NSG 552 EXAM 3

Question 1

Cluster of disorders in which cognitive, behavioral and physiological symptoms indicate that a person continues using a substance despite substance-related problems (American Psychiatric Association, 2013)

“Sub-“

Answer 1

Substance Use Disorders

Question 2

Drug use that is inconsistent with social use patterns.

“abu-“

Answer 2

Abuse

Question 3

Reversible syndrome caused by a specific substance affecting memory, judgement, behavior or social or occupational functioning

“intox-“

Answer 3

Intoxication

Question 4

Substance specific symptoms that occur after stopping or reducing use (opposite of the drug’s intoxication symptoms).

“withd-“

Answer 4

Withdrawal

Question 5

Needing more of the substance to get the desired effect.

“Tol-“

Answer 5

Tolerance

Question 6

Reinforcement occurs in the:

“Ven- teg-“ and “Nuc- accu-“

Answer 6

Ventral tegmental area (VTA) and the Nucleus accumbens (Reward center)

Question 7

Positive rewards of reinforcement= mediated by ____ pathways.

“D-“

Answer 7

DA (dopamine)

Question 8

____________ release within the reward center is enhanced by the release of natural morphine-like neurotransmitters (Neuropeptides- enkaphalins, beta endorphins).

“Dop-“

Answer 8

DA (dopamine)

Question 9

Repeated drug use —> ________ system becomes increasingly sensitized.

“Dop-“

Answer 9

DA (dopamine)

Question 10

Classes of Substance Use Disorders:

Caffeine, nicotine, amphetamines, cocaine, ecstasy

“stim-“

Answer 10

stimulants

Question 11

Classes of Substance Use Disorders:

Benzodiazepines, Alcohol

“depr-“

Answer 11

depressants

Question 12

Classes of Substance Use Disorders:

Opioids

“narc-“

Answer 12

narcotics

Question 13

Classes of Substance Use Disorders:

Lysergic acid diethylamide (LSD) Marijuana

“hall-“

Answer 13

hallucinogens

Question 14

• Impaired fine motor control
• Impaired judgement and coordination
• Ataxic gait and poor balance
• Lethargy, difficulty sitting upright, difficulty with memory,
• Nausea/Vomiting
• Coma = Levels 300mg/dL and over
• Respiratory depression and death possible

This is?

“alc- intox-“

Answer 14

alcohol intoxication

Question 15

Mild: Insomnia, Irritability, Hand tremor

Moderate: Autonomic hyperactivity (diaphoresis, tachy, HTN), Fever

Severe: Seizures (12-48 hours post consumption); Hallucinations; Delirium Tremens (48-96 hours after last drink)

• Anxiety
• Anorexia
• Nausea/Vomiting
• Psychomotor agitation

NOTE: Use the Clinical Institute Withdrawal Assessment(CIWA) to monitor withdrawal

What is this?

“alc- withd-“

Answer 15

alcohol withdrawal

Question 16

________ withdrawal: Insomnia, Irritability, Hand tremor

“mil-“

Answer 16

mild

Question 17

________ withdrawal: Autonomic hyperactivity (diaphoresis, tachy, HTN), Fever

“mod-“

Answer 17

moderate

Question 18

________ withdrawal: Seizures (12-48 hours post consumption); Hallucinations; Delirium Tremens (48-96 hours after last drink)

“sev-“

Answer 18

severe

Question 19

Alcohol Withdrawal delirium: Initial treatment is a ___________.

Careful with the use of antipsychotics because they lower the seizure threshold.

“benz-“

Answer 19

benzodiazepine

Question 20

____________________: Initial treatment is a benzodiazepine.

Careful with the use of antipsychotics because they lower the seizure threshold.

“alc- wit- del-“

Answer 20

Alcohol Withdrawal delirium

Question 21

Alcohol Withdrawal delirium: Initial treatment is a benzodiazepine.

Careful with the use of antipsychotics because the lower the _______ threshold.

“seiz-“

Answer 21

seizure

Question 22

Alcohol Withdrawal delirium: Initial treatment is a benzodiazepine.

Careful with the use of _____________ because the lower the seizure threshold.

“anti-“

Answer 22

antipsychotics

Question 23

• Opioid receptor antagonist
• Reduces desire/cravings
• First line treatment – Good for heavy drinkers
• PO or monthly injection (Vivitrol) - great for patients with non-compliance issues.
• Will precipitate withdrawal in patients with physical opioid dependence.
• D/C 48-72 hours prior to receiving opiate analgesia.

Which med is this?

“nalt-“

Answer 23

naltrexone (Revia, Vivitrol [IM])

Question 24

Functions as “artificial alcohol” by reducing glutamate activity.

• Reduces neuronal hyperactivity during early alcohol recovery – helps sustain abstinence.
• Likely modulates glutamate transmission
• First line treatment in maintaining abstinence after detox
• Used for relapse prevention (post detoxification)
• Can be used in liver disease- not metabolized by the liver (not impacted by ETOH use)
• Can be administered to patients with hepatitis, liver disease and those who continue drinking alcohol
• Contraindicated in severe renal disease.
• Decreases craving – good for individuals who are abstinent or recently relapsed.

Which med is this?

“acamp-“

Answer 24

acamprosate (Campral)

Question 25

Functions as “artificial alcohol” by reducing glutamate activity. Which med is this? "acamp-"

Answer 25

acamprosate (Campral)

Question 26

Reduces neuronal hyperactivity during early alcohol recovery – helps sustain abstinence. Which med is this? "acamp-"

Answer 26

acamprosate (Campral)

Question 27

Likely modulates glutamate transmission Which med is this? "acamp-"

Answer 27

acamprosate (Campral)

Question 28

First line treatment in maintaining abstinence after detox Which med is this? "acamp-"

Answer 28

acamprosate (Campral)

Question 29

Used for relapse prevention (post detoxification) Which med is this? "acamp-"

Answer 29

acamprosate (Campral)

Question 30

Can be used in liver disease- not metabolized by the liver (not impacted by ETOH use) Which med is this? "acamp-"

Answer 30

acamprosate (Campral)

Question 31

Can be administered to patients with hepatitis, liver disease and those who continue drinking alcohol Which med is this? "acamp-"

Answer 31

acamprosate (Campral)

Question 32

Contraindicated in severe renal disease. Which med is this? "acamp-"

Answer 32

acamprosate (Campral)

Question 33

Decreases craving – good for individuals who are abstinent or recently relapsed. Which med is this? "acamp-"

Answer 33

acamprosate (Campral)

Question 34

Opioid receptor antagonist Which med is this? "nalt-"

Answer 34

naltrexone (Revia, Vivitrol [IM])

Question 35

Reduces desire/cravings Which med is this? "nalt-"

Answer 35

naltrexone (Revia, Vivitrol [IM])

Question 36

First line treatment – Good for heavy drinkers Which med is this? "nalt-"

Answer 36

naltrexone (Revia, Vivitrol [IM])

Question 37

PO or monthly injection (Vivitrol)- great for patients with non-compliance issues. Which med is this? "nal-"

Answer 37

naltrexone (Revia, Vivitrol [IM])

Question 38

Will precipitate withdrawal in patients with physical opioid dependence. Which med is this? "nalt-"

Answer 38

naltrexone (Revia, Vivitrol [IM])

Question 39

D/C 48-72 hours prior to receiving opiate analgesia. Which med is this? "nalt-"

Answer 39

naltrexone (Revia, Vivitrol [IM])

Question 40

- Blocks enzyme(Aldehyde dehydrogenase) in the liver - Causes aversion reaction to ETOH(flushing, headaches, n/v, palpitation, SOB, vertigo, hypotension) - Do not administer until the person has been alcohol free at least 12 hours - Educate patients to refrain from using anything that contains alcohol (vinegar, aftershave, perfumes, mouthwash, cough medicine) while taking and up to 2 weeks after discontinuation. - Contraindicated in severe cardiac disease, pregnancy, psychosis - For highly motivated patients Which med is this? "disul-"

Answer 40

disulfiram (Antabuse)- 2nd line

Question 41

Blocks enzyme(Aldehyde dehydrogenase) in the liver Which med is this? "disul-"

Answer 41

disulfiram (Antabuse)- 2nd line

Question 42

Causes aversion reaction to ETOH(flushing, headaches, n/v, palpitation, SOB, vertigo, hypotension) Which med is this? "disul-"

Answer 42

disulfiram (Antabuse)- 2nd line

Question 43

Do not administer until the person has been alcohol free at least 12 hours Which med is this? "disul-"

Answer 43

disulfiram (Antabuse)- 2nd line

Question 44

Educate patients to refrain from using anything that contains alcohol (vinegar, aftershave, perfumes, mouthwash, cough medicine) while taking and up to 2 weeks after discontinuation. Which med is this? "disul-"

Answer 44

disulfiram (Antabuse)- 2nd line

Question 45

Contraindicated in severe cardiac disease, pregnancy, psychosis Which med is this? "disul-"

Answer 45

disulfiram (Antabuse)- 2nd line

Question 46

For highly motivated patients Which med is this? "disul-"

Answer 46

disulfiram (Antabuse)- 2nd line

Question 47

- Potentiates GABA and inhibits Glutamate - Reduces cravings - Remember DOPE-a-max (impaired cognition, nausea, weight loss, metabolic acidosis. Which med is this? "topi-"

Answer 47

topiramate (Topamax) - 2nd line

Question 48

Potentiates GABA and inhibits Glutamate Which med is this? "topi-"

Answer 48

topiramate (Topamax) - 2nd line

Question 49

Reduces cravings Which med is this? "topi-"

Answer 49

topiramate (Topamax) - 2nd line

Question 50

Remember DOPE-a-max (impaired cognition, nausea, weight loss, metabolic acidosis. Which med is this? "topi-"

Answer 50

topiramate (Topamax) - 2nd line

Question 51

Treatment of withdrawal: (Three benzos to keep patient calm and lightly sedated. "L, D, and C"

Answer 51

- lorazepam (Ativan) - diazepam (Valium) - chlordiazepoxide (Librium)

Question 52

MOA: Enhance the effects of GABA Which drug class? "B-"

Answer 52

Benzodiazepines

Question 53

Use these three meds in mild withdrawal: "Gab-, Valp-, and Car-"

