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Boards II > Behaviorial > Flashcards

Behaviorial Flashcards

1
Q

When can you hospitalize against will?

- 2 conditions

A
  • Danger to other, to self, or disability to inhibit ability to perform functions of daily living
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2
Q

IQ

  • stanford binet
  • Weschler
  • mean
  • IQ <70
  • IQ < 40
  • IQ <20
A
  • mental age/ chronologic age * 100
  • scale, use test, 6 verbal, 5 performance
  • 100 w/ SD of 15
  • intellectual disability
  • severe disability
  • profound disability (will need full time care)
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3
Q

Delirium vs dementia

- onset, consciousness, memory, course, prognosis

A
  • Delerium is acute onset, impaired conciousness, global memory impaired, fluctuating, reversible
  • Dementia is gradual, concious, remote memory spared (can tell you about wedding / birth of children), progressive decline, irreversible
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4
Q

Amnesia

  • anterograde
  • retrograde
  • kosakoff
A
  • inability to create new memories
  • cannot remember anything from before accident
  • thiamine def, destruction mamillary bodies, both antero and retro grade amnesia
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5
Q

Bipolar

  • Valproic acid
  • Lithium
  • Carbamazepine
A
  • block Na channel and increase GABA
  • MOA unknown
  • GABA agonist, stabilizes Na channels
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6
Q

Biogenic Amine Theory

  • what is it
  • importance
  • educating patients
A
  • depression is caused by decrease of monoamines, serotonin NE, and dopamine
  • all drugs are aimed at elevating monoamines
  • takes 6-8 wks to reach potential
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7
Q

SSRI

  • MOA
  • OCD and panic disorder
  • anxiety and depression
  • adverse dysfunction
  • what makes serotonin
A
  • block serotonin reuptake
  • sertraline, paroxetine
  • citalopram, fluoxetine
  • sex dysfunction, sedation, suicidal ideation
  • tryptophan
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8
Q

SNRI

  • MOA
  • examples that cause liver and kidney damage
  • examples that increased BP and tachy
A
  • inhibit NE and Serotonin reuptake
  • Venlafaxine, Duloxetine,
  • Desvenlafaxine
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9
Q

Atypicals

  • buproprion
  • mirtazapine
  • Vilazodone
  • Nefazadone and Trazodone
A
  • block dopamine and NE reuptake; short half half, no sex side effects,
  • alpha 2 blocker, highly sedative and no sex dysfunction, but does cause weight gain
  • SSRI that does not have sex side effects
  • 5HTA and HT1 antagonist; N is hepatotoxic, and trazadone causes priaprism (persistenet, painful erection)
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10
Q

TCA

  • MOA
  • amitryptiline
  • amoxapine
  • clomipramine
  • despramine
  • imipramine
  • protriptyline
  • heart effects
A
  • block reuptake of NE
  • highly sedating
  • off label schizo
  • OCD, sedative
  • less sedating than others in class
  • enuresis (bed wetting in children) in children
  • least sedative
  • quinidine life effects -> QRS and QT prolongation -> give hypertonic Na Bicarb
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11
Q

Mono-amine oxidase Inhibitors

  • MAO
  • Tranylcypromine
  • Selegeline
  • tyramine: what is it, what does it do, what can it cause,
A
  • stops breakdown of serotonin, dopamine, etc
  • hepato tox, overdose can cause seizures
  • prevents breakdown of dopamine, helpful w/ parkinsons
  • mono-amine that is naturally produced and causes large release of catecholamines; HTN crisis, neck stiffness, N/V, tachy and stroke; found in cheese and wine
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12
Q

serotonin syndrome

  • caused by
  • sxs
  • tx
  • malignant hyperthermia: mutation, chrom, what happens, trigger, sxs, precaution, tx
A
  • combination of SSRI and MAOI
  • hyperthermia, hyperreflexia, tremor, clonus, HTN, mydriasis, diarrhea, hyperactive bowel
  • sedation, intubation, 5-HT blockade
  • AD, on chrom 19, problem w/ ryanodine receptor on sarcoplasmic reticulum, triggered by anesthetics and caffeine, products cause release of lots of CA from SR -> causing massive release of heat; make sure to ask every pt if they or their family have ever had problems w/ anesthesia, dantrolene
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13
Q

