PEBC Review Exam Questions With Correct
Answers
What |are |the |2 |benzo's |of |choice |in |elderly |patients? |- |CORRECT |ANSWER✔✔-Lorazepam |and |
oxazepam |because |they |have |no |active |metabolites |and |metabolism |is |minimally |affected |by |
aging
What |2 |things |do |you |never |combine |due |to |increased |risk |of |cardiac |and |respiratory |
complications? |- |CORRECT |ANSWER✔✔-IM |Olanzapine |with |benzodiazepines
Which |drugs |are |considered |first |line |in |treating |GAD? |- |CORRECT |ANSWER✔✔-Pregabalin, |
SNRI's |and |SSRI's |(all |in |combo |with |CBT)
What |is |the |recommendation |on |how |long |a |SA |benzo |should |be |used |for? |- |CORRECT |
ANSWER✔✔-ideally |less |than |4 |days
If |initiating |a |stimulant, |what |are |some |baseline |tests |that |should |be |done? |- |CORRECT |
ANSWER✔✔--BP, |HR, |height, |weight
-ECG |(if |previous |cardiac |Hx |or |strong |family |hx)
How |long |are |stimulants |typically |trialled |for? |- |CORRECT |ANSWER✔✔-3-4 |weeks
Long |acting |stimulants |vs. |short |acting |stimulants. |Which |one |do |you |trial |first? |- |CORRECT |
ANSWER✔✔-Long. |Due |to |less |rebound, |decrease |abuse |potential, |and |reduced |admin |of |med
|at |school
,Antidepressants |and |ADHD |- |CORRECT |ANSWER✔✔-AD's |are |not |first |line |for |ADHD |but |may |
be |used |in |adjunct |with |a |stimulant. |Typically |you'll |see |buproprion, |venlafaxine |or |
atomoxetine |(NRI) |used
Alpha-2-agonists |and |ADHD |- |CORRECT |ANSWER✔✔-Clonide |and |guanfacine |--> |add-on |or |
2nd/3rd |line |therapy. |Typically |these |help |with |stim. |induced |insomnia, |aggression, |impulsivity.
Clonidine |is |off |label |whereas |gunafacine |is |the |only |alpha-agonist |that |is |indicated |for |
treatment |of |ADHD
How |long |is |stimulant |therapy |typically |continued |for? |- |CORRECT |ANSWER✔✔-6-12 |months |
but |it |is |common |to |see |it |longer. |No |studies |are |currently |published |with |regards |to |long |
term |(>2 |years) |affects |of |stimulants.
Drug |Holidays |- |CORRECT |ANSWER✔✔-Common |with |stimulants. |Usually |during |summer |
months |when |kids |are |off |school. |To |re-assess |if |the |symptoms |are |still |present |and |if |the |
med. |needs |to |be |continuedt
What |are |manic |symptoms? |- |CORRECT |ANSWER✔✔-Abnormal |and |persistently |elevated |
mood |with |or |without |psychotic |symptoms. |Grandiosity. |Needs |less |sleep |then |usual. |
Increased |activity |and |or |energy
What |are |hypomanic |symptoms? |- |CORRECT |ANSWER✔✔-Same |symptoms |as |mania |but |
without |psychotic |symptoms. |(Hypomania |lacks |psychotic |symptoms)
Bipolar |1 |disorder |- |CORRECT |ANSWER✔✔-Manic |episodes |with |or |without |MDD
Bipolar |2 |disorder |- |CORRECT |ANSWER✔✔-Hypomanic |episodes |with |MDD; |with |no |history |or
|manic |episodes
,Cyclothymic |Disorder |- |CORRECT |ANSWER✔✔-Recurrent |episodes |of |hypomania |and |mild |
(subthreshold) |depressive |symptoms
When |BD |is |severe, |what |other |psychiatric |illness |does |it |resemble? |- |CORRECT |ANSWER✔✔-
Schizophrenia
What |is |extremely |important |to |determine |in |patients |with |query |BD? |- |CORRECT |
ANSWER✔✔-If |they |have |a |positive |family |history. |BD |is |largely |genetic.
