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Block 6 > Week 9 > Flashcards

Week 9 Flashcards

1
Q
  1. Purpose of clinical practice guidelines?
A
  1. convert evidence into recommendations - statements that include recommendations intended to optimize patient care
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2
Q
  1. What are clinical practice guidelines informed by? (3)
A
  1. Based on a systemic review of existing evidence
  2. Developed by knowledgeable multidisciplinary panel of experts and representatives from key affected groups
  3. Consider important patient subgroups and patient preferences
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3
Q

What are the four major dimensions for a life in recovery?

A
  1. Health - overcoming or managing one’s disease or sx
  2. Home - having stable or safe place to live
  3. Purpose - Conducting meaningful daily activities and to participate in society
  4. Community - having relationships and social networks that provide support, friendship, love, and hope
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4
Q

What is the most effective mental health treatment combination?

A
  1. medication and psychotherapy
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5
Q

What is cognitive behavioral therapy?

A

developing and practicing new coping skills. setting short- and long-term goals. developing new problem-solving skills.

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6
Q

What are the 5 stages of death and dying as described by Kubler-Ross

A
  1. Denial
  2. Anger
  3. Bargaining
  4. Depression
  5. Acceptance
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7
Q

What are the 6 areas of cognitive decline related to aging?

A
  1. Complex attention (divided attention, selective attention, processing speed)
  2. Executive function
  3. Learning and memory
  4. Language
  5. Perceptual motor ability (visual perceptions, etc)
  6. Social cognition (recognition of emotions, understanding others mental states, behavior regulation)
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8
Q

Function of these hormones in appetite
1. Leptin
2. Ghrelin
3. Cortisol

A
  1. promote satiety and heat production
  2. increases hunger and is energy saving mechanisms
  3. Makes sure body has enough glucose avail. but does rise in times of stress which makes us eat more
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9
Q

What part of the hypothalamus has large influence over appetite regulation?

A
  1. Hormones cross the BBB at median eminence and work on **arcuate nucleus ** of hypothalamus
  2. At arcuate nucleus - orexigenic and anorexigenic neurons are influenced and influence other nuclei/brain regions
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10
Q

Function of orexigenic and anorexigenic neurons in appetite regulation

A
  1. orexigenic - “find food” actions
  2. anorexigenic - “supress feeding”
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11
Q

Function of Leptin on orixigenic+anorexigenic neurons?

A
    1. Leptin decrease activity of orexigenic neurons (which are meant for “find food” actions)
  2. Leptin increases activity of anorexigenic neurons (which are meant for “supress feeding” actions)
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12
Q

After Leptin affects orexigenic and anorexigenic neurons -> what changes occur in hypothalamus (specifically paraventricular nucleus and ventromedial hypothalamic nucleus)

A

due to leptin influence
1. paraventricular nucleus - mobilizes other system to promote metabolism
2. Ventromedial hypothalamic nucleus - increases brain derived neurotrophic factor to prevent us to wanting to eat + input into lateral hypothalamus (where food and reward meet)

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13
Q

What is the homeostatic vs hedonic system of appetite

A
  1. Homestatic - the baseline need to eat/satiety system
  2. Hedonic - the reward system related to eating
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14
Q

Once the lateral hypothalamus gets input from homeostatic system - what occurs to involve the DA reward system?

A
  1. Lateral hypothalamus projects to
  2. VTA of thalamus
  3. projection to nucelus accumbens (here DA reward system gets involved)
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15
Q

How does chronic stress affect eating?

A
  1. w/chronic stress –> there is increases craving for tasty high calorie food (comfort food) - which gets stored as fat and leads to obesity
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16
Q

Anorexia Nervosa
1. why is there a type of obsession with hyperactivity?

A
  1. With stress there is increased cortisol which supports hyperactivity
  2. Anorexic pts support this loop with cont. stress about body image which leads to need for hyperactivity
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17
Q

what changes with leptin occurs in obese patients (3)

A
  1. Many obese people become desensitized to leptin
  2. Due to leptin resistance, these pts can have low leptin -> leads to food scavenging tactics
  3. Less reward response from food so need more food to feel satisfaction
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18
Q

What is the dx criteria for general sexual dysfunction

A
  1. sx have persisted for a minimum of 6 months or longer
  2. sx cause significant distress
  3. sx are not explained by a nonsexual mental disorder
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19
Q

