Health Care Professionals: Common Competencies, Therapies, and Disorders, Exams of Nursing

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Question Bank for PMHNP Boards questions and answers well atticulated  What is true of interprofessionality? - Correct answer All health professionals have individual professional competencies  What is the significance of an experimental p-value of 0.05 - Correct answer There is a 5% chance of a similar result occurring by chance alone  What percentage of children with oppositional defiance disorder will develop conduct disorder? - Correct answer 30%  In the DSM-5, selective mutism is now considered what type of disorder? - Correct answer anxiety disorder  Symptoms of selective mutism must persist for at least - Correct answer 1 month  Common competencies - Correct answer overlap more than one health care professional, although not necessarily all health care professionals, and are competencies expected of all health care professionals  Complementary competencies - Correct answer enhance the qualities of other professions in provision of care  Collaborative competencies - Correct answer those that each individual profession must possess to work with others, including those who practice within different specialties within a profession.  Interpersonal collaboration is _______ centered - Correct answer patient  Cognitive therapy is recommended for patients that have - Correct answer negative cognitive distortions  irrational beliefs  faulty conceptions  Humanistic Therapy focuses on assisting patients with - Correct answer self-actualization and self-directed growth  Behavioral Therapy focuses on - Correct answer changing maladaptive behaviors through the use of behavioral modification techniques  Existential therapy is for - Correct answer reflection on life  confronting self  120 who got diarrhea ate lettuce. 80 with diarrhea did not eat lettuce. 40 without diarrhea ate lettuce. 160 without diarrhea ate lettuce. What is the odds ratio of eating lettuce and developing diarrhea? - Correct answer 6 ((120X160)/(80x40))  The New Freedom Commission on Mental Health (NFCMH) released a report that suggested - Correct answer implementation a national campaign to reduce the stigma of seeking care  Focusing on promoting recovery and building resilience  The efficacy of mental health treatments was found to be well documented in - Correct answer influential report issued by US Surgeon General in 1999  State of high negative emotion and pessimism - Correct answer neuroticism  Commonly known as an optimistic outlook on life They are are outgoing, like social interaction, respond to external rewards, have more active dopamine networks, and are responsive to positive reinforcement. - Correct answer Extraversion (high levels protect from psychiatric illness)  Introverts are more likely to be _______ motivated and more likely to respond to _______ reinforcement - Correct answer internally  negative (more likely to interact with internal motivation/self-image)  Interpersonal trait of cooperation, easy going nature. Tend to have smooth relationships often at the expense of self-assertion - Correct answer Agreeableness  Associated with self-control and a focused, organized approach to life. Are achievement-oriented goal setters who can delay immediate gratification to obtain their long term desired outcome. They are considered responsible, reliable, and dependable. - Correct answer conscientiousness  In behavioral couples therapy, the initial sessions are spent doing a functional analysis of behavior (FAB). What is true about FAB? - Correct  3 Contraindications to use a calcium channel blocker - Correct answer 1st or second degree heart block  Bradycardia  CHF  4 Side effects of calcium channel blockers - Correct answer Headache  Lower extremity edema  Bradycardia  Heart Block  An NP is evaluating a 78 year old female with depression. She suspects the patient may have Parkinson's disease. Which of the following is consistent with that diagnosis? - Correct answer Postural instability  Pill-rolling tremor  Shuffling Gait  Difficulty initiating movement  Mask-like facies (difficulty initiating movement)  Writhing movements occur with - Correct answer Huntington's chorea  10 Non-motor manifestations of Parkinsons - Correct answer Autonomic dysfunction  Gastrointestical dysfunction  Rhinorrhea  Sleep disturbance  Fatigue  Mood disorder  Cognitive dysfunction  Dementia  Psychosis  Hallucinations  What type of therapy is most useful in depressed HIV positive outpatients? - Correct answer Interpersonal psychotherapy  What type of therapy is most useful in patients with borderline personality disorder? - Correct answer Dialectical behavioral therapy  The NP is caring for a patient dying of lymphoma. The pt's wife states that the pt has been mismanaged and that another practitioner must be assigned to the patient for him to improve. This NP suspects that this individual is in which stage of grief according to Elizabeth Kugler- Ross? - Correct answer Bargaining  Involves resisting or refusing to remember information that has been supplied - Correct answer Denial  Pica and spoon shaped nails are associated with - Correct answer Iron- deficiency anemia (microcytic)  2 common causes of microcytic anemia - Correct answer iron deficiency  anemia of inflammation/chronic disease (TB, HIV, endocarditis, RA, Chrohn's DM, kidney disease, CA)  (Other causes: lead toxicity, alcohol/drug use, zinc excess (copper deficiency))  Initial symptoms of B12 deficiency - Correct answer Generalized weakness  Paresthesias  Possible ataxia  Late symptoms of B12 deficiency - Correct answer Memory impairment  Depressed mood  5 P's of Vitamin B12 deficiency - Correct answer Pancytopenia  (Peripheral and Posterior spinal cord) neuropathy  Pyramidal tract signs  Papillary atrophy of tongue (atrophic glossitis)  2 causes of megaloblastic macrocytic anemias - Correct answer Vitamin B12 deficiency  Folate deficiency  What neurotransmitter is thought to play the most significant role in social phobia? - Correct answer dopamine  What neurotransmitter is thought to mediate social interest, gregariousness, confidence and sensitivity to rejection? - Correct answer dopamine  According to Gonzalez-Jaimes and Turnbull-Plaza (2003, which type of therapy with psychocorporal, cognitive, and neurolinguistic components and a holistic focus is significantly more effective in patients diagnosed with adjustment disorder? - Correct answer mirror psychotherapy  The ________ is part of the treatment to encourage a patient to accept his physical condition - Correct answer mirror  Discussing medical diagnoses and the reaction to it, as well as treatment modalities - Correct answer medical conversation  Therapy that emphasizes personal responsibility, focusing on the individual's experience at the present moment, the therapist-patient relationship, the context of the person's life, and adjustments people make as a result of their overall situation - Correct answer Gestalt Therapy  PANDAs is associated with _________ infections and results in _______ symptoms - Correct answer Group A beta-hemolytic strep  OCD  After camping trip, pt began to have a petechial rash on her legs/trunk, parts of which are turning dark red and purple, temp 102.8, HR 1115, BP 88/50, mm pain, neck stiffness, severe HA. What is the dx? - Correct answer meningococcemia  1 mg of Xanax = _____ mg of Ativan - Correct answer 2  1mg of Xanax = ____mg of phenobarbital - Correct answer 30  1mg Xanax = ____ mg of Clonazepam (Klonopin) - Correct answer 1  1mg Xanax = ____ mg of chlordiazepoxide (Librium) - Correct answer 25  1mg of Xanax = ____ mg of diazepam (Valium) - Correct answer 10  Pt wanting something immediate and non-addictive for breakthrough anxiety - Correct answer Hydroxyzine  How long do GAD symptoms need to occur to make the diagnosis? - Correct answer 6 months  First lab test to check for Sjogren's - Correct answer Anti-nuclear antibody tests  To diagnose Cyclothymic disorder, it must be present for _______ in adults - Correct answer 2 years  To diagnose Cyclothymic disorder, it must be present for _______ in pediatrics - Correct answer 1 year  Hypoglycemia  Hyperthyroidism  Cushing's disease  Arrhythmias  Parathyroid Tumors  Some types of seizures  Depression screening tool used specifically for pregnancy and postpartum - Correct answer Edinburg Depression Scale  How long do symptoms have to be present to diagnose PTSD - Correct answer 1 month  Lab value that would indicate that parathyroid was removed during thyroidectomy - Correct answer Low Calcium  For PCOS, which medication will help with hirsutism? - Correct answer Spironolactone  Lab that is an indicator of inflammation - Correct answer C-reactive protein  Pain medication that inhibitis serotonin and NE reuptake (risk of serotonin syndrome if also on antidepressants) - Correct answer Tramadol  an over-the-counter nonnarcotic drug found in cough preparations which inhibits serotonin reuptake and could cause serotonin syndrome in patients on SSRI's - Correct answer Dextromethorphan (Delsym)  Pre-cursor for Serotonin production - Correct answer L-tryptophan  In panic disorder, 1 of the attacks is followed by at least ______ of persistent worry about having additional attacks, worry about implications of attacks or its consequences, or significant change in behavior related to attacks. - Correct answer 1 month  The origins of panic disorder include - Correct answer childhood trauma  With delayed onset of PTSD, how much time must have past from trauma to onset of symptoms - Correct answer 6 months  First line medication for polymyalgia rheumatica - Correct answer oral prednisone  Acute stress disorder is diagnosed if the characteristic symptoms present within what period of time after experiencing the traumatic event? - Correct answer 1 month  In what Tanner's stage will a male's penis grow more in length than width - Correct answer III  In what Tanner's stage will a male's scrotum begins to grow and redden. Where pubic hair will be straight, fine and sparse - Correct answer II  In what Tanner's stage will a male's pubic hair look more like an adult, but will not cover as much area. Where penis will thicken, testes and scrotum continue to grow. - Correct answer IV  Brain structure R/T development of GAD - Correct answer Amygdala  What circumstance(s) are often correlated to the onset of panic disorder - Correct answer separation from family  serious illness of friend/family  accident  major relationship loss/change  abusing substances  postpartum  Lifetime prevalence of anxiety disorders in the US - Correct answer 25- 35% (18% prevalence)  Buspar needs ______ to have similar efficacy to benzodiazepines - Correct answer 4 weeks  How many panic symptoms must be present for diagnoses. - Correct answer 4  Part of Brain responsible for smell - Correct answer Limbic  Part of brain (lobe) responsible for visual functions - Correct answer Occipital  Part of brain (lobe) responsible for sensory integration and somatosensory function - Correct