Switching Between diff antidepressants

  • SSRI to SSRI
  • SSRI to TCA
  • switching to/from MAOI:
A
  • start new SSRI at equivalent or lower dose
  • cross taper, decrease SSRI while increasing TCA
  • taper drug, stop for two weeks and then restart
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14
Q

Main Problems with Drugs

  • Sedation
  • Ortho hypotension
  • GI distress
  • Weight gain
A
  • give to pts with insomnia and have them take at night; fluoxetine, paroxetine, mirtaapine, trazadone, amitryptilene
  • take this at night, phenelzine, amitryptyline
  • take with food; citalopram,
  • imipramine, clomipramine, paroxetine
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15
Q

Prognosis for psych disorders

  • favorable
  • unfavorable
A
  • acute, good insight

- chronic, no insight

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16
Q

MDD

  • epi
  • what is it
  • caused by
  • serotnin location
  • sleep
  • sex
  • hunger
  • DDX
  • tx
  • refractory depression
A
  • females in 40s
  • pts get repeated bouts of depression, need episodes of 2 weeks that are separated by at least 2 months
  • decreased serotonin and NE
  • serotonergic neurons are found in raphe nuclei of brainstem
  • serotonin important for sleep/wake cycle -> have sleep disturbances
  • low libido
  • can increase or decrease hunger,
  • dysthmia (chronic, mild depression), cyclothymia (cycling between mood elevation and depression w/ normal period in between), bipolar, hypothyroidism, bereavement
  • SSRI and CBT
  • electroconvulsive therapy -> short term memory loss
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17
Q

Grief

  • sxs same as depression
  • sxs diff from depression
  • tx
A
  • sad, sleep disturbances, poor appetite
  • sx wax and wane, lower suicide risk, sx can last while but will eventually get back to normal
  • therapy
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18
Q

Kubler Ross Dying Stages

  • what are the stages
  • do they have to go in order
A
  • denial, anger, bargaining, depression (SIGECAPS), acceptance
  • no, and can go back and forth
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19
Q

Depression

  • DX
  • other needs
  • what is SIGECAPS
A
  • must see 5 or more of SIGECAPS for at least 2 weeks and depressed mood or loss of interest
  • needs to cause significant distress or impairment in social, occupational, or other areas
  • sleep disturbances, loss of interest, feelings of guilt, loss of energy, loss of concentration, change in appetite, psychomotor retardation, suicidal ideation
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20
Q

Risk for Suicide

- SAD PERSONS

A
  • sex (male), age (older), depression, previous attempt (#1), ethanol use, lack of rational thought, sickness, organized plan, no spouse, social support lacking
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21
Q

Depression and Insomnia

- tx

A
  • SSRI and trazadone (5HT2A blocker)
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22
Q

Dysthmic Disorder

  • Dx
  • diff from MDD
A
  • Shows less than 5 SIGECAPS for 2 consecutive years

- if they go to 5 or more SIGECAPS for 2 weeks or more during that time then considered MDD

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23
Q

Post Partum Blues

  • epi
  • sx
  • tx
A
  • 50-85%, starts 2-3 days after birth and resolves w/i 10 days
  • tearfulness, fatigue, depressed, affect, irritable
  • reassurance, watchful waiting
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24
Q

Post Partum Depression

  • range
  • epi
  • reoccurence
  • sxs
  • tx
  • meds, importance
A
  • mild to severe (life threatning to mother and baby)
  • 10% women
  • 25%
  • SIGECAPS
  • mild: therapy, severe: hospitalization
  • sertraline, paroxetine, nortryptilene (can be given while breast feeding)
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25
Q

Post partum psychosis

  • epi
  • time frame
  • sxs
  • tx
A
  • 0.1 - 0.2 %
  • in first 3 months
  • schizo affect, delusions, hallucination, disorganized behavior
  • antipsychotics or antidepressants w/ hospitalization
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26
Q

