Psych - First Aid Flashcards
1
Q
Classical conditioning
A
Learning in which a natural response is elicited by a conditioned stimulus that previously was presented in conjunction with an unconditioned stimulus. Ex. Pavlov’s dogs
2
Q
Classical conditioning usually deals with…
A
involuntary responses.
3
Q
Operant conditioning
A
learning in which a particular action is elicited becasue it produces a punishment or reward
4
Q
Operant conditioning usually deals with…
A
voluntary responses.
5
Q
Positive reinforcement
A
desired reward produces action (mouse presses button to get food)
6
Q
Negative reinforcement
A
target behavior (response) is followed by removal of averse stimulus (mouse presses button to turn off continuous loud noise)
7
Q
Punishment
A
repeated application of aversive stimulus extinguishes unwanted behavior
8
Q
Extinction
A
discontinuation of reinforcement (positive or negative) eventually eliminates the behavior. Can occur in operant or classical conditioning
9
Q
Transference
A
pt projects feelings about formative or other importnat persons onto physician (ex. psychiatrist is seen as a parent)
10
Q
Countertransference
A
doctor projects feelings about formative or other important persons onto pt (ex. pt reminds physician of younger sibling)
11
Q
Acting out
A
expressing unacceptable feelings and thoughts through actions Ex. tantrums
12
Q
Dissociation
A
temporary, drastic change in personality, memory, consciousness or motor behavior to avoid emotional stress ex. extreme forms can result in dissociative identity disorder
13
Q
Denial
A
avoiding the awareness of some painful reality ex. a common rxn in newly diagnosed AIDS and cancer pts
14
Q
Displacement
A
transferring avoided ideas and feelings to some neutral person or object Ex. mother yells at her child bc her husband yelled at her
15
Q
Fixation
A
partially remaining at a more childish level of development Ex. men fixating on sports games
16
Q
Identification
A
modeling behavior after another person who is more powerful ex. abused child identifies with abuser
17
Q
Isolation
A
separating feelings from ideas and events ex. describing murder in graphic detail with no emotional response
18
Q
Projection
A
attributing an unacceptable internal impulse to an external source ex. a man who wants another woman thinks his wife is cheating on him
19
Q
Rationalization
A
proclaiming logical reasons for actions actually performed for other reasons, usually to avoid self-blame Ex. after getting fired, claiming that the job was not important anyway
20
Q
Reaction formation
A
replacing a warded-off idea or feeling by an (unconsciously derived) emphasis on its opposite ex. a pt with libidinous thoughts enters a monastery
21
Q
Regression
A
turning back the maturational clock and going back to earlier modes of dealing with the world ex. seen in children under stress (illness, punishment, new sibling) - bedwetting in a previously toilet-trained child
22
Q
Repression
A
involuntary witholding an idea or feeling from conscious awareness Ex. not remembering a conflictual/traumatic experience; pressing bad thoughts into the unconscious
23
Q
Splitting
A
believing that people are either all good or all bad at different times due to intolerance of ambiguity ex. pt says that all nurses were cold/insensitive but the doctors were warm/friendly
24
Q
Splitting is often seen in…
A
borderline personality disorder.
25
Altruism
alleviating guilty feelings by unsolicited generosity towards others Ex. mafia boss makes large donation to charity
26
Humor
appreciating the amusing nature of an anxiety-provoking or adverse situation Ex. nervous med student jokes about boards
27
Sublimation
replacing an unacceptable wish with a course of action that is similar to the wish but does not conflict with one's value system Ex. teen's aggression toward his father is redirected to perform well in sports
28
Suppression
intentional witholding of an idea or feeling from conscious awareness ex. choosing not to worry about the big game until it is time to play
29
Long-term deprivation of affection in infants leads to...
-decreased muscle tone -poor language skills -poor socialization skills -lack of basic trust -anaclitic depression -weight loss -physical illness
30
Deprivation in an infant for more than 6 months can...
lead to irreversible changes. Severe deprivation can result in death.
31
The main physical abuser of children is usually...
the biological mother and usually occurs before the age of 3.
32
Peak age of sexual abuse in children
9-12 (signs: genital, anal or oral trauma, STDs, UTIs)
33
Evidence of physical abuse
-healed fractures on x-ray (esp. spinal) -burns -subdural hematomas -pattern marks/bruising -rib fractures -retinal detachment/hemorrhage
34
The most common form of child maltreatment is...
child neglect which is the failure to provide a child with food, shelter, supervision, education and affection.