Answer 53

- gabapentin (Neurontin) - valproic acid (Depakene) - carbamazepine (Tegretol)

Question 54

Use these three meds in ____ withdrawal: - gabapentin (Neurontin) - valproic acid (Depakene) - carbamazepine (Tegretol) "mi-"

Answer 54

mild

Question 55

Three supplements used for nutritional deficiencies in treatment of withdrawal. "t" "f" "m"

Answer 55

Thiamine, folic acid and multivitamin

Question 56

These two supplements used to prevent or treat Wernicke’s encephalopathy (B1 deficiency) "pare- thi-" and "fol-"

Answer 56

Parenteral thiamine and folate

Question 57

Another important thing for tx of withdrawal: "flu" and "ele" balance

Answer 57

Fluid and electrolyte balance

Question 58

CIWA Score <10 = "mi-"

Answer 58

mild

Question 59

CIWA score 10-15 = "mod-"

Answer 59

moderate

Question 60

CIWA score 15 = "sev-"

Answer 60

severe

Question 61

Banana Bag ingredients (i.e. thiamine, multivitamin, folic acid). What are we trying to prevent? "Wern-"

Answer 61

Wernicke’s encephalopathy

Question 62

__________ blocks reuptake of dopamine, epinephrine and NE = Stimulant effect "coc-"

Answer 62

Cocaine

Question 63

- Euphoria - Heightened self esteem - Decreased BP - Tachycardia or bradycardia - Nausea - Dilated pupils - Psychomotor agitation or depression - Chills and sweating - Dangerous/Deadly: Seizures, cardiac arrythmias, paranoia, hallucinations NOTE: Cocaine has vasoconstrictive effects= can cause MI, stroke What is this? "coc- intox-"

Answer 63

cocaine intoxication

Question 64

Post intoxication depression “Crash” - Fatigue - Malaise - Hypersomnolence - Depression - Anhedonia - Hunger - Constricted pupils - Vivid dreams What is this? "coc- with-"

Answer 64

cocaine withdrawal

Question 65

NO FDA approved med for treatment of which condition? "coc- with-"

Answer 65

cocaine withdrawal

Question 66

Off-label med treatment for cocaine withdrawal = "Nalt-," "modaf-," and "Topi-"

Answer 66

Naltrexone, modafinil, Topamax

Question 67

Supportive care for which condition ? (control HTN, arrhythmias) "coc- with-"

Answer 67

cocaine withdrawal

Question 68

Used for mild-moderate agitation in cocaine withdrawal = "benz-"

Answer 68

Benzodiazepines

Question 69

Used for severe agitation or psychosis in cocaine withdrawal: "antip-"

Answer 69

antipsychotics

Question 70

___________ use in Cocaine use disorder =increase synaptic dopamine in the brain reward circuit and act as an agonist treatment in the setting of cocaine use disorder "disul-"

Answer 70

disulfiram (Antabuse)

Question 71

NOTE: Medications for cocaine-induced chest pain and myocardial infarction = "nitr-" and "aspi-"

Answer 71

Nitroglycerin, Aspirin

Question 72

NOTE: Medications for cocaine-induced chest pain and myocardial infarction = Nitroglycerin, Aspirin Don't use which med? "meto-"

Answer 72

metoprolol (Lopressor)

Question 73

Often used in dance clubs and raves "Amp-"

Answer 73

Amphetamines

Question 74

Have both stimulant and hallucinogenic properties "Amp-"

Answer 74

Amphetamines

Question 75

Intoxication is similar to cocaine "Amp-"

Answer 75

Amphetamines

Question 76

Can cause ongoing psychosis "Amp-"

Answer 76

Amphetamines

Question 77

Withdrawal can cause prolonged depression "Amp-"

Answer 77

Amphetamines

Question 78

Txt: Rehydrate, correct electrolyte and treat hyperthermia "Amp-"

Answer 78

Amphetamines

Question 79

Intoxication effects of which drug? - Rage - Erythema - Dilated pupils - Delusions - Amnesia - Nystagmus - Excitation - Skin dryness "Phen-"

Answer 79

(Phencyclidine) PCP

Question 80

Treatment for which drug? Treatment: Supportive care (rehydration, electrolyte balance etc.) - Benzos for agitation, anxiety, muscle spasms - Haldol for severe agitation and psychosis "Phen-"

Answer 80

(Phencyclidine) PCP

Question 81

Regarding which illicit substance? - No withdrawal - Recurrence of intoxication due to release of the drug from body lipid stores.

Answer 81

(Phencyclidine) PCP

Question 82

Nystagmus (Red-bolded) side effect of which drug? "Phen-"

Answer 82

(Phencyclidine) PCP

Question 83

The below are part of which drug class? Benzos, barbiturates, Zolpidem, zaleplon, GHB(date rape drug), "sed- hyp-"

Answer 83

sedative hypnotics

Question 84

Intoxication side effects of which drug class? - Drowsiness - Confusion - Hypotension - Slurred speech - Incoordination - Ataxia - Mood lability Impaired judgment - Respiratory depression or death in OD "sed- hyp-"

Answer 84

sedative hypnotics

Question 85

Regarding withdrawal of which drug class? Abrupt abstinence after chronic use can be life-threatening. "sed- hyp-"

Answer 85

sedative hypnotics

Question 86

Intoxication treatment for which drug class? - Maintain airway, breathing and circulation - Supportive care (improve respiratory status, control hypotension) - Activated charcoal and gastric lavage to prevent further GI absorption= in Overdoses - Benzos= Flumazenil in OD (Benzo antagonist) "sed- hyp-"

Answer 86

sedative hypnotics

Question 87

For benzodiazepine OD (a sedative hypnotic) which medication would you use (a benzo antagonist)? "flu-"

Answer 87

flumazenil

Question 88

Regarding withdrawal treatment of which drug class? - Benzodiazepines (stabilize patient and taper gradually) - Carbamazepine or valproic acid (taper not as beneficial) "sed- hyp-"

Answer 88

sedative hypnotics

Question 89

Benefits of use regarding which substance? - decreasing N/V - increasing appetite in AIDS patients - decreasing chronic pain from cancer - lowering intraocular pressure in glaucoma "mari-"

Answer 89

marijuana

Question 90

Euphoria, anxiety, impaired motor coordination, mild tachycardia, Conjunctival injection “red eyes”, dry mouth, Munchies= increased appetite - Cannabis induced Psychotic disorder: paranoia, hallucinations and delusions. These are side effects of intoxication of which substance? "mari-"

Answer 90

marijuana

Question 91

Irritability, anxiety, restlessness, aggression, strange dreams, depression, headaches, insomnia, low appetite Withdrawal effects of which substance? "mari-"

Answer 91

marijuana

Question 92

- Supportive care - Based on symptoms Treatment options for which substance? "mari-"

Answer 92

marijuana

Question 93

Restlessness Insomnia Anxiety Increased GI motility Effects from which substance? "nico-"

Answer 93

nicotine

Question 94

- Intense craving - Dysphoria - Anxiety - Poor concentration - Increased appetite - Weight gain - Irritability - Restlessness - Insomnia Withdrawal of which substance? "nico-"

Answer 94

nicotine

Question 95

Varenicline(Chantix) - Mimics action of Nicotine The most effective tobacco cessation - Reduces rewarding aspects - Prevents withdrawal symptoms Treatment for which substance? "nico-"

Answer 95

nicotine

Question 96

Bupropion (Zyban) - Inhibits reuptake of dopamine and norepinephrine - Helps reduce craving and withdrawal symptoms Treatment for which substance? "nico-"

Answer 96

nicotine

Question 97

Nicotine Replacement therapy (NRT) - Available as transdermal patch, gum, lozenge, nasal spray and inhaler - Nicotine patch- watch for vivid dreams or sleep disruptions Treatment for which substance? "nico-"

Answer 97

nicotine

Question 98

The leading causes of death in patients with serious mental illness are heart disease, cancer, and cerebrovascular or respiratory disease, which can all be linked to smoking. T/F

Answer 98

True

Question 99

This drug class stimulates mu, kappa and delta opiate receptors Effects on the dopaminergic system which mediates their addictive and rewarding properties "opio-"

Answer 99

Opioids

Question 100

Drowsiness N/V ↓GI motility (Constipation; abdominal cramps) Sedation Slurred speech Miosis(constricted pupils) Seizures Respiratory depression Arthralgia/myalgia Intoxication effects of which drug class? "Opio-"

Answer 100

Opioids

Question 101

Flu-like symptoms (body aches, anorexia, rhinorrhea, fever) Diarrhea Anxiety Insomnia Withdrawal effects of which drug class? "Opio-"

Answer 101

Opioids

Question 102

- opium - heroin - morphine - oxycodone - methadone - hydrocodone - codeine Examples of which drug class? "Opio-"

Answer 102

Opioids

Question 103

- Airway support - In overdose, give Naloxone (opioid antagonist) - Ventilator if required - Patients at risk of overdose should be prescribed a naloxone (Narcan) kit to keep at home for emergencies. Treatment for intoxication of which drug class? "Opio-"

Answer 103

Opioids

Question 104

Moderate symptoms = Symptomatic treatment with; - Clonidine for autonomic s/s - NSAIDs for pain, Baclofen for muscular spasms - Benzos for anxiety & agitation - Loperamide for diarrhea - Dicyclomine for abdominal cramps - Promethazine for nausea - Antinausea medications - Hypnotics for insomnia (e.g. trazodone, low dose quetiapine, diphenhydramine) NOTE: In clinical experience, when administered for detoxification and not maintenance, buprenorphine is more effective at suppressing and controlling withdrawal symptoms as the taper nears completion compared with methadone Treatment for the withdrawal of which drug class? "Opio-"

Answer 104

Opioids

Question 105

NOTE: In clinical experience, when administered for detoxification and not maintenance, buprenorphine is more effective at suppressing and controlling withdrawal symptoms as the taper nears completion compared with methadone This is regarding which drug class? "Opio-"

Answer 105

Opioids

Question 106

Naloxone (Narcan) - Potent opioid antagonist - Treatment of choice for opiate overdose - Routinely prescribe for all patients with opioid use disorder - Very short half life - Length of effects 30-90 min Treatment for which drug class? "Opio-"

