More Antidepressant And Mood Stabilizer Questions

Front 1

Dopamine antagonism is more likely to lead to:
Prolactin: decrease or no change or increase?
Motivation: decrease or no change or increase?
Affect: decrease or no change or increase?

Back 1

Prolactin: increase
Motivation: decrease
Affect: blunted

Front 2

Obesity from atypical antipsychotics is mediated by the ___ and ___ receptor antagonism.

Back 2

Obesity from atypical antipsychotics is mediated by the __5HT2C__ and __Histamine (H1)__ receptor antagonism.

Front 3

5HT3 receptor antagonism mediates ___ caused by antidepressants

Back 3

5HT3 receptor antagonism mediates __GI side-effects = diarrhea/ nausea and vomiting__ caused by antidepressants

Front 4

Serotonin agonists cause increased or decreased or no change in libido. This is likely due to what?

Back 4

Decreased (note serotonin antagonizes Dopamine)
Dopamine antagonism.

Front 5

Please list one SSRI which would be least likely to have withdrawal side effects if stopped abruptly.

Back 5

Fluoxetine.

Front 6

List an SSRI most likely to have withdrawal side effects. if stopped abruptly.

Back 6

Paroxetine.

Front 7

Which SSRI has shortest half-life?

Back 7

Fluvoxamine (which is thus prescribed twice a day).

Front 8

Of the following TCAs: amitriptyline, clomipramine, desipramine, doxepin, imipramine, nortriptyline, protryptyline…
which has high anticholinergic effects?

Back 8

amitriptyline, clomipramine, doxepin, imipramine, protryptyline

stinky mnemonic: AC DIP

Front 9

Of the following TCAs: amitriptyline, clomipramine, desipramine, doxepin, imipramine, nortriptyline, protryptyline…
Which has moderate anticholinergic effects?

Back 9

Desipramine, nortriptyline

Front 10

Of the following TCAs: amitriptyline, clomipramine, desipramine, doxepin, imipramine, nortriptyline, protryptyline…
Which has high potency for orthostatic hypotension?

Back 10

amitriptyline, clomipramine, imipramine

stiinky mnemonic: CIA

Front 11

Of the following TCAs: amitriptyline, clomipramine, desipramine, doxepin, imipramine, nortriptyline, protryptyline…
Which has low potency for orthostatic hypotension?

Back 11

Desipramine, nortriptyline, protryptline (note – doxepin is moderate)

Front 12

What is the difference between a psychotic delusion and OCD related fear of contamination?

Back 12

insight that this is irrational

Front 13

What is the first line pharmacologic treatment of OCD?

Back 13

SSRI

Front 14

What antidepressant would you prescribe if this first line for OCD fails?

Back 14

Clomipramine

Front 15

What is the first line psychotherapeutic treatment for OCD?

Back 15

CBT

Front 16

What would you like to rule out first when a patient presents with CC of Panic? Please include at least 3 specific examples.

Back 16

1) PE
2) MI
3) Hyperthyroidism

Front 17

True/False: Sudden onset of dyspnea distinguishes panic disorder from PE.

Back 17

False.

Front 18

True/False: Men and women have equal prevalence of panic disorder.

Back 18

False
(note that depression/anxiety more prevalent in women)

Front 19

True/False: Panic attacks increase the risk of suicide.

Back 19

True.

Front 20

What are first line treatments for Panic Disorder:
Non-addictive Medication? (name two classes)
Psychotherapy? (name two types)

Back 20

SSRI/SNRI
CBT, relaxation therapy

Front 21

True/False: To make a diagnosis of panic disorder, patients must have spontaneous panic attacks.

Back 21

True.

Front 22

What kind of psychotherapy has been proven to help patients with insomnia?

Back 22

CBT.

Front 23

Sleep hygiene related interventions while sleeping?

Back 23

BED is for SLEEP/sex – nothing else
Get out of bed if unable to fall asleep
Do not spend too much time in bed

Front 24

Sleep hygiene related interventions regarding sleep/waking?

Back 24

Sleep/wake time consistency
Maintain a consistent sleep/wake time

Front 25

Sleep hygiene related interventions during daytime?

Back 25

Be Active
Exercise regularly
Spend time outside each day

Front 26

Sleep hygiene related interventions after lunch?

Back 26

No smoking/caffeine/EtOH
Avoid caffeine, tobacco, and alcohol after lunch

Front 27

Sleep hygiene related interventions after early afternoon?

Back 27

No Naps
Restrict naps to 30 minutes in the late morning or early afternoon

Front 28

Sleep hygiene related interventions by evening?

Back 28

No liquids
Limit liquids in the evening

Front 29

Sleep hygiene related interventions before sleep?

Back 29

Light snack
Eat a light snack (i.e., milk, bread) before bed

Front 30

How many stages of sleep are there?

Back 30

Four.

Front 31

What does “REM” stand for?

Back 31

Rapid Eye Movement.

