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140 Cards in this Set
- Front
- Back
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What is the Dietary Supplement Health and Education Act of 1994
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Says that company can claim that their supplement effects a structure or function of the body, but they cannot claim that it cures a disease
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When did CAM become legitimate?
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1995 - FDA declassifed acupuncture needles as an experimental product
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What was the first large trial of CAM therapy for?
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St. John's Wort
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Do supplement companies have to do studies to go on the market?
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No - though they do have to put a disclaimer on their label that their product is not FDA approved
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How much money is spent per year on CAM therapies?
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$30-47 billion
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CAM therapies are employed most commonly for what ailments?
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1. Back px or problem (17%)
2. Head or chest cold 3. Neck px or problem etc... |
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What are the top 5 CAM therapies?
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1. Natural Products, dietary supplements
2. Deep breathing exercises 3. Meditation 4. Chiropractic 5. Yoga *this does not include prayer, which would be on top of list |
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Which supplements increase bleeding time?
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Garlic, Ginseng, Ginkgo biloba
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What supplement inhibits drug metabolism?
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St. John's Wort
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What are the 5 types of CAM therapies?
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1. Alternative Medical Systems
2. Biologically Based Therapies 3. Energy Therapies 4. Manipulative and Body-Based Therapies 5. Mind-Body Interventions |
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What therapies fall under the classification of alternative medical systems?
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1) Traditional Chinese Medicine
2) Ayurvedic Medicine 3) Homeopathy 4) Naturopathy |
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Under which CAM domain do dietary supplements fall?
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they are a subset of biologically-based practices
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What is the difference b/w veritable and putative energies (part of the energy therapies domain of CAM)?
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veritable energy can be measured, putative energy has yet to be measured (e.g. biofields)
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What is NCCAM?
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The National Center for Complementary and Alternative Medicine
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What should the physician do to help facilitate the incorporation of CAM into their patients' treatment plans?
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Protect - from dangerous practices or situations
Permit - non-dangerous practices believed in by the patient Promote - safe, effective practices, especially when no allopathic approaches are available Partner - with alternative practitioners |
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What attractions do drugs with abuse potential have?
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-must have positive psychoactive properties
-tend to satisfy many different functions -must have short latency of onset of effect |
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What are some factors that drug effects depend on?
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-amount taken
-content -setting -set (attitude) -Physical condition of user -Route of administration |
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What is the lifetime risk of abuse/dependence of drugs in men?
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15-20% in men, less in women
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What is intoxication?
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substance-specific syndrome of maladaptive behavioral or psychological changes d/t CNS effects
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What is withdrawal?
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substance-specific syndrome d/t cessation or reduction in use that has been heavy and prolonged
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What is tolerance?
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need for increased amounts for desired effect or diminished effect w/ same amount
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What qualifies substance abuse?
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maladaptive pattern of use leading to impairment or distress, as manifested by one or more of the following occurring w/in a 12 month period:
1. Failure to fulfill role obligations 2. Use in hazardous situations 3. Recurrent legal problems 4. Use despite social/interpersonal difficulties caused/exacerbated by drug HOLD mnemonic |
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What drugs have no defined DSM-IV criteria?
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Caffeine, inhalants, PCP, cannabis, hallucinogens
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What qualifies substance dependence?
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Maladaptive pattern of use leading to clinically significant impairment or distress, as manifested by three or more of the following occurring in a 12 month period
1. Withdrawal symptoms 2. Excessive using 3. Tolerance 4. Occupational/Social abandonment 5. Continued use despite physical/psychological consequences 6. Uncontrolled Use 7. Time increasingly occupied by using WE TO CUT |
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Dopamine is affected by which drugs?
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cocaine, amphetamine, alcohol
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Serotonin is affected by which drugs?
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alcohol, LSD
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Endorphins are affected by which drugs?
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alcohol, opioids, nicotine
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GABA is affected by which drugs?
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alcohol, benzodiazepines
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Glutamate is affected by which drugs?
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alcohol
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ACh is affected by which drugs?
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alcohol, nicotine
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Are tolerance or withdrawal necessary or sufficient for diagnosis of substance dependence?
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NO!
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According to UA, marijuana persists in the body for how many days?
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7-10
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What are the subjective effects of marijuana?