Answer 106

Opioids

Question 107

Methadone (Dolophine) - Long-acting full opioid receptor AGONIST at mu receptor - 1x/daily - Restricted federally licensed substance abuse treatment programs - Monitor for QTC prolongation (cardiac abnormalities) Treatment for which drug class? "Opio-"

Answer 107

Opioids

Question 108

Buprenorphine (Buprenex, Sublocade) Buprenorphine/Naloxone(Suboxone) - Partial Opioid receptor agonist/ opioid antagonist - Decreases cravings - Can precipitate withdrawal if used too soon after full opioid agonist - Sublingual preparation that is safer - Suboxone: 2023- Consolidated Appropriations Act, 2023 removed special waiver needed to prescribe for the treatment of Opioid Use Disorder (OUD). - Must have a DEA Schedule III authority to prescribe. Treatment for which drug class? "Opio-"

Answer 108

Opioids

Question 109

Naltrexone - Competitive opioid antagonist - Pill works approx. 24 hours; Injection may last up to 30 days. - Precipitate withdrawal if used within 7 days of heroin use - Available orally or monthly depot injection. - Treatment of choice for highly motivated patients. - Risk for LFT elevation Treatment for which drug class? "Opio-"

Answer 109

Opioids

Question 110

Decreased mortality with overdose. Which drug class? "opi- ago-"

Answer 110

Opioid Agonists (Buprenorphine/Methadone)

Question 111

- Need to successfully complete opioid withdrawal prior to treatment. - Precipitates withdrawal in patients actively using opioids Which drug class? "opi- ant-"

Answer 111

Opioid Antagonists (Naltrexone)

Question 112

Buprenorphine - Preferred as initial treatment - Lower risk of death in overdose – lower potential of causing respiratory depression. - Providers can prescribe this in outpatient settings – no waiver required. - Fewer drug-drug interactions. Buprenorphine vs Methadone Regarding which drug class? "opio-"

Answer 112

Opioids

Question 113

Methadone - For individuals with high tolerance - Appropriate for patients with higher level of physical dependance or prior misuse/diversion of buprenorphine - Requires daily visits to a licensed opioid treatment program (OTP) Buprenorphine vs Methadone Regarding which drug class? "opio-"

Answer 113

Opioids

Question 114

NOTE: If this medication is used too soon after a patient’s last opioid use, ________________ will displace any residual opioids from the μ receptors and can precipitate withdrawal symptoms "bupr-"

Answer 114

buprenorphine

Question 115

Opioid Use disorder w/ comorbid pain = this med can be used in managing pain "sub-"

Answer 115

Suboxone

Question 116

Inappropriate use of opioids may be an indication that the patient’s pain is uncontrolled. True or False?

Answer 116

True

Question 117

Includes psilocybin (mushrooms), mescaline (peyote cactus) and lysergic acid diethylamide (LSD) "hallu-"

Answer 117

Hallucinogenics

Question 118

- Illusions - Hallucinations - Body image distortions - Labile affect - Dilated pupils - Tachycardia - HTN - Hyperthermia - Tremors - Incoordination - Sweating - Palpitations Intoxication effects of which kind of substance? "hallu-"

Answer 118

Hallucinogens

Question 119

Do not cause physical dependence or withdrawal Regarding which kind of substance? "hallu-"

Answer 119

Hallucinogens

Question 120

May use Benzos and antipsychotic medications for agitation Regarding treatment for which kind of substance? "hallu-"

Answer 120

Hallucinogens

Question 121

- generally act as CNS depressants - Most common in preadolescents or adolescents - E.g. solvents, glue, paint thinners, fuels, isobutyl nitrates (“huffing” “laughing gas” “rush”) Regarding which substance? "inha-"

Answer 121

inhalant

Question 122

- Perceptual disturbances - Paranoia - Lethargy - Dizziness - Nausea/vomiting - Headache - Nystagmus - Tremor - Muscle weakness - Ataxia - Slurred speech - Euphoria - Clouding of consciousness - Stupor or coma Intoxication effects of which kind of substance? "inha-"

Answer 122

inhalants

Question 123

- Does not usually occur - Irritability - Sleep disturbance - Anxiety - Depression - Nausea/vomiting - Craving Withdrawal effects of which kind of substance? "inha-"

Answer 123

inhalants

Question 124

Airway monitoring; Chelation depending on solvent Treatment on the intoxication of which substance? "inha-"

Answer 124

inhalants

Question 125

Loss of ability to control the use of inhalants Regarding which substance? "inha-"

Answer 125

inhalants

Question 126

Compulsivity to use inhalants Regarding which substance? "inha-"

Answer 126

inhalants

Question 127

Negative emotional state when not sniffing/breathing inhalants Regarding which substance? "inha-"

Answer 127

inhalants

Question 128

Common among teenagers Regarding which substance? "inha-"

Answer 128

inhalants

Question 129

E.g., volatile solvents, aerosols, gases, nitrites Regarding which substance? "inha-"

Answer 129

inhalants

Question 130

Methods: Sniffing, spraying into nostrils or mouth, bagging, huffing- breathing in from rag soaked with the chemical; inhalation from balloons Regarding which substance? "inha-"

Answer 130

inhalants

Question 131

Clinical presentation regarding which substance? Ataxia Smell of chemicals on body or clothing Sores and scabs around nose and mouth (Glue Sniffer’s rash) Slurred speech Drowsiness Headaches "inha-"

Answer 131

inhalants

Question 132

Emergency effects regarding which substance? Agitation Fever Seizures Hallucinations Confusion Loss of consciousness Coma Fatal accidental injury "inha-"

Answer 132

inhalants

Question 133

Treatment/management for which substance? - Treat presenting symptoms - Benzodiazepines for managing withdrawal and emergency symptoms (e.g., Valium, Lorazepam. "inha-"

Answer 133

inhalants

Question 134

This med comes in po, injection and implant (NO LIQUID) "nalt-"

Answer 134

Naltrexone

Question 135

- Most-used psychoactive substance in the United States - Coffee, tea or energy drinks "caff-"

Answer 135

caffeine

Question 136

- Anxiety - Insomnia - Muscle twitching - Rambling speech - Flushed face - GI disturbance - Restlessness - Excitement - Tachycardia - More than 1g= tinnitus, severe agitation, cardiac arrhythmias - More than 10g = Death can occur secondary to seizures and respiratory failure Intoxication effect of which substance? "caff-"

Answer 136

caffeine

Question 137

Occurs if cessation is abrupt - Headache - Fatigue - Irritability - Nausea - Vomiting - Drowsiness - Muscle pain - Depression Withdrawal effects of which substance? "caff-"

Answer 137

caffeine

Question 138

Supportive and symptomatic Treatment for which substance? "caff-"

Answer 138

caffeine

Question 139

- When assessing and treating older adults, clinicians not only need to take the above factors into account but also need to consider the potential interaction between alcohol and both prescribed and over-the-counter medications, especially psychoactive medications such as benzodiazepines, barbiturates, and antidepressants. - The Alcohol Use Disorders Identification Test (AUDIT) and the CAGE often are used to screen for at-risk substance use or misuse among older adults - Alcohol problems are common among older adults. - The use of pharmaceutical drugs is prevalent in older adulthood, and the risk of misusing prescription and over-the-counter medications, which include substances such as sedatives/hypnotics, narcotic and nonnarcotic analgesics, diet aids, and decongestants, also increases with age. - Incidentally, benzodiazepines also tend to be one of the most inappropriately prescribed psychotherapeutic medications among older adults

Answer 139

*Geriatric Considerations (part 1)

Question 140

- Clinicians should be cautious when prescribing or recommending a treatment, take both risks and benefits into account when determining a treatment plan, and clearly communicate guidelines for appropriate use to patients. - Clinicians also should carefully consider discontinuing medications that do not prove effective - Illicit drug use among older adults is rare. - Thus, rates of illicit substance use and abuse among older adults will likely continue to rise in the next several decades because of the aging of the baby boom cohort. - When assessing and treating older adults, clinicians not only need to take the above factors into account but also need to consider the potential interaction between alcohol and both prescribed and over-the-counter medications, especially psychoactive medications such as benzodiazepines, barbiturates, and antidepressants.

Answer 140

*Geriatric Considerations (part 2)

Question 141

Red bolded part of geriatric considerations: -The potential interaction between this substance and both prescribed and over-the-counter medications, especially psychoactive medications such as benzodiazepines, barbiturates, and antidepressants. "alco-"

Answer 141

alcohol

Question 142

Alcohol, Cocaine and opioid use disorder can lead to sexual dysfunction. True or false?

Answer 142

True

Question 143

Withdrawal seizures are commonly associated with which substances? "alco-, benz-"

Answer 143

Alcohol, benzodiazepines

Question 144

- Medical Emergency - Reversible - 40% mortality - Commonly experienced by patients in the ICU and post-op - Develops over hours to days - Subtypes: Hyperactive (agitated, restless, hyperalert); Hypoactive(lethargic, slowed, apathetic); Mixed(cycles between hyperactive and hypoactive - Causes: DELIRIUM(Drugs, Electrolyte imbalance, Low oxygen sat, Infection, Reduced sensory input, Intracranial(strokes), Urinary retention, Myocardial) What condition is this? "deli-"

Answer 144

delirium

Question 145

Txt: Symptom treatment - 1:1 sitter Agitation and Psychotic symptoms: - Haldol (PO, IM, IV); Atypical antipsychotics Treatment of which condition? "deli-"

Answer 145

delirium

Question 146

- Group of disorders characterized by gradual development of cognitive deficits - Irreversible Types *Alzheimer's disease (AD)= most common *Vascular disease = 2nd most common *Lewy body disease (LBD) *Frontotemporal degeneration (FTD) HIV infection Huntington disease (HD) Which condition is this? "deme-"

Answer 146

dementia

Question 147

- Gradual progressive decline - Most common type of dementia - Affects memory, learning and language - Aphasia (difficulty with speech) - Apraxia (inability to perform previously learned tasks - Agnosia (inability to recognize an object Etiology: Accumulation of beta-amyloid plaques and intraneuronal tau protein tangles Txt: Cholinesterase inhibitors NMDA receptor antagonists Which type of dementia? "alz-"

