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IPT: Neuro > Block 4 > Flashcards

Block 4 Flashcards

1
Q

Which antidepressants are used in PTSD? Which one is for long-term?

A

Sertraline + Paroxetine

Sertraline is for long-term use

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2
Q

How do SSRIs affect PTSD symptoms that other rx dont?

A

“Numb” the symptoms

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3
Q

Remission of PTSD is defined as…

Adequate? Partial?

A

Remission: >70% reduced symptoms

Adequate: >50

Partial: 25-50%

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4
Q

What are the FDA approved Rx for OCD?

A

Sertraline, Paroxetine

Clomipramine, fluvoxamine, fluoxetine

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5
Q

Cognitive behavioral therapy is recommended for whom in OCD? Meds?

A

Everyone

Meds for moderate-severe OCD

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6
Q

Why are SSRIs picked over clomipramine for OCD?

A

Clomipramine has anticholinergic effects, wt gain, CV issues, and sedation

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7
Q

If SSRI failed for OCD, whats next?

A

Another SSRI

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8
Q

Treatment resistance in OCD is defined as…

A

Decrease 25% from baseline YBOCS score

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9
Q

Which Rx should be avoided in special pop for OCD?

A

Clomipramine

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10
Q

PK of which Rx for OCD is not altered by renal failure pt?

A

Sertraline

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11
Q

Pregnancy and OCD, whats recommended?

A

Behavioral therapy first, then fluoxetine

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12
Q

What is a typical regimen for OCD?

A

SSRI + antipsychotic

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13
Q

Where does clomipramine fall in the regimen for OCD?

A

Second line treatment

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14
Q

Clomipramine monitoring?

A

LFTs

BP

If they have fever or sore throat, WBC

Seizures (dose dependent)

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15
Q

What are the major groups found in the sleep cycle? How long is it?

A

REM + NonREM

70-120 min

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16
Q

DMS-5 of Primary insomnia

A

Difficulty or maintaining sleep for at least 3 months AND 3 nights/week

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17
Q

Which Rx is FDA approved for insomnia maintenance?

A

Doxepin

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18
Q

Which antidepressants can be used in insomnia?

A

Amitriptyline and trazodone

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19
Q

Zolpidem MOA? Zaleplon?

A

Both binds to BZ-1 receptors, Zaleplon has shorter half life

Zolpidem only; Lower doses in women vs men

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20
Q

What special about Eszopiclone vs zolpidem and zaleplon?

A

FDA approved for up to 6 months

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21
Q

Special counseling info for ramelteon?

A

Take within 30 min before you sleep + do NOT take w/ food

Same w/ OX-1 antagonists

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22
Q

What is sleep apnea?

A

Doesnt breathe for at least 10 sec while sleep

Mild: 5-15/hr
Moderate: 15-30/hr
Severe: >30

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23
Q

Narcolepsy monitoring and genes?

A

Hypocretin : <110

Chromo 4p13-q21, HLA antigen

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24
Q

Which stimulants are used for cataplectic symptoms of narcolepsy?

A

None; use TCAs, SSRI, SNRIs, Selegiline

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25
Q

Low to moderate drinkers consume how much alcohol?

A

<20g/day

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26
Q

Consumption of how much alcohol has a higher risk of CHD?

A

> 70g/day

Or binge drinking >5 drinks in less than 2hrs

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27
Q

Are toxic alcohols directly toxic?

A

No, they are inebriating except for isopropanol

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28
Q

Metabolism of Ethylene glycol?

A

Via alcohol dehydrogenase, forms glycolaldehyde and then to glycolate via aldehyde dehydrogenase then to oxlate via thiamine, magnesium and pyridoxine

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29
Q

Metabolism of methanol?

A

Via alcohol dehydrogenase forms formaldehyde and then Formate via aldehyde dehydrogenase

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30
Q

Metabolism of isopropanol?

A

Via alcohol dehydrogenase forms acetone

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31
Q

Osmolarity equation

A

2Na + (BUN/2.8) + (Glucose/18)

+(EtOH/4.6) if alcohol toxicity

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32
Q

Anion gap equation

A

Na - Cl - HCO3

Gap present if >12

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33
Q

How to calculate osmol gap?

A

Measured-Calculated

Normal MEASURED = 285-300

Normal gap = 10-20

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34
Q

How do you interpret which alcohol toxicity is given with anion and osmolar gap?

A

Anion AND Osmolar gap exist? Any toxicity except isopropyl

Just osmolar gap? Isopropyl toxicity

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35
Q

Ethylene glycol is typically found in what?

A

Antifreeze, brake fluid

Fluorescein in antifreeze is what is detectable in urine

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36
Q

How much ethylene glycol should someone be sent to a hospital?

A

10-30ml, but 100ml is considered “toxic”

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37
Q

Ethylene glycol toxicity phases?