answer Parietal  Part of brain (lobe) responsible for executive function, social conduct, judgement, and some motor function - Correct answer Frontal  Occasional crossing of eyes is not normal after the infant is older than ___________ - Correct answer 2 months  If strabismus is left untreated, what may result? - Correct answer ambylopia (affected eye decrease in vision)  What would be the normal testosterone level of a Tanner V male - Correct answer 265-800 ng/dl  Bactrim is contraindicated in - Correct answer Glucose-6-phosphatase deficiency  Folate deficiency anemia  patients with significant hepatic impairment  pregnant patiens  Pt has severe headache behind right eye with eye pain and tearing, sees halos around light fixtures. C/o N/V. R pupil fixed more oval than round, mid-dilated and cloudy. What might be happening - Correct answer Acute angle closure glaucoma (Emergency)  What STD is not reportable in all 50 states - Correct answer HPV  Romberg test is a test of - Correct answer balance  A child will recognize faces and smile appropriately at familiar faces by age ____ - Correct answer 3  A typical _____ can count up to 20 with minimal assistance of an older child or parent - Correct answer 4 year old  A typical _____ can run/walk up and down the stairs - Correct answer 21 month old  A typical _____ is beginning to acquire language skills - Correct answer 14 month old  What herbal supplement is effective for a pt with an adjustment disorder with anxiety according to RCT - Correct answer Kava Kava  What herbal supplement is effective for somatoform disorders according to RCT - Correct answer St. John's Wort  Recurrent spontaneous episodic vertigo, hearing loss. Must have aural fullness or tinnitis on one size to make dx. - Correct answer Meniere's Disease butyrate activity of GABA-A receptors, antagonism of AMPA/kainate subtype of glutamate receptor, and inhibition of carbonic anydrase enzyme? - Correct answer Topiramate  Ex of drugs that are partial agonists at postsynaptic serotonin receptors - Correct answer Hallucinogens like LSD and MDMA  Drug associated with inhibition of catecholamine reuptake in neurons and blockage of NMDA glutamate receptors - Correct answer PCP  Individuals with panic disorder are most commonly affected by which other psychiatric disorder - Correct answer Agoraphobia  When is the use of transdermal selegiline not beneficial? - Correct answer For patients with pheochromocytoma (excess NE can cause HTN crisis) and with planned surgery (need to dc patch for 10 days prior to elective surgery)  Responsible for the catabolism of serotonin, norepinephrine and dopamine - Correct answer Monoamine oxidase (MAO)  Medication that is an irreversible MAO inhibitor that works by selectively inhibiting both MAO-A and MAO-B in the CNS with preservation of MAO-A in the gut. Unless high dosed, little need to follow tyramine restricted diet. - Correct answer Selegiline  Adverse effect of carbamazepine that can be an emergency - Correct answer hyponatremia  toxic epidermal necrolysis  Erythema multiform  Steven's Johnson  Thrombocytopenia  Aplastic Anemia  Agranulocytosis  SLE  arrhythmias  Hepatitis  An NP advises a patient with a significant family hx of breast cancer to perform monthly self-examinations. What term helps to identify this measure? - Correct answer Secondary Prevention  Prevention type designed for early detection of a disease so that morbidity and mortality may be reduced - Correct answer Secondary Prevention  Preventing the disease or condition from occurring - Correct answer Primary Prevention  WIC and promotion of workplace safety laws designated by OSHA are this type of prevention - Correct answer Primary Prevention  Rehabilitation and prevention of complications of disease - Correct answer Tertiary prevention  A support group for a disease or condition is this type of prevention - Correct answer Tertiary Prevention  Exercise for an obese patient is this type of prevention - Correct answer Tertiary  Antisocial personality disorder criteria must show a pattern of disregard of others since age ______ - Correct answer 15  How many criteria does a pt who meets criteria for an Antisocial personality disorder have to have - Correct answer 3 of 7  Name the 7 criteria that pts with Antisocial personality disorder have (must meet 3 of them) - Correct answer Breaking the law  Deceitfulness for personal profit or pleasure  Impulsivity/failure to plan ahead  Aggressiveness/Irritability (physical fights/assaults)  Reckless disregard for safety of self or others  Consistent irresponsibility  Lack of remorse  How old does an individual need to be in order to be diagnosed with antisocial personality disorder? - Correct answer 18 years  The occurrence of antisocial behavior is not exclusively during the course of - Correct answer schizophrenia  bipolar disorder  What is a precursor for antisocial personality disorder - Correct answer conduct disorder  List of Cluster B personality disorders - Correct answer antisocial  borderline  histrionic  narcissistic  List the cluster A personality disorders - Correct answer paranoid  schizoid  schizotypal  List of Cluster C personality disorders - Correct answer avoidant  dependent  obsessive-compulsive  pervasive pattern of excessive emotionality and attention seeking beginning in early adulthood and present in a variety of contexts - Correct answer Histrionic Personality Disorder  A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness must last at least _______ for Oppositional Defiant Disorder diagnosis - Correct answer 6 months  Oppositional defiant disorder does not include: - Correct answer aggression toward people or animals  destruction of property  pattern of theft or deceit  Recurrent behavioral outburst representing a failure to control aggressive impulses. - Correct answer Intermittent Explosive Disorder  In Intermittent Explosive disorder, physical aggression does not result in - Correct answer damage or destruction to property  physical injury to animals or other individuals  Kubler-Ross's stages of grief - Correct answer denial  anger  bargaining  depression/sadness  acceptance  Symptoms can be associated with another medical condition - Correct answer Somatic symptom disorder  Somatic symptom disorder symptoms persist for - Correct answer >6 months  Despite frequent doctors visits and tests, this pt is rarely reassured and can feel that his/her medical care is insufficient - Correct answer Somatic symptom disorder  In order to meet DSM V criteria for somatic symptom disorder, in addition to somatic symptoms, pts must have - Correct answer  Disturbance of the rapprochement subphrase is associated with - Correct answer persistent longing for and dread of fusion with object that is thought to be secondary to aggression or withdrawal in the mother. Thought to contribute to the development of borderline personality disorder.  Phase in which infant shows increased interest in outside world - Correct answer Hatching  Stage where infant recognizes his or her mother but lacks a sense of individuality - Correct answer symbiotic  Narcissistic personality disorders are likely due to - Correct answer inadequate soothing during the symbiotic phase and inadequate refueling during the separation-individuation  Describes the child's understanding that his or her mother is a separate individual and he or she is also separate - Correct answer Object constancy  Object constancy leads to the formation of - Correct answer internalization, which will allow the child to have an internal representation of mother in turn allowing healthy separation, exploration, and development of self-esteem  The three most common causes of secondary obesity - Correct answer Cushing's syndrome  Hypothyroidism  Genetic conditions  Compassion, a desire to do good - Correct answer beneficence  Avoidance of harm - Correct answer Nonmaleficence  the equal and fair distribution of resources, regardless of other factors - Correct answer Justice  Dedication, fairness, honesty, advocacy and commitment to patients. It involves an agreement to keep promises and commitments based on the virtue of caring. - Correct answer Fidelity  Most widely used tool for assessing the healthcare safety culture within an organization - Correct answer Culture of Patient Safety Assessment developed by AHRQ  The Iowa Model of EBP (evidence-based practice) is characterized by which statement? - Correct answer It is important to determine if an identified issue is a priority of the organization  The trigger for change can be - Correct answer Knowledge focused or Problem focused  Identification of a problem and determination of its priority - Correct answer first step in Iowa Model  Review and critique of available literature - Correct answer Second step in Iowa Model  Identification of research evidence to support a change in clinical practice - Correct answer 3rd stage of Iowa Model  Implementation of change - Correct answer 4th step of Iowa Model  Monitoring of Outcomes - Correct answer 5th and final step of Iowa Model  Knowledge-focused triggers include - Correct answer new research  practice guidelines  Problem-Focused Triggers include - Correct answer Clinical problems  Issues in risk management  The first step in getting a bill to the floor is? - Correct answer Drafting a bill  Probability results of study are due to chance - Correct answer P value  Medicare part A coverage includes - Correct answer 1. hospital care and medicines received in hospital  2. SNF  3. nursing home care  4. hospice  5. home health services  Sampling used when the proportion of the study population belonging to each group of interest in known, to obtain an adequate study sample from a small group in the study population. - Correct answer Stratified sampling  Selection of groups under study is random - Correct answer Cluster sampling  Choosing individuals at regular intervals from a sampling frame by selecting a number to determine where to begin selecting individual subjects from a list. - Correct answer Systematic sampling  Making a numbered list of all units in a population from which you want to draw a sample, deciding on the sample size, and selecting the required number of sampling used using a table of random numbers or a lottery method - Correct answer Simple random sampling  What is the prevalence of borderline personality disorder in psychiatry outpatients? - Correct answer 10%  What is the prevalence of borderline personality disorder in psychiatric inpatients - Correct answer 20%  Diagnosis of borderline personality disorder includes 5 or more of the following criteria - Correct answer frantic avoidance of abandonment  unstable relationships  disturbance of identity  recurrent suicidality  unstable mood/affect  chronic feelings of emptiness  intense bouts of difficult-to-control anger  transient paranoia or dissociation  Pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation - Correct answer Avoidant  Pervasive pattern of detachment from social relationships and a restricted range of expression - Correct answer Schizoid  Pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent - Correct answer Paranoid  Pervasive pattern of social and interpersonal discomfort with, and reduced capacity for, close relationships as well as cognitive or perceptual distortions and eccentricities - Correct answer Schizotypical  Pervasive pattern of grandiosity, need for admiration, and lack of empathy - Correct answer Narcissistic  Pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation - Correct answer Dependent  What is the prevalence of obsessive-compulsive personality disorder in the general population - Correct answer 5-10%  Which personality disorder's criteria includes magical thinking - Correct answer Schizotypical  Females with _________ have a virilized clitoris - Correct answer Congenital adrenal hyperplasia (CAH)  A higher degree of ________ has been reported in individuals with CAH, which correlates to the degree of virilization - Correct answer homosexuality  A 2-year old girl with 21-hydroxylase deficiency undergoes genitoplasty. Which statement is true concerning her condition - Correct answer There is a correlation between virilization degree and gender dysmorphia  What is the prevalence of paranoid personality disorder among psychiatric patients? - Correct answer 10-30%  Gender identity usually begins to form by this age - Correct answer 2  Anti-hypertensive effects on sexuality - Correct answer impaired vaginal lubrication and erectile dysfunction d/t antiadrenergic effects  Spironolactone effects on sexuality - Correct answer decreased desire secondary to decreased testosterone  Estrogen effects on sexuality - Correct answer decreased desire secondary to decreased testosterone  Steroid effects on sexuality - Correct answer decreased desire secondary to decreased testosterone  TCA effects on sexuality - Correct answer erectile dysfunction or impaired vaginal lubrication secondary to anticholinergic effects  MAOI effects on sexuality - Correct answer erectile dysfunction or impaired vaginal lubrication secondary to anticholinergic effects  Antipsychotics effects on sexuality - Correct answer erectile dysfunction or impaired vaginal lubrication secondary to anticholinergic effects  SSRI effects on sexuality - Correct answer inhibition of arousal and orgasm by increased serotonergic activity  The diagnosis of a personality disorder requires a pattern of inner experience and behavior that deviates from the expectations of the individual's culture in 2 or more of which 4 areas? - Correct answer cognition  affectivity  impulse control  interpersonal functioning  Individual is only aroused by and can only achieve orgasm through a single type of sexual contact, usually relegated to a specific anatomical location - Correct answer Partialism  Individuals who attempt to avoid penetrative sex due to a lack of interest may have what? - Correct answer Partialism (a type of paraphilia)  Prevalence of antisocial personality disorder in females in the community - Correct answer 1%  2 common defense mechanisms seen in obsessive compulsive personality disorder - Correct answer isolation of affect  intellectualization  Paraphilia are almost never diagnosed in - Correct answer females  (and rarely in a clinical setting)  Age range that is typical for a person that performs frotteurism - Correct answer 15-25 (declines after that)  Pts with a history of childhood separation are more prone to this personality disorder - Correct answer dependent  Pts with dependent personality disorder commonly experience these 2 things from their caretaker? - Correct answer over-involvement  intrusive behavior  Childhood experience common in pts with dependent personality disorder - Correct answer social humiliation - leads them to doubt in their own ability to function independently of others  Pts with obsessive compulsive personality disorder often had parents who were - Correct answer emotionally withholding  overprotective  over-controlling  People with obsessive compulsive personality disorder develop their symptoms as a strategy to - Correct answer avoid punishment (they were often punished by parents and rarely rewarded)  Patients with schizoid personality disorder typically from families that are - Correct answer emotionally reserved  highly formal  aloof  impersonal  (likely were provided inadequate affection prompting their disinterest in forming close relationships later in life)  Patients with this personality disorder displayed excessive shyness and fear when confronted with new people and situations as children - Correct answer avoidant  Many of the patients have a history of painful early experiences and chronic parental criticism - Correct answer avoidant personality disorder  Symptoms of personality disorders are usually consistent with patient's - Correct answer internal sense of self, which is called ego-synodic  What is the term for how easily an individual acts on an initial, emotionally based evaluation of events and people - Correct answer Constraint  Purest expression of the biological basis of personality - Correct answer Temperament  What are the 2 distinct temperaments Kagan and colleagues (1988) identified - Correct answer inhibited  uninhibited  Which of the following medications is the first-line treatment option for a personality change secondary to epilepsy that results in aggressive episodes? - Correct answer Carbamazepine  What is the second-line treatment option for a personality change secondary to epilepsy that results in aggressive episodes - Correct answer benzodiazepines  What is contraindicated in the treatment of aggressive personality changes due to epilepsy - Correct answer antipsychotics  PTSD rates among Native Americans are _____ the national average - Correct answer 3x higher  What disorder is often comorbid with body dysmorphic disorder - Correct answer social phobia  Recovering completely within _______ is characteristic of a conversion disorder - Correct answer 24 hours  For pediatrics with conversion disorder (psychogenic seizure), what might be found in this patient's history - Correct answer She argued with her parents earlier that day over a bad report card  Conversions disorders do not show - Correct answer pain symptoms  What is the typical course of illness anxiety disorder - Correct answer Onset in early adulthood  has a chronic waxing/waning course  Which medications have the strongest evidence for treatment of PTSD - Correct answer Paroxetine  Sertaline  (Venlafaxine also approved by FDA)  Pts with this disorder often exhibit emotional blunting that is sometimes referred to as "la belle indifference" - Correct answer conversion disorder  Pts with ________ PTSD typically show a more robust clinical response to SSRIs - Correct answer non-combat  In treating pts with histrionic personality disorder, which therapy type is useful for addressing provocative and attention seeking behavior? - Correct answer Group therapy (pt may be unaware of behavior and it could help them if others point them out)  What term represents a stable and realistic sense of self? - Correct answer Self-system  means of interpreting social situations and understanding the relational motives and actions of others - Correct answer social system  the capacity to observe the self as it relates to others - Correct answer self-in-relation system  What percentage of patients with neurological problems have conversion symptoms? - Correct answer 1-3%  Body dysmorphic disorder is associated with what risk factor and family history - Correct answer Childhood neglect  OCD  These symptoms are a sign of which drug intoxication: elation  euphoria  increased physical activity  anxiety  tachycardia  arrhythmias, hypertension, mydriasis (pupil dilation), agitation  cognitive impairment - Correct answer cocaine  Most serious complications of cocaine abuse - Correct answer myocardial ischemia and infarction  Signs of ____________: dysphoria, psychomotor slowing, fatigue, increased appetite, craving - Correct answer cocaine withdrawal  Signs of ____________:  piloerection  lacrimation and rhinorrhea  pain in joints and muscles  dysphoria  diarrhea  nausea  vomiting  dilated pupils  insomnia  autonomic hyperactivity  yawning - Correct answer Opioid withdrawal  signs of ______________:  euphoria  drowsiness  impaired coordination  dizziness  confusion  feeling of heaviness in the body  slowed or arrested breathing  constipation  flushing of feelings of warmth  pinpoint pupils - Correct answer opioid intoxication  Signs of ______________  Nystagmus  Dissociative symptoms  anxiety  tremor  numbness  memory loss  analgesia  psychosis  aggression  violence  slurred speech  poor coordination  hallucination - Correct answer Phencyclidine intoxication  Signs of _________:  stimulation  loss of inhibition  headache  N/V  slurred speech  poor motor coordination - Correct answer Inhalant intoxication  Signs of _________:  Exhilaration  loss of inhibitions  slurred speech  staggering gait  euphoria  marked motor impairment  confusion  stupor  coma - Correct answer Sedative hypnotic (alcohol and benzodiazepine) intoxication  Sign of ________:  sweating  flushed face  insomnia  hallucinations  seizure  disorientation  tremors  increased autonomic activity - Correct answer Sedative hypnotic (alcohol and benzodiazepine) withdrawal  What is a symptom of amphetamine withdrawal - Correct answer fatigue  vivid bad dreams  insomnia/hypersomnia  increased appetite  psychomotor agitation/retardation  A 29 year old male with yawning, perspiration, runny nose, dilated pupils, muscle twitching, no abdominal tenderness. Which drug is responsible for these withdrawal symptoms - Correct answer Heroin  The death rate among opioid abusers is ____ greater than the non- using population - Correct answer 20x  Sweating, flushing, sleep disturbances, hallucinations, seizures, and mild mental status changes are early symptoms of - Correct answer alcohol withdrawal 8-10 hours after last drink  LSD is derived from which of the following - Correct answer Ergot fungus  Cocaine is derived from the leaves of the plant - Correct answer erythroxylon coca  A 22 yo F with cystic fibrosis (CF) presents with fatigue, dysphoria, and depression. She stopped taking her meds and is wearing a baby pacifier on her necklace. Why is the pacifier significant in this pt with possible CF exacerbation? - Correct answer MDMA (ecstasy) withdrawal  baby pacifiers are used at "raves" to combat - Correct answer bruxism (teeth grinding) while on MDMA  Ganja is obtained from - Correct answer flowering tops THC 6-20%  Marijuana is obtained from - Correct answer leaves/flowers  Bhang is obtained from - Correct answer dried marijuana leaves (1-3% THC)  Hashish is obtained from - Correct answer resin (THC 6-20%)  In DSM-5 how many of the 11 criteria for substance use disorder must be present to meet "severe" subclassifications? - Correct answer 6  In DSM-5 how many of the 11 criteria for substance use disorder must be present to meet "mild" subclassifications? - Correct answer 2-3  In DSM-5 how many of the 11 criteria for substance use disorder must be