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148 Cards in this Set
- Front
- Back
-body wt < 85% of expected wt (BMI < 17.5)
-intense fear of wt gain even though underwt -distorted perception of body size, wt, or shape -amenorrhea of 3 mos duration (women only) |
dx of anorexia nervosa
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-malnutrition
-muscle wasting -low HR, BP, dizzy, syncope -constipation, delayed gastric emptying -cold, blue hands and feet -secondary amenorrhea, small breast size |
physical sxs of anorexia
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-hypokalemia, increased HCO3
-euthyroid sick syndrome - abNL TFT -anemia -asx hypoglycemia -hyponatremia from excess water intake -low estrogen levels |
lab findings for anorexia
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-prolonged QT interval, reduced LV mass
-bone loss - 2SD below NL in 50% -hypothalamic hypogonadism -cognitive sxs -cerebral atrophy on CT w/ reduced white and gray matter |
findings associated with anorexia
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% concordance in monozygotic twins for anorexia nervosa
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55%
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% concordance in dizygotic twins for anorexia nervosa
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7%
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-persistent denial of problem
-frequent association w/ OCD and OCD personality -self-evaluation and self-esteem seen in terms of body shape -superficial perfect appearance -special, in control & somewhat superior |
psychological etiology of anorexia
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onset of anorexia
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adolescence
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anorexics have ___ & ___ about food or eating
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obsessions & rituals
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treatment of anorexia
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-refeeding, wt gain, and nutrition counseling
-after stabilization: rework self-concept/self-esteem -group and individual therapy -alliance w/ pt and family -educate pt and family |
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criteria for hospitalization of anorexic
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-wt = 25-30% < BMI
-pulse < 40 BPM -arrythmia or prolonged QT interval on ECG -electrolyte abnormalities |
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what meds are given to anorexics in their tx?
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-meds are NOT helpful
-antidepressents for associated depression -low dose neuroleptics for severe obsessional or borderline psychotic thinking |
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-recurrent binge eating (>2x/wk, every wk for 3 mos)
-recurrent purging, excess exercise or fasting (>2x/wk, every week for 3 mos) -excessive concern about body wt or size -absence of anorexia nervosa |
dx of bulimia nervosa
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-very secretive illness
-ego dystonic -near NL wt range -wt and mood fluctuations -other impulse control problems -hx of unsucessful dieting |
associated features of bulimia
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physical sxs of bulimia
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-oral:: dental caries, enamel erosion, parotid enlargement
-GI: esophageal reflux and tears, gastritis, gastric dilation, constipation, GI bleeding -skin: marks on back of hand |
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-low K+, low Cl-, and high HCO3
-non-anion gap acidosis |
labs for bulimia
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what labs indicate vomiting in bulimia?
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-low K+, low Cl-, and high HCO3
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what labs indicate laxative abuse in bulimia?
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non-anion gap acidosis
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tx for bulimia
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-multidisciplinary approach
-primary care, nutrition, and mental health -tx associated psychiatric illness (PTSD, personality d/o, or depression) -meds -therapy (family and individual) -change in attitude -accepting self as not ideal |
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what meds are used to tx bulimia?
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-they are helpful
-SSRIs: Zoloft, Paxil, Prozac, and Celexa |
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sleep problems are often associated w/?
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mental illness
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the first half of the night is when you ge the most ___ ____
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restorative sleep
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second half of the night is when you ___ the most
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dream
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what is the deepest and lightest sleep stage?
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Stage 1 - lightest
Stage 4 - deepest |
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NREM is marked by ___ levels of physiological function
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lower (pulse, respiration, BP, and blood flow)
EEG is also slower |
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in what stage(s) does NREM occur?
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stages 1-4
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what stage(s) are associated w/ parsomnias: night terrors, nightmares, sleep walking, enuresis?
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Stages 3 and 4
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the EEG pattern in REM sleep is...
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similar to wakefulness
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REM is marked by ___ levels of physiological function
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increased (pulse, RR, BP, and muscle tone)
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T/F: in REM a person's temp is higher (feel hot during the night)
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FALSE - feel cold
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How are EEG waves & REM sleep affected by aging?
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waves are slower and REM sleep is less efficient
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Neurotransmitter involved in REM and wakefulness
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NE
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Neurotransmitter involved in sleep
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5HT (Serotonin)
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Neurotransmitter involved in sleep regulation
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Ach
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Neurotransmitter involved in wakefulness (blockers cause sedation)
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DA (dopamine)
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what is a NL amt of sleep hours?
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6-9hrs
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T/F: the need for speed in increased w/ exercise, pregnancy, illness, and stress
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true
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what is needed in a sleep hx?
