Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

phm 701 neuro/psych/sub abuse > Exam 4 > Flashcards

Exam 4 Flashcards

You may prefer our related Brainscape-certified flashcards:
Psychology 101 flashcards GRE® Psychology flashcards
1
Q

Lab findings in ADHD

A
  • Dec total brain volume
  • Dec activity in prefrontal and anterior cingulate cortex
  • Lack of connectivity of ventral striatum
    -Default mode network overactivity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Symptoms of ADHD

A
  • Inattention
  • Hyperactivity
  • Impulsivity
  • 6 or more present for more than 6 months in children, adults 5
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

ADHD Diagnosis pearls

A
  • always drug test (in order to rule out alternative causes)
  • evaluate every child 4-18 with behavioral or academic problems
  • significant impairment in 2 or more settings
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Consequences of untreated ADHD

A
  • delay in language, motor, and social development
  • inc incidence of conflicts
  • inc risk of suicide attempts in early adulthood
  • inc prevalence of SUD + incarceration
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Preschool/school age ADHD non pharm practices

A
  • parent/family edu
  • training on behavioral mod
  • behavioral class management (BCM)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Adolescents ADHD non pharm practices

A
  • break up assignments into segments
  • structure schedule
  • behavioral peer intervention
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Adults ADHD non pharm options

A

-ADHD CBT
-Metacognitive therapy ( 2h/w x 12 weeks)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Dietary supplements in ADHD

A
  • lack of evidence but if there’s deficiencies treat it
  • iron-zinc may inc stimulate effectiveness, omega 3
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Predominant ADHD first line

A

Methylphenidate > Amphetamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Predominant ADHD inadequate response to first line

A

Atomoxetine, Viloxazine, Guanfacine, Clonidine, Bupropion

Try combos or tca next

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Tourette’s

A

DA antagonist or a2 agonist (Clonidine)
- if patient has some response add on stimulant or atomoxetine or alternative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Bipolar/severe aggression (ADHD comorbidity)

A

Atypical APS, Lithium, Anticonvulsant
- if pt has some response add on A LOW DOSE stimulant (AE: mania)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Anxiety/ Depression (ADHD comorbidity)

A

Antidepressant (SSRI)
- if pt has some response add stimulant, no response use alternative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Stimulants MOA in ADHD

A

Block DA & NE uptake, inc catecholamine release, in monoamine oxidase (which inc DA in prefrontal cortex)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Immediate release amphetamines

A
  • mixed amp- IR salts (5-20)
  • amp sulfate IR (5-40)
  • odt (10-40)
  • d-amp-IR/liquid (2.5-40)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Stimulant AEs

A
  • psychiatric (mania/psychosis, aggression, sever anxiety) DOSE REDUCE
  • small cardiac changes ( 5 bpm inc)
  • dose related dec growth (drug free trial yrly)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Stimulants DDI (6)

A
  • MAOI (avoid, 14 day washout)
  • psycho-stimulants ( coffee, sildenafil, nicotine)
  • anti acids, ppis, H2RAs inc absorption of IR, dec absorption of ER MPH
  • Antacids dec excretion of AMP (requiring lower doses)
  • CYP2D6 inhibitors can inc AMP salt exposure (paroxetine & fluoxetine) requiring lower doses
  • Alcohol can cause stimulant dumping
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Common stimulant SE and ways to help (6)

A
  • reduced appetite/ weight loss= high calf meal when stimulant effect low (AM/QHS)
  • stomach ache= take with food or dec dose
  • insomnia = give earlier in the day, dec last dose of day or give it earlier, give sedative meds ( guanfacine, Clonidine, melatonin, cypro)
  • headache = Divide dose, take with food, give analgesic
  • rebound sumptuous= LA stimulant, atomoxetine, antidepressant
  • irritability/jitteriness= comorbid condition, dec dose, mood stabilizer/ atypical antipsychotics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Uncommon stimulant effects (5) and what to do

A
  • dysphoria/euphoria
  • zombie like state
  • tics
  • HTN
  • hallucinations (D/C, reassess, mood stabilizers)
  • dec dose consider alternative
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Immediate release advantages

A

low cost, less insomnia, fewer growth related ADE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Delayed release advantages

A

Med adherence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Delayed release AMP

A
  • mixed AMP-XR salts (5-30mg)
  • AMP sulfate ER suspension (6.3- 12.5)
  • AMP XR ODT (6.3-12.5)
  • D-AMP- ER (5-40 mg)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Clinical pearls about AMP ER Soln

A

-2.5- 5mg
- se: epistaxis(nose bleeds), upper abdominal pain, allergic rhinitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Clinical pearls about AMP XR ODT/Suspension

A
  • food delays time to peak
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Clinical pearls about Mydayis ( Mixed AMP Salts ER)

A

-onset 1-2 hrs, last 16 hours
- triple time release beads within capsules to reduce medication wearing off (better control)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Amphetamines moa at high doses

A

Stimulate serotonin release and acts as serotonin agonist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Transdermal MPH formulation

A
  • indication 6-17 years
  • 10, 15, 20, 30
  • apply 2 hrs b/f needed effect
  • apply to hips only (SE: chemical run throughout body)
  • max wear 9 hrs
  • 1-3 hr effect after removal
  • BBW site rxns: erythema/contact sensitization, chemical, leukoderma/hypopigmentation
28
Q

Transdermal AMP formulation

A
  • approved for 6 and up including adults
  • 4.5, 9, 13.5, 18
  • apply 2 hr prior
  • multiple sites (rotation)
  • max wear for 9 hrs
  • effects last 3 hours after removal
  • <10% of drug this present after disposal
  • app site rxns: pain, itchiness
29
Q

