Neuro Part 11

Front 1

Depression CAN include:

Back 1

psychotic symptoms

Front 2

7 signs of Mania:

Back 2

DIG FAST P

Distractibility

Irresponsibility

Grandiosity

Flight of thought

Activity

Sleep (dec)

Talk (pressured speech)

Psychosis

Front 3

5 primary mood disorders:

Back 3

1. MDD

2. Bipolar Type 1

3. Bipolar Type 2

4. dysthymic disorder

5. cyclothymic disorder

Front 4

diagnosis of MDD requires 5 of these 9 criteria in a span of 2 weeks:

Back 4

SAG E CAPS D

Sleep disturbance

Anhedonia

Guilt

Energy loss/fatigue

Concentration probs

Appetite/wt loss (5% of body weight)

Psychomotor retardation

SI

Depressed mood

Front 5

dysthymia = less-severe MDD =

Back 5

low self-esteem and decreased productivity,

WITHOUT extreme symps like anhedonia and suicidality

- has to last 2 years to be diagnosed as such

Front 6

hypomania =

Back 6

mild symptoms of mania like increased sexual interest and talkativeness,

- lasts at least **4 days**

Front 7

anhedonia =

Back 7

absence of pleasure in one's usual activities

Front 8

SWAG symptoms to differentiate depression from sadness:

Back 8

S—Suicidality (serious thoughts or attempts at self-destruction) or

W—Weight loss (more than 5% of normal body weight without medical cause) or

A—Anhedonia (loss of pleasure or interest in usually pleasurable activities) or

G—Guilt (feelings of responsibility for negative life events when little or none exists)

Front 9

Major Depressive Disorder (MDD) =

Back 9

Unhappiness, decreased interest in one's usual activities and decreased appetite for pleasurable stimuli such as sex and food

Front 10

Bipolar Disorder Type I =

Back 10

discrete episodes of both depression and mania

Front 11

Bipolar Disorder Type II =

Back 11

discrete episodes of both depression and hypomania

Front 12

Cyclothymic Disorder =

Back 12

alternating states of both dysthymia and hypomania

- (like dysthymia, must persist for 2 yrs in adults in order to be diagnosed)

Front 13

Mood Disorder Resulting from General Medical Condition =

Back 13

*secondary mood disorder,* resulting from illness or treatment of illness



mood symptoms in a medically ill patient **resulting directly from the illness or its treatment** rather than from a primary mood disorder

Front 14

Substance-Induced Mood Disorder =

Back 14

mood symptoms caused or exacerbated by the use OR withdrawal of drugs/meds

Front 15

Atypical Depression ~~

(4)

Back 15

1. weight GAIN rather than loss,

2. excessive somnolence

3. feelings of heaviness in the arms and legs (leaden paralysis)

4. craving for carbohydrate-rich food

Front 16

in Masked Depression, pts are:

Back 16

unaware of or deny that they have MDD;

~~ ***vague physical symptoms***

Front 17

Seasonal Affective Disorder = type of MDD; commonly presents with:

Back 17

ATYPICAL symptoms


=> light +/- antidepressants

Front 18

pressured speech =

Back 18

speech that seems forced and rapid

Front 19

flight of ideas =

Back 19

thoughts move quickly from one to another

Front 20

Adjustment Disorder:

(3)

Back 20

1. mood symptoms DON'T meet the full criteria for a major depressive episode

2. occur within 3 mths of a significant psychosocial stressor (but it's not bereavement)

3. persist for up to 6 mths after the stressor has terminated

Front 21

ECT =

Back 21

inducing a grand mal seizure to effectively treat severe depression

Front 22

effect of Lithium:

Back 22

stabilizes mood

Front 23

SE's of Lithium:

(4)