Front 32

A patient informs you she notices fewer dreams since starting a medication. She wants to know if this means she has less REM now. In what sleep stage does dreaming take place?

Back 32

In both REM AND non-REM sleep.

Front 33

Non-REM 1 (N1) Sleep Stage:
what happens? Any associated disorder? Eye movements? EEG characteristics?

Back 33

Transition from wake to sleep
No associated disorder
Slow eye movement
Mixed & theta waves

Front 34

Non-REM 2 (N2) Sleep Stage:
what happens? Any associated disorder? Eye movements? EEG characteristics?

Back 34

No longer conscious, patient is asleep
No associated disorder
No eye movements
Sleep spindles, K complexes

Front 35

Non-REM 3 (N3) Sleep Stage:
what happens? Any associated disorder? Eye movements? EEG characteristics?

Back 35

Deep Sleep
Night terrors, Sleepwalking
No eye movements
Slow wave

Front 36

REM Sleep Stage:
what happens? Any associated disorder? Eye movements? EEG characteristics?

Back 36

REM sleep disorder
REM
Saw-tooth, theta, occasional slow alpha

Front 37

What is the Multiple Sleep Latency Test?

Back 37

After an overnight sleep study: four 20-minute nap opportunities, two hours apart,
During the naps, data such as the patient's EEG, muscle activity, and eye movements are monitored and recorded.
May memorize it this way:
After an overnight sleep study: several nap opportunities
During the naps, pt’s EEG, muscle activity, and eye movements are recorded.

Front 38

What is the Multiple Sleep Latency Test used for?

Back 38

Helps distinguish between physical tiredness from sleep deprivation and true narcolepsy.

Front 39

What does the Multiple Sleep Latency Test look like in patients with narcolepsy?

Back 39

After > 6 hrs sleep, MSLT (multiple sleep latency test) shows:
short sleep latency (do not memorize: < 8 minutes)
sleep onset REM periods (do not memorize: >2)

Front 40

A patient is brought in by his wife because she is concerned that he is acting out his dreams. He starts yelling/kicking/etc. while sleeping.
This is called ___.
Prognostically, this could suggest ___.

Back 40

This is called __REM sleeping behavior disorder__.
Prognostically, this could suggest
__future development of neurodegenerative d/o 10 yrs later: dementia, Parkinson’s or Lewy Body disease__.

Front 41

What lab test would you do to investigate restless leg syndrome?

Back 41

Iron (e.g ferritin).

Front 42

Give two examples of REM sleep disorders.

Back 42

REM sleep disorder, intermittent sleep paralysis

Front 43

Give two examples of Non-REM sleep disorders.

Back 43

sleep terrors, sleepwalking

Front 44

What is the hypothesized purpose of REM sleep?

Back 44

Memory consolidation

Front 45

What is the hypothesized purpose of N3 stage of sleep?

Back 45

Restorative sleep – energy, arousal, wear and tear

(“Sleep that knits the raveled sleeve of care” – Macbeth)

Front 46

How are sleep stages affected in narcolepsy?

Back 46

short REM latency

Front 47

How are sleep stages affected by depression?

Back 47

Increased REM, decreased stage N3

Front 48

SSRIs have the following effect on the amount of time in REM sleep: ___.

Back 48

Decreased

Front 49

Why is SSRI effect on REM clinically relevant?

Back 49

Suppressing REM treats cataplexy, hypnagogic hallucinations and sleep paralysis in narcolepsy.

Front 50

The ratio of time spent sleeping to time in bed is called ___ and is ___ in older people.

Back 50

The ratio of time spent sleeping to time in bed is called __sleep efficiency__ and is __decreased__ in older people.

Front 51

Name symptoms of narcolepsy.

Back 51

Excessive daytime somnolence
Cataplexy (a sudden loss of muscle tone, often triggered by strong emotional reactions)
Symptoms of disordered REM:
- hypnogogic hallucinations
- automatic behavior
- sleep paralysis.

Front 52

Narcolepsy is often associated with low levels of which neurotransmitter?

Back 52

orexin or hypocretin

Front 53

What is narcolepsy?

Back 53

REM sleep intruding into waking life.

Front 54

Define two kinds of narcolepsy.

Back 54

Narcolepsy with cataplexy
Narcolepsy without cataplexy

Front 55

How is narcolepsy with cataplexy diagnosed?

Back 55

1) Excessive daytime sleepiness – (don’t memorize this: at least 3 months duration)
2) Definite cataplexy is present
May be confirmed by EITHER
3)Polysomnogram with two:
– r/o other causes of disrupted nocturnal sleep with sleep study
– After at least 6 hrs of sleep, MSLT (multiple sleep latency test) shows short sleep latency & sleep onset REM periods
OR
4) Low CSF hypocretin-1 level

Front 56

How is narcolepsy without cataplexy diagnosed?

