Usmle Step 1: Psychiatry

Front 1

Pharmacological treatment for: Alcohol withdrawal

Back 1

Benzodiazepines

Front 2

Pharmacological treatment for: Anorexia/bulimia

Back 2

SSRIs

Front 3

Pharmacological treatment for: Anxiety

Back 3

1. Barbiturates
2. Benzodiazepines
3. Buspirone (for GAD, does not cause sedation or addiction, and does not interact with EtOH)
4. MAO inhibitors
5. Venlafaxine (SNRI, for GAD)
6. Olanzapine (an atypical antipsychotic)

Front 4

Pharmacological treatment for: Atypical depression

Back 4

MAO inhibitors

Front 5

Pharmacological treatment for: Bipolar disorder

Back 5

Mood stabilizers (Lithium, Valproic acid, Carbamazepines)

Front 6

Pharmacological treatment for: Depression

Back 6

1. SSRIs (endogenous depression)
2. SNRIs (when SSRIs are ineffective or neuropathic pain)
3. TCAs/Maprotiline (severe major depression)
4. MAO inhibitors (atypical depression or inability to use TCAs)
5. Bupropion
6. Mirtazapine
7. Trazodone/Nefazodone
8. Olanzapine (an atypical antipsychotic)

Front 7

Pharmacological treatment for: Depression with insomnia

Back 7

Trazodone and Mirtazapine

Front 8

Pharmacological treatment for: OCD

Back 8

1. Fluvoxamine (an SSRI)
2. Olanzapine (an atypical antipsychotic)
3. Clomipramine (a TCA)

Front 9

Pharmacological treatment for: Panic disorder

Back 9

TCAs and Buspirone

Front 10

Pharmacological treatment for: Schizophrenia

Back 10

1. Typical Neuroleptics
2. Atypical neuroleptics (for positive and negative symptoms)

Front 11

Drug class: Thioridazine

Back 11

Antipsychotics (Typical neuroleptic with low potency)

Front 12

Drug class: Haloperidol

Back 12

Antipsychotics (Typical neuroleptic with high potency)

Front 13

Drug class: Fluphenazine

Back 13

Antipsychotics (Typical neuroleptic with high potency)

Front 14

Drug class: Chlorpromazine

Back 14

Antipsychotics (Typical neuroleptic with low potency)

Front 15

Drug class: Promethazone

Back 15

Antipsychotics (Typical neuroleptic with low potency)

Front 16

Drug class: Proclorperazine

Back 16

Antipsychotics (Typical neuroleptic with low potency)

Front 17

Drug class: Pimozide

Back 17

Antipsychotics (Typical neuroleptic with high potency)

Front 18

Drug class: Thiothixene

Back 18

Antipsychotics (Typical neuroleptic with high potency)

Front 19

Drug class: Aripiprazole

Back 19

Antipsychotic (Atypical)

Front 20

Drug class: Clozapine

Back 20

Antipsychotic (Atypical)

Front 21

Drug class: Olanzapine

Back 21

Antipsychotic (Atypical)

Front 22

Drug class: Quetiapine

Back 22

Antipsychotic (Atypical)

Front 23

Drug class: Risperidone

Back 23

Antipsychotic (Atypical)

Front 24

Drug class: Ziprasidone

Back 24

Antipsychotic (Atypical)