Bipolar

  • what is it
  • mania (DIG FAST)
  • type 1: characterized by, time frame, occurence
  • type 2: characterized by, time frame, occurence
  • cyclothymia: what is it, occurs
  • rapid cycling: what is it, caused by
  • DDX when in mania
  • what happens when given anti-depressant
  • tx: mani pts, acute;y, long term
  • lithium: possible MOA, side effects, pregnancy
  • inositol depletion hypothesis
A
  • alternating bouts of depression and manic phases
  • distractibility, insomnia, grandiosity, flight of ideas, activity/agitation increased, speech pressured (talk and move fast), throughtlessness
  • manic episodes (lasting at least 1 wk up till 13 wks, with 1/2 cycles per year) w/ or w/o depressive episodes
  • hypomania (last less than 1 week) to full blown depression (lasts at leat 2 weeks); 1/2 cycles per year
  • hypomanic w/ low levels of depression; last for 2 years, symptom free for no more than 2 months, can turn into bipolar
  • at least 4 episodes of depresion/mania over 12 month period; antidepressants
  • cocaine use, amphetamine use, schizo, personality type II disorder
  • it will drive them into manic phase
  • hospitalize mani pt, benzo as sedative then start mood stabilizer, lithium
  • decreased NE and increase serotonin; can cause kidney tox; ebstein anomaly (low tricuspid with small right ventricle
  • overactive inositol signal tranduction pathway can be attributeed to mania and lithium can prevent the overactivity.
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27
Q

Drug induced mania

  • which drugs
  • signs
  • dx
  • tx: acute, long-term
A
  • cocaine and amphetamines
  • mania, tachycardia, HTN, pupillary dilation, arrythmia, ischemia (MI in young pt)
  • urine tox screen, serum tox screen
  • CCB, drug tx
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28
Q

Schizo

  • epi
  • dx
  • schizopheniform
  • brief psych disorder
  • schizoaffective
  • positive sxs: most common, loss of ego boundaries, thought blocking, neologisms, word salad, loose associations, echolalia, perseveration
  • negative sxs
  • DDX: delerium
  • DDX- drugs
A
  • late teen to early 20s
  • 2 or more positive sxs (delusions, hallucination, disorganized behavior, disorganized speech) longer than 6 months
  • sxs for 1-6 months
  • sxs less than a month
  • mood disorder (2 weeks of bipolar, or depression) + schizophenia
  • hallucination, delusions, loss of ego boundaries (invade your personal space), thought blocking (stop talking bc listening to voices), neologisms (inventing new words), word salad (uttering unconnected and unrelated words or phrases), loose association (when talking once sentence to next barely correlate with eachother), echolalia (repeat everything you say), perseveration (say ame thing over and over again)
  • lack of emotional affect, loss of interest in life, poverty of speech
  • in pts with underlying dx, pt not oriented, waxes and wanes, resolves once primary problem fixed
  • LSD & PCP (visual, taste, touch, olfactory hallucinations), Cocaine and amphetamine (paranoid delusions and formication), anabolic steroid, corticosteroid (pyschosis in form of bizzare disturbing dreams and mood disturbances)
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29
Q

Hallucinations

  • what is it
  • auditory: what is it, seen in
  • visual: what is it, seen in
  • olfactory: what is it, seen in
  • tactile: what is it, seen in, formication
A
  • false sensory perception
  • hears things, most common in schizo
  • seeing things, linked to drugs
  • smelling things, caused by brain lesion (temporal) or seizure disorder
  • feels thing, EtOH withdrawal, bugs crawling
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30
Q

Delusion

- what is it

A
  • fixed, false belief despite facts against them
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31
Q

Tx of schizo

  • hospitalization
  • meds
  • haloperidol depo
  • 1st gen anti-pscyhotics
  • 2nd gen anti-pscyhotics
A
  • only if hallucinations are telling them to do something bad
  • dopamine blockers (antipsychotics)
  • IM injection, good for 1 month, increase compliance
  • block dopamine -> positive sxs
  • block 5HT2A -> neg sxs
32
Q

1st gen antipschotics

  • MOA
  • low potency
  • high potency
A
  • block D2 in mesolimbic sxs of brain
  • thioridazine, chlorpromazine (used for hiccups), prochlorperazine (can be used for n/v)
  • fluphenazine, haloperidol (can be used for agitation and tourettes), pimozide
33
Q

2nd gen antipsychotics

  • Aripiprazole
  • Clozapine
  • Olanzapine
  • Quetiapine
  • Risperidone
A
  • partial D2 and 5HT1a, complete 5HT2A, can be used for autism
  • high for D1, D4, 5HT2A, muscarinic, alpha, weak on D2; causes agranulocytosis (bone disorder)
  • strong on 5HT2a
  • weak on D2 and 5HT2a
  • strong on 5HT2a and weak on D2 -> high, can be used for tourettes and autism
34
Q

