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* DIT each session > Day 4.2 Psych > Flashcards

Day 4.2 Psych Flashcards

1
Q

Manic episode

A

> 1week
Distinct period of abnormal and persistently elevated, expansive, or irritable mood.
Can be happy or angry
Often disturbing to the pt, but can also be fun- v. productive

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2
Q

Dx of manic episode

A 
3 or more of DIG FAST:
Distractibility
Irresponsibility- hedonistic
Grandiosity- inflated self-esteem, can be delusional
Flight of ideas- racing thoughts
Activity and agitation increased
Sleep less (decreased need)
Talkative, pressured speech
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3
Q

Hypomanic episode

A

Like manic except mood disturbance doesn’t interfere with social/occupational function, and doesn’t need hospitalization
No psychotic features.

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4
Q

Bipolar disorder

A

At least 1 manic or hypomanic episode.
(manic = bipolar I, hypomanic = bipolar II)
Always get depressive symptoms eventually.
Pt’s mood/fn usu returns to normal bt episodes.
Use of anti-depressants can lead to mania (bc they increase serotonin, NE)
Engage in pleasurable activities w potentially painful consequences
High suicide risk

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5
Q

Rx for bipolar disorder

A 
mood stabilizers:
lithium
valproate
lamotrigine
carbamazapine

atypical antipsychotics:
olanzipine
aripiprazole

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6
Q

Cyclothymic disorder

A

> 2 years

milder form of bipolar- hypomania, mild depression

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7
Q

Lithium mech and use

A

mech unknown, may be related to inhibition of phosphoinositol cascade
Use: mood stabilizer for bipolar disorder, blocks relapse and acute manic events
also used in SIADH
DoC for bipolar, mania

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8
Q

What is SIADH

A

Syndrome of Inappropriate(ly high) Anti-Diuretic Hormone

Excess ADH = retain water and don’t urinate; serum Na+ decreases.

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9
Q

Toxicity of lithium

A 
LMNOP
Lithium side effects:
Movement (tremor)
Nephrogenic DI
hypOthyroidism
Pregnancy problems

Tremor, sedation, edema, heart block, hypothyroidism, polyuria (ADH antagonist, causes nephrogenic DI), teratogenesis (Ebstein’s anomaly of the heart).

Narrow therapeutic window, requires close monitoring of serum levels

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10
Q

Ebstein’s anomaly of the heart

A

Opening of tricuspid valve is directed toward the apex of the RV.
Assoc w lithium in 1st trimester and WPW

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11
Q

Which anti-depressants have no sexual side effects?

A

Bupropion (wellbutrin)- atypical antidepr NDRI

Nefadozone- SNRI

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12
Q

Mjr depressive episode characteristics

A 
>2wks, need at least 5 of these and also must include pt-reported depressed mood or anhedonia:
SIG E CAPS (GAS C PIES)
Sleep disturbance
Interest loss
Guilt/feelings of worthlessness
Energy loss
Concentration loss
Appetite/weight chg
Psychomotor retardation/agitation (leaden/hard to get up off of couch)
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13
Q

Major depressive disorder- recurrent

A

2 or more major depressive episodes with a symptom-free interval of 2 months

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14
Q

Dysthymia

A

Milder form of depression, 2 criteria, lasting at least two years

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15
Q

Seasonal affective disorder

A

assoc’d w winter, improves w light

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16
Q

Lifetime prevalence of depression

A

5-12% male

10-25% female

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17
Q

Sleep patterns of depressed pts

A

Decreases slow wave sleep (Stg 3&4)
Decreased REM latency (get to REM faster)
Increased REM early in sleep cycle
Increased total REM
Repeated night time awakenings
Early morning awakening (imp screening question)

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18
Q

Atypical depression.

