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777 final review Flashcards

1
Q

Anxiety

A

Mild- narrow focus, motivational
Moderate- concentration and focus reduces, not able to see things clearly.
Severe- Cannot function, Unable to comprehend surroundings, physical sx, needs concrete directs (“sit Down, Breathe with me!)
Panic-emergency-medication intervention

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2
Q

ANXIETY AGENTS (BENZODIAZAPINE)

A 
Xanax 
Librium 
Valium 
Ativan
Klonopin
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3
Q

ANXIETY AGENTS (BENZODIAZAPINE)

A 
TARGET SYMPTOMS 
Agitation 
Severe anxiety 
Fears, phobias 
Alcohol withdrawal 
Panic disorder
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4
Q

ANXIETY AGENTS (BENZODIAZAPINE)

A 
SIDE EFFECTS 
Drowsiness 
Dizziness 
Dependence/tolerance 
Toxicity increases with alcohol use 
Hypotension 
Slurred speech
Decreased concentration
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5
Q

SUICIDE

A

Statistics:

High in men, 50 years and older, with high stress such as divorce or loss of job and

Suicide is one of the leading causes of death in adolescents and the elderly

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6
Q

SUICIDE ASSESSMENT

A 
Depressed mood?
Low self esteem?
Hopelessness, Helpless?
Guilt?
Specific intent or plan?
Realistic?
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7
Q

SUICIDE Assess suicide potential?

A

Method or means – May people who are n similar situations to you think about not wanting to live…Has that ever happened to you?“ Have you thought about taking your life?”
Specificity - “Do you have specific plan?“
Availability-“Do you have the means available?”
Assess suicide potentiel…protective fx
Lethality?
High risk factors: depression; past suicide attempts; drug abuseisolation/withdrawal; disoriented/disorganized; hostility

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8
Q

Psychosis

A

PSYCHOSIS: symptom state that refers to the presence of reality misinterpretations, disorganized thinking, and lack of awareness regarding true and false reality.

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9
Q

Psychotic Disorders

A

Schizophrenia spectrum and other psychotic disorders:
Schizophrenia
Other psychotic disorders
Schizotypal (personality) disorder

Defined by abnormalities in 1 of the following 5 domains
Delusions
Hallucinations
Disorganized thinking
Grossly disorganized or abnormal motor behavior, including catatonia
Negative symptoms

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10
Q

SCHIZOPHRENIA spectrum

A

Signs and symptoms:
Mood- anxiety, poor self-esteem,
Affect - flat or inappropriate,
Thought - loose associations, delusions, hallucinations, ideas of reference, neologisms, word salad, echolalia
Behavior – isolation, withdrawal, poor level of functioning

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11
Q

SCHIZOPHRENIA spectrum

A

Positive Symptoms: bizarre behavior
hallucinations, delusions, loose
associations, disorganized thinking

Negative Symptoms: depression
slowed thought, poor spontaneity
flat affect, loss of drive apathy

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12
Q

First Generation Antipsychotic meds

A

Thorazine
Haldol (deconate)
Navane
Prolixin (deconate)

Dopamine blocker
No antidepressant effect
Less weight gain, cheaper, musculoskeletal side effects, TD, EPS

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13
Q

Second generation MEDICATIONS

A 
Risperdal   (Consta)
 Seroquel
 Abilify  (Maintena)
 Zyprexa
 Geodon
 *Less side affect profile - safer drugs
 Metabolic Sx- Diabetes
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14
Q

ANTIPSYCHOTIC Meds (Anticholinergic Side Effects)

A 
Drowsiness
Hypotension
Dry mouth
Blurry vision
Constipation
Decreased urination
Photosensitivity
Weight gain
Amenorrhea
Inhibits sexual desire and performance
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15
Q

MEDICATIONS

A

Antipsychotic
Clozaril
↓ WBC
Agranulocytosis

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16
Q

ANTIPSYCHOTIC SIDE EFFECTS

A

Extrapyramidal:
Pseudo-parkinsonism – tremors, mask like face, drooling
dystonia (muscle spasm)
akathisia (motor restlessness)
tardive dyskinesia (sometimes irreversible, abnormal, involuntary movements)

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17
Q

NEUROLEPTIC MALIGNANT SYNDROME (NMS)

