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63 Cards in this Set
- Front
- Back
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What are 4 classic signs of opiate INTOXICATION?
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-Pinpoint Pupils CONSTRICTION
-Apathy -Psychomotor retardation -Drowsiness |
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What are 4 classic signs then of opiate WITHDRAWAL?
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-Dilated pupils
-Lacrimation/Rhinorrhea -Nausea/vomiting/diarrhea -Fever/muscle aches |
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What is the time frame for when withdrawal symptoms will develop and last for opiate withdrawal?
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Depends on the half-life of the agent used, and the degree that the body is dependent
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What type of half-life opiate agents tend to produce
-Severe/rapid withdrawal -Gradual/less severe course of withdrawal |
Shorter half-life = shorter withdrawal but more severe
Longer half-life = more gradual but less severe |
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What medication can help alleviate symptoms of opiate withdrawal?
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-Clonidine for acute phase autonomic hyperactivity n/v/d
-Methadone for maintainance |
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How does Methadone work?
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It is a long-acting opiate
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What are the symptoms of AUTONOMIC HYPERACTIVITY and when are they seen w/ opioids?
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-Tachypnea, hypertension, tachycardia
-Hyperreflexia, hyperthermia, sweating |
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What are ENDOGENOUS opioids?
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A class of NATURAL peptides that bind all types of human opioid receptors - mu, kappa, and delta
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What i a classic example of endogenous opioids?
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Endorphins
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What is Fasciculation?
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Muscular twitching of contiguous groups of muscle fibers
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What is Lacrimation?
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Secretion of tears from the eyes
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What is Methadone?
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A long-acting opioid agonist with good pharmacokinetic properties
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What makes Methadone useful for maintaining a person after opioid withdrawal?
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It is a good substitute for more dangerous and addictive opioids like HEROIN
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How is Methadone administered?
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Orally
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What is Rhinorrhea?
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Runny nose
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What is the hallmark characteristic of a substance withdrawal syndrome?
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Development of a substance specific pattern of symptoms following cessation of using the substance.
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What has to happen in order for withdrawal to occur?
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Development of PHYSIOLOGIC DEPENDENCE
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Is opioid withdrawal life-threatening?
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Rarely, unless accompanied by a pre-existing physical condition
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How do patients withdrawing from alcohol or BDZ use differ from opioid users?
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More irritable, tremors, insomnia instead of yawning
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What are 3 complications that can arise in SEVERE cases of BDZ or alcohol withdrawal?
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-Seizures
-Coma -Death |
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How does Cocaine withdrawal differ from that of opioids?
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CRASH
-Hyperphagia -HYPERsomnia -Depressed mood |
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What symptom is SELDOM seen in patients in NICOTINE withdrawal?
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Not usually tired/lethargic; rather insomnia and irritable
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What symptoms are generally NOT SEEN in opioid withdrawal?
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-Seizures, tremors
-Delirium/confusion -Lethargy/tired |
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And what is the rule of thumb to remember in treating opioid withdrawal?
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-Shorter the half life, shorter the withdrawal but worse symptoms
-Longer half life, longer withdrawal but less severe sx |
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What would cause a person who is addicted to long-acting opioid to have SEVERE withdrawal symptoms?
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Putting them on an opioid antagonist
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What drug treats the autonomic hyperactivity seen in opioid withdrawal?
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Clonidine
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What does Clonidine NOT do?
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Doesn't reduce cravings for the drug
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What is clonidine?
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An a2-agonist
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What is an OTC that can help a patient going through opioid withdrawal? How?
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Ibuprofen - to help with muscle aches/cramps
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What is the acronym that helps remember signs/sx of opioid withdrawal?
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SLUD
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What 5 medications are useful in opioid withdrawal?
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-Methadone
-Clonidine -Loperamide -Promethazine -Ibuprofen |
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What does Methadone do?
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Reduces craving and substitues the opioid
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What does clonidine do?
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Reduces autonomic hyperactivity by increasing adrenergic activity at locus ceruleus
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What does Loperamide do?
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Reduces diarrhea
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What does Promethazine do?
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Reduces nausea/vomiting
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What does Ibuprofen do?
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Reduces muscle cramps/aches
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What are 2 signs of opioid withdrawal that often appear FIRST and are easy to see?
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-Pupil dilation
-Anxiety |
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What is a common opioid?
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Heroine
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What are the 4 diagnostic criteria for Pain Disorder?
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-Pain at 1/more sites severe enough for clinical eval, is patient's primary complaint
-Very distressing, signif functional impairment -Clinician judges pain onset, worsening, or severity is psychological -Pain not dt another axis I condition, not solely dyspareunia |
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What are 4 components in the best approach to pain disorder?
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-Acknowledge and validate
-Explain that psychologic factors can cause pain -Possible antidepressant -Refer to pain clinic |
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What is BIOFEEDBACK?
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A Relaxation technique
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How does Biofeedback work?
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Patient is trained to induce a physiologic response that allows for a relaxation response
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What are 2 physiologic changes patients are most often trained to induce?
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-alpha waves on EEG
-Vasodilation of peripheral capillaries |
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What is dyspareunia?
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Painful sexual intercourse
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What category of mental disorders is Pain disorder a subset of?
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Somatoform disorders
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Distinguishing feature of Pain Disorder:
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Primary Complaint is of PAIN not explained by anything else
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How can you distinguish pain due to pain disorder from that often seen in Depression?
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In depression the mood symptoms predominate on eval
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How can you distinguish pain due to pain disorder from that often seen in Hypochondriasis?
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Main complaint is not pain but the FEAR of having a serious medical illness
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What drugs have shown to be useful in treating pain disorder?
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Antidepressants - SSRIs and TCAs
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What drugs are generally NOT helpful with pain disorder?
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Analgesics
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What drugs should be AVOIDED in treating pain disorder?
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Narcotics
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What are 3 non-drug approaches that may help in pain disorder?
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-Biofeedback (relaxation)
-Nerve stimulus -Hypnosis |
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What is the duration of time for which pain symptoms have to be present for diagnosis of Pain Disorder?
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At least 6 months
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What is DISSOCIATION?
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A breakdown in the normally integrated functions of Consciousness, Sensor/Motor, Memory, Perception of Self or Environment
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What is Dissociation for?
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Defense mechanism for dealing with emotional conflicts and stressors
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What is an example of Dissociation?
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Woman told her child was killed in a car accident suddenly feels its being told to someone else
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What is Repression?
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A defense mechanism in which wishes, thoughts, or experiences are expelled from ones conscious awareness
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What is an example of Repression?
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Woman told in her dr apt that she has breast cancer goes home and to her husband says she can't remember what her appt was about
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What is the best therapy for patients with Histrionic personality disorder?
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-Supportive psychotherapy
-Limit setting |
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What is Supportive Psychotherapy?
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A method of helping support a pt's EXISTING defense mechanisms so their function in the real world improves
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What is the GOAL of Supportive Psychotherapy?
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To MAINTAIN one's intrapsychic functioning
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What is the goal of Insight-Oriented Psychotherapy?
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To IMPROVE one's intrapsychic functioning
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What 2 defense mechanisms do patients with histrionic PD use most?
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-Repression
-Dissociation |
