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IP3 > Schizophrenia, Substance Abuse, Migraines, Pain > Flashcards

Schizophrenia, Substance Abuse, Migraines, Pain Flashcards

1
Q

Kappa receptor effects

A

dec. GI sedation dysphoria psychosis

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2
Q

A delta fibers -myelination -conduction -respond to what

A

thinly myelinated –conduction=20m/sec respond to noxious mechanical stimuli

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3
Q

Cox 1 location

A

most tissues

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4
Q

Full effects SZP time and symptoms

A

12 weeks ADLS cognition - symptoms delusions

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5
Q

Origins of Neuropathic pain

A

peripheral -abnormal nocicpetor sensitization -dec. threshold -inc. sensitivity to afferent neurons central -central sensitization of nociceptors

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6
Q

Atypical AP high affinity for?

A

5HT2

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7
Q

T/F priamry nociceptive neurons have smaller diameter axons

A

true –slower conduction speed

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8
Q

FGA/SGA potency and Ach?

A

low: most sedating Med: medium sedation High: least sedating

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9
Q

FGA med. potency

A

Loxapine Perhenazine Thiotixene

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10
Q

drug w/ QTc prolongation risk

A

ziprasidone

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11
Q

Step 2 Who ladder

A

Mild-Mod opoids +/- non opioids +/- adjuvant

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12
Q

CIWA scores

A

0-9 very mild withdrawal 10-15 mild 16-20 modest 21-67 severe

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13
Q

Baseline monitoring parameters (11) SZP

A

BP BMI waist circumference A1C fasting lipid panel CMP CBBC TSH EKG pregnancy aims

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14
Q

Who ladder step 1

A

non-opioids +/- adjuvant

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15
Q

urine screen metabolites of oxycodone

A

oxycodone oxymorphone

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16
Q

Dystonia risks (3)

A

treatment naive elderly FGA

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17
Q

TX of - symp in SZP

A

max antipsychotic Add antidepressant

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18
Q

SGA high potency

A

Risperidone Paliperidone

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19
Q

akathesia tx (4)

A

anti-parkinson BB BZD dec. dose

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20
Q

How long does meth stay in urine

A

1-2 days

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21
Q

Tension Tx prophylactic

A

Amitriptyline

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22
Q

buprenorphine MOA

A

partial agonist at mu receptor weak kappa antagonist

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23
Q

urine screen metabolites of codeine

A

codeine morphine hydrocodone

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24
Q

Mod-Severe opioids (6)

A

morphine oxycodone dulaudid opana duragesic methadone

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25
Q

Moderate response time and symptoms on SZP

A

4-6 weeks + symptoms ADL

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26
Q

naloxegol MOA

A

Mu in Gi antagonist

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27
Q

lurasidone major counsel

A

must take w/ >350cal

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28
Q

seizure risk in AP highest?

A

clozapine

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29
Q

alpha 1 antagonism in SZP (2)

A

sedation hypotension

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30
Q

how long does methadone stay in urine

A

3 days

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31
Q

Tension Type HA Dx(3)

A

bilateral not aggravated by acitivites no nausea

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32
Q

ETOH dependence TX

A

Disulfiram

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33
Q

Reduce ETOH craving

A

Naltrexone Acamprosate

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34
Q

GHB MOA

A

weak GABA-B agonist and GHB receptor agonist -open K channel -close Ca channels dec. neuronal acitivation and NT release

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35
Q

Define Dependence

A

removal of the drug results in withdrawal symptoms which can be physical or psychological

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36
Q

opioid function of respiratory depression

A

dec in sensitivity of respiratory center to CO2

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37
Q

drugs w/ high risk of EPS (2)

A

haldol risperidone -b/c high potency FGA: b/c slow dissociation

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38
Q

A beta afferent fibers cause

A

allodynia

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39
Q

opioid use when are pupils large/small

A

intoxication: pinpoint withdrawal: enlarged over dose: ppinpoint

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40
Q

t/f opioid constipation is easier to treat than prevent

A

F

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41
Q

Dephenylheptane Class

A

Methadone

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42
Q

sizure risk in AP lowest?

