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139 Cards in this Set
- Front
- Back
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list examples of Narcotics
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heroin
morphine opium oxycodone Hydrocondone codeine dilaudid, fentanyl, demerol, methadone, vicodine, ultram, lortab |
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side effects of narcotics
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drowsiness
poor concentratin apathy lethargy MIOSIS dilation of the SC vasculature constipation N/V RESPIRATORY DISTRESS |
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OVERDOSE OF NARCOTICS
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MIOSIS
cold clammy skin confusion slurred speech convulsions severe drowsiness RESPIRATORY DEPRESSION (MCC OF DEATH) |
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Tolerance
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characterized by a shortened duration and decreased intensity of analgesia, euphoria, sedation which creates the need to consume more
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what are some medical complications of narcotics? what are they caused by?
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usually caused by adulterants found in street drugs and in the non-sterile practice of injecting
- Infection, sclerosed veins, endocarditis, hepatitis, AIDS, overdose |
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list symptoms of withdrawal from narcotics
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lacrimation
rhinorrhea yawning piloerection sweating flushes mydriasis muscle spasms diarrhea |
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Describe withdrawal without intervention.
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the syndrome will run its course
most of the overt physical symptoms will disappear within 7-10 days |
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Is withdrawal from narcotics life threatening?
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RARELY
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what are the two major patterns of narcotic abuse/dependence?
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1. initiated within the context of medical treatment. escalate their dose by obtaining the drug through fraudulent prescriptions and doctor shopping or branching into illicit drugs
2. initiated outside the therapeutic setting with experimental or recreational use of narcotics |
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how many times a day does a heroin user usually "use"?
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multiple times per day because the sensation of the drug usually only last 2-4 hours
"known as chasing the dragon" |
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what is the active ingredient in oxycontin?
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oxycodone
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what are the benefits of using oxycontin vs heroin?
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legal distribution
cheaper time-released tablet form last for ~ 12 hours affects very similar to heroin |
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examples of depressants abused "legally"
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sedatives
hypnotics tranquilizers anxiolytics BARBS BZDs GHB Rohypnol Alcohol |
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what are the desired effects seen in depressant abuse?
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decreased anxiety
feeling of well being slowed pulse and breathing lowered BP euphoria |
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side effects of depressants.
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decreased inhibition
fatigue confusion impaired coordination, memory, judgement, & concentration |
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signs of intoxication of a depressant
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slurred speech
respiratory depression respiratory arrest Death unsteady gait nystagmus stupor |
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signs of withdrawal from a depressant?
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autonomic hyperactivity (sweating, increased pulse)
TREMOR Seizures transient visual, auditory, tactile hallucinations |
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medical complications of alcohol disorders
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enlargement of liver, jaundice, ascites
gastritis, ulcers, diarrhea, esophageal bleed liver disease, cirrhosis Pancreatitis Cardiomyopathy, HTN Peripheral neuropathy malnutrition, vitamin deficiencies Cerebellar degeneration dementia |
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Wernicke's encephalopathy
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complication of alcohol
- ataxia, confusion, nystagmus - caused by thiamine deficiency: can be reversed with thiamine therapy |
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Wernicke-Korsakoffe syndrome
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- complication of alcohol
anterograde amnesia, confabulation the chronic often irreversible outcome of untreated Wernicke's encephalopathy |
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Fetal alcohol syndrome
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intrauterine growth retardation
facial abnormalities: small head circumference, epicanthal folds, thin, smooth upper lip below normal intelligence ADHD Learning disorders |
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Lab findings in alcohol disorder
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increased MCV
Elevated liver enzymes - increased GGT - increased AST>ALT |
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uncomplicated alcohol withdrawal
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anxiety
hand tremors elevated pulse and BP - sweating, insomnia, Subsides in 5-7 days |
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alcohol withdrawal seizures
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generalized seizure
0 primary in individuals with chronic alcohol dependence |
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Alcohol hallucinations
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vivid unpleasant auditory hallucinations
typically last one week occur in individuals with severe alcohol dependence |
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Alcohol withdrawal delirium
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delirium tremens
- symptoms: confusion, disorientation, visual/tactile hallucinations, agitation, fever, autonomic hyperarousal, seizures Last about 3 days |
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Flunitrazepam
- Rohypnol |
DATE RAPE drug
- amnesia - OD: CNS depression |
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GHB
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signs of intoxication: status seizures, respiratory depression/cheyne-stokes respirations, coma, drowsiness, dizziness, N/V
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what type of drugs might cause delirium?
