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Pharm Step 2Ck Part 2

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eesohbel's version from 2016-08-14 17:08

psych

Question Answer
antipsychotic EPS effectsacute dystonia, akathisia, parkinsonism, tardive dyskinesia
evolution of EPS4hrs acute dystonia, 4 days akinesia, 4 weeks akathisia, 4 months tardive dyskinesia
acute dystoniasuddent, sustained contraction of the neck, mouth, tongue, eye muscles hours
akathisiasubjective restlessness weeks
parksinsonism or dyskinesiagradual onset tremor, rigidity, bradykinesia days
tardive dyskinesiagradual onset after prolonged therapy (greater than 6 months). dyskinesia of the mouth, face, trunk, extremities months
tx for acute dystoniabenzotropine or diphenhydramine
tx for akathisiabeta blocker or benzo
tx for parkinsonismbenzotropine or amantadine
tx for tardive dyskinesiano definitive tx, clozapine may help
tx for OCDCBT and SSRI
tx for specific phobiabehavorial therapy or short acting benzo
tx for social phobiaSSRI/SNRI or CBT
memorize

Toxicity

Question Answer
MDMA toxhypertension, tachycardia, hyperthermia, serotonin syndrome (high fever, AMS, NM irritability seizures) hyponatremia
Benzo toxataxia and sedation
Bath salts toxsevere agitation and combativeness
Cocaine toxincreased HR, BP, euphoria, psychosis
inhalant toxCNS depressant
memorize

acute drug intoxication

Question Answer
opioidsrespiratory depression life threatening pupillary constirction
amphetaminespupillary dilations, hallucinations, delusions
PCPviolent behavior, dissociation, hallucinations, amnesia, nystagmus, ataxia
LSDvisual hallucinations, euphoria, dysphoric/pain, tachycardia/hypertension
cocainechest pain, seizures, mydriasis, tachycardia
methamphetamineviolent behavior, choreiform movements, tooth decay
marijuanaincreased appetite, impaired time perception, conjunctival injection
heroinmiosis, respiratory depression, depressed mental state, constipation, euphoria
MDMAeuphoria. hypertension, tachycardia, hyperthermia, serotonin syndrome and hyponatremia
bath saltssevere agitation and combativeness
inhalantsslurred speech, dizziness, transient euphoria, and loss of consciousness
memorize

treatment for acute drug intoxication

Question Answer
opioidsnaloxone and naltrexone
amphetamineshaloperidol
cocainehaloperidol along with specific medication ex. control hypertension
PCPbenzos or haloperidol
LSDsupportive counselling; traditional antipsychotics and benzos for anxiety
memorize

acute drug withdrawal

Question Answer
alcoholtremor, tachycardia, hypertension, malaise, nausea, seizures, DTs, agitation
opioidsdysphoria, insomnia, anorexia, myalgias, fever. not life threatening
amphetaminescrash
cocainecrash
PCPrecurrence of intoxication symptoms due to reabsoprtion in the GI tract; sudden onset of severe, random violence
LSDnone
marijuananone
barbituatesanxiety, seizures, delirium, life threatening cardio collapse
benzosdeath!!!!
memorize

Psych

Question Answer
a/e clozapineagranulocytosis, leukopenia, seizures, myocarditis, metabolic syndrome
indications for ECTtreatment resistance, psychotic features present, emergency conditions (preggos, refusal eat or drink, imminent risk for suicide)
mild withdrawal from alcoholanxiety, tremors, GI upset. 6-24hrs
alcohol seizures12-48 hrs
alcoholic hallucinosisvisual, auditory or tacitle; intact orientation; stable vital signs. 12-48 hrs
delirium tremensconfusion, agitation, fever, and tachycardia. 48-96 hrs
memorize

Psych

Question Answer
antipsychotic effect on mesolimbic pathwayefficacy
antipsychotic effect on nigrostriatal pathwayEPS (acute dystonia, akathisia, parkinsonism)
antipsychotic effect on tuberinfundibular pathwayhyperprolactinemia
1st line options for bipolar maintenancelithium and valproate
reason to use valproate over lithiumvalproate preferred in patients w/renal dysfunction due to nephrotoxic effects of lithium
memorize