Describe
1. Female Sexual Interest/Arousal Disorder (Disorder of Desire and Arousal)
2. Male Hypoactive Sexual Desire Disorder (Disorder of Desire and Arousal)

A
  1. lack of or significantly reduced sexual interest/arousal
  2. persistent or recurrent deficient/absent sexual/erotic thoughts or fantasies and desire for sexual activity
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20
Q

Describe
1. Female Orgasmic Disorder
2. Erectile Disorder

A
  1. marked dely, infrequency, or absence of orgasm OR reduced intensity of orgasmic sensations
  2. difficulty obtaining or maintaining erection - marked decrease in erectile rigidity
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21
Q

Describe
1. Genito-Pelvic Pain/Penetration Disorder

A
  1. recurrent pain or difficulty with vaginal penetration during intercourse, pelvic pain during intercourse, fear or anxiety about pain as a result of penetration, marked tensing during attempt of vaginal penetration
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22
Q

Describe
1. Transvestic Disorder (paraphilic disorder)
2. Voyeuristic Disorder (paraphilic disorder)

A
  1. Fantasies, sexual urges, or sexual arousal from cross-dressing
  2. Sexual arousal from observing an unsuspecting person who is naked, in process of disrobing, or engaging in sexual acitivity (individual being watched is nonconsenting)
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23
Q

Describe
1. Exhibitionistic Disorder (paraphilic disorder)
2. Frotteristic Disorder (paraphilic disorder)

A
  1. sexual arousal from exposure of one’s genitals to an unsuspecting and nonconsenting person
  2. Sexual arousal from touching or rubbing against a nonconsenting person
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24
Q

What is the sexual response cycle?

A
  1. excitement - initial arousal
  2. plateau phase - full arousal but not yet orgasm
  3. orgasm
  4. resolution phase
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25
Q

Pica
1. What is it
2. Time length

A
  1. persistent eating of non-nutritional and nonfood substances
  2. one month
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26
Q

Rumination Disorder
1. what is it?
2. time length

A
  1. repeated regurgitation of food. Food may be re-chewed, re-swallowed OR spit out
  2. at least one month
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27
Q

Avoidant Restrictive Food Intake Disorder
1. What is it
2. complications

A
  1. Avoidant/restrictive food intake disorder (ARFID) is a type of eating disorder in which people eat only within an extremely narrow repertoire of foods.
  2. can lead to significant weight loss, dependence on enteral feeding or supplements
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28
Q

Anorexia Nervosa
1. Overal description
2. Pt fears
2. Dx criteria
3. Physical exam findings

A
  1. Pt diets and exercise which leads to a very low body weight and BMI.
  2. pt fears gaining weight, has distorted perception of body weight
  3. BMI <18.5
  4. bradycardia, hypotension, decreased bowel sounds, dry skin, hair loss, etc
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29
Q

Anorexia Nervosa
1. Describe Endocrine effects
2. Describe electrolyte effects
3. Describe bone density effects

A
  1. decreased GnRH secretion from hypothalamus -> leads to decreased LH/FSH -> leads to amenorrhea (no menses)
  2. inability to concentrate urine so there is free water loss and hyponatremia (since pt is thirsty and cont. drinking water), volume depletion, low GFR
  3. decreased bone density; can develop osteoporosis
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30
Q

Anorexia Nervosa
Treatment

A
  1. nutritional rehab - slow refeeding
  2. psycho therapy
    drug use is rare, but if used then olanzapine bc it causes weight gain
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31
Q

Bulimia Nervosa
1. Description
2. Dx criteria

A
  1. Binge eat w/inappropriate compensation to avoid weight gain like vomiting, laxatives, diuretics, enemes, excessive exercise, etc
  2. occurs at least once a week for 3 months;; WEIGHT IS USUALLY NORMAL;;; can co-exist with anxiety or depression
32
Q

Russel sign
1. What is it
2. What disease is it found with?