A 
Rigidity
Hyperthermia
Elevated CPK
Changes in levels of consciousness
Hyperthermia
Tachycardia
Diaphoresis
Elevated white count
Tachypnea
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18
Q

Anti-Parkinson Medications (Cogentin, Artane, Benadryl)

A 
Treats:
Rigidity, stiffness 
Restlessness (akathisisa)
Tremor
Muscle spasm in face, neck, back (dystonia)
Motor retardation (akinesia)
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19
Q

SIDE EFFECTS OF ANTIPARKINSON Medication

A 
Dry mouth
Blurry vision
Constipation
Decreased urination
Confusion
Agitation
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20
Q

MEDICATIONS

A

Anti Anxiety - Benzodiazapine

Valium
Librium
Xanax
Klonopin
Ativan

Addictive
Sedating

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21
Q

PERSONALITY DISORDERS , ANTISOCIAL

A 
Inability to delay gratification 
Inability to conform to norms of society
Seeks pleasure
Lacks satisfying, fulfilling, interpersonal   relationships 
Lacks capacity for concern over others
Does not feel guilt
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22
Q

PERSONALITY DISORDERS , BORDERLINE

A 
Physically self-damaging acts
Unstable affect
Chronic feeling of emptiness boredom
Lack of tolerance for being alone
Intense, unstable relationships
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23
Q

Substance Use Disorder (SUDs)

A
  1. Failure to fulfill major role obligations
  2. Physically hazardous situations of use
  3. Social and interpersonal problems
  4. Cravings
  5. Tolerance
  6. Withdrawal
  7. Larger amounts/longer time period
  8. Desire to cut down/control use
  9. Great amount of time spent to obtain/use/recover
  10. Activities given up
  11. Psycholgoical/physical problems
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24
Q

Substance Use D/Os:

A

Substance-Use D/Os: Use and Induced (10 separate)
1. Alcohol-Use D/Os
2. Caffeine-Use D/Os
3. Cannabis-Use D/Os
4. Hallucinogen- Use D/Os
5. Inhalant-Use D/Os
6. Opioid-Use D/Os
7. Sedative-, Hypnotic-, and Anxiolytic-Use D/Os
8. Stimulant-use D/Os (amphetamine & cocaine use D/O)
9. Tobacco –use D/Os 10. Other (or Unknown) Substance-Related Disorders
Non-Substance-Related D/O (includes one disorder)
Gambling Disorder

25
Q

Psychoactive Substances

A 
Alcohol
Anxiolytics
Amphetamines
Caffeine
Cannabis
Cocaine
inhalants
Hallucinogens
Inhalants
Nicotine
Opioids
Phencyclidine (PCP)
Sedatives, hypnotics and anxiolytics
26
Q

SUBSTANCE USE D/O

A

Alcohol Use D/O

Pathological use that interferes with family, social life, work, health. Addiction is demonstrated by tolerance or withdrawal

27
Q

Alcohol USE D/O

A

Symptoms of alcoholic type drinking

Obsessed with getting the drug
Increased or decreased tolerance
Gulping drinks, Blackouts
Drinks alone
Use as a medicine
Drink or drug more than planned
28
Q

ALCOHOL WITHDRAWAL

A

Observe for physical illness or withdrawal:
Occurs 6-48 hours after last drink.
Signs of withdrawal:
8-24 hours after last drink: anxiety, nervousness, irritability, mild tachycardia, hypertension, flushed face, GI upset, insomnia, lasts 48 hours or longer

29
Q

ALCOHOL WITHDRAWAL

A

Alcoholic hallucinosis - 12-48 hours after stopping alcohol
Three to five days- DT’s - agitation, diaphoresis, temp above 100, increased pulse and B/P, dilated pupils, muscle spasm, frightening hallucinations, confusion, disorientation, convulsions, coma, death

30
Q

ALCOHOL WITHDRAWAL

A

Administer librium or a similar drug (any other anti-anxiety minor tranquillizer) in decreasing amounts
Replace fluid and electrolytes, full diet, thiamine for alcoholics
Lighted room to prevent shadows and perceptual disturbances- well controlled, safe environment