Answer 147

Alzheimer's disease

Question 148

- 2nd most common type of dementia - Cognitive decline secondary to large vessel strokes - Risk factors: HTN, DM, Smoking, obesity, HLD, A-fib, Age Which type of dementia? "vasc-"

Answer 148

vascular dementia

Question 149

- Characterized by waxing and waning cognition - Visual hallucinations (well formed images of animals and small people) - Develop EPS (Parkinsonism) @ least 1 year after cognitive decline Etiology: Lewy bodies and Lewy neurites in brain (primarily basal ganglia) Txt: Cholinesterase inhibitors - Seroquel and Clozaril (low doses/short term) - Levodopa/Carbidopa - Melatonin and/or Clonazepam (REM sleep disorder) NOTE: There is potential for severe sensitivity reactions, including exacerbation of parkinsonism, confusion, or autonomic dysfunction, which limits the usefulness of antipsychotic medications in these patients = Sensitive to antipsychotics Which type of dementia? "lew-"

Answer 149

Lewy Body Disease (LBD)

Question 150

- 40% familial - Atrophy of the frontal and temporal lobes Personality/Behavioral - Disinhibition (verbal, physical sexual) Language - Difficulty with speech and comprehension Kluver-Bucy Syndrome: hypersexual, hyperorality Txt: - Symptom focus - SSRI to help with inhibition Which type of dementia? "fron-"

Answer 150

Frontotemporal Degeneration (FTD)

Question 151

- Cholinesterase Inhibitor - Slows clinical deterioration by 6-12 months - Once daily dosing - For mild-moderate NCD - Not effective in severe, end-stage disease - Should STOP if side effects of nausea/vomiting develop S/E: diarrhea, weight loss, abnormal dreams, insomnia, dizziness Which med for dementia is this? "Donep-"

Answer 151

Donepezil (Aricept)

Question 152

- Twice daily dosing - GI side effects - For mild –moderate NCD Which dementia med is this? "gala-"

Answer 152

Galantimine (Razadyne)

Question 153

- Cholinesterase Inhibitor - Twice daily dosing - For mild-moderate AD & Parkinson’s disease dementia - Transdermal patch available – daily form with fewer side effects - For Mild to moderate NCD - Highest GI side effects Which dementia med is this? "Riva-"

Answer 153

Rivastigmine (Exelon)

Question 154

Mood symptoms = SSRIs Aggression/Agitation/Psychosis - Consider atypical antipsychotics (Zyprexa, Seroquel, Risperdal, Haldol) Note: Reserve Benzos for short term and acute episodes This is treatment for which condition? "deme-"

Answer 154

Dementia

Question 155

- NMDA receptor antagonist - Moderate – severe disease - Fewer side effects as compared to the Cholinesterase inhibitors - Promotes synaptic plasticity - May be used in conjunction with cholinesterase inhibitors e.g. Namzric (Mamantine/Donepezil) **May cause hallucinations Which dementia med is this? "mema-"

Answer 155

Memantine (Namenda)

Question 156

Pharmacologic Category: Anti-Amyloid Monoclonal Antibody; Immune Globulin; Monoclonal Antibody Lequembi targets harmful amyloid proteins; reducing existing amyloid brain plaque. Alzheimer disease: IV: Dosing based on actual body weight: 10 mg/kg once every 2 weeks. LEQEMBI can cause serious side effects including: - Amyloid Related Imaging Abnormalities or “ARIA”. ARIA is a side effect that does not usually cause any symptoms, but serious symptoms can occur. ARIA is most commonly seen as temporary swelling in areas of the brain that usually resolves over time. Some people may also have small spots of bleeding in or on the surface of the brain, and infrequently, larger areas of bleeding in the brain can occur. Most people with this type of swelling in the brain do not get symptoms, however some people may have symptoms, such as: –headache –confusion –dizziness –vision changes –nausea –difficulty walking –seizures

Answer 156

LEQEMBI reference

Question 157

This dementia med as compared to Aricept and Namenda = Highest adverse GI effects "riva-"

Answer 157

Rivastigmine

Question 158

Patch available with fewer GI side effects. Which med is this? "riva-"

Answer 158

Rivastigmine (Exelon)

Question 159

Use of this drug class in dementia particularly Lewy Body Dementia. "anti-"

Answer 159

antipsychotics

Question 160

Decreased protein levels = more free meds in the body= risk for toxicity Regarding what? "nor- ag-"

Answer 160

normal aging

Question 161

Regarding aging, if a TCA is indicated: consider this med (fewer anticholinergic side effects) "nort-"

Answer 161

Nortriptyline

Question 162

Regarding aging: Consider this med = MDD w/ symptoms of insomnia and decreased appetite "Reme-"

Answer 162

Remeron

Question 163

Regarding aging: This med = can be used in low doses as an adjunct to antidepressants for patients with severe depression and/ or psychomotor retardation. "methyl-"

Answer 163

Methylphenidate

Question 164

Regarding aging: Consider which dangerous thing? "poly-"

Answer 164

Polypharmacy

Question 165

More likely to cause side effects when used (i.e. memory impairment, ataxia, paradoxical excitement and rebound insomnia) = Trazodone is a safer options Regarding which drug class? "sed- hyp-"

Answer 165

sedative hypnotics

Question 166

The issue of ___________ is of particular concern in older people who, compared with younger individuals, tend to have more disease conditions for which therapies are prescribed.  "poly-"

Answer 166

polypharmacy

Question 167

This increases the potential for drug-drug interactions and for prescription of potentially inappropriate medications "poly-"

Answer 167

Polypharmacy

Question 168

________ medications are associated with multiple adverse effects to which older individuals are particularly susceptible. These include memory impairment, confusion, hallucinations, dry mouth, blurred vision, constipation, nausea, urinary retention, impaired sweating, and tachycardia "antic-"

Answer 168

Anticholinergic

Question 169

- Developed by an expert consensus panel in 1991 - Most widely cited criteria used to assess inappropriate drug prescribing - The criteria are a list of medications considered potentially inappropriate for use in older patients, mostly due to high risk for adverse events.  https://www.elderconsult.com/wp-content/uploads/PrintableBeersPocketCard.pdf "Beer-"

Answer 169

Beers Criteria

Question 170

Effect of ____ use in the elderly = Anticholinergic (dry mouth, confusion, blurred vision, urinary retention, constipation etc.) "Coge-"

Answer 170

benztropine (Cogentin)

Question 171

feeling, thoughts and /or behaviors that are acceptable to self, consistent with one’s fundamental personality "ego s-"

Answer 171

Ego-syntonic

Question 172

feelings, thought and/or behaviors that are distressing, unacceptable or inconsistent with one’s self concept. "ego d-"

Answer 172

Ego dystonic

Question 173

Familial association with psychotic disorders Patient seem eccentric, peculiar or withdrawn - Schizoid - Schizotypal - Paranoid Which cluster?

Answer 173

Cluster A

Question 174

Familial association with mood disorders Patients seem emotional, dramatic or inconsistent - Antisocial - Borderline - Histrionic - Narcissistic Which cluster?

Answer 174

Cluster B

Question 175

Familial association with anxiety disorders. Patients seem anxious or fearful - Avoidant - Dependent - Obsessive-compulsive Which cluster?

Answer 175

Cluster C

Question 176

- Personality disorders are generally very difficult to treat especially since few patients will acknowledge they need help - These disorders tend to be chronic and lifelong - Pharmacologic treatments have limited usefulness except when treating comorbid mental conditions (e.g. MDD) - Psychotherapy is usually most helpful

Answer 176

-

Question 177

Cluster A - General distrust for others Suspicion (without evidence) - Reluctance to confide in others - Suspicions regarding fidelity of spouse or partner Txt: - Psychotherapy is 1st line - Short course of antipsychotic for transient psychosis "para-"

Answer 177

Paranoid

Question 178

Cluster A - Prefer to be alone (voluntary social withdrawal) - Few close friends or confidants - Emotionally cold, detached or flattened affect. Txt: - May benefit from day programs or drop in centers - Consider antidepressants if comorbid depression is present "schizoi-"

Answer 178

schizoid

Question 179

Cluster A - Odd beliefs or magical thinking - Odd /eccentric Txt: - Psychotherapy is 1st choice - Short course of low dose Atypical antipsychotic may help with the cognitive-perceptual disturbances "schizot-"

Answer 179

schizotypal

Question 180

Cluster B - Failure to conform to social norms - Deceitful, manipulative for personal gain - Reckless, irritable - Lack remorse NOTE: Begins as conduct disorder in childhood Txt: - Psychotherapy is ineffective - Treat symptoms of anxiety, depression or aggression but with caution d/t high comorbidity with substance use disorders "antis-"

Answer 180

Antisocial

Question 181

Cluster B - Fear of abandonment - Aggression - Impulsive - Repeated SI attempts/gestures/self-mutilation - “Splitting” Txt: Gold standard = Dialectical behavior therapy (DBT) - Pharmacotherapy as adjunct to psychotherapy. - Mood stabilizers and low dose antipsychotic meds have been found to be effective for mood swings and lability. "bord-"

Answer 181

Borderline Personality Disorder (BPD)

Question 182

Cluster B - Attention seeking - Dramatic, flamboyant and extroverted. - Unable to form long-lasting, meaningful relations. Txt: Psychotherapy is 1st line - Pharmacotherapy to treat associated depressive or anxious symptoms "histr-"

Answer 182

Histrionic

Question 183

Cluster B - Grandiosity - Requires excessive admiration - Sense of entitlement - Lacks empathy - Arrogant or haughty Txt: Psychotherapy is 1st line - Use psychotropics if comorbid psychiatric disorders are diagnosed "narc-"

Answer 183

Narcissistic

Question 184

What is the gold standard txt for borderline personality disorder?

