Schizophrenia, Substance Abuse, Migraines, Pain Flashcards
1
Q
Kappa receptor effects
A
dec. GI sedation dysphoria psychosis
2
Q
A delta fibers -myelination -conduction -respond to what
A
thinly myelinated –conduction=20m/sec respond to noxious mechanical stimuli
3
Q
Cox 1 location
A
most tissues
4
Q
Full effects SZP time and symptoms
A
12 weeks ADLS cognition - symptoms delusions
5
Q
Origins of Neuropathic pain
A
peripheral -abnormal nocicpetor sensitization -dec. threshold -inc. sensitivity to afferent neurons central -central sensitization of nociceptors
6
Q
Atypical AP high affinity for?
A
5HT2
7
Q
T/F priamry nociceptive neurons have smaller diameter axons
A
true –slower conduction speed
8
Q
FGA/SGA potency and Ach?
A
low: most sedating Med: medium sedation High: least sedating
9
Q
FGA med. potency
A
Loxapine Perhenazine Thiotixene
10
Q
drug w/ QTc prolongation risk
A
ziprasidone
11
Q
Step 2 Who ladder
A
Mild-Mod opoids +/- non opioids +/- adjuvant
12
Q
CIWA scores
A
0-9 very mild withdrawal 10-15 mild 16-20 modest 21-67 severe
13
Q
Baseline monitoring parameters (11) SZP
A
BP BMI waist circumference A1C fasting lipid panel CMP CBBC TSH EKG pregnancy aims
14
Q
Who ladder step 1
A
non-opioids +/- adjuvant
15
Q
urine screen metabolites of oxycodone
A
oxycodone oxymorphone
16
Q
Dystonia risks (3)
A
treatment naive elderly FGA
17
Q
TX of - symp in SZP
A
max antipsychotic Add antidepressant
18
Q
SGA high potency
A
Risperidone Paliperidone
19
Q
akathesia tx (4)
A
anti-parkinson BB BZD dec. dose
20
Q
How long does meth stay in urine
A
1-2 days
21
Q
Tension Tx prophylactic
A
Amitriptyline
22
Q
buprenorphine MOA
A
partial agonist at mu receptor weak kappa antagonist
23
Q
urine screen metabolites of codeine
A
codeine morphine hydrocodone
24
Q
Mod-Severe opioids (6)
A
morphine oxycodone dulaudid opana duragesic methadone
25
Moderate response time and symptoms on SZP
4-6 weeks + symptoms ADL
26
naloxegol MOA
Mu in Gi antagonist
27
lurasidone major counsel
must take w/ \>350cal
28
seizure risk in AP highest?
clozapine
29
alpha 1 antagonism in SZP (2)
sedation hypotension
30
how long does methadone stay in urine
3 days
31
Tension Type HA Dx(3)
bilateral not aggravated by acitivites no nausea
32
ETOH dependence TX
Disulfiram
33
Reduce ETOH craving
Naltrexone Acamprosate
34
GHB MOA
weak GABA-B agonist and GHB receptor agonist -open K channel -close Ca channels dec. neuronal acitivation and NT release
35
Define Dependence
removal of the drug results in withdrawal symptoms which can be physical or psychological
36
opioid function of respiratory depression
dec in sensitivity of respiratory center to CO2
37
drugs w/ high risk of EPS (2)
haldol risperidone -b/c high potency FGA: b/c slow dissociation
38
A beta afferent fibers cause
allodynia
39
opioid use when are pupils large/small
intoxication: pinpoint withdrawal: enlarged over dose: ppinpoint
40
t/f opioid constipation is easier to treat than prevent
F
41
Dephenylheptane Class
Methadone
42
sizure risk in AP lowest?