31
Q

Naltrexone

A

1st line…Opioid receptor blocker; cuts back craving and ‘reward’ of use
Side effects: Nausea, vomiting, decreased appetite, dizziness. Injection site (if using depot formulation)
Cons: will precipitate withdrawal in those with physiologic dependence on opioids

32
Q

Disulfiram

A

great for patients with incredible adherence
Blocks aldehyde dehydrogenase, blocks breakdown of alcohol
With alcohol: flushing, headache, nausea/vomiting, palpitations, shortness of breath
Without alcohol: liver failure, metallic taste, neuropathy
*Must watch LFT’s!
AVOID in: Pregnancy, psychosis, severe heart disease

33
Q

Topiramate

A

consider in pts on opioids or who cannot tolerate disulfiram
Potentiates GABA, inhibits glutamate. May reduce cravings Side effects: sedation, decreased appetite, weight loss, dizziness, tremor
Caution in renal disease

34
Q

Opioids (Heroin, Morphine Oxycontin, Percocet)

A

Opium, opium derivatives and synthetic substitutes
Sedative/analgesic effect
Relief of pain, diarrhea, and cough relief
Tolerance and physiological and psychological dependence
Induce euphoria, lethargy and indifference to the environment

35
Q

Opiate withdrawal

A

anxiety, muscle twitches, hot & cold flashes, restlessness, lacrimation, rhinorrhea, dilated pupils, mild hypertension, yawning, piloerection, perspiration, abdominal cramps-10-15 hours after last use - vomiting, diarrhea, tremors last several days

36
Q

Withdrawal from Opiates

A

yawning, rhinorrhea, piloerection, perspiration, lacrimation, mydriasis, tremors (hands), hot & cold flashes (shivering/huddling for warmth), restlessness, vomiting, muscle twitches, diarrhea, abdominal cramps (holding stomach/curled up position), anxiety (range: mild-severe)

37
Q

Naltrexone forOpioid Use Disorder

A

Most ideal pharmacologic treatment

Requires detoxification before initiation or severe withdrawal will be precipitated

Risk of OD if medication stopped

In general poor patient compliance (? Better with long-acting injection) but superb treatment for selected patients

38
Q

Opioid MAT Tx

A

MEDICATIONS - Opioids

Methadone

Buprenorphine

39
Q

Methadone Pharmacokineticsand Dosing

A 
Rapidly absorbed
Peak Levels in 4 hours
t1/2 (half life) =24 hours
Metabolized in liver (p450 3A/4)
Doses should be individualized but higher doses generally more effective (≈80-120mg)
40
Q

Buprenorphine

A 
Poor oral bioavailability (give s/l)
Slow onset
Long duration
Slow offset
24- hour half life
41
Q

Cocaine/ Amphetamines

A

Activity while intoxcated – mimics mania – hyperactivity, wt loss, hypersexuality

Withdrawal symptoms are depression, anxiety, hypersomnia, anergia, wt gain, paranoia

May treat with antidepressants

42
Q

SUBSTANCE USE

A

LSD - makes time pass slowly, causes sounds in color, vivid hallucinations.
PCP - violence, antisocial behavior, hypertension

43
Q

Nicotine - Benefits of Stopping

A 
Live longer
Reduce CV risk after MI by > 1/3 over 5 years
Reduce cancer risk
Improve lung function
Reduce risk of infections
Decreased risk for DMII
Reduce risk of hip fractures
Decrease reproductive disorders
Etc.

Smoking reduction vs cessation?
Maybe helpful for heavy smokers-controversial
Smokers often compensate-longer puffs, etc.

44
Q

Varenicline (Chantix)

A

A4B2 nicotinic cholinergic receptor (nAChR) partial agonist
Mimics the action of nicotine & prevents withdrawal symptoms
Side effects: GI upset, psychiatric changes

45
Q

Bupropion (zyban)

A

Antidepressant that is also a partial agonist at nAChR and inhibitor of dopamine reuptake
Helps reduce withdrawal symptoms.
Tremor, anxiety.

46
Q

Nicotine Replacement (gum, lozenge, inhaler, patch)

A

Replaces nicotine, without additives of tobacco. Often used as a combination of patch (long acting ‘basal’ nicotine level) and gum or lozenge for break through cravings.
Anxiety, restlessness, GI upset, tremor, sleep disturbance

47
Q

SUBSTANCE USE

A

Other substances:
Inhalants- affects lungs & liver
Cocaine - Red excoriated nostrils – manic like behavior
Barbiturate abuse - sluggish, ataxia, irritability, seizures.

