Drugs Flashcards

Question

Alcohol use disorder

Answer 1

- NALTREXONE (opioid receptor antagonist) - decreases the reinforcing effects of alcohol use; decreases cravings, reduces heavy drinking days, and increases days of abstinence. CAN BE INITIATED WHILE PATIENT IS STILL DRINKING. Contraindicated in patients taking opioids and those with acute hepatitis or liver failure; ok to use in mild liver dysfunction - ACAMPROSATE (glutamate modulator) - maintains abstinence; INITATED ONCE ABSTINENCE IS ACHIEVED - DISULFURAM - CANDIDATES MUST BE ABSTINENT AND HIGHLY MOTIVATED

Answer 2

- Acute dystonia - tx: benztropine or diphenhydramine - Akathisia - tx: beta blocker or benzodiazepine - Parkinsonism - tx: benztropine or amantadine - Tardive dyskinesia - tx: no definitive treatment but clozapine may help most commonly associated with prolonged use of antipsychotic meds and is typically seen in pts with chronic psychotic disorders. It's also common for tardive dyskinesia to worsen or first appear following antipsychotic dose reduction or discontinuation. This is due to D2 receptor upregulation supersensitivity resulting from chronic blockade of dopamine receptors. When D2 receptor blockade is reduced, an exaggerated response of the D2 receptor even to low concentrations of dopamine may result in hyperkinetic movements.

Answer 3

Ach receptor partial agonist - can diminish nicotine cravings Side effects: mood changes, suicidality, CV events in ppl with pre-existing CV disease

Answer 4

Hereditary disorder involving alterations in heme biosynthesis Age of onset 30-40's Urinary porphobilinogen is elevated in acute porphyria Suspect in patients with unexplained abdominal pain and new-onset neuropsychiatric symptoms, including neuropathies, anxiety, mood changes, and psychosis Acute symptoms can be episodic and last days-weeks

Answer 5

- inability to recall important personal information, usually of a traumatic or stressful nature - not explained by another disorder (substance use, PTSD)

Answer 6

1st line tx for major depression with psychotic features; appropriate for severely depressed geriatric patients who are not eating or drinking and require a rapid intervention

Answer 7

mental status change, seizures, cardiac conduction delay, anticholinergic toxicity (eg dilated pupils, hyperthermia, flushed dry skin, intestinal ileus) QRS duration > 100 msec has been associated with an increased risk of arrhythmias and/or seizures and is an indication for tx with sodium bicarbonate

Answer 8

Nightmare disorder: recurrent episodes of awakening from sleep with recall of highly disturbing and frightening dream content. on awakening, the child is fully alert, remembers the dream, and usually can be consoled; dreams occur during REM sleep so are more frequent in the second half of the night Sleep terror disorder: non-REM arousal disorder characterized by incomplete awakenings, unresponsiveness to comfort, and no recall of dream content; usually occur in the first third of the night; marked autonomic arousal and amnesia for the episode in the morning

Answer 9

Slightly increased risk of suicidality in child and adolescent patients (18-24) on antidepressants Depressed patients should be carefully monitored for worsening depression and suicidality at the beginning of antidepressant therapy

Answer 10

Often presents with insomnia and/or anxiety - due to mild withdrawal Patients may use alcohol to help fall asleep but as BAL drops, CNS hyperarousal occurs and results in awakenings early in the night --> persistent difficulties in both falling and staying asleep Biomarkers used in screening for unhealthy alcohol use: AST:ALT = 2:1, elevated GGT, macrocytosis, pancytopenia, and increased carbohydrate-deficient transferrin

Answer 11

CBT: challenges maladaptive thoughts that underlie emotional reactions, targets avoidance with behavioral techniques Interpersonal psychotherapy: links current relationship conflicts to depressive symptoms Supportive psychotherapy: reinforces coping skills; therapist as guide Psychodynamic psychotherapy: builds insight into how unconscious conflicts and past relationships cause symptoms - can be used for depression, anorexia, and personality disorders Motivational interviewing: addresses ambivalence and enhances motivation to change DBT: improves emotion regulation, mindful awareness, distress tolerance; manages self-harm Biofeedback: improves awareness and control over physiological reactions; lowers stress levels