35
Evidence of child neglect
-poor hygiene -malnutrition -withdrawal -impaired social/emotional development -FTT
36
Attention Deficit Hyperactivity Disorder (ADHD)
-onset before 12 -poor impulse control -normal intelligence but has difficulty in school
37
ADHD is associated with...
decreased frontal lobe volume/metabolism
38
Treatment for ADHD
-methylphenidate -amphetamines -atomoxetine -behavioral interventions
39
Conduct Disorder
-repetitive, pervasive behavior violating the basic rights of others (physical aggresion, property destruction, theft)
40
After the age of 18, many with conduct disorder will meet the criteria for...
antisocial personality disorder.
41
Oppositional Defiant Disorder
-enduring pattern of hostile, defiant behavior toward authority figures in the absence of serious violations of social norms
42
Tourette Syndrome
-onset before 18 -sudden, rapid, recurrent, nonrhythmic, stereotyped motor and vocal tics that persist for more than 1 year
43
Coprolalia is...
involuntary obscene speech. Seen in only 10-20% of those with Tourette's.
44
Tourette's is associated with...
OCD and ADHD.
45
Treatments for Tourette's
-antipsychotics -behavioral therapy
46
Separation anxiety disorder
-onset 7-9 yrs -overwhelming fear of separation from home or loss of attachment figure -may lead to factitious physical complaints to avoid going to school
47
Treatment for Separation anxiety disorder
-SSRIs -relaxation/behavioral interventions
48
Pervasive developmental disorders are characterized by...
difficulties with language and failure to acquire or early loss of social skills.
49
Pervasive developmental disorders
1. Autism spectrum disorder 2. Rett Disorder
50
Autism is characterized by...
poor social interactions, communication deficits, repetitive behaviros and restricted interests.
51
Autism must present in...
early childhood and may or may not be accompanied by intellectual disability. More common in boys.
52
Rett disorder
-X-linked disorder almost exclusively in girls -symptoms appear at 1-4 yrs old -regression, loss of development and verbal abilities -ataxixa -intellectual disability -sterotyped hand-wrigning
53
Alzheimer NT changes
decreased ACh
54
Anxiety NT changes
increased NE decreased GABA and serotonin
55
Depression NT changes
decreased NE, serotonin and dopamine
56
Huntington NT changes
decreased GABA and ACh increased dopamine
57
Parkinson NT changes
decreased dopamine increased serotonin and ACh
58
Schizophrenia NT changes
increased dopamine
59
Common causes of loss of orientation
-alcohol/drugs -fluid/electrolyte imbalance -head trauma -hypoglycemia -infxn -nutritional deficiencies
60
Order of loss of orientation
1st - time 2nd - place last - person
61
Retrograde amnesia
inability to remember things that occurred before a CNS insult
62
Anterograde amnesia
inability to remember things that occured after a CNS insult (no new memories)
63
Korsakoff amnesia
-classic anterograde amnesia caused by thiamine deficiency and the associated destruction of mammillary bodies -seen in alcoholics and associated with confabulations
64
Dissociative amnesia
inability to recall important personal information, usually subsequent to severe trauma or stress
65
Dissociative amnesia may be associated by...
dissociative fugae (abrupt travel or wandering during a period of dissociative amnesia)
66
Cognitive disorder
-significant changes in cognition (memory, attention, language, judgement)
67
Cognitive disorder includes...
delirium and dementia.
68
Delirium
-waxing and waning level of consciousness with acute onset -rapid decrease in attention span and level of arousal -disorganized thinking, hallucinations, illusions, misperceptions, disturbance in sleep, cognitive dysfunction -abnormal EEG
69
Delirium is usually secondary to...
another illness: -CNS disease -infxn -trauma -substance abuse/withdrawal -metabolic/electroly disturbances -hemorrhage -urinary/fecal retention
70
If a patient has delirium, check for...
drugs with anticholinergic effects. Usually reversible.
71
Dementia is a...
gradual decrease in intellectual ability or cognition without affecting levels of consciousness.
72
Dementia is characterized by...
memory deficits, aphasia, apraxia, agnosia, loss of abstract thought, behavioral/personality changes, impaired judgement. (EEG usually normal)
73
A patient with dementia can develop...
delirium. Ex. a pt with AD who develps pneumonia is at increased risk for delirium.
74
Irreversible causes of dementia
-Alzheimer disease -Lewy body dimentia -Huntington disease -Pick disease -cerebral infarcts -Creutzfeldt-Jakob disease -chronic substance abuse
75
Reversible casues of dementia
-NPH -vitamin B12 deficiency -hypothyroidism -neurosyphilis -HIV
76
In elderly pts, depression may present...
like dementia (pseudodementia).
