Power of twos
Name two medications that block the REUPTAKE of NE
TCA, venlaxaine, bupropion, nefazodone
A selective GABA reuptake inhibitor used for seizures
1. Gabapentin
2. Baclofen
3. Tiagabine
4. Zonisamide
5. Vimpat
Tiagabine
pseulogia phantastica means
pathologic lying
Patient X is seen in the clinic with depressed mood, anergia, anhedonia, and decreased appetite. No SI. Current medications include mirtazapine 30, effexor 187.5, abilify 10. Patient receives psychotherapy weekly. What would be the best next step treatment out of the options below:
1. Start lamotrigine
2. Start depakote
3. Start esketamine
4. Start naltrexone
5. Start wellbutrin
Esketamine
(think treatment resistant depression)
Which of the following is a CYP2D6 inducer
1. Rifampin
2. Terbinabine
3. Paroxetine
4. Bupropion
5. Quinidine
Rifampin
Name this psychological disorder that describes when two individuals, often in a close relationship, share a delusion or psychotic symptoms
Folie a deux
This agent blocks GABA and glycine in the inhibitory interneurons in the spinal cord
1. Atropine
2. Pertussis
3. Tetanus
4. Mycotoxin
5.Botulinum
Tetanus
delusion of people dying or missing body parts is known as
cotard's syndrome
This substance will potentiate the effect of inhalants and are relatively contraindicated in management of inhalant intoxication
1. Cocaine
2. Benzodiazepines
3. Phenobarbital
4. Haldol
5. Clonidine
2. Benzos!
Clozapine is metabolized by this CYP Variant
1. CYP2D6
2. CYP2B6
3. CYP1A2
4. CYP3A4
5. CYP3C1
CYP 1A2
Name two substances/medications that act via NMDA antagonism
PCP
Ketamine
Memantine
Dextromethorphan
Acamprosate (whatttttt)
Despite its name, Gabapentin does not act on the gaba receptor and acts of this type of channel
1.voltage-gated calcium channels
2.voltage-gated sodium channels
3. G-protein
4. Tyrosine kinase
voltage-gated calcium channels
The only finding that is present in carotid artery strokes/occlusions and NOT in MCA strokes
Amaurosis Fugaux
A patient in their mid 50s, with history of alcohol use disorder, anxiety, obesity, and no other relevant medical history is having trouble with falling asleep and staying asleep. Sleep hygiene has failed. Out of the following, which would be the best treatment
1. Mirtazapine
2. Clonazepam
3. Ativan
4. Suvorexant
5. Ambien
Suvorexant
A patient on maintenance methadone is treated with this antibiotic and develops symptoms of lethargy and QTc prolongation.
1. Linezolid
2. Clarithromycin
3. Vancomycin
4. Cefepime
5. Erythromycin
Clarithromycin (3A4 inhibitor)
Name two conditions that are genetically inherited via autosomal dominant fashion
Marfan
Tuberous Sclerosis
Huntington's (Trinucleotide expansion of CAG)
Myotonic Dystrophy (Trinucleotide explansion of CTG)
A 42-year-old man with a history of alcohol use disorder is being treated in an inpatient detoxification unit. On day 2 of admission, he reports intense cravings for alcohol, irritability, and difficulty sleeping. The treatment team decides to initiate a medication to reduce alcohol cravings. Baclofen is chosen as part of his management plan.
Which of the following best explains the mechanism by which baclofen may reduce alcohol cravings in this patient?
A) Inhibition of NMDA glutamate receptors
B) Antagonism of dopamine D2 receptors
C) Agonism of GABA-B receptors
D) Inhibition of GABA transaminase
E) Partial agonism at nicotinic acetylcholine receptors
Baclofen is a GABA-B receptor agonist. In the context of alcohol use disorder, it has been used off-label to reduce cravings and withdrawal symptoms. By activating GABA-B receptors, baclofen can dampen the excitatory neurotransmission that occurs during alcohol withdrawal and may reduce the reinforcing effects of alcohol consumption.
A child who has OCD is initiated on clopramine but noting that the medication has been ineffective despite being prescribed at therapeutic doses. On further questioning, the child was found to love eating this kind of food:
1. Brussels and broccoli
2. Rice and beans
3. Chocolate
4. Grapefruit and oranges
5. Tumeric
Brussels and broccoli
A 26-year-old man presents with acute psychosis and is started on an antipsychotic. The drug works primarily by blocking dopamine D2 receptors in the mesolimbic pathway.