A
  1. scars on knuckles from induced vomiting
  2. Bulimia nervosa
33
Q

Binge Eating Disorder
1. description
2. dx criteria
3. complications
4. tx

A
  1. binge eating with no inappropriate compensation. Patient feels they lack control and feel shame. Will see weight gain.
  2. Occurs once a week for 3 months
  3. High risk of T2D
  4. CBT
34
Q

Define personality disorder

A
  1. Fixed pattern of behavior or way of interacting with environment which cause distress or impaired function - person often unaware
35
Q

What do cluster A personalities consist of?
1. description
2. disorders included

A
  1. Weird, odd, eccentric thinking or behavior
  2. paranoid, schizoid, schizotypal
36
Q

What do cluster B personalities consist of?
1. description
2. disorders included

A
  1. dramatic, overly emotional or unpredictable thinking or behavior
  2. antisocial, borderline, histrionic, narcissistic
37
Q

What do cluster C personalities consist of?
1. description
2. disorders included

A
  1. Anxious, fearful thinking or behavior
  2. avoidant, obsessive-compulsive, dependent
38
Q

Paranoid Personality Disorder
1. description
2. Hallmark ego defense

A
  1. Distrust of others even family and friends, guarded, suspicious + struggles to build close relationships
  2. projection
39
Q

Schizoid Personality Disorder
1. Social preferences
2. Relationships
3. Other descriptions

A
  1. Chooses social isolation
  2. Does not enjoy close friendships and little to no interest in sexual experiences
  3. few or no hobbies, detached with flat affect
40
Q

Schizotypal Personality Disorder
1. Describe way of thinking
2. Social interaction/relationships

A
  1. Odd beliefs or magical thinking (superstitious or supernatural thinking) - BUT OPEN TO CHALLENGES TO BELIEFS
    —> can also have ideas of reference (believe events are somehow related to them)
  2. Fear of social interaction and few close friends
41
Q

Antisocial Personality Disorder
1. Social aspects
2. Other descriptors
3. more common in what sex
4. other names for this?

A
  1. disregard for rights of others
  2. Often break the law and are impulsive, lack remorse
  3. men
  4. before 18 it is called conduct disorder
42
Q

Borderline Personality Disorder
1. Social aspects/description
2. More common in which sex
3. Ego defense mechanism
4. Tx

A
  1. unstable personal relationships, stormy relationship - often fear abandonment
  2. women
  3. Splitting - people are either very good or very bad (black and white thinking)
  4. Dialectical Behavioral Therapy
43
Q

Histrionic Personality Disorder
1. description

A
  1. Wants to be center of attention and may do that with inappropriate sexual behavior
  2. Very concerned with physical appearance
44
Q

Narcissistic Personality Disorder
1. Description

A
  1. inflated sense of self- brags, thinks everything they do is graet
  2. lacks empathy for others bc to them other people are competitors
  3. overreacts to criticism with anger/rage
45
Q

Dependent Personality Disorder
1. descriptions

A
  1. clingly, low self confidence, struggle to care for themselves
  2. hard for them to make decisions on their own and have a hard time expressing opinions
46
Q

Avoidant Personality Disorder
1. Social interactions

A
  1. Want to socialize but they can’t because they are afraid people won’t like them
  2. They feel inadequate and fear rejection from others
47
Q

Obsessive-compulsive PERSONALITY Disorder (OCPD)
1. description
2. differentiate this from OCD

A
  1. preoccupied with order and control - loves to do lists and always needs a plan. Inflexible at work or in relationships. it is ego-syntonic
  2. In OCD the person has intrusive thoughts and compulsions they do to reduce anxiety. It is ego-dystonic.
48
Q

Alcohol
1. MOA
2. Overall effect on CNS system

A
  1. Increase GABAa activation AND inhibits major excitatory neurotransmitters (glutamate at the NMDA receptor)
  2. graded depression of CNS (with increasing alcohol levels)
49
Q

Alcohol Withdrawal Sx
1. at 6 hrs
2. 12-24 hours
3. 24-48 hours
4. 48-96 hours

A
  1. minor (trembling, sweating/fever, irritability, anxiety, headache, tachy, increased BP, insomnia, N/V, diarrhea)
  2. Alcoholic hallucinations
  3. Withdrawal seizure (tonic-clonic)
  4. Delirium tremens
50
Q

Delirium Tremens can occur in alcohol withdrawal 48-96 hours after last drink
1. What sx occur?
2. How is it treated

A
  1. autonomic instability
  2. disturbance in consciousness and cognition
  3. hallucinations/delusions
  4. agitation

Treat with tapered BZD

51
Q

Alcohol withdrawal - How are withdrawal sx treated at
1. 6 hours
2. 12-24 hours
3. 24-48 hours

A
  1. thiamine, folate, multivitamin, dextrose, IV fluids
  2. BZD
  3. BZD taper
52
Q

How does severe liver disease change withdrawal sx treatment in a alcoholic withdrawal?