77
Psychosis
a distorted perception of reality characterized by delusions, hallucinations, and/or disorganized thinking
78
Hallucinations
perceptions in the absence of external stimuli (seeing a light that is not actually present)
79
Delusions
unique, false beliefs about oneself or others that persist despite the facts (thinking aliens are communicating with you)
80
Disorganized speech
words and ideas are strung together based on sounds, puns or loose associations
81
Visual hallucinations are more commonly a feature of...
medical illness (drug intoxication) than psychiatric illness.
82
Auditory hallucinations are more commonly a feature of...
psychiatric illness (schizophrenia) than medical illness.
83
Olfactory hallucinations often occur as...
an aura of psychomotor epilepsy and in brain tumors.
84
Tactile hallucinations are common in...
alcohol withdrawal (formicatin = sensation of bugs crawling on one's skin); also seen in cocaine abuse.
85
Hypnagogic hallucinations occurs...
while going to sleep.
86
Hypnopompic hallucinations occur...
when waking from sleep.
87
Schizophrenia is a...
chronic mental disorder with periods of psychosis, disturbed behavior and thought, and decline in functioning that lasts more than 6 months.
88
Schizophrenia is associated with...
increased dopaminergic activity and decreased dendritic branching.
89
Diagnosis of Schizophrenia requires 2 or more of the following:
1. delusions 2. hallucinations 3. disorganized speech (loose associations) 4. disorganized or catatonic behavior 5. negative symptoms (flat affect, social withdrawal, lack of motivation, lack of speech/thought)
90
Brief sychotic disorder
less than one month, usually stress related
91
Schizophreniform disorder
1-6 months
92
Schizoaffective disorder
at least 2 wks of stable mood with psychotic symptoms plus a major depressive, manic or mixed episode
93
In teens, psychosis/schizophrenia is associated with...
frequent cannabis use.
94
Schizophrenia presents in men...
earlier (late teens to early 20s) than women (late 20s to early 30s).
95
Delusional Disorder
fixed, persistent, untrue belief system lasting more than one month Ex. woman who genuinely believes she is married to a celebrity
96
Dissociative Identity Disorder
presence of 2 or more distinct identities or personality states; more common in women
97
Dissociative Identity Disorder is associated with...
hx of sexual abuse, PTSD, depression, substance abuse, borderline personality disorder and somatoform conditions
98
Depersonalization/Derealization Disorder
persistent feelings of detachment or estrangement from one's own body, thoughts, perceptions and actions (depersonalization) or one's environment (derealization)
99
Mood disorder
characterized by an abnormal range of moods or internal emotional states and loss of control over them; severity of mood causes distress and impairment in social and occupational functioning
100
Mood disorders include...
major depressive disorder, bipolar disorder, dysthymic disorder and cyclothymic disorder
101
Manic episode
distinct period of abnormally, persistently elevated, expansive or irritable mood and increased activity/energy lasting at least one week
102
Diagnosis of Manic episode requires hospitalization or at least three of the following:
manics DIG FAST 1. Distractibility 2. Irresponsibility 3. Grandiosity 4. Flight of Ideas 5. increase in goal-directed Activity/psychomotor Agitation 6. decreased need for sleep 7. Talkativeness
103
Hypomanic episode
like manic episode except mood disturbance is not severe enough to cause marked impairment in social and/or occupational functioning or to necessitate hospitalization; lasts at least 4 consecutive days
104
Bipolar I is defined by...
the presence of at least 1 manic episode with or without a hypomanic or depressive episode.
105
Bipolar II is defined by...
the presence of a hypomanic and a depressive episode.
106
Between episodes in bipolar, pts mood and functioning usually...
returns to normal.
107
Use of antidepressants can lead to...
increased mania. High suicide risk in bipolar.
108
Treatment for Bipolar
-mood stabilizers (lithium, valproic acid, carbamazepine) -atypical antipsychotics
109
Cyclothymic disorder
-dysthymia and hypomania -milder form of bipolar lasting at least 2 yrs
110
In major depressive disorder (MDD), episodes usually last...
6-12 months.
111
MDD episodes are charachterized by at least 5 of the following 9 symptoms for 2 or more weeks
-sleep disturbance -loss of interest (anhedonia) -guilt or feelings of worthlessness -energy loss and fatigue -concentration problems -appetite/weight changes -psychomotor retardation or agitation -suicidal ideations -depressed mood
112
Pts with depression typically have the following changes in their sleep stages:
-decreased slow wave sleep -decreaesd REM latency -increased REM early in sleep cycle -increased total REM -repeated nighttime awakenings -early-morning awakening
113
Persistent, depressive disorder (dysthymia)
depression, often milder, lasting at least 2 yrs
114
Seasonal affective disorder
symptoms usually associated with winter season; improves in response to full-spectrum bright-light exposure
115
Atypical depression is characterized by...
mood reactivity, reversed vegetative symptoms (hypersomnia and weight gain), leaden paralysis, and interpersonal rejection sensitivity
116
Treatment of Atypical Depression
-MAO inhibitors -SSRIs
117
Postpartum mood disturbances has onset within...