present to meet "moderate" subclassifications? - Correct answer 4-5  Sx of this type of intoxication are conjunctival infection, dry mouth and increased appetite - Correct answer Cannabis intoxication  What is the preferred benzodiazepine for treating withdrawal patient with chronic alcohol use disorder and a history of liver disease - Correct answer Oxazepam  MRI in Korsakoff's syndrome shows the following 6 areas of involvement - Correct answer midbrain  pons  hypothalamus  thalamus  mammillary bodies  cerebellum  What vitamin is deficient in Wernicke's encephalopathy and Korsakoff's syndrome - Correct answer Vitamin B1  The proposed addictive component of cannabis - Correct answer releases dopamine in the mesolimbic system  What type of users can appear to be bipolar with mania/hypomania symptoms - Correct answer anabolic steroids  Which drug of abuse is also a schedule III prescription for the treatment of narcoleptic cataplexy? - Correct answer GHB (Xyrem)  Which of the following statements regarding the treatment of cocaine dependent individuals is correct - Correct answer contingency management has been widely accepted and is effective  There are no FDA approved medications, no meds have been shown to reduce relapse  Substances that belong to the "depressant" class - Correct answer ETOH  cannabis  opioids  inhalants  benzodiazepines  Which of the following statements regarding the mechanism of action of vareniciline is accurate - Correct answer It has activity at Alph 4 beta 2 subtype of the nicotinic receptor  It is effective for nicotine/tobacco cessation  A 50 year old man with chronic alcohol use disorder ran out of ETOH and drank methyl alcohol from the factory where he is employed 18 hours ago. He presents at ER with encephalopathy, ataxia, seizures, and bilateral vision loss. Imagineer reveals an intracranial hemorrhage. What is the likely location of his hemorrhage - Correct answer Putamen (formic acide accumulates in this region)  Long term survivors of methyl alcohol intoxication may experience - Correct answer Parkinsonism  Chronic exposure to methyl alcohol may result in - Correct answer axonal polyneuropathy  A 29 year old patient is having marital struggles and multiple recent arguments with her husband presents to the ED complaining of R sided weakness. A neurological evaluation, including imaging, reveals no identifiable diagnosis. Psychiatric consultation is requested. After 2 days, the patient's weakness has subsided and she is discharged home. Which of the following is a positive prognostic factor for her diagnosis - Correct answer Short duration of illness  A 38 year old woman presents to the psychiatry clinic wearing a wig. She has no eyelashes or eyebrows. Which behavioral therapy has been shown to be particularly helpful for this patient's self-inflicted condition? - Correct answer Habit Reversal  Treatment for trichollomania - Correct answer Medication and behavioral therapy (habit reversal - apply barriers such as gloves or hat)  A 19 year old male presents with facial numbness and bilateral vision loss. He reports tingling, cold feet with bluish discoloration. His symptoms most likely resulted from inhalation of which substance. - Correct answer n-Hexane (household glues)  Repeated glue inhalation may cause ______ which has a similar presentation to ______ - Correct answer glue sniffer neuropathy  Guillain Barre Syndrome  Which antidepressant with a tetracyclic structure that works by antagonism of presynaptic alpha 2 agonists and post-synaptic  Affirmations  Reflective listening  Summaries  4 core techniques for motivational interviewing include - Correct answer expression of empathy  rolling with the resistance  developing discrepancy  supporting self-efficacy  Successful malingerers are more likely to have which characteristic compared to unsuccessful maligerers - Correct answer They are more likely to report fewer symptoms  Pt got Tdap 10 years ago, what is she due for - Correct answer Td booster  Which type of group treatment affects the largest number of substance abuse patients - Correct answer self-help groups  inability to recall autobiographical information and apparently purposeful travel associated with amnesia. Onset sudden, memory loss may be refractory - Correct answer dissociative amnesia with dissociative fugue  Pt often feel detached from their body, as if they are watching from outside their body. There is no associated amnesia or change in personality or identity - Correct answer Depersonalization/derealization disorder  Temporary episode of memory loss which can not be associated with a neurological cause. there is no associated change in identity. Onset is sudden, and the person is unable to recall who they are, how they got there, or what they were doing - Correct answer Transient global amnesia  Factitious disorder involves - Correct answer deceptively reporting false symptoms to assume the "sick role"  Dangerous dose of methadone may present as - Correct answer drowsiness  motor impairment  mitosis  nausea  Safest initial methadone dose - Correct answer 10-20mg given in single dose  A dose of ____ methadone can be given if withdrawal symptoms persist an hour after the initial dose - Correct answer 5mg  Piloerection - Correct answer goose bumps  On withdrawal for methadone, signs of insomnia, fatigue, irritability and anxiety may last for - Correct answer weeks to months  Typical methadone maintenance dose - Correct answer 60-100mg daily  The most difficult period is when tapering methadone maintenance at doses - Correct answer <25mg  Which of the following disorders does not fall into the category of somatic symptom and related disorders? - Correct answer Somatization disorder  Examples of Somatic symptom and related disorders - Correct answer somatic symptom disorder  illness anxiety disorder  conversion disorder  factitious disorder  Approximately which percentage of patients with chronic alcohol use disorder have at least 2 parents with chronic alcohol use disorder - Correct answer 30%  Earlier symptoms of GHB withdrawal - Correct answer Anxiety  Insomnia  Tremor  confusion  nausea  vomiting  Early symptoms of MDMA withdrawal - Correct answer Fatigue  dysphoria  depression with loss of appetite  trouble concentrating  Although results vary based on age, gender and drinking pattern of patient, which 2 biomarkers will provide NP up to 90% sensitivity for heavy, chronic alcohol usage? - Correct answer Glutamyltransferase (GGT) & carbohydrate deficient transferrin (CDT)  Blood test that detects heavy alcohol use (5+ or more drinks a day) over the past two weeks - Correct answer CDT  45 year old male brought to ER by son in agitated and disoriented state after tonic clonic convulsions. BP 170/105, pulse 125, RR 15, Temp 99, What is his most likely dx? - Correct answer Alcohol withdrawal  Can resemble manic episode with euphoria, impulsive behavior, aggression, dystonia, heightened self-esteem, mydriasis, increased vitals, hyperthermia, cardiac conduction abnormalities - Correct answer Cocaine intoxication  Common symptoms of include a subjectively altered sense of time, subjective difficulty in vividly recalling past memories, vague somatic symptoms, and fear of irreversible brain damage - Correct answer Depersonalization/derealization disorder  There is an association with childhood interpersonal trauma, and it can be precipitated by severe stress or illicit drug use (most notably hallucinogens, ketamine, MDMA and salvia) - Correct answer Depersonalization/derealization disorder  What drug can precipitate new onset panic attacks and depersonalization/derealization disorder at the same time - Correct answer Marijuana  Average age of onset of depersonalization/derealization disorder - Correct answer 16  Depersonalization disorder is _____ more common in woman than men - Correct answer 2-4x  What pneumococcal vaccine is indicated for all adults over 65 years old - Correct answer PPSV23  What pneumococcal vaccine is indicated for adults <65 with chronic lung conditions, chronic CV disease, DM II chronic renal disease, chronic liver diseases, chronic alcohol use disorder as well as immunocompromising syndrome - Correct answer PPSV13  People who display factitious disorder by proxy are more likely to have which condition - Correct answer Personality disorder  ______ of patients on dosage of _______ of clozapine will have seizures - Correct answer 4-6%  >600mg/day  SSRI's and coagulation - Correct answer increase risk of bleeding d/t interactions with serotonergic receptors on platelets  What SSRI's are most likely to have gastrointestinal side effects - Correct answer sertraline  fluvoxamine  CNS activation (anxiety, restlessness, tremor, and insomnia) occur most commonly with this SSRI - Correct answer fluoxetine  SIADH commonly occurs with this SSRI - Correct answer fluoxetine  Sedation occurs most commonly with this SSRI - Correct answer paroxetine  Which of the following statements is true regarding Gabapentin? - Correct answer It does not interact with anticonvulsants  Somnolence and dizziness are the common side effects and may lead to discontinuation  How does trazodone cause activation of the CNS? - Correct answer Metabolite activity as well as inhibition of serotonin reuptake in presynaptic receptors  What is correct regarding methylphenidate (MPH) - Correct answer patients on transdermal MPH require lower doses than oral extended- release (transdermal does not make first pass in liver)  The ratio of transdermal MPH to oral extended release MPH is - Correct answer 10:15mg  MPH is currently manufactured as a mixture of - Correct answer d and l-threo enantiomers  (d-threo = active form )  Clozapine  -Anticholinergic Effect  -Sedation  -Extrapyramidal Effects - Correct answer High  High  No  Quetiapine  -Anticholinergic Effect  -Sedation  -Extrapyramidal Effects - Correct answer Low  High  Low  Haloperidol  -Anticholinergic Effect  -Sedation  -Extrapyramidal Effects - Correct answer Low  Low  High  Olanzapine  -Anticholinergic Effect  -Sedation  -Extrapyramidal Effects - Correct answer Low  Mid  Low  Risperidal (Risperidone)  -Anticholinergic Effect  -Sedation  -Extrapyramidal Effects - Correct answer Low  Low  Low  Ziprasidone (Geodon)  -Anticholinergic Effect  -Sedation  -Extrapyramidal Effects - Correct answer Low  Low  Low  Aripiprazole (Abilify)  -Anticholinergic Effect  -Sedation  -Extrapyramidal Effects - Correct answer Low  Low  Low  Paliperidone (Invega)  -Anticholinergic Effect  -Sedation  -Extrapyramidal Effects - Correct answer Low  Low  Low  Chlorpromazine (Thorazine)  -Anticholinergic Effect  -Sedation  -Extrapyramidal Effects - Correct answer High  High  Low  What is the mechanism of action of memantine - Correct answer NMDA receptor antagonist (blocks excessive stimulation of glutamate receptors but does not affect normal transmitter activity)  Which of the following classes of antidepressant drugs includes mirtazapine - Correct answer Tetracyclic antidepressants  (noradrenergic and specific serotonergic antidepressant (NaSSA)  Mechanism of action of