A

quetiapine

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43
Q

SGA low potency

A

Clozapine Quetiapine

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44
Q

Define Addiction

A

uncontrollable, compulsive drug seeking and use, even in the face of negative health or social consequences

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45
Q

How long does codeine stay in urine

A

48 hrs

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46
Q

What is the potent metabolite of THC

A

11-hydroxy-THC

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47
Q

TX insomnia in SZP (4)

A

antihistamine sedating antidepressant -trazodone -mirtazapine -doxepin hypnotics BZD

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48
Q

urine screen metabolites of alprazolam

A

alpha hydroxyalprazolam

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49
Q

CGRP receptor blockers (2)

A

Erenumab Fremanezumab

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50
Q

Balbenzine Deutetetrabenzine MOA

A

vesicular monoamine transporter 2 inhibitors

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51
Q

which HA respond to indomethacin (5)

A

stabbing hemicrania exercise HA cough HA sexual activity HA

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52
Q

Preprodynorphin cleaved to what

A

Dynorpin

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53
Q

Tardive dyskinesia risk (4)

A

middle aged women elderly long-term use FGAs high dose/potency

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54
Q

Is a immunoassay urine drug screen qualitative/quantitative

A

Qualitative

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55
Q

iloperidone major counsel

A

miss >3 days must re titrate

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56
Q

Acamprosate counsel

A

crcl 30-50 dose 333 TID Crcl <30 do not use continue use if relapse

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57
Q

Delta receptor effects

A

immune modulation

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58
Q

reason naloxegol stays in GI

A

PEG chain

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59
Q

Triptan contraindication (3)

A

CAD CVD uncontrolled HTN

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60
Q

Neuropathic pain 1st line TX

A

Secondary amines -Nortriptyline -Amitriptyline Ca channel Ligans -Pregabalin -Gabapentin SNRI -Duloxetine Venlafaxine

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61
Q

pain classification

A

existential physical -malignant -nonmalignant –neuropathic –nocicpetive —chronic —acute —-mild/mod/severe

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62
Q

Preproenkephalin cleaved to what?

A

Met-enkephalin Leu-Enkephalin

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63
Q

Cluster HA age of onset

A

3rd generation

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64
Q

Mild-Mod opioids (2)

A

Vicodin Percocet

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65
Q

MOH trigger

A

analgesic use >3 times/wk

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66
Q

Naltrexone major counsel

A

do not use if ALT/AST 3x UL wait until 7-10 days opioid free

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67
Q

how long does alcohol stay in urine

A

1-12 hrs

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68
Q

alcohol MOA

A

stimulation of GABA-A receptors -dec. neuronal firing inhibit NMDA -supress neuronal activity

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69
Q

cluster HA Tx (2) prophylactic

A

lithium CCB

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70
Q

Which one Pos. or Neg have good meausre/snapshot of disease control and which part

A

positive -disorganized

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71
Q

T/F SZP have decreased brain volume

A

True

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72
Q

Tapentadol lMOA

A

Mu agonist Ne reuptake inhibit

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73
Q

SZP what do you do to dose when you hit maintenance

A

same dose or slightly decrease dose

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74
Q

Disulfiram monitoring

A

LFT cardiac tests

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75
Q

Migraine acute tx (5)

A

analgesics caffeine Narcotics DHE Triptan

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76
Q

CIWA-AR definition

A

clinical instisute withdrawal assessment

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77
Q

Naltrexone MOA

A

competeive antagonist at opioid receptor

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78
Q

Migraine Diagnosis

A

5 attacks w/ all: last 4-72 hours Has 2 of following: -unilateral -pulsating -mod/severe pain -aggravation by activity During has one of this: -N/V -photo/phonophobia

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79
Q

2 opioids w/ highest pruritus

A

morphine hydromorphone

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80
Q

Abrupt D/c drugs that cause risks? (3)

A

clozapine quetiapine iloperidone

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81
Q

w/d cannabis DX

A

3+ irritably anxiety weight loss restlessness depressed

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82
Q

cluster HA triggers

A

alcohol tobacco

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83
Q

Gamma hydroxybutyrate (GHB) what is it

A

precursor and metabolite of GABA

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84
Q

pseudoparkinsonism risk (3)

A

women >40 FGA

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85
Q

2 types of nociceptive pin

A

somatic visceral

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86
Q

how long does heroin stay in urine

A

48 hours as morphine

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87
Q

TX of agression/hositility/mania in SZP (4)

A

lithium DVP CBZ LMG

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88
Q

common ending for atypical AP

A

done pine azole

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89
Q

stimulation of A delta and C fibers result in

A

excitatory transmission in dorsal horn neurons triggers NMDA causing long lasting excitability of dorsal horn neurons

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90
Q

Naloxegol indication

A

opioid constipation

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91
Q

positive symp. SZP

A

hallucinations

delusions

thought disorders

disorganized behavior:

*agitation,

*incongruency,

*ADLs

impaired speech: tangentiality, circumstantiality, derailment bizarre behavior i

nsomnia

combativeness

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92
Q

when does adensoine dec and inc?

