood tests
- WBC below 3000 or absolute neutrophil count below 1500 grant discontinuation of drug.
- Clozapine (not routinely used as Antipsychotic but it's effective)

Front 138

Treatment of Amenorrhea and Galactorrhea due to antipsychotic use:

Back 138

Bromocriptine
or
amantadine

Front 139

What antipsychotic medications are less likely to cause amenorrhea or galactorrhea?

Back 139

Olanzapine

Clozapine

Front 140

Psychogenic polydipsia: self induced water intoxication. How to treat:

Back 140

- restrict water intake
- demeclocycline 600 mg po bid

Front 141

What antipsychotic possess the highest risk for seizures?

Back 141

Clozapine
(anticonvulsants can be used to manages the SE)

Front 142

What antipsychotic is less likely to lower the seizure threshold?

Back 142

Haloperidol

Front 143

Clozapine (Clozaril) uses:

Back 143

- For refractory to at least 2 trails of other antipsychotics.
-5 black box warnings

Front 144

Black box warnings of clozapine:

Back 144

agranulocytosis
seizures
myocarditis,
other cardiovascular and respiratory side effects
and dementia related death

Front 145

Risperdal SE:

Back 145

- Atypical antipsychotic
- SE: hyperprolactinemia
- - may induce orthostatic hypotension which presents as dizziness, reflex tachycardia and possibly syncope

Front 146

Paliperidone (Invenga) dosage considerations:

Back 146

- • It should be take it in the AM because GI motility greatly affect its absorption

- possess more risk to prolatenemia than risperidone

Front 147

Olanzepine (Zyprexa) SE:

Back 147

- high level of sedation (has to be given HS)

- Very significant weight gain (appetite is greatly increase)

- also increases trig and glucose levels

Front 148

Antipsychotic meds with high sedation profiles:

Back 148

Clozapine

Olanzepine

Quetiapine (Seroquel)

Front 149

Dosage consideration for ziprasidone (geodon):

Back 149

- Should be taken with foods

- Avoid in pts with significant cardiovascular illness.

Front 150

Aripiprazole most significant SE:

Back 150

Insomnia (activation)

least likely to cause weight gain

Front 151

What is the most difficult SE of iloperidone (Fanapt):

Back 151

Orthostatic hypotension (compared with risperidone)

- It requires 21 days titration to optimal dose

Front 152

List the Atypical Antipsychotic drugs:

Back 152

Clozapine
Risperidone
Olanzapine
Quetiapine
Ziprasidone
Aripiprazole

Front 153

List of typical antipsychotic drugs:

Back 153

Chlorpromazine
thioridazine
mesoridazine
fluphenazine
trifluoperazine
perphenazine
thiothixene
haloperidol
loxapine
molindone
pimozide

Front 154

Most significant SE of thioridazine:

Back 154

Anticholinergic SE

Orthostatic hypotension

Front 155

Most significant SE of haloperidol?

Back 155

EPSE

Front 156

What type of receptor are block by the typical antipsychotic meds?

Back 156

Dopaminergic (SE positive symptoms of Schizophrenia)

histamine type 1 (SE = sedation and weight gain)

cholinergic muscarinic type 1 (SE = anticholinergic)

Front 157

What typical antipsychotic drugs are associated with more weight gain?

Back 157

Low potency agents:
- chlorpromazine
- thioridazine

Front 158

What is the typical antipsychotic associated with least weight gain?

Back 158

Molidone

Front 159

SE associated with low potency antipsychotics:

Back 159

Anticholinergic

Weight gain

Sedation

Front 160

What typical antipsychotic have black box warnings for arrhythmias?

Back 160

thioridazine

mesoridazine

Front 161

What typical antipsychotics are associated with EPSE?

Back 161

High potency:
Haloperidol
fluphenazine

Front 162

Onset of acute dystonias due to typical antipsychotics:

Back 162

Few hours to 1 month

Front 163

Onset of akathisia due to typical antipsychotics:

Back 163

Days to weeks

Front 164

Onset of pseudoparkinsonism due to typical antipsychotics:

Back 164

1 - 3 months

Front 165

Onset of Tardive dyskinesia due to typical antipsychotics:

Back 165

1 year or longer

Front 166

SSRIs and antipsychotic combinations increases...