Mirtazapine - Correct answer blocks presynaptic alpha-2 andrenergic receptor ->  5-HT-1A activation and increased dopamine release  Which FDA established category indicates a potential risk of a drug to cause birth defects in pregancy because there are no adequate and well-controlled studies to show the drug to cause birth defects in pregnant women? - Correct answer Category B  Which of the following statements about carbamazepine is correct - Correct answer Neutropenia occurs often  Serum levels of carbamazepine equilibrate after a fixed daily dose is given for - Correct answer 3-5 days  Metabolism of carbamazepine occurs through the - Correct answer P- 450 3A4 isoenzyme  Carbamazepine mechanism of action is - Correct answer blockade of sodium gated channels  Food intake _____ the absorption of carbamazepine - Correct answer increases  Lab draws with carbamazepine - Correct answer CBC 2 weeks, then at 6 weeks, then q6 months thereafter  Hypothyroidism in pt receiving lithium is associated with - Correct answer rapid cycling  increased risk of developing depression  Blood tests with lithium - Correct answer Thyroid function test (TFT) at least once in the first 6 months of treatment  BMP (renal function) every 3 months  After first 6 months, LFT, TFT q 6-12 months  Lithium induced hypothyroidism generally occurs within the first - Correct answer 6-18 months  Half life of this hypnotic is 1-3 hours - Correct answer ramelton  Half life of this hypnotic is 1-2 hours - Correct answer zaleplon  Half life of these hypnotics is 2-4 hours - Correct answer triazolam  zolpidem  Antidepressant medication with significant anticholinergic side effects do not need to be avoided in patients with which comorbidity - Correct answer constipation (can be managed by bulk-forming laxatives and hydration)  CYP450 substrate of Alprazolam - Correct answer 3A4  CYP450 substrate of Citalopram - Correct answer 2D6  CYP450 substrate of Codeine - Correct answer 2D6  CYP450 substrate of Caffeine - Correct answer 1A2  Acute alcohol consumption _______ CYP450, but chronic use leads to __________ CYP450 - Correct answer inhibits  induces (break down faster - sub therapeutic level)  Monitoring of liver function tests every 6-12 months is required with which of the following mood stabilizers - Correct answer valproic acid  Side effects of carbamazepine - Correct answer sedation  dizziness  fatigue  nausea  ataxia  agranulocytosis  aplastic anemia  side effects of lithium - Correct answer Tremor  polyuria  polydipsia  weight gain  cognitive slowing  hypothyroidism  decreased creatinine clearance  Side effects of lamotrigine - Correct answer benign rash in 10% of people  Steven's Johnson syndrome in <1%  Withdrawal syndrome following abrupt discontinuation of TCA results from - Correct answer cholinergic rebound  Quinidine and TCA both - Correct answer prolong QT intervals  Adverse effects of TCA overdose - Correct answer severe sedation  hypotension  anticholinergic delirium  Although lorazepam has a relatively short half life, it exerts sustained action via which mechanism - Correct answer lower lipophilicity  Being less _______ produces clinical effects more slowly, but may provide more sustained relief, as the drug comes out of the brain slowly - Correct answer lipophilic  Gabapentin overdose is associated with - Correct answer sedation  ataxia  diplopia  Which one more commonly causes weight gain: gabapentin or valproic acid - Correct answer valproic acid  Adverse effect of Topiramate - Correct answer kidney stone formation (especially after CYP450 activity inhibited d/t acute alcohol ingestion)  St. John's wort effect on Topiramate - Correct answer increases clearance d/t induced CYP450 activity  What medications can cause a hypertensive crisis when used with MAOI? - Correct answer meperidine  epinephrine  local anesthetics (containing sympathomimetics)  decongestants  Pt on clozaril and is concerned that PCP prescribed pt this for her psoriasis - Correct answer methotrexate (inc risk leukopenia)  What antidepressant has the greatest evidence of beneficial effects in patients with depressed mood and eating disorders? - Correct answer Fluoxetine  In CATIE, patients were assigned to treatment with - Correct answer olanzapine  perphenzine  quetiapine  risperidone  or (later) ziprasidone  A 55 year old F takes metoprolol to control her HTN. She has toenail fungus and decides to take her husband's Rx for terbinafine. What is the most likely outcome - Correct answer hypotension (unRx med is 2D6 potent inhibitor leading to elevated levels of the HTN med)  Specific Gravity 1.045 indicates - Correct answer fluid volume deficit  dehydration  SIADH  CHF  Acidosis  Prerenal failure  By what age is the process of absorption and transportation of drugs comparable between children and adults - Correct answer 4 months  ECT deliberately induces what type of phenomenon - Correct answer generalized tonic-clonic seizures  What are 2 common side effects of fluoxetine - Correct answer diarrhea  cramps  All women of childbearing age treated with valproic acid should also receive which of the following vitamin supplements - Correct answer Folate (B-9)  Which of the following medications has the most evidence in its effectiveness for treating drug induced psychosis in patients with Parkinson's disease - Correct answer Clozapine  (Olanzapine is a close second)  What is the most common side effect of galantamine? - Correct answer GI disturbances (diarrhea, nausea, vomiting decreases over time)  Class of drug of galantamine - Correct answer cholinesterase inhibitor  Because cholinesterase inhibitors cause action in the parasympathetic nervous system they can cause - Correct answer bradycardia  hypotension  hypersecretion  bronchoconstriction  GI tract hypermotility  decreased intraoccular pressure  Priapism is associated with which drug - Correct answer trazodone  At 45mg mirtazapine, what can happen? - Correct answer increased serum cholesterol inducing cases of acute pancreatitis and diabetic ketoacidosis.  Mood stabilizers like lithium in pregnancy - Correct answer stopped until 2nd trimester to avoid the time of highest teratogenic risk.  In neonates, high potency antipsychotics - Correct answer are least likely to cause anticholinergic, antihistaminic, or hypotensive effects (unlike low potency medications)  What medication has the most evidence supporting its use in bipolar disorder and schizophrenia in pregnant women - Correct answer haloperidol  effective and safe treatment for severe mania in pregnancy - Correct answer ECT  Neonates can show signs of extrapyramidal side effects when - Correct answer a high potency antipsychotic is used near term  When switching from an SSRI or SNRI to an MAOI, which of the following medications requires a 5-6 washout period? - Correct answer Fluoxetine  Besides Fluoxetine, all other SSRI, SNRIs, and TCAs require a standard ___________ washout period when switching to an MAOI - Correct answer 2 week  What medication demonstrates histaminergic mechanism in addition to increasing dopamine binding to the dopamine transporter to increase wakefulness - Correct answer modafinil  Modafinil increases activity in the - Correct answer tuberomammilary nucleus  stratum  cingulate cortex (at higher doses)  Humans with narcolepsy have decreased levels of - Correct answer histamine in the CSF  Modafinil ________ to the dopamine transporter - Correct answer weakly binds (inhibiting reuptake of dopamine)  Dopaminergic mechanisms that are affected by traditional stimulants, such as amphetamine, are not thought to account for the ___________ induced by modafinil - Correct answer wakefulness  What is the mechanism of action of topiramate? - Correct answer inhibits sodium channels  enhances GABA-a receptors  antagonizes kainite and AMPA (glutamate) receptors  Carbamazepine mechanism of action - Correct answer Inhibits voltage- gated sodium channel activation (doesn't block pores).  inhibits pre-synaptic sodium channels  Depakote mechanism of action - Correct answer increases GABA  Lamotrigine mechanism of action - Correct answer inhibits glutamate  inhibits voltage-gated sodium channels  centrally acting, reversible acetylcholinesterase inhibitor used in tx of Alzheimer's dementia - Correct answer Donepezil (Aricept)  Why is Donepezil contraindicated in sick sinus syndrome? - Correct answer Can cause heart block and symptomatic bradycardia  Flushing is caused by - Correct answer excessive dilation of cutaneous arteries caused by muscarinic blockade (eg atropine)  Rash is less common in these drugs, but patients on these 2 drugs are at risk for Steven's Johnson syndrome - Correct answer oxcarbamazepine  carbamazepine  A low ______ value can occur in isolation with oxcarbazepine - Correct answer T4  What mood stabilizer is associated with aplastic anemia and other blood dycrasias in 1 in 10,000-150,000 treated pts? - Correct answer Oxcarbazepine  Carbamazepine overdose is associated with - Correct answer high grade AV block  CNS depression  Oxcarbazepine overdose is associated with - Correct answer CNS depression  Adjuvant therapy in acute mania to treat hyperkinesis, agitation and insomnia - Correct answer benzodiazepine  Pt's with hx of ADHD in childhood may be at particular risk for medication induced agitation with this medication - Correct answer benzodiazepine  What is the initial medication dosage for treatment of uncomplicated depression:  sertraline ____ - Correct answer 50mg (increase q 2 weeks to max 200)  What is the initial medication dosage for treatment of uncomplicated depression:  Fluoxetine ______ - Correct answer 10mg (maintain for 3 weeks, max benefit at 20-40mg)  Typical maintenance dose of fluvoxamine - Correct answer 100- 200mg/day (short half life)  Typical maintenance dose of fluoxetine is - Correct answer 20-40mg/day  Doses of fluoxetine ______ have more side effects and have not been effective - Correct answer >=60mg  A maximum of ______ is recommended for initial treatment with paroxetine - Correct answer 50mg  Which of the following findings is expected in a patient who is an ultra- rapid metabolizer - Correct answer High urinary concentration of the drug's metabolite  lamictal  Use reserved for treatment resistant bipolar disorder due to multiple drug-drug interactions - Correct answer carbamazepine  Unique side effects of aplastic anemia, Stevens Johnson syndrome and SIADH - Correct answer carbamazepine  Unique side effect of hyponatremia (especially with SSRI). No association with SJS or aplastic anemia. CYP3A4 inducer - Correct answer oxcarbazepine  Unusual side effect of metabolic acidosis, kidney stones - Correct answer topiramate  Unusual rare side effect of hepatoxicity and pacreatitis - Correct answer depakote  Unusual side effect of thyroid dysfunction, chronic renal insufficiency, decreased cardiac conduction efficiency, hypercalcemia, mild leukocytosis - Correct answer Lithium  Linezolid, dextromethorphan, meperidine, propoxyphene, methadone, tramadol and high-dose sumatriptan all have this in common - Correct answer greater risk of serotonin syndrome when added to an SSRI.  