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Psychiatry Flashcards

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1
Q

Classical conditioning?

A

Natural response (salivation) elicited by conditioned or learnt stimulus (bell)

Because previously presented in conjunction with unconditioned stimulus (food)

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2
Q

Operent conditioning and the stages?

A

Learning in wich a particular action produces a punishment/reward (usually a voluntary response)

reinforcement: target behavior is followed by reward OR removal of aversive stimulus

Punishment: repeated application of aversive stimulus (postivie punishment) to extinguish unwanted behavior

Extinction: discontinuation of reinforcement (positive or negative) willeventually eliminate the behavior

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3
Q

Tranference?

A

Patient projects feelings about formative or other important persons onto physician

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4
Q

Countertransference?

A

doctor projects feelings about formative or other important persons onto the patient (ex patient reminds physician of their younger sibling)

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5
Q

Ego defense?

A

Mental process (unconscious or conscious) used to resolve conflict and prevent undesirable feelings (anxiety or depression)

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6
Q

Immature defense: acting out?

A

Expressing unacceptable feelings and thoughts through actions (example: tantrums)

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7
Q

Immature defense: denial?

A

Avoiding the awareness of painful reality (common reaction in newly diagnosed HIV)

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8
Q

Displacement?

A

Transferring avoided ideas and feelings to a neutral person or object (vs projection) mother yelled at her child because husband yelled at her

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9
Q

Dissociation?

A

Temporary, drastic change in personality (memory, consciousness, or motor behavior to avoid emoitonal stress)

Extreme forms can result in dissociative identitiy disorder

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10
Q

Fixation?

A

Partially remainging at more childish level of developpement (vs regression)

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11
Q

Idealization?

A

Expressing extremely positive thoughts of self anf others while ignoring negative thoughs

A patient boasts about his physician and accomplishments while ignoring flaws

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12
Q

Identification?

A

Modeling behavior after another person who is more powerful (though not necessarily admired)

Abused child becomes abuser

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13
Q

Intellectualization?

A

Using facts and logic to emotionally distance oneself from a stressful situation

In therapy, patient diagnosed with cancer focuses only on rates of survival

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14
Q

Isolation?

A

Seperating feelings from ideas and events

Describing murder in graphic details with no emotional response

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15
Q

Passive aggression?

A

Failing to meet the needs and expectations of others as an indirect show of support or opposition

Employee repeatedly showing up late for work because disgruntled.

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16
Q

Projection?

A

Attributing inacceptable internal impulse to external source

Man wants to cheat, accuses wife of doing so

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17
Q

Rationalization?

A

Giving logical reasons for actions to avoid self blame

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18
Q

Reaction formation

A

Replacing a warded off idea or feeling by an unconscious emphasis on the opposite

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19
Q

Regression?

A

Involuntarily withholding an idea or feeling from conscious awareness or suppression

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20
Q

Splitting?

A

Believing that all people are either good or bad

Intolerant to ambiguity

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21
Q

Mature defense: 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

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22
Q

Mature defense: altruism?

A

Alleviating negative feelings with unsolicitated generosity

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23
Q

Mature defense: Suppression?

A

Intentionally withholding an idea or feeling of conscious awareness vs repression

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24
Q

Mature defense: humor?

A

Appreciating the amusing nature of an anxiety provoking adverse situation

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25
Q

Psychiatric genetics?

A

Both genetic and environmental factors are involved in the developpement of most pyschiatric discordance

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26
Q

Effects of infant depreivation?

A

Failure to thrive
Poor language and socialization skills
lack of basic trust
Reactive attachement disorder (withdrawn, unresponsive to comfort)

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27
Q

what are the 4W’s of deprivation?

A

Weak
Wordless
Wanting
Wary

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28
Q

What is the evidence of child abuse?

A

Fractures (ribs, lone bone, spiral, multiple at different stages of healing)

Bruises: trunk, ear, neck

Cigarette burns

Subdural hematoma, retinal hemorraghes

Child avoids eye contact during the exam

Results in 4o% deaths in children less then 1 year old

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29
Q

Signs of child neglect?