A

dec. during slow wave sleep inc. after prolonged wakefulness

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93
Q

Cox 2 induction

A

in tissues and inflammatory cells in response to inflammation and pain

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94
Q

suboxone dose day 1 and 2

A

8-2 day 1 16-4 days 2

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95
Q

methadone MOA (3)

A

strong mu agonist nmda antagonist 5ht/Ne reuptake inhibitor

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96
Q

A1 function

A

inhibiton of adenylate cyclase

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97
Q

CB1 signalling MOA

A

inhibit adenylate cyclate -inhibit Ca channel activation -K channel activation

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98
Q

opioid dependence TX

A

buprenorphine +/- nalonxone

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99
Q

inc. prolactin inc risk (3)

A

FGA risperidone paliperidone

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100
Q

Mu receptor endogenous NT

A

Enkephalins Beta-Endorphins

101
Q

When can you add an antidepressant in SZP

A

after psychosis is stabilized or can worsen it

102
Q

adenosine MOA

A

accumulate in basal forebrain and promotes sleep by inhibiting cholinergic neurons after prolonged wakefulness

103
Q

clozapine major SE

A

Agranuloscytosis

104
Q

monitoring SZP every 6 months

A

BP BMI AIMs

105
Q

when to prescribe clozapine

A

tx nonresponse no contraindications 2 adequate trials of others

106
Q

Pathophysiology of SZP

A

* too high DA in mesolimbic pathway causes positive symptoms

* too low in mesocortical pathway causes negative symptoms

107
Q

Types of symptoms of SZP

A

Positive

Negative

108
Q

SZP titrate dose time?

A

ever 2-4 weeks

109
Q

TX of anxiety in SZP (2)

A

antihistamines -hydroxyzine, benedryl BZD

110
Q

urine screen metabolites of lorazepam

A

lorazepam

111
Q

MOA Triptans

A

5HT 1B/1D agonist -dec. cAMP

112
Q

Metabolic SGA low potency (4)

A

ziprasidone lurasidone aripiprazole brexxipiprazole

113
Q

maintenance suboxone dose

A

16-4 daily

114
Q

secondary HA

A

trauma cranial/cervical vas. disorder substance/withdrawal infection psychiatric disorder

115
Q

Primary HA types (3)

A

Migraine Tension-type HA Trigeminal autonomic cephalgias

116
Q

urine screen metabolites of clonzepam

A

clonazepam 7-aminoclonzepam

117
Q

Trigeminal autonomic cephalgias include? (2)

A

Cluster HA paroxysmal hemicrania

118
Q

typical AP have low affinity for what receptor

A

5HT2 H1 M1 A1

119
Q

NMS risk (4)

A

high dose high potency IV use dehydration

120
Q

What is endogenous CB1 receptor NT

A

anandamide

121
Q

normal QTc

A

<430 males <450 females

122
Q

akathesia risks (4)

A

FGA Aripiprazole TCA SSRi

123
Q

What is the confirmation test for urine drug screen

A

liquid chromatography or mass spectrometry

124
Q

Cluster HA Men or Women?

A

Men 5:1

125
Q

Disulfiram MOA

A

aldehyde dehydrogenase inhibitor cause accumulation of acetaldehyde cause toxic effects does not dec. craving

126
Q

opioids and hormones

A

dec. estrogen and testosterone

127
Q

methadone SE (2)

A

QTc prolongation hepatic impairment

128
Q

Which one Pos or Neg symp are associated w/ tx resistance and poor outcomes

A

Negative

129
Q

Alcohol screening (2)

A

CAGE feel need to cut down annoyed by critics guilty eye opener >2 clinically significant Audit >8 hazardous

130
Q

monitoring SZP every 1-2 months

A

BP BMI

131
Q

MOA of caffeine

A

antagonist at adensoine A1/2 receptors

132
Q

Ziprasidone major counsel

A

take w/ >500cal

133
Q

Mu receptor effects

A

euphoria dec. GI tolerance dependence respiratory depression

134
Q

anandamide MOA

A

postsynaptic Ca influx activates PLD acts of NAPE to produce anamdamide to activate CB@ to inhibit NT release

135
Q

H1 antagonism in SZP

A

sedation

136
Q

DSM5 opioid w/d

A

3+ of dysphoric mood n/v muscle aches rhinorrhea pupil dilate diarrhea yawning fever insomnia

