Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
20 Cards in this Set
- Front
- Back
|
141. antidepressant use for enuresis?
|
a. Imipramine.
|
|
|
142. Antidepressant used to treat patients who have severe insomnia?
|
a. Trazodone
|
|
|
143. which antidepressants are safe in pregnancy. With one exception, and what is that exception?
|
a. SSRIs and TCAs
b. exception: paroxetine (Paxil). |
|
|
144. In what conditions should you always think of SSRIs first?
|
a. major depressive disorder
b. bipolar disorder c. anxiety disorders: 1. panic disorder 2. OCD 3. social phobia 4. generalized anxiety disorder d. bulimia nervosa. |
|
|
145. A young male recently started on antidepressants develops prolonged erection. What is the antidepressant he was most likely taking?
|
a. Trazodone.
|
|
|
146. An elderly patient presents with depression and agitation. What is the most appropriate medication?
|
a. Given antidepressant with sedative effects (e.g. doxepin, trazodone)
b. amitriptyline is also sedating, but as anticholinergic effects, which may be problematic in elderly. |
|
|
147. A 25-year-old male with a history of seizures is diagnosed with depression. Which medications should be avoided?
|
a. TCAs and bupropion.
b. The best first-line therapy in patients with seizures as SSRIs. |
|
|
148. The middle-aged woman is brought to the ER with confusion and disorientation. An overdose of prescription medications is suspected. The pressures and 90/50 3 mmHg, heart rate is 111 ppm. Pupils are dilated, mucous membranes are dry and she has facial flushing? What is the most likely cause of acute intoxication?
|
a. Tricyclic antidepressants.
b. TCAs have anticholinergic effects, and are now for blocker, causing peripheral vasodilation and hypotension, and also affecting sodium channels in cardiac tissues. |
|
|
149. What is the most important test to determine severity and prognosis in the above patient?
a. EKG b. EEG c. serum sodium d. serum tricyclic levels e. urinalysis |
1. answer: EKG is the single most important test to guide therapy and prognosis. Watch out for prolonged QRS, QT, and PR intervals. Most serious complication is Vtach and Vfib.
|
|
|
150. In EKG is performed on the above patient and chose PR and QRS prolongation and sinus tachycardia. What is the most appropriate next step in management?
a. Calcium carbonate b. diazepam c. gastric lavage d. insulin and glucose e. sodium bicarbonate |
1. Answer: E- sodium bicarb attenuates TCA cardiotoxicity by alkalinization of blood, which uncouple's TCA from myocardial sodium channels and increases extracellular sodium concentration, thereby improving the gradient across the channel.
|
|
|
151. A 42-year-old woman with a history of hypertension, diabetes and depression presents the clinic with dry eyes and dry mouth. Her medications include HCTZ, metformin, and amitriptyline. Which of the following is the next step in management?
a. Discontinue amitriptyline and change to sertraline. b. Order ANA antibodies c. order SS-ro and SS-la d. prescribed eye drops e. Refer to ophthalmologist |
1. answer: A- . Discontinue amitriptyline and switch to another antidepressant medication with little/no anticholinergic effects. Anticholinergic effects are more severe with amitriptyline, but there almost none with most SSRIs.
|
|
|
152. For what two conditions is lithium the first-line medication?
|
a. Bipolar and schizoaffective disorders.
b. Also, treatment and prophylaxis of mood disorders. |
|
|
153. Side effects of lithium?
|
a. Acne and weight gain are the most common problems
b. dose related tremors, G.I. Distress, and headaches (decrease the dose) c. hypothyroidism in 5% d. polyuria, secondary to medication induced diabetes insipidus. e. Do not use in first trimester of pregnancy. Lithium causes teratogenic cardiac defects |
|
|
154. For what is Divalproex the first-line therapy?
|
a. Rapid cycling bipolar disorder
b. or when lithium is ineffective, impractical, or contraindicated. |
|
|
155. For what condition is carbamazepine, second line therapy?
|
a. Bipolar disorder- when lithium and divalproex are ineffective contraindicated.
b. Is not commonly used because of serious agranulocytosis and significant sedation. |
|
|
156. Note: high-yield topic –know different features of lithium toxicity, MAOI-induced HTN, serotonin syndrome, and neuroleptic malignant syndrome.
|
156. Note: high-yield topic –know different features of lithium toxicity, MAOI-induced HTN, serotonin syndrome, and neuroleptic malignant syndrome.
|
|
|
157. When should you suspect lithium toxicity?
|
a. Elderly patient who takes lithium with renal failure or hyponatremia (may be caused by diuretics, vomiting, or dehydration).
b. The question will describe nausea, vomiting, acute disorientation, tremors, increase DTRs and even seizures |
|
|
158. presentation of neuroleptic malignant syndrome?
|
a. Recently started taking antipsychotics (particularly haloperidol)
b. or a Parkinson's patient who has recently stopped levodopa. c. Look for: 1. high fever 2. tachycardia 3. muscle rigidity 4. altered consciousness 5. autonomic dysfunction |
|
|
159. is neuroleptic malignant syndrome related to dosage?
|
a. No.
b. Is not related to dosage or previous drug exposure. c. There is a 20% mortality rate. |
|
|
160. Treatment of neuroleptic malignant syndrome?
|
a. Transfer to the ICU
b. discontinue antipsychotic c. give bromocriptine to overcome dopamine receptor blockade d. give muscle relaxants: dantrolene, or diazepam to reduce muscle rigidity |
