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NMSP Exam III > Things I Still Don't Know > Flashcards

Things I Still Don't Know Flashcards

1
Q

What are the two types of anorexia nervosa?

A

restricting type and binge eating type/purging type

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2
Q

what are the cardiac medical complications associated with anorexia nervosa?

A

bradycardia, hypotension, QT dispersion, cardiac atrophy, and mitral valve prolapse

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3
Q

what are the dermatologic medical complications associated with anorexia nervosa?

A

Xerosis, lanugo, carotenoderma, acrocyanosis, seborrheic dermatitis

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4
Q

what complications are associated with refeeding syndrome?

A

hypophosphatemia, hypokalemia, CHF, peripheral edema, rhabdomyolysis, seizures, hemolysis

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5
Q

what are common comorbid mood disorders associated with anorexia nervosa?

A

depression, anxiety: OCD***

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6
Q

what is needed for the minimum first line care for AN?

A

nutritional rehabilitation and psychotherapy
hospitalization necessary due to complications of starvation, resistance to re-feeding, suicidality

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7
Q

How long should hospitalization last in an AN patient?

A

until normal weight is achieved to reduce relapse and rehospitalization

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8
Q

How much weight should an inpatient AN patient gain per week?

A

2-3 lbs (.9-1.5 kg)

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9
Q

how much weight should an outpatient AN patient gain per week?

A

.5-1 lb (.2-.5 kg)

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10
Q

what is the usual initial intake of calories for an AN patient?

A

30-40 kcal/kg
then progressively increased to match body tolerance and weight gain goals

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11
Q

When should you consider pharmacotherapy in patients with AN?

A

consider only for patients who have been resistant to other therapies and who are willing to take medications

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12
Q

What medications should be avoided in patients with AN and why?

A

bupropion: increased seizure risk with binging and purging

and TCAs: cardiotoxicity

caution with antipsychotics and antidepressants with risk of QT prolongation

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13
Q

what is the only adjunctive medication shown to help with weight gain in patients with AN?

A

olanzapine (2.5-10 mg)

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14
Q

what can be prescribed to patients to help reduce anxiety associated with confronting meals?

A

lorazepam

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15
Q

how is bulimia nervosa defined?

A

recurrent episodes of binge eating with recurrent compensatory behavior to prevent weight gain such as vomiting, misuse of laxatives, fasting, or exercise

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16
Q

how long do symptoms of BN need to occur in order to be diagnosed?

A

both need to occur at lease once a week for 3 months

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17
Q

what are the electrolyte medical complications associated with BN?

A

dehydration, hypokalemia, hypochloremia, and metabolic alkalosis

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18
Q

what are the GI medical complications associated with BN?

A

mallory-weiss syndrome

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19
Q

what are the dental and skin medical complications associated with BN?

A

tooth enamel erosions and dental caries, scar and callus on dorsum of hand (Russel’s sign), and xerosis

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20
Q

what are the cardiac medical complications associated with BN?

A

hypotension, orthostasis, sinus tach, ECG changes, and arrhythmias

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21
Q

What is the most critical assessment you have to do in the treatment plan of a patient with BN?

A

always monitor the patients for SI

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22
Q

what is the best standard treatment for BN patients?

A

combination of nutritional rehabilitation, CBT, and pharmacotherapy

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23
Q

what medication should be avoided in patients with BN? Why?

A

bupropion: increased seizure risk with binging and purging

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24
Q

what is the first line pharmacotherapy for patients with BN?

A

fluoxetine 60 mg daily

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25
Q

what is second line pharmacotherapy treatment for BN patients?

A

other SSRIs at doses higher than starting dose used to treat MDD (sertraline or fluvoxamine)

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26
Q

what is the first line treatment for patients with binge eating disorder?

A

psychotherapy

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27
Q

generic name for vyvanse?

A

lisdexamfetamine dimesylate

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28
Q

in order to have an intellectual disability, what deficits must be present?

A

must have adaptive functioning deficits in three domains: conceptual, social, and practical

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29
Q

What are the diagnostic tools used for intellectual disability?

