1. Intro to Therp. Tutoring: Halloween Edition (Spooky)
10/31/17
Dylan Knox

2. PSA Always defer to your notes if something is confusing
Ask for help early!
I didn’t have these slides/professors, so I’m making my best guess 

3. Psychiatric Disorders

4. You see a patient who tells you he needs to get back to his meets with the Pope. He is sure that someone is on their way to “get him” if he doesn’t leave now. What disorder does your patient have?
A. Schizophrenia
B. Bipolar disorder
C. Major depression
D. Panic disorder A

5. B. Seasonal Affective Disorder C. Drug-induced Depression
Your patient reports having depressed symptoms for the past month. She noticed that it happened around the time change. She works first shift at the hospital and goes in before sunrise and leaves as the sun sets. What disorder does she likely have?
A. Dysthymia
B. Seasonal Affective Disorder
C. Drug-induced Depression
D. Major Depressive Disorder B

6. Your patient states they started some new medication after being in the hospital. Ever since then, they have felt down and blue for no reason. Which of his discharge medications might be causing this?
A. Aspirin
B. Xarelto
C. Crestor
D. Propranolol D

7. What is not important to keep in consideration while picking a depression medication for a patient?
A. Age
B. Side effects
C. Overdose potential
D. Patient wants a certain medication
E. Cost
F. All are important factors F

8. Your patient presents and is diagnosed with his second episode of depression. How long should be in treated for depression?
A. 3-6 months
B months
C. 3 years
D. Forever C

9. Your patient started an antidepressant today
Your patient started an antidepressant today. He wants to know how long he has to take the medicine before he gets the best response. You tell him:
A. It will work by tomorrow night
B. In about a week
C. In about a month
D. In about two months D
“Best” = maximum response

10. You have a patient who is 17 years old and starting fluoxetine today
You have a patient who is 17 years old and starting fluoxetine today. What is the MOST important thing to counsel them on today?
A. Sexual dysfunction
B. Increased risk for suicidal behavior
C. Anxiety can occur
D. Take with a snack B
Definitely counsel about the other things!! But suicide is really important because the patient might think they are getting worse and take more/less medication or not get help if you don’t counsel them on it!

11. What is not a first line treatment for depression?
A. Paroxetine- SSRI
B. Venlafaxine- SNRI
C. Buproprion- Atypical
D. Amitriptyline- TCA D

12. Your patient started on fluoxetine 2 months ago but now comes back to clinic because he is having trouble “being intimate” with his wife. You:
A. Make no change. It will go away by month 3
B. Change to paroxetine
C. Change to venlafaxine
D. Change to buproprion D

13. Your patient is going to start an antidepressant today
Your patient is going to start an antidepressant today. She has heard they make you gain weight, and she refuses to take a medication that will do that to her. You suggest:
A. Fluoxetine
B. Olanzapine
C. Trazadone
D. Mirtazapine A
B- not for regular MDD
C,D- “atypicals” cause weight gain according to slides

14. What group of antidepressants is it good to steer clear of in elderly patients?
A. All SSRIs
B. All SNRIs
C. Buprioprion
D. TCAs
D- bad for confusion and falling in the elderly
The others have their problems too, so go with what you learned in class 

15. What group of antidepressants has the most side effects, including orthostatic hypotension, anticholinergic effects, weight gain, food interactions, and sedation?
A. TCAs
B. SSRIs
C. SNRIs
D. MAOIs D
TCAs have lots of side effects too; food interactions and drug interactions make MAOIs a last-resort for MOST patients

16. Your patient is picking up a fluoxetine for herself and has several OTC items in hand too. Which one are you concerned with?
A. Dextromethorphan cough medicine
B. Pseudofed
C. Baby aspirin
D. Vitamin C A
Serotonin syndrome risk

17. What side effects would be expected if you stop your antidepressant all at once?
A. None
B. Cough
C. Sleep issues
D. Flu-like symptoms
E. Headache
F. Stye
C, D, E
Stye is a pimple looking bump at the edge of the eyelid- bacterial infection usually- not a correct answer- I was just looking for something off the wall to put on the list
MOST IMPORTANT to remember that you should NOT stop these things all at once!!