Answer 184

Dialectical behavior therapy (DBT)

Question 185

Cluster C - Intense fear of rejection - Fear of embarrassment and criticism - Isolates from relationships Txt: - Psychotherapy - SSRI= if comorbid social anxiety or depression "avoi-

Answer 185

Avoidant

Question 186

Cluster C - Poor self confidence - Cannot make everyday decisions without reassurance from others - Feels helpless when alone Txt: - Psychotherapy - Treat comorbid anxiety or depression "Depe-"

Answer 186

Dependent

Question 187

Cluster C - Preoccupation with details, rules, lists, organization - Excessive devotion to work - Will not delegate tasks - Rigid and stubborn Txt: - Psychotherapy (CBT) - Treat comorbid anxiety or depression "Obses-"

Answer 187

Obsessive compulsive Personality Disorder (OCPD)

Question 188

- First-line treatment for personality disorders is psychotherapy. - Symptom-focused, medication treatment of personality disorders is generally considered to be an adjunct to psychotherapy.  Avoid prescribing medications that can be fatal in overdose, such as tricyclic antidepressants. - Avoid prescribing medications that can induce physiological dependence and tolerance, including benzodiazepines. - Avoid changing medication each time there is a crisis or change in mood symptoms, which may occur frequently and suddenly, and also remit suddenly in some people with personality disorders. - Symptom expression in patients with personality disorders often waxes and wanes in relationship to life circumstances.

Answer 188

General Guidelines

Question 188

- Cognitive and perceptual disturbances - Impulsivity or behavioral dyscontrol - Affective dysregulation Antidepressants and mood stabilizers are dosed as they would be for major depressive disorder and bipolar disorder (e.g. Lithium, Lamictal) Antipsychotics are in general used at a lower dosing range compared with doses used in the treatment of schizophrenia (e.g. Abilify, Risperdal, Seroquel) "Tar- sym- dom-"

Answer 188

Targeted Symptom Domains

Question 189

Note: Causes of sexual dysfunctions maybe physiological (medication side effects/medical conditions), psychological (depression, substance use) or both; Abnormal levels of gonadal hormones (estrogen, testosterone, progesterone) - Dopamine enhances libido - Serotonin inhibits sexual function

Answer 189

General Information

Question 190

enhances libido "dop-"

Answer 190

dopamine

Question 191

inhibits sexual function "ser-"

Answer 191

serotonin

Question 192

Most of the antidepressants except Bupropion (Wellbutrin) & Mirtazepine (Remeron) cause sexual problems E.g. low libido, anorgasmia, erectile dysfunction Antipsychotics = ↑ prolactin (low libido, gynecomastia, galactorrhea, erectile dysfunction etc.)

Answer 192

-

Question 193

Addressing medication induced sexual dysfunction: - Medication reduction - Switching to another medication - Prescribe another medication (e.g. PDE-5 inhibitors)

Answer 193

-

Question 194

__________(1) - take 30 min to 4hours before sexual activity ____________(2) - take 30-60 min before sexual activity Note: Avoid concomitant use w/ nitrates (e.g. nitroglycerine, isosorbide dinitrate, amyl nitrate "poppers”) Caution with patients taking alpha-adrenergic blockers "sild-" "tada-"

Answer 194

(1) Sildenafil (Viagra) (2) Tadalafil (Cialis)

Question 195

The combination of sildenafil and meds such as nitrates can cause an unsafe drop in blood pressure. True or False?

Answer 195

True

Question 196

Absent or deficiency of sexual thoughts, desire or fantasies for more than 6 months Txt - Testosterone as replacement therapy (in men and postmenopausal women) - Low dose vaginal estrogen replacement –improves vaginal dryness and atrophy in postmenopausal women - Medications that increase DA and NE (e.g. Flibanserin and bupropion) may also be used Which sexual disorder? "mal-"

Answer 196

Male Hypoactive sexual desire disorder

Question 197

Difficulty obtaining or maintaining an erection Most common sexual dysfunction in men Txt Sildenafil (Viagra) Phosphodieterase-5 inhibitor (PDE-5) Enhances blood flow to the penis S/E: headaches, flushing, dizziness, hypotension **May cause prolonged erection and priapism** Which disorder is this? "erec-"

Answer 197

Erectile disorder /Erectile dysfunction/Impotence

Question 198

Recurrent pattern of ejaculation during sex within 1 minute and before individual wishes it Txt Prolong time from SSRI and TCAs stimulation to orgasm (e.g. Clomipramine, Fluoxetine, Paroxetine) "prem-"

Answer 198

Premature Ejaculation

Question 199

Absence or reduced sexual interest, thoughts, fantasies, initiation of sex, sexual arousal "fema-"

Answer 199

Female sexual interest/arousal disorder

Question 200

Premature ejaculation= using this med (15mg and 30mg) taken 2- hours before intercourse is effective and safe treatment. "clom-"

Answer 200

clomipramine

Question 201

Description: - Enduring pattern of anger or irritable mood, argumentative, defiant or vindictive behavior - Common in males Management: - Target symptoms = mood and aggression - Treat comorbid conditions (such as ADHD) - Behavior modification "Opp-"

Answer 201

Oppositional defiant disorder (ODD)

Question 202

Description: - Violates the rights of other humans and animals - Inflicts cruelty and harm through physical and sexual violence - May lack remorse Management: - Behavioral modification, family and community - Meds used to target comorbid symptoms and aggression (SSRIs, guanfacine, propranolol, mood stabilizers, antipsychotics) "Cond-"

Answer 202

Conduct Disorder

Question 203

Description: - Characterized by impairments in social communication/interaction and restrictive, repetitive behaviors/interests - 4:1 ration (male/female) Recognized ages - 12-24 months Management: - Early intervention, behavioral therapy, psychoeducation - Alpha-2 agonists (clonidine, guanfacine) and low dose atypical antipsychotics (Risperidone, Abilify)= to help reduce disruptive behaviors, aggression and irritability - Melatonin for sleep, - Remeron for sleep, anxiety "Auti-"

Answer 203

Autism Spectrum disorder(ASD)

Question 204

- Sudden, rapid, repetitive, stereotyped movements or vocalizations - Anxiety, excitement and fatigue are aggravating factor for tics - Tourette’s disorder: most severe characterized by multiple motor tics (face, head, eye blinking, throat clearing) an at least one vocal tic lasting for at least 1 year - Vocal tics( Copralalia/Echolalia) Management: - Behavioral interventions - Consider meds if tics become severely impairing. - 1st choice: Guanfacine (alpha-2 agonist) Clonidine (more sedating) - Severe cases, consider atypical (e.g. risperidone) "Tic-"

Answer 204

Tic disorder (Tourette’s)

Question 205

First choice med for Tic disorder (Tourette’s)? "guan-"

Answer 205

Guanfacine (alpha-2 agonist)

Question 206

Antipsychotic medications for Autism INDICATION: Autism associated irritability, aggression, temper tantrums, self-injurious behaviors, mood lability AGE RANGE: Children 5+ and Adolescents less than 18 (weight based) "Risp-"

Answer 206

Risperidone (Risperdal)

Question 207

Antipsychotic medications for Autism INDICATION: Autism associated irritability, aggression, temper tantrums, self-injurious behaviors, mood lability AGE RANGE: Children and Adolescents 6-17 years old "arip-"

Answer 207

Aripiprazole (Abilify)

Question 208

Regarding atypical antipsychotics for autism, what is one thing you should monitor for? "seda-"

Answer 208

sedation

Question 209

Recurrent urination into clothes or bed wetting Treatment: Psychoeducation, behavioral program - 1st line: Desmopressin (DDAVP) an antidiuretic - 2nd line: Imipramine (TCA) at low doses NOTE: Symptoms are not due to substance (e.g. laxatives) or another medical condition (e.g. anal fissure, spina bifida "enu-"

Answer 209

enuresis

Question 210

Recurrent defecation into inappropriate places (e.g. clothes, floor) Treatment: Psychoeducation, bowel retraining NOTE: Symptoms are not due to substance (e.g. laxatives) or another medical condition (e.g. anal fissure, spina bifida "enco-"

Answer 210

encopresis

Question 211

Impaired cognitive and adaptive/social functioning. - Deficits in intellectual functioning (i.e. reasoning, problem solving, planning, abstract thinking, judgement and learning) - Deficits in adaptive functioning i.e. communication, social participation and independent living. - Severity is mild, moderate, severe and profound Causes: Genetic (Down syndrome); Prenatal (rubella, herpes simplex etc.) Perinatal (Anoxia, prematurity, birth trauma) and Postnatal (malnutrition, toxin exposure, trauma) Management: Behavioral Therapy "Inte-"

Answer 211

Intellectual Disability Disorder (IDD)

Question 212

Difficulty acquiring and using language due to expressive and/or receptive impairment (e.g. reduced vocab). Increased risk in families of affected individuals Treatment: Speech and language therapy, family counseling "lang-"

Answer 212

Language disorder

Question 213

(Phonological Disorder)- difficulty producing articulate, intelligible speech Treatment: Speech and language therapy, family counseling "spee-"

Answer 213

Speech Sound Disorder

Question 214

(stuttering)- Dysfluency and speech motor production issues. Treatment: Speech and language therapy, family counseling "chil-"

Answer 214

Childhood–onset fluency disorder

Question 215

Challenges with the social use of verbal and non-verbal communication Treatment: Speech and language therapy, family counseling "soci-"

Answer 215

Social (pragmatic) communication disorder

Question 216

- Characterized by inattention, hyperactivity and impulsivity inconsistent with the patient’s developmental stage. - Males > females Etiology: - Abnormalities of fronto-subcortical pathways (i.e. frontal cortex and basal ganglia) - Dopamine dysfunction - NE dysfunction "atte-"

Answer 216

ADHD

Question 217

Notably – response to a stimulant does not prove a dx of this disorder The first-line pharmacological tx are stimulants which help to increase DA in PFC MOA: Increase DA in the prefrontal cortex, nucleus accumbens and reward circuitry Treatment: Multimodal(i.e., Medications + educational and behavioral interventions) 1st line: Stimulants (methylphenidate compounds, dextroamphetamine, mixed amphetamine salts)= Ritalin, Concerta, Adderall (Scchedule II) Side effects: GI upset, anorexia, weight loss, BP changes, ↑ HR, Growth suppression(rare),sleep disturbance, jitteriness, headaches, dizziness, mood lability -irritability, psychosis (rare), social withdrawal "AD-"

Answer 217

ADHD

Question 218

1st line: Stimulants for ADHD? "Rit-," "Conc," "Adde-," (methylphenidate compounds, dextroamphetamine, mixed amphetamine salts)

Answer 218

Ritalin, Concerta, Adderall

Question 219

response to a stimulant does not prove a dx of ______. "AD-"