A

Failure to provide child with adequate food, shelter, supervision, education or affection

Evidence: poor hygiene, malnutiriton, withdrawl, failure of emotional developpement

As with child abuse, needs to be reported.

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30
Q

Vulnerable child syndrome?

A

Parent thinks child is especially susceptible to illness of injury

May follow illness or life threatening event

Can lead to overuse of medical services

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31
Q

Attention deficit disorder?

A

Onset before 12 years old
Limited attention span and poor impulse
Charactersized by hyperactivity and impulsivity
(multiple settings)
Normal intelligence with difficulty in learning
50% of individuals have symptoms as adults

Treatement: stimulants (methyphenidate + cognitive behavior therapy)

Alternatives: atomoxetine, guanfacine, clonidine

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32
Q

Autism specturum disorder?

A 
Poor social communication 
repetitive behaviors 
restricted interests
presents in early childhood 
Intellectual diability 
More common in bous 
Increase head and brain size
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33
Q

Rhett syndrome?

A

X linked dominenet (seen in girls) males die

symtpms at ages 1-4 with regrression and loss of developpement of verbal abilities ataxia and sterotyped handwritting

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34
Q

Conduct disorder?

A

Repetitive and pervasive behavior violating the basic rights of others (theft, destruction)

After age 18 will meet criteria for anti-social

Treatment is psychotherapy such as CBT

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35
Q

Oppositional defiant disorder?

A

Pattern of hostile and defiant behavior toward authority figures in violation of social norms (psychotherapy and CBT)

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36
Q

Seperation anxiety disorder?

A

Common from 7-9 years
Overwhelming fear of seperation from home or loss of attachement.

May have false complaints to avoid school

CBT, play therapy, and family therapy

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37
Q

Tourette syndrome?

A

Onset before 18 years of agr
Sudden, rapid, non rythmic,sterotype motor and vocal tics that persist after 1 year

Corprolalia: involuntary, obscene speech in 10-20%
Associated with OCD and ADHD

Treatment with CBT, play therapy, family therapy

For intractable and distressing tics, high grade anti-psychotics (fluphenazine, pimozide) tetrabenazaine, guanfacine, clonidine

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38
Q

Neurotransmitter: alzheimer’s disease?

A

Decrease AcH

Increase glutamate

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39
Q

Neurotransmitter depression?

A

Decrease norrephinephrine

Decrease 5-HT, decrease dopamine

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40
Q

Huntingtons’ neurotransmittor?

A

Decrease GABA, decrease Ach

Increase dopamine

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41
Q

Parkinson’s disease?

A

Decrease dopamine

Increase Ach

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42
Q

Schizophrenia neurotransmiter

A

Increase dopamine

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43
Q

Componenets of orientation?

A

Ability of a person to know where he is

Loss of time, then place, and then person

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44
Q

Common causes of loss of orientation?

A 
ETOH
Drugs
Electrolyte imbalance
Head trauma 
Hypoglycemia 
infection
nutritional deficiency
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45
Q

Retrograde amnesia?

A

Can not remember things before the CNS insult

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46
Q

Antegrade amnesia?

A

Cant remember things that occurred after the CNS insult

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47
Q

Korsakoff sydrome?

A

Amnesia (antegrade more then retrograde)
Caused by vitamin B deficiency
Associated with destruction of mamillary bodies
Seen in ETOH as late manifestaion of Wernicke
Often have confabulation

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48
Q

Dissocaitive amnesia?

A

Inability to recall personal info
Usually due to severe trauma or stress
Can have dissociative fugue (abrupt travel or wandering during period of dissociative amneisa)
Can be associated with traumatic circumstances

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49
Q

Dissociative identity disorder?

A 
Formerly multiple personality disorder 
Two or more personality states
More common in women 
Associated with sexual abuse 
PTSD
Depression
Substance abuse 
Borderline personality 
Somatoform disorders
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50
Q

Depersonalization/derealization disorder?

A

Persistant feeling of detachement or estrangement from one’s own body

Thoughts, perceptions and actions

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51
Q

Characteristics of Delirium?

