BEHAVIORAL MEDICINE & SUBSTANCE USE Flashcards by Bao Truong

What are 2 first-line stimulant types for treatment of ADHD?

1 - Methylphenidate
2 - Dextroamphetamine

How well did you know this?

Not at all

Perfectly

What to use in ADHD when patient cannot tolerate either stimulant class? (2 options)
What class is this medication?

Guanfacine or Clonidine
(alpha-agonist)

How well did you know this?

Not at all

Perfectly

What are the adverse effects of guanfacine or clonidine in treatment of ADHD? (3)

1 - Sedation
2 - Bradycardia
3 - Hypotension

How well did you know this?

Not at all

Perfectly

What are the adverse effects of stimulants for ADHD? (6)
Which one is most common ?

1 - Sleep disturbances (most common)
2 - Decreased appetite / weight loss
3 - Headache
4 - Insomnia
5 - Tics
6 - Emotional lability

How well did you know this?

Not at all

Perfectly

Anxious, diaphoretics, confused, extreme agitation

Withdrawal from what types of drugs? What is the significant complication associated with this withdrawal?

Benzodiazepine

Withdrawal can cause seizures

How well did you know this?

Not at all

Perfectly

What are the only 2 psychotropic medications approved for ASD ?

1 - Risperidone
2 - Aripiprazole

How well did you know this?

Not at all

Perfectly

Which psych med can cause increase prolactin level?

Risperidone

How well did you know this?

Not at all

Perfectly

Which mental health disorder is associated with contact dermatitis?

OCD

How well did you know this?

Not at all

Perfectly

What is an essential component of Rett syndrome?

Expressive dysfunction with diminished language and social skills

How well did you know this?

Not at all

Perfectly

When is the typical onset of Rett syndrome?

6 - 18 months of age

How well did you know this?

Not at all

Perfectly

Young girl with loss of hand skills, loss of acquired language skills, gait abnormalities, stereotypic hand movements

What is the condition?

Rett syndrome

How well did you know this?

Not at all

Perfectly

What causes higher risk of death in patients with Rett syndrome?

Cardiac arrhythmia

(consequence of abnormal regulation of autonomic nervous system)

How well did you know this?

Not at all

Perfectly

Distortions of sensory perceptions, “seeing smells”, euphoria or dysphoria

What is the drug?

LSD

How well did you know this?

Not at all

Perfectly

Slurred speech, lacrimation, salivation, stupor

What is the drug?

Inhalant use (huffing)

How well did you know this?

Not at all

Perfectly

Ataxia, diplopia, lateral nystagmus, euphoria

What is the drug?

Barbiturates

How well did you know this?

Not at all

Perfectly

Clenching/grinding of teeth, hyperthermia, muscle rigidity

What is the drug?

MDMA / Ecstasy

How well did you know this?

Not at all

Perfectly

Excessive salivation, involuntary tongue and limb movement, anxiety, laryngospasm

What is the drug?

Ketamine

How well did you know this?

Not at all

Perfectly

Development of tics while on treatment of ADHD

What is going on? Management

Stimulant medication may unmask/wrosen the underlying tic disorder that co-exists with ADHD

Treat by adding alpha-agonist (clonidine)

How well did you know this?

Not at all

Perfectly

Ataxia, nystagmus, increased appetite, slurred speech, decrease in alertness, anxiety

What is the drug?

Marijuana

How well did you know this?

Not at all

Perfectly

What lab finding is associated with synthetic steroid use?

Elevated serum transaminases

How well did you know this?

Not at all

Perfectly

Skin finding associated with inhalant use?

Perioral / perinasal dermatitis

How well did you know this?

Not at all

Perfectly

Decrease school performance, irritability, conjunctival injection/irritation

What is the drug?

Marijuana

How well did you know this?

