Download - for the Psychiatry Clerkship
![Page 1: for the Psychiatry Clerkship](https://reader035.vdocuments.us/reader035/viewer/2022081503/568148da550346895db5f4a9/html5/thumbnails/1.jpg)
for the Psychiatry Clerkship
![Page 2: for the Psychiatry Clerkship](https://reader035.vdocuments.us/reader035/viewer/2022081503/568148da550346895db5f4a9/html5/thumbnails/2.jpg)
is proudis proudto presentto present
And Now Here
Is The Host . . .
Insert Name Here
![Page 3: for the Psychiatry Clerkship](https://reader035.vdocuments.us/reader035/viewer/2022081503/568148da550346895db5f4a9/html5/thumbnails/3.jpg)
The categories for today’s Jeopardy will be:
![Page 4: for the Psychiatry Clerkship](https://reader035.vdocuments.us/reader035/viewer/2022081503/568148da550346895db5f4a9/html5/thumbnails/4.jpg)
SSRI’s
![Page 5: for the Psychiatry Clerkship](https://reader035.vdocuments.us/reader035/viewer/2022081503/568148da550346895db5f4a9/html5/thumbnails/5.jpg)
SNRI’s
![Page 6: for the Psychiatry Clerkship](https://reader035.vdocuments.us/reader035/viewer/2022081503/568148da550346895db5f4a9/html5/thumbnails/6.jpg)
NDRI’s
![Page 7: for the Psychiatry Clerkship](https://reader035.vdocuments.us/reader035/viewer/2022081503/568148da550346895db5f4a9/html5/thumbnails/7.jpg)
NaSSA’s
![Page 8: for the Psychiatry Clerkship](https://reader035.vdocuments.us/reader035/viewer/2022081503/568148da550346895db5f4a9/html5/thumbnails/8.jpg)
TCA’s
![Page 9: for the Psychiatry Clerkship](https://reader035.vdocuments.us/reader035/viewer/2022081503/568148da550346895db5f4a9/html5/thumbnails/9.jpg)
100 100
200
300
800
700
500
800
SSRI’s NDRI’s TCA’s
100
700
500
700
400
800
600
100
900 900 900 900
300
500
800
NaSSA’s
100
900
500
400
300
200
300
400
600
800
200
300
600
200
500
400
700
600
200
400
700
600
SNRI’s
![Page 10: for the Psychiatry Clerkship](https://reader035.vdocuments.us/reader035/viewer/2022081503/568148da550346895db5f4a9/html5/thumbnails/10.jpg)
Row 1, Col 1
The half-life of this SSRI is about one week
What is fluoxetine (prozac)?
![Page 11: for the Psychiatry Clerkship](https://reader035.vdocuments.us/reader035/viewer/2022081503/568148da550346895db5f4a9/html5/thumbnails/11.jpg)
1,2
SSRI is the abbreviation for this
What is Selective Serotonin Reuptake Inhibitor?
![Page 12: for the Psychiatry Clerkship](https://reader035.vdocuments.us/reader035/viewer/2022081503/568148da550346895db5f4a9/html5/thumbnails/12.jpg)
1,3
If an SSRI with a short half life is abruptly stopped it
may result in this
What is Discontinuation Syndrome?
![Page 13: for the Psychiatry Clerkship](https://reader035.vdocuments.us/reader035/viewer/2022081503/568148da550346895db5f4a9/html5/thumbnails/13.jpg)
1,4
SSRI’s and MAOI’s used in combination carry a high
risk of this side effect
What is serotonin syndrome?
![Page 14: for the Psychiatry Clerkship](https://reader035.vdocuments.us/reader035/viewer/2022081503/568148da550346895db5f4a9/html5/thumbnails/14.jpg)
1,5
This is the most likely SSRI to cause the side effect
of weight gain
What is paroxetine (paxil)
![Page 15: for the Psychiatry Clerkship](https://reader035.vdocuments.us/reader035/viewer/2022081503/568148da550346895db5f4a9/html5/thumbnails/15.jpg)
1,6
The washout period when switching from an MAOI
to any SSRI is this
What is a 2 weeks?
![Page 16: for the Psychiatry Clerkship](https://reader035.vdocuments.us/reader035/viewer/2022081503/568148da550346895db5f4a9/html5/thumbnails/16.jpg)
1,7
This SSRI is the S-enantiomer of citalopram (celexa)
What is escitalopram (lexapro)?