A

Waxing and weaning of level of consciousness
Decrease in attention span and level of arousal
Disorganized thinking, hallucinations and illusions

Usually secondary to other illness (CNS, disease, infection, trauma, substance, metabolic, hemorrage, urinary, fecal retention)

Most common presentation of altered mental status within inpatient setting

Will have diffuse EEG slowing

Treatment is identifying the underlying condition

Haldol may be needed

Benzodiazepines for ETOH withdrawl

TADA approach: tolerate, anticipate, don’t agitate are helpful for management

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52
Q

Characteristics of Dementia?

A

Decrease intellectual function without affecting level of consciousness

Aphasia, apraxia, agnosia and loss of abstract thought
Behavioral problems, impaired judgement

Patient can have delirium ontop of the the dementia

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53
Q

Irreversible causes of dementia?

A 
Alzheimers
Lewy body
Huntington 
Pick disease
Cerebral infarct 
Cresutfeldt-jakob
Chronic substance abuse
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54
Q

what are reversible causes of the dementia?

A 
Hypothyroidism 
Depression 
Vitamin B defieincy
Normal pressure hydrocephalus 
Neurosyphilis 
Increase incidence with age
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55
Q

What screens to do for dementia?

A

Depression
Hypothyroidism
TSH
B12 levels

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56
Q

What is psychosis?

A

Distorted perception caused by delusions, hallucinations, disorganized thinking (can be due to medical illness, psychiatric illness or both

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57
Q

What are delusions?

A

Unique, false beliefs despite the facts

Can be persecutory, referential, gradoise, erotomanic, somatic

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58
Q

What are disorganized thought?

A

Speech may be incoherent
Tangential
Or derailed

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59
Q

What are the different types of hallucinations?

A

Visual: more common in medical illness then psychiatric

Auditory: more common in pyshciatric illness

Olfactory: occur as aura of temporal lobe epilepsy

Gustatoty: rare but seen in epilepsy

Tactile: common in ETOH and withdrawl of stimulant use (cocaine and ampehtamines)

Hypnagogic: occurs while going to sleep (can be seen in narcolepsy)

Hypnopompic: occurs while waking from sleep (sometimes seen with narcolepsu)

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60
Q

Prevalence of schizophrenia?

A

1.5 % prevalence
Males =females = african americans= caucasians
Men present in late teens to early 20s
Women late 20’s to early 30’s

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61
Q

Criteria of diagnosis?

A

Need two of the criteria, lasting more then 6 months for diagnosis

  1. Delusions
  2. Hallucinations (often auditory)
  3. Disorganzied speech
  4. Disorganized or catatonic behavior
  5. Negative symptoms (affective flattening, avolition, anhedonia, asociality, alogia)
62
Q

Schizophrenia brain imaging?

A

Shows ventriculomegaly

63
Q

Brief psychotic disorder?

A

Lasting less then 1 month and usually stress related

64
Q

Schizophreniform disorder?

A

LAsting 1 to 6 months

65
Q

Schizoaffective disorder?

A

More then 2 weeks of hallucinations and delusions without major mood episode(depression or mania)

Plus periods of major mood episode with schizophrenic symptoms

66
Q

Delusional disorder?

A

Fixed, persistant false belief lasting more then 1 month
Functioning is not impaired
Can be shared by two called folie a deux

67
Q

Mood disorder?

A

Abnormal range of moods or emotional states with loss of control

Severity can cause social and occupational functioning decrease

68
Q

What is a maniac episode?

Critieria for diagnosis?

A

Distinct period of abnormally and persistantly elevated, expansive, or irritable mood

Lasts about 1 week

Criteria for diagnosis:
distractability 
irresponsibility (seeks pleasure) 
grandiosity: inflated self esteem 
Flight of ideas
Increase in goal directed activity, agitation
Decrease the need for sleep 
Talkative or pressured speech
69
Q

Maternal post partum blues?

A 
50-85% 
Depressed affect
Tearfulness
Fatigue (2-3 weeks after delivery)
Resolved within 10 days
70
Q

Postpartum depression?

A

10-15% incidence (depressed affect, anxiety and poor concentration)

Treatment CBT and SSRI

71
Q

Post partum psychosis?