quetiapine
43
SGA low potency
Clozapine Quetiapine
44
Define Addiction
uncontrollable, compulsive drug seeking and use, even in the face of negative health or social consequences
45
How long does codeine stay in urine
48 hrs
46
What is the potent metabolite of THC
11-hydroxy-THC
47
TX insomnia in SZP (4)
antihistamine sedating antidepressant -trazodone -mirtazapine -doxepin hypnotics BZD
48
urine screen metabolites of alprazolam
alpha hydroxyalprazolam
49
CGRP receptor blockers (2)
Erenumab Fremanezumab
50
Balbenzine Deutetetrabenzine MOA
vesicular monoamine transporter 2 inhibitors
51
which HA respond to indomethacin (5)
stabbing hemicrania exercise HA cough HA sexual activity HA
52
Preprodynorphin cleaved to what
Dynorpin
53
Tardive dyskinesia risk (4)
middle aged women elderly long-term use FGAs high dose/potency
54
Is a immunoassay urine drug screen qualitative/quantitative
Qualitative
55
iloperidone major counsel
miss \>3 days must re titrate
56
Acamprosate counsel
crcl 30-50 dose 333 TID Crcl \<30 do not use continue use if relapse
57
Delta receptor effects
immune modulation
58
reason naloxegol stays in GI
PEG chain
59
Triptan contraindication (3)
CAD CVD uncontrolled HTN
60
Neuropathic pain 1st line TX
Secondary amines -Nortriptyline -Amitriptyline Ca channel Ligans -Pregabalin -Gabapentin SNRI -Duloxetine Venlafaxine
61
pain classification
existential physical -malignant -nonmalignant --neuropathic --nocicpetive ---chronic ---acute ----mild/mod/severe
62
Preproenkephalin cleaved to what?
Met-enkephalin Leu-Enkephalin
63
Cluster HA age of onset
3rd generation
64
Mild-Mod opioids (2)
Vicodin Percocet
65
MOH trigger
analgesic use \>3 times/wk
66
Naltrexone major counsel
do not use if ALT/AST 3x UL wait until 7-10 days opioid free
67
how long does alcohol stay in urine
1-12 hrs
68
alcohol MOA
stimulation of GABA-A receptors -dec. neuronal firing inhibit NMDA -supress neuronal activity
69
cluster HA Tx (2) prophylactic
lithium CCB
70
Which one Pos. or Neg have good meausre/snapshot of disease control and which part
positive -disorganized
71
T/F SZP have decreased brain volume
True
72
Tapentadol lMOA
Mu agonist Ne reuptake inhibit
73
SZP what do you do to dose when you hit maintenance
same dose or slightly decrease dose
74
Disulfiram monitoring
LFT cardiac tests
75
Migraine acute tx (5)
analgesics caffeine Narcotics DHE Triptan
76
CIWA-AR definition
clinical instisute withdrawal assessment
77
Naltrexone MOA
competeive antagonist at opioid receptor
78
Migraine Diagnosis
5 attacks w/ all: last 4-72 hours Has 2 of following: -unilateral -pulsating -mod/severe pain -aggravation by activity During has one of this: -N/V -photo/phonophobia
79
2 opioids w/ highest pruritus
morphine hydromorphone
80
Abrupt D/c drugs that cause risks? (3)
clozapine quetiapine iloperidone
81
w/d cannabis DX
3+ irritably anxiety weight loss restlessness depressed
82
cluster HA triggers
alcohol tobacco
83
Gamma hydroxybutyrate (GHB) what is it
precursor and metabolite of GABA
84
pseudoparkinsonism risk (3)
women \>40 FGA
85
2 types of nociceptive pin
somatic visceral
86
how long does heroin stay in urine
48 hours as morphine
87
TX of agression/hositility/mania in SZP (4)
lithium DVP CBZ LMG
88
common ending for atypical AP
done pine azole
89
stimulation of A delta and C fibers result in
excitatory transmission in dorsal horn neurons triggers NMDA causing long lasting excitability of dorsal horn neurons
90
Naloxegol indication
opioid constipation
91
positive symp. SZP
hallucinations
delusions
thought disorders
disorganized behavior:
\*agitation,
\*incongruency,
\*ADLs
impaired speech: tangentiality, circumstantiality, derailment bizarre behavior i
nsomnia
combativeness
92
when does adensoine dec and inc?