Answer 219

ADHD

Question 220

2nd line: Alpha-2 agonists (Clonidine, guanfacine) - Can be used instead or as an adjunctive therapy to stimulants - Used in children who respond poorly to other meds, experience side effects or have coexisting conditions such as tics. Treatment for which disorder? "AD-"

Answer 220

ADHD

Question 221

2nd line: Alpha-2 agonists for ADHD - Can be used instead or as an adjunctive therapy to stimulants - Used in children who respond poorly to other meds, experience side effects or have coexisting conditions such as tics. "clon-," "guan-"

Answer 221

(Clonidine, guanfacine)

Question 222

NE reuptake inhibitor (consider when a hx or family hx of illicit substance use is present) for use of ADHD. Which medication? "Atom-"

Answer 222

Atomoxetine (Strattera)

Question 223

First line = Stimulants (Methylphenidate; Dexmethylphenidate ) ****Monitor Height, weight, BP, CBC w/ diff; Pulse quarterly (Height and weight d/t risk of growth restriction) - In healthy individuals, it is not necessary to obtain an EKG prior to initiating a stimulant - Prescription Monitoring Program should be checked MOA: Boosts dopamine, NE and 5HT Methylphenidate (Ritalin, Concerta) - Schedule II - Watch for Leukopenia or anemia - Common side effects(loss of appetite, headache, stomachaches, nausea, weight loss, insomnia) -Taking AM dose after eating breakfast can also help manage s/e of nausea or decreased appetite NOTE: Long-acting forms help with convenience and reduce the rebound side effects. Long acting avoids dosing in school DO NOT USE WITH PREEXISTING CARDIAC CONDITIONS & SYMPTOMS FDA approved for children 6+ E.g. Short acting Ritalin (3-4 hours duration) E.g. Long acting Ritalin LA (8-10 hours); Concerta (10-12 hours)

Answer 223

-

Question 224

DO NOT USE WITH PREEXISTING CARDIAC CONDITIONS & SYMPTOMS "stim-"

Answer 224

stimulants

Question 225

Long-acting forms help with convenience and reduce the rebound side effects. Long acting avoids dosing in school "stim-"

Answer 225

stimulants

Question 226

FDA approved for children 6+ "stim-"

Answer 226

stimulants

Question 227

Short acting Ritalin hours duration?

Answer 227

3-4 hours

Question 228

Long acting Ritalin hours duration?

Answer 228

8-10 hours

Question 229

Long acting Concerta hours duration?

Answer 229

10-12 hours

Question 230

****Monitor Height, weight, BP, CBC w/ diff; Pulse quarterly (Height and weight d/t risk of growth restriction) "stim-"

Answer 230

stimulants

Question 231

First line stimulants? "methyl-," "Dexme-"

Answer 231

Methylphenidate; Dexmethylphenidate

Question 232

- Schedule II d/t high potential for abuse/diversion - May help reduce adverse effects in those who had good response to methylphenidate, but dosing limited because of adverse effects. - Short Acting (Dexedrine, Adderall; Focalin)= 4-6 hours duration - Long Acting (Adderall XR, Vyvanse)= 8-12 hours - FDA approved for children 3+ Side effect: Loss of appetite, headaches, ↑BP; stomachaches, nausea, weight loss, insomnia, anticholinergic, tics/repetitive movements, psychosis "Dextro-"

Answer 232

Dextromethylphenidate (Dexedrine, Adderall)

Question 233

FDA approved stimulant for children 3+ years. "Dextro-"

Answer 233

Dextromethylphenidate (Dexedrine, Adderall)

Question 234

- Many formulations, all focused on increasing dopamine, norepi - Immediate release, Extended releases (of varying durations of action) - Daytrana transdermal patch - Immediate release provides pulsatile release pattern that leads to higher addiction liability than ER formulations - ER formulation sometimes used twice daily depending on duration of action of individual - Choice often driven by insurance formularies: general rule of thumb is to pick either a methylphenidate or an amphetamine formulation and then switch if not responding after titration to reasonable dose Regarding formulations on which med class? "stim-"

Answer 234

stimulants

Question 235

- Symptomatic cardiovascular disease - Moderate to severe hypertension - Hyperthyroidism - Known hypersensitivity or idiosyncrasy to sympathomimetic amines - Motor tics or Tourette syndrome - Glaucoma - Agitated states - Anxiety - History of drug abuse - Concurrent use or use within 14 days of the administration of monoamine oxidase inhibitors Contraindications to which drug class? "stim-"

Answer 235

stimulants

Question 236

Note: A PMHNP might consider using a nonstimulant medication like _______ for ADHD if: - Stimulants are not working well to control ADHD symptoms - Stimulants cause too many side effects - The child or teen has problems with substance abuse - The child or teen has a medical condition for which stimulants cannot be used - e.g. tic disorder "guan-"

Answer 236

guanfacine

Question 237

Labs to obtain before starting ADHD meds?

Answer 237

CBC w/ diff

Question 238

- Black box warning for SI thinking in children/adolescents - A Selective Norepinephrine Reuptake Inhibitor - FDA approved in children 6+ - Not classified as a controlled substance (less abuse potential) - Alternative to stimulants for children and adolescents who have a substance abuse problem, household member with substance abuse problem, tics or severe side effects from stimulants. - Less effective - Rare liver toxicity Which non-stimulant ADHD med is this? "atom-"

Answer 238

Atomoxetine (Strattera)

Question 239

Black box warning for SI thinking in children/adolescents "atom-"

Answer 239

Atomoxetine (Strattera)

Question 240

Alternative to stimulants for children and adolescents who have a substance abuse problem, household member with substance abuse problem, tics or severe side effects from stimulants. "atom-"

Answer 240

Atomoxetine (Strattera)

Question 241

Lowers seizure threshold "bupro-"

Answer 241

Bupropion (Wellbutrin)

Question 242

This drug class = can be used alone or as adjunctive txt. Clonidine = helps with over aroused, easily frustrated, highly active, aggressive impulsivity and hyperactivity ; Monitor BP Guanfacine (Tenex/Intuniv- Long acting): Rarely but can cause low BP and cardiac arrhythmias. FDA approved for children 6-17years - Can take up to 2 weeks to see clinical response - Often used if stimulant not effective enough or not tolerated - Tends to best target sx of children/adolescents including hyperarousal, hyperactivity, aggression, low frustration tolerance - No tics reported - Must be tapered to avoid rebound hypertension "alph-"

Answer 242

Alpha 2 adrenergic agonist (BP meds)

Question 243

helps with over aroused, easily frustrated, highly active, aggressive impulsivity and hyperactivity ; Monitor BP "clon-"

Answer 243

clonidine

Question 244

Rarely but can cause low BP and cardiac arrhythmias. FDA approved for children 6-17years "guan-"

Answer 244

guanfacine (Tenex/Intuniv- Long acting)

Question 245

- Relatively new (approval 2021) - Approved for children ages 10+ - Non-stimulant - Norepinephrine reuptake inhibitor - Common s/e: nausea, decreased appetite, insomnia, GI upset, diarrhea/constipation, tremor, dizziness, orthostatic hypotension - Rare but serious suicidal thoughts/behaviors, seizure "Qelb-"

Answer 245

Qelbree (viloxazine)

Question 246

- CII med - Needs secure electronic prescribing (often two step electronic verification) - Can sometimes write for 90 day supply if it says “for ADHD” but this varies by insurance - Many settings use stimulant agreements to set expectations for management with stimulant - Not everyone is a good candidate for safe use of stimulants - Non-pharm treatments are sometimes helpful alternatives or adjuncts - Dosing can be variable by person for many stimulants RX considerations for which drug class? "stim-"

Answer 246

stimulants

Question 247

This drug class (Clonidine, guanfacine) are used if first line treatment cannot be used (due to intolerable side effects or ineffectiveness) or as adjunctive therapy for stimulants. "alph-"

Answer 247

Alpha-2 agonists

Question 248

We discussed the management of alcohol dependence and withdrawal this week with an emphasis on pharmacological interventions. Identification of intoxication and withdrawal is essential to timely and effective treatment for any substance related symptoms. For alcohol, intoxication would likely be impairment in balance, slurred or impaired speech patterns, slowed reaction times, confusion, and sometimes nausea and vomiting. Supportive care is really the only thing indicated at this point and can include fluids, antiemetics, and supervision. Acute withdrawal would be managed with benzodiazepines (lorazepam is often chosen since it can also be given orally or parenterally). Seizure prevention is important and can be achieved with benzodiazepines. Traditional anticonvulsants have been found to be less efficacious than benzodiazepines. It is important not to administer or prescribe anything that can lower the seizure threshold as some antidepressants can do. Thiamine plays an important role in detox for preventing Wernicke’s encephalopathy. For treatment of dependence options include acamprosate, disulfiram, and naltrexone. Naltrexone is great although should not be used in the presence of elevated LFTs. Acamprosate would be better tolerated for someone who has some degree of liver impairment. Disulfiram works by causing nausea and vomiting with the ingestion of alcohol and is key in assisting a behavioral approach to alcohol abstinence (also works to increase dopamine in the reward pathways in the brain and can be useful in treating cocaine dependence). To recap opiate use disorder- acute intoxication with an opiate (heroin, oxy, fentanyl…) is marked by slowed (sometimes significantly) respirations, low levels of consciousness, slowed heart rate, low blood pressure, constricted pupils, and possibly a lower body temp. Acute intoxication is best treated quickly so naloxone is the best choice for pharmacological treatment. Withdrawal often manifests with watery eyes, flu like symptoms, anxiety, GI distress, and diarrhea. Pharmacological treatment can be initiated with buprenorphine/naloxone (suboxone) but may also include clonidine. Additional substance use disorders to be aware of are cocaine and other stimulants, and nicotine. S&S of acute intoxication of cocaine would include agitation, aggressiveness, muscle twitching, high blood pressure, elevated heart rate, increased temp, hallucinations, and pupil dilation. Treatment for this acute intoxication is best achieved with benzodiazepines, preferably parenteral. Chest pain can also accompany cocaine use disorders. Benzos can help, but nitroglycerine is also used to relieve this. Beta blockers should be avoided due to the possibility of exacerbating vasoconstriction. Important to note, there is no FDA approved pharmacologic treatment for cocaine and stimulant use disorders. Nicotine use disorder is most appropriately treated initially with nicotine replacement therapy. Smoking cigarettes is directly linked with heart disease, cancer and cardiovascular disease. This poses a special risk to those with mental illness, especially those who are on other metabolically offensive agents and/or those who practice unhealthy dietary and activity patterns.