On |another |note |it |is |also |important |to |see |if |the |patient |has |a |hx. |of |substance |abuse |which |
can |exacerbate |psychotic |symptoms |in |BD |1
What |baseline |tests |should |be |done |in |newly |diagnosed |BD |patients? |- |CORRECT |
ANSWER✔✔-Metabolic |tests |(lipids, |FBG, |liver |panel, |weight)
How |long |are |BD |patients |treated |for? |- |CORRECT |ANSWER✔✔-Lifelong
If |a |patient |presents |to |the |hospital |with |manic |symptoms |and |they |are |currently |on |ONLY |an |
antidepressant |to |treat |MDD, |what |should |happen? |- |CORRECT |ANSWER✔✔-Discontinue |the |
antidepressant. |In |patients |with |true |BD, |if |an |SSRI/SNRI |is |initiated, |it |can |induce |mania. |This |
is |why |we |d/c |the |antidepressant
Note: |antidepressants |can |be |used |to |treat |MDD |in |BD |patients |but |never |by |itself. |Must |be |
used |in |combination |with |a |mood |stabilizer |(i.e |lithium)
Treatments |for |BD |1 |- |CORRECT |ANSWER✔✔-1st |line: |Lithium, |divalproex |or |a |second |gen. |
antipsychotic |
Usually |patients |will |be |on |one |drug |to |start, |but |in |severe |cases |they |can |be |on |a |
combination |of |2 |first |line |therapies |(ex: |lithium |and |a |2nd |gen |AP)
, 2nd |line: |carbamazepine, |lithium |+ |divalproex
How |long |should |patients |trial |a |med |for |BD? |- |CORRECT |ANSWER✔✔-Treatment |should |be |
continued |for |a |specific |regimen |for |2 |weeks |at |therapeutic |doses |before |assessing |response
What |med's |should |be |used |to |treat |MDD |in |BD? |- |CORRECT |ANSWER✔✔-If |patient |is |not |
already |on |lithium |then |initiate |lithium. |
*Quetiapine |is |first |line |for |MDD |in |BD*
Other |options |include |lamotrigine |or |quetiapine. |Can |add |on |an |SSRI |or |buproprion |if |MDD |is |
severe |or |uncontrolled
What |does |BD |usually |present |as |in |adolescents? |- |CORRECT |ANSWER✔✔-Depression
What |is |euthymia? |- |CORRECT |ANSWER✔✔-Psychological |normality
When |discontinuing |BD |meds |- |CORRECT |ANSWER✔✔-You |need |to |taper |the |patient |off |of |
them. |Ex: |prior |to |conception |in |a |women |with |BD
Lithium |- |CORRECT |ANSWER✔✔-Patients |on |lithium |need |to |maintain |their |usual |salt |and |
caffeine |intake |and |monitor |fluid |intake. |
Lithium |can |cause |diarrhea |--> |ensure |patients |are |properly |hydrated |if |this |happens |
Single |daily |doses |of |lithium |are |preferred*
Answers
What |are |the |2 |benzo's |of |choice |in |elderly |patients? |- |CORRECT |ANSWER✔✔-Lorazepam |and |
oxazepam |because |they |have |no |active |metabolites |and |metabolism |is |minimally |affected |by |
aging
What |2 |things |do |you |never |combine |due |to |increased |risk |of |cardiac |and |respiratory |
complications? |- |CORRECT |ANSWER✔✔-IM |Olanzapine |with |benzodiazepines
Which |drugs |are |considered |first |line |in |treating |GAD? |- |CORRECT |ANSWER✔✔-Pregabalin, |
SNRI's |and |SSRI's |(all |in |combo |with |CBT)
What |is |the |recommendation |on |how |long |a |SA |benzo |should |be |used |for? |- |CORRECT |
ANSWER✔✔-ideally |less |than |4 |days
If |initiating |a |stimulant, |what |are |some |baseline |tests |that |should |be |done? |- |CORRECT |
ANSWER✔✔--BP, |HR, |height, |weight
-ECG |(if |previous |cardiac |Hx |or |strong |family |hx)
How |long |are |stimulants |typically |trialled |for? |- |CORRECT |ANSWER✔✔-3-4 |weeks
Long |acting |stimulants |vs. |short |acting |stimulants. |Which |one |do |you |trial |first? |- |CORRECT |
ANSWER✔✔-Long. |Due |to |less |rebound, |decrease |abuse |potential, |and |reduced |admin |of |med
|at |school
,Antidepressants |and |ADHD |- |CORRECT |ANSWER✔✔-AD's |are |not |first |line |for |ADHD |but |may |
be |used |in |adjunct |with |a |stimulant. |Typically |you'll |see |buproprion, |venlafaxine |or |
atomoxetine |(NRI) |used
Alpha-2-agonists |and |ADHD |- |CORRECT |ANSWER✔✔-Clonide |and |guanfacine |--> |add-on |or |
2nd/3rd |line |therapy. |Typically |these |help |with |stim. |induced |insomnia, |aggression, |impulsivity.
Clonidine |is |off |label |whereas |gunafacine |is |the |only |alpha-agonist |that |is |indicated |for |
treatment |of |ADHD
How |long |is |stimulant |therapy |typically |continued |for? |- |CORRECT |ANSWER✔✔-6-12 |months |
but |it |is |common |to |see |it |longer. |No |studies |are |currently |published |with |regards |to |long |
term |(>2 |years) |affects |of |stimulants.