18. What is the first line pharmacologic treatment for GAD?
A. SSRI
B. SNRI
C. Buproprion
D. Trazadone
A, B

19. Which medication is NOT FDA approved for GAD?
A. Paroxetine
B. Escitalopram
C. Citalopram
D. Venlafaxine XR C

20. What is an example of a short-acting benzodiazepine?
A. Diazepam
B. Alprazolam
C. Oxazepam
D. Temazepam C

21. Your patient is not responding to both a SSRI and SNRI therapy for GAD
Your patient is not responding to both a SSRI and SNRI therapy for GAD. Patient is a former IV drug user. What is a good option for this patient?
A. Temazepam
B. Hydroxyzine
C. Buspirone
D. Amitriptyline
C- no abuse potential
B and D are probably good options too
A is NOT a good option because of past drug abuse

22. What is first line therapy for OCD?
A. Fluoxetine
B. Sertraline
C. Venlafaxine
D. CBT D
SSRI is first line for pharmacologic therapy

23. Your patient is being treated with sertraline for PTSD but reports having nightmares 5-7 days/week. What medication would you recommend?
A. Zolpidem
B. Trazadone
C. Prazosin
D. Melatonin C

24. What disease state doesn’t benefit from CBT?
A. OCD
B. PTSD
C. Anxiety
D. Depression
E. All benefit E

25. A. Schizophrenia B. Bipolar disorder C. Major depression
A patient is admitted to the psych ward and you conduct an interview with her. In the interview, she does not speak except to say “no” when you ask if she finds pleasure in her everyday activities. After that, she just stares at the wall. What disorder does your patient have?
A. Schizophrenia
B. Bipolar disorder
C. Major depression
D. Panic disorder A
Maybe C- need a little more info than what I gave you probably
Trying to outline that schizophrenia can present with positive or negative sx

26. What is true about your patient because of his disease state?
A. She likely has no other disease states
B. She likely will never have a problem with substance abuse
C. She has a shorter life expectancy than someone without this illness
D. She has the same suicide risk as someone without this illness C

27. Which is not a positive symptom of schizophrenia?
A. Hallucinations
B. Delusions
C. Difficulty speaking
D. Thought disorders C

28. How many consistently occurring symptoms must a person have to be diagnosed with schizophrenia?
B (C is also correct- must be 2 or more)
Sx are- delusions, hallucinations, disorganized/catatonic behavior, negative symptoms

29. What is the general mechanism of antipsychotics?
A. Blocks postsynaptic epinephrine receptors
B. Blocks postsynaptic serotonin (5HT-2) receptors
C. Blocks acetylcholine degradation
D. Blocks postsynaptic dopamine-2 receptors D
Does have some anticholinergic, antihistaminic, and alpha blocking properties

30. What side effect of antipsychotics is related to the alpha blocking mechanism?
A. Neuroleptic effects
B. Anticholinergic effects
C. EPS
D. Orthostasis D
Remember alpha blockers in hypertension lower BP so anything with alpha receptor blocking can cause orthostasis

31. What antipsychotic is the MOST sedating?
A. Aripiprazole
B. Olanzapine
C. Quetiapine
D. Haloperidol
E. Chlorpromazine E

32. Which antipsychotic agent has the MOST EPS side effects?
A. Aripiprazole
B. Olanzapine
C. Quetiapine
D. Haloperidol
E. Chlorpromazine D
EPS- extrapyramidal symptoms (look up a video to really understand what it is)

33. Which antipsychotic medication has the BEST weight gain side effect profile (i.e.-not gaining weight)
A. Aripiprazole
B. Olanzapine
C. Quetiapine
D. Risperidone
E. Chlorpromazine A

34. Which antipsychotic medication has the WORST orthostasis risk?
A. Aripiprazole
B. Olanzapine
C. Quetiapine
D. Haloperidol
E. Chlorpromazine E
First antipsych least selective, most alpha blocking potential

