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Psych 660 > NURS660 Exam 4 > Flashcards

NURS660 Exam 4 Flashcards

1
Q

What meds do you use for ETOH withdrawal and which one first

A

Benzos: valium, ativan, librium

Ativan first bc it’s easy on the liver

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2
Q

What are the neurotransmitters for alcohol and what goes on during drinking and withdrawal

A

GABA: while drinking GABA increases – calm and relax
Glutamate: alcohol leaves and glutamate kicks in

Withdrawal: glutamate causes excitement, restlessness, jittery, hyperactivity, tachy, HTN

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3
Q

MOA for ETOH detox:

A

mimicking the effects of the substance with benzos

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4
Q

CIWA scores for ETOH

A

10 or more you start benzo protocol

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5
Q

ETOH use and needed vitamins … what are we trying to prevent?

A

MV, folic acid, thiamine (B1)
To prevent Warneke encephalopathy

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6
Q

Alcohol use and wellbutrin

A

Don’t use wellbutrin because it lowers the seizure threshold

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7
Q

Antidote for sudden bizzare behavior, confusion, disorientation with ETOH withdrawal:

A

IV thiamine 250mg TID x 5 days

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8
Q

When do withdrawal cravings occur

A

During RESENSITIZATION

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9
Q

S/S of opiate withdrawal

A

pain, diarrhea, shivering, tachy, dilated pupils, shaking, anger, HTN

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10
Q

Treatment for opiate withdrawal

A

clonidine and suboxone

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11
Q

What to check while on suboxone

A
  • Prescription monitoring system
  • UDS
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12
Q

Non-threatening withdrawal substances

A

cocaine, meth, THC

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13
Q

Desensitization is the _____ part of substance abuse

A

tolerance

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14
Q

Acute ETOH r/t CYP

A
  • decreases metabolism - inhibits
  • can cause toxicity for other drugs
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15
Q

Chronic ingestion of ETOH r/t CYP
vs prolonged chronic

A
  • Increased liver enzymes - increased metabolism
  • Prolonged - dmgs liver and CYP is inhibited vs increased
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16
Q

Which receptor do hallucinogenic drugs work on? And how?

