Medical Conditions, Personality Disorders, and Psychiatric Medications, Exams of Nursing

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Question Bank for PMHNP Boards with Answers 2024 What is true of interprofessionality? \ n ✔All health professionals have individual professional competencies What is the significance of an experimental p-value of 0.05 \ n ✔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? \ n ✔30% In the DSM-5, selective mutism is now considered what type of disorder? \ n ✔anxiety disorder Symptoms of selective mutism must persist for at least \ n ✔1 month Common competencies \ n ✔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 \ n ✔enhance the qualities of other professions in provision of care Collaborative competencies \ n ✔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 \ n ✔patient Cognitive therapy is recommended for patients that have \ n ✔negative cognitive distortions irrational beliefs faulty conceptions Humanistic Therapy focuses on assisting patients with \ n ✔self-actualization and self-directed growth Behavioral Therapy focuses on \ n ✔changing maladaptive behaviors through the use of behavioral modification techniques Existential therapy is for \ n ✔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? \ n ✔6 ((120X160)/(80x40)) The New Freedom Commission on Mental Health (NFCMH) released a report that suggested \ n ✔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 \ n ✔influential report issued by US Surgeon General in 1999 State of high negative emotion and pessimism \ n ✔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. \ n ✔Extraversion (high levels protect from psychiatric illness) Introverts are more likely to be _______ motivated and more likely to respond to _______ reinforcement \ n ✔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 \ n ✔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. \ n ✔conscientiousness In behavioral couples therapy, the initial sessions are spent doing a functional analysis of behavior (FAB). What is true about FAB? \ n ✔FAB is concerned only with observable stimuli connected to operant behavior FAB is based on operant conditioning (identifying antecedent stimuli, operant behaviors, and consequent stimuli) The goal of FAB is modifying willful operant behavior Gestalt theory deals with _____, not _____ \ n ✔perceptual psychology behavior Medication that can delay ejaculation in patients with premature ejaculation \ n ✔Paroxetine (and other SSRIs) (others include: Topical anesthetic Tramadol Phosphodiesterase-5 inhibitors) First line treatment for lithium induced diabetes insipidus \ n ✔Amiloride (K potassium diuretic) in addition to dc lithium when possible. Ways to reduce polyuria associated with lithium toxicity \ n ✔reduce lithium dose to minimum effective dose Involves resisting or refusing to remember information that has been supplied \ n ✔Denial Pica and spoon shaped nails are associated with \ n ✔Iron-deficiency anemia (microcytic) 2 common causes of microcytic anemia \ n ✔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 \ n ✔Generalized weakness Paresthesias Possible ataxia Late symptoms of B12 deficiency \ n ✔Memory impairment Depressed mood 5 P's of Vitamin B12 deficiency \ n ✔Pancytopenia (Peripheral and Posterior spinal cord) neuropathy Pyramidal tract signs Papillary atrophy of tongue (atrophic glossitis) 2 causes of megaloblastic macrocytic anemias \ n ✔Vitamin B12 deficiency Folate deficiency What neurotransmitter is thought to play the most significant role in social phobia? \ n ✔dopamine What neurotransmitter is thought to mediate social interest, gregariousness, confidence and sensitivity to rejection? \ n ✔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? \ n ✔mirror psychotherapy The ________ is part of the treatment to encourage a patient to accept his physical condition \ n ✔mirror Discussing medical diagnoses and the reaction to it, as well as treatment modalities \ n ✔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 \ n ✔Gestalt Therapy PANDAs is associated with _________ infections and results in _______ symptoms \ n ✔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? \ n ✔meningococcemia 1 mg of Xanax = _____ mg of Ativan \ n ✔2 1mg of Xanax = ____mg of phenobarbital \ n ✔30 1mg Xanax = ____ mg of Clonazepam (Klonopin) \ n ✔1 1mg Xanax = ____ mg of chlordiazepoxide (Librium) \ n ✔25 1mg of Xanax = ____ mg of diazepam (Valium) \ n ✔10 Pt wanting something immediate and non-addictive for breakthrough anxiety \ n ✔Hydroxyzine How long do GAD symptoms need to occur to make the diagnosis? \ n ✔6 months First lab test to check for Sjogren's \ n ✔Anti-nuclear antibody tests To diagnose Cyclothymic disorder, it must be present for _______ in adults \ n ✔2 years To diagnose Cyclothymic disorder, it must be present for _______ in pediatrics \ n ✔1 year 4 physiological disturbances that may explain some of the symptoms of panic \ n ✔impaired lactate metabolism abnormality of locus coeruleus (Ser, NE, GABA, Dop, cholecystokinin) carbon dioxide hypersensitivity (hyperventilation) A 45-year-old man presents to the ER for "panic attack". He appears agitated, confused, and dizzy. He became more agitated and combative with staff upon further questioning. He states he was prescribed Xanax 0.5mg 3x daily by outpatient psychiatrist. His vitals are WNL. What is most likely his dx \ n ✔Benzodiazepine intoxication Anxiety, tremors, nightmares, insomnia, anorexia, nausea, vomiting, hypotension, seizures, delirium and hyperprexia are sx of. ______ which can result in _______ \ n ✔Benzodiazepine withdrawal (serious medical complications including death) Confusion, AH, VH following a period of insomnia can be a sx of \ n ✔withdrawal delirium Female patients with PTSD commonly have this comorbid diagnoses \ n ✔Major depressive disorder (50%) Percentage of people with PTSD who have alcohol use disorder \ n ✔male 50% female 27% Percentage of people with PTSD who have simple or social phobias \ n ✔30% both male and female Percentage of people with PTSD who have persistent depressive disorder ( previously dysthymia) \ n ✔20% for both male and female Treatment plan for OCD \ n ✔SSRI or Clomipramine Psychotherapy Normal Rinne test is for this nerve \ n ✔CN VIII What ethnic groups are at higher risk for social phobia \ n ✔Native American What ethnic groups are at lower risk for social phobia \ n ✔Asian Black Latino Onset of social phobia is \ n ✔Usually begins in late adolescence or early adulthood (13-20 years) 3 CBT techniques for social phobias \ n ✔exposure cognitive restructuring social skills training Medication used to help with social phobia for public speaking \ n ✔propranolol FDA approved SSRI for social phobia \ n ✔paroxetine What type of fracture is a red flag for child abuse? \ n ✔Spiral of long bone (caused by twisting of extremity) Bruises on the torso in different stages of healing often indicate \ n ✔abuse Tanner Stage: Breast buds undeveloped with papilla elevation only. Villus hair only \ n ✔I Tanner Stage: Breast buds palpable, straight pubic hair mostly on labia \ n ✔II Tanner Stage: Areola begins to enlarge and pubic hair becomes darker, coarser, and curly \ n ✔III 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 \ n ✔Acute angle closure glaucoma (Emergency) What STD is not reportable in all 50 states \ n ✔HPV Romberg test is a test of \ n ✔balance A child will recognize faces and smile appropriately at familiar faces by age ____ \ n ✔3 A typical _____ can count up to 20 with minimal assistance of an older child or parent \ n ✔4 year old A typical _____ can run/walk up and down the stairs \ n ✔21 month old A typical _____ is beginning to acquire language skills \ n ✔14 month old What herbal supplement is effective for a pt with an adjustment disorder with anxiety according to RCT \ n ✔Kava Kava What herbal supplement is effective for somatoform disorders according to RCT \ n ✔St. John's Wort Recurrent spontaneous episodic vertigo, hearing loss. Must have aural fullness or tinnitis on one size to make dx. \ n ✔Meniere's Disease ADPIE stands for \ n ✔Assessment Diagnosis Planning Implementation Evaluation If diagnosed with an adjustment disorder, which dx is most guarded: that of an adult or that of an adolescent? \ n ✔adolescent (more likely to develop major psychiatric illness) Gastrointestinal lithium toxicity symptoms can overlap with \ n ✔normal side effects (N/V) What is FDA approved for suicidality in schizophrenia \ n ✔Clozapine Clozapine can cause this CBC abnormality \ n ✔leukopenia (agranulocytosis) What is the dependent variable of a study examining the effects of a certain medication on hypertension? \ n ✔Blood pressure What is the independent variable of a study examining the effects of a certain medication on hypertension? \ n ✔Medication Effect of a variable that is not controlled \ n ✔Confounding effect Type of error that results in the way the experiment is conducted, often due to the expectations of the researcher \ n ✔Bias Pharmacological treatment of alcohol use disorder \ n ✔Start Naltrexone at 25mg PO daily (1-hour observation for rxn). Naltrexone maintenance dose is usually 50mg PO q day or 380mg IM q 4 weeks Naltrexone side effects \ n ✔Elevated LFTs Mild dysthymia GI upset Resembles GABA and is possibly an NMDA antagonist \ n ✔Acamprosate Aldehyde dehydrogenase inhibitor \ n ✔Disulfiram (Antabuse) Modest efficacy, may work better in combination with Naltrexone for alcohol use disorder \ n ✔Acamprosate No convincing efficacy found for use of this Alcohol Use Disorder pharmacological treatment \ n ✔Disulfiram (Antabuse) Most commonly reported side effect of ECT \ n ✔Retrograde amnesia Neurodevelopmental disorder of biological origin that manifests in learning difficulties and problems in acquiring academic skills markedly below age level and manifested in the early years for at least 6 months that is not attributed to intellectual disabilities, development disorders or neurological or motor disorders \ n ✔Specific Learning Disorder Specific Learning Disorders can be specified as impairment in \ n ✔Reading Written Expression Mathematics The MOST important component when developing evidence based guidelines \ n ✔An evidence review How does botox improve depression? \ n ✔Reducing frown lines when injected into glabellar region According to a study in the 1990s mothers of anorexic pts have an increased prevalence of this disorder \ n ✔Obsessive-compulsive disorder The AST:ALT ratio in patients with Alcoholic liver disease \ n ✔<0.8 >1.5 Liver biopsy reveals fibrosis, necrosis of liver cells, and nodule formation \ n ✔Liver cirrhosis Acute condition with nystagmus, ataxia, confusion, and opthalmoplegia \ n ✔Wernicke-Korsacoff syndrome Elevated bilirubin level is often found in \ n ✔Alcoholic hepatitis Which drug's mechanism of action includes blockage of the voltage dependent sodium channel