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dissociatives/anesthetics
- increased HR & BP, impaired motor function, delirium, panic, agression, MEMORY LOSS, numbness, N/V, depression |
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Ketamine Hydrochloride
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hallucinations, respiratory depression, unconsciousness
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PCP intoxication
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vertical or horizontal nystagmus ***TQ
Catalepsy Hyperacusis Belligerence, violence |
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DXM effects
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hallucinations, dissociative effects, "stoned or drunk" appearance
OD: depressed CNS often sold mistakenly for ecstasy Can cause a false positive for PCP |
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examples of hallucinogens
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LSD
Psilocybin Mescaline |
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T/F
Hallucinogens have no physical dependence or withdrawal |
True
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do hallucinogens cause dilation or constriction of your pupils?
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dilation (mydriasis)
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T/F
Overdose with LSD commonly causes death. |
False
-death is rare with OD of LSD |
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Is cannabis withdrawal recognized by DSM-IV?
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NO
no clinically significant withdrawal syndrome |
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what are one of the first substances abused by children?
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Inhalants
- high incidence of use among 10-12 years of age |
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do inhalants cause withdrawal syndrome?
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NO
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physical changes seen with inhalant intoxication.
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dizziness/headache
nystagmus incoordination slurred speech psychomotor retardation |
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behavioral/psychological changes seen in inhalant intoxication.
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confusion, disorientation
belligerence, aggression apathy hallucinations/delusions |
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medical complications of inhalants
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respiratory arrest or suffocation/sudden death
renal and liver failure acute arrhythmias permanent damage to central and peripheral nervous system |
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why are stimulants abused?
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reverse effects of fatigue on both mental and physical tasks
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what is the medical use of the treatment of stimulants?
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obesity
narcolepsy ADHD |
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what are the most commonly used stimulants?
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nicotine
caffeine |
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behavior/psychological changes in amphetamine intoxication?
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increased energy
repetitive behavior hyperactivity restlessness decreased appetite talkativeness paranoia aggressive or violent behavior auditory, visual, or tactile hallucinations |
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physical changes in amphetamine intoxication?
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tachycardia
pupillary dilation elevated BP weight/appetite loss psychomotor agitation chest pain or cardiac arrhythmias |
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medical complications of amphetamines
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HIV, HBV, HCV
Skin abscesses Sclerosed veins CV problems Newborns: withdrawal symptoms |
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Methamphetamine chronic use causes:
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paranoia
hallucinations picking at the skin violent & erratic behavior |
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Cocaine medical complications
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hypoperfusion of the brain > similar to small strokes
perforated nasal septum respiratory problems MI, palpitations, arrhythmias, sudden death from respiratory or cardiac arrest |
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Pregnancy problems seen with cocaine.
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placental abruption
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what types of drug effects does Ecstasy cause?
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effects of stimulants and hallucinations
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side effects of ecstasy
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teeth grinding, permanent memory loss, dehydration, HTN, heart and kidney failure, hyperthermia
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Is caffeine abuse included in the DSM-IV?
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NO
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signs of caffeine intoxication.
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restlessness
nervousness insomnia flushed face recent consumption of 250 mg or more diuresis GI disturbances muscle twitching rambling flow of thought and speech tachycardia or cardiac arrhythmia |
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what are the desired effects with nicotine use?
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improved mood
decreased tension increased attention increased concentration appetite suppression |
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what are the undesired effects of nicotine use?
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restlessness
insomnia anxiety arrhythmias |
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medical complications of nicotine use
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cancers
CV and cerebrovascular conditions low birth weight infants premature delivery |
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signs of nicotine withdrawal
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insomnia
irritability frustration anger anxiety increased appetite/weight gain |
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what is the lifetime prevalence of a substance abuse disorder?
