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Step 1 Exam > Psych - First Aid > Flashcards

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

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2
Q

Classical conditioning usually deals with…

A

involuntary responses.

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3
Q

Operant conditioning

A

learning in which a particular action is elicited becasue it produces a punishment or reward

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4
Q

Operant conditioning usually deals with…

A

voluntary responses.

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5
Q

Positive reinforcement

A

desired reward produces action (mouse presses button to get food)

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6
Q

Negative reinforcement

A

target behavior (response) is followed by removal of averse stimulus (mouse presses button to turn off continuous loud noise)

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7
Q

Punishment

A

repeated application of aversive stimulus extinguishes unwanted behavior

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8
Q

Extinction

A

discontinuation of reinforcement (positive or negative) eventually eliminates the behavior. Can occur in operant or classical conditioning

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9
Q

Transference

A

pt projects feelings about formative or other importnat persons onto physician (ex. psychiatrist is seen as a parent)

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10
Q

Countertransference

A

doctor projects feelings about formative or other important persons onto pt (ex. pt reminds physician of younger sibling)

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11
Q

Acting out

A

expressing unacceptable feelings and thoughts through actions Ex. tantrums

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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

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13
Q

Denial

A

avoiding the awareness of some painful reality ex. a common rxn in newly diagnosed AIDS and cancer pts

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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

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15
Q

Fixation

A

partially remaining at a more childish level of development Ex. men fixating on sports games

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16
Q

Identification

A

modeling behavior after another person who is more powerful ex. abused child identifies with abuser

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17
Q

Isolation

A

separating feelings from ideas and events ex. describing murder in graphic detail with no emotional response

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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

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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

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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

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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

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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

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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

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24
Q

Splitting is often seen in…

A

borderline personality disorder.

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25
Q

Altruism

A

alleviating guilty feelings by unsolicited generosity towards others Ex. mafia boss makes large donation to charity

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26
Q

Humor

A

appreciating the amusing nature of an anxiety-provoking or adverse situation Ex. nervous med student jokes about boards

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27
Q

Sublimation

A

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

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28
Q

Suppression

A

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

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29
Q

Long-term deprivation of affection in infants leads to…

A

-decreased muscle tone -poor language skills -poor socialization skills -lack of basic trust -anaclitic depression -weight loss -physical illness

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30
Q

Deprivation in an infant for more than 6 months can…

A

lead to irreversible changes. Severe deprivation can result in death.

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31
Q

The main physical abuser of children is usually…

A

the biological mother and usually occurs before the age of 3.

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32
Q

Peak age of sexual abuse in children

A

9-12 (signs: genital, anal or oral trauma, STDs, UTIs)

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33
Q

Evidence of physical abuse

A

-healed fractures on x-ray (esp. spinal) -burns -subdural hematomas -pattern marks/bruising -rib fractures -retinal detachment/hemorrhage

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34
Q

The most common form of child maltreatment is…

A

child neglect which is the failure to provide a child with food, shelter, supervision, education and affection.

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35
Q

Evidence of child neglect

A

-poor hygiene -malnutrition -withdrawal -impaired social/emotional development -FTT

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36
Q

Attention Deficit Hyperactivity Disorder (ADHD)

A

-onset before 12 -poor impulse control -normal intelligence but has difficulty in school

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37
Q

ADHD is associated with…

A

decreased frontal lobe volume/metabolism

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38
Q

Treatment for ADHD

A

-methylphenidate -amphetamines -atomoxetine -behavioral interventions

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39
Q

Conduct Disorder

A

-repetitive, pervasive behavior violating the basic rights of others (physical aggresion, property destruction, theft)

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40
Q

After the age of 18, many with conduct disorder will meet the criteria for…

A

antisocial personality disorder.

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41
Q

Oppositional Defiant Disorder

A

-enduring pattern of hostile, defiant behavior toward authority figures in the absence of serious violations of social norms

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42
Q

Tourette Syndrome

A

-onset before 18 -sudden, rapid, recurrent, nonrhythmic, stereotyped motor and vocal tics that persist for more than 1 year

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43
Q

Coprolalia is…

A

involuntary obscene speech. Seen in only 10-20% of those with Tourette’s.

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44
Q

Tourette’s is associated with…

A

OCD and ADHD.

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45
Q

Treatments for Tourette’s

A

-antipsychotics -behavioral therapy

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46
Q

Separation anxiety disorder

A

-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

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47
Q

Treatment for Separation anxiety disorder

A

-SSRIs -relaxation/behavioral interventions

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48
Q

Pervasive developmental disorders are characterized by…

A

difficulties with language and failure to acquire or early loss of social skills.

