PRITE NINJA PART 2
Acetylcysteine68is68Tx68of68choice68for68OD68of:ACETAMINOPHEN68-68answer--
ACETAMINOPHEN
OD68on68sleeping68pill.68Hot68skin,68blurry68vision,68urinary68
retention,68dry68mucous68membranes,68tachycardia,68
decreased68bowel68sounds.68What68is68the68pill?68-68answer--DIPHENHYDRAMINE
Risk68of68hepatotoxicity68will68peak68in68how68many68hours68after68
acetaminophen68overdose?68-68answer--7268to689668HOURS
MC68complication68of68corticosteroid68therapy?68-68answer--MOOD68DISORDER
What68medication68strategies68is68most68effective68and68rapid68
in68the68treatment68of68severe68bipolar68illness,68manic68phase?68-68answer--
ANTIPSYCHOTIC68MEDICATION68+68LITHIUM68OR68
VALPROATE
Molecular68targets68for68improving68cognition68in68
schizophrenia68have68shown68promise68via68which68of68the68
following68mechanisms?68-68answer--D168RECEPTOR68AGONISM
Which68med68is68helpful68in68Tourette68Syndrome68who68can't68
tolerate68clonidine?68-68answer--GUANFACINE
Guanfacine's68primary68effect68is68through68what68mechanism68
of68action?68-68answer--PRESYNAPTIC68ALPHA268ADRENERGIC68RECEPTOR68
ACTIVATION
Associated68with68neural68tube68defect68in68first68trimester68of68
pregnancy:68-68answer--VALPROATE
Which68of68the68following68meds68is68associated68with68benign68
maculopapular68rash68in68approximately6810-15%68of68pt's68
within68the68first68368weeks68of68treatment?68-68answer--CARBAMAZEPINE
After68psychiatrist68adds68new68med,68pt68turns68bright68red68w/68
sunburn68like68rash,68similar68to68SJS.68Which68med68caused68
this?68-68answer--LAMOTRIGINE
,Rare68occurrences68of68priapism68are68most68frequently68
associated68with:68-68answer--TRAZODONE
Key68element68in68emergency68treatment68of68pt68w68serotonin68
syndrome,68beyond68stopping68offending68agent68is:68-68answer--
SUPPORTING68VITAL68FUNCTIONS
Restlessness,68myoclonus,68hyperreflexia,68diaphoresis,68
shivering,68tremor,68and68confusion68are68compatible68with68
which68diagnosis?68-68answer--SEROTONIN68SYNDROME
Research68on68the68use68of68psychostimulants68to68treat68pts68w/68
secondary68depressive68symptoms68in68medical68setting68
suggest:68-68answer--WHEN68TREATED68WITH68THESE68AGENTS,68PT68MAY68
ENGAGE68IN68REHABILITATION68SOONER.
A68psychiatry68consult68is68placed68regarding68a68patient68with68
SI.68History68of68Bipolar68disorder68and68admitted68for68VRE68
bacteremia.68BP68of68171/95,68temp68of68100.9.68Has68tremors,68
hyperreflexia,68myoclonic68jerks,68not68oriented68at68all,68has68
visual68hallucinations.68Meds68include68linezolid,68lithium,68
sertraline,68Risperdal.68What68is68diagnosis?68-68answer--SEROTONIN68SYNDROME
What68drug68has68been68known68to68cause68hypertensive68
crisis?68-68answer--PHENELZINE
Dry68mouth,68blurred68vision,68constipation,68urinary68
retention.68S/E68of68what68psychotropic?68-68answer--AMITRIPTYLINE
Do68NOT68use68in68pt68w/68narrow-angle68glaucoma68-68answer--AMITRIPTYLINE
African68americans68tend68to68have68higher68activity68of68which68
of68the68following68cytochrome68p45068enzymes?68-68answer--3A4
Which68of68the68following68meds68has68the68lowest68likelihood68
of68discontinuation68symptoms68if68the68medication68is68
abruptly68stopped?68-68answer--FLUOXETINE
What68med68has68some68evidence68of68effectiveness68in68both68
psychotic/nonpsychotic68subtypes68of68body68dysmorphic68
disorder?68-68answer--FLUOXETINE
What68med68is68most68potent68inhibitor68of68the68
norepinephrine68transporter?68-68answer--PAROXETINE
Bipolar68pt68on68lithium68and68Zoloft68for68368yrs.68Level680.8.68
,More68depressed68and68fatigued,68low68energy68level.68
Increasing68Zoloft68ineffective.68Next68step:68-68answer--OBTAIN68TSH68LEVEL
Sudden68death68in68children68taking68which68medication?68-68answer--TRICYCLICS