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-euphoria
-anxiety -social withdrawal -perceptual changes: touch, taste, smell -slowed time sensation -Decreased libido |
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What are the objective effects of marijuana?
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-increased heart rate
-increased appetite -conjunctival reddening - KEY -dry mouth -short-term memory impariment -impaired motor coordination -impaired judgment |
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What are the effects of high doses of marijuana?
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-hallucinations
-delusions of grandeur or persecution -disrupted thought processes -anxiety/panic -decreased intraocular pressure |
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What are the chronic effects of marijuana?
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-bronchitis, asthma, cancer
-amotivational syndrome |
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What portion of the population is most likely to use marijuana?
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adolescents/young adults 18-30, mostly males, though now in all segments of society
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What are some medical uses of marijuana?
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-Decreased intraocular pressure in glaucoma
-appetite stimulant in anorexia nervosa, AIDS -suppresses nausea and vomiting induced by cancer treatment (radiation, chemo), also treatment of AIDS, MS -Decrease immune response of body to reject organ transplants |
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Hallucinogens modify action of what neurotransmitter?
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serotonin
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What are the subjective effects of hallucinogens?
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-perceptual changes, synesthesias
-depersonalization, derealization -illusions, hallucinations -paranoid ideation -psychotic insight -impaired judgment -time distortions |
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What are the objective effects of hallucinogens?
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-mydriasis
-increased BP, HR, sweating -hand tremor, incoordination -blurred vision |
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What subgroup uses hallucinogens the most?
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upper, middle class, 18-34 y/o
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How long is a cocaine rush?
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20-30 minites
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Are PCP and marijuana hallucinogens?
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No
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How long does it take to eliminate 50% of the cocaine in your body?
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1 hr - rapidly metabolzed
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What are the subjective effects of cocaine use?
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-euphoria
-hyperactive, hypervigilant -suppress fatigue, appetite -increased sociability -impaired judgment -difficulty concentrating -hallucination (FORMICATION) |
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If a patient complains of the feeling of ants crawling all over their skin, what is this called and what drug are they most likely abusing?
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formication - this is characteristic of cocaine abuse
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What are the objective effects of cocaine use?
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-Increased HR, BP, arrhythmias
-Vasoconstriction -Dilated pupils -Nausea/vomiting |
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What characterizes cocaine withdrawal?
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-dysphoric mood w/ fatigue, vivid and unpleasant dreams, insomnia/hypersomnia, increased appetite, psychomotor agitation/retardation
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What subgroup is most likely to use powder cocaine? Crack cocaine? When is cocaine most often used?
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Powder: male, white, 30-34
Crack: male, black, 30-34 Use in evenings continuously for several hours |
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What are the medicinal uses for cocaine?
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Dilate pupils
Anesthesia Decreases bleeding |
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What are the effects of amphetamines?
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-Increased energy/activation, hypervigilance
-Increased HR, BP, sweating -Dilated pupils -Evidence of weight loss -Euphoria/decreased fear -High lasting 8-24 hours |
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How long does it take to remove 50% of amphetamines from the body?
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12 hours
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According to UA, how long do amphetamines stay in the body?
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1-3 days
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What is different about the pattern of use for amphetamines?
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Use is cyclic. Also, used in mornings, then every 2-4 hours
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Barbiturates and benzodiazepines are what class of drugs?
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sedative-hypnotics
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how much does alcohol multiply the effect of barbs and benzos?
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10-12 times, lethal
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What are the effects of sedative-hypnotics?
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-innapropriate sexual or aggressive behavior
-impaired judgment -impaired attention and memory consolidation -slurred speech, incoordination, ataxic gait, nystagmus -stupor or coma |
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What are the withdrawal sx of sedative-hypnotics?
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-autonomic hyperactivity
-hand tremor -Insomnia -Nausea/vomiting -agitation, anxiety -SEIZURES, death |
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What two classes of drugs have potentially lethal withdrawal sx?
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Alcohol and sedative-hypnotics (d/t the fact that they cause seizures)
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What is the pattern of use for sedative-hypnotics?
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primarily iatrogenic - given for sleep. Women more likely than men.
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What is the appropriate prescribed use of anti-anxiety drugs?