4 wks of delivery
118
Maternal (postpartum) blues are characterized by...
depressed affect, tearfulness, and fatigue starting 2-3 days after delivery.
119
Maternal blues usually resolves...
within 10 days. Treatment is supportive and requires follow-up.
120
Postpartum depression is characterized by...
depressed affect, anxiety and poor concentration starting within 4 wks after delivery. It lasts 2 wks to a year or more.
121
Postpartum psychosis is characterized by...
delusions, hallucinations, confusion, unusual behavior and possible homicidal/suicidal thoughts/attempts. Usually lasts days to wks.
122
Pathologic grief is...
normal bereavement characterized by shock, denial, guilt and somatic symptoms. Duration varies (up to 6-12 months). May experience simple hallucinations (ex. hearing name called).
123
Electroconvulsive therapy
treatment option for MDD refractory to other treatment and pregnant women with MDD; also considered when immediate response is necessary, in depression with psychotic features and for catatonia.
124
ECT produces...
a relatively painless seizure in an anesthetized pt.
125
Adverse effects of ECT include...
disorientation, temporary HA and partial amnesia (resolves).
126
Risk factors for suicide completion
SAD PERSONS -sex (male) -age (teen or elderly) -depression -previous attempt -ethanol or drug use -loss of rational thinking -sickness -organized plan -no spouse -social support lacking
127
Symptoms of anxiety disorder will...
interfere with daily functioning.
128
Anxiety disorder includes...
panic disorder, phobias, and generalized anxiety disorder.
129
Panic Disorder is defined by...
the presence of recurrent panic attacks (periods of intense fear and discomfort peaking in 10 min with at least 4 of the following): 1. palpitations 2. paresthesias 3. Abdominal distress 4. Nausea 5. intesnse fear of dying or losing control 6. light-headedness 7. chest pain 8. chills 9. choking 10 disconnectedness 11. sweating 12. shaking 13. shortness of breath \*strong genetic component
130
Treatment for Panic Disorder
-behavioral therapy -SSRIs -venlafaxine -benzodiazepines
131
Diagnosis of Panic Disorder requires an attack followed by 1 month of at least 1 of the following:
1. persistent concern of additional attacks 2. worrying about the consequences of the attack 3. behavioral change related to the attacks
132
Specific phobias can be treated with...
systematic desensitization.
133
Types of specific phobia
-social anxiety disorder -agoraphobia
134
Social Anxiety Disorder can be treated with...
SSRIs.
135
Agoraphobia is...
exaggerated fear of open or enclosed places, using pulbic transportation, being in line or in crowds or leaving home.
136
Generalized anxiety disorder is a pattern of...
uncontrollable anxiety for at least 6 months that is unrelated to a specific person, situation or event.
137
Generalized anxiety disorder is associated with...
sleep disturbance, fatigue, GI disturbance and difficulty concentrating.
138
Treatment for Generalized Anxiety Disorder
-SSRIs -SNRIs -Buspirone -Cognitive behavioral therapy
139
Ego dystonic obsessive-compulsive disorder is...
inconsistent with one's own beliefs and attitudes.
140
Treatment of OCD
-SSRIs -Clomipramine
141
In PTSD, the disturbance lasts...
more than one month causing significant distress, negative cognitive alterations and/or impaired functioning.
142
Treatment of PTSD
-psychotherapy -SSRIs
143
Acute stress disorder lasts...
between 3 days and 1 month.
144
Malingering
patient consciously fakes, profoundly exaggerates or claims to have a disorder in order to attain a specific secondary (external) gain (avoiding work or obtaining compensation)
145
Pts who are malingering have...
poor compliance with treatment and follow-up tests and their complaints stop after the gain.