dec. during slow wave sleep inc. after prolonged wakefulness
93
Cox 2 induction
in tissues and inflammatory cells in response to inflammation and pain
94
suboxone dose day 1 and 2
8-2 day 1 16-4 days 2
95
methadone MOA (3)
strong mu agonist nmda antagonist 5ht/Ne reuptake inhibitor
96
A1 function
inhibiton of adenylate cyclase
97
CB1 signalling MOA
inhibit adenylate cyclate -inhibit Ca channel activation -K channel activation
98
opioid dependence TX
buprenorphine +/- nalonxone
99
inc. prolactin inc risk (3)
FGA risperidone paliperidone
100
Mu receptor endogenous NT
Enkephalins Beta-Endorphins
101
When can you add an antidepressant in SZP
after psychosis is stabilized or can worsen it
102
adenosine MOA
accumulate in basal forebrain and promotes sleep by inhibiting cholinergic neurons after prolonged wakefulness
103
clozapine major SE
Agranuloscytosis
104
monitoring SZP every 6 months
BP BMI AIMs
105
when to prescribe clozapine
tx nonresponse no contraindications 2 adequate trials of others
106
Pathophysiology of SZP
\* too high DA in mesolimbic pathway causes positive symptoms
\* too low in mesocortical pathway causes negative symptoms
107
Types of symptoms of SZP
Positive
Negative
108
SZP titrate dose time?
ever 2-4 weeks
109
TX of anxiety in SZP (2)
antihistamines -hydroxyzine, benedryl BZD
110
urine screen metabolites of lorazepam
lorazepam
111
MOA Triptans
5HT 1B/1D agonist -dec. cAMP
112
Metabolic SGA low potency (4)
ziprasidone lurasidone aripiprazole brexxipiprazole
113
maintenance suboxone dose
16-4 daily
114
secondary HA
trauma cranial/cervical vas. disorder substance/withdrawal infection psychiatric disorder
115
Primary HA types (3)
Migraine Tension-type HA Trigeminal autonomic cephalgias
116
urine screen metabolites of clonzepam
clonazepam 7-aminoclonzepam
117
Trigeminal autonomic cephalgias include? (2)
Cluster HA paroxysmal hemicrania
118
typical AP have low affinity for what receptor
5HT2 H1 M1 A1
119
NMS risk (4)
high dose high potency IV use dehydration
120
What is endogenous CB1 receptor NT
anandamide
121
normal QTc
\<430 males \<450 females
122
akathesia risks (4)
FGA Aripiprazole TCA SSRi
123
What is the confirmation test for urine drug screen
liquid chromatography or mass spectrometry
124
Cluster HA Men or Women?
Men 5:1
125
Disulfiram MOA
aldehyde dehydrogenase inhibitor cause accumulation of acetaldehyde cause toxic effects does not dec. craving
126
opioids and hormones
dec. estrogen and testosterone
127
methadone SE (2)
QTc prolongation hepatic impairment
128
Which one Pos or Neg symp are associated w/ tx resistance and poor outcomes
Negative
129
Alcohol screening (2)
CAGE feel need to cut down annoyed by critics guilty eye opener \>2 clinically significant Audit \>8 hazardous
130
monitoring SZP every 1-2 months
BP BMI
131
MOA of caffeine
antagonist at adensoine A1/2 receptors
132
Ziprasidone major counsel
take w/ \>500cal
133
Mu receptor effects
euphoria dec. GI tolerance dependence respiratory depression
134
anandamide MOA
postsynaptic Ca influx activates PLD acts of NAPE to produce anamdamide to activate CB@ to inhibit NT release
135
H1 antagonism in SZP
sedation
136
DSM5 opioid w/d
3+ of dysphoric mood n/v muscle aches rhinorrhea pupil dilate diarrhea yawning fever insomnia
137
how long does weed stay in urine
single use: 2-7 days chronic user: 1-2 months
138
monitoring SZP every 3 months
BP BMI waist circumference A1C fasting lipid panel
139
T/F all AP are equally effective
True if in equipotent doses, but clozapine is superior
140
C fibers -myelinated -conduction -respond to what
unmyelinated \<2m/sec damaged tissue or inflammation b/c high threshold
141
FGA high potency
Trifluoperazine Fluphenazine Haloperidol
142
DSM5 opioid intoxication
pupil constricton and 1+ drowsiness slurred speech impairment mentally
143
Pimavanserin MOA
does not block D2 combo of inverse agonist/antagonist of 5ht2a/c
144
SZP when can you safely reach therapeutic dose
1-4 wks
145
Define Tolerance
↓ in response to a drug dose that occurs w/ continued use
146
HA algorithm
paroxysmal
* benign
Daily
* chronic ---benign
* New onset ---immediate attention
147
metabolic SGA high potency (3)
Quetiapine clozapine olanzapine
148
Reward Pathway
Da increased in nucleus accumbens
149
Migraine prophylactic (8)
VPA propranalol Topamax Timolol Botox CGRP blockers amitriptyline Gabapentin
150
dangerous QTc
\>500 or \>60 above baseline
151
Kappa receptor endogenous NT
Dynorpin
152
tapentadol counsel
do not use in renal/liver probs
153
Are all reinforcers rewarding?
