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Old 05-20-2015
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Default Help w/ a couple of psych questions please

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Last edited by WANDOC; 06-09-2015 at 11:06 PM.
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Old 05-20-2015
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8-C, I think. Note that the patient had mania so you wouldn't expect her to be on bupropion and instead you need a mood stabilizer like Li, valproate or some antipsychotic. Convulsions and nystagmus are signs of Li toxicity. HypoNa (likely due to exercise) would increase the risk of Li toxicity.

6-E. I got this wrong (I picked C first) but turned out Benadryl can cause hypertensive crisis with MAO-I. Maybe due to it's anticholinergic properties?

http://www.webmd.com/drugs/2/drug-51.../intrtype-drug
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Old 06-05-2015
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Quote:
Originally Posted by kp1132 View Post
8-C, I think. Note that the patient had mania so you wouldn't expect her to be on bupropion and instead you need a mood stabilizer like Li, valproate or some antipsychotic. Convulsions and nystagmus are signs of Li toxicity. HypoNa (likely due to exercise) would increase the risk of Li toxicity.

6-E. I got this wrong (I picked C first) but turned out Benadryl can cause hypertensive crisis with MAO-I. Maybe due to it's anticholinergic properties?

http://www.webmd.com/drugs/2/drug-51.../intrtype-drug
I agree with all the choices made but I wanted to add for Q.8. Lithium has tendency to cause NEPHROGENIC Diabetes Insipidous which in turn leads to HYPERnatremia which might have provoked the seizure. As for Q.6 the hypertensive crisis was the result of un opposed anticholinergic activity.
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Old 06-05-2015
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6. I disagree, I did this question today, I answered C and got it correct. The patient was started on a MAOI with only 1 week of washout time for fluoxetine, which has the longest half-life of all the SSRIs. I believe this washout time was not sufficient and this patient has Serotonin Syndrome (not hypertensive crisis). Note the hyperpyrexia, in addition to increased B/P, headache, agitation.

Quoting UpToDate "selective serotonin reuptake inhibitors (SSRIs) may contribute to the development of serotonin syndrome up to several weeks after the drug has been discontinued; the half-life of fluoxetine is one week and that of its metabolite norfluoxetine is up to 2.5 weeks".
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