A

denver developmental screening test, wechler intelligence scale for children
*severity is based on adaptive functioning- not IQ scores

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30
Q

what is global developmental delay?

A

unable to undergo systemic assessments of intellectual functioning
meet observational diagnostic criteria of intellectual disability disorder

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31
Q

what are the 4 communication disorders?

A

language disorder, speech-sound disorder, social (pragmatic) communication disorder, and childhood-onset fluency disorder (stuttering)

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32
Q

What is occurring in autism spectrum disorder?

A

there is an abnormal reaction to sensory input

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33
Q

what is the core neurophysiological feature of autism?

A

sensory integration deficits

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34
Q

the DSM5 criteria that best differentiate intellectual disability from autism spectrum disorder is what?

A

the presence of restricted interests or repetitive behaviors

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35
Q

what are the only 2 FDA approved drugs that are used for the irritability and agitation associated with autism?

A

risperidone and aripiprazole

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36
Q

ADHD is significantly comorbid with a wide range of other psychiatric disorders, such as what?

A

tic disorders

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37
Q

the potential for tics can be exacerbated by what?

A

by stimulant medications used to treat ADHD

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38
Q

what is executive function deficit?

A

an information processing dysfunction within the prefrontal cortex primarily due to a deficiency of dopamine and norepinephrine

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39
Q

How do you make the diagnosis of ADHD in children? IN those older than 17?

A

children: six or more symptoms
adults: 5 or more symptoms

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40
Q

What is the treatment of choice for preschool aged children (4-5) with ADHD?

A

parent and or teacher administered behavior management
if that doesn’t work: methylphenidate

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41
Q

what is the treatment of choice for elementary school aged children (6-11 years of age) with ADHD?

A

medications for ADHD and/or parent/teacher administered behavior management

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42
Q

what is the treatment of choice for adolescents (12-18) with ADHD?

A

medications for ADHD and behavior therapy

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43
Q

what are 2 alpha 2 adrenergic receptor agonists used for ADHD?

A

guanfacine and clonidine

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44
Q

what is the MOA of atomexetine?

A

selective inhibition of presynaptic norepinephrine reuptake

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45
Q

what is the MOA of modafinil?

A

for adults only
binds to dopamine transporter, inhibiting dopamine reuptake

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46
Q

what are the 3 types of motor disorders?

A

developmental coordination disorder, stereotypic movement disorder, and tic disorders

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47
Q

what is stereotypic movement disorder?

A

repetitive, compulsive, and purposeless motor behavior (hand shaking, body rocking, head banging, self biting)

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48
Q

What is the difference between tourette’s disorder and persistent (chronic) motor or vocal tic disorder?

A

T: 2 or more motor tics AND 1 or more vocal tics
persistent (chronic): 1 or more motor tics OR 1 or more vocal tics but not both

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49
Q

how can you treat tourette’s disorder?

A

antidopaminergic drugs: but may cause tardive dyskinesia

dopamine depleters: as effective but do not cause tardive dyskinesia

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50
Q

what are the only approved drugs for the treatment of TD?

A

haloperidol, pimozide, and aripiprazole

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51
Q

How is adjustment disorder defined?

A

symptoms develop within 3 months of an identifiable stressor
MUST resolve within 6 months

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52
Q

What is the first line treatment for adjustment disorder?

A

counseling, psychotherapy

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53
Q

what is the second line treatment for adjustment disorder?

A

antidepressants or anxiolytics

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54
Q

How do you diagnose PTSD?

A
  1. there must be an exposure to trauma
  • directly experienced
  • witnessed
  • learned that trauma occurred to a loved one
  • hear/see other’s trauma but MEDIA DOES NOT COUNT
  1. There must be an intrusion symptom
  • memory
  • dream
  • flashback
  • distress to reminder of traumatic event or feelings
  1. There must be an avoidance symptoms
  • internal
  • external
  1. there must be mood or cognitive symptoms
  • can’t remember the traumatic event
  • self-blame
  1. There must be reactive or emotional arousal symptoms
  • irritable or angry outbursts
  • hypervigilance
  • exaggerated startle
  1. SYMPTOMS FOR MORE THAN ONE MONTH
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55
Q

what is the first line treatment for PTSD?