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49
Q

Pervasive developmental disorders

A
  1. Autism spectrum disorder 2. Rett Disorder
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50
Q

Autism is characterized by…

A

poor social interactions, communication deficits, repetitive behaviros and restricted interests.

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51
Q

Autism must present in…

A

early childhood and may or may not be accompanied by intellectual disability. More common in boys.

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52
Q

Rett disorder

A

-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

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53
Q

Alzheimer NT changes

A

decreased ACh

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54
Q

Anxiety NT changes

A

increased NE decreased GABA and serotonin

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55
Q

Depression NT changes

A

decreased NE, serotonin and dopamine

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56
Q

Huntington NT changes

A

decreased GABA and ACh increased dopamine

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57
Q

Parkinson NT changes

A

decreased dopamine increased serotonin and ACh

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58
Q

Schizophrenia NT changes

A

increased dopamine

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59
Q

Common causes of loss of orientation

A

-alcohol/drugs -fluid/electrolyte imbalance -head trauma -hypoglycemia -infxn -nutritional deficiencies

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60
Q

Order of loss of orientation

A

1st - time 2nd - place last - person

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61
Q

Retrograde amnesia

A

inability to remember things that occurred before a CNS insult

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62
Q

Anterograde amnesia

A

inability to remember things that occured after a CNS insult (no new memories)

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63
Q

Korsakoff amnesia

A

-classic anterograde amnesia caused by thiamine deficiency and the associated destruction of mammillary bodies -seen in alcoholics and associated with confabulations

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64
Q

Dissociative amnesia

A

inability to recall important personal information, usually subsequent to severe trauma or stress

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65
Q

Dissociative amnesia may be associated by…

A

dissociative fugae (abrupt travel or wandering during a period of dissociative amnesia)

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66
Q

Cognitive disorder

A

-significant changes in cognition (memory, attention, language, judgement)

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67
Q

Cognitive disorder includes…

A

delirium and dementia.

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68
Q

Delirium

A

-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

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69
Q

Delirium is usually secondary to…

A

another illness: -CNS disease -infxn -trauma -substance abuse/withdrawal -metabolic/electroly disturbances -hemorrhage -urinary/fecal retention

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70
Q

If a patient has delirium, check for…

A

drugs with anticholinergic effects. Usually reversible.

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71
Q

Dementia is a…

A

gradual decrease in intellectual ability or cognition without affecting levels of consciousness.

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72
Q

Dementia is characterized by…

A

memory deficits, aphasia, apraxia, agnosia, loss of abstract thought, behavioral/personality changes, impaired judgement. (EEG usually normal)

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73
Q

A patient with dementia can develop…

A

delirium. Ex. a pt with AD who develps pneumonia is at increased risk for delirium.

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74
Q

Irreversible causes of dementia

A

-Alzheimer disease -Lewy body dimentia -Huntington disease -Pick disease -cerebral infarcts -Creutzfeldt-Jakob disease -chronic substance abuse

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75
Q

Reversible casues of dementia

A

-NPH -vitamin B12 deficiency -hypothyroidism -neurosyphilis -HIV

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76
Q

In elderly pts, depression may present…

A

like dementia (pseudodementia).

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77
Q

Psychosis

A

a distorted perception of reality characterized by delusions, hallucinations, and/or disorganized thinking

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78
Q

Hallucinations

A

perceptions in the absence of external stimuli (seeing a light that is not actually present)

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79
Q

Delusions

A

unique, false beliefs about oneself or others that persist despite the facts (thinking aliens are communicating with you)

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80
Q

Disorganized speech

A

words and ideas are strung together based on sounds, puns or loose associations

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81
Q

Visual hallucinations are more commonly a feature of…

A

medical illness (drug intoxication) than psychiatric illness.

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82
Q

Auditory hallucinations are more commonly a feature of…

A

psychiatric illness (schizophrenia) than medical illness.

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83
Q

Olfactory hallucinations often occur as…

A

an aura of psychomotor epilepsy and in brain tumors.

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84
Q

Tactile hallucinations are common in…

A

alcohol withdrawal (formicatin = sensation of bugs crawling on one’s skin); also seen in cocaine abuse.

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85
Q

Hypnagogic hallucinations occurs…

A

while going to sleep.

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86
Q

Hypnopompic hallucinations occur…

A

when waking from sleep.