All triptan medications used for migraine treatment will cause cause a significant increase in ________ at higher levels - Correct answer serotonin  Smoking and clozapine - Correct answer decreases clozapine level  Tobacco is a _____________ enzymes - Correct answer potent inducer of 1A2  Daily smoking causes antipsychotics to be ________ - Correct answer cleared more quickly necessitating higher doses  St. John's wort is an ________ agent for _______ - Correct answer inducer  3A4  3A5  Substrates affected by St. John's wort include - Correct answer amprazolam  amlodipine  atorvastatin  diazepam  cyclosporine  serotinergic meds  Cruciferous vegetables induces the metabolism of _________ - Correct answer 1A2  Increasing consumption of cruciferous vegetable would _________ clozapine levels - Correct answer lower (need higher dose to decrease risk for psychosis)  For the ER form of divalproex sodium, what is the correct dosing adjustment compared with regular formula - Correct answer increase ER dose by 15%  What is an appropriate loading dose of valproic acid for a hospitalized patient with significant manic symptoms? - Correct answer 20-30mg/kg  Ventricular arrhythmia and seizures can be the result from ______ overdose - Correct answer TCA  Cardiac conduction defects are most severe with ______ overdose - Correct answer desipramine  TCAs are structurally similar to - Correct answer class I arrhythmias (20% proarrythmic & 20% with preexisting conduction disturbances have cardiac complications when taking)  Tyramine-containing foods should be avoided in pts treated with - Correct answer MAOI  Stevens-Johnson syndrome is associated with - Correct answer Lamictal (Lamotrigine)  SIADH, leading to hyponatremia, has been associated with - Correct answer carbamazepine (Tegretol)  Primary consideration when dosing fluoxetine for 9 year old boy - Correct answer height and weight  Adult values for the cytochrome 450 enzymes are generally achieved by what age? - Correct answer 1 years old  Psychotropic medications are not generally prescribed to children under the age of - Correct answer 5 years  Fluoxetine is FDA-approved in the treatment of depression for what ages - Correct answer ages 8 years and older  Monitor ADHD patients on stimulants for - Correct answer palpitations  syncope  CP  vital signs including high blood pressure  What supplement can cause easy bruising? - Correct answer Ginkgo biloba  Gingko biloba should be avoid with - Correct answer antiplatelet and anticoagulant medications  Supplement contraindicated when taking warfarin - Correct answer gingko biloba  Anti-inflammatory and immune enhancing supplement with no known drug interactions - Correct answer Echinacea purpurea  Another name for garlic - Correct answer Allium sativum  Why should garlic be used cautiously with warfarin? - Correct answer anti-platelet effects  Which SSRI has been associated with hyponatremia and SIADH, particularly in elderly females - Correct answer sertraline  Appropriate ED treatment for panic disorder - Correct answer benzodiazepine  Recurrent episodes with at least four of the following symptoms:  --trembling, diaphoresis, nausea  --CP/palpations/dyspnea/choking sensation  --intense anxiety/fear of dying or losing control  --derealization  --depersonalization  --dizziness  --paresthesias  --anxiety about additional attacks  --avoidance behavior - Correct answer panic disorder  First line tx of panic disorder - Correct answer SSRI (fluoxetine, paroxetine, sertraline)  or SNRI (venlafaxine)  Women with PCOS were far more likely than women without PCOS to have - Correct answer mood and anxiety symptoms  7x more likely to make suicide attempt  What is the mechanism of action of sumatriptan - Correct answer 5HT1D and 5HT1B agonist  What is the mechanism of action of aripiprazole - Correct answer 5HT2C agonist  weak partial agonist 5HT7  Pts with hx of seizure d/o are more safely treated for depression with ______ than with ____- - Correct answer SSRI or venlafaxine  TCA or bupropion  What mood stabilizer can cause hypernatremia - Correct answer Lithium  What medication frequently induces nephrogenic diabetes insipidus - Correct answer lithium  How does lithium cause nephrogenic diabetes insipidus - Correct answer it competes with receptors for the antidiuretic hormone in the kidney, increases water output in urine, causing hypernatremia  What attenuates lithium induced diabetes insipidus - Correct answer amiloride  Benzodiazepine anxiolytic subclasses are divided according to their chemical structures. What does this affect? - Correct answer half-life of the drug in body  Half-life of diazepam - Correct answer 40 hours (oxidized in liver)  Temazepam, lorazepam, and oxazepam are metabolized by ______ and cleared by ________ - Correct answer glucuronidation (hepatic dysfunction not affected)  kidney  Besides hypotension, tachycardia, and weight gain, the side effect of clozapine that is most common - Correct answer hypersalivation/drooling (10-40%)  Medication for sleep-onset insomnia that is not habit forming/no abuse potential - Correct answer Ramelteon (melatonin agonist)  Pt on Coumadin recently prescribed fluconazole. What finding would you expect at her next INR blood test - Correct answer elevated  Blocks voltage-dependent sodium channels and increases gamma aminobutyric acid (GABA) in the brain. Both inhibits GABA metabolism and increases its synthesis - Correct answer Valproic Acid  mechanism of action of modafinil - Correct answer 1A2 inducer  3A4 substrate and inducer  Example of CYP1A2 inducers - Correct answer modafinil  charcoal broiled beef  tobacco  marijuana  omepraxole  cruciferous vegetables  List 6 CYP2C19 inhibitors - Correct answer cimetidine  ketoconazole  lansoprazole  modafinil  omeprazole  topiramate  CYP2C19 inducers - Correct answer carbamazepine, phenytoin, rifampin, prednisone  CYPD6 inhibitor - Correct answer bupropion  citalopram  duloxetine  fluoxetine  fluvoxamine  paroxetine  cimetedine  doxepin  haloperidol  methadone  CYP2D6 inducer - Correct answer dexamethasone  rifampacin  CYP1A2 inhibitor - Correct answer Fluvoxamine  Paroxetine  Amiodarone  Fluroquinolones  Cimetedine  CYP1A2 inducers - Correct answer insulin  modafinil (also 3A4 inducer)  omeprazole  phenobarbital (also 3A4 inducer)  rifampicin (also 3A4 inducer)  CYP2B6 inhibitors - Correct answer Ticlopidine  CYPB6 inducers - Correct answer Phenobarbital  Rifampicin  CYP2C8 inhibitors - Correct answer gemfibrozil  giltazones  CYP2C8 inducers - Correct answer 1. Carbamazepine (Tegretol)  2. Phenobarbitol  3. Phenytoin (Dilantin)  4. Rifampin (Rifadin)  CYP2C9 inhibitors - Correct answer Amiodarone  Fluconazole  isonazid  sulfa drugs  trimethoprim  CYPC19 inducers - Correct answer Phenobarbital  Rifampicin  Bupoprion is a _______ substrate - Correct answer 2D6  Methadone is a _______ substrate - Correct answer 2D6 (and inhibitor)  Fluoxetine is a ______ substrate - Correct answer 2C9  2C19  2D6 and inhibitor  (3A4 inhibitor)  Phenytoin is a _______ substrate - Correct answer 2C9  2C19  (3A4 inducer)  Sertraline is a _______ substrate - Correct answer 2C9  2C19  2D6  Prednisone  Rifampicin  What medications would lower the effectiveness of bupropion - Correct answer Rifampicin  Phenobarbital  What medications would lower the effectiveness of olanzepine? - Correct answer insulin  Modafinil  phenobarbital  rifampicin  Drugs affected by tobacco - Correct answer Theophylline  caffeine  tacrine  imipramine  haldol  estradiol  Cigarette smoking results in _______ clearing of heparin - Correct answer faster (inducer)  Stopping cigarette smoking can result in caffeine __________ - Correct answer toxicity  Patients who smoke may have _____ levels of clozapine, haldol or olanzapine - Correct answer lower serum concentration  The turnover time for CYP1A2 is __________ - Correct answer approximately 3 days with steady state reached at 1 week (important to remember when managing inpatients in smoke-free facility - can result win drug toxicity)  Cumin and turmeric ________ CYP1A2 activity - Correct answer inhibit  blockage of voltage gated sodium channels  decreases glutamate release  potentiates GABA  weak inhibitor of carbonic anhydrase - Correct answer topiramate  inhibition of alpha subunit of G protein associated with cAMP - Correct answer Lithium  Indications:  acute mania - Correct answer Lithium  valproic acid  Indications:  acute/mixed mania - Correct answer Carbamazepine  Valproic acid  Risperidone  Asenapine  Indications:  Trigeminal neuralgia - Correct answer Carbamazepine  Indications:  Partial seizures  Grand mal seizure patterns  Mixed seizure patterns - Correct answer Carbamazepine  Indication:  complex partial seizures  simple and complex seizures  migraine prophylaxis - Correct answer Valproic acid  What mood stabilizer is more likely to cause psoriasis and acne? - Correct answer lithium  What mood stabilizer is more likely to cause thyroid dysfunction? - Correct answer Lithium  What mood stabilizer has neuroprotective effects - Correct answer Lithium  What mood stabilizer inhibits GSK-3 beta? - Correct answer Lithium (plays role in tau phosphrylation)  What mood stabilizer increases bel-2? - Correct answer Lithium (inhibits apoptosis)  What mood stabilizer is more likely to cause renal insufficiency? - Correct answer Lithium  Indications:  maintenance and propylaxis of bipolar - Correct answer Lithium  Risperidone  Indications:  mood stabilizer the augments antidepressant - Correct answer Lithium  Indications:  schizoaffective (bipolar type) - Correct answer Lithium  Indications:  Maintenance of bipolar II - Correct answer Lamictal  Indications: Partial seizures in adult and children - Correct answer oxcarbazepine  Indications: Lennox-Gaust syndrome seizures, partial seizures, tonic- clonic seizures, migraine prophylaxis - Correct answer Topiramate  St John's wort lowers the level of - Correct answer Warfarin  Digoxin  Ginkgo Biloba contraindications - Correct answer pt on antiplately or anticoagulant med  Garlic should be used cautiously with - Correct answer anti platelet and anticlotting medications  After dc of benzodiazepine, rebound insomnia is likely to happen. What's the next step in mgmt? - Correct answer Start sedative antihistamine  What medications should be used with caution or avoided with ECT? - Correct answer theophylline (can prolong seizure and status epileptics)  hypoglycemics  Beta blockers (can cause systole)  Lidocaine (reduce seizure induction)  Lithium (can prolong seizure and confusion)  What med if given with ECT can prolong seizure and confusion? - Correct answer Lithium  What med if given with ECT can cause systole? - Correct answer Beta blockers  What med if given with ECT can reduce seizure induction - Correct answer Lidocaine  Alopecia is transient when taking valproic acid and can be treated with - Correct answer a multivitamin containing zinc and selenium  Side effects of valproic acid are more frequent with ____________ than with other preparations - Correct answer divalproex