137
Q

how long does weed stay in urine

A

single use: 2-7 days chronic user: 1-2 months

138
Q

monitoring SZP every 3 months

A

BP BMI waist circumference A1C fasting lipid panel

139
Q

T/F all AP are equally effective

A

True if in equipotent doses, but clozapine is superior

140
Q

C fibers -myelinated -conduction -respond to what

A

unmyelinated <2m/sec damaged tissue or inflammation b/c high threshold

141
Q

FGA high potency

A

Trifluoperazine Fluphenazine Haloperidol

142
Q

DSM5 opioid intoxication

A

pupil constricton and 1+ drowsiness slurred speech impairment mentally

143
Q

Pimavanserin MOA

A

does not block D2 combo of inverse agonist/antagonist of 5ht2a/c

144
Q

SZP when can you safely reach therapeutic dose

A

1-4 wks

145
Q

Define Tolerance

A

↓ in response to a drug dose that occurs w/ continued use

146
Q

HA algorithm

A

paroxysmal

  • benign

Daily

  • chronic —benign
  • New onset —immediate attention
147
Q

metabolic SGA high potency (3)

A

Quetiapine clozapine olanzapine

148
Q

Reward Pathway

A

Da increased in nucleus accumbens

149
Q

Migraine prophylactic (8)

A

VPA propranalol Topamax Timolol Botox CGRP blockers amitriptyline Gabapentin

150
Q

dangerous QTc

A

>500 or >60 above baseline

151
Q

Kappa receptor endogenous NT

A

Dynorpin

152
Q

tapentadol counsel

A

do not use in renal/liver probs

153
Q

Are all reinforcers rewarding?

A

No negative stimulus can reinforce avoidance behaviors

154
Q

metabolic SGA med potency (4)

A

risperidone paliperidone iloperidone asenapine

155
Q

urine screen metabolites of hydrocodone

A

hydrocodone hydromorphone

156
Q

GHB effects

A

CNS depression “date rape drug”

157
Q

inc. prolactin tx (3)

A

aripiprazole quetiapine clozapine

158
Q

aripiprazole major SE (2)

A

akathesia activating

159
Q

Cause of EPS

A

block DA in nigrostriatal

160
Q

Metabolic FGA med potency

A

Chlorpromazine all others are low

161
Q

types of primary nocicpetive neurons

A

A delta fibers C fibers

162
Q

Cows score

A

5-12 mild 13-24 mod 25-36 mod-severe 36+ severe

163
Q

nalbuphine MOA

A

Mu antagonist kappa agonist

164
Q

Metabolic activity in SZP brain

A

decreased in pre frontal cortex

165
Q

DX of caffeine intoxication

A

5+ of obvious caffine consumptions: restlessness, insomnia

166
Q

5HT antagonism in SZP (2)

A

improve - symp dec. EPS

167
Q

urine screen metabolites of heroin

A

6-MAM morphine

168
Q

who has good prognosis for SZP (6)

A

female

rapid (vs. insidious)

onset of symptoms older

older age of first episode

predominantly positive symptoms

high pre-illness functioning

support structure

169
Q

pseudoparkinsonism tx

A

Anti-Ach

170
Q

delirium tremens

A

48-96 hrs after last drink tachy HTN fever tremor diaphoresis delirium agitaiton

171
Q

Phenanthenes Class (6)

A

Morphine Codeine Oxycodone Hydrocodone Hydromorphone oxymorphone

172
Q

DSMV SZP

A

2+ for 1 month one must be**

delusions**

Hallucinations**

Disorganized speech**

disorganized or catatonic behavior

Negative symptoms

↓ social/occupational function

continuous signs of disturbances for at least 6 months

173
Q

Pain Assessment

A

PQRST provoking factors quality region/radiate severeity/intensity temporal/time

174
Q

urine screen metabolites of morphine

A

morphine hydromorphone

175
Q

1st vs 2nd AP more likely to cause EPS

A

1st

176
Q

pseudo-parkinsonism starts at blocking of what DA%

A

80%

177
Q

Cluster Ha Tx (4) acute

A

100% O2 steroids DHE Triptans

178
Q

Stroke/TIA risk w/ drugs (3)

A

risperidone olanzapine aripiprazole

179
Q

opioid N/V tX

A

Da blocking -prochlorpherazine -haloperidol -metoclopramide

180
Q

What is a reinforcing stimulus

A

↑ possibility that behaviors paired w/it will be repeated

181
Q

1st vs 2nd gen AP better at negative effects?

A

2nd

182
Q

Vivitrol is?