A
  1. Use lorazepam (a BZD) - because seems to safest option
53
Q

Alcohol withdrawal
1. What are the three different maintenance therapies + their function
2. Also mention contraindications if present

A
  1. Disulfiram - inhibits acetaldehyde dehydrogenase (makes alcohol consumption aversive)
  2. Naltrexone - reduces rewarding effects by blocking DA pathway (AVOID IN PTS WITH LIVER PROBLEMS)
  3. Acamprosate - helps maintain abstinence from alcohol by decreasing withdrawal sx that may make individual crave alcohol for relief
54
Q

Opioids
1. drug effects on CNS and body overall
- CNS
- pulmonary
- neuro (brain)
- eyes
- GI

A
  1. CNS depression
  2. respiratory depression
  3. seizures (overdose is life threatening)
  4. pupillary constriction (pinpoint pupils)
  5. constipation
55
Q

Opioids
1. Withdrawal presentations
-mood
-autonomic
-overall body
-eyes and nose
-GI

  1. Can opioid withdrawal be fatal?
A
  1. anxiety, dysphoric mood, insomnia, irritability, restlessness, anorexia
  2. sweating, dilated pupils, chils, piloerection, hypertension, tachy, yawning
  3. Fever, nausea, vomiting
  4. lacrimation, rhinorrhea
  5. diarrhea

very uncomfortable but not fatal

56
Q

Opioid Withdrawal
1. acute management of withdrawal symptoms (3)

A
  1. Clonidine and Lofexidine (alpha 2 adrenergic agonist - attenuate autonomic symptoms)
  2. Methadone - long acting FULL OPIOID AGONIST
  3. Soboxone (Buprenorphine+naloxone) - long acting PARTIAL OPIOID AGONIST
57
Q

Opioid Withdrawal
1. Maintenance management of addiction (3)

A
  1. Methadone - long acting mu opioid receptor full agonist (100 mph). Suppresses craving and minimizes reinforcement. Diminishes euphoria from other fast acting opioids.
  2. Suboxone (buprenorphine and naloxone) - Reduces cravings and has ceiling effect. Has reduced OD risk and reduced abuse potential because it is a partial agonist (50 mph)
  3. Naltrexone - long acting opioid antagonist (0 mph) - blocks cravings for both opioids and alcohol
58
Q

Barbiturates
1. MOA
2. Intoxication toxidrome
3. Ceiling effect

A
  1. GABAa channel agonist - increases the DURATION of Cl channel opening
  2. Respiratory/CNS depresion
  3. Does not have a ceiling effect so this can be toxic
59
Q

Barbiturates
1. Treatment of overdose
2. Withdrawal sx
3. Tx of withdrawal sx (2)

A
  1. intubate if necessary, sx management, support BP
  2. anxiety, seizures, delirium, CV collapse (more similar to BZD)
  3. long acting BZD tapered OR long acting barbiturates
60
Q

Benzodiazepines
1. MOA
2. Intoxication toxidrome
3. Ceiling effect and combination with other substances

A
  1. GABAa receptor modulator - increases FREQUENCY of the Cl channel opening
  2. sexual/aggressive behavior, poor judgement, anterograde amnesia, incoordination, ataxia, minor respiratory depression
  3. No ceiling effect - can be fatal if combined with alcohol, opioids, and other CNS depressants
61
Q

Benzodiazepines
1. Treatment of acute intoxication
2. Side effects of this med?

A
  1. Flumazenil - competitive GABAa antagonist + respiratory support if needed
  2. Can precipitate seizures in some pt
62
Q

Benzodiazepine
1. withdrawal symptoms
-mental health
-autnomic system
-motor
-overal body
-sleep
-neuro

A
  1. rebound anxiety
  2. Autonomic hyperactivity
  3. Psychomotor agitation, tremor, muscle twitching
  4. diaphoresis, N/V
  5. Insomnia
  6. Seizures, hallucinations, delirium
63
Q

Benzodiazepines
1. Tx to reduce withdrawal sx

A
  1. A long acting BZD with gradual taper off (clonazepam, chlordiazepoxide, diazepam - lorazepam for liver diseae pt)
64
Q