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15%
about 2/3 involve alcohol |
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patients receiving treatment for alcohol abuse how many of them use another drug?
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80%
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T/F
25% of hospital admissions involve alcohol |
true
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why can alcohol abuse be treated as a chronic disease?
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biological basis
identifiable signs and symptoms predictable course and outcome |
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what are the four major neurons of addiction?
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1. Dopamine: reward/pleasure, stimulation
2. Serotonin: mood, sleep, perceptions 3. GABA: sedation, anti-anxiety 4. Endorphins: pain |
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what is the strongest chemical pathway of addiction?
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Dopamine
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what are the substance USE disorders?
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substance dependence
substance abuse |
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what are the substance induced disorders?
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substance intoxication
substance withdrawal |
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what are the diagnostic criteria for substance ABUSE?
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1 or more of the following during a 12 month period:
- recurrent substance use resulting in failure to fulfill major role obligations at work, school, or home - recurrent substance use in situations in which it is physically hazardous - recurrent substance related legal problems - continued substance despite persistent/recurrent interpersonal problems caused/exacerbated by the effects of the substance |
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what are the diagnostic criteria for substance DEPENDENCE?
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3 or more the following in a 12 month period:
- Tolerance: a need for increased amounts of the substance to achieve intoxication or desired effect or diminished effect with continued use of same amount - Withdrawal: characteristic syndrome occurs due to cessation/reduction of substance use that has been heavy or prolonged - substance often taken in larger amounts or over longer period than was intended - persistent desire or unsuccessful efforts to cut down or control substance use - great deal of time spent in activities necessary to obtain the substance, use the substance, or recover from its effects - important social, occupational, or recreational activities are given up or reduced because of the substance - substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance |
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Early full remission
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no symptoms of abuse or dependence for at least 1 month, but less than 12 months
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Early partial remission
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1 or more symptoms but not enough for current dx, for at least 1 month but less than 12 months
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Sustained full remission
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no symptoms for at least t12 months
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sustained partial remission
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one or more symptoms but not enough for current dx, for at least 12 months
on agonist therapy in a controlled environment |
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Substance intoxication
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development of a reversible substance specific syndrome due to recent ingestion of a substance
- clinically significant maladaptive behavioral or psychological changes that are due to the effect of the substance on the central nervous system and that develop during or shortly after use of the substance |
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Substance withdrawal
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- development of a substance specific syndrome due to the cessation of or reduction in substance use that has been heavy and prolonged
- the substance specific syndrome causes clinically significant distress or impairment in important areas of functioning - Note: in general the symptoms of withdrawal tend to be the opposite of those seen during intoxication. Intense craving for the substance usually occurs during withdrawal |
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what is the course of substance dependence?
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- course usually chronic, lasting years, with periods of exacerbation and partial or full remission
- may be periods of heavy use, periods of abstinence, periods of non-problematic use - remission often associated with threat of loss - co-occurring mental disorders often increase risk of complications and poot outcome |
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what are the stages of change and what is each stage associated with?
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1. Precontemplation: patient does NOT recognize a problem
2. Contemplation: patient recognizes a problem but is ambivalent about stopping 3. Preparation: patient has decided to change 4. Action: Patient carries out behavioral changes toward treatment goals 5. Maintenance: Focus is relapse prevention |
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when drug screening is used to monitor abuse, how long can the presence of a substance be detected in an individuals hair?
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up to 90 days
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what drugs can be used to prevent/treat serious withdrawal & seizures from alcohol?
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Benzodiazepines
- Ativan and Valium - gradual taper over 1-7 days - can use for any depressants: sedatives, hypnotics, anxiolytics |
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what is Disulfiram used for treatment of?
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aversion therapy
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Oral Naltrexone
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reduction in cravings
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Acamprosate
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used for reduction of cravings and prolonged withdrawal syndrome
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T/F
Antabuse/Disulfiram reduces cravings |
False
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what is the mechanism of action of Disulfiram?