4768yo68pt68presents68with68fever,68confusion,68and68tremor68and68
found68to68be68tachy68and68diaphoretic.68Clonus68easily68
elicited68on68exam.68Pt68suspected68to68have68serotonin68
syndrome,68is68taking68Celexa68and68Lithium.68What68
additional68medication68may68have68contributed68to68
syndrome?68-68answer--ST.68JOHN'S68WORT
Which68med68has68increased68risk68of68hyperglycemia68and68
DM?68-68answer--OLANZAPINE
Autonomic68instability,68nonfocal68neurological68signs,68and68
elevated68temp68associated68with68which68elevated68lab68
value?68-68answer--CREATININE68PHOSPHOKINASE68(CPK)
Retinal68pigmentation68from68long-term68Tx68with:68-68answer--THIORIDAZINE
7568y/o68pt68with68cirrhosis68should68be68given68which68of68the68
following68meds:68-68answer--TEMAZEPAM
Alcohol68use68is68associated68with68what68changes68in68sleep?68-68answer--
DECREASED68REM68SLEEP
Which68of68the68following68medications68is68most68likely68to68
precipitate68a68manic68switch68in68a68patient68with68bipolar68I68
disorder68-68answer--DESIPRAMINE
Which68of68the68following68medications68was68first68used68as68a68
treatment68for68gout68and68later68promoted68by68john68cade68for68
treatment68of68unstable68mood?68-68answer--LITHIUM
Medication68most68likely68to68cause68cognitive68side68effects,68
even68seizures,68if68taken68at68same68time68as68ECT?68-68answer--LITHIUM
A68psychotropic68with68same68pharmacokinetic68properties68
in68Asian68Americans68and68White68Americans68-68answer--LITHIUM
A683268yo68F68comes68to68the68ED68with68CC68of68268weeks68of68
diarrhea.68On68exam68she68is68anxious68and68tremulous68and68is68
not68oriented68to68date68or68time68of68the68day.68She68states68she68
is68taking68"some68drug"68for68Bipolar68disorder68and68adds68
that68she68started68doubling68her68dose68a68month68ago68
, because68she68"wasn't68getting68better68fast68enough."68She68
denies68use68of68drugs/ETOH.68Which68medication68would68
most68likely68cause68the68symptoms68described?68-68answer--LITHIUM
Administration68of68activated68charcoal68is68ineffective68in68
overdose68of:68-68answer--LITHIUM
Drug-drug68interactions68in68pts68taking68HIV68meds68are68
particularly68problematic68with68which68medication:68-68answer--METHADONE
The68use68of68flumazenil68for68treating68benzo68OD68is68limited68
by68...68-68answer--THE68RISK68OF68INDUCING68WITHDRAWAL68SEIZURES68IN68
BENZO-68DEPENDENT68PTS
In68addition68to68benzos,68which68class68of68meds68is68assoc68with68
falls68in68pts68older68than6860?68-68answer--ANTIDEPRESSANTS
The68potency68of68medication68refers68to68which68of68the68
following68properties68of68a68medication?68-68answer--
RELATIVE68DOSE68REQUIRED68TO68ACHIEVE68A68CERTAIN68
EFFEC
6068yo68pt68with68chronic68schizophrenia68takes68cogent68in68for68
neuroleptic68induced68parkinson68now68has68increased68urine68
retention68and68confusion.68What68medication68would68be68
the68best68alternative68for68treating68this68patient's68condition?68-68answer--
AMANTADINE
Most68of68the68body's68serotonin68is68located68where?68-68answer--GI68TRACT
Common68side68effect68of68acetylcholinesterase68inhibitors68-68answer--DIARRHEA
Diphenhydramine's68ability68to68treat68acute68dystonia68is68due68
to68action68on68which68receptor?68-68answer--MUSCARINIC-1
2868y/o68with68BMDII68wants68to68use68phototherapy68for68
depressive68Sx68treatment68in68winter.68What68should68you68
advise?68-68answer--CAN68BE68USED68BUT68REQUIRES68VIGILANCE68AND68
CAREFUL68TITRATION68OF68DOSE
Which68med68is68used68to68treat68hep68C68viral68infection68and68is68
associated68with68depression,68anxiety,68and68cognitive68
impairment?68-68answer--INTERFERON-ALPHA
In68pts68who68surreptitiously68use68excess68sulfonylurea,68
which68of68the68following68substances68can68be68administered68