A

cognitive processing therapy (CPT)

Prolonged exposure (PE)

Eye-movement desensitization and reprocessing

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56
Q

if a patient is presenting with symptoms of PTSD but they have only been occurring for less than a month, what do you need to consider?

A

either acute stress disorder or adjustment disorder

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57
Q

Depression is at risk for what psychosomatic disorders?

A

coronary heart disease, stroke, and diabetic symptoms

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58
Q

What are the psychiatric symptoms associated with SLE?

A

depression, mood disturbances, psychosis, delusions, and hallucinations

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59
Q

What are the psychiatric symptoms associated with hyperthyroidism?

A

nervousness, excitability, irritability, pressured speech, insomnia, psychosis, visual hallucinations

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60
Q

what are the psychiatric symptoms associated with hypothyroidism?

A

lethargy, depressed, personality change, paranoia

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61
Q

what are the psychiatric symptoms associated with Diabetes mellitus?

A

frustration, loneliness, withdrawn, depression

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62
Q

when should you treat for a vitamin B12 deficiency?

A

if the level is less than 400

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63
Q

what are the medical symptoms associated with acute intermittent porphyria (AIP)?

A

abdominal pain, fever, nausea, vomiting, constipation, peripheral neuropathy, paralysis

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64
Q

what are the psychiatric symptoms associated with AIP?

A

acute depression, agitation, paranoia, and visual hallucinations

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65
Q

how do frontal lobe tumors present?

A

mood changes, irritability, facetiousness, impaired judgement, impaired memory, delirium, loss of speech, loss of smell

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66
Q

What are the medical symptoms of PCP induced mental disorder?

A

elevated BP, tachycardia, nystagmus, muscular rigidity, vomiting

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67
Q

what are the psychiatric symptoms associated with PCP induced mental disorder?

A

agitation with blank stare, anxiety, stupor, aggression, panic, bizarre behavior

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68
Q

What psych symptoms could carticosteroids cause?

A

mania or psychosis (hallucinations)

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69
Q

what should you avoid using in elderly patients with delirium?

A

benzodiazepines

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70
Q

What is the most common cause of hallucinations?

A

delirium tremens

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71
Q

2 examples of a factitious disorder?

A

Munchausen’s and Munchausen’s by proxy

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72
Q

what are the prodromal signs and symptoms of schizophrenia?

A

schizoid or schizotypal personalities

few close friends as adolescents

minimal social activities

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73
Q

What are the positive symptoms of schizophrenia and when are they present?

A

typically present in the active phase

delusions, hallucinations, catatonia, and agitation

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74
Q

what are the negative features of schizophrenia and when are they typically present?

A

typically present in the residual phase

affective flattening, apathy, social withdrawal, anhedonia, poverty of thought, and content of speech

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75
Q

how long must the symptoms of schizophrenia be present in order to diagnose?

A

at least 6 months

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76
Q

what is the neurophysiology of the schizophrenic brain?

A

reduced brain volume, decreased limbic system, smaller prefrontal cortex, smaller thalamus

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77
Q

which neurotransmitter is elevated in schizophrenia?

A

dopamine

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78
Q

How do you make the diagnosis of schizophrenia?

A

two or more of the following for most of 1 month; at least one of the first three symptoms:

  1. delusions
  2. hallucinations
  3. disorganized speech
  4. grossly disorganzied or catatonic behavior
  5. negative symptoms

Durations of at least 6 months of persistent symptoms

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79
Q

if a schizophrenic patient is violent in the ED what can you give them?

A

lorazepam and haloperidol IM

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80
Q

What is the single leading cause of death in schizophrenia patients?

A

suicide

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81
Q

how do you make the diagnosis of schizophrenia catatonic type?

A

At least two of the following:

motoric immobility as evidenced by catalepsy or stupor

excessive motor activity

extreme negativism or mutism

posturing or prominent grimacing

echolalia or echopraxia (meaningless repetition of another person’s spoke words or mimic of actions)

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82
Q

what is used for treatment for catatonic disorder schizophrenia?

A

benzodiazepines

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83
Q

What is used for acute psychosis?

