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PANCE Psychiatry
| Question | Answer |
|---|---|
| First line tx. for smoking cessation (2/t nicotine dependence)? | Bupropion. |
| Schizophrenic positive and negative symptoms? | Positive: hallucinations, bizzare behavior, delusions. Negative: flat affect, apathy, poor grooming, social withdrawal, anhedonia, poor eye contact, poverty of speech. 2 OF WHICH FOR 1MO & CONTINUOUS FOR 6MO. |
| Etiology of schizophrenia? | Inc. dopaminergic, serotonin, norepi w/ dec. GABA and limbic system activity (unlike Benzos which INC inhibatory GABA). |
| TOC of schizophrenia? | -done, -zol, -pine -> -dol, -zine. Negative symptoms 1st w/ atypicals or 2nd gen. risperidone/olanzipine/aripirazole, quetiapine) less SE. Positive symptoms 2nd w/ typicals like haloperidol, chlorpromazine. Clonazepine is 2nd line due to agranulocytosi |
| Dx of somatotization disorder? | 4 pain, 2 GI, 1 sexual and 1 pseudo-neuro symptom. Somatoform pain disorder is >6mo complaints. Unresponsive to multiple attempts, secondary gains, in 30-40yo range. Start SSRI and refer to pain clinic. |
| TOC for conversion disorder? | Lorazepam. Females > males. 25% in family practice. |
| Five mood disorders are? | MDD, Bipolar I, Bipolar II, dysthymia and cyclothymia. |
| Types of MDD? | 2+ weeks of SAD, melancholia, atypical, catatonic, or postpartum depression. |
| TOC for Bipolar I/II? | 2nd generations (risperidone, aripiprazole, quetiapine) + lithium + SSRI +/- haloperidol or lorazepam/clonazepam if psychotic. |
| What are the Cluster A (MAD) personality disorders? Difference btw. paranoid and schizotypal? | Schizoid, schizotypal (superstitious, isolated, odd speech and behaviors) and paranoid (defensive, hyper alert, secretive, very sensitive, suspicious). |
| What are the Cluster B (BAD) personality disorders? | Borderline, histrionic, antisocial, and narcissistic. |
| What are the Cluster C (SAD) personality disorders? | Avoidant, dependent and OCD. |
| What drug is contraindicated in anorexics as it lowers the seizure potential? | Buproprion. |
| TOC for alcohol withdrawal? | Benzos (diazepam/Valium), Antabuse, thiamine, folic acid and multivitamins. |
| TOC for depressant withdrawal? | Phenobarbitoal. |
| TOC for opioid withdrawal? | Nalaxone/Narcan, methadone/clonidine taper, ibuprofen for muscle cramps, loperamide for diarrhea and promethazine for nausea. |
| TOC for nicotine withdrawal? | SSRIs like bupropion/Zyban and varenicline/Chantix. |
| Major difference btw. Autism and Asperger's Disorder? | Impaired communication (both shre impaired social interaction and stereotyped behaviors). |
| Rett's Disorder is what? | Almost always in girls with dec. head circumference despite ht/wt growth, loss of social interaction and both motor and language development. |
| Tx for depression in pt already being treated for schizophrenia? | Carbamazepine (Tegretol) mood stabilizer. |
| Monitoring for Clozapine? | Last resort rx FOR RESISTANT SCHIZOPHRENIA causing AGRANULOCYTOSIS (bowel infarction, seizures, myocarditis, DM, sialorrhea and wt gain). Monitor qw for 6mo->q2w for 6mo->q4w. ECT ONLY AFTER CLOZAPINE TX FAILS. |
| Side effect of Buproprion? | Lowers SEIZURE threshold - esp. contraindicated in anorexic pts. |
| SEs of mainline antipsychotics (besides NMS, SS, and tardive dyskinesia)? | FLUOXETINE (PROZAC) MOST STUDIED Wt gain: Clozapine(b/u) & Olanzipine Hyperlipidemia: Olanzipine (wt) DM: Quetiapine QTc: Ziprasidone & NORTRIPTYLINE Dystonia/Parkinsonism/Akathisia: Haloperidol Sex: Risperidone-inc PRL. BUPROPRION LEAST SEX SE |
| Drug used for tx of Neuroleptic Malignant Syndrome? | Bromocriptine / dantrolene (also used in pituitary tumors, T2DM, hyperprolactinemia and Parkinson's Disease AS DOPAMINE AGONIST TO INHIBIT PRL). S/S: catatonia, rigidity, stupor, >100.4F fever, dysarthria, fluctuating BP. |
| Acute dystonic rxn and tardive dyskinesia caused by? | Antipsychotics like Haloperidol and Trifluoperazine. |
| Anticholinergic crises caused by? Suicide attempt with diphenhydramine has what most serious side effect? | Dyphenhydramine or Benztropine (and Chlopromazine and Tyhexylphenidyl). Anti-ACh meds cause arrythmias (in add'n to dry mouth, abd distention, TACHYCARDIA, and coma). |
| Serotonin Syndrome caused by? | 10d WASHOUT WASN'T USED. Autonomic instability by fluctuating BP and flushing from mixing MAOIs with SSRIs. |
| Benzo overdose treated with? | Flumazenil. |
| Opioid dependence and detox treatment combo? | Naltrexone + Clonidine. |
| Conduct vs. Antisocial Personality Disorder? Risk of ADD/ADHD progressing into adulthood? Common SE of stimulants? | -Adolescence vs. Adulthood. -40% risk of antisocial personality disorder in adulthood. -Decreased appetite. Amphetamines & methylphenidate block dopamine & norepi reuptake but amphetamines also inc. norepi release->inc. norepi leads to anorexigenic sta |
| Which is more important to monitor: Lithium vs. valproate levels? | Renal vs. hepatic insufficency in prescribed pts. PICK LITHIUM LEVELS OUT OF ANSWER CHOICES. |
| Treatment of dextroamphetamine overdose? | Ammonium chloride to ACIDIFY urine and eliminate weak base to prevent filtrate remaining. Acetazolamide, Penicillamine, Probenicid and Sodium Bicarb all alkalinize. |
| Adjustment disorder vs. MDD? | Adjustment disorder is within 3mo of trigger. MDD occurs with 5+ criteria in any 2-week period. |
| Nuance of social phobia? | Does desire social contact, but has low self-esteem, in presence of fear of social situations. |
| Best antihistamine that is NON-sedating? | "FEXOFENADINE is fine." Doesn't cross the blood-brain barrier. |
| Tx for overdose for kids vs. adults? | Ipecac (if alert for airway control) vs. gastric lavage (if within 60 min) - but not with hydrocarbons or alkalines. |
| Best drug for trichotillomania/pulling hair out (like Tourette's)? | Fluvoxamine. |
| Main action of Benzos? | INC GABA receptor-mediated Cl conductance. |
| Drugs contraindicated among airline pilots and air traffic controllers? | Besides diphenhydramine, varenicline for smoking cessation. Rx for this group is nicotine replacement tx. |
Created by:
ed24