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Clin Medicine > Behav 2 Pharm > Flashcards

Behav 2 Pharm Flashcards

1
Q

Dementia

A

Ok

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2
Q

Central ache inhibitors

A

Tacrine, donepezil, rivastigmine, galantamine, memantine,

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3
Q

Tacrine

A

• High incidence of hepatotoxicity, newer agents are preferred (no longer used clinically

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4
Q

Addiction vs physical dependency

A

Physical dependence and tolerance are normal physiologic adaptations
-cant diagnose addiction

Addiction-primary chronic disease of brain reward, motivation, memory and related circuitry so get biological, psychological and behavioral dysfunction

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5
Q

Tolerance and physiological dependence , pain relief ,

A

Misinterpreted as drug seeking or relapse behavior

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6
Q

Reward defiency syndrome

A

Dopamine system malfunction

Common pathway for addictive behavior

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7
Q

Addiction genetic

A

Yes but also environmental

Non substance specific

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8
Q

Addictophrenia model

A

Assess disease risk severity

Type I alcoholism-mean Nd women need genetic and env predisposition later in life, mild or severe

Type II-sons of male alcoholics, genetic not env, start adolescence , associated with criminal

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9
Q

Addictophrenia type I

A

Genetic history of addictive disorder-alc
Genetic history of mood disorder
Higher incidence of comorbid mood disorder

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10
Q

Type Ii

A

Genetic history of addictive disorder-mixed substance and non
Genetic history of personality disorder or criminal behavior
Higher incidence of criminal behavior, risk taking and gambling

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11
Q

Type II

A

Genetic history of addictive disorder-not a prerequisite, but increases vulnerability

Significant history of trauma-predominantly alchol and benzodiazepine use

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12
Q

Addictophrenia type IV

A

Genetic history of addictive disorder-not prerequisite but increases vulnerability

Chronic use of high dose drugs known to cause severe physical dependency

High associated with presence of severe psychosocial stressors

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13
Q

Diagnose addictophrenia

A

Overlaps

Rate scal one to ten one ach category

Predict degree of susceptibility and assist in counseling and treatment planning

Validity and reliability has not been tested

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14
Q

Do ppl die when addicted

A

Yes. Fifty percent have comorbid psychiatric disorder

-antisocial PD, depression, suicide

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15
Q

Substance use disorder

A

Using larger amounts for longer

Desire or unsuccessful attempts to cut down or control use

Great deal of time obtaining, using or recovering

Crave, cant fulfill roles, social and interpersonal problems

Stop doing things , tolerance, withdrawal, physical hazard situations

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16
Q

Mild substance use

A

Two to three symptoms

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17
Q

Moderate substance use

A

Four to five symptoms

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18
Q

Severe substance use

A

Six or more symptoms

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19
Q

Early remission

A

No criteria except craving for over three months but less than twelve

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20
Q

Sustained remission

A

No criteria for over twelve months except craving

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21
Q

What is substance abuse mental disorder

A

Symptom of mental disorder

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22
Q

How identify substance abuse mental disorder

A

Developed one month of substance intoxication or withdraw of med

Involved the substance/med is capable of producing the mental disorder

Not better explained by independent mental disorder (preceded substance, mental disorder stay long after substance gone one month)

Not only in delirium

Distress

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23
Q

Intoxication doe snot apply to what

A

Tobacco

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24
Q

What has no withdrawal

A

PCP, inhalants, hallucinogens

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25
Q

Neuroadaptation

A

CNS changes following repeated use such that person develops tolerance and/or withdrawal

-

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26
Q

Pharmacokinetic neuroadaptation

A

Adaptation of metabolizing system

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27
Q

Pharmacodynamic neuroadaptation

A

Ability of cns to function despite high blood levels

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28
Q

Tolerance

A

Increase amount to get effect or decrease effect same amount

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29
Q

Hospital for withdrawa

A

Overdose, severe , , suicide, medical comorbidities

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30
Q

Residential withdrawal

A

No monitoring, restricted env, partial hospitalization

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31
Q

Outpatient withdrawal

A

No risk and highly motivated

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32
Q

Motivational interventions for withdrawal

A

Family, relapse prevention, twelve step, alcohol anonymous, CBT< narcotics anonymous