146
Factitious disorders
pt consciously creates physical and/or psychological symptoms in order to assume "sick role" and to get medical attention (primary (internal) gain)
147
Munchausen Syndrome
Chronic factitious disorder with predominantly physical signs and symptoms
148
Munchausen Syndrome is characterized by...
a history of multiple hospital admissions and willingness to receive invasive procedures
149
Munchausen Syndrome by proxy
when illness in a child or elderly pt is caused by the caregiver; motivation is to assume a sick role by proxy
150
Somatic symptom, etc. is a category of disorders characterized by...
physical symptoms with no identifiable phyical cause; both the illness production and motivation are unconscious drives; symptoms are not intentionally produced or feigned
151
Conversion disorder
-sudden loss of sensory or motor function, often following an acute stressor; pt is aware of but sometimes indifferent toward symptoms (la belle indifference)
152
Illness anxiety disorder (hypochondriasis)
preoccupation with and fear of having a serious illness despite medical evaluation and reassurance
153
Cluster A Personality Disorders (Weird)
1. Paranoid 2. Schizoid 3. Schizotypal (Accusatory, Aloof, Awakward)
154
Cluster A Personality Disorders Features
-odd/eccentric -inability to develop meaningful social relationships -no psychosis -genetic association with schizophrenia
155
Paranoid Personality Disorder
pervasive distrusta nd suspiciousness; projection is the major defense mechanism
156
Schizoid Personality Disorder
Voluntary social withdrawal, limited emotional expression, content with social isolation
157
Schizotypal Personality Disorder
eccentric appearance, odd beliefs or magical thinking, interpersonal awkwardness
158
Cluster B Personality Disorder Features
-dramatic, emotioinal or erratic -genetic association with mood disorders and substance abuse
159
Antisocial Personality Disorder
-disregard for and violation of rights of others, criminality, impulsivity \*must be older than 18 and have a hx of conduct disorder before age 15
160
Borderline Personality Disorder
-unstable mood and interpersonal relationships -impulsiveness -self-mutilation -boredome -sense of emptiness \*\*more common in females
161
A major defense mechanism of borderline personality disorder is...
splitting.
162
Histrionic personality disorder
excessive emotionality and excitability attention seeking sexually provocative overly concerned with appearance
163
Narcissistic personality disorder
-grandiosity -sense of entitlment -lackes empathy and requires excessive admiration -often demands the "best" and reacts to criticism with rage
164
Cluster C personality disorder features
-anxious or fearful -genetic association with anxiety disorders
165
Avoidant Personality Disorder
-hypersensitive to rejection, socially inhibited, timid, feelings of inadequacy, desires relationships with others
166
Dependent Personality Disorder
-submissive and clinging -excessive need to be taken care of -low self-confidence
167
Anorexia is associated with...
decreased bone density metatarsal stress fractures amenorrhea lanugo anemia electrolyte disorders
168
The osteoporosis seen in anorexia is partly due to...
decreased estrogen over time.
169
Bulimia nervosa is associated with...
parotitis enamel erosion electrolyte disturbances alkalosis dorsal hand calluses (Russel sign)
170
DDx for Sexual Dysfunction Disorders include:
-drugs (antihypertensives, neuroleptics, SSRIs and ethanol) -diseases (depression, diabetes, STDs) -psychological (performance anxiety)
171
Sleep terror disorder occurs during...
slow-wave sleep, non-REM (thus, no memory upon arousal); most commonly in children.
172
Nightmares occur during...
REM sleep (and thus, you have a memory of it).
173
Triggers of sleep terror disorder include...
emotional stress, fever or lack of sleep.
174
Narcolepsy is...
disordered regulation of sleep-wake cycles with the primary characteristic being excessive daytime sleepiness. \*strong genetic component
175
Narcolepsy is caused by a decrease in...
orexin production in the lateral hypothalamus.
176
Narcolepsy is associated with (3):
1. hypnagogic/hypnopompic hallucinations 2. nocturnal and narcoleptic episodes that begin with REM 3. cataplexy
177
Cataplexy is...
loss of all muscle tone following a strong emotional stimulus, such as laughter)
178
Treatment for Narcolepsy:
-daytime stimulants (amphetamines, modafinil) -nighttime sodium oxybate (GHB)
179
Substance use disorder is defined as a maladaptive pattern of substance use defined as 2 or more of the following signs in one year:
-tolerance -withdrawal -substance taken in larger amounts or over longer time, than desired -persistant desire/unsuccessful attempts to cut down -significant energy spent obtaining, using or recovering from substance -importnat social, occupational or recreational activities reduced -continued use in spite of the knowledge that it causes a problem -craving -recurrent use in physically dangerous situations -failure to fulfill major obligations at work, school, home -social/interpersonal conflicts
180
6 Stages of Change in overcoming substance abuse
1. Precontemplation 2. Contemplation 3. Preparation/determination 4. Action/willpower 5. Maintenance 6. Relapse
181
Nonspecific symptoms of intoxication with a depressant
-mood elevation -decreased anxiety -sedation -behavioral disinhibition -respiratory depression
182
Nonspecific symptoms of withdrawal from a depressant
-anxiety -tremor -seizures -insomnia
183
Depressants (4)
-alcohol -opioids -barbituates -benzodiazepines
184
Symptoms of alcohol toxicity
-emotional lability -slurred speech -ataxia -coma -blackouts
185
A sensitive indicator of alcohol use is...
serum gamma-glutamyltransferase (GGT).