Back 166

Akathisias

risk for suicide

Front 167

NMS symptoms due to typical antipsychotic use are:

Back 167

fever, extreme rigidity, autonomic instability, altered consciousness, and elevated creatinine kinase activity

Front 168

What low potency typical antipsychotic does not lowers the seizure threshold?

Back 168

Thioridazine

Front 169

atypical antipsychotic with indications for Major Depressive Disorder:

Back 169

Aripiprazole

Olanzapine

Quetiapine

Front 170

Atypical antipsychotic with highest degree of EPSE:

Back 170

Asenapine

Paliperidone

Risperidone

Front 171

Psychotic thinking can be generated by:

Back 171

- Levodopa therapy in pts with Parkinson's Disease.

- Use of CNS stimulants: i.e. Methyphenidate and amphetamines

- Zchizophrenia

Front 172

If no patient specific issues, what atypical antipsychotic are currently more cost effective?

Back 172

Quetiapine and risperidone (over olanzapine)

Front 173

What atypical antipsychotics are considered after quetiapine or risperidone have not worked?

Back 173

Olanzapine

Ziprasidone

Clozapine

Front 174

Antipsychotics that induce significant weight gain:

Back 174

Chlorpromazine

Clozapine

Olanzapine

Front 175

What antipsychotic have injectable dosage forms?

Back 175

Ziprasidone

Olanzapine

Risperidone (long active)

Front 176

Cognitive deficits associated wtih dementia:

Back 176

Memory loss
Dysphasia
Dyspraxia
Disorientation
Impaired calculation
Impaired judgment and problem solving skills

Front 177

Cholinesterase Inhibitors used for dementia:

Back 177

Tacrine
Donepezil
Rivastigmine
Galantamine

Front 178

NMDA receptor antagonist used for dementia

Back 178

Memantine (Namenda)

Front 179

Time frame for improvements for agents used for dementia:

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6 -8 weeks

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MoA of memantine

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It decreases the effects of glutamate

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Common causes of delirium

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• Metabolic disturbances
• Infections
• Recent addition or withdrawal of medication or alcohol
• Anticholinergic medications
• Antihypertensives, narcotics, sedative-hypnotics, antibiotics
• Digoxin, furosemide, cimetidine, ranitidine, corticosteroids, theophylline

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Symptoms of ADHD:

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Hyperactivity/Impulsivity
Inattention

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Diagnostic critira for ADHD:

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Before age 7
For 6 months or more
In > 2 settings

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Stimulants used in ADHD treatment:

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Methylphenidate (Ritalin, Concerta, Methylin, etc)
Dexmethylphenidate (Focalin)
Mixed amphetamine salts (Adderall)
Dextroamphetamine (Dexedrine)
Lisdexamphetamine (Vyvanse)
Methamphetamine (Desoxyn)

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Immediate release stimulant products for ADHD:

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Ritalin
Adderall (up to 12 hrs effect duration)
Desoxyn

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ADHD agent with "smoother" effect:

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Dexmethylphenidate
- Less insomnia
- Less rebound
- Fewer “ups and downs”

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Extended release products for ADHD:

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Methyphenidate:
- Ritaline SR
- Metadate ER and CD
- Concerta (OROS delivery sys)
- Adderall XR

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AE of ADHD meds:

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Decreased appetite
Decreased growth
Insomnia: it may required a small dose at HS
Rebound
SUDDEN CARDIAC DEATH

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Selective norepinephrine uptake inhibitor used for ADHD txt:

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Atomoxetine (Stratterra)
(1st line agent with stimulants)

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SE of atomoxetine:

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Liver toxicity
Suicide

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Selective alpha 2a agonist used in ADHD txt:

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Guanfacine (Intuniv)

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CNS arousal agent used to treat ADHD

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Modafinil (Provigil)
(also indicated for narcolepsy)

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Second line agents for ADHD:

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Bupropion
Venlafaxine
Clonidine (used if insomnia occurs)

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MoA of Methylphenidate

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Increases dopamine levels