A

0.1 to 0.2 incidence: mood congruent delusions, hallucinations and thoughts of harming the baby or self

Risk factors if have bipolar or psychotic delusions

First pregnancy, family history, recent discontiuation of psychotropic medication

Treatment: hospitalization and initiation of atypical antipsychotics (if not sufficient use ECT)

72
Q

Definition of Grief?

A

Shock, denial, guilt, sadness, anxiety, yearning
Hallucinations of the dead person are common
Duration varies, but usually less then 6 months

Pathological grief is persistant and causes functional impairment (can meet the criteria for major depressive episode)

73
Q

Electroconvulsive therapy?

A

For treatment refractory depression
Depression with psychotic symptoms
Acutely suicidal patients
Produces grand mal seizure in anesthetized patient

Adverse effects include: disorientation, temporary headache, antegrade or retrograde amnesia usually resolving in months (safe for pregnancy)

74
Q

What are risk factors for suicide?

A 
Sex
Male
Depression
Previous attemt 
Ethanol or drug use
Rational thinking loss
Sickeness
Organized plan 
No spouse or social support 
Stated future intent

Most common method in the US is with firearms

75
Q

Anxiety disorder?

A

Inappropriate experience of fear and worry and its physical manifestations

Symptoms interfere with daily functioning : panic disorders, phobias, generalized anxiety disorder, selective mutism

Treatment: SSRI, SNRI

76
Q

What are the symptoms of panic disorder?

What is the criteria needed for diagnosis of panic attack?

A 
Palpitations
Paresthesia
De personalization 
Derelaization 
Abdominal distress
Nausea
Intense fear of dying 
Intense fear of losing control or going crazy

1) Persistent concern for additional panic attacks
2) Worrying about the consequences of the attack
3) Behavioral changes related to the attacks

77
Q

Specific phobia?

A

Fear or anticipation of a specific object or situation
Person recognizes that the fear is excessive
Can be treated with systemic desensitization

78
Q

Social anxiety disorder?

A

Exaggerated fear of embarassement in social situations
Treatment CBT, SSRI, venlafaxine
If have occasional anxiety producing situations:

Benzodiazepines or B-blocker

79
Q

Agoraphobia?

A

Exaggerated fear of open or enclosed places
For example, public transportation, in line or crowds
Leaving home alone
Associated with panic disorder
Treatment CBT, SSRI, MAO inhibitors

80
Q

What is generalized anxiety disorder?

A

Anxiety lasting more then 6 months unrelated to specific person, situation or event

Associated with restlessnes, irritablity, and sleep distrubances, fatigue, muscle tension, difficulty concentrating

Treatment: CBT, SSI,SNRI, buspirone,TCA, benzo are second line

81
Q

Adjustement disorder?

A

emotional symptoms (anxiety and depression) causing impairment following psychosocial stressor (illness or divorce) lasting less then 6 months.

Can be more then 6 months if chronic stressor

Treat with CBT and SSi

82
Q

Obsessive compulsive disorder?

A

Recurring intrusive thoughts, feelings or sensations that cause severe distress

Relieved by repetitive functions

Treatment with CBT, SSRI

83
Q

What is ego-dystonic behavior?

A

behavior is inconsistant with one’s belief and attitudes

(vs, obsessive personality disorder and associated Tourette’s syndrome

84
Q

What is body dysmorphic disorder?

A

Preoccupation with minor or imagined defect in appearence

will frequently seek out cosmetic surgery
Treatement with CBT

85
Q

What is post-traumatic stress disorder?

A

Exposure to prior trauma (withnessing death, injury or rape)

Intrusive reexperiencing of the event (nightmare, flashbacks) avoidence of the associated stimuli (changes with cognition or mood)

Persistantly elevated state of arousal

Disturbances last more then 1 month

Treatment with CBT, SSRI, and venalfaxine

86
Q

What is acute stress disorder?

A

Lasts between 3 dyas and 1 month

Treatment: CBT, pharmcotherapy usually not indicated

87
Q

Malignering?

A

False illness for external gain
Poor compliance for follow-up necklace
Complaints cease after gain

88
Q

Facititious disorder?