blockers, augmentation of gamma amino butyrate activity of GABA- A receptors, antagonism of AMPA/kainate subtype of glutamate receptor, and inhibition of carbonic anydrase enzyme? \ n ✔Topiramate Ex of drugs that are partial agonists at postsynaptic serotonin receptors \ n ✔Hallucinogens like LSD and MDMA Drug associated with inhibition of catecholamine reuptake in neurons and blockage of NMDA glutamate receptors \ n ✔PCP Individuals with panic disorder are most commonly affected by which other psychiatric disorder \ n ✔Agoraphobia When is the use of transdermal selegiline not beneficial? \ n ✔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 \ n ✔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. \ n ✔Selegiline Adverse effect of carbamazepine that can be an emergency \ n ✔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? \ n ✔Secondary Prevention Form of thinking that is logical, organized, reality oriented, and influenced by the demands of the environment \ n ✔second process thinking What percentage of the population meets the criteria for 1 or more personality disorders? \ n ✔15% Study on daily exercise improving sleep quality in seniors. What is the dependent variable \ n ✔Sleep quality The federal law that allows parents to provide insurance coverage for their children up to age 26 is \ n ✔Affordable Care Act (ACA) Pedophiles attracted to female victims usually prefer females of what age? \ n ✔8-10 years old What is true of appropriation bills? \ n ✔They provide for spending authority for a single fiscal year What bills establish laws or programs and although they recommend dollar amounts in some cases, do not allocate the funds or guarantee funds for the program \ n ✔Authorization bills What bills usually originate in the House of Representatives and provide spending authority for a single fiscal year \ n ✔Appropriation Bills Provide additional funding for projects as needed thought the current fiscal years \ n ✔Supplemental appropriations Authorization bills are funded by \ n ✔Appropriation Bills What is required for entry to practice as a Nurse Practitioner \ n ✔Competency in nine content domains The NP is caring for a 16 year old who is depressed with suicidal ideation. The pt asked the nurse NOT to tell her parents. The most appropriate intervention for the nurse to do is: \ n ✔Talk to parents and pt together to help the family discuss the pt's depression According to Mahler, which of the following stages of infant development is disrupted in children who develop borderline personality disorder \ n ✔Rapproachment According to Mahler, which of the following stages of development was disrupted int children who developed narcissistic personality disorder \ n ✔Symbiotic phase Phase during first weeks of life, characterized by total detachment and self- absorption, infant spends most of his or her time sleeping \ n ✔Autistic stage When does the symbiotic phase occur \ n ✔about 5 months of age According to Mahler, separation-individuation has 3 stages \ n ✔Hatching (5-9 months) Practicing (9-16 months) Rapproachment (15-24 months) Phase where infant explores the outside world but requires that the mother is present and able to support the child appropriately and emotionally in completing the task? \ n ✔Rapprochment (15-24 months) Phase in which infant develops the physical ability to separate from mother \ n ✔Practicing (9-16 months) Disturbance of the rapprochement subphrase is associated with \ n ✔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 \ n ✔Hatching Stage where infant recognizes his or her mother but lacks a sense of individuality \ n ✔symbiotic Narcissistic personality disorders are likely due to \ n ✔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 \ n ✔Object constancy Object constancy leads to the formation of \ n ✔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 \ n ✔Cushing's syndrome Hypothyroidism Genetic conditions Compassion, a desire to do good \ n ✔beneficence Avoidance of harm \ n ✔Nonmaleficence the equal and fair distribution of resources, regardless of other factors \ n ✔Justice Dedication, fairness, honesty, advocacy and commitment to patients. It involves an agreement to keep promises and commitments based on the virtue of caring. \ n ✔Fidelity Most widely used tool for assessing the healthcare safety culture within an organization \ n ✔Culture of Patient Safety Assessment developed by AHRQ The Iowa Model of EBP (evidence-based practice) is characterized by which statement? \ n ✔It is important to determine if an identified issue is a priority of the organization The trigger for change can be \ n ✔Knowledge focused or Problem focused Identification of a problem and determination of its priority \ n ✔first step in Iowa Model Review and critique of available literature \ n ✔Second step in Iowa Model Identification of research evidence to support a change in clinical practice \ n ✔3rd stage of Iowa Model Implementation of change \ n ✔4th step of Iowa Model Monitoring of Outcomes \ n ✔5th and final step of Iowa Model Knowledge-focused triggers include \ n ✔new research practice guidelines Problem-Focused Triggers include \ n ✔Clinical problems Issues in risk management The first step in getting a bill to the floor is? \ n ✔Drafting a bill Probability results of study are due to chance \ n ✔P value Medicare part A coverage includes \ n ✔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. \ n ✔Stratified sampling Selection of groups under study is random \ n ✔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. \ n ✔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 \ n ✔Simple random sampling Analyst's emotional response to pt \ n ✔countertransference When pt tends to identify aspects as either completely good or completely bad about a person \ n ✔Splitting Mental process that gives rise to lack of connection in the pt's thoughts, memory, and sense of identity \ n ✔Dissociation Substance that is found in lower concentrations in the CSF of impulsive, violent individuals \ n ✔5-HIAA In addition to an assessment of pathological personality traits, alternate model in Section III of the DSM-5 requires an assessment of which category or a personality disorder diagnosis \ n ✔level of impairment in personality functioning A diagnosis of a personality disorder who require at least a level _______ impairment \ n ✔2 ("moderate") What is the prevalence of obsessive-compulsive personality disorder in the general population \ n ✔5-10% Which personality disorder's criteria includes magical thinking \ n ✔Schizotypical Females with _________ have a virilized clitoris \ n ✔Congenital adrenal hyperplasia (CAH) A higher degree of ________ has been reported in individuals with CAH, which correlates to the degree of virilization \ n ✔homosexuality A 2-year old girl with 21-hydroxylase deficiency undergoes genitoplasty. Which statement is true concerning her condition \ n ✔There is a correlation between virilization degree and gender dysmorphia What is the prevalence of paranoid personality disorder among psychiatric patients? \ n ✔10-30% Gender identity usually begins to form by this age \ n ✔2 Anti-hypertensive effects on sexuality \ n ✔impaired vaginal lubrication and erectile dysfunction d/t antiadrenergic effects Spironolactone effects on sexuality \ n ✔decreased desire secondary to decreased testosterone Estrogen effects on sexuality \ n ✔decreased desire secondary to decreased testosterone Steroid effects on sexuality \ n ✔decreased desire secondary to decreased testosterone TCA effects on sexuality \ n ✔erectile dysfunction or impaired vaginal lubrication secondary to anticholinergic effects MAOI effects on sexuality \ n ✔erectile dysfunction or impaired vaginal lubrication secondary to anticholinergic effects Antipsychotics effects on sexuality \ n ✔erectile dysfunction or impaired vaginal lubrication secondary to anticholinergic effects SSRI effects on sexuality \ n ✔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? \ n ✔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 \ n ✔Partialism Individuals who attempt to avoid penetrative sex due to a lack of interest may have what? \ n ✔Partialism (a type of paraphilia) Prevalence of antisocial personality disorder in females in the community \ n ✔1% 2 common defense mechanisms seen in obsessive compulsive personality disorder \ n ✔isolation of affect intellectualization Paraphilia are almost never diagnosed in \ n ✔females (and rarely in a clinical setting) Age range that is typical for a person that performs frotteurism \ n ✔15-25 (declines after that) Pts with a history of childhood separation are more prone to this personality disorder \ n ✔dependent Pts with dependent personality disorder commonly experience these 2 things from their caretaker? \ n ✔over-involvement intrusive behavior Childhood experience common in pts with dependent personality disorder \ n ✔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 \ n ✔emotionally withholding overprotective over-controlling People with obsessive compulsive personality disorder develop their symptoms as a strategy to \ n ✔avoid punishment (they were often punished by parents and rarely rewarded) Patients with schizoid personality disorder typically from families that are \ n ✔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 \ n ✔avoidant Many of the patients have a history of painful early experiences and chronic parental criticism \ n ✔avoidant personality disorder Symptoms of personality disorders are usually consistent with patient's \ n ✔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 \ n ✔Constraint Purest expression of the biological basis of personality \ n ✔Temperament What are the 2 distinct temperaments Kagan and colleagues (1988) identified \ n ✔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? \ n ✔Carbamazepine What is the second-line treatment option for a personality change secondary to epilepsy that results in aggressive episodes \ n ✔benzodiazepines What is contraindicated in the treatment of aggressive personality changes due to epilepsy \ n ✔antipsychotics females that have this are usually infertile have low estrogen levels but do not have higher levels of homosexuality \ n ✔Turner syndrome(45XO) females with this are typically indistinguishable from other females except they are slightly taller and have increased learning difficulties and low-normal intelligence \ n ✔Triple X syndrome Pts with this disorder often exhibit emotional blunting that is sometimes referred to as "la belle indifference" \ n ✔conversion disorder Pts with ________ PTSD typically show a more robust clinical response to SSRIs \ n ✔non-combat In treating pts with histrionic personality disorder, which therapy type is useful for addressing provocative and attention seeking behavior? \ n ✔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? \ n ✔Self-system means of interpreting social situations and