Acetylcysteine68is68Tx68of68choice68for68OD68of:ACETAMINOPHEN68-68answer--
ACETAMINOPHEN
OD68on68sleeping68pill.68Hot68skin,68blurry68vision,68urinary68
retention,68dry68mucous68membranes,68tachycardia,68
decreased68bowel68sounds.68What68is68the68pill?68-68answer--DIPHENHYDRAMINE
Risk68of68hepatotoxicity68will68peak68in68how68many68hours68after68
acetaminophen68overdose?68-68answer--7268to689668HOURS
MC68complication68of68corticosteroid68therapy?68-68answer--MOOD68DISORDER
What68medication68strategies68is68most68effective68and68rapid68
in68the68treatment68of68severe68bipolar68illness,68manic68phase?68-68answer--
ANTIPSYCHOTIC68MEDICATION68+68LITHIUM68OR68
VALPROATE
Molecular68targets68for68improving68cognition68in68
schizophrenia68have68shown68promise68via68which68of68the68
following68mechanisms?68-68answer--D168RECEPTOR68AGONISM
Which68med68is68helpful68in68Tourette68Syndrome68who68can't68
tolerate68clonidine?68-68answer--GUANFACINE
Guanfacine's68primary68effect68is68through68what68mechanism68
of68action?68-68answer--PRESYNAPTIC68ALPHA268ADRENERGIC68RECEPTOR68
ACTIVATION
Associated68with68neural68tube68defect68in68first68trimester68of68
pregnancy:68-68answer--VALPROATE
Which68of68the68following68meds68is68associated68with68benign68
maculopapular68rash68in68approximately6810-15%68of68pt's68
within68the68first68368weeks68of68treatment?68-68answer--CARBAMAZEPINE
After68psychiatrist68adds68new68med,68pt68turns68bright68red68w/68
sunburn68like68rash,68similar68to68SJS.68Which68med68caused68
this?68-68answer--LAMOTRIGINE
,Rare68occurrences68of68priapism68are68most68frequently68
associated68with:68-68answer--TRAZODONE
Key68element68in68emergency68treatment68of68pt68w68serotonin68
syndrome,68beyond68stopping68offending68agent68is:68-68answer--
SUPPORTING68VITAL68FUNCTIONS
Restlessness,68myoclonus,68hyperreflexia,68diaphoresis,68
shivering,68tremor,68and68confusion68are68compatible68with68
which68diagnosis?68-68answer--SEROTONIN68SYNDROME
Research68on68the68use68of68psychostimulants68to68treat68pts68w/68
secondary68depressive68symptoms68in68medical68setting68
suggest:68-68answer--WHEN68TREATED68WITH68THESE68AGENTS,68PT68MAY68
ENGAGE68IN68REHABILITATION68SOONER.
A68psychiatry68consult68is68placed68regarding68a68patient68with68
SI.68History68of68Bipolar68disorder68and68admitted68for68VRE68
bacteremia.68BP68of68171/95,68temp68of68100.9.68Has68tremors,68
hyperreflexia,68myoclonic68jerks,68not68oriented68at68all,68has68
visual68hallucinations.68Meds68include68linezolid,68lithium,68
sertraline,68Risperdal.68What68is68diagnosis?68-68answer--SEROTONIN68SYNDROME
What68drug68has68been68known68to68cause68hypertensive68
crisis?68-68answer--PHENELZINE
Dry68mouth,68blurred68vision,68constipation,68urinary68
retention.68S/E68of68what68psychotropic?68-68answer--AMITRIPTYLINE
Do68NOT68use68in68pt68w/68narrow-angle68glaucoma68-68answer--AMITRIPTYLINE
African68americans68tend68to68have68higher68activity68of68which68
of68the68following68cytochrome68p45068enzymes?68-68answer--3A4
Which68of68the68following68meds68has68the68lowest68likelihood68
of68discontinuation68symptoms68if68the68medication68is68
abruptly68stopped?68-68answer--FLUOXETINE
What68med68has68some68evidence68of68effectiveness68in68both68
psychotic/nonpsychotic68subtypes68of68body68dysmorphic68
disorder?68-68answer--FLUOXETINE
What68med68is68most68potent68inhibitor68of68the68
norepinephrine68transporter?68-68answer--PAROXETINE
Bipolar68pt68on68lithium68and68Zoloft68for68368yrs.68Level680.8.68
,More68depressed68and68fatigued,68low68energy68level.68
Increasing68Zoloft68ineffective.68Next68step:68-68answer--OBTAIN68TSH68LEVEL
Sudden68death68in68children68taking68which68medication?68-68answer--TRICYCLICS