Extrapyrimidal SXS in Tx for schizo

  • which meds
  • why
  • what is it
  • how to fix
  • tardive dyskinesia
  • akathasia
  • neuroleptic malignant syndrome: what is it, labs, urine, tx, diff from serotonin syndrome
A
  • mostly Type 1 but ripseridone (type 2) is worst
  • parkinsonian sxs;
  • diphenydramine or benztropine
  • involuntary perioral movement and choreiform movements of head
  • subjective sense of discomfort like restlessness
  • life threatening muscle rigidty of all muscles, high BP and HR, rhabdo; usually 1-3 days after starting; high WBC, high creatine kinase, high transaminase, high myoglobin w/ myoglobinuria (coca-cola colored, will dip positive for blood but neg RBC cause is detecting myoglobin not hemoglobin), dantrolene, cooling blankets; SS only has muscle rigidity in LE, and SS has hyper reflexia, and will have hyperactive bowel sounds
35
Q

Panic disorder

  • DX
  • sxs
  • blood gas: what happens, tx
  • acute tx
  • 1st line
A
  • severe anxiety over many thing
  • 20s
  • mimics MI (do EKG)
  • palpitation, abd distress, nausea, increased perspiration, chest pain, chills, choking
  • will be hyper-ventalating cause resp alkalosis; low CO2 -> hypocapnia will cause vasoconstriction -> decrease cerebral blood flow; breathe into bag to increase concentration of CO2 and dont cause vaoconstriction of cerebrum
  • benzo
  • SSRI and CBT
36
Q

OCD

  • what is it
  • why
  • usually involves
  • do they justify
  • tx
A
  • recurring thought and compulsions
  • obsessive thoughts lead to anxiety and compulsions relieve anxiety for a bit
  • cleanliness, symmetry, letter patterns
  • recognize and disturbed by disorder
  • SSRI + psychotherapy
37
Q

Generalized Anxiety

  • what is it
  • cannot be
  • leads to
  • NT
  • white coat syndrome
  • sequelae
  • TX: usually, mono, combo
A
  • worry most day for 6 months, trouble concentrating, fatigue and restless
  • caused by only 1 thing -> will be phobia
  • social dysfunction
  • increase NE, decrease GABA and 5HT
  • anxiety when pt sees doctor in white coat, tachycardia and increased BP
  • cause production free fatty acids, corticosterois, lipids, cholesterol, catecholamines,
  • therapy, SSRI or benzo and buspirone (selective antagonist of 5HT1A)
38
Q

Agoraphobia

  • what is it
  • dx
  • tx: prophylaxis, long term
A
  • fear of being unable to get out of situation (like when you’re in crowd)
  • needs to have social or occupational dysfunction
  • propanolol (prophylaxis, blocks sxs of tachy, tremor, diaphoresis); exposure desensitization (expose to what scares them while practicing relaxation technique)
39
Q

Acute Stress Vs PTSD

  • diff
  • sxs
  • tx
A
  • time frame, acute stress: starts w/i 4 weeks of event and lasts from 2 days to w weeks, any longer will be acute PTSD (less than 3 months since event) and after 3 months (from event) it is chronic PTSD
  • numbness, detachment, nightmares, flashbacks, avoidance, anxiety
  • SSRI, benzo’s (acute), therapy (exposure and relaxation)
40
Q

Personality Disorders Cluster A (SCHIZOs)

  • Paranoid: what is it, coping mech
  • Schizoid: what is it
  • Schizotypal: what is it, sequlae
A
  • negative interpretation of words and actions of others (everything is conspiracy); use projection as defense mechanism (take own unacceptable feelings and put on someone else)
  • introverted and socially withdrawn; do not want to form emotional relationships
  • socially isolated but believe in things that society has deemed false (magic), could deteriorate into schizo
41
Q

Personality Disorders Cluster B

  • antisocial: what is it, age
  • borderline: what is it, demonstrate
  • histrionic: what is it, dissociates
  • narcissitic : what is it, sensitive to
A
  • no regard for right, property, safety of others; very charming; must be 18 but have shown sxs by 15
  • wild mood swings, splitting (all in black and white)
  • want all attention and try to get it by dressing provocatively and behave very sexually; feelings
  • entitled to be best and everyone else inferior; criticism
42
Q

