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PCTExam2
| Question | Answer |
|---|---|
| sudden and significant decline from a pervious level of cognitive functioning often associated with sleep disturbances, psychomotor activity, emotional lability, nonspecific neurological abnormalities | delirium |
| 3 types of delirium | hypoactive, hyperactive, & mixed |
| what is the most common type of delirium in older hospital patients? | mixed |
| most potent benzo | xanax |
| why would you want to limit amount of benzos at night to avoid delirium? | doesn't allow you to get to REM sleep |
| what drug is being used more in prevention of delirium and causes sedation (rather than benzo)? | dexmedetomidine |
| treatment of delirium is the same as what? | schizophrenia (except eventually, after find cause, can remove) |
| dexmedetomide works how? benefits? | alpha blocker in CNS (cousin of clonodine); opioid sparing & no respiratory depression |
| chronically depressed mood for at least 2 years | dysthymic disorder |
| symptoms of depression | SIGECAPS (suicidal ideation, interest (lack of), guilt, energy, concentration, appetite, psychomotor agitation or retardation, sleep |
| 5 R's in treatment goals of depression | response, relapse, remission, recovery, recurrence |
| relapse of depression occurs during what time frame? | 6-12 weeks |
| 4 disease states often associated with depression? | hypothyroidism, chronic pain, cancer, hiv |
| 4 "other" treatment options for depression | psychotherapy, ECT, VNS, TMS |
| 1st line tx option in depression? why? | SSRI; easy to take, benign SE profile, effective, non-toxic |
| adequate trial of antidepressant | 3 months |
| what can SSRI initiation do to patient with anxiety? | increase severity of anxiety - start low (also during dose changes) |
| at dose lower than 20mg of venlafaxine what does it act like? | SSRI |
| why is SSRI a better choice over TCA in reference to suicidal patients? | TCA OD can be fatal |
| what is trazodone mostly used for? | insomnia at less than antidepressant dose (<300mg) |
| what BBW does nefazodone have? | liver failure |
| what severe side effect can trazodone have that is a medical emergency? what could it cause? | priapism; impotence |
| what type of foods should you avoid while taking MAOi? | tyramine containing foods |
| selegiline patch avoids what that PO version doesn't? | first pass; tyramine avoidance should only be done in high doses (>9) |
| mental state in which perception of reality is distorted | psychosis |
| chronic disorder of thought and affect with significant disturbance in interpersonal relationships and ability to function in society on a daily basis | schizophrenia |
| onset of schizophrenia usually occurs when? | adolescence - early adulthood (usually earlier in males) |
| what type of symptoms are abnormal behaviors? what type of symptoms are absence of normal behaviors? | positive; negative |
| what 3 types of symptoms are associated with schizophrenia? | positive, negative, and cognitive |
| what are the hardest symptoms to treat in schizophrenia? | delusions |
| what is the most important factor in schizophrenia treatment? | compliance |
| what DA pathway, when blocked, is associated with EPS side effects? | Nigrostriatal |
| what DA pathway, when blocked. is associated with relief of positive symptoms? | mesolimbic |
| what DA pathway, when blocked, is associated with increased blunting of emotions (increased negative symptoms)? | mesocortical |
| what DA pathway, when blocked, is associated with increased prolactin concentration? | tuberoinfundibular |
| 3 antidepressants that inhibit 2D6 (which most what get metabolized?) | wellbutrin, paxil, and prozac; antipsychotics |
| what do we tx akathisia with? | propranolol |
| what do we tx dystonia with? | benztopine and diphenyhadramine |
| depot AP take how long to reach SS? | 3-4 months |
| 3 AP with BBW about QT prolongation? | thioridazine, mesoridazine, and droperidol |
| which depot AP is associated with a dose-dumping effect? | fluphenazine |
| what can cause neuroleptic malignant syndrome? | AP |
| why do second generation AP not have EPS? | more 5-HT actions |
| what 2 AP have the lowest risk of EPS/TD? why? | clozapine & quitapine; they are loosely bound to DA receptors in nigralstriatal pathway |
| serious, non-dose related risks with clozapine? | agranulocytosis and myocarditis |
| what is a reason a patient discharged from inpatient may decompensate while on clozapine? | smoking again - induces 1A2 |
| what drug is FDA approved for prevention of re-emergent suicide events? | clozapine |
| "most typical atypical" | risperidone |
| second generation AP that has the highest risk of EPS (OF 2ND GEN. - STILL LOWER THAN ALL 1ST) | risperidone |
| risperidone may enhance anti-HTN due to what? | a1 blockade |
| if a AP has a high risk of EPS it has a low risk of what type of SE? | anticholinergic |