186
Symptoms of alcohol withdrawal
-if severe, can cause autonomic hyperactivity and DTs
187
Treatment for DTs from alcohol withdrawal
benzodiazepines
188
Symptoms of opioid intoxication
-euphoria -respiratory/CNS depression -decreased gag reflex -pupillary constriction -seizure
189
Treatment for Opioid intoxication
Naloxone, Naltrexone
190
Symptoms of Opioid withdrawal
-sweating -dilated pupils -piloerection -fever -rhinorrhea -yawning -nausea -stomach cramps -diarrhea
191
Treatment for opioid withdrawal
-methadone -buprenorphine
192
Symptoms of Barbituate intoxication
-low safety margin -marked respiratory depression
193
Treatment of Barbituate intoxication
-assist respiration -increase BP
194
Symptoms of Barbituate withdrawal
-delirium -CV collapse
195
Symptoms of benzodiazepine intoxication
-greater safety margin -ataxia -minor respiratory depression
196
Treatment of benzodiazepine intoxication
supportive; consider flumazenil (competitive benzodiazepine antagonist)
197
Symptoms of withdrawal from Benzodiazepines
-sleep disturbance -depression -rebound anxiety -seizure
198
Nonspecific symptoms of stimulant intoxication
-mood elevation -psychomotor agitation -insomnia -cardiac arrhythmias -tachycardia -anxiety
199
Nonspecific symptoms of stimulant withdrawal
-post-use "crash" including depression, lethargy, weight gain and headache
200
Stimulants (4)
1. amphetamines 2. cocaine 3. caffeine 4. nicotine
201
Symptoms of Amphetamine intoxication
-euphoria -grandiosity -pupillary dilation-prolonged wakefulness and attention -HTN -tachycardia -anorexia -paranoia -fever -severe: cardiac arrest, seizure
202
Symptoms of Amphetamine Withdrawal
-andhedonia -increased appetite -hypersomnolence -existential crisis
203
Symptoms of Cocaine Intoxication
-impaired judgement -pupillary dilation -hallucinations -paranoid ideations -angina -sudden cardiac death
204
Treatment of Cocaine intoxication
benzodiazepines
205
Symptoms of cocaine withdrawal
-hypersomnolence -severe psychologic craving -depression/suicide
206
Symptoms of caffeine intoxication
-restlessness -increased diuresis -muscle twitching
207
Symptoms of caffeine withdrawal
-lack of concentration -HA
208
Symptoms of nicotine intoxication
-restlessness
209
Symptoms of nicotine withdrawal
-irritability -anxiety -craving
210
Treatment for nicotine withdrawal
-nicotine patch, gum, etc. -buproprion/varenicline
211
Hallucinogens (3)
-PCP -LSD -Marijuana
212
Symptoms of marijuana intoxication
-belligerence -impulsiveness -fever -psychomotor agitation -analgesia -nystagmus -tachycardia -homicidality -psychosis -delirium -seizures
213
Treatment for PCP intoxication
-benzodiazepines -rapid acting antipsychotic
214
Symptoms of PCP withdrawal
-depression -anxiety -irritability -restlessness -anergia -disturbances of thought and sleep
215
Symptoms of LSD intoxication
-perceptual distortion -depersonalization -anxiety -paranoia -psychosis
216
Symtpoms of marijuana toxicity
-euphoria -anxiety -paranoid delusions -perception of slowed time -impaired judgment -social withdrawal -increased appetite -dry mouth -conjunctival injection -hallucinations
217
Prescription form of marijuana is...
Dronabinol which is used as antiemetic (chemo) and appetite stimulant in AIDS.
218
Symptoms of marijuana withdrawal
-irritability -depression -insomnia -nausea -anorexia \*most peak at 48 hrs and last 5-7 days
219
Marijuana is generally detectable in the urine for...
4-10 days.
220
Heroin addicted pts are at increased risk for...
hepatitis, abscesses, overdose, hemorrhoids, AIDS, and right-sided endocarditis.
221
If you suspect heroin addiction, look for...
track marks (needle sticks in vein).