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87
Q

Schizophrenia is a…

A

chronic mental disorder with periods of psychosis, disturbed behavior and thought, and decline in functioning that lasts more than 6 months.

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88
Q

Schizophrenia is associated with…

A

increased dopaminergic activity and decreased dendritic branching.

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89
Q

Diagnosis of Schizophrenia requires 2 or more of the following:

A
  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)
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90
Q

Brief sychotic disorder

A

less than one month, usually stress related

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91
Q

Schizophreniform disorder

A

1-6 months

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92
Q

Schizoaffective disorder

A

at least 2 wks of stable mood with psychotic symptoms plus a major depressive, manic or mixed episode

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93
Q

In teens, psychosis/schizophrenia is associated with…

A

frequent cannabis use.

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94
Q

Schizophrenia presents in men…

A

earlier (late teens to early 20s) than women (late 20s to early 30s).

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95
Q

Delusional Disorder

A

fixed, persistent, untrue belief system lasting more than one month Ex. woman who genuinely believes she is married to a celebrity

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96
Q

Dissociative Identity Disorder

A

presence of 2 or more distinct identities or personality states; more common in women

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97
Q

Dissociative Identity Disorder is associated with…

A

hx of sexual abuse, PTSD, depression, substance abuse, borderline personality disorder and somatoform conditions

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98
Q

Depersonalization/Derealization Disorder

A

persistent feelings of detachment or estrangement from one’s own body, thoughts, perceptions and actions (depersonalization) or one’s environment (derealization)

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99
Q

Mood disorder

A

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

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100
Q

Mood disorders include…

A

major depressive disorder, bipolar disorder, dysthymic disorder and cyclothymic disorder

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101
Q

Manic episode

A

distinct period of abnormally, persistently elevated, expansive or irritable mood and increased activity/energy lasting at least one week

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102
Q

Diagnosis of Manic episode requires hospitalization or at least three of the following:

A

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

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103
Q

Hypomanic episode

A

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

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104
Q

Bipolar I is defined by…

A

the presence of at least 1 manic episode with or without a hypomanic or depressive episode.

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105
Q

Bipolar II is defined by…

A

the presence of a hypomanic and a depressive episode.

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106
Q

Between episodes in bipolar, pts mood and functioning usually…

A

returns to normal.

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107
Q

Use of antidepressants can lead to…

A

increased mania. High suicide risk in bipolar.

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108
Q

Treatment for Bipolar

A

-mood stabilizers (lithium, valproic acid, carbamazepine) -atypical antipsychotics

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109
Q

Cyclothymic disorder

A

-dysthymia and hypomania -milder form of bipolar lasting at least 2 yrs

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110
Q

In major depressive disorder (MDD), episodes usually last…

A

6-12 months.

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111
Q

MDD episodes are charachterized by at least 5 of the following 9 symptoms for 2 or more weeks

A

-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

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112
Q

Pts with depression typically have the following changes in their sleep stages:

A

-decreased slow wave sleep -decreaesd REM latency -increased REM early in sleep cycle -increased total REM -repeated nighttime awakenings -early-morning awakening

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113
Q

Persistent, depressive disorder (dysthymia)

A

depression, often milder, lasting at least 2 yrs

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114
Q

Seasonal affective disorder

A

symptoms usually associated with winter season; improves in response to full-spectrum bright-light exposure

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115
Q

Atypical depression is characterized by…

A

mood reactivity, reversed vegetative symptoms (hypersomnia and weight gain), leaden paralysis, and interpersonal rejection sensitivity

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116
Q

Treatment of Atypical Depression

A

-MAO inhibitors -SSRIs

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117
Q

Postpartum mood disturbances has onset within…

A

4 wks of delivery

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118
Q

Maternal (postpartum) blues are characterized by…

A

depressed affect, tearfulness, and fatigue starting 2-3 days after delivery.

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119
Q

Maternal blues usually resolves…

A

within 10 days. Treatment is supportive and requires follow-up.

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120
Q

Postpartum depression is characterized by…

A

depressed affect, anxiety and poor concentration starting within 4 wks after delivery. It lasts 2 wks to a year or more.

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121
Q

Postpartum psychosis is characterized by…

A

delusions, hallucinations, confusion, unusual behavior and possible homicidal/suicidal thoughts/attempts. Usually lasts days to wks.

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122
Q

Pathologic grief is…

A

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).

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123
Q

Electroconvulsive therapy

A

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.

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124
Q

ECT produces…

A

a relatively painless seizure in an anesthetized pt.