Front 25

Drug class: Citalopram

Back 25

Selective Serotonin Reuptake Inhibitor

Front 26

Drug class: Escitalopram

Back 26

Selective Serotonin Reuptake Inhibitor

Front 27

Drug class: Fluoxetine

Back 27

Selective Serotonin Reuptake Inhibitor

Front 28

Drug class: Fluvoxamine

Back 28

Selective Serotonin Reuptake Inhibitor

Front 29

Drug class: Paroxetine

Back 29

Selective Serotonin Reuptake Inhibitor

Front 30

Drug class: Sertraline

Back 30

Selective Serotonin Reuptake Inhibitor

Front 31

Drug class: Venlafaxine

Back 31

Serotonin/Norepinephrine Reuptake Inhibitor

Front 32

Drug class: Duloxetine

Back 32

Serotonin/Norepinephrine Reuptake Inhibitor

Front 33

Drug class: Bupropion

Back 33

Atypical antidepressant

Front 34

Drug class: Mirtazapine

Back 34

Atypical antidepressant

Front 35

Drug class: Nefazodone

Back 35

Atypical antidepressant

Front 36

Drug class: Trazodone

Back 36

Atypical antidepressant

Front 37

Drug class: Amitriptyline

Back 37

Tricyclic Antidepressant

Front 38

Drug class: Amoxapine

Back 38

Tricyclic Antidepressant

Front 39

Drug class: Clomipramine

Back 39

Tricyclic Antidepressant

Front 40

Drug class: Desipramine

Back 40

Tricyclic Antidepressant

Front 41

Drug class: Doxepin

Back 41

Tricyclic Antidepressant

Front 42

Drug class: Imipramine

Back 42

Tricyclic Antidepressant

Front 43

Drug class: Maprotiline

Back 43

TETRAcyclic Antidepressant

Front 44

Drug class: Nortriptyline

Back 44

Tricyclic Antidepressant

Front 45

Drug class: Protriptyline

Back 45

Tricyclic Antidepressant

Front 46

Drug class: Trimipramine

Back 46

Tricyclic Antidepressant

Front 47

Drug class: Phenelzine

Back 47

Monoamine Oxidase Inhibitor

Front 48

Drug class: Tranylcypromine

Back 48

Monoamine Oxidase Inhibitor

Front 49

Drug class: Carbamazepines

Back 49

Mood stabilizer

Front 50

Drug class: Valproic acid

Back 50

Mood stabilizer

Front 51

Drug class: Lithium salt

Back 51

Mood stabilizer

Front 52

Mechanism of neuroleptics

Back 52

Most block dopamine D2 receptors (as excess dopamine effects are connected with schizophrenia)

Front 53

Mechanism of Venlafaxine

Back 53

Inhibits reuptake of serotonin (at all doses), norepinephrine(at high doses), and dopamine (mild)

Front 54

Mechanism of lithium

Back 54

Not established; possibly related to inhibition of PIP resynthesis leading to its relative depletion in neurons

Front 55

Mechanism of buspirone

Back 55

Stimulates 5-HT1A receptors

Front 56

Mechanism of SSRIs

Back 56

Selective serotonin reuptake inhibition, leading to down regulation of presynaptic inhibitory receptors, leading to increased release of neurotransmitter, leading to therapeutic response.

Front 57

Mechanism of tricyclic antidepressants

Back 57

1. Nonselectively inhibit reuptake of norepinephrine and serotonin (beneficial)
2. Block serotonergic, alpha-adrenergic, histaminic, and muscarinic receptors (not beneficial)

Front 58

Mechanism of clozapine

Back 58

Blocks D2 like normal neuroleptic, but also blocks 5HT2 as well as D1, D4, muscarinic, and alpha-adrenergic receptors.

Front 59

Mechanism of risperidone

Back 59

Blocks 5HT2 receptors more than D2 receptors

Front 60

Mechanism of aripiprazole

Back 60

Partial agonist of D2 and 5HT1A receptors, and blocks 5HT2A receptors.

Front 61

Mechanism of bupropion

Back 61

Unknown

Front 62

Mechanism of mirtazapine

Back 62

Alpha2 antagonist (increasing release of NE and serotonin) and potent 5-HT2 and 5-HT3 receptor antagonist

Front 63

Mechanism of duloxetine

Back 63

SNRI. Inhibits reuptake of serotonin and norepinephrine at all dose.

Front 64

Mechanism of nefazodone and trazodone

Back 64

Block 5-HT1 presynaptic autoreceptors, thereby increasing serotonin release. Weak inhibitors of serotonin re-uptake.

Front 65

Mechanism of MAO inhibitors

Back 65

Irreversibly inhibits monoamine oxidase which normally inactivates monoamines such as NE, 5-HT, and DA that leak out of presynaptic vesicles. MAO inhibitors allow these leaky molecules to accumulate and activate post synaptic response.

Front 66

Pharmacological treatment for: Psychosis

Back 66

1. Typical neuroleptics

Front 67

Pharmacological treatment for: Acute mania

Back 67

1. Typical neuroleptics
2. Olanzapine
3. Lithium (relapse and treatment)

Front 68

Pharmacological treatment for: Tourette syndrome

Back 68

1. Typical neuroleptics
2. Olanzapine

Front 69

Pharmacological treatment for: Bedwetting

Back 69

1. Imipramine (a tricyclic antidepressant)

Front 70

Pharmacological treatment for: Hypochondriasis

Back 70

1. MAO inhibitors

Front 71

Antidepressants which have adverse effect of GI distress

Back 71

SSRIs: all

SNRIs: all

Atypical: Nefazodone

Tricyclic: Clomipramine

MAO inhibitors: none

Front 72

Antidepressants which have adverse effect of sedation

Back 72

Note: useful effect if agitated

SSRIs:
1. Fluvoxamine
2. Paroxetine

SNRIs: none

Atypical: All except bupropion

Tricyclic: All except desipramine and protryptiline

MAO inhibitors: none

Front 73

Antidepressants which have high potential for orthostatic hypertension

Back 73

SSRIs: none

SNRIs: none

Atypical: none

Tricyclic:
1. Amitriptyline
2. doxepin

MAO inhibitors: All

Front 74

Antidepressants which have adverse effect of weight gain

Back 74

SSRIs: none

SNRIs: none

Atypical: Mirtazapine

Tricyclic: (so big you need a DICTAphone to type)
1. Doxepin
2. Imipramine
3. Clomipramine
4. Trimipramine
5. Amitriptyline