A

Physical and psychological symptoms to assume sick role

89
Q

Facitious disorder imposed on self?

A

Chronic facititious disoder, multiple hospital admission, and will undergo tests

90
Q

Facititious disorder imposed on another?

A

Illness in child or elderly parent is fabricated by care caregiver

91
Q

Somatic symptom disorder?

A

Bodily complains (pain and fatigue) that last for years. excessive, persistent thoughts about symptoms

92
Q

Conversion disorder?

A

Loss of sensory or motor function following a stressor.

The patient is indifferent about the symptoms

93
Q

Illness anxiety disorder?

A

Excessive preoccupation with having a serious illness, often despite reassurance or minimal symptoms

94
Q

Pseudosyseis?

A

False, non delusional belief of being pregnen

May have signs of pregnancy

95
Q

Personality trait?

A

endurine, repeitive patter of precieving, relating to and thinking about the environment, or one’s self

96
Q

Personality disorder?

A

Inflexble, maladpative and rigidly pervasive pattern of behavior causing distress

Patient is not aware of the problem

97
Q

Cluster A personality disorder?

What do they consist of?

A

Odd and eccentric (inability to develope meaningful social interactions

No psyhcosis
Genetic association with schizophrenia

Paranoid: Pervasive distrust and sucpisciousness

Schizoid: Voluntary social withdrawl, limited emotional expression, content with social isolation

Schizotypal: eccentric appearnace, odd beliefs, magical thinking, interpersonal awkwardness

98
Q

Cluster B personality disorders?

A

Dramatic, emotional, erratic, genetic association with mood disorders and substance abuse

Antisocial: disregard for and violation of rights of others (criminality, impulsivity, males more then females)

Must be more then 18 years old and have a history of conduct disorder before the age of 15

Borderline: unstable mood andinterpersonal relationships (impulsive, self mutilation)

feeling of emptiness

Histrionic: excessive emotionality and excitability
Attention seeking, sexually provocative splitting is a major defense mechanism

Narcissistic: grandiosity
Sense of entitlement
Lack of empathy
Est

99
Q

Cluster C personality?

A

Anxious or fearful (genetic association with anxiety disorders)

Avoidant: hypersenstive ro rejection (socially inhibited) feeling of inadequacy, desires relationship with others

Compulsive-Obsessive: Preoccupation with order, perfection, control, OCD

Dependent: submissive and clingy
Excessive need to be taken care of
Low self-confidence

100
Q

Anorexia nervosa?

A 
Excessive dieting and eating with BMI less then 18.5 
Distortion of body immage
Decrease in bone densitt 
metatarsal stress fractures 
Amenorrhea 
loss of GnRH secreation
Luango 
Anemia 
Electrolyte imbalance 
Coexists with depression 
Increase in insulin with hypophophatemia 
Cardiac complications
101
Q

Bullimia nervosa?

A

Binge eating in inappropriate compensatory behavior (vomiting, laxatives, diuretics)
Occuring for 3 months
Normal body Mass index
Assocaited with parotitis, enamel erosision, electorlyte disturbances, alkalosis, dorsal hand calluses from induced vomiting

102
Q

Binge eating disorder?

A

Regular episodes of excessive, uncontrollable eating without inappropriate compensatory behaviors, increase risk of diabetes

103
Q

Gender dysphoria?

A

Strong, persistant cross gender identification that leads to persistant discomfort with sex assigned at birth, causing significant distress

104
Q

Transesual?

A

Desire to live as the opposite sex

Often through surgery or hormone treatment

105
Q

Transvestitre?

A

Paraphelia, not gender dysphoria (wearing clothes of the opposite sex)

106
Q

Sexual dysfunction?

A

Hypoactive sexual desire or sexual aversion
Sexual arousal disorderds
Orgasmic disorder (anorgasmia, premature ejaculation, sexual pain)

Differential diagnosis: Drugs (anti-ypertensives, neuroleptics, SSRI, ethanol)

Diseases: (depression, diabetes, STI)

Psychological (performance anxiety

107
Q

Sleep terror disroder?

