BEHAVIORAL MEDICINE & SUBSTANCE USE Flashcards
What are 2 first-line stimulant types for treatment of ADHD?
1 - Methylphenidate
2 - Dextroamphetamine
What to use in ADHD when patient cannot tolerate either stimulant class? (2 options)
What class is this medication?
Guanfacine or Clonidine
(alpha-agonist)
What are the adverse effects of guanfacine or clonidine in treatment of ADHD? (3)
1 - Sedation
2 - Bradycardia
3 - Hypotension
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
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
What are the only 2 psychotropic medications approved for ASD ?
1 - Risperidone
2 - Aripiprazole
Which psych med can cause increase prolactin level?
Risperidone
Which mental health disorder is associated with contact dermatitis?
OCD
What is an essential component of Rett syndrome?
Expressive dysfunction with diminished language and social skills
When is the typical onset of Rett syndrome?
6 - 18 months of age
Young girl with loss of hand skills, loss of acquired language skills, gait abnormalities, stereotypic hand movements
What is the condition?
Rett syndrome
What causes higher risk of death in patients with Rett syndrome?
Cardiac arrhythmia
(consequence of abnormal regulation of autonomic nervous system)
Distortions of sensory perceptions, “seeing smells”, euphoria or dysphoria
What is the drug?
LSD
Slurred speech, lacrimation, salivation, stupor
What is the drug?
Inhalant use (huffing)
Ataxia, diplopia, lateral nystagmus, euphoria
What is the drug?
Barbiturates
Clenching/grinding of teeth, hyperthermia, muscle rigidity
What is the drug?
MDMA / Ecstasy
Excessive salivation, involuntary tongue and limb movement, anxiety, laryngospasm
What is the drug?
Ketamine
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)
Ataxia, nystagmus, increased appetite, slurred speech, decrease in alertness, anxiety
What is the drug?
Marijuana
What lab finding is associated with synthetic steroid use?
Elevated serum transaminases
Skin finding associated with inhalant use?
Perioral / perinasal dermatitis
Decrease school performance, irritability, conjunctival injection/irritation
What is the drug?
Marijuana
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)
- Dyslipidemia (common)
- Liver dysfunction
- Insulin resistance
- Hypertension
- Long QT
- Increase prolactin level
What are side effects of risperidone in treatment of ASD? (6)
- Dyslipidemia (common)
- Liver dysfunction
- Insulin resistance
- Hypertension
- Long QT
- 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
