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118 Cards in this Set
- Front
- Back
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What rx can be lethal combined with a MAOI?
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Venlafaxine (drugs involving NE ... amphetamines)
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What is a parasomnia
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physiologic/arousal disorders occuring during slow wave sleep
e.g. restlesslegs, sleep walking, periodic leg movements |
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What is one of the least nauseating antidepressants?
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Mirtazapine . Remeron
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Which ds has the highest relative risk in first degree relatives?
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Bipolar Disorder
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What is the effect of the following on labs (i.e. lytes)?
Oxcarbazepine ? Valproate? Topiramate? Lithium? Gabapentin? |
Oxcarb: significant hyponatremia
Valp: elevated liver enz, increased ammonia levels, rare hyponatremia Topiramate: hyperchloremic, non-ion-gap metabolic acidosis (elevated chloride levels) (high Cl, reduced bicarb level) Lithium: diabetes inspidus, hypernatremia Gabapentin: no lyte abnormalities |
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What is rapid cylcing associated with often? more common in women or men?
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Antidepressant use
much more common in women Note: substance abuse excludes dx of rapid cycling |
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Stroke on left side is associated with ?
Mood, anxiety, or psychosis? on Right side? |
left side stroke assoc with depression
right sided assoc with mania |
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What is genetically linked to OCD?
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depression, anxiety, and tourette's
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What rx would give if:
depression, substance abuse (nicotine), and adhd sx |
bupropion
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Which dementia?
1. early changes in personality ... late decline in memory? 2. triad of dementia, involuntary mvment, and periodic EEG activity? 3. hallucinations and psychosis 4. Early age of onset? |
1. Pick's Disease
2. Creutzfeldt-Jacob disease 3. Lewy body 4. HIV, Huntington's ds |
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what does normally tend to decline with age?
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speed of learning, processing and performing ....
but not STM, Knowledge fun, Language |
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Which "club drugs" asssociated with:
1. altered mental state, convlusions, hypo/hyperthermia, CVS instability, hepatoxicity, and death 2. Euphoria, vomiting, muscle spasms, LOC (with EtOH, very slowed resp) 3. Perception and sensation seperated. Dreamy feeling/numbness, hallucinations 4. decreased memory, decreased bp, drowsiness, visual disturbances, dizziness, confusion, GI disturbance, urinary retention |
1. MDMA
2. GHB 3. Phencyclidine/ketamine 4. Flunitrazepam (Rohypnol) "roofies" |
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Anatomy of emotional tone of speech or prosody = ?
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Wernicke's does understanding of language in dominant hemisphere
corresponding area in other hemi detects tone/prosody = right parietotemporal cortex Broca's area is repsonsible for motor output Corresponding area, in R premotor cortex, is involved in expressive language production or the "music" for the content |
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Alcohol has ? order kinetics.
women have ? body water content compared to men alcohol is distributed in the ? women have a ? ratio of fat-to-water content as they age women have ? quantities of alcohol dehydrogenase in the gut compared to men. women's bodies absorb ?(more or less) of the alcohol they drink than men blood alcohol concentration in women can vary according to ? |
Alcohol has zero order kinetics.
women have more body water content compared to men alcohol is distributed in the tbw women have a higher ratio of fat-to-water content as they age women have lower quantities of alcohol dehydrogenase in the gut compared to men. women's bodies absorb more of the alcohol they drink than men blood alcohol concentration in women can vary according to menstrual cycle |
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Relative risk of the following for 1st degree relatives:
1. Bipolar ds 2. Sz 3. Panic Ds 4. AN 5. Alcoholism 7. Somatization |
1. Bipolar ds 25%
2. Sz 18& 3. Panic Ds 10% 4. Alcoholism 7% 5. AN 5% 6. Somatization 3% |
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What psych med is associated with hyponatremia?
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oxcarbazepine (2.5%) develop
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What Rx can cause elevated liver fxn tests and increase ammonia levels?
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Valproate
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What rx causes hyperchloremic, non-ion-gap metabolic acidosis (high Cl, low Bicarb)
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Topiramate
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What rx can cause diabetes insipudus ... which would then lead to hyponatremia?
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Lithium
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What electrolyte changes does gabapentin cause?
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nil
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Rapid cycling: associated with ?
number of episodes? women make up ?% of rapid cyclers |
antidepressant use
4 or more 70 to 90% are women |
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Desipramine is substrate for what P450?
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2d6
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fluoxetine inhibits what p450?
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2d6
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Which dementia has early personality changes and late memory changes?
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pick's disease
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pick's disease affects what lobes?
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frontal and temporal
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what dementia associated with this triad: dementia, involuntary movement, periodic eeg activity?
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Creutzfeldt-Jacob disease
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hallucinations and psychosis associated with what dementia?
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lewy body dementia
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echolalia and echopraxia may be seen in what disease?
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depression with catatonic features
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features of mood ds with catatonic features = ?
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motoric immobility
extreme agitation extreme negativism pecularities of voluntary movement echolalia or echopraxia |
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what substance associated with:
change in mse convulsions hypo-or hyperthermia cv instability hepatoxicity death |
MDMA
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what sub associated with:
sleepyness, vomitting, muscle spasms, loss of consciousness, mixed with etoh get slowed breathing? |
GHB
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dreamy state, numbness in extremities, hallucinogenic effect = ?
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ketamine
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date rape drug, amnesia, lower blood pressure, drowsiness, visual disturbances, dizziness, confusion, gi disturbances, urinary retention
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flunitrazepam
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brain are associated with emotional tone of speech?
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right parietotemporal cortex
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what does the right parietotemporal cortex correspond to in the left?
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wernicke's
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what is analogous in right brain to broca's area? and what is the fxn of that?
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right premotor cortex
expressive language production music for the semantic content |
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Lithium + what rx can cause toxicity?
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thiazide diuretic
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how does the kidney process Lithium?
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excretes it
reabsorbed it in the proximal tubules with sodium and water |
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can lithium cause a nepropathy associated with protein loss?
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yes
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can Li cause a Tublointerstitial nepropathy?
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yes .... through cumulative exposure which results in gradually lower gfrs
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What is genetic connection of borderline pd?
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5X greater in first degree relatives
greater familial risk of substance related ds, aspd, and mood ds |
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OCD and relationship to:
1. attention 2. responsibility 3. memory 4. spatial recognition |
1. attention - decreased capacity for selective attention
2. responsibility -- have negative beliefs 3. memory - biased for disturbing themes, decreased confidence in memory 4. spatial recognition - deficits |
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what is codein's relationship to p450?
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p450 2d6 used to convert it to morphine, active ingredient, if blocked must increase dose
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bereavement vs mdd?
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worthlessness
generalized (vs specific to deceased) guilt preoccupation with death (vs wish to join deceased ... seen in bereavement) pm retardation hallucinations other than of deceased |
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what does the reticular activating system regulate?
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arousal,
sleep-wake cycles, conscious activity |
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what does the hypothalamus do?
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hormonal regulation
eating drinking |
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what structure is associated with motivation?
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ventral striatum
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which dementia?
insidous onset early onset (earlier than alz) incontinence, speech and language abnormalities aptahy socially inappropriate behaviour localized deficits on imaging (frontotemporal regions) |
Pick's disease
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dementia associated with basal ganglia changes on mri?
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CJD
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Dementias associated with neurological findings
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Huntington's
parkinson's |
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parathyroid effects of lithium?
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hypercalcemia and hyper-parathyroidism
with hyperplasia and adenomas of parathyroid glands |
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what is metoclopramide
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Metoclopramide (INN) (pronounced /ˌmɛtəˈklɒprəmaɪd/) is an antiemetic and gastroprokinetic agent. Thus it is primarily used to treat nausea and vomiting, and to facilitate gastric emptying in patients with gastroparesis. It is also a primary treatment for migraine headaches.
It appears to bind to dopamine D2 receptors where it is a receptor antagonist, and is also a mixed 5-HT3 receptor antagonist/5-HT4 receptor agonist |
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can you get eps from metoclopramide?
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yes
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relationship of carbamazepine and liver enzymes?
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induces, so can oral contraceptive
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which mood stabilizers processed by liver?
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lamotrigine,
valproate |
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brain structures associated with ocd?
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cortex
striatum thalamus tx reduces orbitofrontal cortex and anterior cingulate cortex activity |
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AN comorbid disorders in order of frequency?
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MDD 65%
Social phobia 34% OCD 26% |
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which brain areas associated with alcohol dependence
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ventral tegmentum
nucleus accumbens prefrontal cortex |
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which brain regions associated with sz
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anterior cingulate gyrus
thalumus cerebellum temporal lobe regions |
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AN brain region?
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thalamus
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substance associated with: ataxia, dysarthria, nystagmus, miosis
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PCP or phencyclidine
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do you get hypertension and agitation with heroin intoxication
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not reallly
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what rx associated with hyponatremia?
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carbamazepine
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which sleep ds more common in males?
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sleep terror disorder
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features associated with late onset depression (elderly) versus young
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elderly more likely to have dementia on imaging,
poorer response to tx chronic medical illness |
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what can lower lamotrigine levels?
what can raise? |
enzyme inducers: carb, phenytoin, OCP's
valproate inhibits metabolism and doubles blood levels |
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Degenerative dementias such as ??
are distinguished from non-generative dementias by intrinsic genetic processes that lead to neuron destruction rather than complications from systemic medical conditions? |
huntington's
and parkinson's disease |
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? reduces the clearance of lamotrigine by 50%
What rx increase lamotrigine clearance? |
Divalproex
... Carb, Pheny, Phenobarbital reduce levels |
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amygdala plays key role in ?
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emotional coding of sensory cues
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? is involved in recalling previously learned material?