A

IM injections

haloperidol, fluphenazine, lorazepam

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84
Q

what is used in the stabilization phase of schizophrenia?

A

newer atypical antipsychotics

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85
Q

what is used for the treatment of the maintenance phase of schizophrenia?

A

to keep patients free from symptoms while avoiding incapacitating side effects

long-acting depot injections

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86
Q

what are two examples of first generation antipsychotic adverse effects?

A

EPSs and neuroleptic malignant syndrome

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87
Q

what are the side effects associated with clonzapine?

A

agranulocytosis and weight gain

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88
Q

what is the adverse effect of risperidone?

A

increased prolactin

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89
Q

what is the adverse effect associated with ziprasidone?

A

QTc prolongation

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90
Q

What is a brief psychotic disorder?

A

presence of at least one or more of the following. At least one of 1,2, or 3

  1. delusions
  2. hallucinations
  3. disorganized speech
  4. grossly disorganized or catatonic behavior

duration of an episode of the disturbance is at least 1 day and no more than 1 month with eventual return to premorbid level of functioning

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91
Q

What is schizophreniform?

A

meets criteria A, D, and E for schizophrenia

an episode of the disorder lasts at least 1 month but less than 6 months

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92
Q

What is delusional disorder?

A

delusions of at least one month’s duration

has never met criterion A for schizophrenia (for more than a few hours)

functioning is not impaired, and behavior is not odd or bizarre

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93
Q

What is the timeline for schizophrenia?

A

greater than 6 months

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94
Q

what is the timeline for schizophreniform?

A

1-6 months

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95
Q

what is the timeline for brief psychotic disorder?

A

less than 1 month

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96
Q

What are the 4 factors involved in classical conditioning?

A

unconditioned stimulus, unconditioned response, conditioned stimulus, conditioned response

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97
Q

What is extinction?

A

it is possible to extinguish this learned response but must expose to CS many times without giving the UCS

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98
Q

What is generalization?

A

when other similar stimuli/situation also becomes the CS for the CR

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99
Q

What can you use classical conditioning for?

A

to treat phobias

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100
Q

what is the relaxation activity considered to be in classical conditioning?

A

a UCS

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101
Q

What is systematic desensitization?

A

make a list- a hierarchy of fears

select a feared object/ situation low on list and use relaxation to condition it until there is much less anxiety/fear

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102
Q

what is operant conditioning?

A

learning is the association of things that take place sequentially

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103
Q

what is classical conditioning?

A

learning is the association of things that take place together in time

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104
Q

Which antipsychotic medication is used for recurrent suicidal behavior?

A

clozapine

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105
Q

which antipsychotic drug is used for hallucinations/delusions associated with Parkinson Disease psychosis?

A

pimvanserin

106
Q

what type of drugs reduce the positive symptoms of schizophrenia?

A

D2 antagonists

107
Q

what does D2 antagonism increase?

A

prolactin levels

108
Q

what do the FGA primarily block?

A

dopamine type 2 post synaptic receptors

109
Q

what are the effects of alpha-adrenergic receptors being blocked?

A

orthostatic hypotension and dizziness/syncope

110
Q

The FGA can be divided into two broad categories. What are they?

A

high potency and low potency

111
Q

what are the high potency FGA?

A

haloperidol and fluphenazine

112
Q

what are the effects of the high potency FGA?

A

more movement (EPS) and endocrine effects (prolactin)

113
Q

what are the low potency FGA agents?

A

chlorpromazine and thioridazine

114
Q

what are the effects of the low potency FGA?

A

more sedation, hypotension, tachycardia, ECG-changes

115
Q

what is thioridazine associated with?

A

Torsade’s de Pointes and sudden death

116
Q

How do you treat dystonia?

A

anticholinergics: benztropine, diphenhydramine, and trihexyphenidyl

117
Q

how do you treat parkinsonism EPS associated with FGA use?

A

benztropine and dopamine enhancer Amantadine

118
Q

How do you treat tardive dyskinesia caused by FGA use?

A

selective vesicular monoamine transporter 2 (VMAT2): valbenazine and deutetrabenazine

119
Q

What is a major class warning of the SGA side effects?

