Drug Tx Of Psychotic Disorders,mood Disorders

Front 1

mean age of onset for major depressive disorder (MDD)?

course length?

Back 1

40 women 2x as likely (20-25%)

6-13 mos

Front 2

depression is most common in what demographic?

Back 2

elderly

Front 3

period of highest risk of recurrence of MDD?

Back 3

first year 50%

if 2 episodes 70%
if 3 episodes 90%

Front 4

ratio of depressed patients contemplating suicide?

percent of hospitalized depressives who commit suicide over a lifetime?

Back 4

2/3

15%

Front 5

who is at greatest risk of successful suicide?

Back 5

elderly men

Front 6

list risk factors for suicide

Back 6

old, living alone, recent major loss, chronic illness, low self-esteem, prior attempts, cognitive impairment, hoplessness, drugs or alcohol

Front 7

suicide risk factor most closely related to success?

what percent of primary care patients have depression?

Back 7

hoplessness

10%

Front 8

60% of patients having nine or more physical complaints have?

low back pain and multiple sclerosis correlate with 50% having what problem?

Back 8

mood disorder


mood disorder/ depression

Front 9

4th leading worldwide cause of disability and disease burden?

Back 9

Major Depressive Disorder (MDD)

Front 10

3 drug types that can cause depression?

Back 10

beta blockers, sedative/hypnotics, oral contraceptives

Front 11

weakest d2 binding atypical antipsychotic drug?

why is it still efficacious?

Back 11

clozapine

binds but has a fast dissociation
preferentially binds 5HT receptors

Front 12

name 2 atypical antipsychotics approved for maintenance of bipolar disorder?

Back 12

olanzapine
aripiprazole

Front 13

approved atypicial drug for tic disorder?

For unipolar, non-psychotic depression?

Back 13

primozide


aripiprazole

Front 14

atypical antipsychotic used to reduce suicidal tendancy?

Back 14

clozapine

Front 15

haloperidol side effects

Back 15

extrapyramidal : parkinson-like syndrome, bradykinesia, rigidity, tremor

Front 16

tardive dyskinesia is characterized by?

common drugs causing TD?

how to Tx?

Back 16

choreoathetoid movements of muscles in the lips and buccal cavity
cuased by long-term use of antipsych.
only temporary relief by incleasing neuroleptics

Front 17

most common EPS due to antipsychotics?

Back 17

akathisia (inner restlessness)

Front 18

aripiprazole action?

Back 18

partial agonis of D2 ant 5HT1a

antagonist of 5HT2a

Front 19

high dose clozapine can cause?

Back 19

agranulocytosis
seizures

Front 20

risk factors for tardive syndrome?

Back 20

elderly

Front 21

first gen or second gen?

higher occurence of metabolic disorder side effects?

Back 21

2nd gen

Front 22

metabolic side effects of 2nd gen antipsychotics?

Back 22

hyperlipidemia
hyperglycemia
weight gain

also poverty

Front 23

endocrine side effects of 2nd gen?

other side effects?

Back 23

galactorrhea
hyperprolactinemia

sedation,malais, sexual, headache

Front 24

1st gen or 2nd gen ?

idiosyncratic side effects

treat with?

Back 24

1st gen

hyperpyrrexia
dysautonomia

Dantolene, bromocriptine

Front 25

which antipsychotic can cause myocarditis?

what else does it cause esp. when given with benzos?

Back 25

clozapine


respiratory distress

Front 26

which drug causes cardio conduc tion velocity problems?

Back 26

thioridazine

Front 27

symptoms pointing to melancholic MDD?

Back 27

early morning riser
depression worse in morning
excessive weight loss
exessive guilt
psychomotor slowing

Front 28

6th most common disability worldwide?

Back 28

bipolar disorder

Front 29

% suicide risk in bipolar disorder?

success?

Back 29

25-50% over lifetime


12-19% success

Front 30

bipolar disorder has 30% co-morbidity with?

Back 30

substance abuse

Front 31

causes of secondary mania?

Back 31

stroke
hyperthyroidism
MS
CNS infection
extrapyramidal sytemic disease

Front 32

criteria for dysthymic disorder

Back 32

pessimism
depressed most of day
more days than not
2 years
low self-esteem

Front 33

what is double depression?

Back 33

dysthymic with a superimposed major depressive episode

Front 34

criteria for cyclothymic?

often have family history of?

Back 34

2 years of hypomania plus depression (non-major)

type I bipolar

Front 35

Dx:
dysphoria related to a stressor that does not meet criteria for major depression and does not persist for 6 mos.

Back 35

adjustment disorder with depressed mood

Front 36

Dx:
severe depression for 2 months or more no guilt or thought of worthlessness or suicide

Back 36

bereavement

Front 37

Tx premenstral dysphoric disorders

Back 37

SSRI''s : fluoxetine, trazodone

Front 38

drugs that block NE reuptake

Back 38

tricyclics: desipramine, maprotiline
also block seratonin reuptake

Front 39

premenstrual dysphoric disorder (PMDD) is characterized by ?

Back 39

more physical symptoms and mild emotional overtones

Front 40

prevalence of PMDD?

Tx :?
efficacy?%

Back 40

3-8% of women in reproductive years

SSRI's (fluoxetine)

60%

Front 41

etiology of major depression

Back 41

loss parent undder age 11
loss of spouse
learned helplessness

Front 42

simplified mediation of mood symptoms by biogenic amines

Back 42

NE= depression
seratonin(5HT)= behavior, appetite
dopamine=pleasure,sex

Front 43

metabolite low in CSF of suicide patients?