sodium  What antipsychotic has a very low risk of TD's and no increase in prolactin? - Correct answer Quetiapine  With what antipsychotic should you monitor with ophthalmological exam, AIMS, blood glucose, lipid profile, weight? - Correct answer Quetiapine  With what antipsychotic should you monitor prolactin level? - Correct answer Risperidone  With what antipsychotic should you monitor CBC? - Correct answer Clozapine  What antipsychotic has potent alpha-1 blockade (prazosin like effects for PTSD related nightmares) and need to watch for orthostatic hypotension? - Correct answer Lloperidone  What med causes notable side effects of agranulocytosis, seizures, myocarditis, cardiorespiratory failure - Correct answer Clozapine  What antipsychotic has blood level available? - Correct answer Clozapine  What antipsychotic can cause oral hypesthesia? - Correct answer Asenapine  Major side effects of this antipsychotic include - Correct answer Rare EPS  Prominent Sedation  Very low weight gain  What antipsychotic causes excess salivation? - Correct answer Clozapine  What antipsychotic reduces suicide? - Correct answer Clozapine  What antipsychotic can cause rebound psychosis and cholinergic rebound when abruptly withdrawing - Correct answer Clozapine  What antipsychotic is preferred treatment of behavioral disturbance in children - Correct answer Risperidone  There is a ________________ in patients taking anticonvulsants per black box warning - Correct answer suicide and depression  Carbamazepine, phenytoin and oxcarbazepine are _______ of the CYP3A4 system and can ___________ levels of antidepressants and antipsychotics - Correct answer inducer  lower  Barbituates and gapapentin have an increase risk of ________ in epileptic patients - Correct answer depression  What is not a reasonable way to treat hypotension caused by an MAOI - Correct answer introduce a small amount of cheese into diet (amount of tyramine differs among types of cheeses)  What are safe ways to increase BP in person taking MAOI - Correct answer increase salt intake  fludrocortisone 0.6-0.8mg daily  wear support stocking  ensure adequate hydration  stimulant medication  When is the best time to measure plasma levels of lithium during therapy? - Correct answer 12 hours after last dose  A substance that decreases the metabolism of drugs - Correct answer inhibitor  Is echinacea an inducer or inhibitor? - Correct answer Inhibitor  Mechanism of atomoxetine - Correct answer blocks reuptake of norepinephrine  Atomoxetin increases NE and DA levels by _____ in the _______ - Correct answer 3x  prefrontal cortices  (no change in striatum or nucleus accumbans)  Increased NE has been shown to improve - Correct answer depressive symptoms  fatigue  hypersomnia  motoric retardation  anhedonia  Common side effects of atomoxetine are - Correct answer dry mouth  insomnia  constipation  urinary hesitancy  Valproic acid ________ the elimination half life of lamotrigine - Correct answer doubles  Which med is used to tx alcohol use disorder by inhibiting a step in alcohol metabolism, leading to buildup of a toxic metabolite - Correct answer Disulfiram  Disulfiram blocks _______ leading to - Correct answer aldehyde dehydrogenase  unpleasant hangover like side effects from drinking ETOH (accumulation of acetaldehyde)  ______ and ______ block the activation of the reward system associated with alcohol and opiates - Correct answer Naltrexone  Nalmefene  Cognitive affects of taking benzodiazepines are greatest in _____ - Correct answer elderly (especially at risk is pts with delirium and dementia)  Initial side effects of benzodiazepines can persist and worsen in pts - Correct answer with liver disease  taking longer-acting agents (diazepam)  What antidepressants significantly increase dopamine? - Correct answer Phenelzine  Selegiline  (Bupropion is slight)  Which antidepressants significantly increase NE? - Correct answer Desipramine  Amitriptyline  Buproprion  Duloxetine  Phenelzine  Selegiline  Which antidepressants increase does not increase DA or 5-HT but increases NE? - Correct answer Desipramine  Which antidepressants increase NE and 5-HT, but not DA - Correct answer Amitriptyline  Duloxetine  Effexor  A 14 year old boy is dced on carbamazepine after an admission for acute mania. About 4 weeks later, he is again acutely manic despite having been initially stabilized on carbamazepine. What is the likely cause of this medication failure? - Correct answer Autoinduction  transcription up regulation of genes involved in its own metabolism - Correct answer Autoinduction  How long does auto induction of carbamazepine take - Correct answer 3-5 weeks (after ignition of a fixed dose when taken consistently)  Meds that can increase serum concentration of 3A4 temporarily (but ultimately act as an inhibitor) - Correct answer Cimetidine  Erythromycin  Grapefruit juice  Vagus nerve stimulation is FDA approved for - Correct answer epilepsy  treatment resistant depression  it involves surgical implantation of a device in the carotid sheath - Correct answer vagus nerve stimulation  Adding ginseng to lithium can cause - Correct answer irritability, insomnia and mania  Adding ginseng to neuroleptics or phenelzine can cause - Correct answer irritability, insomnia and mania  What adverse reaction is associated with mirtazapine use? - Correct answer Agranulocytosis (1/1000)  Mirtazapine ______ nausea and vomiting due to ________ - Correct answer improves  5-HT3 receptor blockade  Urinary ______ can occur with mirtazapine - Correct answer frequency  Kava acts on ________ receptors and long term use has been linked with ___________ - Correct answer GABA  liver toxicity  Foods that act as inducer - Correct answer Cauliflower  leafy green vegetables  broccoli  carrots  licorice  Foods that act as inhibitor - Correct answer grape (resveratrol)  grapefruit juice  cranberry  pomegranate  mango  red peppers  green tea  vitamin E  kava kava root  Cocaine during pregnancy has been associated with - Correct answer Uterine Growth Restriction (IUGR)  Placental Abruption  Small for gestational age (SGA)  Carbamazepine is ______ for mothers who are breastfeeding - Correct answer Safe  Valproid acid is ______ for mothers who are breastfeeding - Correct answer safe  Phenytoin is ______ for mothers who are breastfeeding - Correct answer safe  Phenobarbital is ______ for mothers who are breastfeeding - Correct answer safe  Primidone is ______ for mothers who are breastfeeding - Correct answer safe  Lithium is ______ for mothers who are breastfeeding - Correct answer unsafe (EKG changes and toxicity)  Lamotrigine is ______ for mothers who are breastfeeding - Correct answer unsafe (risk of fatal rash)  Clonazepam is ______ for mothers who are breastfeeding - Correct answer unsafe (CNS/respiratory depression)  Can cause hyponatremia especially when given with SSRI - Correct answer Oxcarbazepine  Lithium _______ affect the efficacy of oral contraceptives at any dose - Correct answer does not  Carbamazepine_______ affect the efficacy of oral contraceptives at any dose - Correct answer does (decreases efficacy)  Another name for Carbamazepine - Correct answer Tegretol  Topiramate _______ affect the efficacy of oral contraceptives at any dose - Correct answer at doses >200mg does (decreases efficacy)  Oxcarbazepine _______ affect the efficacy of oral contraceptives at any dose - Correct answer does (decreases efficacy)  A 64 year old man with early stage Parkinson's disease takes the MAO- B inhibitor selegiline for symptomatic relief. Why are MAO-B inhibitors favored over MAO-A inhibitors for treating Parkinson's disease - Correct answer MAO-A normally metabolized tyramine  Two MAO-Bi drugs that have been approved by FDA without dietary restrictions for early stage Parkinson's (but lose selectivity at high- dose) - Correct answer Selegiline  rasagiline  MAO-B inhibitors principally block - Correct answer dopamine  phenylethylamine  What will not increase lithium levels? - Correct answer High sodium diet  A low sodium diet is likely to ______ lithium - Correct answer increase  Toxicity of Lithium occurs at levels marked by tremor, GI symptoms, blurred vision, increased DTR, vertigo, and confusion - Correct answer >1.5 meq/L  Life-threatening toxicity of Lithium occurs at - Correct answer >2.0 meq/L  At Lithium level of ___________ seizures, coma, arrhythmias, and permanent neurological impairment may occur - Correct answer >2.5 meq/L  In acute toxicities with lithium levels >4.0 meq/L ________ is the only way to get lithium out of the bloodstream - Correct answer hemodialysis  Medications associated with higher level of Lithium - Correct answer diuretics  Asenapine (Saphris) competes with lamotrigine at _______________ - Correct answer glucuronidation site 1A4  Atorvastatin (Lipitor) competes with lamotrigine at _______________ - Correct answer glucuronidation site 2B7  buprenorphine/naloxone competes with lamotrigine at _______________ - Correct answer glucuronidation site 2B7  Ibuprofen (Advil, Motrin) competes with lamotrigine at _______________ - Correct answer glucuronidation site 2B7  Fenofibrate (Tricor) competes with lamotrigine at _______________ - Correct answer glucuronidation site 2B7  Oxycodone/APAP (Percocet) competes with lamotrigine at _______________ - Correct answer glucuronidation site 2B7  Hydromorphone (Dilaudid) competes with lamotrigine at _______________ - Correct answer glucuronidation site 2B7  Methadone competes with lamotrigine at _______________ - Correct answer glucuronidation site (2B7)  Tacrolimus (Prograf) competes with lamotrigine at _______________ - Correct answer glucuronidation site 2B7  Codeine competes with lamotrigine at _______________ - Correct answer glucuronidation site 2B7  Temazepam (Restoril) competes with lamotrigine at _______________ - Correct answer glucuronidation site 2B7  Valproic Acid (Depakote) competes with lamotrigine at _______________ - Correct answer glucuronidation site 2B7  Simvastatin (Zocor) competes with lamotrigine at _______________ - Correct answer glucuronidation site 2B7  carvediolol (Coreg) competes with lamotrigine at _______________ - Correct answer glucuronidation site 2B7  Cyclosporine competes with lamotrigine at _______________ - Correct answer glucuronidation site 2B7  Lorazepam (Ativan) competes with lamotrigine at _______________ - Correct answer glucuronidation site 2B7  Oxazepam (Serax) competes with lamotrigine at _______________ - Correct answer glucuronidation site 2B7  Benzodiazepines that undergo glucuronide conjugation 2B7 (not via the cytochrome p450 system) - Correct answer Oxazepam  Temazepam  Lorazepam  (OTL mnemonic: Outside The Liver).  