A

Period of screaming in the middle of the night
During the slow-wave/deep N3 sleep
Most common in children
Occurs during NON REM sleep (no memory of arousal)

Triggers

108
Q

Narcolepsy?

A

Disodered regulation of sleep-wake cycle
Excessive day-time sleepiness (awaken feeling rested(

Caused by decrease hypocrtein production in the lateral hypothalamus

109
Q

What are symptoms associated with narcolepsy?

A

Hypnagogic: just before sleep pr hypnopomic (just after awakaing) hallucinations

Nocturnal or narcoleptic sleep episodes that start with REM sleep

Cataplexy: loss of all muscle tone following strong emotional stimulus such as laughter in some patients

There is strong genetic component
Treatement with daytime stimulants (apmphetamines, modainil, and nighttime sodium oxybate (GHB)

110
Q

What are signs of substance abuse?

A

Maladaptive pattern of substance use as defined as 2 or more of the following signs within 1 year

Tolerance
Withdrawl
Substance taken in larger amounts or over longer period of time then desired

Persistent desire, or unsuccessful to cut down

Significant energy spent obtaining, using, or recovering from substance

Important social, occupational, or recreational activities are reduced because of substance abuse

Continued use despite knowing there are physical and pyschological problems

Craving

Failure to fulfill major obligation at work, school or home

Social or interpersonal conflicts related to substance abuse

111
Q

Stages of change in overcoming substance addiction?

A

Precontemplation: not even acknowledging that there is a problem

Contemplation: acknowlegde there is a problem but not ready or willing to make a change

Action/willpower: changing behavior

Maintenecce: maintaining behavior changes

Relaspse: returning to old behaviors
Abandoning new changes

112
Q

ETOH intoxication and withdrawl?

A 
emotional liability 
Slurred speecj 
ataxia
Coma
Blackout
Serum glutamyltransferease GGT
AST value is twice of ALT

Severe wihdrawl:
Autonoic hyperactivity
DT in 5-15% mortality
Treat with benzo

113
Q

Opiod intoxication and withdrawl?

A 
Euphoria
Respiratory and CNS depression
Pinpoint pupils 
Pupillary constriction 
Pinpoint pupils 
Seizures 
Most common cause of drug overdose is death

Treatment naloxone and naltexone

Withdrawl: 
Sweating
Dilated pupils 
piloerection
fever
rhinorrhea 
yawning 
nausea 
stomach cramps 
dirreha

Treatment: long term support, methadone, buprenophine

114
Q

Barbituates intoxication/withdrawl?

A

Low margin of safety
Marked respiratory depression
Treatment: symptom management (assist respiration and increase BP)

withdrawl: Delirium (life threatening cardiovascular collaspse)

115
Q

Benzodiazepines?

A

Greater safety margin
Ataxia, minor respiratory depression

Treatment wih flumazenil

Withdrawl: sleep disturbances, depression, rebound anxiety seizure

116
Q

Amphetamine intoxication and withdrawl?

A 
Euphoria: mood elevation, psychomotor agitation
Insomnia
Cardiac arrythmias 
Tachycardia
Anxiety
117
Q

Cocaine intoxication?

A

Impaired judgement
Pupillary dilatation
Prolonged wakfulness
Angina and sudden death

Treatment:
Alpha blockers
Benzodiazepines

B blockers are NOT recommended

118
Q

Caffeine?

A

Restlessness
Increase diuresus
Muscle twitching

Withdrawl: headache (difficulty concentrating)
Flu like symptoms

119
Q

Nicotine?

A 
Intoxication: restlessness
Withdrawl: irritability
anxiety
Restlessness 
difficulty concentrating 
treatment with: nicotine patch, gum, lozenges, bupropion/varenicline
120
Q

What are the classes of hallucinations?

A

Phencyclidine
Lysergic acid
Marijauna
MDMA (esctacy)

121
Q

Phencyclidine?

A 
Intoxification:
violence
impulsivity 
Pyschomotor agitation 
Nystagmus
Tachycardia 
HTN
analgesia 
Psychosis 
Delirium 
Seizures
Trauma is most common comlication

Treatment: benzodiazepine

122
Q

Lysergic acid?