4768yo68pt68presents68with68fever,68confusion,68and68tremor68and68
found68to68be68tachy68and68diaphoretic.68Clonus68easily68
elicited68on68exam.68Pt68suspected68to68have68serotonin68
syndrome,68is68taking68Celexa68and68Lithium.68What68
additional68medication68may68have68contributed68to68
syndrome?68-68answer--ST.68JOHN'S68WORT
Which68med68has68increased68risk68of68hyperglycemia68and68
DM?68-68answer--OLANZAPINE
Autonomic68instability,68nonfocal68neurological68signs,68and68
elevated68temp68associated68with68which68elevated68lab68
value?68-68answer--CREATININE68PHOSPHOKINASE68(CPK)
Retinal68pigmentation68from68long-term68Tx68with:68-68answer--THIORIDAZINE
7568y/o68pt68with68cirrhosis68should68be68given68which68of68the68
following68meds:68-68answer--TEMAZEPAM
Alcohol68use68is68associated68with68what68changes68in68sleep?68-68answer--
DECREASED68REM68SLEEP
Which68of68the68following68medications68is68most68likely68to68
precipitate68a68manic68switch68in68a68patient68with68bipolar68I68
disorder68-68answer--DESIPRAMINE
Which68of68the68following68medications68was68first68used68as68a68
treatment68for68gout68and68later68promoted68by68john68cade68for68
treatment68of68unstable68mood?68-68answer--LITHIUM
Medication68most68likely68to68cause68cognitive68side68effects,68
even68seizures,68if68taken68at68same68time68as68ECT?68-68answer--LITHIUM
A68psychotropic68with68same68pharmacokinetic68properties68
in68Asian68Americans68and68White68Americans68-68answer--LITHIUM
A683268yo68F68comes68to68the68ED68with68CC68of68268weeks68of68
diarrhea.68On68exam68she68is68anxious68and68tremulous68and68is68
not68oriented68to68date68or68time68of68the68day.68She68states68she68
is68taking68"some68drug"68for68Bipolar68disorder68and68adds68
that68she68started68doubling68her68dose68a68month68ago68
, because68she68"wasn't68getting68better68fast68enough."68She68
denies68use68of68drugs/ETOH.68Which68medication68would68
most68likely68cause68the68symptoms68described?68-68answer--LITHIUM
Administration68of68activated68charcoal68is68ineffective68in68
overdose68of:68-68answer--LITHIUM
Drug-drug68interactions68in68pts68taking68HIV68meds68are68
particularly68problematic68with68which68medication:68-68answer--METHADONE
The68use68of68flumazenil68for68treating68benzo68OD68is68limited68
by68...68-68answer--THE68RISK68OF68INDUCING68WITHDRAWAL68SEIZURES68IN68
BENZO-68DEPENDENT68PTS
In68addition68to68benzos,68which68class68of68meds68is68assoc68with68
falls68in68pts68older68than6860?68-68answer--ANTIDEPRESSANTS
The68potency68of68medication68refers68to68which68of68the68
following68properties68of68a68medication?68-68answer--
RELATIVE68DOSE68REQUIRED68TO68ACHIEVE68A68CERTAIN68
EFFEC
6068yo68pt68with68chronic68schizophrenia68takes68cogent68in68for68
neuroleptic68induced68parkinson68now68has68increased68urine68
retention68and68confusion.68What68medication68would68be68
the68best68alternative68for68treating68this68patient's68condition?68-68answer--
AMANTADINE
Most68of68the68body's68serotonin68is68located68where?68-68answer--GI68TRACT
Common68side68effect68of68acetylcholinesterase68inhibitors68-68answer--DIARRHEA
Diphenhydramine's68ability68to68treat68acute68dystonia68is68due68
to68action68on68which68receptor?68-68answer--MUSCARINIC-1
2868y/o68with68BMDII68wants68to68use68phototherapy68for68
depressive68Sx68treatment68in68winter.68What68should68you68
advise?68-68answer--CAN68BE68USED68BUT68REQUIRES68VIGILANCE68AND68
CAREFUL68TITRATION68OF68DOSE
Which68med68is68used68to68treat68hep68C68viral68infection68and68is68
associated68with68depression,68anxiety,68and68cognitive68
impairment?68-68answer--INTERFERON-ALPHA
In68pts68who68surreptitiously68use68excess68sulfonylurea,68
which68of68the68following68substances68can68be68administered68