A

I = CNS (30min to 12hrs)

II = Metabolic (12-24hrs)

III = Renal (2-3days)

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38
Q

How do you treat early ethylene toxicity?

A

Nasogastric aspiration (if less than one hr)

Sodium bicarb if acidosis is life-threatening

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39
Q

How do you manage ethylene glycol toxicity?

A

Ethanol and fomepizole (adjust fomepizole if HD) to inhibit alcohol dehydrogenase (lvls have to be >20)

Shunting therapy

Hemodialysis

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40
Q

How much methanol is considered toxic?

A

Found in windshield fluid

15ml (cell death, increases formic acid and blindness)

Methanol level >25

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41
Q

How does formic acid transform to water and carbon dioxide?

A

Via folate

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42
Q

How does acetone cause acidosis?

A

It doesnt by its own

It does form ketones and that itself can cause acidosis tho

43
Q

Antidote + alcohol toxicity, which alcohol doesnt have one?

A

Isopropanol

44
Q

How is ethanol metabolised?

A

Through 3 ways (and is subject to genetic polymorphisms)

Alcohol dehydrogenase
CYP2E1
Peroxidase-catalase system

45
Q

How do you treat acute intoxication of ethanol?

A

Nasogastric aspiration, supportive care (D5NS, banana bag)

46
Q

What is a main concern of acute intoxication of ethanol?

A

Wernicke’s encephalopathy due to thiamine deficiency

Starvation ketosis

Dehydration

47
Q

What role does NAD+/NADH play with gluconeogenesis and glycolysis in ethanol metabolism?

A

Increased NADH/NAD+ ratio (used NAD+, reduced)

Decreased gluconeogenesis and increased glycolysis

Hypoglycemia

48
Q

What role does NAD+/NADH play with pyruvate in ethanol metabolism?

A

Increased NADH/NAD+ ratio (used NADH, increased)

Increases pyruvate, which is converted to lactate

Lactic acidosis

49
Q

What role does NAD+/NADH play with fat breakdown and synthesis in ethanol metabolism?

A

Increased NADH/NAD+ ratio (used NAD+, reduced)

Less breakdown and increased synthesis

Steatosis of liver

50
Q

Patho of ethanol homeostasis in:

Non-alcoholics
Intoxication (non regular)
Chronic/regular use
Withdrawal

A

Non alcoholics; balance of GABA and Glutamate

Non regular drinkers; GABA is upregulated

Chronic/regular drinkers; both are upregulated, but is at “homeostasis”

Withdrawal; Glutamate is upregulated

51
Q

What Rx can you use for ethanol withdrawal?

A

BZD; lorazepam, diazepam, chlordiazepoxide

52
Q

Lorazepam
Diazepam
Chlordiazepoxide

Routes of each?

A

IV, IM, PO for lorazepam and diazepam

Chlordiazepoxide is PO only

53
Q

Lorazepam
Diazepam
Chlordiazepoxide

Active metabolites?

A

Lorazepam is the only one that doesnt have one

54
Q

Lorazepam
Diazepam
Chlordiazepoxide

Onset and half life?

A

Diazepam has shortest onset and longest half life

Lorazepam has 10-20 min onset with 12 hr half life

Chlordiazepoxide has longest onset with 12-24hr half life

55
Q

Isopropyl
Methanol
Ethylene glycol
Ethanol

Oxalic acid metabolite

A

Ethylene glycol

56
Q

Isopropyl
Methanol
Ethylene glycol
Ethanol

Formic acid metabolite

A

Methanol

57
Q

Isopropyl
Methanol
Ethylene glycol
Ethanol

Doesnt have a metabolite

A

Ethanol

58
Q

Isopropyl
Methanol
Ethylene glycol
Ethanol

Acetone metabolite

A

Isopropyl

59
Q

Isopropyl
Methanol
Ethylene glycol
Ethanol

Found in liquor

A

Ethanol

60
Q

Isopropyl
Methanol
Ethylene glycol
Ethanol

Windshield fluid

A

Methanol

61
Q

Isopropyl
Methanol
Ethylene glycol
Ethanol

Rubbing alcohol

A

Isopropyl

62
Q

Isopropyl
Methanol
Ethylene glycol
Ethanol

Antifreeze

A

Ethylene glycol

63
Q

Isopropyl
Methanol
Ethylene glycol
Ethanol

Has no anion gap

A

Isopropyl

64
Q

Isopropyl
Methanol
Ethylene glycol
Ethanol

Ketosis exist

A

Only is isopropyl and ethanol

65
Q

Isopropyl
Methanol
Ethylene glycol
Ethanol

Hypoglycemia occurs

A

Ethanol

66
Q

Isopropyl
Methanol
Ethylene glycol
Ethanol

Blindness

A

Methanol

67
Q

Isopropyl
Methanol
Ethylene glycol
Ethanol

Gastritis

A

Isopropyl

68
Q

Isopropyl
Methanol
Ethylene glycol
Ethanol

Renal failure

A

Ethylene glycol

69
Q

Isopropyl
Methanol
Ethylene glycol
Ethanol

Is osmotically active

A

All of them

70
Q

What is the most common assay method for drug test?