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hippocampus
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social behaviour structure?
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frontal cortex
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structures involved in normal sleep patterns?
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thalamus
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structures involvedin signaling reward by exogenous substances?
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nucleus accumbens
ventral tegmentum |
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which rx's associated with tx alcohol dependence?
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naltrexone
ondonsetron (off-label) acamprosate disulfiram |
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? Disorders are more common in fragile X syndrome than any other form of mental retardation?
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anxiety disorders
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what predicts good lithium response?
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euphoric mania
nonrapid cycling full interepisode remission no comorbidity lack of psychotic features few lifetime episodes mania-depression-euthymia course |
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children have less or more efficient renal function than adults?
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more efficient
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first line treatment for mild severity ptsd? mroe severe?
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psychotx only
then psychotx +rx |
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process of gene mapping, performted to see if a particular allele occurs more frequently than by chance in affected individuals = what type of study?
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association study
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a type of gene-mapping study, examines whether two or more genetic loci are co-inherted more often than expected by chance?
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linkage studies
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type of study done to determine mode of inheritance .. dominant or recessive
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segregation analysis
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clonazepam has fda approval for what?
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panic disorder (and seizure disorders)
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most effective rx for rapid cycling bipolar ds?
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divalproex
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which rx's associated with tx alcohol dependence?
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naltrexone
ondonsetron (off-label) acamprosate disulfiram |
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? Disorders are more common in fragile X syndrome than any other form of mental retardation?
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anxiety disorders
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what predicts good lithium response?
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euphoric mania
nonrapid cycling full interepisode remission no comorbidity lack of psychotic features few lifetime episodes mania-depression-euthymia course |
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children have less or more efficient renal function than adults?
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more efficient
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first line treatment for mild severity ptsd? mroe severe?
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psychotx only
then psychotx +rx |
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process of gene mapping, performted to see if a particular allele occurs more frequently than by chance in affected individuals = what type of study?
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association study
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a type of gene-mapping study, examines whether two or more genetic loci are co-inherted more often than expected by chance?
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linkage studies
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type of study done to determine mode of inheritance .. dominant or recessive
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segregation analysis
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clonazepam has fda approval for what?
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panic disorder (and seizure disorders)
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most effective rx for rapid cycling bipolar ds?
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divalproex
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grapefruit juice is potent inhibitor of?
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3A4
benzo's calcium channel blockers statis cyclosporines buspirone levels increase |
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a test to determine the chromosomal region where a disorder resides by search for co-segration of a genetic marker with the disorder locus
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linkage analysis
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which is longer lasting in tx of enuresis: bell and pad or rx?
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bell and pad
tricyclics and desmopressin fade |
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chronic alcoholism associated with several neurologic findings ...
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cerebellar anterior lobe degeneration
retrobulbar optic neuorpathy wernicke's encephalopathy amnestic disorder (korsakoff's) |
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in order to determine the genomic location of a susceptiblity gene for panic disorder, which test is most appropriate?
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gene finding
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describe molecular genetics
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uses critical dna variants to trace biological pathways from dna to disorders
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what studies are done to quanitify the degree of familial aggregation and or heritability
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basic genetic epidemiology
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Heretibality or proportion of phenotypic difference among individuals that can be attributed to genetic factors for
sz ocd alcohol depedence mdd panic ds |
sz: 70 to 89%
60% for OCD 40 to 60% for alcohol dependence 40 to 45% for MDD and panic Ds |
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pancreatitis associated with what rx?
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valproate
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dementia, ataxia, and macrocytic anemia?
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b12 def
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dementia, diarrhea, dermatitis?
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b3 defiency or pellagra
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relation of the following drugs in terms of lithium levels
1. Theophylline 2. ziprasidone 3. hctz 4. celecoxib |
1. Theophylline :lowers (diuretic)
2. ziprasidone: no change 3. hctz: raises 4. celecoxib: raises slightly |
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in the primary care setting, mdd most commonly presents with?
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multiple somatic sx, with back pain among most frequent
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lamotrigine and weight effect?
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little weight change, slight gain
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brain change most associated with MDD?
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decreased size of the caudate
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ocd and increased blood flow in what region?
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basal ganglia, especially caudate
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structural findings in ocd with caudate
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bilateral shrinkage
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side fx of dopa in patients with parks?
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vivid dreams
night terrors delirium delusions ... especially after 2 or more years |
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which dementia most associated with myoclonus?
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CJD
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dysarthria associated with?
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head injury
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choreoathetosis sign of ?
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huntington's disease
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frontal release signs seen in?
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pick's disease
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for successful processing of traumatic events, three process must be accomplished?
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engage emotionally with memory of trauma
trauma story must be organized and articulated in a sequenced and coherent fashion dysfunctional thoughts that commonly occur after trauma must be addressed and corrected |
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ptsd considered chronic after?
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3months
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kidney stones side fx of which rx?
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topiramate
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