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-typical night's sleep
-pattern on wkend -napping -acute vs. chronic -awaken or difficulty falling asleep -caffeine and tabacco -illicit drugs and alcohol -meds (stimulants) -snoring, sleep apnea -depression, anxiety, other psych illness -interview the partner |
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insomnia, hypersomina, narcolepsy, breathing-related sleep disorder, and circadian rhythm sleep disorder
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dyssomnias
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nightmare d/o, sleep terror d/o, sleepwalking, and parasomnia not otherwise specified
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parasomnias
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-difficulty fallings asleep or staying asleep for at least a month
-happens at least 3x/wk -causes sig distress or impairment in social or occupational function -not due to substance, medical condition, or other sleep disorder |
primary insomnia
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-excess sleepiness or prolonged daytime sleep episodes for at least 1 mo
-causes sig distress or impairment in social or occupational functioning -not due to med condition, substance, or other d/o |
primary hyperinsomnia
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-irresistible attacks of refreshing sleep daily over at least 3 mos
-not due to substance or med conditon or other sleep d/o -one or both: cataplexy and/or recurrent intrusions of REM manifested as hallucinations or sleep paralysis at beginning or end of sleep |
Narcolepsy
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cataplexy
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loss of muscle tone associated w/ intense emotion
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associated w/ leukocyte antigen HLA-DR2
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narcolepsy
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sleep apnea
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breathing stops for > 10s, >5h or 30x/night
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sxs of sleep apnea
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-restless sleep
-loud snoring -apnea periods -h/a or fatigue upon wakening |
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nightmare d/o
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-occurs during REM, late at night
-NO tx |
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sleep terror disorder
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-arousal during the first 1/3 of night in NREM
-amnesia for the episode |
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sleep walking
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-first 1/ of night in NREM
-unresponsive and have amnesia for the episode -NO tx |
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sex, gender identities and roles, sexual orientation, eroticism, pleasure, intimacy, and reproduction...experienced and expressed in thoughts, fantasies, desires, beliefs, attitudes, values, behaviors, practices, roles and relationships.
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human sexuality defined by WHO
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sex defined as a noun is...
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male or female
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sex defined as a verb is...
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sexual acts; varies widely according to culture, class, etc
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what is gender?
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social construction of femininity and masculinity
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what is sexual orientation?
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refers to a person's erotic and romantic attractions to one or more sexes; who you are attracted to
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what is sexual identity?
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sense of ourselves in both individual and political ways, encompasses both our gender and our sexual orientation.
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what is adrogengy?
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intergendered; in the middle of masculinity/feminity
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what is transgenered?
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someone whose gender identity and gender roles encompass both
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what is intersex?
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people who are in the middle; have some of both biological features; used to be called hermaphrodites
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what is sexual coercion?
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any nonconsensual sexual behavior that occurs as a result of arguing, pleading and cajoling and includes, but is not limited to, force.
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what is deconstruction?
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see normal and deviant as deliberate social practices and cultural discourses.
interrogate the proscribed expectations, duties, and rights that define the relationship b/w a perosn in a particular position and the other people w/ whom she or he interacts |
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in the dying, tx delusions w/?
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low dose antipsychotics (1mg Risperdal)
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in the dying, tx fatigue/weakness w/?
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stimulants
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in the dying, tx dysphagia w/?
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liquid diets
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in the dying, tx dyspnea, cough w/?
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bronchodilators, opioids
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in the dying, tx n/v w/?
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odansetron and compazine
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in the dying, tx anxiety/depression w/?
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antidepressents, benzos
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Elisabeth Kubler-Ross Stages of Dying
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-shock and denial
-anger -bargaining -depression -acceptance |
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hospice care is for pts w/ ___ ___ to live
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< 6mos
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in the dying, tx pain w/?
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aggressive opioids
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in the dying, a very ___ threshold for tx is used
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low
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loss of a parent under the age of 14 is associated w/
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higher rates of depression as an adult
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existenstial crisis
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-what is the purpose of living?
-i'm angry w/ God for letting this happen -is this all there is to life? |
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mid-life crisis
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-illusion of control and invulnerability taken away
-realization that life has limits -new sports car, new career, changes in relationships -attempt to reassert youth and vitality as a defense against againg and death |
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NL grief
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-sadness, crying, sleep and appetite disturbance, weakness and fatigue
-rollercoaster course -6mos-1yr for resolution is common -complex psychological process of working through and making some sense of the loss and continuing w/ life |
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abNL grief
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-suicidal ideaion or psychotic sxs
-intense and excessive guilt or self-reproach -interference w/ daily functioning, work or school |
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among teens, every drug is decreased in use, except?
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-cocaine/crack
-Rx drugs (vicodin & oxycotin) -inhalants (easy access) |
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what are the gateway to drugs?
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-POT
-ETOH -tabacco (down due to education) |
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why do teens use drugs?
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-peer pressure
-feel good/get high -relax & relieve tension -boredom -to escape |
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addiction is a ___-____-____ disease
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bio-psycho-social
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dependence
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person who has been on a certain prescription for 6mos and goes through a stage of minor w/d after the meds are abruptly stopped
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addiction
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person who is prescribed to take 3 percocet a day but takes 10 instead.
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hallmark of addiction
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denial
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chromosome identified as culprit to addiction?