A

characterized by hypersomnia, hyperphagia (overeating), and mood reactivity- ability to experience improved mood in response to positive events, vs persistent sadness, and psychomotor retardation (feeling like lead)
Assocd w weight gain and sensitivity to rejection
Most common subtype of depression
Rx: MAOIs, SSRIs (NOT TCAs)

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19
Q

What are the 3 post-partum mood disturbances, epi

A

Postpartum blues: 50-85%
Postpartum depression: 10-15%
Postpartum psychosis: 0.1-0.2%

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20
Q

Postpartum blues

A

Mild depression for 10days/2wks
Increased tearfulness, tiredness.
Rx supportive care, usually resolves. follow up at postpartum visit
Educate pts about this before birth! 50-85% of pts!!

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21
Q

Postpartum depression

A

Depressed affect that doesn’t resolve after 2 weeks
Anx, poor concentration
A mjr depressive episode, just in the postpartum period.
Lasts 2 wks to over a year
Rx: anti-depressants, CBT, psychotherapy, supportive therapy

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22
Q

Postpartum psychosis

A

delusions, confusion, unusual bhvr, homicidal or suicidal ideations or attempts
Days-over 1mo
High assoc w bipolar disorder
Rx antipsychotics, antidepressants, in-pt hospitalization if pt is a danger

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23
Q

ECT

A

Treatment option for mjr depressive disorder if other Rx doesn’t work.
Cause painless seizure in an anesthetized pt.
Can cause disorientation and antero/retrograde amnesia (minimize by performing ECT unilaterally)

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24
Q

Risk factors for suicide completion

A 
SAD PERSONS:
Sex (male)
Age (teen or elderly)
Depression
Prev attempt
Ethanol/drug use
Rational thinking
Sickness (medical illness, 3+ prescriptions)
Organized plan
No spouse (divorced/widowed/single, esp if childless)
Social support lacking

Also, schizophrenia, access to a gun, and borderline personality disorder
Women try more, men succeed more.

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25
Q

List the TCAs

A

-ipramines and -tylines:

Imipramine, amitriptyline, desipramine, nortryptiline, clomipramine, doxepin, amoxapine.

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26
Q

How do TCAs work?

A

They block the reuptake of NE and Serotonin.

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27
Q

Use for TCAs

A

Mjr depression.
Imipramine: bed-wetting
Clomipramine: OCD
Also used for fibromyalgia (sympt improve w improved ability to sleep). Use nortriptyline for elderly pt/pt w fibromyalgia bc less side effects on ACh.

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28
Q

Side effects of TCAs

A

Sedation
alpha-blocking effects (hypotension, sedation, dizziness)
atropine-like (anticholinergic) effects- tachycardia, urinary retention
Tertiary TCAs (amitriptyline) have more anticholinergic effects than Secondary TCAs (nortriptyline).
Desipramine is the least sedating and has a lower seizure threshold.

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29
Q

TCA toxicity

A

Tri-C’s: convulsions, coma, cardiotoxicity (arrhythmias)
also, respiratory depression, hyperpyrexia-d/t convulsions.
Confusion and hallucinations in elderly d/t anticholinergic side effects (so use nortriptyline)
Rx: NaHCO3 for CV toxicity

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30
Q

List the SSRIs

A 
Fluoxetine
Paroxetine
Sertraline
Citalopram
Fluvoxamine
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31
Q

How do SSRIs work?

A

Sertonin-specific reuptake inhibitors

Usu takes 2-3 wks for them to start working (bridge w amphetamines)

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32
Q

Clinical use for SSRIs

A 
Depression
bulemia
basically any anx disorder:
generalized anx disorder
panic disorder
PTSD
OCD
social phobias
can also use for atypical depression
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33
Q

SSRI toxicity

A

Less toxicity than TCAs
Sexual dysfn #1 reason for discontinuation
GI distress
Serotonin syndrome w any other drug that increased serotonin (eg MAOI)

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34
Q

What is serotonin syndrome?