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Fixed interval (constant blood level), rather than PRN (variable interval)
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What is the prototype narcotic drug? What are other narcotic drugs?
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Opium. Also morphine, heroin, vicodin, etc
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Is narcotic withdrawal life threatening?
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No
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What are the effects of narcotics?
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-treat px, suppress cough, alleviate diarrhea, and indue anesthesia
-sense of well-being, reduced anxiety -drowsiness, impaired attention or memory, apathy, lethargy, constricted pupils, constipation, nausea, vomiting, resp. depression. -risk of infection, disease, adulteration, and OD |
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What marks narcotic overdose?
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pinpoint pupils, cold clammy skin, confusion, severe drowsiness, slow or troubled breathing
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Withdrawal from narcotics use includes what?
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4 or more of the following sx for a progressive, 7-10 day course:
-dysphoric mood -watery eyes/nose ** -yawning -diarrhea -insomnia -fever -nausea/vomiting -chills alternating w/ seating -drug craving -deep muscle and bone px ** -dilated pupils |
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Narcotics withdrawal sx can be induced by what?
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opiate antagonists, e.g. Naltrexone
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What is the pattern of narcotics use?
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iatrogenic starts it, then drug-seeking behavior ensues. experimental, sporadic, or recreational use. Younger age of initial use more likely to progress to dependence
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violent, confused, bizarre, manic-like behavior is pathomnemonic for abuse of what drug?
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PCP
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What kind of a drug is PCP?
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A dissociative (sensory blocking) anesthetic
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How fast is the onset of sx of PCP use? It includes what?
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within an hour of use. 2 or more of the following sx:
1) Vertical or horizontal nystagmus 2) Hypertension or tachycardia 3) Numbness, decreased response to px 4) Ataxia, dysarthria, muscle ridigity 5) Seizures, coma 6) Hyperacusis 7) Bizarre, violent behavior |
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What is the pattern of use for PCP?
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smoke several times a day, peak in minutes
oral - peak ~1 hr mild intox resolves 8-20 hours, severe - days more in males, minorities, 20-40 y/o |
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What are inhalants?
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commercial and volatile solvents like plastic cement, lacquer, nail polish remover, petroleum products, amyl nitrate. Also aerosols
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How do inhalants work?
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CNS depressant. Highly lethal
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What are the acute effects of inhalant use?
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-incoordination, dizziness, slurred seech, ataxia, nystagmus, tremor, blurred vision
-euphoria -belligerence, assaultiveness -depressed reflexes, incoordination, lethargy, muscle weakness, stupor -perceptual disturbances |
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What is the pattern of use for inhalants?
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used recreationally by poorer pre-teens and teens (10-15 y/o most, 10:1 male to female)
model after parents' use of alcohol |
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Which classes of drugs cause nystagmus?
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-sedative hypnotics
-inhalants -PCP |
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What is polysubstance dependence?
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use of 3 or more substances, none predominates
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What is the most frequently used depressant?
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Alcohol
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How many Americans abuse alcohol or are alcohol dependent?
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19 million Americans (1 in 13 adults)
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What is the ratio of alcohol abuse in men:women? Who starts drinking earlier?
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5:1, men start drinking earlier in life than women
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In which gender does alcohol abuse and dependence progress more rapidly?
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in women, causing more health-related problems
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What cultural group has slightly higher abuse and dependence of alcohol?
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Latino males
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What cultural group has the least incidence of alcohol abuse and dependence? Why?
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Asian populations d/t adverse physical effects
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What are some health-related problems associated w/ drinking?
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various cancers, brain damage, immune system problems, fetal alcohol syndrome
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The same amount of alcohol is found in:
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-one 12 oz can of beer
-one 5 oz glass of wine -one and a half ounces (shot) of liquor |
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What is moderate drinking?
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2-3 drinks for men, 1-2 drinks for women
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What are the DSM-IV alcohol-related disorders?
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intoxication, withdrawal, abuse, dependence
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what are some behavioral/psychological changes that occur shortly after alcohol ingestion?
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labile mood, poor judgment, inappropriate aggression or sexual behavior. Also, slurred speech, incoordination, unsteady gate, stupor, nystagmus, poor attention/memory
must NOT be d/t a medical condition or mental disorder |
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There are no withdrawal sx for which drugs?
