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Psychiatric > Quiz 1 > Flashcards

Quiz 1 Flashcards

1
Q

what is the legal driving limit of BAL?

A

0.08

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2
Q

what level of BAL do you see changes in behavior and cognition?

A

0.02-0.03

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3
Q

coma and possible death are expected at a BAL of what level?

A

0.4

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4
Q

what term is described as abnormal need for a substance?

A

DEPENDENCE

  • psychological: craving the behavior the drug gives
  • physiological: having withdrawals if D/C drug
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5
Q

What is the term used to describe the need to increase the dose to achieve the same effect OR a diminished effect with continued use?

A

Tolerance

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6
Q

Abnormal physical and physiological symptoms that follow abrupt D/C of a substance

A

Withdrawals

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7
Q

Of the criteria to diagnose a substance use disorder, >2 are needed over what period of time for diagnosis?

A

12 months

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8
Q

patient presents with a positive urine drug screen. What is the next step?

A

do Gas Chromatography to confirm and rule out false positive.

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9
Q

T or F: blood tests are more definitive than urine tests for drug screening

A

True!

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10
Q

controlled substance use requires blood tests for screening how often?

A

every 3-6 months

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11
Q

Which part of marijuana causes the “HIGH”

A

THC

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12
Q

which part of marijuana is used for pain?

A

CBD

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13
Q

why does THC stay in the system for a long period of time?

A

THC is stored in fat

urine testing positive for 4-6 days in short term users and 20-50 days in long-term users

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14
Q

what is the most commonly used illegal stimulant in minnesota

A

methamphetamines

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15
Q

patient presents to the clinic with delusions of parasitosis and aggression. On physical exam you notice dental decay. What is at the top of your diagnosis?

A

Methamphetamine abuse

dental decay is also known as “meth mouth”

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16
Q

What 2 meds are used to treat ACUTE intoxication of stimulants?

A

benzodiazepines + antipsychotics (if needed)

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17
Q

how long to keep a patient with an ACUTE stimulant intoxication?

A

72 hour hold with psych hospitalization (incase they are a threat to self or others)

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18
Q

T or F: low to moderate doses of caffeine per day improve attention and task performance

A

True

30-200 mg per day are good!

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19
Q

at what level of caffeine can you diagnose a patient with caffeinism?

A

> 500 mg per day

can mimic an anxiety disorder

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20
Q

What are the 4 most commonly used substances?

A

alcohol, marijuana, opiates, meth

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21
Q

how would you describe At-Risk drinking?

A

repetitive use of alcohol as coping for anxiety, depression, etc.

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22
Q

what number of drinks for men and women are used to describe alcohol abuse?

A

MEN: >4 drinks per day or 14 per week

WOMEN: >3 drinks per day or 7 per week

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23
Q

patient presents with Wernicke-Korsakoff syndrome. What does this mean and what is going on with the patient?

A

thiamine deficiency

he has alcoholism

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24
Q

your patient has confusion, speech difficulty. On exam, he has asterixis. What are you thinking?

A

Hepatic encephalopathy (end stage alcoholism)

treat with lactulose to lower ammonia levels

25
Q

when a patient extends his wrist, you notice a flapping movement of the hands. What is this?

A

asterixis “liver flap”

hallmark of end-stage alcoholism/hepatic encephalopathy

26
Q

patient presents with confusion + ataxia (balance troubles) + ophthalmoplegia (6th nerve palsy). What is this?

A

Wernicke encephalopathy (classic triad)

27
Q

what is the classic triad of Wernicke encephalopathy?

A

confusion + ataxia + ophthalmoplegia

28
Q

in alcoholism, what will the AST/ALT ratio be like?

A

> 2:1 ratio

GGT elevated
Ammonia elevated

29
Q

which lab values will be LOW in alcoholism?

A

Potassium and Magnesium

30
Q

a person has small eyes, thin upper lip, and flat philtrum. His mother reports learning and attention problems. What do you think he has?

A

fetal alcohol spectrum disorder

31
Q

overdose is defined as a BAL of what?

A

> 0.35 for most people

characterized by respiratory depression, seizure, shock, coma

32
Q

T or F: acute alcohol intoxication will yield hyperglycemia

A

FALSE: hypoglycemia in kids and diabetics

33
Q

What is the treatment for acute intoxication?

A

supportive (let them sleep it off in safe environment)

-antiemetics, fluids, resp support if needed

34
Q

which symptoms is NOT part of alcohol withdrawal:

tachycardia, drop in BP, fever, tremor, headache, anxiety

A

drop in BP - you will see elevated BP

35
Q

what is the time frame for onset of symptoms of alcohol withdrawal?

A

6-36 hours after last drink

36
Q

peak intensity of alcohol withdrawal?

A

48-72 hours after last drink

37
Q

alcohol withdrawal seizures typically occur how long after stopping alcohol?

A

6-48 hours

38
Q

describe what the alcohol withdrawal seizures are like

A

brief
nonfocal
occur 1-2 times
self-limited

39
Q

T or F: a seizure is often the first sign of alcohol withdrawal

A

True

40
Q

what can alcohol withdrawal seizures progress to?

A

Delirium Tremens

41
Q

what is Delirium tremens and how is it managed?

A

most severe form of alcohol withdrawal: confusion, hallucinations, fever, tachy, htn

-give LARGE DOSE of Benzodiazepines

42
Q

what is the mainstay of alcohol withdrawal treatment?

A

benzodiazepines

43
Q

although benzos are the mainstay of alcohol withdrawal treatment, what is given FIRST??

A

IV thiamine (to prevent development of Wernicke encephalopathy)

44
Q

do you screen your 19 year old patient for alcohol misuse?

A

YES - everyone over 18

45
Q

which 2 drugs are used to treat alcoholism?

A

Disulfiram (Antabuse) - causes vomiting with alcohol use

Naltrexone - reduces cravings

46
Q

it is difficult to see opiate intoxication on physical exam. What one finding might you see?

A

miosis - pinpoint pupils

patient might also feel euphoria, drowsiness, nausea

47
Q

this opiate medication can cause QT prolongation and torsades

A

methadone

48
Q

what is used for treatment of opiate intoxication?

A

Naloxone (Narcan)

given IM or IV; may need to be repeated due to short duration

49
Q

what might your patient experience with mild opiate withdrawal?

A

cravings, yawning, rhinorrhea, restlessness

moderate-severe: above plus piloerection, mydriasis, tachycardia

50
Q

which 3 drugs are used in long term treatment of opiate withdrawal

A

methadone
suboxone + buprenorphine
naltrexone

51
Q

When diagnosing a patient with depression, they need 5/9 symptoms for what duration?

A

almost all day every day for 2 weeks

must include anhedonia and/or depressed mood

52
Q

how long is an adequate trial of antidepressants?

A

4-12 months

53
Q

what psych disorder is characterized by alternating shifts in emotions from periods of depression to periods of mania (highs)

A

bipolar disorder

54
Q

what should never be used alone in treating depression?

A

antidepressants - always combine w/ antipsychotics or benzos

55
Q

T or F: bipolar disorder is genetic

A

TRUE: 10x more likely to get it if family member has it.

56
Q

what is bereavement?

A

grief after loss through death

57
Q

diagnosing bereavement and deciding to treat it requires a grief period of over how long?

A

> 6 months + 1 of the symptoms:

intense yearning for person and feelings of emptiness, recurrent thoughts that life is meaningless and urge to join them

58
Q

which demographics are most common for suicide?

A

native americans
native Alaskans

children

Psychiatric (2 decks)

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