A

there is a greater risk of stroke in the elderly with dementia

120
Q

what are the SGAs that cause the most significant weight gain?

A

clozapine and olanzapine

121
Q

what are the SGAs that cause the most metabolic effects (increase glucose and lipids)?

A

clozapine and olanzapine

122
Q

What SGA agent is most likely to cause QTc prolongation/ ECG changes?

A

ziprasidone

123
Q

What are the four antipsychotic screening scales and what do they screen for?

A

GASS- general side effects

BARS- akathisia

AIMS- movements disorders

EPRS- extrapyramidal symptoms

124
Q

which SGA agent is most likely to cause agranulocytosis?

A

Clozapine

so monitor WBC

125
Q

which SGA agent is most likely to cause seizures?

A

clozapine

126
Q

what is drug reaction with eosinophilia and systemic symptoms (DRESS)?

A

rare drug-induced hypersensitivity

skin eruption, eosinophilia, a long latency (2-8 weeks_ between drug exposure and disease onset)

127
Q

which SGA agent is most likely to cause DRESS?

A

olanzapine

128
Q

Which class of drugs is likely to cause neuroleptic malignant syndrome?

A

SGAs

129
Q

what is the presentation of NMS?

A

severe parkinson like movement disorder with wide spread muscle contraction, AMS, hyperthermia, dehydration

130
Q

Adherence is critical in schizophrenia patients. How can you manage non-adherence in schizophrenia patients?

A

with long-acting injectable agents

131
Q

what are the long acting injectable agents used in non-compliant schizophrenia patients?

A

risperidone

olanzapine

aripiprazole

paliperidone

132
Q

which antipsychotic agent is most likely to cause orthostatic hypotension?

A

thioridazine

133
Q

which SGA would have the lowest impact on BMI?

A

ziprasidone

134
Q

when is the DAST-10 questionnaire used?

A

to screen for drug abuse

135
Q

what occurs at .05 BAC?

A

judgement and restraint impaired

136
Q

what occurs at .30 BAC?

A

stupor

137
Q

what occurs at .4-.5 BAC?

A

coma

138
Q

what are the neurological effects of alcohol?

A

polyneuropathy, cerebellar degeneration, dementia, Wernicke’s encephalopathy, korsakoff syndrome

139
Q

What happens in cases of alcohol withdrawal?

A

delirium tremens

  • tremulousness
  • delusions
  • hallucinations
    • seizures
140
Q

what causes wernicke’s encephalopathy?

A

thiamine deficiency

141
Q

what is the clinical triad of wernicke’s encephalopathy?

A

ophthalmoparesis with nystagmus

ataxia

confusion

142
Q

how do you guide treatment of alcohol withdrawal?

A

the clinical institute withdrawal assessment (CIWA)

143
Q

what is the detox order set on a patient with alcohol withdrawal?

A

benzodiazepines

antipsychotics (haloperidol)

IV Fluids (BANANA BAG→ magnesium, potassium, thiamine, folic acid)

144
Q

what is in a banana bag?

A

magnesium, potassium, thiamine, and folic acid

145
Q

What drug can be used to maintain abstinence in alcoholics following withdrawal that’s MOA is inhibits GABA in the CNS

A

acamprosate

146
Q

what drug can improve abstinence in alcohol dependence whose MOA is an opioid antagonist

A

naltrexone

147
Q

what is the MOA of gabapentin when used for alcohol dependence treatment and rehabilitation?

A

prevents pain response and has anxiolytic activity

promotes abstinence and reducing drinking in individuals with alcohol use disorder

148
Q

what is disulfram used for?

A

it is not commonly used due to poor efficacy and potential for severe medical complications

used to control alcohol intake as a deterrent

149
Q

what is a common adverse reaction of disulfram?

A

produces unpleasant adverse effects if the patient drinks alcohol during the course of treatment

150
Q

What should you use on a patient with known liver impairment who is withdrawing from alcohol?

A

lorazepam (bc it doesn’t require liver metabolism)

151
Q

What is the treatment for withdrawal of stimulants?

A

antidepressants and hospitalization

152
Q

how do you treat hypertension and hyperthermia caused by stimulants?