A

Agonism of 5HT2A

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17
Q

What is the neurotransmitter for cocaine

A

DA

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18
Q

What loop is associated with ADHD

A

CSTC loop

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19
Q

PFC r/t ADHD

A

cognition and attention

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20
Q

Anterior cingulate cortex r/t ADHD

A

selective attention – details, not listening, careless mistakes

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21
Q

Dorsolateral PFC r/t ADHD

A

problem solving – sustained attention

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22
Q

Orbital PFC r/t ADHD

A

impulsive behavior

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23
Q

Dorsal striatum r/t ADHD

A

compulsive behavior

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24
Q

VTA r/t ADHD

A

controls reward and impulse

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25
Prefrontal motor cortex r/t ADHD
Hyperactive: fidgeting, leaving seat, running
26
Orbitofrontal cortex r/t ADHD
Impulsive: excessive talking, blurting, not waiting for turn
27
Hippocampus r/t Dementia
memory center
28
Benzos, Meclizine, and Sennakot r/t dementia
Benzos and meclizine can make memory worse Sennakot can cause aggression
29
Alzheimer's s/s
- Gradual - Marker: beta-amyloid plaques - Hereditary
30
Frontotemporal dementia s/s
Aggression Hypersexual behaviors Hyperverbal Nosey Lasts up to a year - then death
31
Lewy Body dementia s/s
- Rapid eye movement - hallucinations - Usually die within 6 mo
32
Vascular Dementia s/s
hx of TIA or TBI or CVA
33
Parkinson's dementia s/s
can't dx for a year shuffling
34
Huntington's chorea dementia
- hyperreflexia, chorea - chorea is marker
35
Acamprosate (Campral) - Use - MOA
Use - ETOH disorder MOA - blocks presynaptic glutamate so if patient drinks they don't get the euphoria
36
Amphetamine (Adderall) - Which pathway - What causes dependency - Before starting ...
- Mesolimbic pathway to increase DA via DAT - Dependency caused by competitiveness at the DAT - UDS - Drug monitoring system - Hx of structural cardiac concerns?
37
Why is ER amphetamine better for addiction?
occupy NET in the PFC slow enough and long enough that they enhance TONIC NE and DA signaling but not quickly or potentently to the point phasic signalling is increased in the NA Tonic: even tone Phasic: short bursts
38
Atomoxetine (Strattera) - MOA - CYP - liver?
- Non stimulant NE reuptake inhibitor - Increases DA in PFC -- not via DAT - CYP2D6 so inhibitors causes problems ---- Paroxetine, fluoxetine, quinidine, wellbutrin - Rare: liver failure
39
Clonidine - Use - When not to use
detox r/t alpha2 agonism Don't use if hypotensive --> use suboxone
40
Donepezil (aricept) - what kind of med - When used - MOA - SE
Anticholinesterase Helps with hippocampus Improves cognition but doesn't stop progression Lots of GI SE: diarrhea/n/v
41
Disulfram
Aversion therapy for ETOH disorder -- makes violently ill Blocks enzymes that break down acetaldehyde -- leads to accumulation. SE: throbbing HA, diaphoresis, flushing, stomach upset, n/v Last drink should be at least 12 hrs Wait to drink 2 weeks after taking the medication
42
Galantamine
acetylcholinesterase Positive allosteric modulation on nicotinic receptor Alzheimer's
43
Lisdexamphetamine
Hair loss over 50mg
44
Memantine (Namenda)
NMDA receptor antagonist
45
Methylphenidate (Ritalin)
Similar to cocaine Blocks DAT/NET -- increaesed availability Can induce psychosis with too much DA
46
Naloxone (Narcan)
opioid overdose antidote
47
Naltrexone (Revia)
blocks mu receptor only for ETOH and Opiate use disorder reduces excitement (glutamate) and cravings No desensitization of the GABA -- so no cravings
48
Rivastigmine (exelon)
anticholinesterase comes in patch due to bad GI problems -- caused by peripheral inhibition of the butyrylcholinesterase and acetylcholinesterase
49
Viloxazine
Same as Strattera: Non stimulant NE reuptake inhibitor - Increases DA in PFC -- not via DAT but also has 5HT2B/C OK for liver issues 1A2 vs 2D6
50
What order do we treat different disorders
ETOH/Substance use dependence Mood disorders Anxiety ADHD Nicotine dependence
51
Amphetamine based meds MOA
Amphetamine based meds Increase DA and NE Competitively inhibits DAT (gets taken up by DAT) Packed into vesicles so displaces DA into terminals
52
Ritalin (methylphenidate)
Blocks DAT and NET This leads to increased availability in the synaptic cleft Doesn’t lead to increased release – just more availability by blocking transporters
53
At mu opioid receptors, naltrexone acts as a/an:
Antagonist
54
Which of the following interact with the mu opioid receptors as full agonists
Endogenous opioids Heroin Rx opioids
55
Which of the following MATs is effective against fentanyl overdose?
NALOXONE – NOT NALTREXONE
56
Deep repetitive transcranial magnetic stimulation (drTMS) may be helpful in treating AUD, because it has been shown to
Reduce cravings Reduce intake of alcohol
57
Impulsivity associated with ADHD is hypothetically regulated by the
Orbital frontal cortex
58
Problems with selective attention associated with ADHD are hypothetically regulated by the:
Anterior cingulate cortex
58
As individuals with ADHD progress into adulthood, they generally experience a decline in:
Impulse and hyperactive symptoms
59
In individuals with comorbid substance abuse and ADHD, it is generally advisable to address which condition first?
Substance use
60
Why does atomoxetine lack abuse potential?
It increases dopamine levels in the prefrontal cortex but not in the nucleus accumbens
61
Rita is a 28-year-old patient with untreated ADHD. You are currently deciding between guanfacine and clonidine as potential treatments for this patient. The selective alpha 2A agonist guanfacine appears to be:
Better tolerated than the alpha 2 agonist clonidine
62
George is an 81-year-old patient with Alzheimer's dementia. He is currently taking rivastigmine 4 mg/day but is experiencing treatment-induced nausea and diarrhea. These gastrointestinal side effects may be due to which action of rivastigmine?
Peripheral inhibition of acetylcholinesterase & butyrylcholinesterase
63
Which of the following dementia treatments has the secondary property of positive allosteric modulation at nicotinic receptors?
Galantamine
64
Which of the following properties of memantine may be useful in treating Alzheimer’s disease?
NMDA antagonism at the magnesium site
65
Addiction may be explained by neuroadaptation, such that _____ cortico-subcortical loops supporting impulsive reward seeking give way to _____ cortico-subcortical loops supporting compulsive behaviors.
Ventral, dorsal
66
The addition of clonidine also functions to reduce the intensity of withdrawal via what action?
Alpha 2A agonism
67
Alcohol has what effect on GABA and glutamate within the ventral tegmental area?
Increases GABA and decreases glutamate
68
Guanfacine and food
ABSORPTION OF GUANFACINE IS SIGNIFICANTLY INCREASED WHEN TAKEN WITH A HIGH-FAT MEAL

Psych 660 (6 decks)

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