Which of the following side effects is most likely due to dopamine blockade in the nigrostriatal pathway?
A) Sedation
B) Galactorrhea
C) Tardive dyskinesia
D) Weight gain
E) Orthostatic hypotension
Answer: C) Tardive dyskinesia
Explanation: The nigrostriatal pathway modulates movement. Chronic D2 receptor blockade in this pathway can lead to extrapyramidal symptoms, including tardive dyskinesia, a late-onset involuntary movement disorder.
A patient is admitted to inpatient psychiatric unit with active visual hallucinations, paranoia, and severe anxiety. The patient reports nausea, abdominal pain, leg numbness and leg weakness. Admission labs notable for sodium of 130. The patient started seizing on the unit and Keppra was administered for status epilepticus. Which medication would be the safest to use afterwards to manage the pt's symptoms?
1. carbamazapine
2. phenytoin
3. phenobarbital
4. gabapentin
5. valproic acid
Gabapentin
Clinical Vignette:
A 62-year-old man without insurance presents with a 6-month history of progressive memory loss, bradykinesia, and visual hallucinations. His neurological exam reveals resting tremor, rigidity, and shuffling gait. He also has episodes of paranoid delusions.
Which of the following combination is the best treatment
A) Bromocriptine and haldol
B) Donepezil and olanzapine
C) Rivastigmine and seroquel
D) Galantamine and pimavanserin
E) Memantine and clozapine
Rivastigmine and seroquel
A 29-year-old man with generalized anxiety disorder has been taking alprazolam daily for six months. He abruptly stops the medication and presents two days later with tremors, anxiety, diaphoresis, and visual hallucinations. The physician explains that his symptoms are due to sudden withdrawal from a drug that enhances inhibitory neurotransmission in the brain.
Which of the following best describes the mechanism of action of the drug responsible for his symptoms?
A) Agonist at GABA-B receptors
B) Antagonist at GABA-A receptors
C) Positive allosteric modulator of GABA-A receptors
D) Inhibitor of GABA reuptake transporters
E) Antagonist at NMDA receptors
Correct Answer: C) Positive allosteric modulator of GABA-A receptors
Explanation:
Benzodiazepines like alprazolam are positive allosteric modulators of the GABA-A receptor. They enhance the effect of GABA, the primary inhibitory neurotransmitter in the CNS, by increasing the frequency of chloride channel opening. Abrupt cessation after long-term use can lead to a withdrawal syndrome characterized by CNS hyperexcitability, including anxiety, tremors, and hallucinations.
Clinical Vignette:
A 29-year-old man recovering from a traumatic brain injury believes that multiple staff members are actually the same person in disguise, attempting to deceive or harm him. His CT scan showed a frontal lobe contusion and temporal lobe involvement in area of fusiform gyrus.
Which of the following types of delusions is most consistent with this patient's presentation?
A) Capgras delusion
B) Fregoli delusion
C) Erotomanic delusion
D) Nihilistic delusion
E) Somatic delusion
B) Fregoli delusion
A 34-year-old man with bipolar I disorder is treated with lithium. In addition to mood stabilization, lithium has been shown to have neuroprotective effects.
Which of the following best describes a proposed mechanism of lithium’s neuroprotective action?
A) Inhibition of dopamine reuptake
B) Activation of GABA-A receptors
C) Inhibition of inositol monophosphatase
D) Blockade of NMDA glutamate receptors
E) Agonism of serotonin 5-HT2C receptors
Answer: C) Inhibition of inositol monophosphatase
Explanation: One of lithium’s key mechanisms is inhibition of inositol monophosphatase, which reduces phosphatidylinositol signaling. This is part of the "inositol depletion hypothesis", and it’s thought to contribute to lithium’s mood-stabilizing and neuroprotective effects.
A young college woman came to your office with symptoms of poor sleep, increased spending, high energy, and rapid thinking. Lamotrigine is started and titrated to 200mg daily with good effect. The patient was continued on this dose of lamotrigine for several months then reported acute worsening anxiety, worsened sleep, and irritability. Review of records indicate the patient started on combined hormonal oral contraceptives three weeks ago. What is the mechanism that caused the patient's symptoms?
1. CYP2D6 inhibition
2. Increased expression of UGT1A4
3. Decreased glucuronidation
4. CYP3A4 induction
5. Decreased renal clearance
2. Increased expression of UGT1A4