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96 Cards in this Set
- Front
- Back
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What are some of the Comorbidities with Substance abuse?
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• Anxiety, mood, antisocial personality, borderline personality, conduct disorders and schizophrenia
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Name some long-term effects of alcohol abuse?
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• Peripheral neuropathy
• Wernicke’s encephalopathy – acute, ataxia, confusion, ocular abnormalities (nystagmus). • Korsakoff’s syndrome – chronic, irreversible, anterograde amnesia, confabulation, impaired recent memory • Esophagitis • Gastritits • Mal-nutrition • Fatty liver • Alcoholic hepatitis • Ascites |
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What does C.A.G.E. stand for? Used to screen for alcohol abuse
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• Cut down
• Annoyed • Guilty • Eye-opener |
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What is given to alcoholics to prevent or reverse Wernicke’s encephalopathy?
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Thiamine (Vitamin B1)
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What neurotransmitters are imbalanced due to alcohol abuse?
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GABA & Glutamate
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What is Antabuse (Disulfiram) used for?
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• Treatment of alcohol dependence in the maintenance phase
• Prevents liver from metabolizing alcohol • Used to deter drinking – will cause bad reactions such as facial flushing, HA, vomiting, diaphoresis, dyspnea, chest pain. Patient’s will still have desire and cravings. • Cant use anything with alcohol in it – mouthwash, cough syrup • BAL (blood alcohol level) must be 0 before administering |
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Besides Antabuse (Disulfiram) – what other medications can be used to treatment alcohol dependence?
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• Revia (Naltrexone) – reduces desire/cravings (black box warning –hepatotoxicity)
• Campral (Acamprosate) – restores GABA/Glutamate balance, monitor for suicidal thinking/depression, can cause renal impairment |
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What is given to patients during alcohol detoxification to help with withdrawal symptoms?
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• BZD – Librium/Ativan (to decrease withdrawal symptoms)
• Anticonvulsants (for seizures0 • Propranolol (for tremors) • Multivitamin and folic acid • Thiamine (B1) – (to prevent Wernicke’s encephalopathy • CIWA – clinical instrument of withdrawal assessment |
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What neurotransmitter is associated with addiction (pleasure center)?
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Dopamine (e.g. opioids)
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What is the treatment for an opiate overdose?
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• Narcan (Naloxone) – v-fib, sz, MI
• Revex (Nalmefene) - arrthymias, sz |
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How can you tell if someone is using opiates? (think RAM)
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• Resp. depression
• Altered mental status • Miosis (constricted pupils) |
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What is the often the first sign of opiod withdrawal?
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Dilated pupils and anxiety
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The “runnys” are associated with __opioid__ withdrawal
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Diarrhea, rhinorrhea, lacrimation, diaphoresis, salivation
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What are some side effects of amphetamines?
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Weight loss, insomnia, nervousness, parnoia, psychosis, arrthythmia/HF
(increase energy, HR) |
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Common symptoms of Methamphetamines are ___________ and ___________
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insomnia, irritablity, aggressive behavior
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What is the most successful treatment of opiate detoxification?
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Methadone
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Which drug is used to treat opiate withdrawal (after detox)?
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Naltrexone (Revia)
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Cocaine blocks ______ reuptake
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dopamine
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1 cup of coffee = mg?
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150 mg caffiene
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What are some L/T side effects of hallicuinogens?
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Flashbacks - can occurs days, months, years after using drugs (e.g. cocaine)
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How much caffiene would cause tinnitus, severe agitation, arrhythmias?
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6 cups coffee or 1000 mg of caffiene
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What should be avoided during hallucinogen flashback treatment?
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Antipsychotics
(may make it worse) |
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PCP intoxication if a psychiatric _________
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Emergency
Potential for extreme violence and psychosis |
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What are some side effects of steroid use?
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Mania, depression, suicide
delusions, rage, mood swings |
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"Sudden sniffing death" is related to what substance?
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Inhalants
- causes death by suffocation (e.g. glue, Lysol) |
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Name some 'date rape' drugs?
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Rohypnol (Flunitrazepam)
Memory loss, antergrade amnesia |
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What is considered one of the most lethal substances in society?
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Nicotine
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Why is it difficult to prove that someone has been given a date rape drug? (GHB-gamma hydroxybutyrate)
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Take effect in 10 minutes and clears system in 2 hours. No tests available to detect.