A

phentolamine

153
Q

How do you treat psychotic symptoms caused by stimulants?

A

haloperidol

154
Q

how do you treat a patient who is withdrawing from sedatives/hypnotics/anxiolytics? *which can be fatal

A

phenobarbital (used to wean patients off)

155
Q

what are the common signs of LSD and PCP intoxication?

A

violent behavior, rapid SI or HI

156
Q

what should you suspect if a patient presents with LSD or PCP intoxication?

A

polysubstance user

157
Q

how do you treat LSD and PCP intoxication?

A

diazepam and sedation with haloperidol

158
Q

what is a common symptom of LSD and PCP withdrawal?

A

flashbacks

159
Q

how do you treat a patient who is withdrawing from LSD and PCP?

A

benzodiazepine administration

160
Q

how do you assess opiate withdrawal?

A

Clinical opiate withdrawal scale (COWS)

161
Q

how do you treat a patient withdrawing from opioids?

A

buprenorphine or methadone

or buprenorphine and naloxone

162
Q

how do you maintain treatment for an opioid dependent patient?

A

buprenorphine (with or without naloxone)

163
Q

what is the MOA of stimulants?

A

block presynaptic reuptake, interference with vesicular monoamine transporter, and increase NT release

164
Q

what is methylphenidate’s main activity?

A

inhibition of DA reuptake and inhibition of NT pre-synaptic reuptake

165
Q

what forms do IR amphetamine-based stimulants come in?

A

T(d), L(ds), C (as), and ODT

166
Q

what forms do extended release amphetamine-based stimulants come in?

A

liquid (a) and capsules (a, d, and l)

167
Q

what forms do immediate release methylphenidate come in?

A

tabs (d, m) and liquid (m)

168
Q

what forms do sustained methylphenidate come in?

A

tabs

169
Q

what forms do extended release methylphenidate stimulants come in?

A

capsule, chewable tablet, liquid, transdermal patch, tablet

170
Q

what are the three non-stimulants for ADHD?

A

atomoxetine, guanfacine, and clonidine

171
Q

when is the onset of activity for non-stimulant ADHD medications?

A

1-4 weeks following administration

172
Q

what is the main effect of non-stimulants?

A

to enhance neurotransmitter transmission

173
Q

what is the MOA of atomoextine?

A

inhibition of NE pre-synaptic reuptake

174
Q

what is the MOA of guanfacine/ clonidine?

A

agonist of CNS alpha2 adrenergic receptors

175
Q

what is a notable adverse effect of atomexetine?

A

suicidal thoughts

176
Q

what antihypertensives can be used for ADHD?

A

clonidine and guanfacine

177
Q

what is recommended for discontinuation of clonidine and guanfacine?

A

downward dose titration over 1+ weeks bc of risk of rebound hypertension

178
Q

what antidepressant can be used for nicotine withdrawal?

A

bupropion

179
Q

what antidepressant can be used for enuresis?

A

imipramine

180
Q

what antidepressant can be used for diabetic peripheral neuropathy, fibromyalgia, and chronic musculoskeletal pain?

A

duloxetine

181
Q

what antidepressant can be used for stress incontinence?

A

duloxetine

182
Q

what are the serious side effects of SSRIs?

A

serotonin syndrome

183
Q

what are some of the symptoms of serotonin syndrome?

A

abdominal pain, flushing/sweating, hyperreflexia, hyperthermia, mental status changes

184
Q

what are the symptoms of antidepressant withdrawal?

A

FINISH:

flu-like symptoms

insomnia

nausea

imbalance

sensory disturbances

hyperarousal

185
Q

all antidepressants have a black box warning of what?

A

increase in risk of suicidal ideations, behaviors, and actions- highest risk in children/adolescents/young adults

186
Q

which SSRI has the most drug-drug interactions?

A

fluoxetine - CYP450 inhibitor

187
Q

what is the MOA of second degree TCAs

A

MOA: inhibit NE > 5-HT

188
Q

what are the side effects of TCA overdose?

A

3 Cs: coma, cardiotoxicity, and convulsions

189
Q

non-TCA SNRIs have SE’s relatively similar to SSRIs, with generally less risk of what?