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inhibits aldehyde dehydrogenase in alcohol metabolism
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when is Naltrexone used in the treatment of alcohol abuse?
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- reduces alcohol cravings by adjusting natural endorphin levels in the brain
- especially effective in subjects with a strong family hx of alcoholism - most common side effect is NASEAU/HEADACHE - Liver can be affected at high doses |
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Acamprosate
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decreases cravings
reduces post acute withdrawal syndrome Binds to glutamate and inhibits glutamate's relate, thus decreasing the degree of excitation or withdrawal - wel tolerated with major side effects being intestinal cramps and diarrhea - NOT metabolized by the liver |
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should a pregnant opioid dependent patient be detoxified?
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NO
- the treatment of choice is METHADONE for maintenance - BUPRENORPHINE: postpartum detox and maintenance |
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Varenicline (Chantix)
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partially activates nicotine receptors
analogous to Buphrenorphine for opiod addiction - start taking 1 week before quit date - VERY expensive - some reports of adverse psychiatric effects: hostility, agitation, depressed mood, suicidal thoughts and actions |
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what is a notable side effect of Topiramate in the treatment of stimulant addiction?
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transient parasthesias
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what distinguishes infancy, childhood, and adolescent disorders from other disorders in the DSM-IV?
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the time of onset
these disorders are present before age 18 |
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what sex are child/adolescent psychiatric disorders more prevalent in?
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boys
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T/F
IN primary care estimated 25% of children and adolescents have a psychological problem associated with chief medical complaint |
True
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T/F
half of all lifetime cases of mental psychiatric disorders begin by age 14 |
True
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Autistic disorder is ______ _______ form. Asperger's disorder is a ______ _______.
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Autistic disorder is a more severe form
Asperger's disorder is a milder form. |
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what is PDD NOS
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Symptoms of Autism/Asperger's disorder are present but do not meet specific diagnostic criteria
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how do some children present early in life as Autistic?
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- some are perceived as different by parents during first few months of life
- 1 yo birthday tapes/rates able to identify 80% of cases - some present with delayed speech during second year of life - others appear to be normal and then lose skills after one year of age - most parents sense that something is wrong by 18 months of age |
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what are the essential features of Autistic disorder?
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Delays or abnormal functioning in all of the following areas:
1. social interaction 2. communication 3. behavioral patterns - before age 3 (can have deficit in at least 1 area) - not better accounted for by another diagnosis |
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what is the role of the pediatrician or FP in recognizing an autism spectrum disorder?
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very important!
Early intervention leads to better outcome |
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how can a PCP assess patients for autism spectrum disorders?
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routine screening for developmental milestones for all children at will child visits
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what are the absolute indications for immediate evaluation of a patient for an autism spectrum disorder?
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1. no smile or joyful expression by 6 months
2. no babbling, pointing, or other gestures by 12 months 3. no single words by 16 months 4. no 2-word spontaneous phrases by 24 months 5. does not respond to name 6. any loss of language or social skills at any age |
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If a screening indicates a possible ASD, what do you do next?
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refer the patient to:
1. audiologic evaluation: language disfunction 2. psychologist for comprehensive evaluation/psychological testing (send to psychologist first, than Dr.) 3. Intervention services |
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what are the goals of treatment of an ASD?
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development: language, social, and self-care skills
increase educational achievements decrease problematic behaviors |
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what is Asperger's disorder?
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similar to autism, but without delays in language and cognitive development
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Copropraxia
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obscene gestures
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Echopraxia
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imitation of someone else's movements
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Coprolalia
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usually socially unacceptable words, frequently obscene
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Palilalia
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repeating one's own words
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Echolalia
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repeating another's words or phrases
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Transient tic disorder
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duration of at least 4 weeks not more than 12 consecutive months (it's transient)
- disturbance causes marked distress or significant impairment in functioning |
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chronic motor or vocal tic disorder
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motor or vocal tics
duration of at least one year |
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Tourette's disorder
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presence of multiple motor tics and one or more vocal tics although not necessarily concurrent
the tics occur many times a day, nearly every day for more than a year onset before age of 18 |
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course of Tourette's disorder
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mean age of onset: 6-7 years old
motor tics typically preceed vocal tics Fluctuating course: remission lasting for weeks to years may occur most patients improve considerably as adults no way to predict prognosis |
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treatment for Tourette's disorder or any tics.