Psych 2

Question Answer
first tx for acute maniaantipsychotics, lithium and valproate
severe mania w/acute aggitationantipsychotic
side effect prolactin increaserisperidone can lead to galactorrhea, amenorrhea and infertility
baseline studies for lithium therapyBUN, creatinine, calcium, urinalysis, thyroid, ECG
acute a/e of lithiumtremor, ataxia, polyuria
chronic a/e of lithiumnephrogenic diabetes insipidus, thyroid, hyperpara
MAOIS plus tyraminehypertensive crisis
MOA of second generation antipsychoticsserotonin 2A and dopamine D2 antagonists
MOA of first generation antipsychoticsdopamine antagonism
tx for acute bipolar depressionquetiaine, lurasidone and lamotrigine
memorize

Psych 3

Question Answer
second generation antipsychotic a/e as a classlower risk EPS, higher metabolic
second generations w/highest metabolic riskolanzapine and clozapine
a/e ziprasidone atypicalQT prolongation
tx for Touretteshaloperidol, and second generation antipsychotics such as risperidone
memorize

ANTIDEPRESSANTS IN OTHER DISORDERS

Question Answer
OCDSSRI in high doses, TCAs (clomipramine)
Panic disorderSSRI, TCA (imipramine), MAOI
Eating disorderSSRI (high dose), TCAs, MAOI
DysthymiaSSRI
Social phobiaSSRI, TCA, MAOI
GADSSRI, SNRI (venlaflaxine), TCA
Posttraumatic stress disorderSSRI
IBSSSRI, TCA
EnuresisTCA (imipramine)
Neuropathic painTCAs (amitriptyline and nortriptyline), duloxetine
Chronic painSSRI, TCA
FibromyalgiaSSRI
MigraineTCA (amitriptyline), SSRI
Smoking CessationBupropion
Premenstrual dysphoric disorderSSRI
Depressive phase of manic depressionSSRI
InsomniaMirtazapine, TCA (amitriptyline)
acute maniaantipsychotic first hten lithium
maintenence bipolarlithium/valproate +/- SSRU
second line maint bipolarcarbemazepine/lamotrigine
memorize

MOOD STABILIZERS

Question Answer
decrease suicidalitylithium
blood levels are useful for?lithium, valproic acid, carbamazepine, clozapine
avoid what with a patient on lithium?NSAIDS and diuretics esp. thiazides
factors that affect lithium levels?NSAIDS (decrease), aspirin, dehydration (increase), salt deprivation (increase), sweating (increase), impaired renal fun (increase), diuretics and thiazides
what is lithium used for?acute mania, cyclothymia, unipolar depression
prior to starting lithium, what should you do?BUN, creatinine, calcium, urinalysis, thyroid function, pregnancy test, ECG in patients w/CVD rf
how long does lithium take to work?5-7 days
do blood levels of lithium correlate to clinical efficacy?YES, check after 5 days, then every 2-3 until therapeutic
draw backs to lithium?narrow therapeutic index (0.7-1.2 is therapeutic. >1.5 is toxic. >2 is lethal)
lithium side effects?polyuria, polydipsia, NDI, sedation, coarse tremor, ataxia, MS changes, CONTRAINDICATED IN RENAL DISEASE, weight gain, ebstein anomaly
valproic acid side effects?sedation, weight gain, alopecia, pancreatitis, hepatotoxicity, thrombocytopenia, teratogenic, NYSTAGMUS, ataxia, N/V, coma, lethargy
what is valproic acid best for treating?mixed episodes and rapid cycling bipolar
what is carbamazepine best for?mixed episodes and rapid cycling bipolar, less effective for depressed phase
how does carbamazepine work?blocks Na+ channels and blocks APs
what do you need to obtain before starting carbamazepine?CBC, LFTs
side effects of carbamazepine?GI and CNS (drowsy, ataxia, sedation, confusion), SJS, SIADH, leukopenia, hyponatremia, hepatitis, teratogenic (neural tube defects)
auto induction of CYP?carbamazepine
nystagmus in toxicity?carbamazepine
what to monitor with valproic acid?LFTs and CBC
what is lamotrigine useful for?bipolar depression (prevention only, not acute episode)
how does lamotrigine work?works on Na+ channels that modulate glutamate and aspartate
side effects of lamotrigineSJS, teratogen, TITRATE SLOWLY to avoid SJS!!!
valproate and lamotrigine relationship?valproate increases lamotrigine levels, and lamotrigine will decrease valproate levels
topiramate usepromote weight loss, tx headaches, impulse control in borderline PD
side effects of topiramatekidney stones, hypochloremic non-anion gap metabolic acidosis
most limiting side effect of topiramate?cognitive slowing
as effective as carbamazepine in mood stabilization but better tolerated?Oxcarbazepine
adjunctive to help with anxiety and sleep?Gabapentin
Used in generalized anxiety and fibromyalgiapregabalin
memorize