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What can be used to treat nitotine addiction?
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Zyban (bupropion)
Clonidine (Catpres) |
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Name some risk factors for psychiatric disorders in childhood and adolescence
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Severe mental discord
Low socioeconomic status Large families (overcrowding) Parental criminality ** Maternal psychiatric disorders** Foster care placement |
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What can traumatic life events during childhood and adolescence lead to ?
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Insure attachments
PTSD Conduct disorders Impaired social/cognitive function Depression/suicidal behaviors |
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Abused children are at risk for _______ disorder
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Dissociative identity disorder
(use to be called multiple personality disorder) |
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What are some the presenting symptoms of Autism?
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Impaired in communication and imaginative activity (e.g. language delay/absence, pronoun reversal, singsong speech, lack of spont. make-believe play, inability name objects)
Impairment in social interactions (e.g. no eye contact/facial expression, aversion physical contact, failure to dev. peer relationships) |
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What medications are used for Autistic Disorder?
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Antipsychotics
Propranolol (Inderal) Clomipramine (Anafranil) |
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What part of the brain is effected with Autism?
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Left sided (controls language, logic, reasoning)
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What developmental disorder is only seen in females?
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Rhett syndrome
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What is the difference between Asperger's syndrome vs Austism?
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Austism - before 3 yrs
Asperger's - school age, no significant delays cognitive/language, Age approp self-help skills, but impaired social interactions, like repetitive behavior/activities (think RAIN MAN) |
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What are some characteristics of ADHD?
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Inattention
Impulsivity Distractibility Hyperactivity |
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What is Childhood Disintegrative Discorder?
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Loss of skills (either communication, social, motor, b/b control) after at least 2 years of normal functioning
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What are some co-morbidities of ADHD?
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Oppositional Defiant Disorder
Conduct disorder Mood disorders Tourette's disorder |
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The drug of choice for ADHD is ?
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Psychostimulants
Ritalin Adderall Dexedrine Concerta |
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What is Oppositional Defiant Disorder?
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Recurrent - negatisvistic, disobedient, hostile, defiant behaviors toward authority figures
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What are the characterists of Oppositional Defiant Disorder (must be present 6 months or more)?
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Loses temper
Argues w/ adults Defies Blames others Annoyed, angry, spiteful |
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Is childhood onset Conduct Disorder associated with physical aggression?
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TRUE
They violate the rights of others - often using violence - under age 10 |
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Conduct disorders frequently lead to _________ Disorder.
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Adult Anti-social Disorder
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What are some predisposing factors for Conduct Disorders?
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Inconsistent parenting with harsh discipline
Early institutional living Associated w/ delinquent peer group |
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What is separation anxiety?
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When a child become excessive anxious when separated or anticipates separation from home or parental figure
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What is the pharmacolgical treatment for Conduct/Oppositional Defiant Disorder?
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Anti-anxiety agents (diazepam, alprazalom, librium) - s/t use
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Name some medications for Tourette's syndrome?
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Haldol -if severe
Pimozide (Orap) - no kids under 12 Clonidine (Catapres) - drug of choice |
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What are some types of somatization disorders?
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Somatization
Conversion disorder Sleep disorder Hypochondriasis Body Dysmorphic disorder Pain disorder |
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What is somatization?
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The expression of phycholical stress through physical symptoms (not intentional)
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Whis disorder is associated with "doctor shopping"?
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Pain disorder
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What is 'conversion disorder'?
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loss or change in body function - that is not present - they only think it is. (think 'Taladelga Nights')
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Which disorder is associated with history of life-threatening illness to self or significant other?
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Hypochondrias
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Body Dysmorphic disorder is a co-morbidity of _______
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Depression
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Give an example of a pseudoneurological symptom.
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Difficulty swallowing 'lump in throat'
Double vision Loss of touch/pain sensation Deaf Seizures |
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What is narcolepsy?
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excessive sleep
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What is Body Dysmorphic disorder?
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Preoccupation with imagined defect in appearance (e.g. facial flaws)
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What medication(s) used to treat insomnia?
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Ambien
Sonata Lunesta (luna = moon) |
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What drug can be used to treat narcolepsy?
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Stimulant drugs-
Amphetamines Ritalin |
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What is a common co-morbidity of alcohol abuse?