Answer 12

Schizoaffective disorder: delusions or hallucinations for 2+ weeks in the absence of major depressive or manic episode Bipolar I with psychotic features: psychotic symptoms occur exclusively during manic or depressive episodes

Answer 13

Emotional or behavioral symptoms developing within 3 months of an identifiable stressor and lasting no longer than 6 months once the stressor ceases Tx: psychotherapy- focuses on developing coping mechanisms and improving the individual's response to and attitude about the stressful situation

Answer 14

Hospitalization to maintain safety is indicated for patients with active SI that includes a plan and intent to act Patients with SI but no specific plan or intent need intensive outpatient tx, but not necessarily hospitalization

Answer 15

Victims are at increased lifetime risk for major depression and contemplation of suicide or actual attempts Also at increased risk for medical problems, including STD's, pelvic pain, fibromyalgia, functional GI disorders, and cervical cancer which may be linked to an avoidance of pelvic exams

Answer 16

Chronic depressed mood >2 years (1 year in children/adolescents) No symptom-free period for >2 months

Answer 17

Associated with mood disorders Immobility or excessive purposeless activity Mutism, stupor (decreased alertness and response to stimuli) Negativism (resistance to instructions) Catalepsy (limbs in fixed posture for long periods) Posturing Echolalia, echopraxia Tx: benzos (lorazepam), ECT Lorazepam challenge test (1-2 mg IV): resulting in partial temporary relief within 5-10 minutes confirms diagnosis

Answer 18

Neuroimaging studies have frequently shown loss of cortical tissue volume with ventricular enlargement, usually lateral ventricular enlargement --- Pts with schizophrenia who have critical, hostile or over-involved family members have a higher risk of relapse, while pts have a decreased risk of relapse if the home atmosphere is stable and family stressors are kept to a minimum Family psychosocial interventions are indicated for patients with a recent psychotic episode who have significant ongoing contact with family members

Answer 19

Commonly abused inhalants: glue, toluene, nitrous oxide, amyl nitrite, spray paints Abused by sniffing, huffing, bagging Boys age 14-17 are at highest risk for abuse Signs of acute intoxication: brief transient euphoria, LOC Inhalants are highly lipid soluble and produce immediate effects that typically last 15-45 minutes; they are rapidly eliminated and are not included in most routine hospital toxicology screens Act as CNS depressants and may cause death Dermatitis (glue sniffer's rash) due to chemical exposure can be seen around the mouth or nostrils

Answer 20

Marked anxiety about a specific object or situation for >6 months First-line tx is behavioral therapy, which involves exposure to the phobic stimulus in a controlled setting

Answer 21

Symptoms last >3 days and <1 month Exposure to actual or threatened trauma Intrusive memories, nightmares, flashbacks with intense psychological/physiological reactions Amnesia for event, detachment, avoidance of reminders Negative mood Arousal with sleep disturbance, irritability, hypervigilance, exaggerated startle, impaired concentration Early recognition and intervention are important as patients with ASD are at higher risk for subsequent PTSD

Answer 22

Can manifest with neuropsychiatric manifestations such as psychosis, depression, mania, anxiety, seizures, HA, peripheral neuropathy, strokes, and chorea Manifestations are thought to be due to immune-mediated inflammation and vasculitis Suspect in female with hx of arthralgia, thrombocytopenia, hematuria, proteinuria

Answer 23

Contraindications: CKD, heart disease, hyponatremia or diuretic use Baseline studies: BUN, cr, Ca, UA, thyroid function tests, EKG in pts with coronary risk factors Side effects: Acute - tremor, ataxia, weakness, polyuria, polydipsia, vomiting, diarrhea, cognitive impairment Chronic - nephrogenic DI, thyroid dysfunction, hyperparathyroidism

Answer 24

Intoxication: acute psychotic symptoms (paranoia and hallucinations), physical aggression-violent behavior, severe agitation, impulsivity, impaired judgement, NYSTAGMUS

Answer 25

Intoxication: euphoria, anxiety, agitation, psychosis, delirium, PUPILLARY DILATION, increased DTR's Overdose can cause cardiac arrhythmias, MI's, seizures, stroke

Answer 26

Intoxication: euphoria, visual hallucinations, subjective perceptual intensification (colors are richer, tastes are heightened, sensation is enhanced), depersonalization, illusions, PUPILLARY DILATION