125
Q

Adverse effects of ECT include…

A

disorientation, temporary HA and partial amnesia (resolves).

126
Q

Risk factors for suicide completion

A

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
Q

Symptoms of anxiety disorder will…

A

interfere with daily functioning.

128
Q

Anxiety disorder includes…

A

panic disorder, phobias, and generalized anxiety disorder.

129
Q

Panic Disorder is defined by…

A

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
Q

Treatment for Panic Disorder

A

-behavioral therapy -SSRIs -venlafaxine -benzodiazepines

131
Q

Diagnosis of Panic Disorder requires an attack followed by 1 month of at least 1 of the following:

A
  1. persistent concern of additional attacks 2. worrying about the consequences of the attack 3. behavioral change related to the attacks
132
Q

Specific phobias can be treated with…

A

systematic desensitization.

133
Q

Types of specific phobia

A

-social anxiety disorder -agoraphobia

134
Q

Social Anxiety Disorder can be treated with…

A

SSRIs.

135
Q

Agoraphobia is…

A

exaggerated fear of open or enclosed places, using pulbic transportation, being in line or in crowds or leaving home.

136
Q

Generalized anxiety disorder is a pattern of…

A

uncontrollable anxiety for at least 6 months that is unrelated to a specific person, situation or event.

137
Q

Generalized anxiety disorder is associated with…

A

sleep disturbance, fatigue, GI disturbance and difficulty concentrating.

138
Q

Treatment for Generalized Anxiety Disorder

A

-SSRIs -SNRIs -Buspirone -Cognitive behavioral therapy

139
Q

Ego dystonic obsessive-compulsive disorder is…

A

inconsistent with one’s own beliefs and attitudes.

140
Q

Treatment of OCD

A

-SSRIs -Clomipramine

141
Q

In PTSD, the disturbance lasts…

A

more than one month causing significant distress, negative cognitive alterations and/or impaired functioning.

142
Q

Treatment of PTSD

A

-psychotherapy -SSRIs

143
Q

Acute stress disorder lasts…

A

between 3 days and 1 month.

144
Q

Malingering

A

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
Q

Pts who are malingering have…

A

poor compliance with treatment and follow-up tests and their complaints stop after the gain.

146
Q

Factitious disorders

A

pt consciously creates physical and/or psychological symptoms in order to assume “sick role” and to get medical attention (primary (internal) gain)

147
Q

Munchausen Syndrome

A

Chronic factitious disorder with predominantly physical signs and symptoms

148
Q

Munchausen Syndrome is characterized by…

A

a history of multiple hospital admissions and willingness to receive invasive procedures

149
Q

Munchausen Syndrome by proxy

A

when illness in a child or elderly pt is caused by the caregiver; motivation is to assume a sick role by proxy

150
Q

Somatic symptom, etc. is a category of disorders characterized by…

A

physical symptoms with no identifiable phyical cause; both the illness production and motivation are unconscious drives; symptoms are not intentionally produced or feigned

151
Q

Conversion disorder

A

-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
Q

Illness anxiety disorder (hypochondriasis)

A

preoccupation with and fear of having a serious illness despite medical evaluation and reassurance

153
Q

Cluster A Personality Disorders (Weird)

A
  1. Paranoid 2. Schizoid 3. Schizotypal (Accusatory, Aloof, Awakward)
154
Q

Cluster A Personality Disorders Features

A

-odd/eccentric -inability to develop meaningful social relationships -no psychosis -genetic association with schizophrenia

155
Q

Paranoid Personality Disorder

A

pervasive distrusta nd suspiciousness; projection is the major defense mechanism

156
Q

Schizoid Personality Disorder

A

Voluntary social withdrawal, limited emotional expression, content with social isolation

157
Q

Schizotypal Personality Disorder

A

eccentric appearance, odd beliefs or magical thinking, interpersonal awkwardness

158
Q

Cluster B Personality Disorder Features

A

-dramatic, emotioinal or erratic -genetic association with mood disorders and substance abuse

159
Q

Antisocial Personality Disorder

A

-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
Q

Borderline Personality Disorder

A

-unstable mood and interpersonal relationships -impulsiveness -self-mutilation -boredome -sense of emptiness **more common in females

161
Q

A major defense mechanism of borderline personality disorder is…

A

splitting.