A

caused by taking multiple drugs that increase serotonin
hyperthermia, musc rigidity (contraction), CV collapse, flushing, diarrhea, seizures
Rx: cooling and benzos 1st, then cyproheptadine (serotonin receptor antagonist)

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35
Q

Drugs associated with Serotonin Syndrome (so don’t give these with SSRIs)

A 
Other SSRIs, SNRIs, MAOIs
St. John's Wort, kava kava
Sibutramine (SNRI for weight loss)
Tryptophan
Cocaine, amphetamines
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36
Q

SSRI withdrawal

A

dizziness, nausea, fatigue, musc aches, anx, irritibility- get all of these with short-acting SSRIs, so give long acting fluoxetine (t1/2 is 9 days) to gradually taper.

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37
Q

List the SNRIs

A 
Venlafaxine
Duloxetine
Desvenlafaxine
Nefadozone (no sexual side effects)
Milnacipran
Sibutramine (for weight loss)
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38
Q

How do SNRIs work?

A

Inhibit reuptake of both serotonin and NE

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39
Q

What are SNRIs used for?

A

Depression
Velafaxine- also used in gen anx disorder
Duloxetine- used for diabetic peripheral neuropathy
Duloxetine has a greater effect on NE.

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40
Q

Toxicity of SNRIs

A

Increased BP is most common

Also, stimulant effects, sedation, nausea

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41
Q

List MAOIs

A

Phenelzine
Tranylcypromine
Isocarboxazid
Selegiline (an MAO-B inhibitor, but not an anti-depressant. used for parkinsons)

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42
Q

Mechanism of MAOI

A

Nonselective MAO inhibition, leading to increased levels of amine NTs (Dopa, NE, Epi, Serotonin) bc MAO is inhibited and doesn’t break them down as usual

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43
Q

Clinical use for MAOIs

A

Atypical depression
Anx
Hypochondriasis (hypochondriac)

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44
Q

Toxicity for MAOIs

A

HTN crisis when ingesting food with tyramine (wine, cheese, beer, soy sauce, any food that’s aged)
HTN crisis with Beta-agonists
CNS stimulation
Contraindicated with SSRIs or meperidine (narcotic analgesic) to prevent serotonin syndrome
MAOI washout period- wait 2 wks before starting or after finishing MAOIs to avoid any interactions w other antidepressants

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45
Q

What are the atypical antidepressants?

A

Bupropion (wellbutrin) NDRI
Mirtzapine (a tetracyclic)
Trazodone (a tetracyclic)
Maprotiline

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46
Q

What atypical antidepressants are often used with SSRIs?

A

Buproprion (NDRI) and Trazodone

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47
Q

Buproprion

A

NDRI, Atypical antidepressant
Also used for smoking cessation
Increases NE and dopamine by unknown mech (so good w SSRI to increase serotonin and therefore cover all NTs)
Toxicity: stimulant effects (tachycardia, insomnia- so take in morning); headache. No sexual side effects.
Can cause seizure in bulemics or in anyone w hx of seizures or when given w anything that lowers the seizure threshold

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48
Q

Mirtzapine

A

Atypical antidepressant, tetracyclic.
Alpha2 antagonist (so increases rls of NE and serotonin), and potent serotonin receptor antagonist
Good for elderly pt w decreased appetite and insomnia (use side effects to advantage)
Toxicity: sedation, decreased appetite, weight gain, dry mouth (there are anti-histamine side effects)

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49
Q

Maprotiline

A

Atypical antidepressant
Blocks NE reuptake
Toxicity: sedation, orthostatic hypotension

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50
Q

Trazodone

A

Atypical antidepressant, tetracyclic.
Primarily inhibits serotonin reuptake.
Used for insomnia (esp in elderly) and at high doses for antidepressant
Toxicity: sedation, nausea, priapism (trazoBONE), postural hypotension

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51
Q

Amytriptylline side effects

A 
Amytriptylline = TCA
dry mouth
tinnitus
blurred vision
mania
these are mostly due to amytriptylline's anti-cholinergic activity
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52
Q

Cyclothymia vs dysthymia

A

Cyclothymia - milder form of bipolar, >2 years (think cyclic)
Dysthymia - milder form of depression >2 years (D for depression)