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33
Q

Do a lot of ppl have more than one psychiatric disorder

A

Yes. Fifty percent

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34
Q

Alcohol intoxication level

A

.08

Fatal if get to airway issue and cns depression, pulmonary aspiration

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35
Q

Early alcohol withdrawal

A

Anxiety, irritability, htn, hyperthermia, tachycardia, nausea

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36
Q

Seizures alcohol withdrawal

A

Twenty four to fort with

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37
Q

Delirium tremendous

A

Forty eight to seventy two
Three to ten days after
Agitation, confusion, disoriented, fever, HTN, diaphoresis, autonomic hyperactive ,
Hallucinations, autonomic instability, life threatening

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38
Q

Hallmark of delirium tremendous

A

Profound global confusion

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39
Q

Chronic intake alcohol

A

Increased opiates, activate GABA A producing GABA inhibition, influx cl, impregnate NMDA which mediates glutamate and interacts with serotonin and dopamine receptors

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40
Q

Withdrawal alcohol

A

Loss gaba a receptor stimulation causes reduce cl cause tremors, diaphoresis, tachycardia, anxiety, seizures,

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41
Q

Inhibits NMDA receptos

A

Seizures, delirium

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42
Q

CIWA

A

Numerical value to symptoms with points

> ten severe withdrawal

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43
Q

Treat withdrawal alcohol

A

Benzodiazepines GABA agonist

Anticonvulsants for seizure risk -carbamazepine or valproic acid

Thiamine supp

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44
Q

Meds for staying off alc

A

Disulfiram, naltrexone, acamprosate

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45
Q

Disulfiram

A

No work more harm than good

Inhibits aldehyde DH

Can cause death if alcohol given
Psychiatric AE, dermatological rashes, polyneuropathy, hepatotoxicity

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46
Q

Naltrexone

A

Opioid antagonist

Check LFT

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47
Q

Acamprosate

A

Unknown moa check kidney function

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48
Q

Benzodiazepine

A

Similar to alc but less cognitive impaired

More lipophilic shorted action

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49
Q

Withdrawal benzodiazepines

A

Similar to alcohol can get from tapering too fast

Sconvert short to long half life then slowly taper

Decrease does every week or two

If rapid give valproic acid or carbamazepine

Or gabapentin and tizanidine

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50
Q

Opioid intoxication

A

Pinpoint pupils, constipation, bradycardia, hypotension, decreased rr

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51
Q

Withdrawal opioids

A

Not life threatening unless severe medical illlness but uncomfortable, dilated pupils lacrimation, goosebumps, nv

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52
Q

Treat opioid with

A

Anti-emetic, antacids, NSAIDS< BZd

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53
Q

Treat

A

Support education, skills, methadone, naltrexone, buprenorphine

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54
Q

Methadone

A

From methadone assisted treatment program

Oral

High risk deadly when used with benzodiazepine, or 3a4 substrate

Mu agonist

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55
Q

What do if not MAT and in er for pain

A

Call service at methadone clinic then give dose

If need mroe dont use another 3a4 substrate

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56
Q

Naltrexone

A

Opioid blocker, mu antagonist

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57
Q

Buprenorphine

A

Partial mu agonist

Need to take ASAM course to give prescription

If highly motivated

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58
Q

Stimulate acute intox

A

Euphorias, vigor, gregariousness, hyperactivity, restlessness, interpersonal sensitivity, anxiety tension, anger, impaired judgement,

Tachycardia HTN NV

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59
Q

Chronic stimulant

A

Blunting, fatigue, sadness, withdrawal hypotension bradycardia

Psychosis

Withdrawal suicide risk and depression

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60
Q

Cocaine

A

CVA and MI get EKG

Rhabdomyolysis with compartment syndrome

Neuroadaptation prevent reuptake of DA

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61
Q

Amphetamine

A

Neurotoxicity from chronic from glutamate and axonal degeneration

Fatal in brugada syndrome

Psychosis

Neuroadaptation inhibits reuptake of da, ne, se, mainly da

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62
Q

Tobacco

A

CYP1a2 induced

Stop olanzapine
No intoxication diagnosis

Neuroadaptation-nicotine acetylcholine receptors on da neurons in ventral tegmental area release da in nucleus accumbens