162
Q

Histrionic personality disorder

A

excessive emotionality and excitability attention seeking sexually provocative overly concerned with appearance

163
Q

Narcissistic personality disorder

A

-grandiosity -sense of entitlment -lackes empathy and requires excessive admiration -often demands the “best” and reacts to criticism with rage

164
Q

Cluster C personality disorder features

A

-anxious or fearful -genetic association with anxiety disorders

165
Q

Avoidant Personality Disorder

A

-hypersensitive to rejection, socially inhibited, timid, feelings of inadequacy, desires relationships with others

166
Q

Dependent Personality Disorder

A

-submissive and clinging -excessive need to be taken care of -low self-confidence

167
Q

Anorexia is associated with…

A

decreased bone density metatarsal stress fractures amenorrhea lanugo anemia electrolyte disorders

168
Q

The osteoporosis seen in anorexia is partly due to…

A

decreased estrogen over time.

169
Q

Bulimia nervosa is associated with…

A

parotitis enamel erosion electrolyte disturbances alkalosis dorsal hand calluses (Russel sign)

170
Q

DDx for Sexual Dysfunction Disorders include:

A

-drugs (antihypertensives, neuroleptics, SSRIs and ethanol) -diseases (depression, diabetes, STDs) -psychological (performance anxiety)

171
Q

Sleep terror disorder occurs during…

A

slow-wave sleep, non-REM (thus, no memory upon arousal); most commonly in children.

172
Q

Nightmares occur during…

A

REM sleep (and thus, you have a memory of it).

173
Q

Triggers of sleep terror disorder include…

A

emotional stress, fever or lack of sleep.

174
Q

Narcolepsy is…

A

disordered regulation of sleep-wake cycles with the primary characteristic being excessive daytime sleepiness. *strong genetic component

175
Q

Narcolepsy is caused by a decrease in…

A

orexin production in the lateral hypothalamus.

176
Q

Narcolepsy is associated with (3):

A
  1. hypnagogic/hypnopompic hallucinations 2. nocturnal and narcoleptic episodes that begin with REM 3. cataplexy
177
Q

Cataplexy is…

A

loss of all muscle tone following a strong emotional stimulus, such as laughter)

178
Q

Treatment for Narcolepsy:

A

-daytime stimulants (amphetamines, modafinil) -nighttime sodium oxybate (GHB)

179
Q

Substance use disorder is defined as a maladaptive pattern of substance use defined as 2 or more of the following signs in one year:

A

-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
Q

6 Stages of Change in overcoming substance abuse

A
  1. Precontemplation 2. Contemplation 3. Preparation/determination 4. Action/willpower 5. Maintenance 6. Relapse
181
Q

Nonspecific symptoms of intoxication with a depressant

A

-mood elevation -decreased anxiety -sedation -behavioral disinhibition -respiratory depression

182
Q

Nonspecific symptoms of withdrawal from a depressant

A

-anxiety -tremor -seizures -insomnia

183
Q

Depressants (4)

A

-alcohol -opioids -barbituates -benzodiazepines

184
Q

Symptoms of alcohol toxicity

A

-emotional lability -slurred speech -ataxia -coma -blackouts

185
Q

A sensitive indicator of alcohol use is…

A

serum gamma-glutamyltransferase (GGT).

186
Q

Symptoms of alcohol withdrawal

A

-if severe, can cause autonomic hyperactivity and DTs

187
Q

Treatment for DTs from alcohol withdrawal

A

benzodiazepines

188
Q

Symptoms of opioid intoxication

A

-euphoria -respiratory/CNS depression -decreased gag reflex -pupillary constriction -seizure

189
Q

Treatment for Opioid intoxication

A

Naloxone, Naltrexone

190
Q

Symptoms of Opioid withdrawal

A

-sweating -dilated pupils -piloerection -fever -rhinorrhea -yawning -nausea -stomach cramps -diarrhea

191
Q

Treatment for opioid withdrawal

A

-methadone -buprenorphine

192
Q

Symptoms of Barbituate intoxication

A

-low safety margin -marked respiratory depression

193
Q

Treatment of Barbituate intoxication

A

-assist respiration -increase BP

194
Q

Symptoms of Barbituate withdrawal

A

-delirium -CV collapse

195
Q

Symptoms of benzodiazepine intoxication

A

-greater safety margin -ataxia -minor respiratory depression

196
Q

Treatment of benzodiazepine intoxication

A

supportive; consider flumazenil (competitive benzodiazepine antagonist)

197
Q

Symptoms of withdrawal from Benzodiazepines

A

-sleep disturbance -depression -rebound anxiety -seizure

198
Q

Nonspecific symptoms of stimulant intoxication

A

-mood elevation -psychomotor agitation -insomnia -cardiac arrhythmias -tachycardia -anxiety