35. What is an adequate trial of taking antipsychotics as prescribed?
A. 2 weeks
B. 4 weeks
C. 8 weeks
D. 12 weeks
B- 4-6 weeks

36. How do you monitor antipsychotic medications?
A. Blood levels
B. Adherence
C. Clinical response
D. Adverse effects
E. Patient willingness to D/C medications

37. What antipsychotic medication does not come in an injectable form according to your slides?
A. Fluphenazine
B. Olanzapine
C. Quetiapine
D. Haloperidol
E. Chlorpromazine
E, C
Good for people who are nonadherent

38. A. He’s fine B. Insomnia C. Bipolar I disorder D. Major depression
A patient presents to your care with a 4 day history of no sleep. He is not concerned about this because he has completed 4 home improvement projects he’s been meaning to finish and borrowed money from his buddies at work to go to Tunica tonight because “he feels like he’s going to hit it big.” What is his diagnosis?
A. He’s fine
B. Insomnia
C. Bipolar I disorder
D. Major depression
Bipolar II disorder C
He has insomnia but it’s a symptom of the Bipolar I
Difference between I and II- outlined in your notes- I- mania (7 days) phases II- hypomania=not as long as a mania phase, maybe not as severe

39. What is not one of the goals of bipolar management?
A. Reduce symptoms
B. Delay recurrence of new mood episode
C. Begin lithium as soon as possible
D. Improve psychosocial function C
May want to start lithium, but not always!

40. What are the 3 classes of medications used to treat bipolar disorder?
A. Benzodiazepines
B. Mood stabilizers
C. Antipsychotics
D. Antidepressants
B,c,d

41. What is the gold standard for bipolar disorder mania?
A. Aripiprazole
B. Olanzapine
C. Risperidone
D. Lithium D

42. A. Valproate B. Lithium C. Risperidone D. Aripiprazole
Your patient has had multiple manic episodes in the past and you are starting prophylaxis for mania today. She has responded well to valproate in the past. What should you start today?
A. Valproate
B. Lithium
C. Risperidone
D. Aripiprazole A

43. What is the therapeutic range of lithium?
A mEq/L
B mEq/L
C mcg/L
D mcg/L B
mcg/L is valproate level

44. Your patient is starting lithium today
Your patient is starting lithium today. What side effects should you counsel her on?
A. Weight gain
B. Weight loss
C. Polyuria
D. Oliguria
E. Hyperthyroidism
F. Hypothyroidism
G. Drug interactions- lots of them
A, C, F, G

45. What are the boxed label warnings for Valproic acid?
A. Nephrotoxicity
B. Pancreatitis
C. Hepatotoxicity
D. Ototoxicity
E. Neurotoxicity
F. Teratogenicity
B, C, F

46. What medication can you use for acute depression in bipolar disorder?
A. Lithium
B. Valproate
C. Quetiapine
D. Lamotrigine (monotherapy)
A or C
D- in combo with lithium only for acute (alone for maintenance)

47. What medical conditions can cause insomnia?
A. Bipolar disorder
B. Hypertension
C. Schizophrenia
D. Chronic pain
A, C, D

48. Your patient is having trouble staying asleep at night but reports being able to fall asleep just fine. What is a good option for him?
A. Zolpidem IR (Ambien)
B. Zaleplon (Sonata)
C. Eszopiclone (Lunesta)
D. Ramelteon (Rozerem) C
A would be good if ER formulation

49. What medication for insomnia works on the GABA system?
A. Zolpidem
B. Melatonin
C. Trazodone
D. Quetiapine A

50. What is a unique side effect of trazodone compared to zolpidem?
A. Somnolence
B. Dizziness
C. Priapism
D. Headache C

51. Questions/comments/concerns?
Dylan Knox

52. Cyclothymic presentation
“mild mood disorder”
Mood swings between mild depression and hypomania
Never reach the severity and duration of major depressive disorder or mania
Milder symptoms that bipolar disorder