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CMN574 > Unit 2: adhd, eating disorders, substance abuse > Flashcards

Unit 2: adhd, eating disorders, substance abuse Flashcards

1
Q

etiology of ADD/ADHD

A
  • genetics
  • metabolic issues
  • CNS trauma or infection
  • premature birth
  • sleep apnea & other organic causes
  • majority is unknown
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2
Q

ADD/ADHD is the most common _______

A

neurodevelopment disorder

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3
Q

ADD/ADHD can occur alone or with other comorbidities such as

A
  • learning disabilities
  • anxiety disorders (MOST COMMON)
  • depression
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4
Q

ADD/ADHD occurs in _____% of children and _____% of adults

A
  • 7-8% of children

* 2.5% of adults

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5
Q

triad of symptoms/characteristics for ADD/ADHD

A
  • hyperactive- impulsive = interrupting, taking risks, “bugs” people, hyperactive
  • inattentive = messy, not organized, no timg mgmt, fails deadlines, can occur with OSA
  • combined type
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6
Q

early diagnosis of ADD/ADHD and treatment is important for ______ outcomes

A

improved

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7
Q

major factors of ADD/ADHD treatment failure are (2)

A
  • improper dx

* failure to recognize comorbidities

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8
Q

symptoms need to be present before age _____ and in more than 1 _____

A
  • 12

* setting

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9
Q

mgmt ADD/ADHD

A
  • treat comorbidities
  • behavior modification techniques
  • social skill training
  • counseling
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10
Q

meds for ADD/ADHD are usually what class?

A

stimulants

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11
Q

CNS stimulants are a schedule _____ drug

A

2

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12
Q

stimulants have a high potential for ____ & _____ and therefore you must assess ______ risk before prescribing and monitor for symptoms during use

A
  • abuse and dependence

* abuse risk

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13
Q

every pt on stimulants needs a baseline _____ eval

A

cardiac

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14
Q

pts on stimulants with additional cardiac risk factors require _____ and _____ assessment (in addition to cardiac) at baseline and when else?

A
  • BP and HR

* after dose increase and periodically

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15
Q

in peds what other baseline assessment is needed prior to initiation of stimulants

A
  • height and weight

* required periodically as well

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16
Q

if pt is under prolonged tx with stimulants what other dx tests should you consider?

A

annual CBC w diff and platelets (why?)

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17
Q

stimulant names mentioned in pt

A

*methlyphenidate = concerta, ritalin, quillichew ER, etc…

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18
Q

ALWAYS check for _____ when rx’ing stimulants…. or anything really….

A

drug interactions

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19
Q

you must discuss ______ with pts on stimulants

A

safety

ppt says “can get jail time” meaning if they sell or if we dont discuss safety….?

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20
Q

non stimulant meds for ADD/ADHD

A
  • bupropion
  • clonidine Er
  • Guanfacine
  • Atomoxetine adjunct 2nd line
  • others when treating other comorbidities
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21
Q

non stimulants can be used _____ or with other _____ when treating ADD/ADHD

A

alone or in combo with other stimulants

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22
Q

eating disorders mentioned in ppt (5)

A
  • anorexica nervosa (AN)
  • bulimia nervosa (BN)
  • binge eating disorders (BED)
  • atypical AN
  • avoidant-restrictive food intake disorders (ARFID)
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23
Q

etio of eating disorders?

A

strong evidence in genetics
*other theories = environmental factors
psychological factors
societal factors (promotion of thinness)

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24
Q

science is unsure if neurotransmitters ______ to the development of EDs or if the changes are a ________ of the physiologic changes associated with the EDs

A
  • contribute to

* consequence of

25
dx of AN in adolescents....
see ppt... vague but general stuff we're all prob already aware of
26
dx of AN in adults
* disturbance of body image * intense fear of becoming fat * weight loss leading to body weight <15% below expected * absence of 3 consecutive menstrual cycles
27
2 major types of AN are?
* restricting * binge-eating/purging * can have combination
28
atypical AN is defined as what?
someone having a type of AN but weight is normal or above normal
29
what labs should you check on a pt w AN?
TSH, electrolytes, LFTs, cholesterol, CBC w diff, creatinine, phosphorus, calcium, magnesium, U/A, EKG, bone density
30
_____ is a common side effect of AN, esp in females with amenorrhea
osteoporosis
31
AN is associated with what thyroid disorder?
functional hypothyroid (euthyroid sick)
32
name 3 s/s of hypothyroid
* hair thins * brittle nails * dry skin
33
AN is associated with what arrythmia? especially in what position?
* brady | * supine
34
AN is associated with what BP abnormality? what is the A&P behind this?
* hypotension * LV mass decreased >> stroke volume compromised >> peripheral resistance increases >>> all contribute to LV systolic dysfunction
35
AN can develop what 2 cardiac irregularities?
* prolonged QTc syndrome * increased QT dispersion (irregular QT intervals) * ***these put them at risk for cardiac arrythmias
36
AN is associated with what circulatory abnormalities?
* decreased peripheral circulation | * hands and feet maybe cold/blue
37
AN is associated with what dermatologic abnormality?
* lanugo | * primal response to starvation
38
as the GI tract adapts to reduced intake associated with AN... what s/s might you see?
* early satiety * GERD * inability take in normal amounts of food
39
in AN normal _______ reflex may be ______ due to lack of stimulation by food. This can cause what 2 symptoms?
* gastrocolic reflex * bloating and constipation * delayed gastric emptying may develop
40
what labs should you check in a pt with BN?
* electrolytes | * amylase (may be increased due to chronic parotid stimulation)
41
treatment for enlarged parotid glands ST BN?
heat | suck tart candy
42
what labs do you want to check in BED?
* thyroid * cholesterol * trigs
43
BED treatment?
psychotherapy, meds
44
meds for BED?
``` topamax antidepressants vyvyanse wellbutrin nutritional supps if needed ```
45
for dx s/s of BED must occur at least _____ for how long?
* 1x/week | * 3mo
46
ARFID definition:
*avoidance or restriction of oral food intake
47
ARFID definition:
* avoidance or restriction of oral food intake * ABSENCE OF criteria for AN (disturbed body image, fear of weight gain/body fat) * **AN w/o distress of body shape or fears of fatness
48
s/s of ARFID
* lack of interest in eating * avoidance to sensory characteristics of food (?) * concern for aversive consequences of eating (?) * inadequate nutritional/energy needs met
49
there is a lack of what AN feature in the ARFID dx?
*lack of drive for thinness
50
treatment for ARFID?
* brief medical hospitalizations | * long psychiatric or residential hospitalizations.... wtf
51
labs to run on pts suspected of substance abuse?
* urine & blood tests | * hair - can be false +
52
treatment for SA?
* office-based * inpt * outpt * individual/group * may need detox
53
_____ is the gateway drug and usually begins in ______ school and occurs more in boys or girls? whites or other races?
* alcohol * middle school * boys > girls * whites > other races
54
______ is the most common illegal drug
marijuana
55
nicotine addiction can occur as quickly as ______
one month
56
smoking cessation referral sources:
* 1-800-quitnow * tobacco cessation clinics * community programs * psychotherapies
57
five A's for tobacco cessation
* ask * advise * assess * assist * arrange
58
meds for tobacco cessation include (4) and can decrease relapse rates by _____x as those quitting without
* sustianed release antidepressants * bupropion * clonidine * nortriptyline * 5x
59
facility referrals for tobacco cessation
* low-intensity * outpt * school based * residential * hospital based * day treatment * dual-diagnosis facilities

CMN574 (6 decks)

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