Cluster C Personality Disorders

  • Avoidant: what is it, fears
  • Dependent: what is it
  • obsessive compulsive: what is it, preoccupied w, ego defense
A
  • feelings of inadequacy, sensitive to negative comments, with low self esteem, fears rejection (want relationship but scared)
  • clingy behavior, does not like to be by themselves
  • similar to OCD but don’t think that anything is wrong with their behavior; preoccupied with details, neatness, rules; use isolation as ego defense
43
Q
  • Id: what is it, do you know,
  • Superego: what is it; aware; formed from
  • ego: what is it, do you know
A
  • selfish, pleasure oriented part of personality w/ no ability to delay gratification; unconscious; not socially acceptable
  • individuals consciously perceived rules/ regulations; unconscious, pre-conscious, conscious; formed by parents
  • makes decisions from id using rules of superego; both conscious and unconscious
44
Q

Deterministic Theory

  • what is it
  • defense mechanisms: what is it, are you aware, how
A
  • supports notion that all human behavior is caused and can be explained
  • ways of coping to resolve emotional conflict; unconscious; distort, falsify, or deny reality so you can get through whatever is currently happening
45
Q

Mature Defense mech

  • used by
  • altruism
  • anticipatoin
  • humor
  • suppressoin
  • sublimation
A
  • adults who are healthy and emotionally stable
  • doing good for others in order to dampen/eliminate ones negative feelings
  • planning in present in anticipation of future discomfort
  • joking in the presence of painful and or anxiety causing situations
  • temporarily keeping feelings out of conscious mind intentionally
  • taking unacceptable feelings and using them for more acceptable cause
46
Q 
Immature Defense Mech
- used by
- acting out
- denial
- discplacement
- dissociation
- fixation
- identification
- isolation of affect
- projection
- passive aggression
- rationalization
- reaction formation
- regression
- repression
splitting
A
  • adults aiming to decrease stress and/or anxiety when faced when uncomfortable situations
  • demonstrate feelings or thoughts through action
  • outright avoidance of ones own external reality
  • transferring ones owns feelings or ideas to another person
  • avoidance of emotional stress by changing personality
  • maintaining degree childish behavior; certain parts of emotional development do not occur (guy playing videogame)
  • attempting to act/ behave similarly to a perceived figure power
  • act of isolating ones feelings from event
  • putting ones own upsetting feelings onto another
  • indirectly demonstrating ones opposition through suboptimal performance
  • avoidance of self blame by using logic for behaviors that were performed for completely different reason
  • doing complete opposite of ones own internal ideas or feelings
  • dealing with reality through modalities used at an earlier stage of development (getting upset and then bed wetting)
  • keeping memories or feelings from consciousness unintentiionally
  • seeing things or people as completely one way or another
47
Q

Other Defense Mech

  • Pathologic
  • Neurotic
A
  • used to alter one’s relaity to avoid having to deal with it; psychotic denial -> 16 yr old pregnant girl who thinks she is just gaining weight and at delivery just thinks she is constipated
  • used to cope temporarily but when used excessively disturbs ability to cope with several aspects of life;
48
Q

Facititous Disorders

  • what is it
  • muchausen syndrome
  • munchausen by proxy
A
  • pts assume the sick sick role by mimicking physical or psych sxs; not trying to gain anything
  • factitious disorder w/ physical sxs
  • pt claims sxs in someone who is under his/her care
49
Q

Somatoform vs malingering vs factitious disorder

  • somatoform
  • factitous
  • malingering
A
  • not conscious
  • falsification and exaggeration of sxs w/o wanting of gain
  • trying to gain something out of pretending to be sick
50
Q

Somatoform disorders

  • somatization disorder: epi, what is it, tx
  • conversion disorder: what is it, how to help, tx
  • hypochondriasis: what is it, manage with
  • body dysmorphic disorder: what is it, complications, tx
A
  • female, younger than 30; somatic complaints in many diff sxs but all tests r/o medical causes; schedule reg visits, do not repeat invasive tests, try to explore problem and refer to psych
  • neuro sxs that come from outside stressor; idnetify stressor that caused problem; supportive w/ therapy
  • pts have preoccupation w/ dx and misinterpretation of sxs as worrisome problems; reg clinical visits
  • overly preoccupied with body and usually obssess over single feature; major depression and high suicide; SSRI and therapy
51
Q