OVERDOSES

Question Answer
tinnitusaspirin
resp alk with metabolic acidaspirin
tx aspirin overdosesodium bicarb
hyperthermic, dry flushed skin, agitated, stumbling arounddiphenhydramine
diphenhydramine overdose txphysostigmine
coarse tremor, AMS, diarrhea, n/vlithium tox
tx lithium toxfluids and dialysis
widened QRSTCA tox
treat TCA tox?sodium bicarb, magnesium
abdominal pain, n/v, jaundice, elevated LFTsacetaminophen tox
tx acetaminophen tox?N acetyl cysteine
memorize

OTHER

Question Answer
elevated CPKNMS
extreme hyperthermiaNMS
lead pipe rigidityNMS
treat NMS?cooling, fluids, dantrolene, bromocriptine
myoclonus and flushingserotonin syndrome
treat serotonin syndrome?supportive care, Tylenol, fluids, cyproheptadine
most common side effects of methylphenidate?difficulty falling asleep, decreased appetite, which can lead to slowed growth (hence need for medication vacations). Also increased systolic bp
treatment of tics or tourettes?Clonidine or haloperidol for more severe cases
treatment of delirium and irritation in the elderly?avoid benzos and diphenhydramine (anticholinergic s/e). Choose low dose atypical antipsychotic like risperidone
treatment for acute agitation in elderly?haloperidol (and least likely to cause falls!) UNLESS there is prolonged QTc, in which case you should use a low dose antipsychotic like olanzapine
reduce alcohol cravings?Naltrexone and acamprosate (GABA agonist)
how to treat nightmares in patients with PTSD?Prazosin (alpha 1 blocker)
meds for alzheimers?Memantine, Donepezil, Galantamine, Rivastigmine, Tacrine (not used much bc hepatotoxic)
what do you administer to any patient found unconscious suspicious of substance overdose?dextrose D50, naloxone, thiamine
best med for opioid detox?Buprenorphine mixed opioid antagonist and agonist
this treats depression, neuropathic pain, and fibromyalgiaduloxetine (SNRI)
bipolar and trigeminal neuralgia treatment?Carbamazepine
short term treatment of insomnia?zolpidem
side effect of TMSheadache
memorize

Section

Question Answer
clinical manifestations of acetaminophen poisoningnausea/vomitting, anorexia; may progress over days to jaundice,abdominal pain, liver failure
clinical manifestations of anticholinergic agents"mad as a hatter, red as a beet, blind as a bat, hot as a hate, dry as a bone"
clinical manifestations of carbon monoxidelethargy, irritabile, confusion, dizziness, headache, nausea
clinical manifestations of ethanol posioning lethargy, CNS depression, ataxia, coma, hypotension, hypothermia (in young children)
clinical manifestations of ibuprofennausea/vomitting, GI bleeding
clinical manifestations of methanolincreased minute ventilation to offset metabolic acidosis; ocular findings 18-24 hours after ingestion
clinical manifestations of iron overloadacute liver failure, seizures, shock, coa
organophosphate poisoningSLUDGE
opiatesbradycardia, hypotension
sympathomimetic agentstachycardia, hypertension, fever, large pupils
TCAanticholinergic affects
memorize

