777 final review Flashcards

Question

Psychoactive Substances

Answer 1

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

Answer 2

Alcohol Use D/O Pathological use that interferes with family, social life, work, health. Addiction is demonstrated by tolerance or withdrawal

Answer 3

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 ```

Answer 4

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

Answer 5

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

Answer 6

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

Answer 7

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

Answer 8

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

Answer 9

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

Answer 10

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

Answer 11

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

Answer 12

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)

Answer 13

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

Answer 14

MEDICATIONS - Opioids Methadone Buprenorphine

Answer 15

``` 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) ```

Answer 16

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

Answer 17

Activity while intoxcated – mimics mania – hyperactivity, wt loss, hypersexuality Withdrawal symptoms are depression, anxiety, hypersomnia, anergia, wt gain, paranoia May treat with antidepressants

Answer 18

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

Answer 19

``` 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.

Answer 20

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

Answer 21

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

Answer 22

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

Answer 23

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

Answer 24

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

Answer 25

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

Answer 26

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

Answer 27

``` 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

Answer 28

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

Answer 29

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)

Answer 30

``` 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 ```

Answer 31

``` 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.

Answer 32

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.

Answer 33

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

Answer 34

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

Answer 35

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