understanding the relational motives and actions of others \ n ✔social system the capacity to observe the self as it relates to others \ n ✔self-in-relation system What percentage of patients with neurological problems have conversion symptoms? \ n ✔1-3% Body dysmorphic disorder is associated with what risk factor and family history \ n ✔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 \ n ✔cocaine Most serious complications of cocaine abuse \ n ✔myocardial ischemia and infarction Signs of ____________: dysphoria, psychomotor slowing, fatigue, increased appetite, craving \ n ✔cocaine withdrawal Signs of ____________: piloerection lacrimation and rhinorrhea pain in joints and muscles dysphoria diarrhea nausea vomiting dilated pupils insomnia autonomic hyperactivity yawning \ n ✔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 \ n ✔opioid intoxication Signs of ______________ Nystagmus Dissociative symptoms anxiety tremor numbness memory loss analgesia psychosis aggression violence slurred speech poor coordination hallucination \ n ✔Phencyclidine intoxication Signs of _________: stimulation loss of inhibition headache N/V slurred speech poor motor coordination \ n ✔Inhalant intoxication Signs of _________: Exhilaration loss of inhibitions slurred speech staggering gait euphoria marked motor impairment confusion stupor coma \ n ✔Sedative hypnotic (alcohol and benzodiazepine) intoxication Sign of ________: sweating flushed face insomnia hallucinations seizure disorientation tremors increased autonomic activity \ n ✔Sedative hypnotic (alcohol and benzodiazepine) withdrawal Sign of ___________: Altered states of perception and feeling hallucinations nausea increased body temperature HR and BP pupillary dilation poor appetite sweating sleeplessness numbness dizziness rapid shifts in emotion depression anxiety \ n ✔Hallucinogen intoxication A 30-year-old female presents to the ED with severe anxiety, palpitations, restlessness, and irritability. She reports no previous history of these symptoms. Her BP is 160/100, pulse is 115 beats/min, temperature 98 degree F, and pupils are dilated What condition explains her symptoms \ n ✔cocaine intoxication Which statement differentiates the actions of cocaine and amphetamines \ n ✔Cocaine prevents dopamine reuptake but amphetamines both slow dopamine reuptake and induces dopamine release In the COMBINE trial for alcohol dependent patients acamprosate faired ____ compared to various combinations of naltrexone and combined behavioral intervention \ n ✔poorly For Alcohol dependent patients, the COMBINE trial found that \ n ✔any combination of therapies including CBT, naltrexone, or both performed better than any combinations that did not include these interventions Buprenorphine is a ______ at mu receptors and binds with ______ \ n ✔partial agonist high affinity (20x stronger per gram weight of morphine) This is resistant to cases of overdose to reversal by naloxone \ n ✔buprenorphine d/t high binding affinity DSM-5 requires ____ of 9 criteria to be met for persistent and recurrent maladaptive gambling behavior \ n ✔4 thalamus mammillary bodies cerebellum What vitamin is deficient in Wernicke's encephalopathy and Korsakoff's syndrome \ n ✔Vitamin B1 The proposed addictive component of cannabis \ n ✔releases dopamine in the mesolimbic system What type of users can appear to be bipolar with mania/hypomania symptoms \ n ✔anabolic steroids Which drug of abuse is also a schedule III prescription for the treatment of narcoleptic cataplexy? \ n ✔GHB (Xyrem) Which of the following statements regarding the treatment of cocaine dependent individuals is correct \ n ✔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 \ n ✔ETOH cannabis opioids inhalants benzodiazepines Which of the following statements regarding the mechanism of action of vareniciline is accurate \ n ✔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 \ n ✔Putamen (formic acide accumulates in this region) Long term survivors of methyl alcohol intoxication may experience \ n ✔Parkinsonism Chronic exposure to methyl alcohol may result in \ n ✔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 \ n ✔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? \ n ✔Habit Reversal Treatment for trichollomania \ n ✔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. \ n ✔n-Hexane (household glues) Repeated glue inhalation may cause ______ which has a similar presentation to ______ \ n ✔glue sniffer neuropathy Guillain Barre Syndrome Which antidepressant with a tetracyclic structure that works by antagonism of presynaptic alpha 2 agonists and post-synaptic serotonergic receptors is of interest for a psychiatrist looking to prescribe pharmacologic treatment to a patient with chronic alcohol use disorder with a major depressive episode? \ n ✔Mirtazapine This would not show on the toxicology screen and is a drug of abuse, particularly in pubescent boys, that could cause a period of unconsciousness \ n ✔Nitrites (present in liquid incense) onanism \ n ✔masturbation Amnesic disorders are secondary syndromes caused by \ n ✔systemic medical or primary cerebral diseases substance use disorders medication adverse effects In contrast to transient global amnesia, dissociative amnesia typically does not involve \ n ✔deficits in learning and recalling new information Dissociative disorders are often associated with \ n ✔emotionally stressful life events involving the money, legal systems, or troubled events What is the lifetime suicide-attempt rate in patients with body dysmorphic disorder \ n ✔22-24% Wernike's encephalopathy triad \ n ✔confusion ataxia ophthalmolopegia What type amnesia is classically associated with confabulation do Korsakoff disease patients have? \ n ✔anterograde and retrograde amnesia Xerostomia \ n ✔dry mouth caused by reduction or absent flow of saliva Icterus \ n ✔jaundice According to a recent study, the volumes of which brain structures are significantly smaller in patients with dissociative identity disorder versus healthy subjects? \ n ✔Hippocampus and amygdala In using the Structured Interview of Reported Symptoms (SIRS) test, when would a patient be considered to be malingering? \ n ✔They score in the definitive range in 1 primary subscale or probable range in 3 sub scales A 48 year old pt admitted with profuse sweating, diarrhea, abdominal cramps, vomiting, yawning, muscle aches, restlessness, and insomnia for 1 day. Physical exam reveals BP 155/105 mmHg and a temp of 100 degrees F. The patient is cold with muscle twitches and dilated pupils. She is highly motivated to detoxify. Which medication is the best choice for detox? \ n ✔Methadone Which of the following is useful in treating the autonomic effects of opiate withdrawal \ n ✔Clonidine Which of the following is useful for treating hyperthermia in opiate withdrawal \ n ✔cold blankets ice packs Which of the following is useful for treating seizures in cocaine overdose \ n ✔benzodiazepine Which of the following is useful for treating malignant hypertension in cocaine overdose \ n ✔IV phentolamine Which 2 medications are useful for treating agitation in cocaine overdose? \ n ✔lorazepam haloperidol What is the most common type of psychiatric condition in an emergency room \ n ✔Substance-related disorders "You have been through so much recently but you remain certain that alcohol is not a problem for you" This is an example of a \ n ✔reflective statement "What do you feel about all this?" is an example of \ n ✔open-ended question "You have done a phenomenal job staying sober in the past." is an example of \ n ✔affirmation "let me see if I understand you. It sounds like you've been trying to stop using for some time but are on the fence right now about stopping. Is that about right?" is an example of \ n ✔Summary Statement OARS stands for \ n ✔Open-ended questions Affirmations Reflective listening Average age of onset of depersonalization/derealization disorder \ n ✔16 Depersonalization disorder is _____ more common in woman than men \ n ✔2-4x What pneumococcal vaccine is indicated for all adults over 65 years old \ n ✔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 \ n ✔PPSV13 People who display factitious disorder by proxy are more likely to have which condition \ n ✔Personality disorder Diarrhea, lacrimation and runny nose are mainly associated with \ n ✔opioid withdrawal Beta blocker given when pt has cocaine intoxication could possibly cause? \ n ✔unopposed alpha stimulation May have recurrent gaps in recall of everyday events, not just of traumatic experiences. \ n ✔Disassociative identity disorder What is Quetiapine FDA approved for \ n ✔bipolar depression schizophrenia acute mania What is Aripiprazole FDA approved for \ n ✔Agitation in autism, bipolar depression, bipolar mania, schizophrenia What is risperidal FDA approved for \ n ✔Schizophrenia, acute/mixed mania, Autism (5-16 years), bipolar maintenance What is Olanzapine FDA approved for? \ n ✔Schizophrenia, bipolar mania and depression agitation What is Clozapine FDA approved for? \ n ✔schizophrenia (especially tx resistant) schizoaffective What is asenapine FDA approved for? \ n ✔Schizophrenia acute/mixed mania What is Lurasidone approved for? \ n ✔schizophrenia What is ziprasidone approved for \ n ✔schizophrenia acute psychosis agitation bipolar disorder mania What is iloperidone FDA approved for? \ n ✔schizophrenia A 40 year old F is taking theophylline for her asthma. She is known to have a prolonged hx of tonic-clonic seizures. However, you remember from your studies that CYP450 participates in theophylline metabolism, and that certain anti-epileptic affect CYP450 activity. Which adjustment is likely to be warranted in this patient? \ n ✔Give carbamazepine Consider increasing the theophylline dose in the future Theophylline \ n ✔bronchodilator with a very narrow therapeutic index Metabolized by CYP450 Valproic acid ________ CYP450 causing theophylline to _______ \ n ✔inhibits accumulate (need lower dose) Phenobarbital __________ CYP 450 causing theophylline to _______ \ n ✔induces clear faster (need higher dose) Carbamazepine __________ causing theophylline_______ \ n ✔induces CYP450 to clear faster (need higher dose) Phenytoin ________ CYP450 causing theophylline to ________ \ n ✔induces clear faster (need higher dose) After stopping diazepam in pt who is a chronic user \ n ✔Monitor patient for a week (withdrawal seizures occur about 5-7 days after drug is stopped) Ideally should be gradually tapered at max rate of 10% per day. You will not see any signs of withdrawal of diazepam until \ n ✔5-7 days due to long half-life Which of the following statements is correct concerning clozapine \ n ✔TD is not commonly associated with clozapine compared to other antipsychotics Agranulacytosis is the most significant adverse effect of \ n ✔clozapine If agranulocytosis occurs in a pt on clozapine, it will more likely happen \ n ✔in first 6 