199
Q

Nonspecific symptoms of stimulant withdrawal

A

-post-use “crash” including depression, lethargy, weight gain and headache

200
Q

Stimulants (4)

A
  1. amphetamines 2. cocaine 3. caffeine 4. nicotine
201
Q

Symptoms of Amphetamine intoxication

A

-euphoria -grandiosity -pupillary dilation-prolonged wakefulness and attention -HTN -tachycardia -anorexia -paranoia -fever -severe: cardiac arrest, seizure

202
Q

Symptoms of Amphetamine Withdrawal

A

-andhedonia -increased appetite -hypersomnolence -existential crisis

203
Q

Symptoms of Cocaine Intoxication

A

-impaired judgement -pupillary dilation -hallucinations -paranoid ideations -angina -sudden cardiac death

204
Q

Treatment of Cocaine intoxication

A

benzodiazepines

205
Q

Symptoms of cocaine withdrawal

A

-hypersomnolence -severe psychologic craving -depression/suicide

206
Q

Symptoms of caffeine intoxication

A

-restlessness -increased diuresis -muscle twitching

207
Q

Symptoms of caffeine withdrawal

A

-lack of concentration -HA

208
Q

Symptoms of nicotine intoxication

A

-restlessness

209
Q

Symptoms of nicotine withdrawal

A

-irritability -anxiety -craving

210
Q

Treatment for nicotine withdrawal

A

-nicotine patch, gum, etc. -buproprion/varenicline

211
Q

Hallucinogens (3)

A

-PCP -LSD -Marijuana

212
Q

Symptoms of marijuana intoxication

A

-belligerence -impulsiveness -fever -psychomotor agitation -analgesia -nystagmus -tachycardia -homicidality -psychosis -delirium -seizures

213
Q

Treatment for PCP intoxication

A

-benzodiazepines -rapid acting antipsychotic

214
Q

Symptoms of PCP withdrawal

A

-depression -anxiety -irritability -restlessness -anergia -disturbances of thought and sleep

215
Q

Symptoms of LSD intoxication

A

-perceptual distortion -depersonalization -anxiety -paranoia -psychosis

216
Q

Symtpoms of marijuana toxicity

A

-euphoria -anxiety -paranoid delusions -perception of slowed time -impaired judgment -social withdrawal -increased appetite -dry mouth -conjunctival injection -hallucinations

217
Q

Prescription form of marijuana is…

A

Dronabinol which is used as antiemetic (chemo) and appetite stimulant in AIDS.

218
Q

Symptoms of marijuana withdrawal

A

-irritability -depression -insomnia -nausea -anorexia *most peak at 48 hrs and last 5-7 days

219
Q

Marijuana is generally detectable in the urine for…

A

4-10 days.

220
Q

Heroin addicted pts are at increased risk for…

A

hepatitis, abscesses, overdose, hemorrhoids, AIDS, and right-sided endocarditis.

221
Q

If you suspect heroin addiction, look for…

A

track marks (needle sticks in vein).

222
Q

Treatment for heroin addiction

A

-Methadone -Naloxone + Buprenorphine -Naltrexone

223
Q

Methadone is a…

A

long-acting oral opiate; used for heroin detoxification

224
Q

Naloxone + Buprenorphine is a…

A

partial opioid agonist; long-acting with fewer withdrawal symptoms than methadone

225
Q

Naltrexone is…

A

a long-acting opioid antagonist used for relapse prevention once a pt is detoxified from heroin

226
Q

Complications of Alcoholism (5)

A
  1. alcoholic cirrhosis 2. hepatitis 3. pancreatitis 4. peripheral neuropathy 5. testicular atrophy
227
Q

Treatment for Alcoholism

A

-Disulfiram

228
Q

Wernicke-Korsakoff syndrome is caused by..

A

thiamine deficiency. It has a triad of confusion, ophthalmoplegia and ataxia. May progress to irreversible memory loss, confabulation and personality change.

229
Q

Wernicke-Korsakoff is associated with…

A

periventricular hemorrhage/necrosis of the mammillary bodies.

230
Q

Treatment for Wernicke-Korsakoff is…

A

IV vitamin B1 (thiamine).

231
Q

Mallory-Weiss Syndrome is…

A

longitudinal, partial thickness tear at the GE junction caused by excessive vomiting. Often presents with hematemesis. Associated with pain.