Back 56

1) Excessive daytime sleepiness – (don’t memorize this: at least 3 months duration)
2) No cataplexy or cataplexy-like episodes present
May be confirmed by
3)Polysomnogram with two:
– r/o other causes of disrupted nocturnal sleep with sleep study
– After at least 6 hrs of sleep, MSLT (multiple sleep latency test) shows short sleep latency & sleep onset

Front 57

Describe 5 nonpharmacological measures to treat narcolepsy.

Back 57

SLEEP ENOUGH!
1) Enough sleep at night (do not memorize: at least 7–8 hrs)
2) Regularly scheduled daytime naps
SAFETY!
3) Inform family, friends, coworkers of potential signs of narcoleptic spells to reduce injuries from sudden falls
4) Avoid operating motor vehicles or other dangerous equipment when feeling sleepy
ACTIVE!
5) Regular exercise

Front 58

Name two meds for narcolepsy.

Back 58

STIMULANTS
- Amphetamines
- Modafanil
- Selegeline

Front 59

Before diagnosing narcolepsy in a patient with daytime sleepiness, ensure that the patient __.

Back 59

Before diagnosing narcolepsy in a patient with daytime sleepiness, ensure that the patient __is not just sleep-deprived__.

Front 60

Name two classes of drugs for CATAPLEXY.

Back 60

Sodium oxybate recently approved by the FDA for treating cataplexy. No one knows how it works. Helps nighttime sleep?
Serotonin reuptake inhibitors (i.e.TCAS/SSRIs/SNRIs) treat cataplexy, hypnagogic hallucinations and sleep paralysis

Front 61

What is the target plasma level for lithium (range)?

Back 61

0.8 -1.2

Front 62

What are 6 neurological symptoms of lithium toxicity?

Back 62

cerebellar symptoms: Coarse tremor, Ataxia, Nystagmus
Hyperreflexia
Altered MSE
Muscle fasciculations/seizures

stinky mnemonic: CAN(ned) HAM

Front 63

Name two other life-threatening consequence of lithium toxicity.

Back 63

arrhythmias, renal failure

Front 64

In combination with valproic acid, lamotrigine dose should be adjusted up or down?

Back 64

Down

Front 65

In combination with carbamazepine, lamotrigine dose should be adjusted up or down?

Back 65

Up

Front 66

List at least 3 different medications to treat ADHD from 3 different medication classes.

Back 66

1) bupropion
2) atomoxetine
3) amphetamine (Ritalin/Dexedrine/etc)

Front 67

What medication is commonly used to manage the autonomic dysregulation associated with opiate withdrawal?

Back 67

Clonidine

Front 68

Provide a hypothesis as to why clonidine is useful for management of autonomic dysregulation associated with opiate withdrawal.

Back 68

Opiates suppress sympathetic drive.
Withdrawal from opiates increase sympathetic activity.
Thus, clonidine helps.

Front 69

Name 3 common side-effects of opiates regarding vitals, pupils and GI.

Back 69

Decreased RR
Pinpoint pupils (Miosis)
Constipation

Front 70

Name 3 common withdrawal symptoms of opiates regarding vitals, pupils and GI.

Back 70

Increased BP/HR
Large pupils (Mydriasis)
Diarrhea, cramps

Front 71

Lorazepam, Alprazolam, Clonazepam: number from most to least potent.

Back 71

Lorazepam - 3
Alprazolam - 2
Clonazepam - 1

Front 72

List 3 medications with evidence of helping nicotine dependence that are not simply alternative nicotine delivery systems?

Back 72

1) bupropion
2) nortriptyline
3) varenicline (chantix)

Front 73

Which 3 benzodiazepines are not extensively metabolized by the cytochrome p450 group of liver enzymes?

Back 73

Oxazepam, Temazepam, Lorazepam

stinky mnemonic:“Off The Liver”:

Front 74

Which p450 enzyme subset metabolizes the majority of the benzodiazepines?

Back 74

3A4

Front 75

What is the difference between substance abuse vs dependence?

Back 75

Abuse: harmful use
Dependence: can’t quit (w/d, tolerance)

Front 76

Amphetamines: How many days is urine positive? False positive from what? False negative from what?

Back 76

1-3 days
Many (name two): Chlorpromazine, bupropion, propanolol, pseudoephedrine, dexatrim, selegline, tyramine, tranylcypromine
No false negatives.

Front 77

Opiates: How many days is urine positive? False positive from what? False negative from what?

Back 77

2-3 days
Poppy seeds
Methadone, fentanyl

Front 78

BDZs: How many days is urine positive? False positive from what? False negative from what?

Back 78

1-14 days
No false positives.
clonazepam, lorazepam, alprazolam.

Front 79

Cocaine: How many days is urine positive? False positive from what? False negative from what?

Back 79

2-4 days (if high dose/chronic use: 7-22 days)
No false positives or false negatives.

Front 80

Marijuana: How many days is urine positive? False positive from what? False negative from what?

Back 80

If chronic, up to 30 days; otherwise less than 10
No false positives or false negatives.

Front 81

PCP: How many days is urine positive? False positive from what? False negative from what?

Back 81

Less than 20 days
dextromethorphan
No false negatives.