MAO inhibitors: none

Front 75

Toxicities of typical neuroleptics

Back 75

1. Extrapyramidal dopamine side effects
2. Endocrine dopamnine side effects (dopamine receptor antagonism leading to hyperprolactinemia leading to gynecomastia)
3. Blocking muscarinic receptors (dry mouth, constipation)
4. Blocking alpha-adrenergic receptors (hypotension)
5. Blocking histamine receptors (sedation)
6. Neuroleptic malignant syndrome
7. Tardive dyskinesia

Front 76

Describe neuroleptic malignant syndrome.

Back 76

Neuroleptic malignant syndrome can cause you HARM

1. Hyperpyrexia
2. Autonomic instability
3. Rigidity
4. Myoglobinuria

Front 77

How is neuroleptic malignant syndrome treated?

Back 77

Dantrolene or dopamine agonists (bromocriptine)

Front 78

Describe tardive dyskinesia and what causes it?

Back 78

Long-term antipsychotic use leads to dopamine receptor sensitization which causes stereotypic oral-facial movements

Front 79

Mechanism and treatment for extrapyramidal side effects

Back 79

Blocking of dopamine's inhibitory effects causes excess stimulation by acetylcholine. Treat wth anticholinergic drugs like thioridazine.

Front 80

Toxicities of atypical neuroleptics

Back 80

Weight gain. Clozapine may cause agranulocytosis. (Requires weekly WBC monitoring.) Fewer extrapyramidal and anticholinergic side effects than typical neuroleptics.

Front 81

Which atypical neuroleptic can cause agranulocytosis?

Back 81

Clozapine (requires weekly WBC monitoring)

Front 82

Toxicities of lithium

Back 82

Mnemonic: LMNOPP (prounounced "pee-pee")

Lithium side effects
1. Movement (Tremor)
2. Narrow therapeutic window
3. hypOthyroidism
4. Pregnancy problems (Teratogenesis)
5. Polyuria as lithium is ADH antagonist, leading to nephrogenic diabetes insipidus

Front 83

Toxicities of SSRIs

Back 83

1. GI distress
2. Sexual dysfunction (anorgasmia)
3. Serotonin syndrome (with MAO inhibitors)

Front 84

What is serotonin syndrome?

Back 84

Excess serotonergic activity caused by use of both SSRIs and MAO inhibtiors
1. Hyperthermia
2. Muscle rigidity
3. Cardiovascular collapse

Front 85

Side effects and toxicities of tricyclic antidepressants

Back 85

TCAs mess you up. Make you a stuttering SHAARCCC
1. Sedation
2. Hyperpyrexia
3. alpha-blocking effects
4. atropine-like (anticholinergic) effects (tachycardial, urinary retention, confusion and hallucinations in elderly)
5. Respiratory depression

and the Tri-C's:
6. Convulsions
7. Coma
8. Cardiotoxicity (arrhythmias)

Front 86

Treatment for confusion and hallucinations in elderly on tricyclic antidepressants

Back 86

Due to anticholinergic activity. Use nortriptyline instead.

Front 87

Toxicities of bupropion

Back 87

1. Stimulant effects (tachycardia, insomnia)
2. Headache
3. Seizure in bulimic patients

Front 88

Toxicities of venlafaxine

Back 88

Things have trouble going down your SINCS (GI distress)

1. Stimulant effects
2. Increased blood pressure
3. Nausea
4. Constipation
5. Sedation

Front 89

Toxicities of mirtazapine

Back 89

1. Sedation
2. Increased appetite
3. Weight gain
4. Dry mouth

Front 90

Toxicities of Maprotiline

Back 90

1. Sedation
2. Orthostatic hypotension

Front 91

Toxicities of Trazodone

Back 91

1. Sedation
2. Nausea
3. Priapism
4. Postural hypotension

Front 92

Toxicities of MAO inhibitors

Back 92

1. Hypertensive crisis with tyramine ingestion and meperidine
2. CNS stimulation
3. Serotonin syndrome (when coadministered with SSRIs or beta-agonists)
4. Increased risk of orthostatic hypotension