friday flashcards
alzheimers
strong MEMORY impairment
Frontotemporal degeneration
Behavioral or Language variant
loss of sympathy, decline in speech
Lewy Body dz
Visual Hallucinations
REM sleep disorder
SEVERE sensitivity to Antipsychotics
Dont give Antipsychotics to
pts with Lewy Body dz
Vascular
dementia brought on by TIA or Stroke
Vascular dementia, will see on MRI
White matter hyperintensity
TBI (concussion)
LOC, post trauma amnesia, confused, neuro signs
can be acute or repeated trauma
Poorer outcomes w TBI are
repeated concussion
>40 YO
poor motor fx
non-reactive pupils
Prion dz
Insidious onset, but RAPID PROGRESSION
Myoclonus, Ataxia
Examples of Prion
Creutzfeldt-Jacob
Mad Cow dz
Cholinesterase inhibitors to tx dementia
Aricept
Razadyne
Namenda
NMDA antagonist to tx Dementia
Namenda
Characteristics of Alcoholism
it's a PRIMARY dz Progressive and fatal Impaired control Preoccupation Adverse consequences Denial
Four features of Alcoholism
Craving
Impaired control
Physical dependence
Tolerance
Bio-Psycho-Social model of Alcoholism
Bio (genetics, cells0
Psycho (cognitive, behavior)
Social (environment, inner circle)
Executive control
Prefrontal cortex
Nucleus Accumbens
Dopamine system target
alcoholism
Imbalance b/w
Pleasure and Control
in alcoholism
Dopamine system
Nucleus accumbens
Genetic pre-D for Alcoholism
in the Dopamine Transporter
Genetic pre-D for Alcoholism
Compulsivity is what runs in the family, surfaces as Alcoholism
Screening tools for Alcoholism
CAGE or AUDIT
At risk users
“substance misuse”
> 14 /week for men
> 7 /week for females
Problem users
“substance abuse”
experience problems related to use
health, legal, family, school, work
Dependent users
“addiction”
increased loss of control, alc related consequences, physiological dependence
CAGE screening
4 questions
if get +1, consider going to AUDIT
ADUT screening
best for Alcohol abuse, problem drinking
10 Qs
more sensitive and specific
CAGE questionarre
4 questions:
- feel like ought to cut down
- annoyed by others telling u to quit
- feel guilty
- need to use first in morning
Level of drinking
Abstinence Experiment Social/recreational Habit Abuse Addiction
Diagnostic criteria of Alcoholism
2+ within 12 months
4 categories of Alcoholic diagnostic criteria
Impaired Control
Social impairment
Risky Use
Pharm
3 motivational techniques for getting patient into Alcohoism treatment
Confrontation
Empathy
Offering Hope
How much is too much alcohol?
Tolerance + Dependence + Compulsion = get help
In patient DETOX of alcoholism
Benzos (“pam”)
Lorazepam
PhenoBARBitol
Nutritional support for Alc DETOX
Thiamine
Extended tx for Alcoholism
Disulfuram
Acamprosate
Naltrexone
Methadone or Buprenorphine (Suboxone) are used to treat
Opioid addiction
How does Suboxone work
Bind to mu receptor (same as morphine) but doesn’t produce same effects
weak partial agonist
reduce Craving and Prevents euphoria (low abuse potential)
3 derivatives of opium
Morphine
Codeine
Thebaine
Morphine divides into (3)
Hydromomorphone
Oxymorphone
Heroin
Thebaine divides into (2)
Oxycodone
Etorphine
Synthetic opiates
Methadone Meperidine Propoxyphene LAAM Fentanyl
Dysphoria
Kappa
Sedation
Mu and Kappa
Dependencee
Mu and Kappa
Rick of continued opioid use increases at
4-5 DAYS
Drug seeking behavior
The over reporting/ over fabrication of sx
Common drugs that are sought to abuse
Euphoria Rapid onset/high potency/short duration High purity Water soluble Brand name
Specific drugs that are often abused
Opiates -percocet, vicodin, morphine Sleep aids -Benzos: xanax, valium, ambien -barbs
Opioid use disorder
have TWO of criteria
Opioid use disorder
Early >3 months
Late remission >12 months
Severity of OUD
mild 2-3 sx
moderate 4-5 sx
severe 6+
Tx of OUD
Narcan for OD
Clonidine for SNS overstimulation
Methadone taper
Extended tx of OUD
Methadone or Buprenor (Suboxone)
Suboxone
binds to same Mu receptors
reduces craving and prevents euphoria
long acting, decreased respiratory depression
Suboxone requires
DEA ‘X’ license/ MAT training