232
Q

Delirium tremens is…

A

a life-threatening alcohol withdrawal syndrome that peaks 2-5 days after the last drink.

233
Q

Symptoms of Delirium tremens in order of appearance

A

-autonomic system hyperactivity (tachycardia, tremors, anxiety, seizures) -psychotic symptoms (hallucinations, delusions) -confusion

234
Q

Treatment for Delirium tremens

A

-benzodiazepines

235
Q

Preferred drug for ADHD

A

Methylphenidate

236
Q

Preferred drug for alcohol withdrawal

A

benzodiazepines

237
Q

Preferred drugs for anxiety

A

-SSRIs -SNRIs -Buspirone

238
Q

Preferred drugs for bipolar

A

-mood stabilizers (lithium, valproic acid, carbamazepine) -atypical antipsychotics

239
Q

Preferred drug for bulimia

A

SSRI

240
Q

Preferred drugs for depression

A

-SSRIs -SNRIs -TCAs -Bupropion -Mirtazapine (esp. with insomnia)

241
Q

Preferred drugs for OCD

A

SSRIs clomipramine

242
Q

Preferred drugs for panic disorder

A

-SSRIs -venlafaxine -benzodiazepines

243
Q

Preferred drug for PTSD

A

SSRIs

244
Q

Preferred drug for schizophreina

A

antipsychotics

245
Q

Preferred drug for social phobias

A

-SSRIs -beta-blockers

246
Q

Preferred drug for tourette’s

A

-antipsychotics (haloperidol, risperidone)

247
Q

CNS Stimulants (4)

A
  1. methylphenidate 2. dextroamphetamine 3. methamphetamine 4. phentermine
248
Q

Mechanism of CNS Stimulants

A

-increase catecholamines at the synaptic cleft, esp. NE and DA.

249
Q

Clincial use of CNS stimulants

A

ADHD Narcolepsy Appetite control

250
Q

Antipsychotics (neuroleptics) (5)

A
  1. Haloperidol 2. Trifluoperazine 3. Fluphenazine 4. Thioridazine 5. Chlorpromazine
251
Q

Mechanism of Antipsychotics

A

All typical antipsychotics block dopamine D2 receptors (increase cAMP).

252
Q

Clinical use of antipsychotics

A

-schizophrenia (mainly + symptoms) -psychosis -acute mania -Tourette’s

253
Q

Antipsychotics are very slow to be removed from the body because…

A

they are highly lipid soluble and are stored in body fat.

254
Q

Toxicity of antipsychotics

A

-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
Q

Neuroleptic malignant syndrome

A

toxicity of antipsychotics causing rigidity, myoglobinuria, autonomic instability and hyperpyrexia

256
Q

Treatment forNeuroleptic malignant syndrome

A

-dantrolene -D2 agnoists (bromocriptine)

257
Q

Tardive dyskinesia

A

toxicity of antipsychotics casuing oral-facial movements

258
Q

High potency antipsychotics

A

-Trifluoperazine, Fluphenazine, Haloperidol *these cause neurologic side effects (EPS system)

259
Q

Low potency antipsychotics

A

-Chlorpromazine, Thioridazine *these cause non-neurologic side effects

260
Q

Chlorpromazine can also cause…

A

cornela deposits.

261
Q

Thioridazine can cause…

A

retinal deposits.

262
Q

Haloperidol can also cause…

A

NMS or tardive dyskinesia.

263
Q

Evolution of EPS side effects

A

-4 hr acute dystonia -4 day akathisia -4 wk bradykinesia -4 month tardive dyskinesia

264
Q

Atypical Antipsychotics (6)

A
  1. Olanzpaine 2. Clozapine 3. Quetiapine 4. Risperidone 5. Aripiprazole 6. Ziprasidone
265
Q

Clinical use of atypical antipsychotics

A

-schizophrenia (+ and - symptoms) -Bipolar -OCD -anxiety disorder -depression -mania -tourette’s

266
Q

Olanzapine/Clozapine may cause…

A

significant weight gain.

267
Q

Clozapine may cause…

A

agranulocytosis (requires weekly WBC monitoring) and seizure.

268
Q

Risperidone may increase…

A

prolactin (lactation/gynecomastia) leading to decreased GnRH, LH and FSH (irregular menstruation/fertility).

269
Q

Ziprasidone may…

A

prolong the QT interval.

270
Q

Clinical use of Lithium

A

-mood stabilizer for bipolar disorder -blocks relapse and acute manic episodes -SIADH

271
Q

Toxicity of Lithium

A

-tremor -sedation -edema -heart block -polyuria -teratogenesis

272
Q

Lithium causes polyuria because…

A

it is an ADH antagonist causing nephrogenic DI.