months of tx to woman Ashkenazi Jewish descent to those of advanced age ______ of patients on dosage of _______ of clozapine will have seizures \ n ✔4-6% >600mg/day SSRI's and coagulation \ n ✔increase risk of bleeding d/t interactions with serotonergic receptors on platelets What SSRI's are most likely to have gastrointestinal side effects \ n ✔sertraline fluvoxamine CNS activation (anxiety, restlessness, tremor, and insomnia) occur most commonly with this SSRI \ n ✔fluoxetine SIADH commonly occurs with this SSRI \ n ✔fluoxetine Sedation occurs most commonly with this SSRI \ n ✔paroxetine Which of the following statements is true regarding Gabapentin? \ n ✔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? \ n ✔Metabolite activity as well as inhibition of serotonin reuptake in presynaptic receptors What is correct regarding methylphenidate (MPH) \ n ✔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 \ n ✔10:15mg MPH is currently manufactured as a mixture of \ n ✔d and l-threo enantiomers (d-threo = active form ) Clozapine -Anticholinergic Effect -Sedation -Extrapyramidal Effects \ n ✔High High No Quetiapine -Anticholinergic Effect -Sedation -Extrapyramidal Effects \ n ✔Low High Low Haloperidol -Anticholinergic Effect -Sedation -Extrapyramidal Effects \ n ✔Low Low High Olanzapine -Anticholinergic Effect -Sedation A woman who has been on a long-term treatment for anxiety no longer feels relief after taking her Rx medication at max dose for the past dose? What explains her tolerance \ n ✔Saturated binding sites Which amphetamine isomer is most rapidly eliminated from the body \ n ✔Dextro- isomer in acidified urine Which statement regarding tricyclic antidepressants (TCA) and anticholinergic side effects is true? \ n ✔TCAs can be dangerous to patients with pre-existing glaucoma and lead narrow-angle glaucoma Examples of anticholinergic effects \ n ✔dry mouth blurry vision constipation tachycardia delirium TCA's can cause sedation and hypotension d/t \ n ✔alpha-1 receptor blockade in blood vessels Anticholinergic effects result from the \ n ✔blockade of muscarinic cholinergic receptors What enzymes are responsible for metabolizing 90% of drugs processed in liver \ n ✔1A2 2C9 2C19 2D6 3A4 3A5 Example of drugs to avoid when on bupropion \ n ✔Clozapine Theophylline Clomipramine (d/t inc risk seizures) Which of the following benzodiazepines is most rapidly absorbed when taken orally? \ n ✔diazepam Which statement is true of the Minnesota Multiphasic Personality Inventory (MMPI) \ n ✔It is a broad-based measure of personality traits and psychopathology It test cognitive ability and intelligence \ n ✔Stanford-Binet Intelligence Scale It measures cognitive impariment \ n ✔MMSE It measures a person's emotional functioning \ n ✔Rorschach test ("inkblot" test) Which of the following statements about lithium-induced hypothyroidism is correct \ n ✔occurs more commonly in woman Hypothyroidism is not a contraindication for \ n ✔lithium treatment (can be treated with levothyroxine) Hypothyroidism in pt receiving lithium is associated with \ n ✔rapid cycling increased risk of developing depression Blood tests with lithium \ n ✔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 \ n ✔6-18 months Half life of this hypnotic is 1-3 hours \ n ✔ramelton Half life of this hypnotic is 1-2 hours \ n ✔zaleplon Half life of these hypnotics is 2-4 hours \ n ✔triazolam zolpidem Antidepressant medication with significant anticholinergic side effects do not need to be avoided in patients with which comorbidity \ n ✔constipation (can be managed by bulk-forming laxatives and hydration) CYP450 substrate of Alprazolam \ n ✔3A4 CYP450 substrate of Citalopram \ n ✔2D6 CYP450 substrate of Codeine \ n ✔2D6 CYP450 substrate of Caffeine \ n ✔1A2 Acute alcohol consumption _______ CYP450, but chronic use leads to __________ CYP450 \ n ✔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 \ n ✔valproic acid Side effects of carbamazepine \ n ✔sedation dizziness fatigue nausea ataxia agranulocytosis aplastic anemia side effects of lithium \ n ✔Tremor polyuria polydipsia weight gain cognitive slowing hypothyroidism decreased creatinine clearance Side effects of lamotrigine \ n ✔benign rash in 10% of people Steven's Johnson syndrome in <1% Withdrawal syndrome following abrupt discontinuation of TCA results from \ n ✔cholinergic rebound Quinidine and TCA both \ n ✔prolong QT intervals Adverse effects of TCA overdose \ n ✔severe sedation hypotension anticholinergic delirium Although lorazepam has a relatively short half life, it exerts sustained action via which mechanism \ n ✔lower lipophilicity Being less _______ produces clinical effects more slowly, but may provide more sustained relief, as the drug comes out of the brain slowly \ n ✔lipophilic Gabapentin overdose is associated with \ n ✔sedation ataxia diplopia Which one more commonly causes weight gain: gabapentin or valproic acid \ n ✔valproic acid Adverse effect of Topiramate \ n ✔kidney stone formation (especially after CYP450 activity inhibited d/t acute alcohol ingestion) St. John's wort effect on Topiramate \ n ✔increases clearance d/t induced CYP450 activity What medications can cause a hypertensive crisis when used with MAOI? \ n ✔meperidine epinephrine local anesthetics (containing sympathomimetics) decongestants Pt on clozaril and is concerned that PCP prescribed pt this for her psoriasis \ n ✔methotrexate (inc risk leukopenia) What antidepressant has the greatest evidence of beneficial effects in patients with depressed mood and eating disorders? \ n ✔Fluoxetine In CATIE, patients were assigned to treatment with \ n ✔olanzapine no long term effects no physiological dependence or withdrawal syndrome Most common negative side effect of zolpidem \ n ✔sleep-associated disorders short acting sedative sleep agent that is associated with test disturbance \ n ✔Eszopiclone Primary overdose symptoms with clozapine include \ n ✔delirium lethargy tachycardia hypotension respiratory failure What is the most common side effect of galantamine? \ n ✔GI disturbances (diarrhea, nausea, vomiting decreases over time) Class of drug of galantamine \ n ✔cholinesterase inhibitor Because cholinesterase inhibitors cause action in the parasympathetic nervous system they can cause \ n ✔bradycardia hypotension hypersecretion bronchoconstriction GI tract hypermotility decreased intraoccular pressure Priapism is associated with which drug \ n ✔trazodone At 45mg mirtazapine, what can happen? \ n ✔increased serum cholesterol inducing cases of acute pancreatitis and diabetic ketoacidosis. Mood stabilizers like lithium in pregnancy \ n ✔stopped until 2nd trimester to avoid the time of highest teratogenic risk. In neonates, high potency antipsychotics \ n ✔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 \ n ✔haloperidol effective and safe treatment for severe mania in pregnancy \ n ✔ECT Neonates can show signs of extrapyramidal side effects when \ n ✔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? \ n ✔Fluoxetine Besides Fluoxetine, all other SSRI, SNRIs, and TCAs require a standard ___________ washout period when switching to an MAOI \ n ✔2 week What medication demonstrates histaminergic mechanism in addition to increasing dopamine binding to the dopamine transporter to increase wakefulness \ n ✔modafinil Modafinil increases activity in the \ n ✔tuberomammilary nucleus stratum cingulate cortex (at higher doses) Humans with narcolepsy have decreased levels of \ n ✔histamine in the CSF Modafinil ________ to the dopamine transporter \ n ✔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 \ n ✔wakefulness What is the mechanism of action of topiramate? \ n ✔inhibits sodium channels enhances GABA-a receptors antagonizes kainite and AMPA (glutamate) receptors Carbamazepine mechanism of action \ n ✔Inhibits voltage-gated sodium channel activation (doesn't block pores). inhibits pre-synaptic sodium channels Depakote mechanism of action \ n ✔increases GABA Lamotrigine mechanism of action \ n ✔inhibits glutamate inhibits voltage-gated sodium channels centrally acting, reversible acetylcholinesterase inhibitor used in tx of Alzheimer's dementia \ n ✔Donepezil (Aricept) Why is Donepezil contraindicated in sick sinus syndrome? \ n ✔Can cause heart block and symptomatic bradycardia Flushing is caused by \ n ✔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 \ n ✔oxcarbamazepine carbamazepine A low ______ value can occur in isolation with oxcarbazepine \ n ✔T4 What mood stabilizer is associated with aplastic anemia and other blood dycrasias in 1 in 10,000-150,000 treated pts? \ n ✔Oxcarbazepine Carbamazepine overdose is associated with \ n ✔high grade AV block CNS depression Oxcarbazepine overdose is associated with \ n ✔CNS depression Adjuvant therapy in acute mania to treat hyperkinesis, agitation and insomnia \ n ✔benzodiazepine Pt's with hx of ADHD in childhood may be at particular risk for medication induced agitation with this medication \ n ✔benzodiazepine What is the initial medication dosage for treatment of uncomplicated depression: sertraline ____ \ n ✔50mg (increase q 2 weeks to max 200) What is the initial medication dosage for treatment of uncomplicated depression: Fluoxetine ______ \ n ✔10mg (maintain for 3 weeks, max benefit at 20-40mg) Typical maintenance dose of fluvoxamine \ n ✔100-200mg/day (short half life) Typical maintenance dose of fluoxetine is \ n ✔20-40mg/day Doses of fluoxetine ______ have more side effects and have not been effective \ n ✔>=60mg A maximum of ______ is recommended for initial treatment with paroxetine \ n ✔50mg Which of the following findings is expected in a patient who is an ultra-rapid metabolizer \ n ✔High urinary concentration of the drug's metabolite Low plasma concentration of the drug Which statement correctly describes the inducer/inhibitor pharmacology of sertraline and tramadol when a patient is taking both medications? \ n ✔Sertraline at 200mg is a potent inhibitor of 2D6 and increases levels of tramadol (increased risk seizures) Inhibitors reduce the metabolism of ______ leading to elevated levels of ___________ \ n ✔medications/substrates medications/substrates To have lower levels of tramadol, a patient must take a CYP2D6 _______ \ n ✔inducer What medications selectively inhibit the reuptake of both serotonin and norepinephrine \ n ✔SNRIs: duloxetine venlafaxine desvenlafaxine 3A5 Substrates affected by St. John's wort include \ n ✔amprazolam amlodipine atorvastatin diazepam cyclosporine serotinergic meds Cruciferous vegetables induces the metabolism of _________ \ n ✔1A2 Increasing consumption of cruciferous vegetable would _________ clozapine levels \ n ✔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 \ n ✔increase ER dose by 15% What is an appropriate loading dose of valproic acid for a hospitalized patient with significant manic symptoms? \ n ✔20-30mg/kg Ventricular arrhythmia and seizures can be