Amphetamines
1. MOA
2. General effects of the drug

A
  1. Stimulates DA, NE, 5HT release plus decrease reuptake of these NT
  2. Euphoria, psychosis, increased energy, pupils dilated, tachy, cardiac arrhythmias, seizures, bruxism (meth mouth), dyskinesia, etc
65
Q

Amphetamines
1. Treatment of intoxication
2. Use of restraints?
3. Withdrawal sx
4. Tx for withdrawal

A
  1. IV hydration, BZD (for agitation/seizures), Antipsychotics (for persistent psychosis)
  2. No - may result in rhabdomyolysis
  3. Dysphoria or depressed mood, lethargy, psychomotor retardation, hypersomnia
  4. no med has shown to be effective
66
Q

MDMA (ecstasy)
1. MOA
2. Effects of drugs
3. tx of intoxication
4. withdrawal sx
5. tx of withdrawal

A
  1. Typical effects of MDMA can be predominantly attributed to the ** activation of the 5-HT system**
  2. feelings of love and social closeness, sympathomimetic toxidrome (restlessness, agitation, tachy), hyponatremia due to increased fluid intake
  3. No specific tx
  4. depresion and anxiety as levels of DA, NE, and 5-HT decrease
  5. No specific tx
67
Q

Cocaine
1. MOA
2. Effects of drugs
3. withdrawal sx

A
  1. Blocks re-uptake of DA, NE, and 5HT
  2. Mental status changes (euphoria, overconfidence, grandiosity), sympathetic activation (tachy, pupillary dilation, hypertension, seizures), severe vasospams (myocardial ischemia, mucosal atrophy/nosebleed/nasal septum perforation when administered intranasally)
  3. “crash” with dysphoric mood, severe depression sx, fatigue, psychomotor retardation, malaise,
68
Q

Cocaine
1. tx of intoxication
2. Should you restrain patients?
3. Tx of withdrawal sx

A
  1. Antipsychotics and BZD as needed
  2. No can cause rhabdomyolysis
  3. Bupropion (similar action as cocaine), SSRIs for depression maybe, therapy
69
Q

PCP (phencyclidine)
1. MOA
2. Intoxication toxidrome

A
  1. Glutamate (NMDA) receptor antagonist
  2. Hallucinations, dissociation, belligerence, fear, paranoia, hostile/violent behavior (including homicidality), impaired judgement, numbnes or diminished response to pain, etc
70
Q

PCP (phencyclidine)
1. Tx of intoxication
2. Withdrawal sx
3. Tx for Withdrawal sx

A
  1. supportive care, maybe BZD for severe psychomotor agitation
  2. depression, anxiety, irritability, restlessness, disturbances of thought and sleep
  3. No specific tx
71
Q

LSD
1. MOA
2. intoxication presentation

A
  1. Acts on 5-HT receptor
  2. visual hallucinations and synesthesias (seeing sound as color), marked anxiety or depression, delusions, pupil dilation, tachy, sweating, palpitation, “bad trip”
72
Q

LSD
1. Tx of intoxication
2. withdrawal sx

A
  1. Antipsychotics, BZD as needed + talking down and counseling
  2. NOT SEEN - bc LSD does not affect DA or GABA system
73
Q

Marijuana and Synthetic Cannabinoids
1. MOA

A
  1. THC - Partial agonists at CB-1 in CNS and CB-2 in PNS
  2. Synthetic cannabinoids - usually full agonists at cannabinoids receptors and more potent than THC
74
Q

Marijuana and Synthetic Cannabinoids
1. intoxication presentation

A
  1. regular THC: euphoria, relaxation, disinhibition, paranoid delusions, pereception of slowed time, conjunctival injection, impaired motor coordination, imparied short term memory, etc
  2. synthetic -> has more dramatic psychoactive effects (severely altered mental status, psychosis, violent behavior)
75
Q

Marijuana and Synthetic Cannabinoids
1. Tx of intoxication
2. Withdrawal presentation

A
  1. no specific tx
  2. Mild sx like irritability, anger, aggression, anxiety, nausea, insomnia
76
Q

Inhalants
1. MOA
2. intoxication presentation
3. tx of intoxication
4. withdrawal sx

A
  1. not known
  2. Beligerence, assaultiveness, apathy, impaired judgement + maybe dizziness, nystagmus, incoordination, slurred speech, unsteady gait, tremor, etc
  3. No specific tx
  4. Not well categorized, no tx

Block 6 (9 decks)

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