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53
Q

Mech of action for benzodiazapines

A

facilitate GABA by increasing frequency of Cl- chnl opening

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54
Q

Mech of action for barbituates

A

Facilitate GABA by increasing duration of Cl- chnl opening

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55
Q

NDRI

A

NE Dopamine Reuptake Inhibitor

Bupropion (atypical antidepressant)

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56
Q

Nortryptilline

A

TCA

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57
Q

Selegiline

A

MAOI (for parkinsons, not for depression)

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58
Q

Buproprion

A

NDRI, atypical antidepressant

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59
Q

Mirtazapine

A

Tetracyclic, atypical antidepressant

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60
Q

Fluvoxamine

A

SSRI

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61
Q

Doxepin

A

TCA

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62
Q

Phenelzine

A

MAOI

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63
Q

Fluoxetine

A

SSRI

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64
Q

Clomipramine

A

TCA

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65
Q

Imipramine

A

TCA

66
Q

Amitryptilline

A

TCA

67
Q

Nefazodone

A

SNRI

68
Q

Milnacipran

A

SNRI

69
Q

Desipramine

A

TCA

70
Q

Sertraline

A

SSRI

71
Q

Venlafaxine

A

SNRI

72
Q

Paroxetine

A

SSRI

73
Q

Tranylcypromine

A

MAOI

74
Q

Duloxetine

A

SNRI

75
Q

Citalopram

A

SSRI

76
Q

Desvenlafaxine

A

SNRI

77
Q

Trazodone

A

Tetracycline, Atypical antidepressant

78
Q

Panic disorder

A 
Recurrent periods of intense fear and discomfort peaking in 10min
Must have at least 4:
PANICS (PPANIICCCCSSS)
Palpitations
Paresthesia
Abd distress
Nausea
Intense fear of dying/losing control
LIght-headedness
Chest pain
Chills
Choking
disConnectedness
Sweating
Shaking
Shortness of breath

Described in context of occurance (eg panic disorder w agorophobia)
Assocd w persistent fear of having another attack

79
Q

Rx for panic disorder

A

Rx CBT (identifying underlying thought processes), SSRIs, TCAs, benzodiazepines (only when needed- simply having them can reduce incidence), B blockers (decrease HR)

80
Q

Specific phobia

A

Excessive/unreasonable fear that interferes w normal function
Cued by presence or anticipation of specific object/situation (eg fear of heights)
Pt recognizes fear is excessive
Rx systematic desensitization

81
Q

Social phobia (social anx disorder)

A

Exaggerated fear of embarassment in social situations (eg public speaking, using public restrooms)
Rx SSRIs

82
Q

OCD

A

Recurring intrusive thoughts, feelings, sensations (obsessions) that cause severe distress; relieved in part by the performance of repetitive actions (compulsions)
Ego-DYStonic: behvr is NOT consistent with one’s own beliefs/attitudes (vs O-C PERSONALITY disorder)
Ego-dystonic- the pt doesn’t like it
Assoc w Tourette’s
Rx: SSRIs, clomipramine (TCA)

83
Q

PTSD

A

Persistent reexperiencing of prev traumatic event.
Nightmares, flashbacks, intense fear, helplessness, horror
Avoidance of stimuli assocd w trauma, persistant increased arousal
Lasts >1mo w onset any time after event. Causes significant distress or impaired fn
Rx Psychotherapy, SSRIs

84
Q

Acute stress disorder

A

Sympt of PTSD but lasting bt 2 days to 1 mo

Actual PTSD is >1mo

85
Q

Generalized anx disorder

A

> 6mo
Anx that doesn’t fit into any other category
Uncontrollable anx that is NOT related to a specific person, situation, event.
Assoc w sleep disturbance, fatigue, difficulty concentrating
Rx: Buspirone, SSRIs, benzos

86
Q

Adjustment disorder

A

6mo in presence of a chronic stressor)

87
Q

Buspirone

A

Used for Generalized Anx Disorder (>6mo)
Stims serotonin receptors
Does not cause sedation, addiction, tolerance
Does not interact w alcohol (vs barbituates, benzos, which do)

88
Q

Malingering

A

Pt consciously fakes or claims to have a disorder in order to attain a specific secondary gain (eg avoiding work, obtaining drugs)
Avoids treatment by medical personnel
Complaints stop after pt gets what they want (not the case in factitious disorder)
Motivation is conscious- pt knows why they are doing it.