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chromosome 10
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addiction =
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drug + time + X (genetic or environment)
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area of the brain that controls emotions/feeling; "pleasure center"
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limbic system
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area of the brain responsible for the site of action of cocaine
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focus cerellus
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area of the brain where the neurotransmitters act
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mid-forebrain
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neurotransmitter involved w/ stimulant drugs
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dopamine
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neurotransmitter involved w/ multiple drugs of abuse
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Ach
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neurotransmitter involved w/ hallucinogens
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Serotonin
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neurotransmitter involved w/ cocaine primarily and opioids
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NE
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neurotransmitter involved w/ sedatives and ETOH
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gaba(gamma)-aminobutyric acid
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neurotransmitter involved w/ opiates
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endorphine
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neurotransmitter involved w/ ETOH
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G-protein
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is addiction a brain dysfunction?
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yes
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C-A-G-E
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C-need to cut down
A-annoyed by criticism G-guilty E-need an eye opener 70% sensitive and 90% specific test |
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substance w/d or alcoholics will have a ___ pulse
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rapid
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sedative drugs will have a ____ BP
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lower
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alcohol _____ the RR
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depresses
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cocaine use or w/d will have a ____ RR
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elevated
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spider angiomas is a sn of
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vascular cirrhosis of the liver; sn of alcohol abuse; usually appear in the chest
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telangiectases is a sn of
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cirrhosis of the liver due to alcohol abuse; seen in the abdomen and lower chest
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enlarged spleen will cause a ____ in the platelet count
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decrease
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pupils are dilated w/ use of ____
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stimulants
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pupils are constriced w/ use of ____
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opiates
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nystagmus is found in pts on _____
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sedatives
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what can be a tip off for AIDS/HIV?
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adenopathy
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rhonchi heard w/ use of ____
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crack or pot
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wheeze heard w/ use of ___ & ___
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crack and pot
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what is a tip off of liver disease?
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gynecomastia
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murmurs can be caused by use of? pt may have?
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consequence of IV drug use; may have subacute endocarditis
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decreased bowel sounds indicate?
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opioid use
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increased bowel sounds indicate?
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stimulant drug use
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palmar erythema sn of?
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cirrhosis of the liver; alcohol disease
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testicular atrophy sn of?
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liver disease
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increased WBC seen in?
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early alcoholics
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decreased WBC seen in?
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chronic alcoholics
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H/H decreased in?
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endocarditis and alcoholics
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MCV increased in?
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alcoholics
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decreased BUN seen in?
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Stage 3/4 of liver disease
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increased BUN seen in?
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GI bleeding
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H-A-L-T
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H-drink to get HIGH
A-drink ALONE L-LOOK forward to drinking T-TOLERANCE |
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B-U-M-P
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B-BLACKOUTS
U-UNPLANNED drinking M-drink MEDICINALLY P-PROTECT your supply |
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F-A-T-A-L D-T's
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F-FAMILY HX
A-AA T-THOUGHTS of suicide A-ALCOHOLISM L-LEGAL problems D-DEPRESSION T-TRANQUILIZER use |
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a maladaptive pattern of behavior substance use leading to clinically significant impairment or distress, as manifested by certain traits, over a 12 mo period
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substance abuse
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a maladaptive pattern of substance use, leading to clinically significant impairment or distress manifested by 3 or more trains over a 12 mo period
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substance dependence
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legal limit neuro status in PA
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0.08%
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3 phases of treatment for drug abuse
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-detox
-rehab -after care |
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w/d sedatives are dangerous b/c a person can do into ___ ___
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status epilepticus
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what are the stimulants?
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-cocaine
-amphetamines (meth, ritalin) -opioids (heroin, morphine, opium) |
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what are the sedatives/hypnotics?
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-barbs
-ethchlorvinyl -methaqualone -meprobamate -benzodiazepenes -glutethimide -PCP |
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what are the hallucinogens?
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-phenylethylamines
-tryptamines -ergotamines -anticholinergics |
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what are the inhalants?
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-solvents (glue, petroleum products, paint thinner/nail polish, butanediol-industrial solvent)
-amylnitrate & butyl nitrate -anesthetics (ether, chloroform, NO) -aerosols |
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what are the club drugs?
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-MDMD
-ketamine -GHG - #1 date rape drug -rohypnol -nexus -Illis, WET |
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Grade I seizure
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all minor s/s
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Grade II seizure
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minor + hallucinations
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Grade III seizure
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minor + hallucinations + seizure
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Grade IV
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DTs
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three types of dual dx
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-affective or mood d/o
-ADHD -personality d/o |
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hallmark of sedative use
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blackout
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tx alcoholism
|
-antabuse (disulfiram)
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also used in tx of cocaine
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-antabuse (disulfiram)
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antidote for opioid overdose
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-naltrexone (Revia)
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decreases cravings for alcohol
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-campral (acamprostate)
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lessens cravings for cocaine
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-topamax (topiramate)
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tx opioid addiction, blocks mu receptor
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-suboxone (buprenorphine)
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prevents severe w/d from heroine use
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-methadone
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