A 
Perceptual distortion (visual, auditory)
Depersonalizarion 
Anxiety 
Paranoia 
Psychosis 
Possible flashback
123
Q

Marijuana?

A 
Euphoria 
Anxiety 
Paranoid delusions
Perception of slowed time 
Impaired judgement 
Social withdrawl
Increase appetite 
Dry mouth 
Conjunctival injection

Pharmaceutic form: dronabinol
(used for antimetic when on chemotherapy
Can also be used to stimulate the appetite in AIDS

Withdrawl: 
Irritability
Anxiety
Depression
Insomnia 
Restlessness
Decrease appetite 
Difficulty concentrating 
Anxiety   
Detectable in urine for up to one month
124
Q

MDMA (ecstasy)?

A 
Hallucinogenic stimulant 
euphoria 
Disinhibition 
Hyperactivity 
Life threatening effects include hypertension
Tachycardia 
Hyperthermia 
hyponatremia 
serotonin syndrome
125
Q

Heroine addication?

A

Users have increase risk of HIV
Abcesses
Bacteremia
Right heart endocarditis

126
Q

What are treatment options for heroine addiction?

A

Methadon: long acting oral opiate used for heroin detoxification or long term maintenece

Nalxone: antagonist and partial agonist
NOT oral bioavialabe
Withdrawl only occurs if injected (lower abuse potential)

Naltrexone: long acting opiod anatgonist used for relapse preventiononce detoxified

127
Q

Alcholism?

A

Physiologic tolerance and dependence with symptoms of withdrawl

Tremor, tachycardia, HTN, malaise, nausea, DT when intake is interrupted

Complications: cirrhosis, hepatitis, pancreatitis, periphereal neuropathy, testicular atrophu

Treatment: disulfiram (to condition the patient to abstain from ETOH)

naltresxone

supportive care

Groups such as Alcoholic annonymous

Helpful in sustaining abstinence and supporting patient family

128
Q

Wernicke-Korsakoff syndrome?

A

Vitamin B1 deficiency
Triad: confusion, opthamlmoplegia, ataxia
Can go to irreveresible memory losss, confabulation, personality change (Kosakoff syndrome)

Associated with periventricular hemorraghe /necrosis of mamillary bodies

Treatment is IV vitamin B

129
Q

What is Mallory-Weiss syndome?

A

partial thickness tear in gastroesophageal junction caused by excessive/forcful vomiting

Often presents with hematemesis
Misdiagnosed as ruptured esophageal varices

130
Q

Delirium Tremens?

A

Life threatening ETOH withdrawl
Peaks 2-5 days after the last drink
Characterized by autoimmune hyperactivity (tachycarida, tremens, seizures(

Usually within a hospital setting

Treatment with benzodiazepines

There is also a phenomen known as ETOH hallucinations (12-48 hours after the last drink)

Treatment with benzodiazepines (chlordiazepoxide, lorazepam, diazepam)

131
Q

Medication for ADHD?

A

Stimulants (methyphenidate, amphetamine)

132
Q

Medication for ETOH withdrawl?

A

Benzodiazepine
Chlordiazepoxide
Lorazepam
Diazepam

133
Q

Medication for bipolar disorder

A

Lithium
Valporic acid
Atypical antipsychotics

134
Q

Bulimia Nervosa?

A

SSRI

135
Q

Depression?

A

SSRI

136
Q

Generalized anxiety disordeer?

A

SSRI, SNRI

137
Q

Obssesive compulsive disorder?

A

SSRI, venlafaxine, clomipramine

138
Q

Panic disorder?

A

SSRI, venlafaxine, benzodiazepine

139
Q

PTSD?

A

SSRI, venlafaxine

140
Q

Schizophrenia?

A

atypical antipsychotic

141
Q

Social anxiety disorder?

A

SSRI, venalfaxine

Performance only:B blocker, benzodiazepine

142
Q

Tourette’s syndrome?

A

Antipsychotic (fluphenazine, pimozide tetrabenazine

143
Q

Medications considered CNS stimulants?