Rapid tolerance

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63
Q

Withdrawal tobacco

A

Dysphagia, irritability, anxiety, decreased conc, insomnia, increased appetite

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64
Q

Med tobacco

A

Bupropion

Varenicline

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65
Q

Hallucinogens

A

Natural peyote

Synthetic LSDD

DMT, STP, MDMA,

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66
Q

MDMA

A

Enhanced empathy, personal insight, euphoria, increased energy,

Illusions, hyperacusis, sensitivity to touch, taste/smell altered,

Tolerance quick and teeth grinding if continue use

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67
Q

Fever MDMA

A

HIHGH up to forty three

Tachycardia, sweating, muscle spasms

Rhabdomyolysis, renal failure, seizures, DIC, arrhythmia, death

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68
Q

Neuroadaptation mdma

A

Serotonin, da, ne, but mainly 5HT2 agonist

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69
Q

Psychosis mdma

A

Hallucinations, paranoid, serotonin neural injury

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70
Q

Withdrawal mdma

A

Unclear

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71
Q

Cannabis

A

Increase appetite, tachycardia, panic, psychosis, color sound taste change, relaxation

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72
Q

Neuroadaptation

A

Cb1 cb2 receptors coupled with G protein and AC to Ca channel inhibiting calcium influx

Decrease uptake gaba and da

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73
Q

Who has high risk psychosis cannabis

A

MALES

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74
Q

Withdrawal cannabis

A

Insomnia, irritability, anxiety, poor appetite, expression,

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75
Q

Treat cannabis

A

Detox, behavioral model, no pharmacological treatment

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76
Q

PCP

A

Vertical nystagmus and horizontal

Severe dissociative reactions

HTN

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77
Q

Treat pcp

A

Antipsychotic drugs or BZd

Low stimulation env

Acidity urine

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78
Q

Neuroadaptation pcp

A

Opiate receptor effects
Allosteric modulator of glutamate NMDA receptor

No tolerance or withdrawal

79
Q

Adhd

A

Ok

80
Q

Increasing ADHD

A

Increasing awareness and access to services

81
Q

Comorbid ADHD

A

Mood disorders, anxiety, substance disorders, explosive,

82
Q

Tourettes is associated with what

A

OCD and ADHD

83
Q

Tourettes triad

A

TS, ADHD, OCD

84
Q

Chronic tic disorder

A

Higher in ADHD

85
Q

ADHD suicide

A

Yes up

86
Q

What is executive function

A

Information processing dysfunction within prefrontal cortex

Defiency of dopamine and NE

87
Q

What area of the rain is dysfunction in ADHD

A

Dorsal anterior midcingulate cortex

88
Q

What regions of brain have decreased activation in patients with adhd

A

Right inferior prefrontal cortex
Supplementary motor area
Anterior cingulate cortex
Left caudate into putamen and insula and right mid thalamus

89
Q

Attention tastes

A

Decreased activation right dorsolateral prefrontal cortex, left putamen and globus pallidus, right posterior thalamus, caudate tail , right inferior parietal lobe, precuneus and superior temporal lobe,

90
Q

Attention task increased activation

A

Left cuneus and right cerebellum

91
Q

DSM-V diagnostic criteria for ADHD

A

Children still should have six or more symptoms

17 and up at least 5

92
Q

Inattentative ADHD

A

Can’t give close attention and sustaining attention, not listening, avoids thinking, distracted

93
Q

Hyperacute type ADHD

A

Fidgets, cant stay still, driven by a motor, talks a lot, blurts out answers, cant wait

94
Q

What history get ADHD

A 
History of disease
Developmental history
Medical history
Family history
Screen for comorbid disorders
95
Q

TOVA

A

Test of variables of attention

Test is shorter in kids

96
Q

Conners continuous performance test

A

Task oriented computerized assessment of attention related problems in 8 and older

Related to attention

97
Q

How give conners continuous performance test

A

15 min computer test

98
Q

Conners adult adhd rating scales

A

Correlates with the measures believed to measure related constructs

99
Q

Treat adhd

A

Don’t yell or cticize less harsh parenting

100
Q

Treat med 4-5

A

Methylphenidate if behavior therapy no work

101
Q

Treat adhd 6-11

A

Stimulant and BHT

102
Q

Treat adhd 12-18

A

BHT and med

103
Q

12-18

A

Get assent from adolescent BHT and med

104
Q

Alternative to stimulant for adhd

A

Guanfacine and clonidine

A2 adrenergic agonists

105
Q

Bupropion

A

Antidepressant with catecholamines gif effects

Increase seizure but lack abuse liability, single daily dosing, and efficacy for co occurring anxiety and depression