Drug |Holidays |- |CORRECT |ANSWER✔✔-Common |with |stimulants. |Usually |during |summer |
months |when |kids |are |off |school. |To |re-assess |if |the |symptoms |are |still |present |and |if |the |
med. |needs |to |be |continuedt
What |are |manic |symptoms? |- |CORRECT |ANSWER✔✔-Abnormal |and |persistently |elevated |
mood |with |or |without |psychotic |symptoms. |Grandiosity. |Needs |less |sleep |then |usual. |
Increased |activity |and |or |energy
What |are |hypomanic |symptoms? |- |CORRECT |ANSWER✔✔-Same |symptoms |as |mania |but |
without |psychotic |symptoms. |(Hypomania |lacks |psychotic |symptoms)
Bipolar |1 |disorder |- |CORRECT |ANSWER✔✔-Manic |episodes |with |or |without |MDD
Bipolar |2 |disorder |- |CORRECT |ANSWER✔✔-Hypomanic |episodes |with |MDD; |with |no |history |or
|manic |episodes
,Cyclothymic |Disorder |- |CORRECT |ANSWER✔✔-Recurrent |episodes |of |hypomania |and |mild |
(subthreshold) |depressive |symptoms
When |BD |is |severe, |what |other |psychiatric |illness |does |it |resemble? |- |CORRECT |ANSWER✔✔-
Schizophrenia
What |is |extremely |important |to |determine |in |patients |with |query |BD? |- |CORRECT |
ANSWER✔✔-If |they |have |a |positive |family |history. |BD |is |largely |genetic.
On |another |note |it |is |also |important |to |see |if |the |patient |has |a |hx. |of |substance |abuse |which |
can |exacerbate |psychotic |symptoms |in |BD |1
What |baseline |tests |should |be |done |in |newly |diagnosed |BD |patients? |- |CORRECT |
ANSWER✔✔-Metabolic |tests |(lipids, |FBG, |liver |panel, |weight)
How |long |are |BD |patients |treated |for? |- |CORRECT |ANSWER✔✔-Lifelong
If |a |patient |presents |to |the |hospital |with |manic |symptoms |and |they |are |currently |on |ONLY |an |
antidepressant |to |treat |MDD, |what |should |happen? |- |CORRECT |ANSWER✔✔-Discontinue |the |
antidepressant. |In |patients |with |true |BD, |if |an |SSRI/SNRI |is |initiated, |it |can |induce |mania. |This |
is |why |we |d/c |the |antidepressant
Note: |antidepressants |can |be |used |to |treat |MDD |in |BD |patients |but |never |by |itself. |Must |be |
used |in |combination |with |a |mood |stabilizer |(i.e |lithium)
Treatments |for |BD |1 |- |CORRECT |ANSWER✔✔-1st |line: |Lithium, |divalproex |or |a |second |gen. |
antipsychotic |
Usually |patients |will |be |on |one |drug |to |start, |but |in |severe |cases |they |can |be |on |a |
combination |of |2 |first |line |therapies |(ex: |lithium |and |a |2nd |gen |AP)
, 2nd |line: |carbamazepine, |lithium |+ |divalproex
How |long |should |patients |trial |a |med |for |BD? |- |CORRECT |ANSWER✔✔-Treatment |should |be |
continued |for |a |specific |regimen |for |2 |weeks |at |therapeutic |doses |before |assessing |response
What |med's |should |be |used |to |treat |MDD |in |BD? |- |CORRECT |ANSWER✔✔-If |patient |is |not |
already |on |lithium |then |initiate |lithium. |
*Quetiapine |is |first |line |for |MDD |in |BD*
Other |options |include |lamotrigine |or |quetiapine. |Can |add |on |an |SSRI |or |buproprion |if |MDD |is |
severe |or |uncontrolled
What |does |BD |usually |present |as |in |adolescents? |- |CORRECT |ANSWER✔✔-Depression
What |is |euthymia? |- |CORRECT |ANSWER✔✔-Psychological |normality
When |discontinuing |BD |meds |- |CORRECT |ANSWER✔✔-You |need |to |taper |the |patient |off |of |
them. |Ex: |prior |to |conception |in |a |women |with |BD
Lithium |- |CORRECT |ANSWER✔✔-Patients |on |lithium |need |to |maintain |their |usual |salt |and |
caffeine |intake |and |monitor |fluid |intake. |
Lithium |can |cause |diarrhea |--> |ensure |patients |are |properly |hydrated |if |this |happens |
Single |daily |doses |of |lithium |are |preferred*