Back 23

1. renal dysfunction

2. thyroid dysfunction

3. tremor

4. wt gain


understand that lithium is very effective but it is also very toxic with a narrow therapeutic window
a. Common: cognitive slowing, GI upset, polyuria/polydipsia, tremor
b. Severe: cardiac conduction delays, diabetes insipidus, hypothyroidism
c. Moderate toxicity:
i. Symptoms – twitching, slurred speech, lethargy, hyperreflexia, vertigo, GI upset
ii. Treatment – supportive measures (stop lithium, fluids, etc.)
d. Severe toxicity:
i. Symptoms – seizures, stupor, coma, CV collapse, death
ii. Treatment – hemodialysis

Front 24

when Li is contraindicated or when the patient shows rapid-cycling bipolar disorder (>4 episodes in a year), _________________________________ are preferred

Back 24

anticonvulsants like CBZ

- combinations of Li and anticonvulsants can be used for patients who do not show an adequate response to either

Front 25

sedative agents such as Lorazepam and Clonazepam are commonly used in the emergency room to treat:

Back 25

acute manic states,

b/c they resolve symps quickly

Front 26

Sometimes, depressed patients show confused thinking and mild memory problems. In the elderly, these cognitive symptoms may be misdiagnosed as dementia, that is,

Back 26

pseudodementia

Front 27

which class of meds can provoke either hypomania or full-blown mania in a Bipolar pts?

Back 27

antidepressants

Front 28

major difference between Bipolar and cyclothymic disorder =

Back 28

NO psychosis in cyclothymic disorder

Front 29

2 MAOI antidepressants:

Back 29

1. Phenel-zine

2. Tra-nyl-cypromine

Front 30

mechanism of MAOI's:

Back 30

*irreversibly* inhibit MAO,

the enzyme that breaks down monoamine NT's

Front 31

3 indications for MAOI's:

Back 31

1. first-line for ATYPICAL depression

2. anxiety

3. MDD (after other tx's have failed)

Front 32

SE's of MAOI's:

(3)

Back 32

orthostatic hypotension, sedation, sexual dysfunction

Front 33

Interactions of MAOI's:

(2)

Back 33

1. risk of SER Syndrome if given in conjuction with SSRI's, SNRI's, etc.

Symptoms include diarrhea, restlessness, hyperreflexia, autonomic instability, hyperthermia, rigidity, and delirium. (Note the similarity to NMS; hyperreflexia is a distinguishing feature)

2. Tyramine-Induced Hypertensive Crisis: Tyramine is a potent releaser of NOR, which causes vasoconstriction and thus elevated BP. Tyramine is normally degraded by MAOa; when this enzyme is inhibited by MAOIs, small amounts of dietary tyramine can result in a hypertensive crisis.
- Symptoms include nausea, vomiting, occipital headache, stiff neck, and sweating.
- avoid foods high in tyramine (wine and cheese)

Front 34

6 SSRI antidepressants:

Back 34

1. Ci-talo-pram

2. Es-ci-talo-pram

3. Fluoxetine

4. Fluvoxamine

5. Paroxetine

6. Sertraline

Front 35

mechanism of SSRIs:

Back 35

blocks PREsynaptic reuptake of already-released SER

( => increased SER lvls)

Front 36

Indications for SSRI's:

(2)

Back 36

1. MDD

2. various anxiety disorders

Front 37

SE's of SSRI's:

(3)

Back 37

1. GI: nausea and loose bowel movements

2. sexual: decreased libido, delayed ejaculation, anorgasmia

3. wt gain (Paroxetine only)

Front 38

Interactions/met of SSRI's:

(4)

Back 38

1. H met

2. Fluoxetine has the longest h-life (~2 weeks)
Fluvoxamine and Paroxetine have the shortest.

- SSRIs with shorter half-lives are more likely to induce a discontinuation syndrome composed of flu-like symptoms and vivid dreams

3. all SSRIs are contraindicated with Pimozide (antipsychotic)

4. risk SER syndrome

Front 39

3 SNRI antidepressants:

Back 39

1. Ven-la-faxine

2. Des-ven-la-faxine

3. Du-lox-etine

Front 40

mechanism of SNRIs:

Back 40

block the reuptake of presynaptic SER and NOR

(Dose-dependent – at lower doses these drugs function as SSRIs; at higher doses they block the reuptake of NOR as well)

Front 41

Indications for SNRI's:

(3)

Back 41

1. MDD

2. various anxiety disorders

3. neuropathic pain

Front 42

SE's of SNRI's:

(3)

Back 42

1. GI
(nausea and loose bowel movements)

2. Sexual: decreased libido, delayed ejaculation, anorgasmia

3. HTN of diastolic BP

Front 43

Interactions/Metabolism of SNRI's:

(3)

Back 43

1. H met (CYP450)

2. Duloxetine = mod CYP450 inhibitor

3. risk SER Syndrome

Front 44

3 Tricyclic antidepressants:

Back 44

1. Ami-triptyline

2. Nor-triptyline

3. I-mi-pramine

Front 45

mechanisms of Tricyclic Antidepressants (TCAs):

(3)

Back 45

1. block SER and NOR reuptake

2. block Histamine r's with high affinity

3. block Muscarinic r's with high affinity

Front 46

Indications for TCA's:

(4)

Back 46

1. MDD

2. chronic pain

3. HA's (prophylaxis and treatment)

4. enuresis (Imipramine only)

Front 47

SE's of TCA's:

(3)

Back 47

1. anticholinergic (blurred vision, constipation, dry mouth, orthostatic hypotension, sedation, urinary retention)

2. CV: tachycardia, prolonged QT

3. OD's lethal

Front 48

Interactions/met of TCA's:

(1)

Back 48

risk of SER Syndrome

Front 49

4 Atypical Antidepressants:

Back 49

1. Bupropion

2. Mir-ta-zapine

3. Amox-apine

4. Trazodone

Front 50

Bupropion =

Back 50

atypical UNIcyclic antidepressant

Front 51

mechanism of Bupropion (unicyclic antidepressant):

Back 51

inhibits reuptake of ***DOPA and NOR***

- lack of sexual SE's = preferred over SSRI's

Front 52

indications for Bupropion:

(3)

Back 52

1. MDD

2. SAD

3. smoking cessation

Front 53

common SE's of Bupropion:

(5)

Back 53

1. constipation

2. HA

3, nausea

4. anxiety

5. insomnia

Front 54

severe SE's of Bupropion:

(2)

Back 54

1. sez's
(contraindicated in patients with eating disorders or epilepsy)

2. psychosis

Front 55

2 atypical antidepressant-tetracyclines:

Back 55

1. Mirtazapine

2. Amoxapine

Front 56

mechanism of Mirtazapine and Amoxapine (tetracyclines):

Back 56

increase concentrations of NOR and SER

Front 57

Trazodone = Atypical Antidepressant =

Back 57

**5HT2 antagonist**

=> prevents SER reuptake

Front 58

indications for Mirtazapine, Amoxapine, and Trazodone:

(2)

Back 58

1. MDD

2. insomnia
(more sedating than other antidepressants)

Front 59

3 SE's of Mirtazapine and Amoxapine:
(tetracyclines)

Back 59

1. wt gain

2. sedation

3. agranulocytosis (severe, rare)

Front 60

SE's of Trazodone:

(2)

Back 60

1. anticholinergic (common)

2. priapism (urologic emergency)

Front 61

Interactions of Atypical Antidepressants:

(3)

Back 61

1. H met

2. avoid using with MAOIs (risk hypertensive crisis)

3. (Bupropion only) use with caution with other dopaminergic agents e.g. L-dopa
(risk of DOPA toxicity)

Front 62

mechanism of Lithium:

Back 62

alters cation transport across cell membranes in nerve/muscle cells

=> influences reuptake of SER +/- NOR

Front 63

interactions/metabolism of Li2+ :

(2)

Back 63

1. 100% renal

2. co-administration of diuretics, ACEI's, or NSAIDs (except salicylates) is dangerous due to risk of Li toxicity