![Page 17: for the Psychiatry Clerkship](https://reader035.vdocuments.us/reader035/viewer/2022081503/568148da550346895db5f4a9/html5/thumbnails/17.jpg)
1,8
These two SSRI’s have very short half lives & should
be tapered to be discontinued
What is paroxetine (paxil) & fluvoxamine (luvox)
![Page 18: for the Psychiatry Clerkship](https://reader035.vdocuments.us/reader035/viewer/2022081503/568148da550346895db5f4a9/html5/thumbnails/18.jpg)
1,9
This is a common side effect of all SSRI’s & the doctor should
specifically ask about it as the patient may otherwise
be too embarrassed to talk about it
What are sexual side effects?
![Page 19: for the Psychiatry Clerkship](https://reader035.vdocuments.us/reader035/viewer/2022081503/568148da550346895db5f4a9/html5/thumbnails/19.jpg)
2,1
The mechanism of action of SNRI’s is this
What is Serotonin Norepinephrine Reuptake Inhibitor?
![Page 20: for the Psychiatry Clerkship](https://reader035.vdocuments.us/reader035/viewer/2022081503/568148da550346895db5f4a9/html5/thumbnails/20.jpg)
2,2
This SNRI is the psychoactive metabolite of another SNRI
What is desvenlafaxine (pristiq)
![Page 21: for the Psychiatry Clerkship](https://reader035.vdocuments.us/reader035/viewer/2022081503/568148da550346895db5f4a9/html5/thumbnails/21.jpg)
2,3
Whether the dose is very high, moderate, or low, this
neurotransmitter’s reuptake is blocked by venlafaxine (effexor)
What is serotonin?
![Page 22: for the Psychiatry Clerkship](https://reader035.vdocuments.us/reader035/viewer/2022081503/568148da550346895db5f4a9/html5/thumbnails/22.jpg)
2,4
At very high doses (>375mg/d) of venlafaxine (effexor) this neurotransmitter’s reuptake
may begin to be blocked
What is dopamine?
![Page 23: for the Psychiatry Clerkship](https://reader035.vdocuments.us/reader035/viewer/2022081503/568148da550346895db5f4a9/html5/thumbnails/23.jpg)
2,5
What is duloxetine (cymbalta)
This SNRI is preferred for painful symptoms of depression or diabetic neuropathy pain
![Page 24: for the Psychiatry Clerkship](https://reader035.vdocuments.us/reader035/viewer/2022081503/568148da550346895db5f4a9/html5/thumbnails/24.jpg)
2,6
As with the SSRI’s, some patients take SNRI’s for depression, have an initial response,
continue taking the medication but then experience this
What is poop-out syndrome (relapse)?
![Page 25: for the Psychiatry Clerkship](https://reader035.vdocuments.us/reader035/viewer/2022081503/568148da550346895db5f4a9/html5/thumbnails/25.jpg)
2,7
As with all antidepressants, a depressed patient started on an
SNRI who experiences activation & agitation may be having this
What is an induced bipolar state?
![Page 26: for the Psychiatry Clerkship](https://reader035.vdocuments.us/reader035/viewer/2022081503/568148da550346895db5f4a9/html5/thumbnails/26.jpg)
2,8
While venlafaxine (effexor) may cause the side effect of sweating,
ironically it may be helpful to perimenopausal women with this
What are hot flashes/flushes?
![Page 27: for the Psychiatry Clerkship](https://reader035.vdocuments.us/reader035/viewer/2022081503/568148da550346895db5f4a9/html5/thumbnails/27.jpg)
2,9
Venlafaxine (effexor) has this relatively common, dose dependent, cardiac system
related side effect
What is increased blood pressure?
![Page 28: for the Psychiatry Clerkship](https://reader035.vdocuments.us/reader035/viewer/2022081503/568148da550346895db5f4a9/html5/thumbnails/28.jpg)
3,1
This medication is the most well known NDRI
What is Bupropion (Wellbutrin)
![Page 29: for the Psychiatry Clerkship](https://reader035.vdocuments.us/reader035/viewer/2022081503/568148da550346895db5f4a9/html5/thumbnails/29.jpg)
3,2
NDRI’s are useful in treating cravings from dependence
on this substance
What is nicotine (smoking cessation)?