Answer 248

Week 9 recap notes.

Question 249

Acute withdrawal would be managed with __________________ (lorazepam is often chosen since it can also be given orally or parenterally). Seizure prevention is important and can be achieved with the same drug class. "benz-"

Answer 249

benzodiazepines

Question 250

It is important not to administer or prescribe anything that can lower the seizure threshold as some ______________ can do. "anti-"

Answer 250

antidepressants

Question 251

_________ plays an important role in detox for preventing Wernicke’s encephalopathy. "thia-"

Answer 251

Thiamine

Question 252

For treatment of dependence options include acamprosate, disulfiram, and ____________. _____________ is great although should not be used in the presence of elevated LFTs. "nal-"

Answer 252

Naltrexone

Question 253

For treatment of dependence options include _____________, disulfiram, and naltrexone. _________ would be better tolerated for someone who has some degree of liver impairment. "acam-"

Answer 253

Acamprosate

Question 254

For treatment of dependence options include acamprosate, _________, and naltrexone. ___________ works by causing nausea and vomiting with the ingestion of alcohol and is key in assisting a behavioral approach to alcohol abstinence (also works to increase dopamine in the reward pathways in the brain and can be useful in treating cocaine dependence). "disu-"

Answer 254

Disulfiram

Question 255

Acute opiate intoxication is best treated quickly so ____________ is the best choice for pharmacological treatment. "nalo-"

Answer 255

naloxone

Question 256

Withdrawal often manifests with watery eyes, flu like symptoms, anxiety, GI distress, and diarrhea. Pharmacological treatment can be initiated with _______________(1) but may also include ___________(2). "bup-" "clon-"

Answer 256

(1) buprenorphine/naloxone (suboxone) (2) clonidine

Question 257

S&S of acute intoxication of _______ would include agitation, aggressiveness, muscle twitching, high blood pressure, elevated heart rate, increased temp, hallucinations, and pupil dilation. "coca-"

Answer 257

cocaine

Question 258

Treatment for acute intoxication of cocaine is best achieved with _________, preferably parenteral. "benz-"

Answer 258

benzodiazepines

Question 259

Chest pain can also accompany ________ use disorders. Benzos can help, but nitroglycerine is also used to relieve this. "coca-"

Answer 259

cocaine

Question 260

Regarding acute intoxication of cocaine, _____________ should be avoided due to the possibility of exacerbating vasoconstriction. "beta-"

Answer 260

Beta blockers

Question 261

Important to note, there is no FDA approved pharmacologic treatment for ________ and ________ use disorders. "coca-," "stim-"

Answer 261

cocaine, stimulant

Question 262

_________ use disorder is most appropriately treated initially with nicotine replacement therapy. Smoking cigarettes is directly linked with heart disease, cancer and cardiovascular disease. This poses a special risk to those with mental illness, especially those who are on other metabolically offensive agents and/or those who practice unhealthy dietary and activity patterns. "Nico-"

Answer 262

Nicotine

Question 263

Pre-existing cardiac issues can pose increased risk for adverse cardiac events when using a ___________. "stim-"

Answer 263

stimulant

Question 264

For behaviors related to ____________, behavioral treatment is the first line. "inte-"

Answer 264

IDD (intellectual disability disorder)

Question 265

Abrupt onset of sexual dysfunction that correlates with the initiation of an _____ is likely due to the _____. You should still take the time to assess other etiologies, but firstly reducing the dose if clinically plausible is a good strategy for management. "SS-"

Answer 265

SSRI

Question 266

In males, _______________ should be ruled out if there is a desire disorder. "hypo-"

Answer 266

hypogonadism

Question 267

If premature ejaculation is problematic, __________ can be used on demand, but other SSRI can also be used on a daily basis (or on demand, although the literature supports _____________ the most in the on demand method. In practice, several are used such as paroxetine and sertraline). "clom-"

Answer 267

clomipramine

Question 268

Remember that for older males, there are likely other causes of erectile dysfunction. In the presence of medical conditions such as CVD and diabetes, medications are not likely the culprit. If they have CVD and are on ____________, you must proceed with caution as this can cause blood pressure to drop. "nitr-"

Answer 268

nitrates

Question 269

ED is not a primary psychiatric disorder, so this condition can be referred to PCP. Especially if there are comorbid medical conditions. Medications like __________ are only indicated for once daily dosing and have not been studied to be used more than this. "sild-"

Answer 269

sildenafil

Question 270

____________ disorders are notoriously difficult to treat and pharmacologic options have limited benefit. We generally treat the comorbid psychiatric illness and treat symptomatically. When deciding on pharmacological treatment, one must take the entire picture into context and make medication decisions based on doing the least harm while balancing the potential benefits. It is essential to know the relative safety profiles of medications to be able to effectively choose. "pers-"

Answer 270

Personality

Question 271

Reinforcement occurs in the __________ and the __________. "ven-teg- ar-" and "nucl- accu-"

Answer 271

Ventral tegmental area (VTA) Nucleus accumbens (Reward center)

Question 272

___________ can be used for both ETOH and opioid use disorders "nalt-"

Answer 272

Naltrexone

Question 273

Benzodiazepines in borderline personality disorder (any personality disorder). Should it be used?

Answer 273

No, due to high risk for substance abuse and lethality in overdose

Question 274

Treatment recommendations caution against pharmacological treatment of the primary traits of ASPD? True or False?

Answer 274

True

Question 275

A 52-year-old man is brought into the emergency department with complaints of “feeling unwell.” He is notably agitated, yawns frequently, and has multiple episodes of diarrhea. Physical examination reveals diaphoresis, rhinorrhea, and dilated pupils. Which of the following is the most likely diagnosis? A. Benzodiazepine withdrawal B. Hallucinogen intoxication C. Opioid withdrawal D. Stimulant intoxication

Answer 275

C. Opioid withdrawal

Question 276

32-year-old man presents to your clinic after losing his job because he was intoxicated while working. He has been drinking daily since he was 16 years old. He was able to complete college and went to work full-time right after graduation but has lost several jobs since. His wife has threatened to divorce him if he does not get help. Which of the following medications would be the most useful as a behavioral modifier to decrease his alcohol use? A. Acamprosate B. Disulfiram C. Flumazenil D. Naltrexone

Answer 276

B. Disulfiram

Question 277

Which of the following statements best describes the use of medication in control of agitated and aggressive behaviors in older adults with major neurocognitive disorders? A. Although used in practice, there is a risk of increased death with antipsychotics B. The best evidence is for the use of cognitive enhancers to reverse the disease process C. The FDA has indicated that antipsychotics are safe first-line options D. Non-pharmacological interventions are generally not effective

Answer 277

A. Although used in practice, there is a risk of increased death with antipsychotics

Question 278

The Psychiatric Nurse Practitioner is treating a 12-year-old for attention deficit hyperactivity disorder. The parents ask for a trial of a non-stimulant for their child. Which of the following is not an appropriate order? A. Strattera 25 mg B. Clonidine 0.1 mg daily C. Guanfacine ER 1 mg daily D. Adderall 10 mg daily

Answer 278

D. Adderall 10 mg daily

Question 279

Which of the following medications is associated with the highest incidence of erectile dysfunction? A. Lamotrigine B. Clonazepam C. Paroxetine D. Doxepin

Answer 279

C. Paroxetine

Question 280

A 45-year-old male has been diagnosed with depression, anxiety, and antisocial personality disorder (ASPD). He has a history of substance abuse and suicidal behavior, including attempted medication overdoses. Which of the following medications would be the safest and most efficacious option to treat this patient’s mental health disorders? A. Fluoxetine B. Amitriptyline C. Alprazolam D. Buspirone

Answer 280

A. Fluoxetine

Question 281

Gold standard tx for BPD?

Answer 281

 Gold standard = Dialectical behavior therapy (DBT)

Question 282

Antisocial personality disorder begins as what in childhood?

Answer 282

Conduct disorder

Question 283

Effect of _________ use in the elderly = Anticholinergic (dry mouth, confusion, blurred vision, urinary retention, constipation, etc.) * Always review medications and be cautious of this. "Coge-"

Answer 283

Cogentin (benztropine)

Question 284

Regarding normal _____: * Decreased protein levels = more free meds in the body = risk for toxicity "agi-"

Answer 284

aging

Question 285

Regarding normal aging: * Consider _______ = MDD w/ symptoms of insomnia and decreased appetite "Rem-"

Answer 285

Remeron

Question 286

Promotes synaptic plasticity "mema-"

Answer 286

Memantine

Question 287

* DO NOT USE WITH PREEXISTING CARDIAC CONDITIONS & SYMPTOMS * FDA approved for children 6+ "methyl-"

Answer 287

Methylphenidate (Ritalin, Concerta)

Question 288

- Psychotherapy (CBT) - Treat comorbid anxiety or depression Treatment for which personality disorder? "ob-"

Answer 288

Obsessive

Question 289

Patients on what medication for smoking cessation treatment should be observed for neuropsychiatric symptoms including changes in behavior, hostility, agitation, depressed mood, and suicide-related events, including ideation, behavior, and attempted suicide. "bupro-"

Answer 289

bupropion

Question 290

First-line treatment for personality disorders is _____________, "psyc-"

Answer 290

psychotherapy

Question 291

Symptom-focused, medication treatment of personality disorders is generally considered to be an adjunct to psychotherapy. Avoid prescribing medications that can be fatal in overdose, such as __________ antidepressants "tric-"

Answer 291

tricyclic

Question 292

Do not administer disulfiram until the person has been alcohol free at least __ hours.