89
Q

Factitious disorder

A

Pt consciously creates physical/psychological sympt in order to assume “sick role” and to get medical attention (primary gain)
But their motivation for doing this is UNconscious- pt doesn’t know why they are doing it.

90
Q

Munchausen’s syndrome

A

Chronic factitious disorder w predominantly physical signs and symptoms.
Hx of multiple hospitalizations, willingness to receive invasive procedures

91
Q

Munchausen’s syndrome by proxy

A

Caregiver causes illness in child
Motivation is to assume a sick role by proxy
This is child abuse

92
Q

Faking illness to get out of work

A

Malingering

93
Q

Imagining going through the steps of a scary exam

A

Systematic desensitization (somatic desensitization)

94
Q

Somatoform disorders

A

Physical sympt w no identifiable physical cause. Illness production and motivation are unconscious drives. Sympt not intentionally produced or feigned. More common in women.
Types: somatization disorder, conversion, hypochondriasis, body dysmorphic disorder, pain disorder, pseudocyesis

95
Q

Somatization disorder

A

variety of complaints in multiple organ systems over a period of years
at least 4 pain, 2 GI, 1 sexual, 1 pseudoneurologic

96
Q

Conversion

A

motor or sensory symptoms- paralysis, blindness, mutism, pseudoseizures), often after acute stressor.
Pt is aware of sympt but unusually indifferent- la belle indifferance

97
Q

Hypochondriasis

A

preoccupation and fear of having a serious illness despite medical eval and reassurance

98
Q

Body dysmorphic disorder

A

preoccupation w minor or imagined defect in appearance, leading to significant emotional distress/impaired functioning
Pts often repeatedly seek cosmetic surgery

99
Q

Pain disorder

A

prolonged pain w no physical findings

100
Q

Pseudocyesis

A

false belief of being pregnant

101
Q

Motivation unconscious, creation of sympt conscious

A

Factitious disorder (incl munchausen’s)

102
Q

Motivation conscious, creation of symp conscious

A

Malingering

103
Q

Motivation unconscious, creation of sympt unconscious

A

Somatization

104
Q

Personality trait

A

enduring repetitive pattern of perceiving, relating to, thinking abt the env and oneself
exhibited in a wide range of imp social and personal contexts

105
Q

Personality disorder

A

inflexible, maladaptive, rigidly pervasive pattern of behavior causing subjective distress and/or impaired functioning
pt is usu not aware of problem
usu NOT dx’d in children, stable by early adulthood
can’t change them.

106
Q

Cluster A personality disorders

A

A = Weird- accusatory, aloof, awkward.
Odd, eccentric. Inability to devp meaningful social relationships
Not psychotic, but genetic assoc w schizophrenia
3 Types: paranoid, schizoid, schizotypal (ssp=scary street people)

107
Q

Cluster B personality disorders

A

B = Wild- bad, borderline, bubbly, best
Dramatic, emotional, or erratic
Genetic assoc w mood disorders and substance abuse.
4 types: antisocial, borderline, histrionic, narcissistic

108
Q

Cluster C personality disorders

A

C = Worried (cowardly, compulsive, clingy)
Anxious or fearful
Genetic assoc w anx disorders
3 types: avoidant, OC personality disorder (not OCD!), dependent

109
Q

Borderline personality disorder

A 
Cluster B (bad, BORDERLINE, bubbly, best)
Unstable mood and interpersonal relationships, impulsiveness, self-mutilation, suicide ideation, sense of emptiness
F>M
Splitting is a mjr defense mech (all gd or all bad)
110
Q