Child abuse

  • burns
  • fractures
  • sex: signs/sxs; management
  • poisioning
  • acetaminophen: amount for tox, metabolism, MOA for injury,
  • arsenic: where is it located, sxs of poisioning, tx
A
  • immersion (dipped into hot water), cigarette, full thickness 3rd degree
  • chip, spiral, rib
  • vaginal, penile, rectal pain, erythema, discharge, dysuria, constipation, enuresis; treat injuries and report to CPS
  • 250 mg/ jg body weight or 12g/day; in liver, 90% by sulfation and glucouronide conjugation and 10% through cytochrome 450; the cytochrome p450 will make NAPQI metabolite causing hepatocellular damage; n-acetyl cysteine which will act as glutatione substitute and bind to toxic metabolites
  • in pesticide; GI, HTN, tachy, garlic odor on breath; dimercaprol will chelate arsenic but can cause nephrotx and HTN
52
Q

Adolescent Meds

  • most common cause of death
  • suicide
  • substance abuse: importance, first use
  • sex: percentage, consequences
A
  • accident, MVA
  • females make more attempts but males succeed more often
  • major cause of death, average first use is 12-14
  • 60% males, and 50% females have had sex by the end of high school; unwanted pregnancies and STDs
53
Q

Autism

  • what is it
  • signs/sxs
  • aspergers
A
  • pervasive developemtnal disorder that affects social interaction, language and emotions
  • starts efore 3 y.o., wont make eye contact, attachment to foreign object, rituals
  • like autism but normal language development
54
Q

Rett syndrome

  • genetics
  • signs and symptoms
A
  • x-linked dominant, only females will live

- syptoms begin 1-4 yrs old and will have developemntal and verbal regrssion, hand wringing

55
Q

Depression in children

  • preschool
  • adolescents
  • usually caused by
  • management
A
  • hyperactivity or agressiveness
  • irritability, boredom, antisocial
  • sxs
  • therapy first
56
Q

Separation Anxiety

  • what is it
  • sxs
  • tx
A
  • abnormal attachment to parental figure w/ irrational fear that authority figure will no return
  • n/v, headache, nightmares, trouble sleeping bc of what happened
  • desensitizing therapy
57
Q

Oppositional Defiant Disorder

  • what is it
  • socially
  • precursor to
A
  • temperamental w/ people they know well
  • does not have friends and does not do well
  • anti-social personality disorder or conduct disorder
58
Q

Conduct disorder

  • what is it
  • precursor to
  • management
A
  • child is bully, fights, cruel, no regard for others property, w/o guilt
  • anti-social personality disorder
  • structure and strict rules w/ consequences when rules are broken
59
Q

ADHD

  • what is it
  • DX
  • management
A
  • inability to focus or concentrate when performing tasks and hyperactivity
  • 6 or more sx of inattention, 6 or more sx of hyperactivity in children younger than 16
  • amphetamines, methylphenidate (ritalin; NE and dopamine reuptake inhibitor), adderall (amphetamine and dextroamphetamine)
60
Q

Tourettes

  • what is it
  • tx; facial tics; other
A
  • involuntary motor or vocal tics that must be present for longer than a year
  • haloperidol, facial: botox and topiramate; some just grow out of it
61
Q

EtOH

  • causes
  • blood alcohol above 0.1
  • blood alcohol above 0.2
  • decision making
  • withdrawal: causes
  • management
A
  • disinhibition and decreased cognition
  • slurred speech, impaired decision making
  • motor impairment, LOC, blackout
  • incapacitated so no
  • delerium tremens for 2-5 days; auto hyperactivity, psych sxs, tremor
  • AA, benzos are first line (diazepam and chlordiazepoxide), liver dysfxn use short acting benzos (lorazepam and oxazepam)
62
Q

Cocaine

  • sxs
  • key feature
  • what does it do
  • withdrawal
A
  • symp overactivity, tachy, HTN, arrythmia, seizurem agitation, dilated
  • MI in 20 yr old
  • blocks reutake of dopamine at synaptic cleft
  • increase of PS
63
Q

Opioids

  • kinds
  • what does it do
  • pregnancy: what happens, tx
  • biggest issue
  • treating overdose
  • addiction tx
A
  • heroin, oxycodone
  • PS over activation
  • drowsy, pupil constricted, decreased resp drive, slurred speech
  • child will go through acute opioid withdrawal -> give dilute version of opium that is then tapered to wean them off
  • tolerance bc of phosphorylation of mu receptor and so pts need higher and higher doses to control pain
  • naloxone: mu receptor antagonist that has higher affinity for mu receptor than opioid; can be sold OTC; naltrexone does same
  • use methadone, will slowly taper doses to wean pt off
64
Q