273
Q

Fetal cardiac defects from lithium include…

A

Ebstein anomaly and malformation of the great vessels.

274
Q

Buspirone mechanism

A

stimulates 5-HT(1A) receptors

275
Q

Use of Buspirone

A

-generalized anxiety disorder (1-2 wks to take effect) (does not interact with alcohol)

276
Q

SSRIs (4)

A
  1. Fluoxetine 2. Paroxetine 3. Sertraline 4. Citalopram
277
Q

Mechanism of SSRIs

A

5-HT specific reuptake inhibitors

278
Q

Use of SSRIs

A

-depression -GAD -Panic disorder -OCD -bulimia -social phobias -PTSD

279
Q

Toxicity of SSRIs

A

-GI distress -sexual dysfunction -serotonin syndrome w/ any drug that increases 5HT (MAO inhibitors, SNRIs, TCAs)

280
Q

Serotonin Syndrome

A

-hyperthermia -confusion -myoclonus -CV collapse -flushing -diarrhea -seizures

281
Q

Serotonin Syndrome is treated with…

A

Cyproheptadine (5-HT2 receptor antagonist)

282
Q

For SSRIs to start taking effect, it takes…

A

4-8 wks.

283
Q

SNRIs (2)

A

Venlafaxine Duloxetine

284
Q

Mechanism of SNRIs

A

inhibit 5-HT and NE reuptake

285
Q

Use of SNRIs

A

depression -Venlafaxine also for GAD and panic disorder -Duloxetine also for diabetic peripheral neuropathy

286
Q

Toxicity of SNRIs

A

increased BP stimulant effects sedation nausea

287
Q

Tricyclic Antidepressants (7)

A
  1. amitriptyline 2. nortriptyline 3. imipramine 4. desipramine 5. clomipramine 6. doxepin 7. amoxapine
288
Q

TCAs mechanism

A

block reuptake of NE and 5-HT

289
Q

Uses of TCAs

A

-depression -OCD (clomipramine) -fibromyalgia

290
Q

Toxicity of TCAs

A

-sedation -alpha-1 blocking effects (postural hypotension) -atropine-like effects (anticholinergic - tachycardia, urinary retention, dry mouth) -convulsions -coma -cardiotoxicity -respiratory depression -hyperpyrexia

291
Q

Tertiary TCAs (amitriptyline) have more…

A

anticholinergic effects than secondary TCAs (nortriptyline) have.

292
Q

Desipramine is less…

A

sedating but has higher seizure incidence.

293
Q

In the elderly, TCAs can cause…

A

confusion and hallucinations due to anticholinergic side effects (use nortriptyline).

294
Q

Treatment for cardiotoxicity from TCAs

A

NaHCO3.

295
Q

Monoamine oxidase inhibitors (4)

A
  1. Tranylcypromine 2. Phenelzine 3. Isocarboxazid 4. Selegine (slective MAO-B inhibitor)
296
Q

Mechanism of MAO inhibitors

A

inhibition of MAO leading to increased levels of amine neurotransmitters (NE, 5-HT, DA)

297
Q

use of MAO inhibitors

A

-atypical depression -anxiety -hypochondria

298
Q

Toxicity of MAOIs

A

-hypertensive crisis (typically w/ ingestion of tyramine) -CNS stimulation

299
Q

MAOIs are contraindicated with…

A

SSRIs TCAs St. John’s wort Meperidine Dextromethorphan

300
Q

Atypical Antidepressants

A
  1. Buproprion 2. Mirtazapine 3. Trazodone
301
Q

Buproprion increases…

A

NE and DA

302
Q

Besides depression, buproprion is also used for…

A

smoking cessation.

303
Q

Toxicity of Buproprion

A

-stimulant effects -HA -seizure in bulimic pts

304
Q

Mirtazapine MOA

A

-alpha2-antagonist (increased release of NE and 5-HT) -potent 5-HT2 and 5-HT3 antagonist

305
Q

Toxicity of Mirtazapine

A

-sedation -increased appetite -weight gain -dry mouth

306
Q

Trazodone mechanism

A

-blocks 5-HT2 and alpha1-adrenergic receptors

307
Q

Trazodone is primarily used for…

A

insomnia.

308
Q

Toxicity of Trazodone

A

sedation nausea priapism postural hypotension

Step 1 Exam (32 decks)

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