![Page 30: for the Psychiatry Clerkship](https://reader035.vdocuments.us/reader035/viewer/2022081503/568148da550346895db5f4a9/html5/thumbnails/30.jpg)
3,3
Not only do NDRI’s not have this common SSRI side effect, NDRI’s may be used to treat patients who
have this SSRI side effect
What is sexual dysfunction?
![Page 31: for the Psychiatry Clerkship](https://reader035.vdocuments.us/reader035/viewer/2022081503/568148da550346895db5f4a9/html5/thumbnails/31.jpg)
3,4
Like most anti-depressants, at typical doses NDRI’s carry a small risk of this serious side effect but
the risk increases from 0.4% to 4% at very
high doses
What is a seizure?
![Page 32: for the Psychiatry Clerkship](https://reader035.vdocuments.us/reader035/viewer/2022081503/568148da550346895db5f4a9/html5/thumbnails/32.jpg)
3,5
Compared to SSRI’s or SNRI’s, NDRI’s are less effective in treating this class of
psychiatric illnesses
What are Anxiety Disorders
![Page 33: for the Psychiatry Clerkship](https://reader035.vdocuments.us/reader035/viewer/2022081503/568148da550346895db5f4a9/html5/thumbnails/33.jpg)
3,6
NDRI’s may be especially helpful in treating this sleep disturbance that
is seen in atypical depression
What is hypersomnia? (> 10 hours/nite)
![Page 34: for the Psychiatry Clerkship](https://reader035.vdocuments.us/reader035/viewer/2022081503/568148da550346895db5f4a9/html5/thumbnails/34.jpg)
3,7
NDRI’s commonly do this to a patient’s weight
What is decrease? (or no change)
![Page 35: for the Psychiatry Clerkship](https://reader035.vdocuments.us/reader035/viewer/2022081503/568148da550346895db5f4a9/html5/thumbnails/35.jpg)
3,8
While not a first line treatment, NDRI’s “stimulating” effects may be
helpful in treating children and adults with this disorder
What is Attention Deficit Hyperactivity Disorder (ADHD)?
![Page 36: for the Psychiatry Clerkship](https://reader035.vdocuments.us/reader035/viewer/2022081503/568148da550346895db5f4a9/html5/thumbnails/36.jpg)
3,9
Onset of therapeutic action is usually not immediate, but is delayed
until this time period
What is 2-4 weeks
![Page 37: for the Psychiatry Clerkship](https://reader035.vdocuments.us/reader035/viewer/2022081503/568148da550346895db5f4a9/html5/thumbnails/37.jpg)
4,1
NaSSA stands for this
What is Noradrenergic and Specific Serotonergic Agent?
![Page 38: for the Psychiatry Clerkship](https://reader035.vdocuments.us/reader035/viewer/2022081503/568148da550346895db5f4a9/html5/thumbnails/38.jpg)
4,2
NaSSA’s novel mechanism of action by which norepinephrine and
serotonin system activity is increased is this
What is pre-synaptic alpha 2 adrenergic antagonist
![Page 39: for the Psychiatry Clerkship](https://reader035.vdocuments.us/reader035/viewer/2022081503/568148da550346895db5f4a9/html5/thumbnails/39.jpg)
4,3
The medication that is in the NaSSA class is this
What is mirtazepine (remeron)?
![Page 40: for the Psychiatry Clerkship](https://reader035.vdocuments.us/reader035/viewer/2022081503/568148da550346895db5f4a9/html5/thumbnails/40.jpg)
4,4
SSRIs or venlafaxine (effexor) may cause these common side effects
which NaSSA’s 5HT3 antagonism may help reduce or remove
What are GI side effects? (nausea, diarrhea, stomach cramps)
![Page 41: for the Psychiatry Clerkship](https://reader035.vdocuments.us/reader035/viewer/2022081503/568148da550346895db5f4a9/html5/thumbnails/41.jpg)
4,5
This mirtazapine (remeron) side effect is more likely in women than men, before
menopause than after, and is unlikely to be a problem if it
has not occurred within the first 6 weeks of treatment
What is weight gain?