Schizoid

A 
Cluster A (accusatory, ALOOF, awkward)
Schizoid = Avoid
Voluntary social withdrawal, limited emotional expression, content w social isolation (vs avoidant, cluster c who is hps to rejection and wants relationships)
111
Q

Narcissistic personality disorder

A

Cluster B (bad, borderline, bubbly, BEST)
Grandiosity, sens of entitlement, lacks empathy and req’s excessive admiration
often demands the best and reacts to criticism with rage

112
Q

Dependent personality disorder

A

Cluster C (cowardly, compulsive, CLINGY)
submissive and clinging
excessive need to be taken care of
low self-confidence

113
Q

Paranoid personality disorder

A 
Cluster A (ACCUSATORY, aloof, awkward)
pervasive distrust and suspiciousness
projection is a mjr defense mech
114
Q

Obsessive compulsive personality disorder

A 
Cluster C (cowardly, COMPULSIVE, clingy)
Pre-occupation w order, perfectionism, and control. Ego-syntonic- the behavior IS consistent w own beliefs and attitudes (vs OCD, where it's not)
115
Q

Avoidant personality disorder

A 
Cluster C (COWARDLY, compulsive, clingy)
HPS to rejection, socially inhibited, timid, feelings of inadequacy
Desires relationships w others, but afraid. (vs schizoid, which avoids)
116
Q

Antisocial personality disorder

A

Cluster B (BAD, borderline, bubbly, best)
Disregard for and violation of rights of others, criminality
M>F
if s conduct disorder
antiSOCial = SOCiopath

117
Q

Schizotypal

A 
Cluster A (accusatory, aloof, AWKWARD)
Eccentric appearance, odd beliefs or magical thinking, interpersonal awkwardness
Schizotypal, dress like a pickle!
118
Q

Histrionic

A 
Cluster B (bad, borderline, BUBBLY, best)
Excessive emotionality and excitability, attention seeking, sexually provacative, overly concerned w appearance
119
Q

What are the genetic associations with cluster A, B, C

A

A: schizophrenia
B: mood disorders, substance abuse
C: anx disorders

120
Q

Substance dependence

A

Maladaptive pattern of substance use, 3 or more of the following signs in 1 year:
Tolerance (need more to get same effect)
Withdrawal
Substance taken in lgr amts and over longer time than desired
Persistent desire/unsuccessful attempts to cut down
Significant energy used to obtain, use, recover from substance
Reduced number of imp social, job-related, fun activities d/t substance use
Continued use even tho know it’s bad

121
Q

Substance abuse

A

Maladaptive pattern leading to clinically significant impairment/distress.
Sympt have NEVER met criteria for dependencs.
Recurrent use, leading to failure to fulfill mjr obligations at work/school/home
Recurrent use in physically dangerous situations
Recurrent legal problems bc of substance abuse
Keep using it in spite of persistent problems caused by use

122
Q

Substance withdrawal

A

Bhvrl, physiologic, cognitive state caused by cessation or reduction of heavy/prolonged use.
Sympt/signs often opposite of those seen in intoxication.

123
Q

S&S depressant:

Alcohol intoxication

A 
Disinhibition
Emotional lability
Slurred speech
Ataxia
Coma 
Blackouts
Serum gamma-glutamyltransferase (GGT)- sensitive indicator of alch use
Fatty chg of liver
AST = 2xALT (A Scotch & Tonic)
Rx: time! (naltrexone, disulfiram are for prevention)
124
Q

S&S depressant:

Alcohol withdrawal

A 
Alch withdrawal is life threatening!
Tremor 
Tachycardia
HTN
Malaise
Nausea
Seizures
DTs- delirium tremens
Tremulousness
Agitation
Hallucinations (incl tactile- ants)

Rx for DTs: benzodiazapines (or alcohol)