222
Treatment for heroin addiction
-Methadone -Naloxone + Buprenorphine -Naltrexone
223
Methadone is a...
long-acting oral opiate; used for heroin detoxification
224
Naloxone + Buprenorphine is a...
partial opioid agonist; long-acting with fewer withdrawal symptoms than methadone
225
Naltrexone is...
a long-acting opioid antagonist used for relapse prevention once a pt is detoxified from heroin
226
Complications of Alcoholism (5)
1. alcoholic cirrhosis 2. hepatitis 3. pancreatitis 4. peripheral neuropathy 5. testicular atrophy
227
Treatment for Alcoholism
-Disulfiram
228
Wernicke-Korsakoff syndrome is caused by..
thiamine deficiency. It has a triad of confusion, ophthalmoplegia and ataxia. May progress to irreversible memory loss, confabulation and personality change.
229
Wernicke-Korsakoff is associated with...
periventricular hemorrhage/necrosis of the mammillary bodies.
230
Treatment for Wernicke-Korsakoff is...
IV vitamin B1 (thiamine).
231
Mallory-Weiss Syndrome is...
longitudinal, partial thickness tear at the GE junction caused by excessive vomiting. Often presents with hematemesis. Associated with pain.
232
Delirium tremens is...
a life-threatening alcohol withdrawal syndrome that peaks 2-5 days after the last drink.
233
Symptoms of Delirium tremens in order of appearance
-autonomic system hyperactivity (tachycardia, tremors, anxiety, seizures) -psychotic symptoms (hallucinations, delusions) -confusion
234
Treatment for Delirium tremens
-benzodiazepines
235
Preferred drug for ADHD
Methylphenidate
236
Preferred drug for alcohol withdrawal
benzodiazepines
237
Preferred drugs for anxiety
-SSRIs -SNRIs -Buspirone
238
Preferred drugs for bipolar
-mood stabilizers (lithium, valproic acid, carbamazepine) -atypical antipsychotics
239
Preferred drug for bulimia
SSRI
240
Preferred drugs for depression
-SSRIs -SNRIs -TCAs -Bupropion -Mirtazapine (esp. with insomnia)
241
Preferred drugs for OCD
SSRIs clomipramine
242
Preferred drugs for panic disorder
-SSRIs -venlafaxine -benzodiazepines
243
Preferred drug for PTSD
SSRIs
244
Preferred drug for schizophreina
antipsychotics
245
Preferred drug for social phobias
-SSRIs -beta-blockers
246
Preferred drug for tourette's
-antipsychotics (haloperidol, risperidone)
247
CNS Stimulants (4)
1. methylphenidate 2. dextroamphetamine 3. methamphetamine 4. phentermine
248
Mechanism of CNS Stimulants
-increase catecholamines at the synaptic cleft, esp. NE and DA.
249
Clincial use of CNS stimulants
ADHD Narcolepsy Appetite control
250
Antipsychotics (neuroleptics) (5)
1. Haloperidol 2. Trifluoperazine 3. Fluphenazine 4. Thioridazine 5. Chlorpromazine
251
Mechanism of Antipsychotics
All typical antipsychotics block dopamine D2 receptors (increase cAMP).
252
Clinical use of antipsychotics
-schizophrenia (mainly + symptoms) -psychosis -acute mania -Tourette's
253
Antipsychotics are very slow to be removed from the body because...
they are highly lipid soluble and are stored in body fat.
254
Toxicity of antipsychotics
-extrapyramidal system effects (dyskinesias) -endocrine side effects (galactorrhea) -dry mouth, constipation (from blocking muscarinic receptors) -hypotension (from blocking alpha-1 receptors -sedation (from blocking histamine receptors)
255
Neuroleptic malignant syndrome
toxicity of antipsychotics causing rigidity, myoglobinuria, autonomic instability and hyperpyrexia
256
Treatment forNeuroleptic malignant syndrome
-dantrolene -D2 agnoists (bromocriptine)
257
Tardive dyskinesia
toxicity of antipsychotics casuing oral-facial movements
258
High potency antipsychotics
-Trifluoperazine, Fluphenazine, Haloperidol \*these cause neurologic side effects (EPS system)
259
Low potency antipsychotics
-Chlorpromazine, Thioridazine \*these cause non-neurologic side effects
260
Chlorpromazine can also cause...
cornela deposits.
261
Thioridazine can cause...
retinal deposits.
262
Haloperidol can also cause...
NMS or tardive dyskinesia.
263
Evolution of EPS side effects
-4 hr acute dystonia -4 day akathisia -4 wk bradykinesia -4 month tardive dyskinesia
264
Atypical Antipsychotics (6)
1. Olanzpaine 2. Clozapine 3. Quetiapine 4. Risperidone 5. Aripiprazole 6. Ziprasidone
265
Clinical use of atypical antipsychotics
-schizophrenia (+ and - symptoms) -Bipolar -OCD -anxiety disorder -depression -mania -tourette's
266
Olanzapine/Clozapine may cause...
significant weight gain.