Answer 27

Enuresis - only pathological after age 5 Encopresis - pathological after age 4

Answer 28

Men > women Mild form - no harm; 2x/week for 3 months Severe form - + harm; 3x ever over the course of 12 months Medications and therapy are useless so the question is 'do you need to incarcerate?' mild-no, severe-yes, but it is not up to the doctor anyway it is up to law enforcers

Answer 29

Setting fires for sexual arousal Must happen 2 or more times to diagnose --> is this arson? --> look for what the motivation is if setting fire to kill someone --> arson if setting fire due to inappropriate response to stressor --> intermittent explosive disorder if setting fire to collect insurance --> malingering/fraud if setting fire bc they like to --> pyromania Medications and therapy are useless

Answer 30

Pull out hair due to some anxiety Hair is of varying lengths Must rule out fungus Most feared complication: bezoar (variant form where person eats the hair that is pulled out; causes SBO)

Answer 31

5 types: Intrusion - memories, flashbacks, nightmares Mood changes - depressed mood Dissociation - depersonalization Avoidance - not going to the place where it happened, avoiding symbols or cues Arousal - irritability, hypervigilance Tx: psychotherapy (group therapy), SSRI's F/u: mood disorders, substance abuse

Answer 32

Pediatric disorders Pathology: neglect or abuse or lack of attachment as a child or in infancy Reactive Attachment Disorder - child has trouble forming emotional bonds or pairing with others, lonely, may suffer from depression Disinhibited Social Engagement Disorder - child pairs too much, does not differentiate between stranger and familiarity Dx: child must be <5 y/o to be diagnosed Must r/o autism, learning disabilities Tx: parental/caretaker education F/u: mood disorders, substance abuse

Answer 33

Only need 1 manic episode to diagnose "E" + 3 sx for more than 1 week ``` Distractibility Insomnia Grandiosity Flight of ideas Agitation/Activities Sexual exploits Talkative Elevated mood Racing thoughts ``` R/o substance abuse, bipolar II, and cyclothymia

Answer 34

Hypomania + major depressive episode | R/o catatonia and psychosis bc presence of either --> Bipolar I

Answer 35

``` Denial Depression Bargaining Anger Acceptance ```

Answer 36

Onset and Duration: Bereavement - anytime; lasts < 1 year PCBD - at least 6 months after the event; lasts 1+ years MDD - anytime; lasts 1+ years Focus of bereavement is on the deceased; reason for suicide is also focused on the deceased "I want to be with the person"; hopeful for happiness in the near future Focus of MDD is pervasive and global; hopeless about happiness in the near future; reason for suicide is due to negative reflection on self Focus of PCBD is same as bereavement (on the deceased; reason for suicide is to be with deceased) but has symptoms similar to MDD (pervasive and global symptoms, hopeless)

Answer 37

Chronic methamphetamine abuse can cause psychotic symptoms, including paranoid delusions and auditory, visual, and tactile hallucinations (bugs crawling under the skin). Other signs include marked weight loss, severe tooth decay, and excoriations due to skin picking , increased DTR's

Answer 38

Glucocorticoids, particularly at high doses, are often implicated

Answer 39

3 stages: 1) similar to EtOH intoxication 2) tachycardia, HTN, metabolic acidosis 3) renal failure from oxalate crystal formation

Answer 40

A group of 5 disorders characterized by delays in development in basic functions such as communicating and socializing - Atypical autism - Autism - Asperger's - Rett syndrome - Childhood disintegrative disorder

Answer 41

Found in synthetic heroin | Causes symptoms of Parkinson's bc it is a toxin that damages dopaminergic neurons in the substantia nigra/basal ganglia

Answer 42

Hypocretin deficiency is often found Order and length of non-REM and REM sleep is disturbed with REM sleep beginning at sleep onset instead of after a period of NREM sleep. Some patients will also experience an increase in REM density. This decreases sleep efficiency. Treatments include improved sleep hygiene, scheduled daytime naps, and avoidance of shift work. Amphetamines and non-amphetamines such as methylphenidate, modafinil and sodium oxybate can by prescribed to address daytime sleepiness.

Answer 43

mydriasis, dry mouth, tremors, rapid speech, agitation, and increased blood pressure Psychosis can sometimes occur