NBME Step 2 CK Form 7 Haloperidol (NBME Answers)

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submitted by ∗step_prep5(246)

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Key idea: Systemic steroids are associated with psychosis and this patient is receiving ACTH, which will stimulate the adrenal gland to release increased amounts of glucocorticoids/steroids, likely precipitating her psychosis (delusions, bizarre behaviors, etc.)
Alprazolam = Benzo (avoided in older patients due to risk of delirium)
Amitriptyline = TCA antidepressant (refractory depression, neuropathic pain, migraines)
Lithium = Bipolar disorder
Sertraline = SSRI (depression, PTSD, panic disorder, etc.)

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nala_ula so for NBME, 47 years is OLD?? This is vague, if they're going to make people choose between haloperidol and a benzodiazepine, shouldn't they actually make the ages in more of a spectrum? +2

lindasmith462 not sure if this is steroid induced psychosis (other than some super old paper from the 50s could find anything related to ACTH and psychosis and it actually seems to be prefered over steroid tx in MS because of lack of psychosis sx). Also benzos could be used first line for agitation/delirium/psychosis but I think its only lorazepam or midazolam? IDK I hate the NBME so much rn on this Q +

charcot_bouchard Yes. u need injection stuff for acute psychosis. I think u have the only explanation possible. Also this patient has frank psychosis not just agitation. So we need antipsych+/-antichol for this. +