106
Q

Atomoxetine

A

Inhibits presynaptic ne reuptake resulting in increased synaptic NE and DA

Long QT
Caution with CVD

107
Q

Modafinil

A

Binds da transporter, inhibiting reuptake

Dermatological and psychiatric reactions

108
Q

Methylphenidate

A

Reuptake inhibitor of da

109
Q

Amphetamine

A

Reuptake inhibitor of catecholamines and releases

110
Q

Why methylphenidate good

A

Betwe CPT response, Bette with tourettes, visuomotor disorder, less anorexia and sleep delay not there

111
Q

Advantages to amphetamine

A

More consistent response day to day
Higher proportion of patients with good/excellent response
Better with comorbid conduction disorder/oppositional defiant
Less depression/apathy
Fewer stomachaches
May be better with higher

112
Q

Integration

A

Happening!

113
Q

What is integrated care

A

Systematic coordination of general and behavioral healthcare

Substance abuse and mental health and primary are

114
Q

Team based care

A

At least 2 providers who work with patient and their caregivers

115
Q

Behavioral health

A

Behavioral factors in medical care -mental health, lifestyle

116
Q

3 factors driving the integrated healthcare movement

A

Hig prevelance of behavioral health conditions in primary care

Most behavioral health conditions remain undetected and untreated

Cost of untreated behavioral health conditions is exorbitant

Poor follow through on referrals to outside speciality

Poor health outcome when compared ot other wealthy country’s-excessive expenditure, policy changes, disparities, provider burnout,

117
Q

Benefits of integrated care

A

Improved experience, outcomes, expenditures, satisfaction

118
Q

Triple aim

A

Framework for an approach to optimizing health system performance. New design must be developed to simultaneously pursue
1. Improving patient experience, improving health of populations, reducing per capita cost

119
Q

Triple aim

A

Population health, experience, per capita cost

120
Q

Provider burn out

A

Less likely with BHC get improved job satisfaction, can address behavior, more likely to continue able to see more patients in 20, recognize behavior

121
Q

Quadruple aim

A

Reduce care costs, satisfied patients, improved population health, satisfied providers

122
Q

Interprofessional education

A

When 2 or more professions learn from , about and with each other

123
Q

Interprofessional education

A

Core curriculum prepares us to function collaboratively on health care teams by making each year of curriculum, to learn in academic and/or clinical environments that permit interaction with students enrolled in other profession

124
Q

PCBH

A

Improves access rates

125
Q

Primary care behavioral health SH

A

SHARES MANY COMMON AIMS AND FEATURES OF PATIENT CENTERED MEDICAL HOMES AND WHOLE PERSON CARE

RECOGNITION OF ASSISTANCE FOR OVERBURDENED PRIMARY CARE PROVIDERES AND SYSTEMS

GENERALIST AND POPULATION-HEALTH BASED MODEL

126
Q

DESCRIBE WHAT AN EFECTIVE FULLY INTEGRATED ARE TEAM LOOKS LIKE

A

Shared treatment space

Systemspathways: shared care provision, medical records

Type of collaboration: full and reciprocal

Composition-entire clinic staff
————approach/function
-hudDlEs before clinic

Treatment plans: shared and mutually supported
-scope of problems targeted (targeted vs. non targeted)

127
Q

Describe what an effective fully integrated care team looks like

A

Allows for immediate warm hands off

PCP retains full responsibility for the patient and possesses the final decision makeing authority for patients

128
Q

Explain four functions that a behavioral health consultant can provide to assist a physician in his or or her day to day practice

A

Assessment, education, brief intervention, referral, warm hands off, chronic illness, mental health disorders, prevention, quality improvement, early intervention, stress mediated disease/symptoms, chronic pain management program chronic care registries, SUBSTANCE MISUSE. IMPROVED COMMUNICATION BETWEEN PROVIDER AND PATIENTS