What drug has been associated with insulin-like effect responsible for lowering blood glucose and increasing appetite and weight gain? - Correct answer Lithium  What drug has been associated with myocarditis? - Correct answer Clozapine  What drug has been associated with eosinophilic colitis - Correct answer Clozapine  In studies, which ECT modality reduces cognitive side effects but is less effective in terms of symptom reduction? - Correct answer unilateral non dominant  A patient discharged on valproate has been stable for many years on lamotrigine, and you would like to initiate therapy with this medication and reach a therapeutic level before tapering off the valproate. What would be the starting dose of lamotrigine? - Correct answer Half of what it would normally be since half life effect is doubled  Between olanzapine, clozapine, quetiapine, and haldol, which is least associated with sedation? - Correct answer Haldol  3 antipsychotics with high anticholinergic effects - Correct answer clozapine  thioridazine  chlorpromazine  4 antipsychotics associated with high sedation - Correct answer clozapine  quetiapine  thioridazine  chlorpromazine  Olanzapine is associated with _______ sedation - Correct answer mild  What antipsychotic is not associated with EPS? - Correct answer Clozapine  Risperidone is _____ anticholinergic, ______ sedation _______ EPS - Correct answer low  low  low  Haloperidol is ______ anticholinergic, _______ sedation, ______ EPS - Correct answer low  low  high  Thiroidazine is _____ anticholinergic, _____ sedation, ____ EPS - Correct answer high  high  low  Chorpromazine (Thorazine) is ______ anticholinergic, ______ sedation )______ EPS - Correct answer high  high  low  Quetiapine is _____ anticholinergic, ______ sedation, ______ EPS - Correct answer low  high  low  Olanzapine (Zyprexa) is ______ anticholinergic, ______ sedation, ______ EPS - Correct answer low  mid  low  Ziprasidone (Geodon) is ______ anticholinergic, _____ sedation, _____ EPS - Correct answer low  low  low  Aripiprazole (Abilify) is _______ anticholinergic, ______ sedation, ______EPS - Correct answer low  low  low  Another name for Abilify - Correct answer Aripiprazole  While caution needs to be applied weighing risks and benefits, ECT has been safely administered (after appropriate subspecialty consultation) to pts with a hx of - Correct answer brain surgery  deep brain stimulators  cardiac pacemakers  AICD  vagus nerve stimulator  seizures  space occupying intracerebral lesions  ADHD patients may have side effects from stimulants that represent - Correct answer manifestation or exacerbation of comorbid disorder (ie GAD)  Side effect of treatment  Antihistamine _______ is used to increase appetite - Correct answer Cyproheptadine  Medications to treat sleep problems associated with stimulant use - Correct answer Melatonin  Clonidine  Diphenhydramine  Trazodone  Mirtazapine  Hyperparathyroidism is associated with which medication - Correct answer Lithium  hyperparathyroidism - Correct answer excessive levels of parathyroid hormone  Ketoconazole is ______ of the ______ enzyme - Correct answer inhibitor  3A4  Cannabinoids is a _______ of the ______ enzyme - Correct answer inhibitor  3A4  Phenytoin, Carbamazepine, and St John's wort have this in common - Correct answer 3A4 inducer  Ketoconazole, amiodarone, and erythromycin have this in common - Correct answer 3A4 inhibitor  Regarding ECT treatment for depression in adolescents, which of the following statements is correct - Correct answer response to ECT is similar in adolescents and adults  Before ECT is used on an adolescent - Correct answer 2 child and adolescent psychiatrists who are not the primary caregivers for the adolescent should be consulted and agree that it is indicated  Which antidepressant is least likely to cause significant drug-drug interactions in the elderly - Correct answer Venlafaxine (most SSRIs cause some inhibition of the 2D6 enzyme which leads to increased plasma level of other drugs (ie antiarrhythmics, benztropine, TCA, many antipsychotics)  A 26 year old F with dx of bipolar on lithium presents to ED with marked tremor, ataxia, and confusion after a suspected suicide attempt less than an hour before admission. Her lithium level is 2.1. Over the next half hour, the pt becomes increasingly confused and then unresponsive, what is the next step in management? - Correct answer Alert nephrology for emergent hemodialysis  Which medication has been helpful in women with stress incontinence - Correct answer Duloxetine  Another name for Lurasidone - Correct answer Latuda  Another name for Latuda - Correct answer Lurasidone  Indicated for bipolar depression - Correct answer Latuda (Lurasidone)  What medication given in combination with Latuda may cause orthostatic hypotension - Correct answer beta blocker  Which substance or technique was first used to induce convulsion to treat psychiatric illness and catatonia - Correct answer Camphor  What medication when given with SSRI is most likely to predispose patients to serotonin syndrome - Correct answer Meperidine (Demerol)  Valproic acid is superior to lithium in patients with - Correct answer mixed symptoms  prominent depressive symptoms during mania  multiple prior mood episodes  ________ is more effective than Valproic acid in reducing symptoms of acute mania - Correct answer Olanzapine  Valproic acid and _________ are equally efficacious in the treatment of acute mania - Correct answer haldol (response rate 48-53%)  Divalproex sodium is also known as - Correct answer Depakote  Valproic acid  Valproate Sodium  Max dose of Divalproex Sodium - Correct answer 60mg/kg/day  Depakote is also known as - Correct answer Divalproex Sodium  Valproic Acid  Volproate Sodium  Carbamazepine may ______ the effectiveness of Risperidone - Correct answer Decrease  Carbamazepine is metabolized in the ____ by ____ substrate - Correct answer liver  3A4  ________ requires monitoring for signs of bruising and bleeding - Correct answer Carbamazepine  What medication causes metabolic acidosis via carbonic anhydrase inhibition? - Correct answer Topiramate  What does metabolic acidosis via carbonic anhydrase inhibition initiate? - Correct answer kidney stone formation  Carbamazepine acts as a CYP 450 3A4 ____, ____ the effectiveness of other CYP 3A4 substrates - Correct answer inducer  lowering  What anti-epileptic medication causes bone marrow suppression, resulting in agranulocytosis and leukopenia - Correct answer Carbamazepine (Tegretol)  What antidepressant should be used in caution with a patient taking a protease inhibitor (ritonavir, saquinavir) because of toxic interaction - Correct answer Nefazodone  Nefazodone is also know as - Correct answer Serzone  Serzone is also known as - Correct answer Nefazodone  Naltrexone is also called - Correct answer ReVia  Which MAOI antidepressant has the lowest incidence of sexual dysfunction? - Correct answer Tranylcypromine  Which MAOIs have a high incidence of sexual dysfunction - Correct answer Isocarboxazid  Phenelzine  Tranylcypromine is also known as - Correct answer Parnate (MAOI)  Isocarboxazid is also known as - Correct answer Marplan (MAOI)  Phenelzine is also known as - Correct answer Nardil (MAOI)  The 2015 Beers criteria contains a strong recommendation against using SSRI in combination with other __________ in older adults based on moderate evidence for __________ - Correct answer CNS acting medications  increased fall and fx risk  Memantine is also known as - Correct answer Namenda  Memantine mechanism of action - Correct answer NMDA receptor antagonist  Potent allosteric potentiating ligand of human nicotinic acetylcholine receptors - Correct answer Galantamine  Galantamine is also known as - Correct answer Razadyne  an acetylcholinesterase inhibitor that inhibits both butyrlcholinesterase and acetylcholinesterase - Correct answer Rivastigmine  Selectively inhibits acetylcholinesterase unlike Rivastigmine - Correct answer Donepezil  Donepezil is also known as - Correct answer Aricept  Precursor to the neurotransmitters dopamine, norepinephrine and epinephrine (collectively known as catecholamines) - Correct answer L- DOPA  2 typical antiparkinsonian drugs that are ineffective in the tx of antipsychotic-induced Parkinsonism - Correct answer Levodopa  Selegiline  antipsychotic-induced Parkinsonism medication that works for tx, but its effects tend to wear off - Correct answer Amantadine  Lithium is associated with risk of Ebstein's anomaly which is malformation of which structure - Correct answer Tricuspid valve  What is true regarding methylphenidate and amphetamine? - Correct answer Both stimulants increase intrasynaptic levels of NE and Dopamine  Through which receptor dose mirtazapine exert its effect - Correct answer Alpha-2 adrenergic antagonism.  What do oral contraceptives, reserpine, clonidine, ETOH, hydralazine, amantadine, benzodiazepines, and guanethidine have in common - Correct answer can cause depression  Reserpine (Serpasil) - Correct answer peripherally-acting sympathetic antagonist used for HTN; depletes stores of catecholamines in neurons; decreases TPR and CO  Guanethidine (Ismelin) - Correct answer adrenergic neuron blocker  can cause depression  Loxapine (Loxitane) - Correct answer typical tetracyclic antipsychotic with antidepressant properties  It's active metabolite is amoxapine which is a secondary amine tricyclic antidepressant - Correct answer Loxapine (Loxitane)  Patients with atypical depression respond particularly well to this MAOI - Correct answer Phenelzine (Nardil)  What is the most appropriate medication for melancholic depression in the geriatric population? - Correct answer Nortriptyline  Nortriptyline is also called - Correct answer Pamelor  Which of the following is the safest short acting barbiturate that can be used as an induction for anesthesia? - Correct answer Sodium thiopental  What medication should be avoided in patient with hx of epilepsy and hyperlipidemia who wants to quit tobacco use? - Correct answer Bupropion  What is the best medication option for pt who wants to quit tobacco use who has a hx or seizures - Correct answer Varenicline  can be combined with NRT  Nephrolithiasis occurs in about _______ of topiramate pts - Correct answer 15%  Associated with acute myopia and secondary closure glaucoma, causing ocular pain and blurred vision d/t increased intraocular pressure - Correct answer Topiramate  Metabolic acidosis is associated with ______, _____ levels should be monitored during use - Correct answer topiramate  serum bicarbonate  These side effects do not improve over time with topiramate use - Correct answer Decreased appetite  paresthesias  cognitive slowing  Weight loss is a significant side effect of - Correct answer topiramax  Placing electromagnetic coil on scalp and running electricity through it - Correct answer TMS  When was ECT first used in the US - Correct answer 1940s  Which TCA has been found in considerably higher concentration in breast milk compared to other medications in the same class? - Correct answer Doxepin  Doxepin is also known as - Correct answer Sinequan (TCA)  Inhibits voltage-dependent sodium channels and presynaptic sodium channels - Correct answer Carbamazepine (Tegretol)  Increases GABA in brain - Correct answer Depakote  Inhibits glutamate releases - Correct answer Carbamazepine  Inhibits sodium channels, enhances GABA-a receptors, and antagonizes kainite at AMPA receptors - Correct answer Topiramate