Front 64

indications of Valproate:

(3)

Back 64

1. manic/maintenance phases of bipolar disorder

2. rapid-cycling pts

and

3. mixed episodes (concurrent depressive and manic symptoms)

Front 65

indications for Carbamazepine:

(2)

Back 65

manic and maintenance phases of bipolar disorder

Front 66

indications for Lamotrigine:

(2)

Back 66

maintenance and *depressive* episodes of bipolar

Front 67

Valproate and carbamazepine are said to “treat from above” (during the manic/maintenance phases) while lamotrigine:

Back 67

“treats from below” (during the maintenance/depressive phases).

Front 68

mesolimbic dopaminergic tract =

Back 68

the dopaminergic neurons in the ventral tegmentum of the BS.

which project forward to the frontal cortex, which releases DOPA to the nucleus accumbens

Front 69

nucleus accumbens (NA) =

Back 69

a small nucleus in the BG associated with addiction

Front 70

substance abuse =

Back 70

substance use over minimum of **1 year** that leads to impairment of occupational, physical, or social functioning

- NOT diagnosed when the patient meets the criteria for substance dependence.

Front 71

substance dependence =

Back 71

substance abuse + withdrawal symptoms, tolerance, or compulsive use

(so WORSE than substance abuse)

Front 72

withdrawal ~~

Back 72

development of *physical OR psychological symps*

Front 73

tolerance =

Back 73

need for increased amounts to achieve the same effects

Front 74

cross-tolerance =

Back 74

development of tolerance to one substance because of using another substance

Front 75

Benzodiazepines =

Back 75

commonly-abused sedative psychoactives

- anxiolytics, hypnotics, and other indications

Front 76

Barbituates =

Back 76

sedative psychoactives with high abuse potential

- rarely prescribed as hypnotics anymore

Front 77

prescription opioids =

Back 77

m.c.ly abused class of prescription drugs

- abuse has been rising

Front 78

amphetamines =

(+2)

Back 78

commonly-abused stimulants

- prescribed for ADD and narcolepsy

- stimulate the release of DOPA

Front 79

cocaine is a ___________ which blocks _______________________________

Back 79

stimulant

the reuptake of DOPA

Front 80

detoxification =

Back 80

treatment of withdrawal symptoms

Front 81

flumazenil =

Back 81

Benzo r' antagonist used in the treatment of Benzo OD

Front 82

Naloxone =

Back 82

opioid r' antagonist used in the treatment of opioid OD

Front 83

disulfirim prevents alcohol use by:

Back 83

blocking the breakdown of alcohol, resulting in acetaldehyde accumulation

Front 84

concomitant ingestion of alcohol with disulfirim =>

(3)

Back 84

1. intense nausea

2. HA

3. flushing

- all act as aversive stimuli

Front 85

Naltrexone =

Back 85

an opioid r' antagonist for alcohol abuse

- works by blunting the positive effects of alcohol

Front 86

"MICA" patients =

Back 86

mentally-ill chemically-addicted pts

= **both mental illness AND substance abuse**

Front 87

Buprenorphine =

Back 87

mixed opioid agonist/antagonist

Front 88

methamphetamines =

Back 88

powerfully-addictive amphetamine derivatives

- known as "meth," "crystal"

Front 89

Amotivational Syndrome =

Back 89

syndrome associated with *chronic marijuana use*, characterized by decreased desire to work and increased apathy

Front 90

alcohol, Benzo's, and Barbs are:

ALL increase:

Back 90

sedatives

**all increase GABA**

Front 91

USD does NOT include:

Back 91

LSD screen

Front 92

one prominent symptom of Delirium =

Back 92

fever

Front 93

Longer than two months ~~

Back 93

start thinking about depression (not bereavement anymore)

Front 94

CAGE:

Back 94

1. felt the need to CUT down?