A

EI

71
Q

What are the federal (DHHS) guidelines that workplace must test for?

A

Marijuana

Cocaine

Opiates

PCP

Amphetamines

Methamphetamines

72
Q

What medications would cause a false positive value of amphetamines on the EI?

A

Selegine, bupropion, pseudoephedrine, metformin

73
Q

What medications would cause a false positive value of BZDs on the EI?

A

Sertraline, efavirenz

Only measures nordiazepam and oxazepam

74
Q

What medications would cause a false positive value of opiates on the EI?

A

FQs, naltrexone, poppy seeds

Only detects morphine and codeine

75
Q

Does passive smoke or ingestion of hemp food cause a positive test on EI?

A

No

76
Q

Estimated detection time in urine of amphetamine? Pseudoephedrine? Methylphendiate?

A

Amphetamine - 3 days

Pseudoephedrine - 5 days

Methylphenidate - 1 to 2 days

77
Q

Estimated detection time in urine of BZD?

A

Diazepam - 10 days

Others = 5 days

78
Q

Estimated detection time in urine of opiates?

A

Morphine and codeine - 3 days

79
Q

Estimated detection time in urine of buprenorphine?

A

7 days

80
Q

Estimated detection time in urine of LSD?

A

<1 days

Metabolite = 5 days

81
Q

Estimated detection time in urine of marijuana?

A

Single use - 3 days

4-6x/week = 5 days

Daily = 10 days

Heavy use = 30 days

82
Q

Estimated detection time in urine of PCP?

A

8 days

83
Q

How are hair samples stored?

A

Dark room temp w/ gentle air to be dried if needed (not blow dry)

84
Q

What makes a good test in regards to sensitivity and specificity?

A

Both >95%

85
Q

How long does it take for the breath test?

A

2 minutes

86
Q

Does physical dependence constitute addiction?

A

No, but often accompanies it

87
Q

What is the only actual evidence of physical dependence?

A

Withdrawal syndrome

88
Q

In addiction, what pathway is mostly affected?

A

Mesolimbic / Nucleus Accumbens

Dopamine and glutamate

89
Q

Opioid withdrawal sx?

A

Not life-threatending

Pupil dilation
Sweat
Tachycardia
V/D
Yawn
Increase BP
90
Q

BZD withdrawal sx?

A

High doses - seizures and delirium

Moderate doses - anxiety, light sensitivity, cramps, sleep issues

91
Q

Barbiturate withdrawal sx?

A

Tremors, hallucinations, hyperthermia, seizures, respiratory depression and arrest, coma, death

92
Q

Order of potency

Carfentanil, Fentanyl, Heroin, Morphine, Sufentanil

A

Morphine (1)

Heroin (2)

Fentanyl (100)

Sufentanil (500)

Carfentanil (10,000)

93
Q

Which body systems are affected by amphetamine toxicity?

A

CV + CNS

Same as cocaine

94
Q

How is heroin metabolized? Codeine?

A

Converts to diacetylmorphine then hydrolyzed to morphine

Codeine (an inactive prodrug) also is converted to morphine via 2D6

95
Q

Opioid dependent vs opioid naive pt on heroin and PK

A

Naive = less concentration

Dependent = heroin concentration is much higher

96
Q

Non Pharm AUD - Mild Tx

A

AA

Set goals

Drink less, alternate alcoholic with non alcoholic

Basic stuff

97
Q

Non Pharm AUD - Moderate/severe Tx

A

Make recovery your priority in first few months

Avoid triggers (pubs, friends)

Sleep regular schedule

Contingency plan for relapse, contact someone if this occurs

98
Q

What is the delay, distract, and urge surfing technique?

A

Delay: wait x min to act on craving

Distract: prepare list of distraction ahead of time

Urge surfing: Picture urge as something else and imagine doing that instead

99
Q

What are the 3 FDA Rx for alcohol cessation?

A

Disulfiram, Acamprosate, Naltrexone

100
Q

Disulfiram MOA?

A

Metabolites of DSF inhibit aldehyde dehydrogenase

Leads to facial flushing, N/V, tachycardia

Enzyme inhibition is IRREVERSIBLE

Used cautiously in mild/moderate

Avoid in SEVERE cases

101
Q

Acamprosate MOA?

A

Used after detoxification to decreases craving

102
Q

Naltrexone MOA?

A

Similar to Acamprosate in that it reduces craving

103
Q

Buprenorphine MOA?

A

Partial mu agonist and kappa antagonist

IPT: Neuro (4 decks)

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