129
Q

BHC chronic medical conditions

A

HA, insomnia, HTN, asthma, diabetes, obesity, chronic pain

130
Q

Lifestyle modifications BHC

A

Tobacco, cessation , weight, alcohol misuse, nonadherence, PA

131
Q

Areas commonly addressed by BHC

A

Depression, GENERALISTS PERSPECtIVE, anxiety

132
Q

Motivational interviewing

A

Helps ambivalence

-mixed feelings; feeling two ways about something; desire to do two opposing or conflict things

133
Q

Biopsychosocial

A

A patien resists colonoscopy , patients asthma and co occurring depression get worse despite evidence based treatment , dying patient in unwilling to let go of interventions, even thought he acknowledges that they are futile

134
Q

How BHC help

A

Prioritize concerns and clarify issues, address stresss, lifestyle and cultural and family variables related to. Sleep

-connect patient with social work, increase disease self management

Education about condition

Help prioritize concerns,

135
Q

What area surrounds broca, wernicke, and arcuate fasciculus

A

Mediation also system for language, including a number or areas int her temporal, parietal and frontal association areas. This relays information to the language implementation system from the third system in language production

136
Q

Conceptual system of language

A

Broadly distributed set of structures that provides the concepts underlying our language.

137
Q

0-6 months

A

Language universalists recognize all sounds that might be language as distinct sounds

138
Q

6-9 mo

A

Brains change and start to recognize the specific language sounds of their native language. Drop use of phenomena that dont occur in their language

139
Q

When language complete/the language acquisition pathway

A

1 year

Babbling converted to language

140
Q

Second language learned during language acquisition phase

A

Activates adjacent region of brocabut same pathway as first language

141
Q

What is social cognition

A

Function in interpersonal and social situations

Emotion comrpeshension and theory of mind

142
Q

Social cognition

A

Ability to infer emotional state of another from observable information such as prosody and facial expression

143
Q

Emotion comprehension

A

Neural circuits for recognizing emotion in others are also involved in producing that emotion in ourselves

144
Q

Steps one through threeemotional compression

A

Perception of facial expressions requires that we identify a face as something

Bring in the emotional component
-same circuit recognizes it in someone else bc facial details that cue us as to what emotion we are seeing in another person are concentrated in very specific areas in a triangle of eyes, nose mouth! (Normal person gaze scans another persons face in a triangle eyes to mouth)

145
Q

The __ controls the use of the eyes and directs the gaze to that triangle (particularly the eyes) when looking at human faces

A

Amygdala

146
Q

How see face if damage to amygdala

A

Spends little time looking at the eyes of another and doesnt methodically scan face

147
Q

Mirror neuron system

A

Mirror neurons fire both when do something (smile) and see someone else do same

Imitative learning

148
Q

Anterior mirror system

A

Identifies the goal of the action

149
Q

Posterior mirror neuron system

A

Identifies the motor actions

150
Q

Posterior sector of the superior temporal sulcus

A

Provides the visual input

151
Q

Imitative behavior is crucial to developing social cognitive skills=we tend to imitate emotional state/behavior as well as motor behavior. The circuit for imitating is believed to interact with Limbic structures via the _

A

Insula

152
Q

Prosody

A

Study of the tine and rhythm of speech and how these features contribute to meaning. Study of aspects of speech that typically apply to a level above that of the individual phoneme and very often to sequences of words )prosodic phrase)

153
Q

Steps of prosody

A
  1. Primary auditory cortex is required for the basics of sound processing, including identity of pitch, loudness, and other characteristics of the sound
  2. That information is then sent to the right posterior superior temporal sulcus where, along with other acoustical information rom secondary auditory processes, we begin to piece together the meaning of the loudness, pitch, etc of the focalization
  3. Perception of prosody

The judgement of the emotional stimulus is then determined int he frontal cortex

154
Q

Theory of mind

A

Ability to understand the mental states of others and to appreciate how these differ from our own

155
Q

Core pathway of theory of mind

A

Amygdala and connections to the medial temporal lobes and orbitofrontal areas

156
Q

Decision making: stimulus encoding system

A

Orbitofrontal cortex

Ventromedial prefrontal cortex

Striatum

157
Q

Action selection system

A

Anterior cingulate cortex

Learns and encodes the subjective value of the results.
Error detection

158
Q

Expected reward system: predicts expected reward

A

Basal ganglia
Amygdala
Insular cortex-Processing of social emotions

Intraparietal cortex-somatosensory processing and planning/intent

159
Q

A decision in which the risks are explicit relies most heavily on the

A

Stimulus encoding system

160
Q

Ambiguous risk decisions in which the risks are unknown rely most heavily ont he _