| worst second generation AP associated with wt gain, hyperglycemia, new onset DM & DKA? | olanzapine |
| if you have to use AP in Parkinson's what would you chose? | clozapine or quetiapine (low doses) |
| ziprasidone must be taken how? shouldn't be given to who? | w/ at least 500 calories; patients with eating disorders |
| DA-5-HT System Stabilizer (works as Antag in hyper-DA areas, and Agonist in hypo-DA areas)? | Aripiprazole |
| "ants in your pants" | akathesia |
| what is the main problem with aripiprazole? | akathesia |
| problems with second generation | increased risk of DM, hyperlipidemia |
| in CATIE trial, what was the drug with the longest time to D/C | olanazapine |
| in CATIE trial, what was the % D/C | 74 |
| in CATIE trial, what FGA was used? what did it show? | perphenazine (medium-potency); no worse for EPS |
| chronic episodic disorder | bipolar |
| type I BP? type II BP? | full mania; hypomania |
| more episodes of mania/hypomania experienced, more likely that patient will be what? | refractory to tx |
| what is the key with BP tx? | prevention of episodes |
| role that AP play in BP | maintenance & acute tx |
| during mania how long does it take medications to work? | very fast |
| 3 most commonly used mood stabilizers | lithium, depakote, & tegratol |
| mix between schizophrenia and depression | schizoaffective disorder |
| at least 2 years of numerous periods of hypomania symptoms and depressive symptoms | cyclothymic disorder |
| 3 or more symptoms of major depressionduring a full manic or hypomanic episode | mixed mania |
| at least 4 episodes of a mood disturbance within a 12 month period (difficult to tx) | rapid cycling |
| when would you chose depakote over lithium 1st line in BP? | rapid or mixed or renal disease |
| how long does it take lithium to get to SS? | 5 days |
| lithium inhibits synthesis and peripheral conversion of what? | T3/T4 |
| lithium may cause an autoimmune reaction due to what? | antithyroglobulin antibodies |
| lithium levels should be higher or lower in manic episode? | higher |
| depakote can do what to lamictal? | increase level by up to 60% |
| what is lamictal's role in BP? | helps in prevention of future depressive episodes, not useful in acute episodes - may start during acute to get in system (Most useful in BPII) |
| what should never be used long term in BP? | antidepressants |
| which medication useful in prevention of BP episodes must be titrated really really slowly to avoid stevens-johnson syndrome | lamictal |
| only time carbamazepine should be used in BP | if patient can't tolerate carbamazepine |
| AP used in BP at a counter for wt gain | topamax |
| what 2 AP have data in monotherapy? | olanzapine and aripiprazole |
| when should you consider changing maintenance medication in BP? | if pt has a stressor that brought on episode- don't change if you increase dose and it clears episode don't change if you increase dose and it doesn't clear episode change maintenance |
| what do FGA lack with respect to SGA in BP? | mood stabilization |
| how long do you wait to check trough of VPA? | 3 days |
| all atypical AP have what indication in BP? | acute mania |
| 3 models of anxiety disorder | noradrenergic, GABA receptor, and 5-HT |
| TCA can be used 1st line for what anx disorder? | OCD |
| divided dosing of benzos does what? | cuts down on SE (sedation) and also anxiety |
| conversion of clonazepam, alprazolam, lorazepam, & diazepam | 0.25mg, 0.5mg, 1mg, 5mg |
| in prescribing a benzo to a patient with liver disease what should you give them? | lorazepam or oxazepam |
| after response achieved how long should you treat anxiety disorders with SSRI/SNRI? | 1 year |
| what regulatory mechanism occurs during alcohol abuse over time that is also the cause of withdrawal symptoms? | up regulation of glutamate to counteract the alcohol increasing GABA; unopposed glutamate is what causes withdrawals |
| 2 life-threatening effects of alcohol withdrawals | seizures (grand-mal) & delirium tremens (DT) |
| goal in alcohol withdrawal tx? drug of choice? | increase GABA & decrease glutamate; benzodiazepine |
| what can you get with thiamine deficiency? | WKS |
| what should be used for opioid dependence in pregnancy? | buphrenophine |
| what urine drug screen is preliminary? confirmatory? | immunoassay; GC-MS |
| 4 types of movement disorders | akathisia, TD, dystonia, parkinsonism |
| drug most associated with akathisia | aripiprazole |
| abnormal involuntary muscle movements that are disfiguring | tardive dyskinesia |
| idiosyncratic, unpredictable, usually sustained involuntary muscle contraction | dystonia |
| how long does it take for dystonic rxn to be relieved after administration of anticholinergic? | within 2-3 minutes |
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templets
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