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Caffeine
Hallucinogens Inhalants Marijuana PCP |
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Define alcohol withdrawal
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cessation of or significant reduction in alcohol use that has been heavy and prolonged w/ at least 2 of the following:
-autonomic hyperactivity -hand tremor -insomnia -nausea/vomiting -hallucinations/illusions -anxiety/psychomotor agitation -grand mal seizures |
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Most people w/ diagnosis of substance abuse/dependence also have what DSM-IV problem?
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abuse of another substance
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What is CAGE?
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A quick alcohol consumption assessment tool.
C - have you ever felt you need to CUT down? A - have people ANNOYED or criticized you a/b your drinking? G - have you ever felt bad or GUILTY about your drinking? E - Have you ever had a drink in the AM as an EYE opener? -always ask CAGE first |
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how long does it take the liver to detoxify one drink?
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One hour
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When does alcohol easily cross the BBB?
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After stroke or traumatic injury
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Once ingested, EtOH immediately affects what part of the brain?
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frontal lobe function
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Continued ETOH consumption alters or impairs what higher cortical functions?
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-narrowing of visual fields: visual neglect
-comprehension and relevance of incoming information -encoding (verbal/auditory memory) -blackouts |
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Higher BAC affects what SUBcortical functions?
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Cerebellum: decreased balance, poor fine motor control
Brain Stem: decreased arousal and life-sustaining functions (HR, resp, etc.) Spinal Cord - decreased rxn time and impaired reflexes |
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Children of alcoholics are how many more times more likely to develop the disosrder?
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3-4 times
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What are the treatment approaches for alcoholism?
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-Minnesota Model (12 steps)
-Cognitive Behavioral Therapy -Motivational Interviewing -Medications -Harm Reduction |
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What medications are used to treat alcoholism?
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-antabuse (disulfiram)
-Antidepressants, anti-anxiety meds -Naltrexone, naloxone (narcotic antagonist) -Acamprosate (anti-craving) |
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What is the Harm Reduction treatment approach to alcoholism?
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accepts the notion that some people will not be able to stop abusing substance of choice, recognizes abstinence as an ideal outcome, but focuses on reducing harmful consequences vs. reducing use.
Embraces "bottom up" (addict advocacy) vs. "top down" (authoritarian) approach ex: methadone maintenance, needle exchange programs |
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There are no withdrawal sx for which drugs?
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Caffeine
Hallucinogens Inhalants Marijuana PCP |
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Define alcohol withdrawal
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cessation of or significant reduction in alcohol use that has been heavy and prolonged w/ at least 2 of the following:
-autonomic hyperactivity -hand tremor -insomnia -nausea/vomiting -hallucinations/illusions -anxiety/psychomotor agitation -grand mal seizures |
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Most people w/ diagnosis of substance abuse/dependence also have what DSM-IV problem?
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abuse of another substance
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What is CAGE?
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A quick alcohol consumption assessment tool.
C - have you ever felt you need to CUT down? A - have people ANNOYED or criticized you a/b your drinking? G - have you ever felt bad or GUILTY about your drinking? E - Have you ever had a drink in the AM as an EYE opener? -always ask CAGE first |
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how long does it take the liver to detoxify one drink?
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One hour
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When does alcohol easily cross the BBB?
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After stroke or traumatic injury
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Once ingested, EtOH immediately affects what part of the brain?
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frontal lobe function
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Continued ETOH consumption alters or impairs what higher cortical functions?
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-narrowing of visual fields: visual neglect
-comprehension and relevance of incoming information -encoding (verbal/auditory memory) -blackouts |
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Higher BAC affects what SUBcortical functions?
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Cerebellum: decreased balance, poor fine motor control
Brain Stem: decreased arousal and life-sustaining functions (HR, resp, etc.) Spinal Cord - decreased rxn time and impaired reflexes |
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Children of alcoholics are how many more times more likely to develop the disosrder?
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3-4 times
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What are the treatment approaches for alcoholism?
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-Minnesota Model (12 steps)
-Cognitive Behavioral Therapy -Motivational Interviewing -Medications -Harm Reduction |
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What medications are used to treat alcoholism?
