Week4 Lectures Flashcards by Nneka I

high blood pressure + tremors WITH seizures + delirium is chr of ___ withdrawal (etOH, cocaine, heroine)

etOH

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VOLES is used to dx? what does it stand for

metabolic(non strutural) cause for acute confusion + agitation (

Vitamin defc 
O2/CO2 hypoxia/hypercabia (pneumonia)
Liver dmg 
Electrolyte ∆ (dehydration/Kidney)
Substances

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altered mental status + hallucination; seizures* + , tremors* + psychomotor agitation; 2-5 days after last drink, lasting 1-5 days; death by arrhythmia (hypovolemia + ∆ electrolytes)

Delirium Tremens from etOH withdrawal

hint: ↑HR, BP, temp + diaphoresis

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how do you tx delirium tremens?

tw benzos EARLY; AVOID SGAs only* (grand mal seizures kills pt)

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on imaging: lesions in medial thalamus and hypothalamus; atrophy of mamillary bodies; confabulation dt affected fornix + hippocampus (short term recall)

Wernicke-Korsakoff dz

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pt presents with confusion + cogn deficits; lateral and conjugate gaze palsy/paralysis; and ataxia

classic triad for Wernicke Encephalopathy

(encephalopathy; ophthalmoplegia; ataxia)

Cain criteria: 2/4 (defc risk + triad)

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in WK rx, Low does thiamine is for ___ and high dose thiamine is for _____

prevention; treatment

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Naltrexone, and Acamprosate; and Disulfiram are used to treat?

relapse prevention in etOH use do

hint: Disulfiram is 2nd line

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Out of the 3 below, which is a Mu antag; GABA/glutamate modulator; ALDH blocker

Acamprosate/Naltrexone/Disulfiram

Mu Opiate antag = Naltrexone
Acamprosate = GABA/glu modulator
Disulfiram = ALDH blocker

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3 methods to treating benzo dependence

sub a short acting BZ with long acting BZ (clonazepam), then taper
Phenobarb (less safe)
anticonvulsants (Valproate + Carbamazepine?

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how would you treat pt who is unresponseive, w/ miosis + resp depression?

heroin/opioid OD! tw Naloxone

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pt with SNS arousal sx, GI distress; and flu-like sx (shivers, goosebumps, lacrimation + rhinorrhea) is most likely experiencing? (cocaine/etoH/opioid) ___ withdrawal

Opioid withdrawal

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how to treat Acute opioid withdrawal,
mild?
moderate?
severe?

mild = clonidine
moderate = buprenorphine (partial agonist)
severe = methadone

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how to treat chronic opioid dependence:
opiate agonist?
partial opiate agonist?
opiate antagonist?

opiate agonist = methadone maint.
partial opiate agonist = Suboxone (buprenorphine + naloxone)
opiate antagonist = Naltrexone (oral/IM)

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sort the following efx among the 3 opiate rcps: euphoria, analgesia, dysphoria

Mu =  euphoria + analgesia 
Kappa = dysphoria + analgesia 
Delta = analgesia ONLY

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Top 3 illicit dugs used in order

Marijuana
Rx pain relievers
Cocaine

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Why is urine toxicology screen preferable?

drugs + metabs last longer in urine

hint: 72 hr (amphetamines, cocaine, opioids) 1wk-1mo (THC)

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other useful tests for etOH screening (besides triglycerides + uric acid)

AST>ALT, inc MCV (>100)l CDT transferrin

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Tox screens are avail for (4)

opioids
etOH
benzos
tobacco

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DARES is used for ____; what does it stand for?

Motivational Interviewing Principles;

Develop discrepancy
Avoid Argumentation 
Roll with Resistance
Express Empathy by reflecting
Support Self-Efficacy

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OARS is used for ____; what does it stand for?

Motivational Interviewing skills;

Open ended questions
Affirmation
Reflections
Summaries

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Contraindication for Immunotherapy (Abs) for substance use do tx?

heart attack risk with over use

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how is Amphetamine worse than Cocaine?

displaces DA from DAt and VMAT –> ↑DA gradient –> forcing DA into synapse via DAT (uncontrollable leaks) –> psychosis, agitation, aggressiveness

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euphoria, hyperactivity, initial hypersexuality, anorexia; rigidity, seizures are chr in stimulant (withdrawal/intoxication)

intoxication

hint: confusion is rare

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apathy, irritability, craving, depression, fatigue, hypersomnia/phagia lasting <72 h are chr in stimulant (withdrawal/intoxication)

withdrawal

peristent psychocosis and hallucinogen persisting perception disorder are are ____

long term effects of hallucinogens

Varenicline (Chantix) is used for ____; SEs in addition to nausea, insomnia, and nightmares include (3)

seizure alcohol CVD + MI

nicotine gum is contraindicated in

TMJ and dental dz

Bupropion (zyban) is used for ____; SEs in addition to depression, htn, arrthmia include (3)

SI**, seizure, eating disorder

The nicotine patch is dosed for 1 mon each at __ ___ and ___; in addition to HS rxn, palipations, and dreams , SEs include (3)

21, 14, 7, mg/d arrhythmia, post MI, pregnancy

Off label smoking cessation drug that can cause SI arrhythmia, seizure, TD

Nortrptyline

off label smoking cessation drug with post partum, perioperative warnings

clonidine hint: SEs incl sedatio, brady, dry mouth, hypotn

____ is the #1 cause in the preventable death

smoking hint: 1 in 5 deaths

___ is the most effective pharmatx for smoking cessation

varenicline

5 A's and 5 R's for motivational interviewing

``` Ask about use Advise to quit Assess willingness Assist quitting Arrange f/u 1 wk after ``` ``` Relevance (stakeholders, prior attempts) Risk Rewards Roadblocks Repetition ```

inability to recall important autobiographical information *** dt traumatic/stressful event; how is it different from dementia amnesia?

dissociative amnesia dementia amnesia - forget recent events, date, time hint: 5-20% combat amnesia

bewildered wandering or purposeful travel assc w/ amnesia (identity/autobiographical info)

fugue state (dssc amnesia)

name the type of memory: 1. specific events and context 2. words and meanings (objects, factos, concepts) 3. how to perform actions; skills

1. episodic 2. semantic 3. procedural

name the type of memory: 1. episodic + semantic 2. muscle memory for tasks xtra: brain structure responsible

1. Declarative/Explicit - hippocampus | 2. procedural/Implicit - Basal Ganglia

presence of 2+ distinct personality traits that causes sgf distress or impairment; caused by dirupted attachment (↑stress from abuse, painful medical procedure)

Dssc identity do hingt: sx begin in childhood

fluctuations in skills/habits/knowledge; unexplained possessions; sudden changes in relationships

DID

feelings of unreality/detachments from one's self being an outside observer emotional/physical numbing

Depersonalization

experiences of unreality/detachment from surroudnings

Derealization

Onset of depersonzn/derealzn do is typically ____ and unusual for ____

adolescence or 20; | unusual in later adulthood

1. robust evidence for treating depression, anxiety, stress tolerance 2. preliminary evidence for brain changes in just weeks 3. emphasizes acceptance (non interfering obsv) in dealing with ± affect phobia

benefits of mindfulness meditation (3)

works via: placebo response physio benefits/SEs of supplements mind-body cxn

how CAM works

Explain the cholinergic anti-inflamm pathway (2)

- WBCs w/ ACh rcps inhib cytokine release - PNS (vagal input) inh inflamm hint: mindful meditn - ↑PNS

This can serves as monotx (mild) or adjunct (severe); ``` MOA includes: ↑5HT, NE Mods HPA axis ↑neural growth factors ↑hippocampal neurogenesis ```

Exercise (Naturopathy)

Kava kava and St Johns wort affect ___ and ____ respectively

``` KK = liver damage; SJW = p450 interaction ```

Sympathomimetic mydriatics (3)

pupillary dilators Cocaine Amphetamines Methylphenidate (ADD)

Anticholinergics mydriatics AAAS (4)

``` pupillary dilators (block CN III) Antihistamines Antidepressants Anticholinergics Sympathomimetics ```

hallucinogens + alcohols are egs of (mydriatics/mitotics)

mydriatics

opioids sedative hypnotics cholinergics (insecticides) PCP (phenycyclidine) are all egs of (mydriatics/mitotics)

miotics

Sympatholytic miotics (2)

𝛂 blockade 1. Clonidine (sedative anti-htn) 2. tetrahydrazoline (eye drops)

cocaine in the pediatric popn is explained by (3)

1. placental transfer 2. breast milk 3. passive exposure to 2˚ sources

pediatric pt who is tachycardic, hypertensive, seizures, dilated pupils*, fever, diaphoresis. But labs, CSF, CT are all normal

cocaine intoxication ⊕urine tox screen

10 yr pt recovering from chicken pox presents with sgf agitation suprapubic mass; absent bowel sounds, mydriasis, dry mucus membranes; temp, HR, RR, and BP are all ↑ large amt of versed was used to sedate tx?

antihistamine OD --> toxic encephalopathy tw Physostigmine (antilirium) hint: looks like anticholinergic poisoning

Name the drug class? Migraine tx that is selective 5HT 1B and 1D AGONISTS; 1st line for specific for migraines. Action of each rcp type?

Triptans ``` 1B = vasoC 1D = 1st/2nd order neuronal inh ``` hint: take early; ± prevent CGRP release

What drug? migraine tx that acts via vasoC and ↓trigeminovasc pathway

ergotamines hint: w/ caffeine

longer acting migraine drug that can be used at later stage of attack; more SEs than triptain; pre rx with anti emetics in pregnancy (contra) ; IV use for status migrainous

DHE

what SSNOOP used for and what does it stand for?

2˚ headache red flags ``` Systemic sx Secondary causes Neuro Signs Onset Older age Pattern, Pregnancy, Papilledema ```

1. Triptans + DHE 2. NSAIDS, cambia PWD, Ketoralac 3. antiemetics ± benedryl ...in that order are all indicated for?

acute migraine treatment

1. Onabot 2. Topiramate 3. Propanolol/Timolol 4. Amitriptyline ...in that order all indicated for? Which is FDA approved?

preventative migraine tx; Onabot (botoxA) is the only FDA approved

Name the number of days to classify MOH for each drug below: 1. Triptans, ergots, DHE 2. simple analgesics 3. Butalbital 4. Opioids

1. > 10 days/mo 2. > 15 days/mo 3. > 5 days/mo 4. > 8 days/mo

Preferred preventative tx for TTH

amiTriptyline hint: also NSAIDS, tylenol, muscle relaxants for acute

4 S's and ipsi ANS sx are indicative of? what do the 4 S's stand for

TACS (trigem autonomic cephaglias); Sidelocked Severe Short Sharp

Tx for SUNA and SUNCT TACS (1)

lamictal

Tx for PH and hemicrania continua?

indomethacin

cluster HA SUNA + SUNCT Paroxysmal hemicrania Hemicrania continua ...these conditions are classf'd as?

TACS (trigem autonomic cephaglias)

1. 100% O2 2. Sumatriptan 3. Zolmitriptan (nasal*) 4. IP/IV DHE 5. Intranasal licocaine ...in that order all indicated for?

Abortive TACS tx hint: also use nasal DHE; neuroleptic sedation

1. Prednisone taper (2 days) 2. IV DHE (2-3 days) ...in that order all indicated for?

Transitional TACS Tx hint: short term bridge tx

1. Verapamil (watch EKG) 2. low dose lithium carbonate 3. SPG block, topiramate, valp. acid, gabapentine, melatonin ...in that order all indicated for? ...in that order all indicated for?

preventative TACS tx (bridge)