A

sexual dysfunction

190
Q

SEs of SNRIs: include?

A

insomnia

hypertension

agitation/nervousness

191
Q

what limits the use of nefazodone?

A

hepatic toxicity

192
Q

what is the main side effect of NDRIs?

A

seizures (dose-dependent or those at risk)

193
Q

what is the side effect associated with phenelzine?

A

sedation

194
Q

when using MAOIs what is there major concern of?

A

hypertensive crisis

195
Q

when is esketamine indicated?

A

for treatment-resistant depression in conjunction with ongoing antidepressant therapy AND MDD with suicidal ideations/behaviors

196
Q

what is lithium’s MOA?

A

myoinositol depletion; lithium inhibits PKC and MARCKS: antimanic effects

197
Q

what type of ion is lithium?

A

a monovalent ion

198
Q

lithium interacts with what other agents?

A

other agents that impact Na+/K+:

diuretics, ACEi, and NSAIDs

199
Q

3 mood stabilizers initially developed as anti-seizure agents utilized to treat bipolar disorder include?

A

valproic acid/ divalproex

lamotrigine

carbamazaepine

200
Q

when is lamotrigine indicated?

A

for the maintenance of Bipolar disorder

201
Q

what are the two basic physiological processes occur during the excitement stage. what are they?

A

vasodilation/constriction and mytonia

202
Q

how do you make the diagnosis of erectile dysfunction?

A

at least one of the three following symptoms must be experienced on almost all occasions of sexual activity for 6 months

203
Q

how long does marijuana test positive in the saliva?

A

1-7 days

204
Q

how long does marijuana test positive in the hair?

A

90 days

205
Q

how long does marijuana test positive in the blood?

A

1-7 days

206
Q

how long does marijuana test positive in the urine?

A

3-77 days (10-30 days for regulars)

207
Q

what are the labeled indications of dronabinol?

A

anorexia in AIDS pt, chemotherapy induced n and v

208
Q

what is nabilone used for?

A

chemotherapy induced n and v

209
Q

what is cannabidiol?

A

CBD- second most abundant cannabinoid

(-)- CBD enantiomer

210
Q

where does THC and CBD accumulate?

A

in adipose tissue due to high lipophilicity

211
Q

what is CBD metabolized by?

A

in the liver by 7 CYPs

212
Q

What is epidiolex used for?

A

it is oral CBD solution recently approved for epilepsy in 2 years or older

213
Q

what is the MOA of cocaine?

A

inhibition of dopamine reuptake

214
Q

why is ketamine used?

A

to reduce the amount of morphine needed for pain control

215
Q

what is an example of a mu-opioid receptor agonist?

A

buprenorphine

216
Q

what is an example of a nicotinic receptor partial agonist?

A

varenicline (chantix)

217
Q

what are the 4 drugs used for the treatment of alcohol withdrawal syndrome?

A

diazapam, lorazepam, oxazepam, and thiamine

218
Q

what are the 3 drugs used for the prevention of alcohol abuse?

A

acamprosate, disulfram, and naltrexone

219
Q

what are the drugs used for the treatment of acute methanol or ethylene glycol poisoning?

A

ethanol or fomepizole

220
Q

what drug overdose causes constricted pupils?

A

heroin or other strong opioids

221
Q

when is caffeine used medically?

A

with painkillers and for treating headaches after epidural anesthesia

222
Q

What defines binge drinking?

A

for women: 4 or more drinks during a single occasion

for men: 5 or more drinks during a single occasion

223
Q

what defines heavy drinking?

A

women: 8 or more drinks per week
men: 15 or more drinks per week

224
Q

what is ethanol metabolized by?

A

alcohol dehydrogenase to acetalldehyde

225
Q

what is acetalldehyde metabolized by and to?

A

by: aldh to acetate

226
Q

what is the MOA of disulfram?

A

irreversibly inhibits aldehyde dehydrogenase

227
Q

what is the MOA of acamprosate?

A

weak NMDA receptor antagonist and GABAa receptor agonist

228
Q

what happens when you mix opioids and sedative-hypnotics?