48
Q

12 step/Alcoholics Anonymous (AA)

A

A support group for alcoholics
Al-Anon and Al-Ateen are groups for spouses, parents, and teenagers who are involved with alcoholics.
The focus is on helping these non-alcoholics learn to live and work effectively with alcoholics. The underlying belief is that family members often assume the role of enablers or co-alcoholics, perpetuating the alcoholic’s drinking patterns.
As the family attempts to adjust to the alcoholic’s lifestyle, they develop behavioral and emotional problems. Protected by the enabler, the alcoholic is spared the consequences of his or her alcoholism. The alcoholic blames he enabler and the enabler feels guilty and attempts to control family life and the behaviors of the alcoholic, e.g., throwing out liquor, taking the car keys. This does not work. Consequently, enablers feel worthless and helpless because they are unsuccessful in terminating the alcoholism.
NA is Narcotics Anonymous
12 Steps of AA

49
Q

Cognitive Disorders

A 
Delirium	
Acute and reversible 	 
Sudden onset	
Signs and Symptoms:	
Disorientation- speech incoherent 
Clouding of consciousness 	 
Impaired judgment, memory 	
Perceptual impairment- illusions, hallucinations, misinterpretation
50
Q

Dementia

A

Chronic and irreversible
Insidious onset
death of neurons

Associated Symptoms:

a. Anxiety-Depression
b. Irritability
c. Shame
d. Decreased control over sexual and aggressive impulses

51
Q

Dementia

A 
Impairment in: abstract thinking, judgment,  impulse control and social conduct
Behavior is uninhibited, inappropriate
Personal hygiene is neglected
Language may or may not be affected
aphasia

Personality changes are common
For the most part dementia is PROGRESSIVE, it does not resolve, except in rare instances
Apraxia
Mood is irritable
Difficult comprehending their limitations

52
Q

Dementia Tx

A

Support medical treatment and physical status
Provide for adequate nutrition, fluids, rest
Maintain safety factors (lighting, etc)
Foster optimum functioning and independence
Assist with or limit the need to make choice
Use matter of fact attitude with deficits and deterioration - focus on strengths

53
Q

Eating Disorders

A

Anorexia (hunger is denied yet there are constant thoughts of food) with weight loss of 25% of total body weight
Distorted attitude toward eating, food, or weight (almost to the point of being delusional)

54
Q

ANOREXIA - symptoms

A 
Calorie restriction
Bulimia - binging 
Lanugo (fine, downy hair covering body) 
Amenorrhea and sexual organ atrophy
Overactivity
Bradycardia
Vomiting after meals (patient feels guilty that she ate) 
Use of laxatives
55
Q

Bulima

A 
Client- Normal or overweight
Binge eating 
High calorie High Sugar food
May be followed by “Purging”
Purging- vomiting, enemas, laxatives

Client may have gastric or dental sx evidence of disorder

Client tends to hide the binge eating.

Termination of a binge because of abdominal pain, onset of sleep, interruption by others or self-induced vomiting.

56
Q

Binge-Eating Disorder

A

Eating much more rapidly than normal.
Eating until feeling uncomfortably full.
Eating large amounts of food when not feeling physically hungry.
Eating alone because of feeling embarrassed by how much one is eating.
Feeling disgusted with oneself, depressed, or very guilty afterward.
Marked distress regarding binge eating is present.

57
Q

Attention Deficit Hyperactivity Disorder

A

Persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development
Hyperactive-impulsive type
Inattentive type
Combined type

58
Q

Epidemiology

A

5% of children, 2.5% of adults
Most frequent psychiatric disorder in childhood
Most cultures
More frequent in males by 2:1 ratio in children and 1.6:1 in adults
Females more likely to have inattentive features

59
Q

Diagnostic Features

A

Persistent pattern of inattention and/or hyperactivity-impulsivity
Interferes with functioning or development
Begins in childhood
Manifestations of the disorder present in more than one setting
Symptoms vary depending on setting

777 (10 decks)

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