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Depression
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What are the first line drugs for treatment of Major Depression Disorder?
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SSRI's
(Zoloft, Paxil, Lexapro, Prozac, Luvox, Celexa) |
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What is dysthymia?
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chronic low level depression
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Can Serotonin Syndrome be fetal?
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YES
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What are the neurotransmitters that are low/decreased in depression?
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HANDS - 4 up 1 down
Histamine - down Acetylcholine - up Norephinephrine - down Dopamine - down Sentonin - down |
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What is a high priority question to ask a depressed patient?
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suicidal ideation
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Which drug can be used for mild to moderate depression mixed with anxiety?
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Xanax
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Which neurotransmitters are increased in Bipolar -mania?
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Dopamine
Norepinephine |
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What are some co-morbidities of Bipolar Disorder?
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Substance abuse (increases risk of suicide)
Anorexia nervosa (incrase risk of suicide) ADHD Anxiety/personality disorders |
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What are some disturbances in thought processes?
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Rapid speech
Themes Grandiose delusions Clanging Flight of ideas |
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What is the drug of choice for Bipolar disorder?
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Lithium
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How often should lithium serum levels be drawn after the last dose?
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12 hours
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Name an anticonvulsant used to treat Bipolar Disorder?
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Carbamazepine (Tegretol)
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What is the maintance level of Lithium?
Acute mania? |
0.4 - 1.0 mEq/L
1.0 - 1.5 mEq/L |
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What are the expected side effects of lithium (at the therapeutic level)?
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Fine hand tremors
Polyuria Thrist Mild nausea Weight gain |
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What is a serious side effect of Carbamazepine (Tegretol)? (anti-convulsant to treat bipolar)
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blood dyscrasias
agranulocytosis & aplastic anemia |
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Why are tri-cyclic antidepressants contraindicated in treatment of bipolar depression?
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Due to the risk of increase mania, increase suicide attempts
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What are the preferred antidepressants for bipolar depression?
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Wellbutrin
Prozac Effexor |
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What are med's used to treat anxiety in bipolar disorders?
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PAM has anxiety
Clonazepam Lorazepam |
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What are some positive (+) symptoms of schizophrenia?
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Hallucinations
Delusions Bizarre behavior Formal thought disorder |
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What are some negative (-) symptoms of schizophrenia?
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Affective blunting
Anergia (lack of energy) Anhedonia (no pleasure in life) Poverty of ideas/content of speech Thought blocking |
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Which type of drugs treat the positive symptoms of schizophrenia?
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Typical anti-psychotics
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Which type of drugs treat the negative and positive symptoms of schizphrenia?
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Atypical (2nd generation)
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What are some common delusions in schizophrenia?
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Thought broadcasting
Thought insertion Thought withdrawal (brainwashing) |
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Which type of hallicination is most common in schizophrenia?
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Auditory
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What are some common side effects of traditional anti-psychotics (schizophrenia)
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EPS
NMS (neuroleptic maligant syndrome) |
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Name some examples of pseudoparkinsonism?
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Pill rolling
shuffle gait Mask like facies Tremors |
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What is NMS?
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Life threatening emergency Hypodopaminergic crisis
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What are the s/s of NMS?
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CHARMR
CPK elevated Hyperthermia Autonomic instability (tachy) Rigidity Mental status changes Rhabodmyolysis |
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What is EPS?
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Extrapyramidal Symptoms
Akathisia Pseudoparkinsonism Dystonias Tardive dyskinesia (abnormal, invol. movement) |
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What is the drug of choice for treating NMS?
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Parlodel
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"A Ghose Really Can See Zebras" is a way to remember some atypical antipsychotics. Name these.
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Abilify
Geodon Risperdal Clozaril Seroquel Zyprexa |
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How do your treat EPS symptoms?
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ABC's
Artane Benadryl Cogentin Symmetrel |
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Why do atypcial antipsychotic drugs have a black label warning for the elderly with dementia?
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Due to death from CV or diabetic complications
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Name some types of schizophrenia?
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Paranoia -reponsive to tx, auditory hallucinations
Disorganized - most regressed/socially impaired, only able to live in structured and well-supervised setting |
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Which schizophrenia is associated with 'waxy flexibilty'?
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Catatonic
Often echoes words others say |