267
Clozapine may cause...
agranulocytosis (requires weekly WBC monitoring) and seizure.
268
Risperidone may increase...
prolactin (lactation/gynecomastia) leading to decreased GnRH, LH and FSH (irregular menstruation/fertility).
269
Ziprasidone may...
prolong the QT interval.
270
Clinical use of Lithium
-mood stabilizer for bipolar disorder -blocks relapse and acute manic episodes -SIADH
271
Toxicity of Lithium
-tremor -sedation -edema -heart block -polyuria -teratogenesis
272
Lithium causes polyuria because...
it is an ADH antagonist causing nephrogenic DI.
273
Fetal cardiac defects from lithium include...
Ebstein anomaly and malformation of the great vessels.
274
Buspirone mechanism
stimulates 5-HT(1A) receptors
275
Use of Buspirone
-generalized anxiety disorder (1-2 wks to take effect) (does not interact with alcohol)
276
SSRIs (4)
1. Fluoxetine 2. Paroxetine 3. Sertraline 4. Citalopram
277
Mechanism of SSRIs
5-HT specific reuptake inhibitors
278
Use of SSRIs
-depression -GAD -Panic disorder -OCD -bulimia -social phobias -PTSD
279
Toxicity of SSRIs
-GI distress -sexual dysfunction -serotonin syndrome w/ any drug that increases 5HT (MAO inhibitors, SNRIs, TCAs)
280
Serotonin Syndrome
-hyperthermia -confusion -myoclonus -CV collapse -flushing -diarrhea -seizures
281
Serotonin Syndrome is treated with...
Cyproheptadine (5-HT2 receptor antagonist)
282
For SSRIs to start taking effect, it takes...
4-8 wks.
283
SNRIs (2)
Venlafaxine Duloxetine
284
Mechanism of SNRIs
inhibit 5-HT and NE reuptake
285
Use of SNRIs
depression -Venlafaxine also for GAD and panic disorder -Duloxetine also for diabetic peripheral neuropathy
286
Toxicity of SNRIs
increased BP stimulant effects sedation nausea
287
Tricyclic Antidepressants (7)
1. amitriptyline 2. nortriptyline 3. imipramine 4. desipramine 5. clomipramine 6. doxepin 7. amoxapine
288
TCAs mechanism
block reuptake of NE and 5-HT
289
Uses of TCAs
-depression -OCD (clomipramine) -fibromyalgia
290
Toxicity of TCAs
-sedation -alpha-1 blocking effects (postural hypotension) -atropine-like effects (anticholinergic - tachycardia, urinary retention, dry mouth) -convulsions -coma -cardiotoxicity -respiratory depression -hyperpyrexia
291
Tertiary TCAs (amitriptyline) have more...
anticholinergic effects than secondary TCAs (nortriptyline) have.
292
Desipramine is less...
sedating but has higher seizure incidence.
293
In the elderly, TCAs can cause...
confusion and hallucinations due to anticholinergic side effects (use nortriptyline).
294
Treatment for cardiotoxicity from TCAs
NaHCO3.
295
Monoamine oxidase inhibitors (4)
1. Tranylcypromine 2. Phenelzine 3. Isocarboxazid 4. Selegine (slective MAO-B inhibitor)
296
Mechanism of MAO inhibitors
inhibition of MAO leading to increased levels of amine neurotransmitters (NE, 5-HT, DA)
297
use of MAO inhibitors
-atypical depression -anxiety -hypochondria
298
Toxicity of MAOIs
-hypertensive crisis (typically w/ ingestion of tyramine) -CNS stimulation
299
MAOIs are contraindicated with...
SSRIs TCAs St. John's wort Meperidine Dextromethorphan
300
Atypical Antidepressants
1. Buproprion 2. Mirtazapine 3. Trazodone
301
Buproprion increases...
NE and DA
302
Besides depression, buproprion is also used for...
smoking cessation.
303
Toxicity of Buproprion
-stimulant effects -HA -seizure in bulimic pts
304
Mirtazapine MOA
-alpha2-antagonist (increased release of NE and 5-HT) -potent 5-HT2 and 5-HT3 antagonist
305
Toxicity of Mirtazapine
-sedation -increased appetite -weight gain -dry mouth
306
Trazodone mechanism
-blocks 5-HT2 and alpha1-adrenergic receptors
307
Trazodone is primarily used for...
insomnia.
308
Toxicity of Trazodone
sedation nausea priapism postural hypotension