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medication is not recommended unless there is marked distress, significant impairment in functioning or pain/injury from tics
1st line: low dosage of alpha-adrenergic drugs: Clonidine/Guanfacine 2nd line: atypical/second generation anti-psychotics: Risperidone |
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PANDAS
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Pediatric
Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections |
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exhibitionism
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recurrent sexual urges, sexually arousing fantasies, or behavior involving exposing one's genitalia to strangers
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Voyeurism
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recurrent sexual urges, sexually arousing fantasies, or behavior involving observing an unsuspecting person disrobing, unclothes or involved in sexual activity
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Fetishism
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recurrent sexual urges, sexually arousing fantasies, or behaviors that involve the use of nonliving objects
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Frotteurism
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recurrent sexual urgest, sexually arousing fantasies, or behaviors that involve rubbing against or touching a nonconsenting individual
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Sexual sadism
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recurrent sexual urges, sexually arousing fantasies, or behaviors that involve inflicting harm and suffering on another individual either physical or psychological
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Sexual masochism
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recurrent sexual urges and sexually arousing fantasies that involve situations in which one is being humiliated, made to suffer, or beaten, bound, or hurt in some way.
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Oppositional defiant disorder
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essential features: a pattern of negativistic, hostile, and defiant behavior lasting at least six months during which four or more of the following are present:
often loses temper often argues with adults often actively defies or refuses to comply with adults requests or rules often deliberately annoys people often blames others for his or her mistakes or behaviors if often touchy or easily annoyed by others is often angry and resentful is often spiteful or vindictive |
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parent training for children with ODD
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basic social learning principles introduced to parents
ignore or punish problem behaviors and reward incompatible behaviors tying privileges to responsibilities and teach parent consistency |
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essential feature of Conduct disorder
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repetitive and persistent patter of behavior in which either the rights of others or major age appropriate societal rules or norms are violated as manifested by the presence of 3 or more of the following criteria in the past 12 months:
aggression to people and animals destruction of property deceitfulness or theft serious violation of the rules |
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what is the prognosis of Conduct disorder?
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poor prognosis associated with early onset, history of abuse, comorbid ADHD, and substance abuse
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Separation anxiety disorder
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developmentally inappropriate and excessive anxiety concerning separation from home or from those to whom the child is attached of at least 4 weeks duration (3+ criteria)
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what may separation anxiety disorder precede the development of?
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development of panic disorder with agoraphobia
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what is the treatment of choice for separation anxiety disorder?
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EXPOSURE
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what is the treatment of choice for ADHD?
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medication
behavior management is also important |
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what is the rate of lifetime childhood diagnosis for ADHD?
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7.8%
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what are the essential features of ADHD diagnosis?
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either six symptoms of inattention, or six or more symptoms of hyperactivity-impulsivity for at least 6 months to a degree that is maladaptive and inconsistent with developmental level
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what are the similar features of ADHD and bipolar disorder?
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hyperactivity
impulsivity mood lability, irritability |
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what is there strong evidence for etiology of ADHD?
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strong evidence of genetic contribution
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does the family environment make a significant contribution to ADHD?
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NO
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what biochemical mediators may play a role in ADHD?
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Dopamine and Norepinephrine
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who is it important to obtain evidence from in regarding the evaluation of a patient for ADHD?
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important to obtain evidence regarding DSM-IV criteria directly from parents and teacher
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what does a stimulant effect in the treatment of ADHD?
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stimulant medications improves core symptoms of ADHD
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what are considered the first line medication for ADHD treatment?
|
medications
- Methylphenidate and amphetamine preparations are equally effective |
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what are common side effects of stimulant therapy for ADHD?
|
reduced appetite, weight loss
- recommended to be taken after meals insomnia stomach pain irritability often disappears in 2-3 weeks |
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what are some common concerns with stimulants?
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precipitation or exacerbation of tics
growth suppression development of substance abuse |