Back 43

5-HIAA

Front 44

major depression brain scan shows?

serum hormones?

Back 44

reduced gray matter in prefrontal cortex

elevated serum cortisol with loss of diurnal variation

Front 45

sleep disturbances in MDD?

Back 45

prolonged latency
short REM
decreased stage 3,4
decreased arousal
early morning waking

Front 46

cellular changes induced by antidepressants

Back 46

increased intersynaptic NT levels
incr. CREB expression(transcription)
incr. BDNF (target)
neurogenesis
structural changes

Front 47

genetic concordance in monozygotic twins for bipolar disorder?

% of treatable?

Back 47

80%

80%

Front 48

electroconvulsive therapy is the single most effective treatment for ?

side effect?

Back 48

major depression
esp. psychotic and suicidal

disorientation
short-term retrograde mem loss

Front 49

pregnant women with mania Tx:

Back 49

electroconvulsant therapy

Front 50

seratonin is synthesized from?

which 2 enzymes

Back 50

tryptophan

trp hydroxylase (rate limiting)
5HTP decarboxylase

Front 51

neurotransmitters are released into?

Back 51

extracellular space

Front 52

norepinephrine is synthesized from ?

rate limiting step?

Back 52

tyrosine

tyrosine hydroxylase

Front 53

seratonin receptor present in raphae nucleus and post-syn neurons of hippocampus?

Back 53

5HT1A

Front 54

MAOI representative drug Tx:

A
B
side effect dangers

Back 54

phenelzine MAO- A
selegiline MAOI-B (parkinsons)

tyramine foods=hypertensive crisis
tryptophan=orthostatic hypotension

Front 55

side effects of MAOI's primarily due to ?
hypertensive crisis symptoms?

Back 55

alpha-adrenergic blockade

headache,nausea,sweating,pallor
vomiting,hyperpyrexia

Front 56

name three tricyclic antidepressants


side effects?

Back 56

amitryptiline
desipramine
nortryptiline

cardiac conduction prob.

Front 57

TCA's action

cautions?

Back 57

inhibit reuptake of 5HT, NE
alpha-1 blockade
muscarinic blockade
histamine blockade
high overdose potential

Front 58

histamine blockade side effects?

seratonin blockade side effects?

Back 58

weight gain, orthostatic hypotension
drowsy
anxiety, seratoninsyndrome(adrenergic
sexual side effects

Front 59

a-adrenergic blockade side effects?

Back 59

orthostatic HT
reflex tachycardia
can't ejaculate

Front 60

nor-epi blockade side effects

Back 60

anxiety
tremor
tachycardia

Front 61

SSRI's treat (5)?

Back 61

depression
OCD
panic disorder
PTSD
social phobiia

Front 62

name two SSRI's

mechanism?

Back 62

fluoxetine

sertraline
inhibits 5HT reuptake
CP450

Front 63

describe serotonin syndrome

Back 63

agitated,confused
insomnia, beh. changes
rigid, tremors,sweating
hyperpyrexia,tachycardia,hypertension

Front 64

can't give SSRI' s with?

Back 64

MAOI's or another antidepressant

Front 65

SSRI withdrawal syndrome

Back 65

flu-like restless, confused,irritable

Front 66

name two SNRI's
effect?
monitor?

Back 66

venlafaxine, duloxetine
block reuptake 5HT>NE (ven.)
monitor diastolic BP

Front 67

which therapy is best for MDD?

Back 67

cognitive-behavioral

Front 68

mirtazapine
mechanism?

side effects?

Back 68

alpha-2 antagonist

sedation, weight gain

Front 69

bupropion

mechanism?

side effects?

Back 69

augments NE release

weight neutral****
quit smoking

Front 70

trazodone

mechanism?
side effects?

Back 70

5HT2A antagonist

priopism
sedating

Front 71

efficacy of SSRI's vs. TCA

Back 71

SSRI=TCA

Front 72

overdose dangers (7-10day)
MAOI
SSRI
TCA

Back 72

MAOI=hypertensive crisis,hyperpyrexia

SSRI=25 day supply

TCA=cardiac, seizures

Front 73

Tx for mood disorder with psychotic depression?

Back 73

SSRI + antipsychotic or ECT

Front 74

lithium mode of action


elimination

Back 74

enters sodium channels
blocks IP3
increases 5HT

renal

Front 75

significant risk in lithium use?

symptoms of early intoxication?

Back 75

hypothyroidism

tremor,nausea,vertigo,delerium,diarrhea

Front 76

drugs that elevate lithium levels

Back 76

ACE inhibitors
NSAIDS
diuretics (thiazides)

Front 77

drugs that lower lithium levels?

Back 77

caffeine
laxatives
theophylline

Front 78

valproic acid action?

side effects?

used for?

Back 78

brain GABA-ergic

teratogen, dyspepsia,weight gain

rapid cycling bipolar

Front 79

carbamazepine used for?

side effects?

Back 79

manic phase of bipolar

agranulocytosis,aplastic anemia
neural tube defects, drowsy, slurred s.

Front 80

rare side effect of lomotrigine?

used for?

Back 80

stevens-johnson syndrome

depressive phase of bipolar

Front 81

2 drugs to treat neural malignant syndrome ( hyperpyrexia, rigidity, dysautonomia, cognitive changes)
1 non-drug Tx?

Back 81

dantrolene
bromocriptine
ECT