Answer 292

12

Question 293

Pay attention to MOA buprenorphine --> mu receptor _______ ________ "par- agon-"

Answer 293

partial agonist

Question 294

Lewy body dementia people? Answer: they are very sensitive to _____________ "antip-"

Answer 294

antipsychotics

Question 295

Frontal temporal dementia ppl what do you give them for disinhibition? Ans: ____ class meds "SS-"

Answer 295

SSRI

Question 296

What is one form of Naltrexone delivery method limited to inpatient use? "im-"

Answer 296

implant

Question 297

What is the mechanism of action buprenorphine? "mu rec- par- ago-"

Answer 297

Mu receptor partial agonist for opioid withdrawal

Question 298

What medication taken too soon after last opioid use increases the chances of intense withdrawal that comes on very quickly (precipitated withdrawal)? "bupren-"

Answer 298

buprenorphine

Question 299

Nausea and vomiting; Diarrhea; Dehydration; Irritability; Restlessness; Yawning; Twitching; Increased heart rate and blood pressure; Chills; Increased temperature; Rhinorrhea; Lacrimation; Dilated pupils Opioid intoxication or opioid withdrawal?

Answer 299

Opioid withdrawal

Question 300

Nausea and vomiting; Respiratory depression; Constipation; Itching; Mioisis (small pupil); Euphoria; and Sedation Opioid intoxication or opioid withdrawal?

Answer 300

Opioid intoxication

Question 301

What medication is given for opioid intoxication during cardiac or respiratory depression is a concern? "nalo-"

Answer 301

Naloxone

Question 302

What would NOT be the treatment for chest pain and MI from cocaine? "beta-"

Answer 302

Beta blockers are to be avoided due to unopposed a-adrenergic stimulation.

Question 303

What class of drugs are to be avoided for acute alcohol intoxication? "benz-"

Answer 303

benzodiazepines

Question 304

What medications can you give for patients with hepatic dysfunction? "oxaz- and lora-"

Answer 304

oxazepam and lorazepam

Question 305

What are the treatments for alcohol withdrawal symptoms?

Answer 305

Diazepam intravenous; Lorazepam intravenous or intramuscular; Thiamine intravenous or intramuscular; Addressing electrolyte imbalances

Question 306

What are the treatments for DT?

Answer 306

Acute care management; Parenteral diazepam or lorazepam; Thiamine; Antipsychotics if necessary

Question 307

What is the mechanism of action of disulfiram?

Answer 307

Via negative reinforcement, where drinking is avoided due to unpleasant effects.

Question 308

What is the mechanism of action of Acamprosate?

Answer 308

NMDA receptor antagonist

Question 309

How is Acamprosate cleared? "rena-"

Answer 309

renally

Question 310

What medication can be given to patients with AUD with hepatic dysfunction? "acam-"

Answer 310

acamprosate (Campral)

Question 311

What medication is suitable for AUD with comorbid OUD? "nalt-"

Answer 311

Naltrexone

Question 312

What medication only deals with physical dependence, but does not address the psychological component of smoking? "nico-"

Answer 312

NRT

Question 313

What are the "Very Bad Cancer" medications? "vare-, bupro-, clon-"

Answer 313

Varenicline; Bupropion; Clonidine

Question 314

What medication for smoking cessation treatment should be observed for neuropsychiatric symptoms that include changes in behavior, hostility, agitation, depressed mood, and suicide-related events that include ideation, behavior, and attempted suicide? "bupro-"

Answer 314

bupropion

Question 315

What medications can treat agitation in patients with dementia? "atyp- antip-"

Answer 315

atypical antipsychotics

Question 316

What type of medications are used only for short-term and acute episodes of aggression, agitation, and psychosis in patients with dementia? "benz-"

Answer 316

benzodiazepines

Question 317

What medical emergency can be caused with TCAs, anticholinergics, benzodiazepines, non-benzodiazepines, corticosteroids, H2 blockers, and opioids in elderly patients? "delir-"

Answer 317

delirium

Question 318

A type of frontotemporal degeneration (FTD) that results from bilateral lesions of the medial temporal lobe and manifests with hypersexuality and hyperorality. "kluv-"

Answer 318

Kluver-Bucy syndrome

Question 319

What type of medications are appropriate for mild to moderate dementia? "Damn, Grandma's Regressing" "don-, riva-, gala-"

Answer 319

Donepezil; Rivastigmine; Galantamine "Damn, Grandma's Regressing"

Question 320

Which TCA has the fewest anticholinergic effects? "nort-"

Answer 320

Nortriptyline

Question 321

What TCA is the most appropriate in the elderly? "nort-"

Answer 321

Nortriptyline

Question 322

What type of medications are preferred in the elderly? "SS-"

Answer 322

SSRIs

Question 323

What medication is the most appropriate for elderly patients with MDD, insomnia, and decreased appetite? "mirt-"

Answer 323

mirtazapine

Question 324

What medication is the best alternative to sedative-hypnotic use for insomnia in the elderly as it is less likely to cause memory impairment, paradoxical excitement, or rebound insomnia? "traz-"

Answer 324

trazodone

Question 325

What are the "Man, ADHD Does Damage" medications? "meth-, amp-, dexm-, dext-"

Answer 325

Methylphenidate; Amphetamine salts; Dexmethylphenidate; Dextroamphetamine

Question 326

What are the 5 non-stimulants for treating ADHD? "TC-, clon-, guan-, bupro-, atom-"

Answer 326

TCAs; Clonidine; Guanfacine; Bupropion; Atomoxetine

Question 327

What are the "Calm Teens Give Better Answers" medications? "TC-, clon-, guan-, bupr-, atom-"

Answer 327

TCAs; Clonidine; Guanfacine; Bupropion; Atomoxetine

Question 328

What types of stimulants are used when patient needs a duration of action longer than 4 hours, improves adherence, and is less likely to be abused? "inter- or long-"

Answer 328

intermediate or long-acting

Question 329

What symptom do children exhibit that requires blood pressure and heart rate monitoring? "dizz-"

Answer 329

dizziness

Question 330

If dizziness in children occurs at peak, what should the patient be switched to? "long- form-"

Answer 330

A longer acting formula

Question 331

If a patient exhibits this stimulant associated symptom, they should be switched to a shorter acting formula? "inso-"

Answer 331

insomnia

Question 332

Prior to starting a stimulant, the patient history, family history, and exam should be conducted with a focus on what? "card-"

Answer 332

cardiovascular

Question 333

What stimulant side effect may require discontinuation of medication? "ti-"

Answer 333

tics

Question 334

What condition is pharmacological treatment initiated as first-line therapy after careful assessment and targets co-occurring disorders? "inte- dis-"

Answer 334

intellectual disability

Question 335

What medications should not be combined with stimulants? "SN-, moo- sta-, MA-, antip-, TC-"

Answer 335

SNRIs; Mood stabilizers; MAOIs; Antipsychotics; TCAs

Question 336

What medications are "Stimulants Make Me Act Tense?" "SN-, moo- sta-, MA-, antip-, TC-"

Answer 336

SNRIs; Mood stabilizers; MAOIs; Antipsychotics; TCAs

Question 337

What non-stimulant ADHD medication is most appropriate in a patient with co-occurring depression? "bupro-"

Answer 337

bupropion

Question 338

What type of medication class is considered a "reasonable choice" in a patient with co-occurring depression and anxiety? "TC-"

Answer 338

TCAs

Question 339

What 2 medications are approved by the FDA to treat severe behavioral issues in ASD, specifically tantrums, self-injury, and aggression? "risp-, arip-"

Answer 339

risperidone, aripiprazole

Question 340

What is the on-demand treatment for premature ejaculation? "clom-"

Answer 340

clomipramine

Question 341

What medication, if combined with nitrates, can cause an unsafe drop in blood pressure, headaches, flushing, and dizziness? "sild-"

Answer 341

sildenafil

Question 342

What is the most appropriate medication for a female with depression and hyperarousal? "bupro-"

Answer 342

bupro-"

Question 343

What SSRI is most likely to cause sexual dysfunction? "parox-"

Answer 343

paroxetine

Question 344

What SSRI may be used to treat premature ejaculation? "parox-"

Answer 344

paroxetine

Question 345

What can be done to reduce sexual side effects caused by psychotropic medications? "dos- red-"

Answer 345

dose reduction

Question 346

What is a Cluster B personality disorder that begins as a conduct disorder in childhood? "antiso-"

Answer 346

antisocial

Question 347

What is the gold-standard treatment for borderline disorder? "dial-"

Answer 347

dialectical behavior therapy (DBT)

Question 348

What class of medications are strongly discouraged in treating BPD due to risks of worsening impulsivity and suicidality? "benz-"

Answer 348

benzodiazepines

Question 349

What type of treatment is not recommended when treating the primary traits of antisocial personality disorder? "pharm-"

Answer 349

pharmacological

Question 350

What is the treatment for male hypoactive sexual desire disorder and female sexual interest/arousal disorder? "horm-"

Answer 350

hormone replacement therapy

Question 351

Guanfacine is an alpha 2 agonist. True or False?

Answer 351

True

Question 352

What is the first-line medication for tic disoder? "guan-"

Answer 352

guanfacine

Question 353

What are the first-line treatments options for enuresis? "desmo-, imipr-"

Answer 353

desmopressin, imipramine

Question 354

What is the management of IDD deficits? "beha- ther-"

Answer 354

behavioral therapy

Question 355

What stimulant medication is FDA approved for children 6+ that should not be used in patients with pre-existing cardiac conditions? "methyl-"

Answer 355

methylphenidate

Question 356

What FDA stimulant is approved for children 3+? "dextrome-"

Answer 356

dextromethylphenidate

Question 357

What non-stimulant is approved for children aged 6-17? "guan-"

Answer 357

guanfacine

Question 358

What is the mechanism of action of Naloxone?

Answer 358

Pure opioid antagonist that competes and displaces opioids receptor sites.

Question 359

____________ is sometimes thought of as a temporary measure. Its use in opiate abstinence is also called medication-assisted treatment (MAT) with suboxone may be lifelong rather than bridge therapy to be discontinued when the addiction is stabilized. Because low endogenous opioid availability is implicated in not only the pain response but also hypothetically in mood states, impulsivity, aggression, and even autism, ongoing MAT has the potential to improve outcomes for patients long-term. "subo-"

Answer 359

Suboxone

Question 360

Differentiation between delirium and dementia is also important and can usually be distinguished by the relatively _____ onset of symptoms with delirium vs gradual progression with dementia. "rap-"

Answer 360

rapid

Question 361

For delirium, give ______________. "hal-"

Answer 361

Haldol