A

increased CNS depression, esp resp depression

229
Q

what happens when you mix antipsychotic agents and opioid drugs?

A

increased sedation.

230
Q

what happens when you mix MAOIs and opioid drugs?

A

hyperpyrexic coma

hypertension

231
Q

which opioid agonist is combined with acetaminophen?

A

hydrocodone

232
Q

what is pentazocine used for?

A

in the management of pain severe enough to require an opioid analgesic and for which alternative treatments are inadequate

233
Q

what happens if you use pentazocine during pregnancy?

A

neonatal opioid withdrawal syndrome

234
Q

what should you avoid using meperidine with?

A

avoid mixed agonist/antagonist analgesics use with meperidine because the analgesic effect may be reduced or may precipitate withdrawal symptoms

235
Q

which opioid agonist is the lightest tool in the toolbox/ contains the least opioid analgesic activity?

A

codeine

236
Q

what do you do if a patient overdoses on loperamide?

A

naloxone can be given as an antidote

237
Q

what must you check in a patient who is on buprenorphine?

A

you must monitor patients starting or ending CYP3A4 inhibitors or inducers for potential over or under dosing

238
Q

what is the key reason you would use naltrexone?

A

treatment of alcohol use disorder

239
Q

what does naltrexone have high affinity for?

A

mu receptors

240
Q

What are the three primitive defense mechanisms?

A

projection, denial, and splitting

241
Q

what is displacement?

A

shifts aggressive impulses to less threatening target

parent yells at child when actually angry with spouse

242
Q

what is an example of introjection defense mechanism?

A

an abused child becomes a abusive parent

243
Q

what is isolation of affect?

A

person describing a murder with graphic detail but no emotional response evident

244
Q

what is reaction formation?

A

converting unconscious wishes or impulses considered threatening into their opposite

two co-workers fight, but secretly attracted to each other

245
Q

what are the mature defense mechanisms?

A

humor

suppression

altruism

sublimation

246
Q

how do you distinguish quirkiness from personality disorders?

A

look for functional impairment

247
Q

How do you make the diagnosis of a major depressive episode?

A

at least 5 of the following for a 2 week period with at least one being

depressed mood

or loss of interest

248
Q

how do you diagnose major depressive disorder?

A

the presence of one or more major depressive episodes and the absence of any manic, hypomanic, or mixed episodes

249
Q

what is the treatment of choice for psychotic depression?

A

ECT

250
Q

what is significant about using ketamine for MDD?

A

there is a 50% reduction in suicidal thoughts within 24 hours

251
Q

how do you make the diagnosis of persistent depressive disorder (dysthymia)?

A

depressed mood for most of the day (at least 2 years adults and 1 year children)

that has not been severe enough to meet the criteria for MDE

252
Q

how do you diagnose a manic episode?

A

abnormal and persistently elevated expansive or irritable mood lasting at least 1 week with at least 3 symptoms (DIGFAST)

253
Q

how do you diagnose a hypomanic episode?

A

episodes only need to last 4 days and must not include psychotic features

254
Q

how do you make the diagnosis of bipolar II disorder?

A

patients have had one major depressive episode and one hypomanic episode

255
Q

what are the drugs of choice for treatment of bipolar disorder type 1?

A

mood stabilizers: lithium, valproic acid

carbamazepine

256
Q

how do you make the diagnosis of cyclothymic disorder?

A

it is characterized as dysthymic disorder with intermittent hypomanic period

2 years

257
Q

how do you make the diagnosis of panic disorder?

A

recurrent unexpected panic attacks

at least one attack followed by one month of worry about additional attacks

258
Q

how do you make the diagnosis of GAD?

A

excessive anxiety and worry occurring more days than not for at least 6 months for most of the day

259
Q

what does sig e caps stand for?

A

sleep-lack of

interest-lack

guilt

energy-lack of

concentration-difficult

appetite- decreased or increased

psychomotor- decreased

suicidal ideation

260
Q

what does DIG FAST stand for?

A

distractibility

inflated self esteem

grandiosity

flight of ideas

activity/agitation

speech-pressured

thoughtlessness

NMSP Exam III (5 decks)

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