125
Q

S&S depressants:
opioid intoxication
eg morphine, heroin, methadone

A 
CNS depression
Naus/vom
constipation
pupillary constriction (pinpoint pupils)
seizures (OD is life-threatening)
Rx: naloxone, naltrexone
126
Q

S&S depressants:
opioid withdrawal
eg morphine, heroin, methadone

A 
uncomfortable, but NOT life threatening like alch withdrawal)
anx
insomnia
anorexia
sweating
dilated pupils
piloerection (cold turkey)
fever
rhinorrhea
nausea, stomach cramps, diarrha (flu-like sympt)
yawning

Rx: treat sympt; naloxone + buprenorphone (suboxone); methadone

127
Q

S&S depressants:

Barbituate intoxication

A

Respiratory depression.
Have a low safety margin
Rx: manage sympt (assist breathing, increase BP)

128
Q

S&S depressants:

Barbituate withdrawal

A

Anx
seizures
delirium
life-threatening CV collapse

129
Q

S&S depressants:

Benzodiazapine intoxication

A 
Greater safety margin than barbituates.
Amnesia
ataxia
somnolence (that's why ppl use them)
minor respi depression
additive effects w alcohol.

RX: flumazenil (competitive GABA antagonist)

130
Q

S&S depressants:

Benzodiazapine withdrawal

A

Rebound anx
seizures
tremor
insomnia

131
Q

Prevention of relapse in alcoholics

A 
AA
disulfiram
naltraxone
topiramate (anti-seizure drug)
acamprosate
132
Q

Delirium Tremens

A

life-threatening alch withdrawal syndrome
peaks 2-5 days after last drink
in order of appearance:
autonomic system hyperactivity (tachycardia, tremors, anx, seizures)
psychotic symptoms (hallucinations, delusions)
confusion

RX: benzos

133
Q

Alcoholism

A

physiological tolerance and dependence w sympt of withdrawal (tremor, tachycardia, HTN, malaise, nausea, DTs) when intake is interrupted
complications - alcoholic cirrhosis, hepatitis, pancreatitis, peripheral neuropathy, testicular atrophy, sat night palsy (compress radial nerve), aspiration pneumonia
Alch is a diuretic, so it causes tubular dysfn and will decrease Mg2+ levels- give alcoholics Mg2+ in the ER, esp if they are having heart problems.

134
Q

Wernicke-Korakoff syndrome

A

Seen in alcoholics.
Caused by thiamine/B1 deficiency
Triad: confusion, opthalmoplegia, ataxia (Wernicke’s encephalopathy)
May progress to irreversible memory loss, confabulation, personality chg (Korsakoff’s psychosis)
Assoc w periventricular hemorrhage/necrosis of mammillary bodies.
RX: IV thiamine/B1

135
Q

Mallory-Weiss syndrome

A

See in alcoholism
Longitudinal lacerations at the GE junction, caused by excessive vomiting.
Often presents w hematemesis
Assoc w pain (vs esophageal varices, which bleed but are painless)

136
Q

Heroin addiction

A

Users at incrsd risk for hepatitis, liver abscess, overdose, hemorrhoids, AIDS, right-sided endocarditis, tricuspid valve endocarditis. Many of risks are due to needle use, not heroin itself
Look for needle sticks in veins (track marks)
Will have sympt of opioid intoxication (pinpoint pupils, respi depression, coma)

Rx: Naloxone, naltrexone, methadone, suboxone

137
Q

Nalxone, naltrexone

A

Competitively inhibit opioids
Used in cases of opioid OD
If unconscious pt in ER, often give these just in case it’s OD.