Methylphenidate clinical pearls

A
  • Can use used in seizure patients
  • Less DDIs (can use with CYP2D6 concerns)
  • Used to treat tics
  • Men have inc bioavail
30
Q

Amphetamine CI

A
  • history of CV disease ( mod- severe HTN, HF, recent MI )
31
Q

SNRI in ADHD

A
  • Atomoxetine
  • Viloxazine
    *full benefit takes 6-8 weeks, behaviors may worsen initially
32
Q

SNRI AE

A
  • upset stomach, psychiatric & cardio effects (not recommended in HD)
  • Fatigue, sedation, dizziness
  • liver toxicity w/ long term use
  • renal dose adj
33
Q

SNRI BBW

A

New onset sucidiality

34
Q

SNRI DDI

A
  • QT prolongation w/ TCA & APS
  • Atomoxetine conct inc by paroxetine and fluoxetine
  • Vuloxetine is strong CYP1A2 inhs
35
Q

Which MPH products are 30/70

A

MPH ER
MPH ER Chew
MPH CD (beads)

36
Q

Which MPH are 50/50

A

MPH LA
DEX-MPH-XR

37
Q

Clinical pearls about MPH XR ODT (Contempla)

A
  • do not push blister pack, peel back foil
  • dissolve in tongue
38
Q

Clinical pearls about Jornay PM (MPH ER)

A
  • take in the evening (8 pm)
  • drug first layer takes 10hr to dissolve, second layer dissolves through the day
    -14 hr from dose to peak effect
  • 2 drug compartments
39
Q

a2 agonist

A

Clonidine 0.1 QHS or BID max .4
Guanfacine 1-4 mg QD, max 7

40
Q

a2 agonist ae

A
  • sedation/dizziness/hypotension
    -constipation
    -heart block
    -dont take w/ high fat meal
41
Q

bupropion

A
  • 50-300 mg QD
  • metabolized faster in prepubertal children BID dosing
42
Q

Bupropion AE

A
  • appetite suppression
  • seizures
43
Q

TCA Monitoring and AE

A
  • 4 wks to see max effects
    -AE sedation, constipation, lethal overdose, rapid HR, weight gain, heart block
44
Q

Lithium/ Anticonvulsants in ADHD

A
  • treats aggression, explosive behaviors, impulsivity
    -BPD & ADHD
45
Q

APS in ADHD

A
  • 1st gen: chlorpromazine & Haloperidol treats hyperactivity; EPS concerns
  • 2nd gen treats severe aggression; metabolic risk
46
Q

What to use in patients with SUD

A
  • Atomoxetine, a2 agonist, bupropion
    -low doses of stimulates ER only
47
Q

treatment for tics

A

-MHP, clonidine, guanfacine, atomoxetine

48
Q

What products are appropriate for 3-5 year olds

A

Only IR products MHP & AMP

49
Q

Neuropathic pain def

A

pain caused by a lesion or disease of the somatosensory nervous system; nervous system damage

50
Q

Nervous System Damage

A
  • inc nerve firing
  • dec inh of neuronal activity
  • sensitization causing amplification and sustain sensory
51
Q

presentation of neuropathic pain

A
  • Spontaneous; continuous or intermittent
  • Hyperalgesia: inc pain from painful stimuli
  • Allodynia: pain from non-painful stimuli
52
Q

Counseling for neuropathic pain

A
  • Meds should not be taken on prn basis
  • Take days to weeks for max effect
  • Will dec pain NOT resolve it
    -always initiate non pharm
53
Q

Painful Diabetic Neuropathy Patho

A
  • Damage to peripheral nerves and abnorm electric connections causes hyper excitability and activation of NMDA
54
Q

PDN Treatments

A

-TCA, SNRI, Gabapentinoids +/- Na channel blockers
- Topical Capsaicin or Lidocaine

55
Q

Post herpetic Neuralgia

A
  • Reactivation of varicella-zoster virus (shingles)
  • distribution along dermatomes
  • sensory damage leads to dec neuritic density
56
Q

PHN treatment

A
  • TCA, Antiepi (gaba, pregab, divalproex), Tramadol, opioids
    -lidocaine (focal!) and capsaicin
57
Q

Lower back pain

A
  • cyclical mechanism
58
Q

LBP treatment

A
  1. NSAIDS
  2. Tramadol or Duloxetine 3. Opioids (last line)
59
Q

Fibromyalgia

A
  • enhanced sensitivity to stimuli (heat and cold) in all 4 quadrants
  • fog (fatigue & sleep)
  • women
  • neuroendocrine abnormalities
  • genetics
60
Q

Fibromyalgia Treatment

A

Amtriptyline, Duloxetine or Milnacipran, Tramadol, Pregab, Cyclobenzapine

61
Q

TCA Pearls

A

-Notriptyline, Despramine, Amitriptyline, Imipramine
-AE: beers list NO IN ELDERLY, delayed onset, cardiotoxic

62
Q

SNRI AE and CI

A
  • Duloxetine, Venlafaxine,
    –AE: Serotonin syn;
    –CI: Hepatic impairment, ESRD
  • Milnacipran
    –AE: BID, HTN
63
Q

Gabapentinoids

A

-Renal dose adj; crcl<15 lowest
-pregablin is a control
-both have slower onset

64
Q

opioids in pain

A

Last line
Tramadol (lower addiction profile) and Tapentadol

65
Q

Capsaicin

A

dont stick on sensitive areas
-ae burning

phm 701 neuro/psych/sub abuse (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions