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254 Cards in this Set

  • Front
  • Back
CHAPTER ONE
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MSE
Mental Status Examination
Obtundation
The client needs to be lightly shaken to elicit a response, but she may be confused and slow to respond
Stupor
The client require spainful stimuli to elicit a brief response. She may not e able to respond verbally
Decorticate rigidity
Flexion and internal rotation of upper-extremity joints and legs
Decerebate rigidity
neck and elbow extension, wrist and finger flexion
What three areas does the Glasgow Coma Scale assess?
Eye, verbal, and motor response
What is the best score on the Glasgow Coma Scale?
15
What score on the Glasgow Coma Scale indicates that the client is comatose?
3
HEADSS
Psychosocial assessment tool of risk factors in the adolescent: Home, Education/employment, peer group Activities, Drugs, Sexuality, and Suicide/depression
MPQ
McGill Pain Questionnaire
PAINAD
Pain Assessment in Advanced Dementia
Axis I
Clinical disorders and other conditions that may be a focus of clinical attention
Axis II
Personality disorders and mental retardation
Axis III
General medical conditions
Axis IV
Psychosocial and environmental problems
Axis V
GAF scale
GAF scores of 80-100 indicate
normal or near-normal function
GAF scores of 60-80 indicate
moderate problems
GAF scores of 40 and below indicate
serious mental disability and/or functioning impairments
A GAF score of 50/80 indicates
a present GAF score of 50 and previous score of 80 in the past year
CHAPTER TWO
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MH patients have the right to
humane Tx and care; voting; and due process of law
Tort
A wrongful act or injury committed by an entity or person against another person or another person's property. Can be used to decide liability issues.
Voluntary commitment
Client is not required to take medications or treatment, and can leave at any time
Involuntary (civil) commitment
Client enters against will; judge may determine the need for commitment; several physicians must certify that the condition requires commitment
Emergency involuntary commitment
Client is hospitalized to prevent harm to self or others
Observational / Temporary Involuntary Commitment
Client is in need of observation, diagnosis, and Tx plan
Long-term or formal involuntary commitment
Must be imposed by court, length varies but usually around 60 - 180 days. Sometimes there is no set release date
Does a client under involuntary commitment have the right to refuse Tx?
Yes, unless they have been judged incompetent after a hearing
Assault
Making a threat to a client's person
Battery
Touching a client in a harmful or offensive way
Types of intentional torts include (3)
false imprisonment, assault, battery
CHAPTER THREE
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Intrapersonal communication
Talking to self
Interpersonal communication
Talking between 2 or more people in a group
Public communication
Communication that occurs within large groups of people
Transpersonal communication
Communication that addresses an individual's spiritual needs and provides interventions to meet those needs
List the types of effective communication
silence, active listening, open-ended questions, clarifying techniques, offering general leads, broad opening statements, Showing acceptance and recognition, focusing, asking questions, giving information, presenting reality, Summarizing, Offering self, Touch
List the types of clarifying techniques
Restating, Reflecting, Paraphrasing, Exploring
Restating
Therapeutic technique in which nurse uses the client's exact words
Reflecting
Therapeutic technique in which nurse directs the focus back to the client
Paraphrasing
Therapeutic technique in which nurse restates the client's feelings and thoughts for the client to confirm what has been communicated
Exploring
Therapeutic technique in which nurse gathers more information regarding important topics mentioned by the client
Focusing
Therapeutic technique in which nurse helps the client to concentrate on what is important
List barriers to effective communication
Asking irrelevant questions, offering personal opinions, giving advice, giving false reassurance, minimizing feelings, changing the topic, asking 'why' questions, offering value judgments, excessive questioning, responding approvingly or disapprovingly
CHAPTER FOUR
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List the four healthy defense mechanisms
Altruism, sublimation, humor, suppression
List the six intermediate defense mechanisms
Repression, reaction formation, somatization, displacement, rationalization, undoing
List the eight immature defense mechanisms
Projection, acting-out behaviors, dissociation, devaluation, idealization, splitting, passive aggession, and denial
Altruism (as a defense mechanism
Dealing with anxiety by reaching out to others
Sublimation
Dealing with unacceptable feelings or impulses by unconsciously substituting acceptable forms of expression
Suppression
Voluntarily denying unpleasant thoughts and feelings
Repression
Putting unacceptable ideas, thoughts, and emotions out of conscious awareness
Displacement
Shifting feelings related to an object, person, or situation to another less threatening object, person, or situation
Reaction formation
Overcompensating or demonstrating the opposite behavior of what is felt
Somatization
Developing a physical symptom in place of anxiety
Undoing
Performing an act to make up for prior behavior
Rationalization
Creating reasonable and acceptable explanation for unacceptable behavior
Passive aggression
Indirection behaving aggressively but appearing to be compliant
Acting-out behaviors
Managing emotional conflicts thorugh actions, rather than self-reflection
Dissociation
Temporarly blocking memories and perceptions from consciousness
Devaluation
Expressing negative thoughts or self or others
Idealization
Expressing extremely positive thoughts of self or others
Splitting
Demonstrating an inability to reconcile negative and positive attributes of self or others
Projection
Blaming others for unacceptable thoughts and feelings
Denial
Pretending the truth is not reality to manage the anxiety of acknowledging what is real
The phases of the therapeutic relationship are
Orientation, Working, Termination
Transference
occurs when the client views a member of the helath care team as having characteristics of another person who has been significant to the client's personal life
Countertransference
occurs when a health care team member displaces characteristics of people in her past onto a client
CHAPTER SIX
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NAMI
National Alliance on Mental Illness
HMOs
Health Maintenance Organizations
PPOs
Preferred Provider Organizations
MBHOs
Managed Behavioral Healthcare Organizations
Primary Prevention
promotes health and prevents mental health problems from occurring
Secondary Prevention
Focuses on early detection of mental illness
Tertiary Prevention
focuses on rehabilitation and prevention of further problems in clients previously diagnosed
Assertive Community Treatment (ACT
Includes nontraditional case management and treatment by an interdisciplinary team for a caseload of clients with severe mental illness who are noncompliant with traditional treatment; provides crisis intervention, assistance with independent living, and information regarding resources for necessary support services.
Psychosocial rehabilitation programs
Provide a structured range of programs for clinents in am mental health setting, including residential services and day programs for older adults for whom care is provided
CHAPTER SEVEN
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Classical psychoanalysis
a therapeutic process of assessing unconscious thoughts and feelings, and resolving conflict thorugh talking to a psychoanalyst for many sessions and over months to years
Why is psychoanalysis (classical) not often used?
Due to the long length of time required
Free association
spontaneous, uncensored verbalization of whatever comes to a client's mind
How is psychotherapy different from classical psychoanalysis
involves more verbal therapist-to-client interaction
How is psychodynamic psychotherpay different from psychoanalysis
oriented more to the client's present state rather than his early life
IPT - Interpersonal PsychoTherapy
used for clients with specific problems; can improve interpersonal relationships, communication, role-relationships, bereavement
Cognitive therapy
based on the cognitive model, which focuses on individual thoughts and behaviros to solve current problems; treats depression, anxiety, eating disorders, and other issues that can be improved by changing a client's attitude toward life experiences
Behavioral therapy
believes that changing behavior is key to treating problems such as anxiety and depression; based on the theory that behavior is learned and has consequences
Cognitive reframing
The client is helped to look at irrational cognitions in a more realistic light and to restructure those thougths in a more positive way; assists clients to identify negative thoughts that produce anxiety, examine the cuase, and develop supportive ideas that replace negative self-talk
Modeling
the therapist or others serve as role models for the client, who learns improved behavior by imitation
Operant conditioning
positive rewards are given for positive behavior
Systematic desensitization
planned, progressive, or graduated exposure to anxiety-provoking stimuli in real-life situations, or by imagining events that cause anxiety
Aversion therapy
a maladaptive behavior is paired with a punishment or unpleasant stimuli to change the behavior
Flooding
exposting a client, while accompanied by a therapist, to a reat deal of undesireable stimuli in an attempt to turn off the anxiety response
Response prevention
preventing a client from performing a compulsive behavior with the intent that anxiety will be diminished
Thought stopping
teaching a client, when negative thoughts or compulsive behaviors arise, to say or shout 'stop' and substitute a positive thought
CHAPTER EIGHT
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Group norm
the way the group behaves during sessions, and over time, it provides structure for the group
Subgroup
small number of people within a larger group who function separately from the group
Three types of group roles
Maintenance, Task, and Individual roles
Maintenance roles
members who take on these roles tend to help maintina the purpose and process of the group
Task roles
members take on very tasks within the group processes
Individual roles
these roles tend to prevent teamwork, because individuals take on roles to promote their own agenda
Placating
One member takes responsibility for problems in order to keep peace at all costs
Scapegoating
a member of the family with little power is blamed for all problems within the family
Triangulation
a third party is drawn into the relationship with two members who relationship is unstable
Multigenerational issues
these are emotional issues or themes within a family that continue for at least three generations, such as a pattern of addiction
CHAPTER NINE
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GAS
general adaptation syndrome = fight or flight response
PMR - progressive muscle relaxation
a person trained in this method can help a client attain complete relaxation within a few minutes of time
Assertiveness training
One technique teaches the cleint to assert his feelings by describing a situation or behavior that causes stress, stating his feelings about the behaavior or situation, and then making a change
CHAPTER TEN
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How MIGHT ECT work?
theory suggests that ECT may enhance the effects of neurotransmitters (serotonin, dopamine, and norepinephrine) in the brain
List two groups of depressed patients for whom ECT may be an option
(1) clients for whom the risks of other treatments outweigh the risks of ECT, (2) clients who are actively suicidal and for whom there is a need for rapid therapeutic response
What types of schizophrenic patients require ECT?
types that are less responsive to neuroleptic medications (catatonic, shizoaffective disorders)
What types of manic patients require ECT?
bipolar disorder with rapid cycling (4 or more episodes of acute mania within 1 year) and very destructive behavior - typicallly have poor response to lithium therapy
List four contraindications for ECT
Recent MI, Hx of CVA, cerebrovascular malformation, intracranial mass lesion
What type of depression is ECT not useful for?
situational depression
The typical course of ECT Tx is what
3 times/week for a total of 6-12 Tx
What medications should be d/c-ed before ECT?
any meds that affect seizure threshold; MAOIs and lithium 2 weeks before
Why should severe HTN be controlled in the ECT patient?
a short period of HTN occurs STAT after the ECT
Any cardiac conditions, such as dysrhythmias, should be monitored and treated before ECT
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What medication is given 30 minutes before ECT and what does it do?
IM injection of atropine sulfate or robinul (Glycopyrrolate) to decrease secretoins and counteract any vagal stimulation
When is ECT administered?
early in the AM after the client has fasted for 8-12 hours
A short-acting anesthetic is administered before ECT, such as what
methohexital (Brevital) via IV bolus
A muscle relaxant is administered after the anesthetic to the ECT patient, such as
succinylcholine (Anectine)
How long is an ECT stimulus applied?
0.2-0.8 seconds
Following ECT, when does the client be transferred back to the mental health unit?
30-60 minutes
What happens to heart rate baseline during ECT?
rises by 25% in procedure and early recovery
What happens to B/P in ECT?
initially falls and then rises, lowering to normal after procedure
What S/S occur following ECT?
HA, muscle soreness, nausea
CHAPTER ELEVEN
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What is GAD and how long does it last?
Generalized Anxiety Disorder, 6 months
What is acute stress disorder?
exposure to a traumatic event causing numbing, detachmnet, and amnesia about the event for not more than 4 weeks following the event
Anxiety disorders are more likely to occur in men or women?
Women
How long do panic disorders last?
15-30 minutes
Systematic desensitization
begins with mastering of relaxation techniques, then client is exposed to increasing levels of an anxiety-producing stimulus and uses relaxatoin to overcome the resulting anxiety.
Flooding
exposing the client to a great deal of anxiety-producing stimuli in order to turn off the anxiety response
Response prevention
focuses on preventing the client from performing a compulsive behavior with the intent that anxiety will be diminished
CHAPTER TWELVE
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MDD stands for what and how long do the S/S last?
Major depressive disorder - five specific S/S lasting for a minimum of 2 weeks, occur at least every day for most of the day
Describe MDD with atypical features
S/S include chagnes in appetite or weight gain, excessive daytime sleepiness
Describe MDD with postpartum onset
episode begins within 4 weeks of childbirth
Describe MDD with seasonal characteristics
Seasonal affective disorder (SAD) which occurs during winter and may be treated with light therapy
Describe MDD with chronic features
a depressive episode that lasts over 2 years
Describe the three phases of MDD
(1) acute - severe symptoms of depression; (2) maintenance - increased ability to function; (3) continuation - remission of S/S
Who are depressive disorders more common in?
2x as common in females between the ages of 15 and 40 than in males
Depression is very common in the elderly and is sometimes confused with dementia. What S/S of depression might be confused with dementia?
memory loss, confusion, behavioral problems such as social isolation or agitation
Serotonin deficiency is a risk factor for what?
depression
Anergia
lack of energy
Psychomotor retardation
slowed physical movement, slumped posture
Psychomotor agitation
restlessness, pacing, finger tapping
St. John's Wart is used to relieve what?
S/S of mild depression
What are adverse effects of St. John's Wart?
photosensitivity, skin rash, rapid heart rate, GI distress, abdominal pain
What can occur if St. John's Wart is taken with SSRIs?
serotonin syndrome
What is light therapy used for?
it is the first-line Tx for SAD, inhibits nocturnal secretion of melatonin
Describe light therapy?
exposure of the face to 10,000-lux light box for 30 minutes a day, once or in 2 divided doses
What is TMS?
transcranial magnetic stimulation - a new therapy using electromagnetic stimulation of the brain; it may be helpful for depression that is resistant to other forms of Tx
What is VNS
Vagus nerve stimulation - an implanted device that stimulates the vagus nerve, it can be used for clients who have depression that is resistant to at least 4 antidepressant medications
CHAPTER THIRTEEN
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When do bipolar disorders usually emerge?
in late adolescence/early adulthood
Children are not usually diagnosed with bipolar disorders until when?
after the age of 7
Describe the phases of bipolar disorder
(1) acute - acute mania; (2) maintenance - increased ability to function; (3) continuation - remission of S/S
Hypomania is a less severe episode of mania that lasts how long?
at least 4 days
What is a mixed episode of bipolar disorder?
a manic episode and an episode of major depression experienced at the same time - marked impairment in functioning and may require admission to an acute care mental health facility to prevent self-harm or other-directed violence
What is rapid cycling of bipolar disorder?
four or more episodes of acute mania within 1 year
Bipolar I disorder
The client has at least one episode of mania alternating with major depression
Bipolar II disorder
The client has one or more hypomanic episodes alternating with major depressive episodes
Cyclothymia
The client has at least 2 years of repeated hypomanic episodes alternating with minor depressive episodes
What may lead to a relapse episode of mania in bipolar disorder?
use of substances (ETOH, drugs, caffeine)
How much sleep does a client with mania require?
a minimum of 4-6 hours
CHAPTER FOURTEEN
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Paranoid schizophrenia
characterised by suspicion toward others
Disorganized schizophrenia
characterized by withdrawal from society and very inappropriate behaivors (poor hygiene, muttering constantly); frequently seen among the homeless; S/S include loose associations, bizarre mannerisms, incoherent speech, hallucinations and delusions (much less organized that those in clients with paranoid type)
Schizoaffective disorder
the client's disorder meets both the criteria for schizophrenia and of the affective disorders (depression, mania, or a mixed disorder)
Brief psychotic disorder
the client has psychotic S/S that last between 1 day to 1 month in duration
Schizophreniform disorder
the client has S/S like those of schizophrenia, but the duration is from 1-6 months and social/occupational dysfunction may not be present
Shard psychotic disorder
AKA 'Folie a Deux'
Secondary (induced) psychosis
S/S of psychosis are brought on by a medical disorder or by use of chemical substances
Positive S/S of schizophrenia
These S/S are normal processes, but at abnormal levels - hallucinations, delusions, alterations in speech, bizarre behavior, such as walking backward constantly
Negative S/S of schizophrenia
These S/S refer to a lack of normala processes - flat affect, alogia, avolition, anhedonia, anergia
ideas of reference
misconstrues trivial events and attaches personal significance to them, such as believing that others are talking about him
thought broadcasting
believes that her thought are heard by others
thought insertiion
believes that others' thoughts are being inserted into his mind
Thought withdrawal
Believes that her thoughts have been removed from her mind by an outside agency
Word salad
words jumbled together with little meaning or significance to listener
Clang association
meaningless rhyming of words, often forceful
Flight of ideas
Associative looseness
What are personal boundary difficulties and what are two types?
disenfranchisement with one's own body, identity, and perceptions. Includes depersonalization and derealizataion
Depersonalization
nonspecific feeling that a person has lost her identity; self is different or unreal
Derealization
perception that environment has changed
Wavy flexibility
excessive maintenance of positoin
Negativism
doing the opposite of what is requested
CHAPTER FIFTEEN
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Describe the three clusters of personality disorders
(A) odd or eccentric; (B) dramatic, emotional, erratic; © anxious or fearful
Splitting is commonly associated with which disorder?
borderline personality disorder
Cluster A personality disorders
paranoid, schizoid, schizotypal
Cluster B personality disorders
antisocial, borderline, histrionic, narcissistic
Cluster C personality disorders
avoidant, dependant, obsessive-compulsive
Dialectical behavior therapy
a cognitive-behavioral therapy used for clients with borderline personality disorder; focuses on gradual behavior changes and provides acceptacne and validation for these clients, who are very frequently suicidal and have self-mutilating behaviors
CHAPTER SIXTEEN
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What are cognitive disorders characterized by?
the disruption of thinking, memory, processing, and problem solving
List some risk factors for cognitive disorders
physiological chagnes, family genetics, infections (HIV/AIDS), tumors, substance abuse, drug intoxication, drug withdrawal
What are risk factors for Alzheimer's disease?
advanced age, female gender, prior head trauma, family history of alzheimer's disease, trisomy (Down syndrome)
What happens to VS in delirium?
may be unstable and abnormal due to medical illness
What happens to VS in dementia?
stable unless other illness is present
What causes dementia?
generally caused by a chronic disease, such as Alzheimer's disease, or is the result of chronic ETOH abuse, may be caused by permanent trauma, such as head injury
List and describe the stages of Alzheimer's
(1) no impariment, (2) very mild cognitive decline, which may be normal age-related changes, or very early signs of Alzheimer's disease, (3) mild cognitive decline, including problems with memory or concentration that may be measurable in clinical testing or during a detailed medical interview, (4) moderate cognitive decline that is clearly detected during a medical interview, (5) moderately severe cognitive decline, (6) severe cognitive decline, (7) very severe cognitive decline
Confabulation
the client may make up stories when questioned about events or activities that she does not remember - an unconscious attempt to save self-esteem and prevent admitting that she does not remember the occasion
Perseveratoin
the client avoids answering questions by repeating phrases or behavior - an unconscious attempt to maintain self-esteem when memory has failed
Amnestive disorder may be secondary to what?
substance abuse or another medical condition - there is normally no personality change or impairment in abstract thinking
Changes due to amnestic disorders include what?
decreased awareness of surroundings, inability to learn new information despite normal attention, inability to recall previously learned information, possible disorientation to place and time
What is the effect of estrogen therapy on Alzheimers?
may prevent it, but it is not useful in decreasing the effects of pre-existing dementia
CHAPTER SEVENTEEN
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Substance abuse is diagnosed over how long?
12 months
Tolerance
the need for higher and higher doses of a substance to achieve the desired effect
Withdrawal
the stopping or reduction of intake that results in specific physical and psychological signs and symptoms
What defense mechanism is commonly used by clients who have substance abuse problems?
denial
Legally intoxicated is described as
Blood Alcohol Concentration (BAC) of 0.08% (80g/dL)
Death from ETOH could occur at what levels?
levels greater than 0.35% (350 g/dL)
What are two serious effects of excess alcohol?
respiratory arrest and peripheral collapse
What are several effects of chronic alcohol?
direct cardiovascular damage, erosive gastritis, GI bleeding, acute pancreatitis
When do effects of ETOH withdrawal occur?
usually start within 4-12 hours of the last intake, peak after 24-48 hours, and then suddenly disappear
What are S/S of ETOH withdrawal?
abdominal cramping, vomiting, tremors, restlessness and inability to sleep, increased VS, and tonic-clonic seizures
ETOH withdrawal delirium may occur when?
2-3 days after cessation of ETOH
How long does ETOH withdrawal delirium last?
2-3 days
What are the S/S of ETOH withdrawal delirium?
severe disorientation, psychotic symptoms (hallucinations), severe HTN, cardiac dysrhythmias, delirium, may progress to death
What is the antidote to Benzodiazepine toxicity?
flumazenil (Romazicon)
What are the withdrawal S/S of Benzodiazepines?
anxiety, insomnia, diaphoresis, HTN, possible psychotic reactions, seizure activity
What is the antidote for barbiturate toxicity?
There is none
What are the milder S/S of barbiturate withdrawal?
the same as those seen in ETOH withdrawal
What are the severe S/S of barbiturate withdrawal?
possibly life-threatening convulsions, delirium, and cardiovascular collapse similar to that of ETOH withdrawal
What are the toxic effects of chronic cannabis use?
lung cancer, chronic bronchitis, and other respiratory effects; in high doses, paranoia
What are the withdrawal S/S of cannabis
depression, possibly
What are examples of cannabis
MJ or hashish, which is more potent
What are the S/S of mild cocaine toxicity
dizziness, irritability, tremor, blurred vision
What are the S/S of severe cocaine toxicity
hallucinations, seizures, extreme fever, tachycardia, HTN, chest pain, possible cardiovascular collapse and death
What are the S/S of cocaine withdrawal
depression, fatigue, craving, excess sleeping or insomnia, dramatic unpleasant dreams, psychomotor retardation or agitation
What are the S/S of amphetamine toxicity?
impaired judgment, psychomotor agitation, hypervigilance, extreme irritability, acute cardiovascular effects (tachycardia, increased B/P)
What are the S/S of amphetamine withdrawal?
craving, depression, fatigue, sleeping
What is the antidote for opioids
naloxone (Narcan) by IV
What are examples of opioids
heroin, morphine, hydromorphone (Dilaudid)
Opioid withdrawal causes an abstinence syndrome. What are the S/S?
begins with sweating and rhinorrhea progressint to piloerection (goosebumps), tremors, irritability followed by severe weakness, N/V, pain the muscles and bones, and muscle spasms. Lasats 7-10 days but not fatal
What are examples of inhalants?
amyl nitrate, nitrous oxide, solvents
What are the toxic effects of inhalants?
CNS depression, symptoms of psychosis, respiratory depression, possible death
What are the withdrawal S/S of inhalants
none
What are the examples of hallucinogens
lysergic acid diethylamide (LSD), mescaline (peyote), phencyclidine piperidine (PCP)
What are the toxic effects of hallucinogens
panic attacks, flashbacks occurring intermittently for years
What are the withdrawal S/S of hallucinogens?
None
What medications are used for ETOH withdrawal?
valium, ativen, tegretol, catapres
What meds are used for ETOH abstinence?
antabuse, revia, campral
what meds are used for opioid withdrawal
methadone, catapres, subutex, buprenorphine + naloxone
What meds are used for nicotine withdrawal?
bupropion, nicotine replacement therapy