138
Q

Methadone

A

long-acting oral opiate, used for heroin detox or long-term maintenance

139
Q

Suboxone

A

naloxone + buprenorphine (partial agonist)
long-acting w fewer withdrawal sympt than methadone.
naloxone is not active when taken orally, so withdrawal sympt occur only if injected. (lower abuse potential)

140
Q

Rx for benzo OD

A

Flumazenil

141
Q

What drug categories cause pupillary constriction (miosis)

A

Opiods

Organophosphates, any Anti-AChE (stigmines)

142
Q

What drug categories cause pupillary dilation (mydriasis)

A

Stimulants- amphetamines, cocaine
Muscarinic antagonists- atropine
Withdrawal of Opioids
Hallucinogens- LSD

143
Q

CAGE questionnaire

A 
Alch screening:
Cut back
Annoyed (when ppl ask you abt it)
Guilty
Eye-opener
144
Q

Rx for alcoholic with hypoglycemia

A

Give B1/Thiamine BEFORE giving glucose.
Alcoholics have impaired gluconeogenesis- they can’t generate glucose. But, if you just give them glucose, will cause Werenke-Korsakoff. So give B1 first, then can give glucose.

145
Q

What’s in a banana bag?

A

thiamine (B1), folate, multivitamines, Mg2+

give to alcoholics

146
Q

B1/thiamine deficiency

A

Causes Wereke-Korsakoff or Beri Beri (dry/wet)

147
Q

Rx for alcoholics (prophylaxis)

A

AA, disulfiram, etc
HBV, HAV, pneumonia, influenza vaccines
Warn abt tylenol use- 4g is toxic to liver.

148
Q

S&S stimulants:

Amphetamines intoxication/OD

A 
Psychomotor agitation
Impaired judgement
Pupillary dilation
HTN
Tachycardia
Euphoria
Prolonged wakefulness and attn
Cardiac arrhythmias
Delusions, hallucinations
Fever
149
Q

S&S stimulants:

Amphetamine and Cocaine withdrawal

A 
Post-use "crash"
severe depression, suicidality
lethargy, hypersomnulence, fatigue, malaise
stomach cramps, hunger
severe psychological craving
150
Q

S&S stimulants:

Cocaine OD

A 
Euphoria
Psychomotor agitation
impaired judgement
tachycardia
pupillary dilation
HTN
hallucinations (tactile)
paranoid ideations
angina
sudden cardiac death
151
Q

Rx for cocaine OD

A

benzos, haloperidol

152
Q

S&S stimulants:

Caffeine OD

A

Restlessness, insomnia, increased diuresis, muscle twitching, cardiac arrhythmia- PACs, PVCs (premature atrial, ventricle contractions)

153
Q

S&S stimulants:

Caffeine withdrawal

A

Headache, lethargy, depression, weight gain

154
Q

S&S stimulants:

Nicotine OD

A

Restlessness, insomnia, anx, arrhythmias- PACs, PVCs

155
Q

S&S stimulants:

Nicotine Withdrawal and RX

A

Irritability, headache, craving, weight gain
RX: nicotine replacement (gum, patch, losenge)
help prevent relapse w bupropion/varenicline

156
Q

S&S hallucinogens:

PCP intoxication/OD

A 
Belligerence (!)
impulsiveness
fever
psychomotor agitation
vertical and horizontal nystagmus
tachycardia
ataxia
Violence- homicidality
psychosis, delirium
157
Q

Rx for PCP intoxication

A

Benzos, haloperidol

158
Q

S&S hallucinogens:

PCP withdrawal

A

Depression, anx
irritability, restlessness
anergia, disturbances in thought and sleep
violence (can have with both OD and withdrawal)

159
Q

S&S hallucinogens:

LSD OD

A 
marked anx or depression
delusions
visual hallucinations
flashbacks (even years later)
pupillary dilation
160
Q

S&S hallucinogens:

MJ intoxication

A 
euphoria, anx, paranoid delusions
perception of slowed time
impaired judgement
increased appetite
dry mouth, hallucinations
red eyes (conjunctivitis)
long term: social withdrawal
teens who use have incrsd risk for schizophrenia
161
Q

S&S hallucinogens:

MJ withdrawal

A 
Irritability, depression
insomnia
nausea, anorexia
Most sympt peak in 48 hrs and last 5-7 days
Can detect in urine up to 1mo after use

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