PCP

  • what happens
  • tx
  • risk
A
  • intense psychosis, violent behavior, excessive strength -> act like hulk
  • sedate w/ haloperidol
  • rhabdo
65
Q

LSD

  • what does it do
  • risk
A
  • heightened sensation to sound, taste, tough, color

- not deadly

66
Q

Marijuana

  • THC
  • effects
  • good alt to
A
  • stimulates cabinoid receptor
  • hunger, mood, memory, and pain sensation
  • opioids
67
Q

Neuroleptic Malignant Syndrome

  • dx
  • sxs
  • tx
A
  • need hs of exposure to neuroleptic meds w/i last week
  • hyperthermia, generalized rigidity, auto instability (HTN, tachy), altered mental status
  • dantrolene and dopamine antagonist (bromocriptine)
68
Q

Sleep Stages: BATS DB

  • awake eyes open
  • awake eyes closed
  • stage 1 sleep: waves, what is happening
  • stage 2 sleep
  • stage 3 sleep
  • REM sleep
A
  • beta
  • alpha
  • theta waves, drowsy
  • sleep spindles and k complexes, awareness of external env disappears and bruxism occurs here
  • delta waves, parasomnia occurs, and relieves subjective feeling of sleepiness
  • beta waves (90-120 min), when you dream
69
Q

Parasomnia

  • night terrors: when, what is it, results in
  • nightmares: when, what is it, results in
  • sleep walking: when, what is it, results in
A
  • occur during non-REM, child will awaken screaming but not remember next day, usually fall back to sleep
  • During REM, often something that leads to nightmares, good recollection of dream
  • during Non-REM, pt gets out of bed and wanders, can be dangerous, pt has no memory
70
Q

Dys-somnia

  • Insomnia: what is it, manage w/ lifestyle, meds; avoid
  • Narcolepsy: what is it, caused by, side effects, management
  • Sleep apnea: what is it, two types, obstructive (why, sxs, management)
  • Pickwickian Syndrome
A
  • unable to fall asleep or stay asleep, for longer than 1 month; sleep routine, exercise regularly, OTC anti-histamines, short course of benzos; EtOH, but puts pt in REM sleep faster and so get poor quality of sleep
  • recurrent sleep attacks where pt falls immediately into REM sleep; low levels of orexin (reg arousal, appetite, wakefulness); sudden collapse bc of muscle tone loss; modanifil (will increase histamine levels to keep awake and alert)
  • periods of no breathing while sleeping; apnea - cessation of breathing for 10 or more sec , hypoapnea - reduced airflow; obstructive is most common and caused bc of obstruction of larynx w/ sxs of daytime sleepiness, loud snoring HTN and managed with CPAP and weight los
  • central alveolar hypoventilation bc weight of fat in lungs does not allow for alveoli to expand; somnolescence, obecity, erythrocytosis
71
Q

Sex and gender identity

  • sex identity
  • gender odentity
  • gender dysphoria
A
  • based on biology, known by 3 yrs old
  • self perception
  • when sex identity does not match gender identity for more than 6 months; looking for wearing opp gender clothes, dislike of birth genitalia and desire to have opposite genitalia
72
Q

Adjustment Disorder

  • what is it
  • sxs of
  • management
A
  • behavioral or emotional sxs brought on by stressful life events
  • depression and anxiety
  • symptoms will stop w/i 6 months of the stressor going away
73
Q

Infant deprivation

  • what is it
  • sxs
A
  • if child deprived from primary care giver can develop failure to thrive
  • poor language, poor socialization, lack of trust, weight loss, physical illness
74
Q

Disruptive, impulse-control and conduct disorder

  • intermittent explosive disorder: what is it, timing
  • kleptomania: what is it
A
  • episode of aggression beyond what is normal, episodic

- impulse to steal w/o gain associated from the item stolen and guilt felt after

75
Q

Pyromania

- what is it

A
  • purposeful fire setting bs of fascination w/ fire and inability to resist the impulse
76
Q

Trichtillomania

- what is it

A
  • purposeful hair pulling

Boards II (20 decks)

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