A

methylphenidate, dextroamphetamine, methamphentamine

Mechanism: increase catecholamines in synaptic cleft
(especially norephinenprine and dopamine)

Use in: ADHAD,narcolepsy. and appetite control

144
Q

How does Lithium work?

A

Not established (might be linked to inhibition of the phosphoinoside cascade

Clincial use: mood stabilizer for bipolar events
Blocks relaspse and acute maniac events

Adverse effects:

Tremor
Hypothyroidism
Polyuria (caused by nephrogenic diabetes insipidus)
Can cause Ebstein anomaly (in newborn if taken by mother)
Narrow therapeutic window
Requires close monitoring of serum levels
Almost exclusively excreted by the kidneys
If used with Thiazide can be implicated in lithium toxicity

145
Q

What are the side-effects of lithium?

A

Movement (tremor)
Nephrogenic diabetes insipidus
Hypothyroidism
Pregnancy problems

146
Q

Mechanism and use of Buspirone?

A

Stimulates 5-HT receptors
Clinical use in generalized anxiety disorder
Does not cause sedation, addiction, or tolerance
Takes 1-2 weeks to take effect
Does not interact with ETOH

147
Q

SSRI mechanism, use and side-effects?

A

examples: fluoxetine, proxetine, sertaline, citalopram
mechanism: 5-HT specific reuptake inhibitors
Clinical: depression, anxiety, panic disorder, OCD, bulemia, social anxiety disorder, PTSD, premature ejaculation, premenstral dysphoric disorder

Adverse effects: 
Increase in BP is the most common
Stimulant effects 
Sedation 
Nausea
148
Q

What is serotonin syndrome?

A

Can occur with any drug that increases 5-HT (MAO inhibitors, SNRI, and TCA)

Characterized by:
Neuromuscular activity (clonus, hyperreflexia, hypertonia, tremor and seizure)

Autonomic stimulation (hyperthermia, diaphoresis, diarrhea)

Treatment: cryproheptaine

149
Q

Tri-cyclic anti-depressents: mechanism, clinical use, adverse effects?

A

Examples: amitriptyline, nortriptyline, imipramine, desipramine, clomipramine, doxepin, anoxapine

Mechanism: Blocks reuptake of norepinephrine and 5 HT

Clinical use: Major depression, OCD, peripherial neuropathy, chronic pain, migraine prophylaxis

Adverse effects: Sedation
Alpha-blocking (postural hypotension)
Atropine like effects (tachycardia, urinary retention, dry mouth)

NOTE: 3rd generation TCA have more anticholinergic effects then 2TCA

3rd can prolong the QT interval 
Cardiotoxicity 
Respiratory depression 
Hyperpyrexia
Confusion 
Hallucinations
150
Q

Monamine oxidase inhibitors (mechanism, clinical use, adverse effects)

A

Tranylcypromine
Phenelzine
Isocarboxazid
Selegiline

Mechanism: Non selective MAO inhibition with increase levels of amine neurotransmittos (noreepinephrine, 5-HT, dopamine)

Clinical use: Atypical depression, anxiety

Adverse effects: HTN crisis (especially when eated with tyramine, found in foods such as aged cheese)

CNS stimulation
Contraindicated with SSRI, TCA, St-John’s Wort, meperidine, destromethophan (or may cause serotonin sydrome)

Wait 2 weeks after stopping MAO before starting serotonergic drugs or stopping dietary restrictions

151
Q

what are the atypical anti-depressents? And their mechanism?

A

Bupropion( increase in norepinephrine and dopamine via unknown mechanism )

Used for smoking cessation
Toxicity: tachycardia, insomnia, headache, anorexia (no sexual side effect)

Mirtazapine (alpha antagonist) increase release of NE, potent 5 HT2 and 5-HT3 receptor antagonist and H3 antagonist

Toxicity; Sedation, increase appetite, weight gain and dry mouth (weight gain might be good in elderly)

Trazadone; bocks 5HT 2, alpha adrenergic and Hi receptors
Used primarily for insomnia
High dose needed for anti-depresent effect
Toxicity: sedation, nausea, priapism, postural hypotension

Vernicline: Nicotinic AcH receptor, partial agonist
Used for Smoking cessation
Toxicity: Sleep disturbances

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