![Page 42: for the Psychiatry Clerkship](https://reader035.vdocuments.us/reader035/viewer/2022081503/568148da550346895db5f4a9/html5/thumbnails/42.jpg)
4,6
Patients taking mirtazapine (remeron) and an MAO-I at the
same time, or within 2 weeks of the other, are at risk for
this serious side effect
What is serotonin syndrome?
![Page 43: for the Psychiatry Clerkship](https://reader035.vdocuments.us/reader035/viewer/2022081503/568148da550346895db5f4a9/html5/thumbnails/43.jpg)
4,7
Mirtazapine (remeron) is an antagonist of:
a presynaptic receptor, serotonin post synaptic receptors,
and this post synaptic receptor
What is histamine? (H1)
![Page 44: for the Psychiatry Clerkship](https://reader035.vdocuments.us/reader035/viewer/2022081503/568148da550346895db5f4a9/html5/thumbnails/44.jpg)
4,8
Onset of therapeutic effect on insomnia and anxiety is typically in this
time period
What is almost immediately?
![Page 45: for the Psychiatry Clerkship](https://reader035.vdocuments.us/reader035/viewer/2022081503/568148da550346895db5f4a9/html5/thumbnails/45.jpg)
4,9
Cytochrome P450 enzyme system that is significantly effected by
mirtazepine (remeron) is
What is none?
![Page 46: for the Psychiatry Clerkship](https://reader035.vdocuments.us/reader035/viewer/2022081503/568148da550346895db5f4a9/html5/thumbnails/46.jpg)
5,1
A tertiary amine, amitriptyline (elavil), is metabolized to a secondary amine which is
this TCA
What is nortriptyline (pamelor)?
![Page 47: for the Psychiatry Clerkship](https://reader035.vdocuments.us/reader035/viewer/2022081503/568148da550346895db5f4a9/html5/thumbnails/47.jpg)
5,2
Blurred vision, urinary hesitancy, dry mouth, and constipation are
due to this neurotransmitter receptor activity by TCA’s
What is anticholinergic activity?
![Page 48: for the Psychiatry Clerkship](https://reader035.vdocuments.us/reader035/viewer/2022081503/568148da550346895db5f4a9/html5/thumbnails/48.jpg)
5,3
A tertiary amine, imipramine (tofranil), is metabolized to a
secondary amine which is this TCA
What is desipramine (norpramin)?
![Page 49: for the Psychiatry Clerkship](https://reader035.vdocuments.us/reader035/viewer/2022081503/568148da550346895db5f4a9/html5/thumbnails/49.jpg)
5,4
TCA’s may be more effective than SSRI’s in treating depression for
this sex of the clinical population
What are men?
![Page 50: for the Psychiatry Clerkship](https://reader035.vdocuments.us/reader035/viewer/2022081503/568148da550346895db5f4a9/html5/thumbnails/50.jpg)
5,5
Fluoxetine (prozac), paroxetine (paxil), bupropion (wellbutrin), duloxetine
(cymbalta) and other medications may increase all TCA’s concentration by
inhibiting this p450 enzyme
What is cytochrome p450 2D6?
![Page 51: for the Psychiatry Clerkship](https://reader035.vdocuments.us/reader035/viewer/2022081503/568148da550346895db5f4a9/html5/thumbnails/51.jpg)
5,6
Side effects of dizziness, sedation, and hypotension likely result
from TCA’s antagonist activity of this receptor
What is alpha adrenergic-1 receptor?
![Page 52: for the Psychiatry Clerkship](https://reader035.vdocuments.us/reader035/viewer/2022081503/568148da550346895db5f4a9/html5/thumbnails/52.jpg)
5,7
Side effects of sedation and weight gain from TCA’s are likely due
to antagonist activity at this receptor
What is histamine (H1)?
![Page 53: for the Psychiatry Clerkship](https://reader035.vdocuments.us/reader035/viewer/2022081503/568148da550346895db5f4a9/html5/thumbnails/53.jpg)
5,8
TCA’s mechanism of action for treating depression is this
What is serotonin and norepinephrine reuptake inhibition?
![Page 54: for the Psychiatry Clerkship](https://reader035.vdocuments.us/reader035/viewer/2022081503/568148da550346895db5f4a9/html5/thumbnails/54.jpg)
5,9
The dangerous side effects from a TCA overdose are cardiac
arrhythmias caused by blockade of this
What are sodium channels?