the result from ______ overdose \ n ✔TCA Cardiac conduction defects are most severe with ______ overdose \ n ✔desipramine TCAs are structurally similar to \ n ✔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 \ n ✔MAOI Stevens-Johnson syndrome is associated with \ n ✔Lamictal (Lamotrigine) SIADH, leading to hyponatremia, has been associated with \ n ✔carbamazepine (Tegretol) Primary consideration when dosing fluoxetine for 9 year old boy \ n ✔height and weight Adult values for the cytochrome 450 enzymes are generally achieved by what age? \ n ✔1 years old Psychotropic medications are not generally prescribed to children under the age of \ n ✔5 years Fluoxetine is FDA-approved in the treatment of depression for what ages \ n ✔ages 8 years and older Monitor ADHD patients on stimulants for \ n ✔palpitations syncope CP vital signs including high blood pressure What supplement can cause easy bruising? \ n ✔Ginkgo biloba Gingko biloba should be avoid with \ n ✔antiplatelet and anticoagulant medications Supplement contraindicated when taking warfarin \ n ✔gingko biloba Anti-inflammatory and immune enhancing supplement with no known drug interactions \ n ✔Echinacea purpurea Another name for garlic \ n ✔Allium sativum Why should garlic be used cautiously with warfarin? \ n ✔anti-platelet effects Which SSRI has been associated with hyponatremia and SIADH, particularly in elderly females \ n ✔sertraline Appropriate ED treatment for panic disorder \ n ✔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 \ n ✔panic disorder First line tx of panic disorder \ n ✔SSRI (fluoxetine, paroxetine, sertraline) or SNRI (venlafaxine) MAO-B inhibitor with FDA indication for depression, Parkinson's disease and major depression \ n ✔selegiline pheochromocytoma \ n ✔a benign tumor of the adrenal medulla that causes the gland to produce excess epinephrine It is associated with episodes of tachycardia, HA, diaphoresis, and paroxysmal or sustained HTN SSRI-induced sexual dysfunction occurs in \ n ✔men mostly (tends not to dissipate with ongoing tx but does dissipate on dc tx) L-carnitine is effective in the treatment of methamphetamine toxicity via which mechanism \ n ✔preventing formation of free radicals and peroxynitrite in neurons decreases free radicals in the neuron needed to transport long-chain fatty acids into the mitochondria for fatty acid oxidation Which cytochrome P450 enzyme is predominantly present at but levels fall quickly and are undetectable in most adults? \ n ✔3A7 Last P450 cytochrome to develop \ n ✔1A2 P450 enzymes present in newborns at very low concentration but surge quickly to about 20-30% of adult values within the first week of life \ n ✔3A4 2D6 2C9/19 Erythromycin _______ the metabolism of drugs \ n ✔decreases (inhibits) sick-faces.com/g is a mnemonic to remember \ n ✔inhibitors list drugs on the sick-faces.com/g mnemonic of inhibitors \ n ✔sodium valproate isoniazid cimetidine ketoconazole fluconazole alcohol binge chloramphenicol erythromycin sulfonamides ciprofloxacin omeprazole metronidazole grapefruit juice smoking, griseofulvin and carbamazepine are all \ n ✔inducer What birth defect has been associated with lithium use in pregnancy (only psychoactive drug associated with this) \ n ✔Ebstein's anomaly PCOS is associate with ________ use in pregnancy \ n ✔valproic acid Narcolepsy with cataplexy and excessive daytime sleepiness FDA approved treatment \ n ✔sodium oxybate (Xyrem) What antidepressants can reduce cataplexy attacks \ n ✔clomipramine fluoxetine duloxetine venlafaxine <1% is excreted unchanged in feces and urine \ n ✔trazodone Trazodone is about ________ protein bound \ n ✔89-95% Trazodone's peak plasma level occurs after \ n ✔1 hour when taken on empty stomach modafinil (also 3A4 inducer) omeprazole phenobarbital (also 3A4 inducer) rifampicin (also 3A4 inducer) CYP2B6 inhibitors \ n ✔Ticlopidine CYPB6 inducers \ n ✔Phenobarbital Rifampicin CYP2C8 inhibitors \ n ✔gemfibrozil giltazones CYP2C8 inducers \ n ✔1. Carbamazepine (Tegretol) 2. Phenobarbitol 3. Phenytoin (Dilantin) 4. Rifampin (Rifadin) CYP2C9 inhibitors \ n ✔Amiodarone Fluconazole isonazid sulfa drugs trimethoprim CYPC19 inducers \ n ✔Phenobarbital Rifampicin Bupoprion is a _______ substrate \ n ✔2D6 Methadone is a _______ substrate \ n ✔2D6 (and inhibitor) Fluoxetine is a ______ substrate \ n ✔2C9 2C19 2D6 and inhibitor (3A4 inhibitor) Phenytoin is a _______ substrate \ n ✔2C9 2C19 (3A4 inducer) Sertraline is a _______ substrate \ n ✔2C9 2C19 2D6 Fluoxetine is a _______ substrate \ n ✔2C9 2C19 2D6 and inhibitor (3A4 inhibitor) Fluvoxamine is a ______ substrate \ n ✔2C9 1A2 2C19 2D6 and inhibitor Amitriptyline is a _____ substrate \ n ✔1A2 2C19 Clozapine is a _____ substrate \ n ✔1A2 Duloxetine is a _____ substrate \ n ✔1A2 2D6 and inhibitor Haloperidal is a _____ substrate \ n ✔1A2 2D6 (and inhibitor) Imipramine is a _____ substrate \ n ✔1A2 2C19 Mirazapine is a _____ substrate \ n ✔1A2 2D6 Ondanseteron is a _____ substrate \ n ✔1A2 Warfarin is a _____ substrate \ n ✔1A2 2C9 Olanzepine is a _____ substrate \ n ✔1A2 2D6 Citalopram is a _______ substrate \ n ✔2C19 2D6 (and inhibitor) Diazepam is a _____ substrate \ n ✔2C19 escitalopram is a _____ substrate \ n ✔2C19 2D6 Paroxetine is a _______ substrate \ n ✔2D6 and inhibitor Amphetamine is a _________ substrate \ n ✔2D6 Atomoxetine is a _______ substrate \ n ✔2D6 Clomipramine is a _________ substrate \ n ✔2D6 Risperidal is a _____ substrate \ n ✔2D6 Venlafaxine is a _____ substrate \ n ✔2D6 Buspirone is a _______ substrate \ n ✔3A4 St. John's wort is a _______ inducer \ n ✔3A4 Oxcarbazepine and carbazepine are __________ inducers \ n ✔3A4 Grapefruit juice is a ______ inhibitor \ n ✔3A4 Clonazepam (Klonopin) is a ______ substrate \ n ✔3A4 Xanax is a ______ substrate \ n ✔3A4 Buprenorphine is a _______ substrate \ n ✔3A4 Topiramate is a ______ substrate \ n ✔3A4 Sildenafil (Viagra, Revatio) is a _____ substrate \ n ✔3A4 Flurazepam (Dalmane) is a ________ substrate \ n ✔3A4 Particularly potent inhibitors of 3A4 \ n ✔clarithromycin itraconazole ketoconazle Particularly potent inducer of 3A4 \ n ✔rifampin (90% reduction in serum concentrations of 3A4 substrates) If you add rifampin to triazolam, what happens to the concentration of triazolam? \ n ✔90% decreased concentration (ineffective) What meds would lower the effectiveness of amphetamine \ n ✔Dexamethasone Rifampicin What medications would lower the effectiveness of citalopram \ n ✔Carbamazepine Prednisone Rifampicin What medications would lower the effectiveness of bupropion \ n ✔Rifampicin Phenobarbital What medications would lower the effectiveness of olanzepine? \ n ✔insulin Modafinil phenobarbital rifampicin Drugs affected by tobacco \ n ✔Theophylline caffeine tacrine imipramine haldol estradiol Side effects of valproic acid are more frequent with ____________ than with other preparations \ n ✔divalproex sodium Carbamazepine and fluoxetine interaction \ n ✔Increased carbamazepine levels Carbamazepine and lithium interaction \ n ✔increased risk of neurotoxicity Carbamazepine and oral contraceptive (OBC) interaction \ n ✔decreased levels of OBC Carbamazepine and valproic acid interaction \ n ✔increased carbamazepine levels decreased valproic acid levels Is phenytoin an inducer or inhibitor? \ n ✔inducer Is Valproic acid an inducer or inhibitor? \ n ✔inhibitor Is ciprofloxacin an inducer or inhibitor? \ n ✔inhibitor Is ketoconazole an inducer or inhibitor? \ n ✔inhibitor Indications: Schizophrenia \ n ✔Quetiapine Aripiprazole Risperidone Paliperidone Olanzapine Clozapine Asenapine Lurasidone Ziprasidone Lloperidone Indications: Acute psychosis \ n ✔Ziprasidone Indications: agitation \ n ✔Ziprasidone Olanzapine Aripiprazole Indications: schizoaffective \ n ✔Clozapine Paliperidone Indications: Autism (5-16 years) \ n ✔Risperidone Aripiprazole (all ages) Antipsychotics FDA indicated for bipolar disorder \ n ✔Ziprasidone Olanzapine Risperidone Quetiapine Aripiprazole Which antipsychotic should you avoid in patients with a significant cardiac history? \ n ✔(due to increased QTc) Lloperidone Ziprasidone Patients tend to lose weight (no significant increase in lipids or glucose) when treated with this antipsychotic long term \ n ✔Lurasidone Antipsychotic that is category B for pregnancy, little prolactin increase \ n ✔Lurasidone What antipsychotic is related to mirtazapine and likely has antidepressant properties? \ n ✔Asenapine What antipsychotic has the notable side effect of metabolic syndrome and diabetic ketoacidosis? \ n ✔Olanzapine What antipsychotic has the notable side effect of dose-related hyperprolactinemia? \ n ✔Risperidone What antipsychotic has the notable side effects of metabolic syndrome and cataracts (in animal studies) \ n ✔Quetiapine What antipsychotic has no increase in prolactin? \ n ✔Quetiapine What antipsychotic has a black box warning of suicide in children \ n ✔Aripiprazole What antipsychotic is most likely to cause akathisia and can be activating at low doses \ n ✔aripiprazole What antipsychotic is preferred in Parkinson's and Lewy body demential due to low EPS \ n ✔Quetiapine What antipsychotic has a very low risk of TD's and no increase in prolactin? \ n ✔Quetiapine With what antipsychotic should you monitor with ophthalmological exam, AIMS, blood glucose, lipid profile, weight? \ n ✔Quetiapine With what antipsychotic should you monitor prolactin level? \ n ✔Risperidone With what antipsychotic should you monitor CBC? \ n ✔Clozapine What antipsychotic has potent alpha-1 blockade (prazosin like effects for PTSD related nightmares) and need to watch for orthostatic hypotension? \ n ✔Lloperidone What med causes notable side effects of agranulocytosis, seizures, myocarditis, cardiorespiratory failure \ n ✔Clozapine What antipsychotic has blood level available? \ n ✔Clozapine What antipsychotic can cause oral hypesthesia? \ n ✔Asenapine Major side effects of this antipsychotic include \ n ✔Rare EPS Prominent Sedation Very low weight gain What antipsychotic causes excess salivation? \ n ✔Clozapine What antipsychotic reduces suicide? \ n ✔Clozapine What antipsychotic can cause rebound psychosis and cholinergic rebound when abruptly withdrawing \ n ✔Clozapine What antipsychotic is preferred treatment of behavioral disturbance in children \ n ✔Risperidone There is a ________________ in patients taking anticonvulsants per black box warning \ n ✔suicide and depression Carbamazepine, phenytoin and oxcarbazepine are _______ of the CYP3A4 system and can ___________ levels of antidepressants and antipsychotics \ n ✔inducer lower Barbituates and gapapentin have an increase risk of ________ in epileptic patients \ n ✔depression What is not a reasonable way to treat hypotension caused by an MAOI \ n ✔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 \ n ✔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? \ n ✔12 hours after last dose A substance that decreases the