Not at all

Perfectly

Hyponatremia and seizure after taking a drug

What is the drug? How to explain hyponatremia

MDMA

cause hyperthermia leading to consuming large amounts of water

Impaired short-term memory, nystagmus, ataxia, confusion in an alcoholic

What is going on?

Wernicke-Korsakoff syndrome
aka Vitamin B1 (thiamine) deficiency

How to distinguish folate vs B12 deficiency?

**B12 deficiency -> neurologic abnormalities** (peripheral neuropathy, reversible dementia) (i.e. neuroexam normal -> more likely folate deficiency)

Dry mouth is associated with which drug?

Methamphetamine

Clenching/grinding of teeth associated with which drug?

MDMA

Most common physical finding of barbiturate use?

Nystagmus

What is the first step after diagnosis of ADHD ?

Screen for co-morbidities

What are co-morbidities of ADHD that should be screened after ADHD is diagnosed? (3)

1 - Learning disabilities 2 - Anxiety 3 - Depression

Diagnostic criteria for Tourette syndrome (4)

1 - >= 2 motor tics and >= 1 vocal tic (not necessarily at same time) 2 - Tics occurred > 1 year 3 - Tics started before 18 yo 4 - Tics not caused by use of substance or other medical condition

Most common pulmonary complications of inhalant use (2)

1 - Pneumothorax 2 - Pneumomediastinum

Visual and auditory hallucination, euphoria, altered time perception Which OTC med might be abused to have this effect?

Dextromethorphan

What is purpose of CRAFFT questions? What are components made up the acronyms? (6)

Risk for drug & substance abuse - Car with drug - Relax with drug / peeR pressure - Alone with drug - Forget with drug - Friends / family concerns - Trouble because of drug

What is the threshold for a positive CRAFFT screen?

Score >= 2

What are criteria for positive depression screening? (8)

SIEGECAPS >= 5 symptoms for at least 2 weeks - Sleep - Interest loss - Guilt - Energy - Concentrating - Appetite - Psychomotor activity change - Suicidal ideation

Which drug can precipitate acute manic episode?

SSRI

Episodes of hyperventilation followed by hypoventilation, apnea during weakfulness What is the associated syndrome?

Rett syndrome

Which is a feature that distinguish conduct disorder from ODD?

Initiating physical fights (usually not in ODD)

Yawning, restlessness, dilated pupil, tachycardia, hypertension What is going on?

Opioid withdrawal

What increase prenatal risk for ADHD? (4)

Fetal exposure to **alcohol, lead, tobacco or cocaine**

What are potential fatal complications of cocaine use? How? (3)

Vasoconstriction lead to: 1 - Cerebral stroke or hemorrhage 2 - Seizures 3 - MI

Most commonly used substance by adolescents

Alcohol

Most commonly used substance by adolescents

Alcohol

What are side effects of risperidone in treatment of ASD? (6)

1. Dyslipidemia (common) 2. Liver dysfunction 3. Insulin resistance 4. Hypertension 5. Long QT 6. Increase prolactin level

What are side effects of risperidone in treatment of ASD? (6)

1. Dyslipidemia (common) 2. Liver dysfunction 3. Insulin resistance 4. Hypertension 5. Long QT 6. Increase prolactin level

What are Spice and K2?

Synthetic cannabinoids

What is the orthopedic complications of androgenic steroids in adolescent?

Early epiphyseal closure

Hyperreflexia, muscle rigidity, drooling, nystagmus What is the drug?

Phencyclidine (PCP) (a hallucinogen)

Hypotension, generalized hypotonia, nystagmus, altered mental status If this is related to a substance, what it is?

Benzodiazepine overdose

Overdose of which drug can lead to dysrhythmias and cardiac arrest?

Cocaine

Tooth decay, gingival hypertrophy What drug causes this?

Meth

Heightened sensory awareness, tachycardia, teeth grinding What drug?

MDMA

Hallucinations, paranoia, seizures What drug?

Bath Salt

Euphoria, alertness, decreased need for sleep What drug?

Cocaine