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-antabuse (disulfiram)
-Antidepressants, anti-anxiety meds -Naltrexone, naloxone (narcotic antagonist) -Acamprosate (anti-craving) |
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What is the Harm Reduction treatment approach to alcoholism?
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accepts the notion that some people will not be able to stop abusing substance of choice, recognizes abstinence as an ideal outcome, but focuses on reducing harmful consequences vs. reducing use.
Embraces "bottom up" (addict advocacy) vs. "top down" (authoritarian) approach ex: methadone maintenance, needle exchange programs |
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What is fetishism? What is transvestic fetishism?
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fetish object is required or strongly preferred for sexual excitement. Can include focus on body parts
transvestic fetishism: cross dressing (males) |
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What is masochism?
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acts (real, not simulated) of being humiliated, beaten, bound, or otherwise made to suffer
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What is sadism?
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acts (real, not simulated) involving psychological or physical suffering (including humiliation) of the victim
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Name the paraphilias
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fetishism, transvestic fetishism, masochism, sadism, exhibitionism, voyeurism, pedophilia, frotteurism
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Which paraphilias are crimes in the U.S. (mainly by men)?
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Exhibitionism, voyeurism, and frotteurism
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What is exhibitionism?
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exposure of one's genitals to an unsuspecting stranger in a public place
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What is voyeurism?
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observing an unsuspecting person who is naked, disrobing, or engaging in sexual activity
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What is pedophilia?
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sexual activity w/ a child (<13), person >16, and at least 5 yrs older
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What is Frotteurism?
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touching and rubbing against a non-consenting person
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What characterizes gender identity disorders?
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strong and persistent cross-gender identification. Persistent discomfort w/ his or her own sex or a sense of inappropriateness of gender role of that sex.
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Name the parts of the human sexuality pyramid, top down
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sex --> gender --> sexual orientation
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What is sexual addiction?
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one who compulsively seeks out sexual experiences and whose behavior becomes impaired if unable to gratify sexual impulses
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What are the three main reasons patients do not bring up sexual concerns? What noticeably is NOT on this list?
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1) Doctor would dismiss concerns
2) Doctor would be uncomfortable 3) No medical treatment for problem *Gender difference b/w doctor and patient is not on this list |
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What are the stages of the sexual response cycle?
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1) Desires
2) Excitement/arousal 3) Orgasm 4) Resolution |
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What are the causes of sexual dysfunction?
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1) Physical
2) Psychological 3) Interrelation of causes 4) Past negative attitudes |
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What is the triple distortion of sexual dysfunction?
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overemphasis on:
male initiative coitus orgasm |
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marital difficulties are comorbid with what sexual problems?
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Arousal problems
inhibited enjoyment orgasm dyspareunia vaginal dryness |
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Name the sexual dysfunctions that are problems of sexual pain
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Dyspareunia - genital px associated w/ sexual intercourse
Vaginismus - involuntary spasm of the musculature of the outer third of the vagina that interferes w/ sexual intercourse |
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Name the sexual dysfunctions that are problems of desire
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Sexual aversion - aversion to and avoidance of sexual contact
Inhibited (hypoactive) sexual desire - deficient sexual fantasies and desire for sexual activity. Judgment of deficiency or absence is made by clinician, taking into account factors that affect sexual functioning, such as age and context of person's life |
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What are the subtypes of sexual dysfunctions?
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lifelon
acquired generalized situational d/t psychological factors d/t medical factors |
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Name the sexual dysfunctions that are problems of arousal
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female sexual arousal disorder: persistent or recurrent inability to attain or maintain adequate lubrication/swelling response
Male erectile disorder: persistent or recurrent inability to attain or maintain an adequate erection |
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Name the sexual dysfunctions that are problems of orgasm
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female orgasmic disorder: delay or absence of orgasm following normal arousal
male orgasmic disorder: same; sexual activity judged by clinician to be adequate in focus, intensity, and duration for person's age premature ejaculation: orgasm and ejaculation with minimal stimulation or before person wishes |
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What are the most prevalent sexual complaints in women?
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Lack of interest
unable to achieve orgasm sex not pleasurable px during sex |
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What is PLISSIT?
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A graduated counseling system for sexual dysfunction.
Permission giving Limited Information Specific Suggestions Intensive Therapy |