metabolism of drugs \ n ✔inhibitor Is echinacea an inducer or inhibitor? \ n ✔Inhibitor Mechanism of atomoxetine \ n ✔blocks reuptake of norepinephrine Desvenlafaxine is ________ protein bound with ____ likelihood of displacing tightly protein-bound medication like phenytoin and warfarin \ n ✔weakly reduced The SNRIs have an ______ onset of action compared to SSRIs due to _________ \ n ✔earlier rapid down-regulation of beta-adrenergic receptor-coupled cAMP Do stimulants cause an increase in tics \ n ✔no (can worsen for a short interval, then go back to baseline) Most prescription and nonprescription medications can be used safely with _________ \ n ✔stimulants (MAOI formally contraindicated but can be used with caution in tx resistant cases) Excessive caffeine intake with stimulants may _________ the effectiveness of the stimulant \ n ✔decrease (increase sleep problems) Use of stimulants with anticonvulsants may require \ n ✔dosage adjustment and blood levels of both medication due to decreased effects of anticonvulsants SSRI associated with the greatest weight gain \ n ✔Paroxetine Amiloride is used to treat which side effect of lithium \ n ✔Renal side effects TCA for OCD \ n ✔Clomipramine Induction of a seizure with ECT occurs when an applied electrical stimulus causes which of the following? \ n ✔Depolarization of cell membranes of neurons in brain synchronously 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? \ n ✔Autoinduction transcription up regulation of genes involved in its own metabolism \ n ✔Autoinduction How long does auto induction of carbamazepine take \ n ✔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) \ n ✔Cimetidine Erythromycin Grapefruit juice Vagus nerve stimulation is FDA approved for \ n ✔epilepsy treatment resistant depression it involves surgical implantation of a device in the carotid sheath \ n ✔vagus nerve stimulation Adding ginseng to lithium can cause \ n ✔irritability, insomnia and mania Adding ginseng to neuroleptics or phenelzine can cause \ n ✔irritability, insomnia and mania What adverse reaction is associated with mirtazapine use? \ n ✔Agranulocytosis (1/1000) Mirtazapine ______ nausea and vomiting due to ________ \ n ✔improves 5-HT3 receptor blockade Urinary ______ can occur with mirtazapine \ n ✔frequency Kava acts on ________ receptors and long term use has been linked with ___________ \ n ✔GABA liver toxicity Foods that act as inducer \ n ✔Cauliflower leafy green vegetables broccoli carrots licorice Foods that act as inhibitor \ n ✔grape (resveratrol) grapefruit juice cranberry pomegranate mango red peppers green tea vitamin E kava kava root Cocaine during pregnancy has been associated with \ n ✔Uterine Growth Restriction (IUGR) Placental Abruption Small for gestational age (SGA) Carbamazepine is ______ for mothers who are breastfeeding \ n ✔Safe Valproid acid is ______ for mothers who are breastfeeding \ n ✔safe Phenytoin is ______ for mothers who are breastfeeding \ n ✔safe Phenobarbital is ______ for mothers who are breastfeeding \ n ✔safe Primidone is ______ for mothers who are breastfeeding \ n ✔safe Lithium is ______ for mothers who are breastfeeding \ n ✔unsafe (EKG changes and toxicity) Lamotrigine is ______ for mothers who are breastfeeding \ n ✔unsafe (risk of fatal rash) Clonazepam is ______ for mothers who are breastfeeding \ n ✔unsafe (CNS/respiratory depression) Can cause hyponatremia especially when given with SSRI \ n ✔Oxcarbazepine Lithium _______ affect the efficacy of oral contraceptives at any dose \ n ✔does not Carbamazepine_______ affect the efficacy of oral contraceptives at any dose \ n ✔does (decreases efficacy) Another name for Carbamazepine \ n ✔Tegretol Topiramate _______ affect the efficacy of oral contraceptives at any dose \ n ✔at doses >200mg does (decreases efficacy) Oxcarbazepine _______ affect the efficacy of oral contraceptives at any dose \ n ✔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 \ n ✔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) \ n ✔Selegiline rasagiline MAO-B inhibitors principally block \ n ✔dopamine phenylethylamine What will not increase lithium levels? \ n ✔High sodium diet A low sodium diet is likely to ______ lithium \ n ✔increase Toxicity of Lithium occurs at levels marked by tremor, GI symptoms, blurred vision, increased DTR, vertigo, and confusion \ n ✔>1.5 meq/L Life-threatening toxicity of Lithium occurs at \ n ✔>2.0 meq/L At Lithium level of ___________ seizures, coma, arrhythmias, and permanent neurological impairment may occur \ n ✔>2.5 meq/L Fenofibrate (Tricor) competes with lamotrigine at _______________ \ n ✔glucuronidation site 2B7 Oxycodone/APAP (Percocet) competes with lamotrigine at _______________ \ n ✔glucuronidation site 2B7 Hydromorphone (Dilaudid) competes with lamotrigine at _______________ \ n ✔glucuronidation site 2B7 Methadone competes with lamotrigine at _______________ \ n ✔glucuronidation site (2B7) Tacrolimus (Prograf) competes with lamotrigine at _______________ \ n ✔glucuronidation site 2B7 Codeine competes with lamotrigine at _______________ \ n ✔glucuronidation site 2B7 Temazepam (Restoril) competes with lamotrigine at _______________ \ n ✔glucuronidation site 2B7 Valproic Acid (Depakote) competes with lamotrigine at _______________ \ n ✔glucuronidation site 2B7 Simvastatin (Zocor) competes with lamotrigine at _______________ \ n ✔glucuronidation site 2B7 carvediolol (Coreg) competes with lamotrigine at _______________ \ n ✔glucuronidation site 2B7 Cyclosporine competes with lamotrigine at _______________ \ n ✔glucuronidation site 2B7 Lorazepam (Ativan) competes with lamotrigine at _______________ \ n ✔glucuronidation site 2B7 Oxazepam (Serax) competes with lamotrigine at _______________ \ n ✔glucuronidation site 2B7 Benzodiazepines that undergo glucuronide conjugation 2B7 (not via the cytochrome p450 system) \ n ✔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? \ n ✔Lithium What drug has been associated with myocarditis? \ n ✔Clozapine What drug has been associated with eosinophilic colitis \ n ✔Clozapine In studies, which ECT modality reduces cognitive side effects but is less effective in terms of symptom reduction? \ n ✔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? \ n ✔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? \ n ✔Haldol 3 antipsychotics with high anticholinergic effects \ n ✔clozapine thioridazine chlorpromazine 4 antipsychotics associated with high sedation \ n ✔clozapine quetiapine thioridazine chlorpromazine Olanzapine is associated with _______ sedation \ n ✔mild What antipsychotic is not associated with EPS? \ n ✔Clozapine Risperidone is _____ anticholinergic, ______ sedation _______ EPS \ n ✔low low low Haloperidol is ______ anticholinergic, _______ sedation, ______ EPS \ n ✔low low high Thiroidazine is _____ anticholinergic, _____ sedation, ____ EPS \ n ✔high high low Chorpromazine (Thorazine) is ______ anticholinergic, ______ sedation )______ EPS \ n ✔high high low Quetiapine is _____ anticholinergic, ______ sedation, ______ EPS \ n ✔low high low Olanzapine (Zyprexa) is ______ anticholinergic, ______ sedation, ______ EPS \ n ✔low mid low Ziprasidone (Geodon) is ______ anticholinergic, _____ sedation, _____ EPS \ n ✔low low low Aripiprazole (Abilify) is _______ anticholinergic, ______ sedation, ______EPS \ n ✔low low low Another name for Abilify \ n ✔Aripiprazole Another name for Aripiprazole \ n ✔Abilify Another name for Clozapine \ n ✔Clozaril Another name for Clozaril \ n ✔Clozapine Another name for Seroquel \ n ✔Quetiapine Another name for Quetiapine \ n ✔Seroquel Another name for Invega \ n ✔Paliperidone Another name for Paliperidone \ n ✔Invega Another name for Thioridazine \ n ✔Mellaril Another name for Mellaril \ n ✔Thioridazine Another name for Clorpromazine \ n ✔Thorazine Another name for Thorazine \ n ✔Clorpromazine Another name for Tegretol \ n ✔Carbamazepine Another name for Valproate \ n ✔Depakote Another name for Depakote \ n ✔Valproate Sodium Valproic Acid Divalproex Sodium Another name for Valproic Acid \ n ✔Valproate Sodium Depakote Divalproex Sodium Another name for Oxcarbazepine \ n ✔Trileptal Which antidepressant is least likely to cause significant drug-drug interactions in the elderly \ n ✔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? \ n ✔Alert nephrology for emergent hemodialysis Which medication has been helpful in women with stress incontinence \ n ✔Duloxetine Another name for Lurasidone \ n ✔Latuda Another name for Latuda \ n ✔Lurasidone Indicated for bipolar depression \ n ✔Latuda (Lurasidone) What medication given in combination with Latuda may cause orthostatic hypotension \ n ✔beta blocker Which substance or technique was first used to induce convulsion to treat psychiatric illness and catatonia \ n ✔Camphor What medication when given with SSRI is most likely to predispose patients to serotonin syndrome \ n ✔Meperidine (Demerol) Valproic acid is superior to lithium in patients with \ n ✔mixed symptoms prominent depressive symptoms during mania multiple prior mood episodes ________ is more effective than Valproic acid in reducing symptoms of acute mania \ n ✔Olanzapine Valproic acid and _________ are equally efficacious in the treatment of acute mania \ n ✔haldol (response rate 48-53%) Divalproex sodium is also known as \ n ✔Depakote Valproic acid Valproate Sodium Max dose of Divalproex Sodium \ n ✔60mg/kg/day Depakote is also known as \ n ✔Divalproex Sodium Valproic Acid Volproate Sodium Carbamazepine may ______ the effectiveness of Risperidone \ n ✔Decrease Carbamazepine is metabolized in the ____ by ____ substrate \ n ✔liver 3A4 ________ requires monitoring for signs of bruising and bleeding \ n ✔Carbamazepine What medication causes metabolic acidosis via carbonic anhydrase inhibition? \ n ✔Topiramate What does metabolic acidosis via carbonic anhydrase inhibition initiate? \ n ✔kidney stone formation Carbamazepine acts as a CYP 450 3A4 ____, ____ the effectiveness of other CYP 3A4 substrates \ n ✔inducer lowering What anti-epileptic medication causes bone marrow suppression, resulting in agranulocytosis and leukopenia \ n ✔Carbamazepine (Tegretol) What antidepressant should be used in caution with a patient taking a protease inhibitor (ritonavir, saquinavir) because of toxic interaction \ n ✔Nefazodone Nefazodone is also know as \ n ✔Serzone Serzone is also known as \ n ✔Nefazodone Trazodone is also known as \ n ✔Desyrel Desyrel is also known as \ n ✔Trazodone Nefazodone and Trazodone are both ________ blockers \ n ✔5-HT2a Nefazodone and Trazodone side effects \ n ✔sedation, GI distress, postural hypotension (alpha block), trazaBONE-sexual side effects Which drugs is only an antiepileptic (not used as a mood stabilizer)? \ n ✔Levetiracetam What is the minimum amount of time to continue maintenance ECT treatment to achieve the best outcome after pt has discharged. He responded to 3 administrations of ECT? \ n ✔6 months 3 