A

Expected reward system and eventually the action selection system

161
Q

Neurophysiology of Limbic system

A

Ok

162
Q

Limbic system

A

Fighting, feeling, feeding, fleeing, fucking

Emotion and motivational drives

163
Q

Hypothalamus

A

Physiological responses connection to ANS

164
Q

Olfactory areas

A

Olfaction and emotion strongly linked

Parts of Limbic system deal with olfaction (in addiction to emotion)

165
Q

Thalamus

A

Anterior nucleus part of papez circuit

Other regions involved in both input and output of Limbic system

166
Q

Basal ganglia

A

Nucleus accumbens
Putamen
Each plays a different role in emotion

167
Q

Hippocampus

A

Another part of the papez circuit

Memory and emotion are strongly linked

Parahippocampal regions linked to surprise

168
Q

Amygdala

A

Association with emotion recognized very early

Particularly fear and anger

169
Q

Cingulate cortex

A

Mostly paleocortex

Many of these neurons show after discharge

170
Q

Circuits that allow us to experience an emotional re the same as what

A

Circuits that allow us eat identify emotion in others

171
Q

When do mirror neurons fire

A

When smile and see other smile

172
Q

Innate fear

A

Fear that requires no experience

173
Q

Learned fear

A

Learned

Indirect or direct

174
Q

Amygdala

A

Processing and recognition of social cues related to fear

Emotional conditioning in response to fear

Memory

175
Q

Learned fear

A

A direct thalmo-amygdaloid pathway to the lateral nucleus of the amygdala:mediates rapid response

An indirect thalami cortico amygdaloid pathway to the lateral nucleus of the amygdala: this pathway mediates later responses

176
Q

Learned fear inputs arrive where

A

Lateral nucleus of the amygdala

177
Q

Lateral nucleus of amygdala

A

Integrates the inputs for learned fear so paired information is sent to basal and intercalated nuclei for additional processing then sent to central nucleus of the amygdala

178
Q

Hypothalamus learned fear

A

Hypothalamus is important in generating physiologic response

Decides what responses are required and relays information appropriately

179
Q

Damage to amygdala

A

Fear is not perceived, therefore conditioning related to fear does not occur

180
Q

Anger

A

Amygdala and dopamine receptors

181
Q

Inhibiting anger

A

Neocortex, ventromedial hypothalmic, septal nuclei

182
Q

Avoidance

A

Opposite pleasure/reward-prevent the occurrence of a behavior that has short term rewards but long term negative consequences

183
Q

Avoidance substrate

A

Lateral posterior hypothalamus, dorsal midbrain, entorhinal cortex

184
Q

Sadness anatomical substrate

A

Lower sector of the anterior cingulate cortex

Strongly activated when recalling sad events

185
Q

Disgust

A

Insular cortex/putamen

Processing and recognition of social cues related to disgust

Damage abolishes

186
Q

Surprise

A

Strongly associated with parahippocampal gyrus

Parahippocampal gyrus is important in detecting novelty or unexpected events

187
Q

Anterior cingulate cortex

A

2 regions

Ventral-affective
Dorsal-cognitive

188
Q

Cortical role in emotion

A

Integration of visceral, attentional and emotional input

Regulation of affect-particularly top-down control

Monitors or detects conflict between our functional state and new information that has potential or motivational consequences. It does not decide what to do, but relays the information to the 2 divisions

189
Q

Dorsolateral division receives input of

A

Received input from

Motor areas, basal ganglia, pre and supplementary motor cortex

Cingulate cortex, espicially parts related ot performance monitoring

Several cortical association areas

190
Q

Ventromedial prefrontal cortex receives input from

A

Amygdala, hippocampus, temporal visiual association area, dorsolateral prefrontal cortex

191
Q

Three roles of cortical emotion

A

Reward processing, integration of bodily signals, top down regulation

192
Q

Reward processing

A

With the amygdala, we link new stimulus to a primary reward

193
Q

Integration of bodily signals

A

Gut feeling -decision when logical analysis is unable to help

194
Q

Top down regulation

A

Espicially towards delayed gratification

Clin Medicine (28 decks)

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