Antidotes

Question Answer
acetaminophenn-acetyl cysteine
anticholinergic agentsphysostigmine
COoxygen
irondeferoximine chelation
organophosphatesatropine
opiatesnaloxone
memorize

Antidotes

Question Answer
Methamphetamine antidoteAmmonium chloride
Methamphetamine - Rx for SxBenzodiazepines, Antipsychotics, Antihypertensives
Acetaminophen antidoteN-acetylcysteine (replenishes glutathione, which works on elimination + provides sulfhydryl groups to enhance the non-toxic sulfating elimination of the drug)
Salicylates antidote Sodium bicarbonate, dialysis
Organophosphate antidotePralidoxime
Organophosphate - Rx for SxAtropine
Antimuscarinic agent antidotePhysostigmine
ß-blocker antidoteGlucagon, Atropine, Calcium
Non-dihydropyridine Ca2+ channel blocker antidoteGlucagon, Atropine, Calcium
Digitalis antidoteAnti-dig Fab fragments
Digitalis antidoteK+ and Mg++ optimization
Digitalis antidoteAtropine
Iron overload antidoteDeferoxamine
Lead poisoning antidote in childrenDimercaprol, Calcium EDTA, Succimer, Penicillamine
Lead poisoning antidote in adultsCalcium EDTA, Succimer
Mercury, arsenic, gold antidoteDimercaprol, Succimer
Copper, arsenic, gold antidotePencillamine
CO poisoning antidote 100% O2, Hyperbaric O2
Methylhemoglobin antidoteMethylene blue, Vit. C
Cyanide antidoteHydroxocobalamin, Thiosulfate, Nitrates
Methanol antidoteFomepizole, Ethanol, dialysis
Ethylene glycol antidoteFomepizole, Ethanol, dialysis
Opiod antidoteNaloxone (short t1/2), Naltrexone
Benzodiazepine antidoteFlumazenil
TCAs antidoteSodium bicarbonate
Heparin antidoteProtamine
Warfarin antidoteVitamin K (slow), fresh frozen plasma
tPA, streptokinase, urokinase antidoteAminocaproic acid
Theophylline antidoteß-blocker
Tumor Lysis Syndrome "antidote"Allopurinol or Rasburicase
memorize

Treatment

Question Answer
acetaminophencharcoal
ethylene glycolfomepizole
ibuprofencharcoal
methanolfomepizole or ethanol
organophosphatecharcoal
sympathomimemticcharcoal
TCAcharcoak
memorize

Surgery

Question Answer
heparin in ESRDunfractionated heparin
acute reversal of warfarin pre-opinfusion of FFP, or prothrombin-complex concentrate plus vitamin
tx for iron poisoningdeferoxamine
memorize

misc

Question Answer
diuretic that causes hearing lossloops
moa metoclopramideprokinetic agent used to treat nausea, vomiting and gastroparesis
a/e metoclopramidedopamine receptor antagnoist canc ause EPS
1st line treatment for eneuresisdesmopressin
tx for foodborne botulismbotulinum antitoxin
tx for BPHalpha 1 blockers (tamsulosin) or 5-alpha reductase inhibitors (finasteride)
tx for acetaminphen intoxicationfirst levels plus activated charcoal then n-acetylcysteine
memorize

misc

Question Answer
for drug induced EPSbenzotropine, triphexyphenidyl
bromocriptinedopamine agonist
selegilineMAO-B inhibitor for parkinson's
electrolyte abnormality that makes digoxin toxicity worsthypokalemia
trastuzumab forHER2 + breast cancer
a/e trastuzumabcardiotoxicity. do echo before initiating
comon choice of treatment for alcohol withdrawalchlordiazepoxide (librium)
memorize

diabetic drugs

Question Answer
metformin a/elactic acidosis. weight neutral
sulfonyureas a/eweight gain and hypoglycemia
TZDS a/eweight gain, edema, CHF, bone fracture, bladder cancer
DPP IV inhibitors (sitaliptin) when to userenal insufficiency
GLP-1 agonist (ex. exenatide)causes weight loss. association w/pancreatitis
memorize

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