No negative stimulus can reinforce avoidance behaviors
154
metabolic SGA med potency (4)
risperidone paliperidone iloperidone asenapine
155
urine screen metabolites of hydrocodone
hydrocodone hydromorphone
156
GHB effects
CNS depression "date rape drug"
157
inc. prolactin tx (3)
aripiprazole quetiapine clozapine
158
aripiprazole major SE (2)
akathesia activating
159
Cause of EPS
block DA in nigrostriatal
160
Metabolic FGA med potency
Chlorpromazine all others are low
161
types of primary nocicpetive neurons
A delta fibers C fibers
162
Cows score
5-12 mild 13-24 mod 25-36 mod-severe 36+ severe
163
nalbuphine MOA
Mu antagonist kappa agonist
164
Metabolic activity in SZP brain
decreased in pre frontal cortex
165
DX of caffeine intoxication
5+ of obvious caffine consumptions: restlessness, insomnia
166
5HT antagonism in SZP (2)
improve - symp dec. EPS
167
urine screen metabolites of heroin
6-MAM morphine
168
who has good prognosis for SZP (6)
female
rapid (vs. insidious)
onset of symptoms older
older age of first episode
predominantly positive symptoms
high pre-illness functioning
support structure
169
pseudoparkinsonism tx
Anti-Ach
170
delirium tremens
48-96 hrs after last drink tachy HTN fever tremor diaphoresis delirium agitaiton
171
Phenanthenes Class (6)
Morphine Codeine Oxycodone Hydrocodone Hydromorphone oxymorphone
172
DSMV SZP
2+ for 1 month one must be\*\*
delusions\*\*
Hallucinations\*\*
Disorganized speech\*\*
disorganized or catatonic behavior
Negative symptoms
↓ social/occupational function
continuous signs of disturbances for at least 6 months
173
Pain Assessment
PQRST provoking factors quality region/radiate severeity/intensity temporal/time
174
urine screen metabolites of morphine
morphine hydromorphone
175
1st vs 2nd AP more likely to cause EPS
1st
176
pseudo-parkinsonism starts at blocking of what DA%
80%
177
Cluster Ha Tx (4) acute
100% O2 steroids DHE Triptans
178
Stroke/TIA risk w/ drugs (3)
risperidone olanzapine aripiprazole
179
opioid N/V tX
Da blocking -prochlorpherazine -haloperidol -metoclopramide
180
What is a reinforcing stimulus
↑ possibility that behaviors paired w/it will be repeated
181
1st vs 2nd gen AP better at negative effects?
2nd
182
Vivitrol is?
naltrexone
183
urine screen metabolites of buprenorphine
norbuprenorphine
184
Typical AP have high affinity for which receptor
DA
185
Aripiprazole MOA
partial DA2 agonist 5HT2 antagonist 5HT1 partial agonist
186
cause of migraine (2)
release of CGRP -calcitonin gene-released peptide cortical spreading depression
187
Tramadol MOA
0 Mu activity - less of an agonist of + - inhibit NE reuptake + inhibit 5HT reuptake
188
Addictive drugs are both ____ and \_\_\_\_
rewarding reinforcing
189
Atypical affinity for Da receptor
low/med
190
Hallucinogens MOA
partial agonist at 5HT2A
191
Tension HA TX acute (2)
relaxation techniques occasional analgesics OTC
192
if pain is severe/uncontrolled how much can you inc. opioid dose?
