Overview Psychiatric medications can be broken down into the following categories antidepressants antipsychotics mood stabilizers include lithium anxiolytics Mechanism Mood stabilizer Mechanism unknown may be related to inhibition of phosphoinositol recycling in neurons Indications Clinical use mood disorders bipolar disorder for acute treatment of mood episodes and maintenance therapy (prevention of future episodes) major depressive disorder (MDD) adjunctive treatment for some patients who have failed treatment with an antidepressant alone reduces suicide risk in bipolar disorder and MDD SIADH Toxicity and Side Effects Toxicity very narrow therapeutic index requires blood monitoring toxicity may be seen at levels higher than 1.5 mEq/L increased risk in patients who are volume depleted or hyponatremic caution if adding hydrochlorathiazide, NSAID, or ACE-inhibitor loop diuretics do not increase toxicity tremor (coarse tremor indicates likely toxicitiy) sedation ataxia acne edema heart block exclusively excreted by the kidneys (reabsorbed at the proximal convoluted tubule with Na+) and long term use may cause a glomerulopathy hyperparathroidism hypothyroidism polyuria ADH antagonist resulting in nephrogenic diabetes insipidus reason for use in SIADH leukocytosis teratogenesis if given in pregnancy cardiac malformations including Ebstein anomaly in first trimester
QUESTIONS 1 of 5 1 2 3 4 5 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (M1.PY.15.75) A 19-year-old African American male with a history of bipolar I disorder presents to the psychiatrist for a follow-up visit. During the session, the patient explains that for the past 2 months he has felt significantly fatigued and constipated. He is always complaining of feeling cold and has gained several pounds although his diet has not changed. A blood sample was sent for analysis, revealing the following: TSH - 6 mIU/L (nl = 0.4-4.0 mIU/L), free T4 - 0.4 ng/dL (nl = 0.7-1.9 ng/dL), and serum T4 - 2.1 mcg/dL (nl = 4.6-12 mcg/dL). Which of the following is responsible for these abnormalities? Tested Concept QID: 106839 Type & Select Correct Answer 1 Valproic acid 13% (6/46) 2 Lithium 76% (35/46) 3 Carbamazepine 4% (2/46) 4 Lamotrigine 0% (0/46) 5 Olanzapine 4% (2/46) M 3 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review tested concept Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (M1.PY.13.109) A 27-year-old P1G1 who has had minimal prenatal care delivers a newborn female infant. Exam reveals a dusky child who appears to be in distress. Her neck veins are distended and you note an enlarged v wave. She has a holosystolic murmur. Following echocardiogram, immediate surgery is recommended.For which of the following conditions was the mother likely receiving treatment during pregnancy? Tested Concept QID: 100625 Type & Select Correct Answer 1 Depression 4% (5/141) 2 Hypothyroidism 6% (9/141) 3 Diabetes 10% (14/141) 4 Bipolar disorder 76% (107/141) 5 Hypertension 2% (3/141) M 4 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review tested concept