2. Annoyed you by criticizing your drinking?

3. Guilty about drinking?

4. Eye-Opener?

Front 95

alcohol withdrawal treatment:

(3)

Back 95

1. *hospitalization*
(due to sez's, CV symps)

2. +Benzo's

3. +thiamine


if DTs:

fluid for dehydration, Lorazepam if liver-sick

Front 96

what do Naltrexone or acamprosate do in relation to alcohol?

Back 96

blunt the positive effects of alcohol

Front 97

heroin is an opioid; =>

Back 97

mood elevation, dec. anxiety

Front 98

classic triad of opioid OD =

Back 98

1. coma

2. respiratory depression

3. miosis (pinpoint pupils)

Front 99

classic triad of opioid **withdrawal:**

Back 99

1. piloerection (goose bumps)

2. lacrimation

3. rhinorrhea

(autonomic instability)

Front 100

other symps of opioid withdrawal:

(4)

Back 100

1. Agitation

2. Sweating

3. Yawning

4. pupil dilation

Front 101

detox of opioids =

(2)

Back 101

1. Methadone or Buprenorphine for gradual withdrawal

2. Clonidine if abrupt withdrawal

Front 102

3 stimulants (drugs)

Back 102

1. cocaine

2. amphetamines

3. nicotine

Front 103

stimulants cause increase in:

Back 103

DOPA in the brain

=> elevation in mood, hallucinations/delusions

Front 104

drug for smoking cessation:

Back 104

Bupropion

Front 105

speedball =

Back 105

stimulant + depressant

(e.g. cocaine + heroine)

Front 106

**high of cocaine is followed by:**

Back 106

*depression,* sometimes within an hour

Front 107

2 dangerous possibilities with cocaine use:

Back 107

1. CV problems

2. sudden death

Front 108

withdrawal from stimulants =>

(think caffeine withdrawal)

(3)

Back 108

1. tiredness

2. HA

3. hunger (if from amphetamines)

Front 109

treatment for stimulant use =

(2)

Back 109

1. Benzo's for agitation/anxiety

2. antipsychotics

Front 110

psilocybin =

Back 110

"shrooms"

- hallucinogenic, no therapeutic indications

Front 111

monoamine increased by LSD:

(lysergic acid diethylamide)

Back 111

SER

- ingested

Front 112

mescaline =

Back 112

hallucinogen derived from cactus

~~ Native Americans

Front 113

ketamine =

(+2)

Back 113

"special K"

- hallucinogenic anaesthesia
- glutamate agonist

Front 114

MDMA =

(3-4-methylenedioxymethamphetamine)

Back 114

ecstasy

- a synthetic hallucinogen and
amphetamine-like properties

Front 115

ecstasy can ALSO induce:

Back 115

SER syndrome

Front 116

hashish =

Back 116

cannabis product

composed of resin glands

Front 117

THC =

(Tetrahydrocannabinol)

Back 117

principal psycho-active constituent (cannabinoid) of marijuana

Front 118

cannibis =

Back 118

marijuana

Front 119

marijuana is a:

Back 119

hallucinogen

Front 120

6 symps of marijuana use:

Back 120

1. inc. HR

2. inc. BP

3. red eyes

4. munchies

5. slowed rxn time

6. some hallucination

Front 121

PCP
(phencyclidine)

(4)

Back 121

1. "angel dust"

2. hallucinogen

3. no therapeutic indications

4. glutaminergic

Front 122

PCP binds:

Back 122

NMDA r's

Front 123

symptoms of PCP uuse:

(3)

Back 123

1. inc. BP

2. agitation

3. violent episodes

Front 124

symptoms of PCP OD:

(4)

Back 124

1. hyperthermia

2. nystagmus

3. coma

4. death

Front 125

***there are NO specific treatments for:***

Back 125

hallucinogen use/OD

Front 126

pupil constriction ~~ which class of drugs?

Back 126

opioids

Front 127

pupil dilation ~~ which kinds of drugs?

(2)

Back 127

1. stimulants

2. LSD

Front 128

CV symps ~~ which kind of drugs?

(1)

Back 128

stimulants