specific indications for continuation ECT are \ n ✔1. hx of recurrent episodes responsive to ECT AND 2. ineffectiveness of or intolerance to prophylactic pharmacotherapy OR 3. patient preference Average duration of continuation ECT \ n ✔10 weeks Continuation ECT following successful ECT typically involves gradual shifting from \ n ✔frequent weekly to monthly treatments over 1-3 months and then maintaining the monthly administration schedule for at least 6 months after remission Long term use of continuation maintenance ECT is indicated when \ n ✔pt hx suggest high risk of delayed relapse on medication alone or evidence of decompensation occurs during attempts to stretch interval between treatments during the continuation phases When someone is on continuation maintenance ECT, the need should be reviewed by practitioner and patient at least \ n ✔twice a year Consent for continuation maintenance ECT should be reobtained at least every \ n ✔6 months What needs to be reevaluated every 6 months with continuation maintenance ECT \ n ✔need/indication anesthetic/medical complications cognitive tests (presence of persistent memory deficits weighed against anticipated benefits) Even in patients who do not have a hx of diabetes, a possible side effect of olanzapine \ n ✔Diabetic ketoacidosis Hyperosmolar nonketotic coma What is considered a side effect of antipsychotics and is treated by beta blockers (propranolol) \ n ✔Akathisia Nefazodone is a potent ________ of CYP 450 \ n ✔inhibitor Medication can be used as an antidote to SSRI induced impotence \ n ✔Nefazodone Unlike other antidepressants, this medication enhances rapid eye movement (REM) and may increase restful sleep in some patients \ n ✔Nefazodone This antidepressant medication is not usually given first line for depression or at all anymore due to risk of liver failure (need to do liver function tests) \ n ✔Nefazodone Haldol should be avoided in \ n ✔pregnant women (d/t risk for birth defects) Common reasons for inadequate response to antidepressants include \ n ✔inadequate dosing pt non-compliance misdiagnosis substance abuse (especially ETOH) Dc medications too quickly/early Associated with acute myopia and secondary closure glaucoma, causing ocular pain and blurred vision d/t increased intraocular pressure \ n ✔Topiramate Metabolic acidosis is associated with ______, _____ levels should be monitored during use \ n ✔topiramate serum bicarbonate These side effects do not improve over time with topiramate use \ n ✔Decreased appetite paresthesias cognitive slowing Weight loss is a significant side effect of \ n ✔topiramax Placing electromagnetic coil on scalp and running electricity through it \ n ✔TMS When was ECT first used in the US \ n ✔1940s Which TCA has been found in considerably higher concentration in breast milk compared to other medications in the same class? \ n ✔Doxepin Doxepin is also known as \ n ✔Sinequan (TCA) Inhibits voltage-dependent sodium channels and presynaptic sodium channels \ n ✔Carbamazepine (Tegretol) Increases GABA in brain \ n ✔Depakote Inhibits glutamate releases \ n ✔Carbamazepine Inhibits sodium channels, enhances GABA-a receptors, and antagonizes kainite at AMPA receptors \ n ✔Topiramate Duloxetine should not be given to patients who \ n ✔consume large amounts of alcohol or have chronic liver disease Duloxetine has a ________ half-life than venlafaxine \ n ✔Longer (dc syndrome less likely) Duloxetine increases this enzyme \ n ✔hepatic transaminases What do charcoal broiled beef, tobacco, marijuana, modafinil, omeprazole and cruciferous vegetables have in common? \ n ✔1A2 inducer What do caffeine, clozapine, duloxetine, imipramine, olanzapine, ramelteon and amitriptyline have in common? \ n ✔1A2 substrate What do fluvoxamine, cimetidine, ciprofloxacin, grapefruit juice, ketoconazole have in common \ n ✔1A2 inhibitors Which pair is least likely to cause weight gain? \ n ✔Lamotrigine and topiramate Which pair of antipsychotics is most likely to cause weight gain \ n ✔Clozapine and olanzapine Which pair of mood stabilizers is most likely to cause weight gain? \ n ✔Valproic acid and lithium Drugs that can induce mania \ n ✔stimulants bromides cocaine antidepressants isoniazid procarbazine steroid amphetamines Medical conditions that can cause mania \ n ✔syphilis brain tumors influenza Q fever multiple sclerosis delirium Which of the following symptoms characterizes the toxicity of clomipramine \ n ✔Convulsions and coma Mechanism of action of Clomipramine \ n ✔blocks reuptake of NE and 5-HT (TCA) Patients require ______ weekly for the first ______ months if they are using clozapine to monitor ________ \ n ✔CBC with a differential 6 ANC for agranulocytosis When starting clozapine, CMP, Fasting lipid and fasting glucose should be monitored at some point within the first ____ of treatment to screen for metabolic syndrome, then if check does not demonstrate sx of metabolic syndrome, screening can be done ______ \ n ✔3 months annually Which medication side effect is NOT associated with lithium or valproic acid \ n ✔eosinophilic colitis Pancreatitis is a rare but potentially deadly side effect of \ n ✔valproic acid Hepatic failure is associated with \ n ✔valproic acid hyperparathyroidism and hyperglycemia have been associated with \ n ✔Lithium Hyperplasia and ademomas of parathyroid glands have been associated with \ n ✔Lithium Mechanism of action of varenicline \ n ✔partial agonist of alpha4beta2 and full agonist of alpha7 mechanism of action of bupropion (Zyban) that helps with smoking cessation \ n ✔partial agonist of alpha4beta2 and partial agonist of alpha7 mechanism of action of NRT that helps with smoking cessation \ n ✔Full agonist at alpha4beta2 and full agonist at alpha7 Neuroleptics and antiemetic drugs such as metoclopramide are dopamine _____ \ n ✔receptor antagonists Rifampicin is an __________ of CYP _______ \ n ✔inducer 2D6 Clozapine leads to seizures in ____ of patients taking >=6--mg \ n ✔4% ___________ is most likely to cause seizures among typical antipsychotics \ n ✔Chlorpromazine Which drug is effective in improving sexual dysfunction in men but when given with an antidepressant to counter its adverse sexual effects can be counterproductive because it is actually anxiogenic? \ n ✔Yohimbine Can help reverse some sexual dysfunction caused by SSRIs at 4-12mg/day, but also can reverses the antidepressant or anti-obsessive effects of SSRIs \ n ✔Cyproheptadine The use of _____ has been more effective than placebo in men with SSRI-induced sexual dysfunction \ n ✔Sildenafil (Viagara) ______ Has been reported to increase overall sexual satisfaction in both men and women \ n ✔Sildenafil (Viagara) Valproic acid is a CYP450 ________ \ n ✔inhibitor What is NOT true regarding typical antipsychotic overdose \ n ✔Dialysis is useful in treating it. (It is often lethal due to significant cardiovascular effects) What seizure medications are considered safe for use in breastfeeding mothers \ n ✔Carbamazepine (Tegretol) Valproic Acid (Depakote) Phenytoin (Dilantin) Phenobarbital Primidone (Mysoline) Enzyme induction generally occurs over the course of ______ \ n ✔1-2 weeks Who exhibits enzyme inhibition \ n ✔premature infants elderly men and women patients with liver disease What medication is a tetracyclic antidepressant \ n ✔mirtazapine OD of this medication presents as dizziness, ataxia, ophthalmoplegia, hyponatremia, and thrombocytopenia \ n ✔Carbamazepine Drugs tend to be absorbed more slowly when a patient has a full stomach. Which medication should be taken on an empty stomach? \ n ✔Sedatives/hypnotics What is the difference in side effects between SNRIs and SSRIs \ n ✔SNRIs may cause HTN SSRIs cause more wt gain, especially paroxetine SNRIs cause less sexual dysfunction when compared to SSRIs Withdrawal tends to be worse with SNRIs Which of the following is a three question screening tool used for dx of ETOH abuse and dependence in pt who is acutely ill or otherwise poorly disposed to speak with the practitioner? \ n ✔AUDIT-C AUDIT has ____ multiple choice questions regarding the _________ and is the ______ for screening for identification of _______ \ n ✔10 quantity and frequency of alcohol consumption, drinking behavior and alcohol related problems Gold standard Alcohol Use Disorders CAGE is a _____ item screening took with a ______ sensitivity and ______ specificity for AUD \ n ✔4 50-75% 80% C in CAGE \ n ✔Have you ever felt you should Cut down on your drinking? A in CAGE \ n ✔Have people ANNOYED you by criticizing your drinking? G in CAGE \ n ✔Have you ever felt bad or guilty about your drinking? E in CAGE \ n ✔Have you ever had a morning eye-opener MAST stands for \ n ✔Michigan Alcohol Screening Test MAST has ____ screening questions with ______ answers \ n ✔25 yes/no On administration of a drug that causes CYP2D6 inhibition, which side effect of methylphenidate will increase? \ n ✔none because it does not have any significant metabolism via that enzyme and the majority of metabolism occurs at first pass and outside the liver Due to a high risk for dependence, for which hypnotic must a test dose be given if a pt's dose is not known \ n ✔Barbiturates If a pt is given too large of a dose of Barbituates, this will happen \ n ✔nystagmus slurred speech ataxia sedation What change in the dose-response curve is observed when a pt becomes tolerant of a medication \ n ✔shift to right Buspirone primarily acts on which receptor \ n ✔5-HT1A Which medications (not yet FDA approved) can be used to treat kleptomania? \ n ✔Fluoxetine Naltrexone Which of the following is characteristic of fetal phenytoin syndrome \ n ✔Hypertelorism Hypertelorism \ n ✔eyes spaced widely apart fetal valproate syndrome features \ n ✔bifrontal narrowing midface hypoplasia broad nasal bridge short nose with anteverted nares epicanthic folds micrognathia shallow philtrum thin upper lip thick lower lip NSAID ______ Lithium clearance and can cause side effects such as ______ \ n ✔decrease tremor What antidepressant is associated with significant sexual side effects and weight gain \ n ✔Phenelzine Some patients on chronic lithium treatment may have gradually _______ \ n ✔increased creatinine Development of hypothyroidism that is not responsive to thyroxine constitutes a valid reason to consider \ n ✔discontinuation of lithium ECG effects common in LIthium \ n ✔changes in depolarization phase worsening existing arrhythmias With most modern devices, the dosage of ECT is changed by varying which aspect \ n ✔time of exposure to fixed current When drug is quickly metabolized to inactive metabolites, which of the following statements may be true of this patient \ n ✔She is a poor metabolizer Donazepil is believed to improve \ n ✔memory in neurocognitive disorder by increasing the amount of acetylcholine available in the synaptic cleft by inhibiting its breakdown by acetylcholinesterase. This inhibition is reversible. Barbituates ________ plasma TCA, _____ the antidepressant effects because of their induction of __________ and accelerated _______ \ n ✔lower diminishes liver microsomal enzymes degradation of the TCA Barbiturates act on ______ receptors \ n ✔GABA For gastrointestinal issues associated with Lithium use \ n ✔change to longer-acting oral preparation or use lithium citrate syrup For lithium associated edema \ n ✔administer spironolactone (25mg/day) and follow lithium levels closely For lithium tremor \ n ✔administer propranolol (10-30mg TID) or primidone (25- 100mg/day) as second-line For lithium hypothyroidism treat with \ n ✔thyroid hormone and continue lithium therapy When in the body is melatonin made \ n ✔Pineal gland (Serotonin derivative) Hormones hypothalamus makes \ n ✔TRH (thyrotropin releasing hormone) dopamine GHRH (growth hormone releasing hormone) SS (somatostatin) GnRH (gonadotropin releasing hormone) CRH (corticotropin releasing hormone) oxytocin vasopressin (ADH) The posterior pituitary stores and releases \ n ✔oxytocin and vasopressin (ADH) The anterior pituitary makes \ n ✔ACTH TSH FSH LH Brief psychotherapy that focuses on resolving interpersonal problems \ n ✔interpersonal psychotherapy Interpersonal psychotherapy takes ______ to complete \ n ✔12-16 weeks Psychotherapy used for people struggling with longstanding difficulties in the way they think and feel about themselves, their environment, and other people \ n ✔psychoanalysis The principles that govern behavioral therapy are based on early studies of _______ by _______ and _________ by ________ \ n ✔operant conditioning Skinner classical conditioning Pavlov In patients with eating disorders, which characteristics do not require hospitalization \ n ✔nausea/vomiting Main indications for hospitalization in pt with eating disorder \ n ✔severe starvation and weight loss hypotension hypothermia electrolyte imbalance suicidal ideation/psychosis failed outpatient tx Median age of onset for generalized anxiety disorder \ n ✔early adulthood (25-35) What is the typical age of onset for panic disorder? \ n ✔Early adulthood What treatment can cause cardiac malformations in the developing fetus if used in a pregnant patient \ n ✔Lithium Standing in line at a store would likely provoke anxiety in patients with \ n ✔agoraphobia Which medical condition is associated with anorexia nervosa \ n ✔Lanugo bradycardia pancytopenia osteopenia metabolic encephalopathy arrhythmias elevated LFTs elevated BUN decreased T3/T4 parotid gland enlargement seizures peripheral neuropathy What is the most common personality disorder in bulimia nervosa patients \ n ✔borderline Children with PTSD have nightmares involving______ rather than recurring dreams of traumatic events \ n ✔monsters rescues threats The DSM-5 diagnosis of anorexia nervosa no longer requires \ n ✔irregular menses in postmenarcheal females (unspecified eating disorder replaces NOS) Fluoxetine has a half life of approximately \ n ✔48 hours Venlafaxine has a half life of \ n ✔5 hours (parent drug) 11 hours (active metabolite) Citalopram has a half life of approximately \ n ✔24-48 hours Sertraline has a half life of approximately \ n ✔26 hours Of the following: amitriptyline, duloxetine, mirtazapine, and sertraline, which has the fewest side effects \ n ✔Mirtazapine The risk of weight gain with mirtazapine may be diminished at doses \ n ✔>30mg/day The noradrenergic effects of mirtazapine tends to be \ n ✔dose dependent increases significance at >15mg/day noradrenergic \ n ✔activated by, or involving norepinephrine in the transmission of nerve impulses Mirtazapine blocks serotonin 2A, 2C, and 3 receptors, so the side effects of _______ are avoided \ n ✔anxiety nausea/Gi distress sexual dysfunction In Mirtazapine, blocking serotonin 2A and H1 antihistamine receptors accounts for the side effects of \ n ✔sedation weight gain Mirtazapine appears to have no clinically significant effect on \ n ✔seizure threshold cardiovascular syndrome A dose dependent relationship between Miratazpine and _____ has been demonstrated \ n ✔increased appetite and weight Unlike DSM4, in DSM 5, which of the following statements is true regarding separation anxiety disorder? \ n ✔It is diagnosed with onset at any age. Separation anxiety disorder last for _____ in children or _______ in adults \ n ✔4 weeks 6 months Among the general population, which of the following disorders is most commonly comorbid in anorexia nervosa \ n ✔Major depressive disorder (56%) 25% of anorexic pts have these disorders \ n ✔alcohol use disorder specific phobias social anxiety disorders Up to 35% of anorexia patients have \ n ✔obsessive compulsive disorder Double the dose of lamotrigine when taking the following medications concomitantly \ n ✔carbamazepine phenytoin phenobarbital primidone rifampin The lifetime prevalence of social phobia is _____ and slightly more common in______ \ n ✔13% women What ethnic group is at the highest risk of having social phobia? \ n ✔Native American People who have social phobia are less likely to live in ______ setting \ n ✔an urban Onset of social phobia is usually in \ n ✔adolescence early adulthood FDA approved medication for social phobia \ n ✔paroxetine (beta-blockers public speaking) The 3 CBT techniques used for social phobia treatment are \ n ✔exposure cognitive restructuring social skills training Subtypes of social phobia \ n ✔Natural environment (heights, lightning, bodies of water) Blood injection injury (fears of blood medical procedures, needles etc) Situational (fears of situations such as being in an elevator tight space, driving or airplanes) What is the most common category of mental illness in the United States \ n ✔Anxiety disorder Function MRI measures which of the following \ n ✔Changes of blood flow in brain TSH is low in \ n ✔hyperthyroidism Hyperthyroidism may manifest like ______ before classic sx of Graves' disease appear \ n ✔generalized anxiety or panic In patients presenting with dementia, what is true about brain tumors? \ n ✔paraneoplastic limbic encephalitis should be suspected Early sx of paraneoplastic limbic encephalitis are \ n ✔confusion agitation memory loss progressing to dementia Tumors tend to be ______ symptomatic than ischemic strokes affecting comparable brain volume \ n ✔less Brain tumors in adults are associated with psychiatric symptoms in ________ of patients \ n ✔50% What is the superior level of evidence in regards to therapeutic clinical research? \ n ✔RCT, especially meta-analysis of multiple RCT's Imaging of Cushing's disease requires an ____ because it is commonly caused by _____ \ n ✔MRI pituitary adenoma Cushing's syndrome is often preceded by \ n ✔psychiatric symptoms: -irritability -crying -pronounced suicidality -rarely psychosis When Cushing disease pts require high doses of steroids, it may trigger \ n ✔mania, requiring mood-stabilizing medication as prophylaxis FDA approval for Marinol (dronabinol) \ n ✔Anorexia in AIDS anti-nausea/antiemetic for chemo Once rabies reaches the CNS, a pt will experience \ n ✔physical agitation episodic confusion psychosis combativeness In rabies, the virus travels \ n ✔inwards from the peripheral nerves to infect the CNS Nonneuronal tissues can be affective Paralytic rabies occurs in _____ of pts exposed to rabies \ n ✔20% Vocal cord paralysis often occurs in \ n ✔rabies Hypothyroidism carries a greater risk of developing \ n ✔carpal tunnel syndrome Depressive symptoms persist in hypothyroid pts after therapy in _____% of pts \ n ✔10 A manifestation of late state hypothyroidism \ n ✔myxedema madness myexedema madness \ n ✔hallucinations and paranoia late state of hypothyroidism physical findings in hypothyroidism \ n ✔thin dry hair dry skin constipation carpal tunnel syndrome lateral eyebrow loss hearing loss When studying pt's favorite color and presence of bipolar disorder, which test will analyze the data most effectively? \ n ✔Chi-square test Used to compare samples with non-measurable nominal/categorical variables \ n ✔chi-square test used to compare the means of 2 independent and different sample populations (ie height of men in Texas and NY) \ n ✔T-test It requires a large sample or known population variance \ n ✔z-test Study follows a group of similar individuals to determine risk of developing disease \ n ✔Cohort Study Analyzes a known outcome by looking back in time to assess exposure \ n ✔Case- control Analyzes a population (or representative subset) at a single point in time (a cross sectional) to assess disease incidence and prevalence \ n ✔Cross sectional study Experimental/clinical trial that studies the effect of an intervention by comparing the treatment to a placebo in 2 equivalent groups separated by randomization \ n ✔RCT In patient with cerebral ataxia, Parkinsonism, bone pain, mental slowing, attention problems, hypercalcemia and elevated parathyroid hormone, what is true \ n ✔Correcting calcium level will prevent delirium Stones (kidney stones), groans (bone pain), and psychiatric overtones is mnemonic for \ n ✔hypercalcemia As many as _____ % of patient with hyperparathyroidism and elevated calcium have no recognizable symptoms \ n ✔50% Which ethic group tends to have the highest preference for life-sustaining tx in terminal illness? \ n ✔African Americans What ethnic group has the lowest rate of preference for life-sustaining treatment in terminal illness \ n ✔European Americans The most common value in a data set is called the \ n ✔mode An estimate _____% of pts with chronic alcohol use disorder relapse within 3 months after treatment completion \ n ✔50 Which of the following medications is not recommended for relapse prevention in detoxified patients with chronic alcohol use disorder \ n ✔Chlordiazepoxide Anti-craving drugs used to prevent alcohol relapse \ n ✔Topiramate Acamprosate (also works in acute post-withdrawal period) For an idealized population graphed into a perfect bell shaped curve, 1 standard deviation of the mean would include what percentage of people? \ n ✔68% For an idealized population graphed into a perfect bell shaped curve, 2 standard deviations of the mean would include what percentage of people? \ n ✔95% For an idealized population graphed into a perfect bell shaped curve, 3 standard deviations of the mean would include what percentage of people? \ n ✔99.7% Tumors of the upper brainstem can cause \ n ✔akinetic mutism Early signs of encephalitic paraneoplastic syndromes are \ n ✔confusion agitation memory loss progressing to dementia Leading cause of paraneoplastic syndromes \ n ✔small cell carcinoma of the lung Cancer that is frequently preceded by depression \ n ✔Pancreatic New onset of symptoms and _____ increase the likelihood that psych sx may be due to HIV related cause \ n ✔CD4 count<600 (generally seen only in advanced disease stages) What is true about acute intermittent porphyria (AIP) \ n ✔phenothiazines are safe to treat psychosis