50-100%
193
Potency of opioids
fentanyl oxymorphone hydromorphone oxycodone hydrocodone=morphine merperidine methadone Tramadol
194
Drugs cause alpha adrenergic probs (4)
Clozapine quetiapine chlorpromazpine iloperidone
195
how long does BZD stay in urine
short acting: 3 days long acting/chronic: 4-6wk
196
DA2 antagonism in SZP (2)
relief of + symp EPS SE
197
Classifications of Migraine
W/out aura w/ aura chronic migraine complications of migraine probable migraine Episodic associated
198
Trigeminal Neuralgia prophylatic TX (2)
CBZ OXC
199
what is a reward stimulus
interpreted as intrinsically positive or something to be approached
200
Negative symp. SZP
amotivation
social withdrawal
affective flattening
alogia: quiet
apathy
anhedonia
inattentiveness
poor grooming
201
monitoring SZP
every 2-4 weeks
202
DX of caffeine withdrawal (4)
HA fatigue irritable flu like
203
ETOH w/d tx
BZD fluids vitamins
204
renal cautions for opioids
hydromorphone merperidine morphine
205
Alcohol inoxication DX
1+ of kinda drunk symptoms
206
urine screen metabolites of Diazepam
temazepam nordiazepam oxazepam
207
Asenapine major counsel
no food/drink for 10-15 mins
208
drugs w/ low risk EPS (2)
Chlorpromazine Quetiapine
209
Acamprosate MOA
inc. activity of GABA system and dec. activity of NMDA
210
pimavanserin indicaiton
hallucinations delusions
211
Phenylpeperdine Class (2)
Meperidine Fentanyl
212
common endings for typical AP
zine zone dol
213
Prolonged QTC
\>450 males \>470 females
214
Opioid screening
SBIRT ORT -\<3 low risk -4-7 moderate -\>8 high
215
how much do you need to block DA for anti-psychotic effect
\>60%
216
Can nerve damage lead to neuropathic pain
yes
217
POMC prepropimelanocortin cleaved to what?
beta-endorphin
218
NMS tx (2)
stop AP supportive measures -IV fluids cooling blankets bromocriptine dantrolene
219
opioid w/d tx
methadone buprenorphine
220
A2 function
activation of adenylate cyclase
221
2 most important factors in selecting adjuvant analgesics for neuropathic pain
comorbid conditions medication SE
222
Cannabis Intoxication DX
2+ conjunctival infection inc. appetitie dry mouth tachy
223
step 3 Who ladder
Mod-severe opioids +/- non opioids +/- adjuvant
224
What drug has lowest indcidence of DIMD NMs
Clozapine
225
how long of no alcohol before using disulfiram
12 hours
226
Suboxone monitoring
LFT CNS depression BP
227
Assess Opioid Withdrawal
COWS -clinical opioid withdrawal scale -sweating pupil size bone/joint ache yawning
228
good for renal impairment
oxycodone fentanyl
229
opioid neurotoxicity
opioid rotation hydration BZD
230
cause of aura
cortical spreading depression
231
2 major types of pain
Nociceptive Neuropathic
232
Alcohol Withdrawal DX
2+ of: sweating pulse \>100 hand tremor insomnia n/v hallucination anxiety seizures delirum temens
233
Dystonia tx (2)
benedryl benztropine
234
Initial response time and symptoms in SZP
1-2 weeks sleep appetite agitation initial + symptoms
235
length of antipsychotic tx
1-2 years but likely lifelong
236
TX location of alcohol withdrawal
seizure/delirium: inpatient CIWA 0-15 outpatient CIWA \>15 inaptient
237
non-opiods (4)
APAP ASA SNAID Tramadol
238
monitoring SZP annually
same as baseline PRN TSH PRN pRN EKG PRN pregnancy
239
Non-genetic causes of SZP (3)
\* random developmental processes
\* malnutrition
\* in utero viral infection
240
Tardive dyskinesia Tx (2)
Valbenzine Deutetetraevnzine
241
symptoms of schizophrenia (4)
impaired cognition
active psychosis
non-logical thought process
dec. social/occupational function
242
MOA cocaine
competively inhibit monoamine reuptake block DA reuptake 100%
243
opioid receptors MOA
all G coupled -hlep open K channels -help close Ca channels -inhibit adenylate cyclase -dec. cAMP
244
FGA low potency (2)
chlorpromazine Thioridazine
245
T/F SZP have small ventricles
False
246
NMS signs anagram
FEVER fever encephalopathy vitals unstable elevated enzymes rigidity of muscles
247
Delta receptor endogenous NT
Enkephalin
248
opioid withdrawal will cause death y/n
no