A

naltrexone

183
Q

urine screen metabolites of buprenorphine

A

norbuprenorphine

184
Q

Typical AP have high affinity for which receptor

A

DA

185
Q

Aripiprazole MOA

A

partial DA2 agonist 5HT2 antagonist 5HT1 partial agonist

186
Q

cause of migraine (2)

A

release of CGRP -calcitonin gene-released peptide cortical spreading depression

187
Q

Tramadol MOA

A

0 Mu activity - less of an agonist of + - inhibit NE reuptake + inhibit 5HT reuptake

188
Q

Addictive drugs are both ____ and ____

A

rewarding reinforcing

189
Q

Atypical affinity for Da receptor

A

low/med

190
Q

Hallucinogens MOA

A

partial agonist at 5HT2A

191
Q

Tension HA TX acute (2)

A

relaxation techniques occasional analgesics OTC

192
Q

if pain is severe/uncontrolled how much can you inc. opioid dose?

A

50-100%

193
Q

Potency of opioids

A

fentanyl oxymorphone hydromorphone oxycodone hydrocodone=morphine merperidine methadone Tramadol

194
Q

Drugs cause alpha adrenergic probs (4)

A

Clozapine quetiapine chlorpromazpine iloperidone

195
Q

how long does BZD stay in urine

A

short acting: 3 days long acting/chronic: 4-6wk

196
Q

DA2 antagonism in SZP (2)

A

relief of + symp EPS SE

197
Q

Classifications of Migraine

A

W/out aura w/ aura chronic migraine complications of migraine probable migraine Episodic associated

198
Q

Trigeminal Neuralgia prophylatic TX (2)

A

CBZ OXC

199
Q

what is a reward stimulus

A

interpreted as intrinsically positive or something to be approached

200
Q

Negative symp. SZP

A

amotivation

social withdrawal

affective flattening

alogia: quiet

apathy

anhedonia

inattentiveness

poor grooming

201
Q

monitoring SZP

A

every 2-4 weeks

202
Q

DX of caffeine withdrawal (4)

A

HA fatigue irritable flu like

203
Q

ETOH w/d tx

A

BZD fluids vitamins

204
Q

renal cautions for opioids

A

hydromorphone merperidine morphine

205
Q

Alcohol inoxication DX

A

1+ of kinda drunk symptoms

206
Q

urine screen metabolites of Diazepam

A

temazepam nordiazepam oxazepam

207
Q

Asenapine major counsel

A

no food/drink for 10-15 mins

208
Q

drugs w/ low risk EPS (2)

A

Chlorpromazine Quetiapine

209
Q

Acamprosate MOA

A

inc. activity of GABA system and dec. activity of NMDA

210
Q

pimavanserin indicaiton

A

hallucinations delusions

211
Q

Phenylpeperdine Class (2)

A

Meperidine Fentanyl

212
Q

common endings for typical AP

A

zine zone dol

213
Q

Prolonged QTC

A

>450 males >470 females

214
Q

Opioid screening

A

SBIRT ORT -<3 low risk -4-7 moderate ->8 high

215
Q

how much do you need to block DA for anti-psychotic effect

A

>60%

216
Q

Can nerve damage lead to neuropathic pain

A

yes

217
Q

POMC prepropimelanocortin cleaved to what?

A

beta-endorphin

218
Q

NMS tx (2)

A

stop AP supportive measures -IV fluids cooling blankets bromocriptine dantrolene

219
Q

opioid w/d tx

A

methadone buprenorphine

220
Q

A2 function

A

activation of adenylate cyclase

221
Q

2 most important factors in selecting adjuvant analgesics for neuropathic pain

A

comorbid conditions medication SE

222
Q

Cannabis Intoxication DX

A

2+ conjunctival infection inc. appetitie dry mouth tachy

223
Q

step 3 Who ladder

A

Mod-severe opioids +/- non opioids +/- adjuvant

224
Q

What drug has lowest indcidence of DIMD NMs

A

Clozapine

225
Q

how long of no alcohol before using disulfiram

A

12 hours

226
Q

Suboxone monitoring

A

LFT CNS depression BP

227
Q

Assess Opioid Withdrawal

A

COWS -clinical opioid withdrawal scale -sweating pupil size bone/joint ache yawning

228
Q

good for renal impairment

A

oxycodone fentanyl

229
Q

opioid neurotoxicity

A

opioid rotation hydration BZD

230
Q

cause of aura

A

cortical spreading depression

231
Q

2 major types of pain

A

Nociceptive Neuropathic

232
Q

Alcohol Withdrawal DX

A

2+ of: sweating pulse >100 hand tremor insomnia n/v hallucination anxiety seizures delirum temens

233
Q

Dystonia tx (2)

A

benedryl benztropine

234
Q

Initial response time and symptoms in SZP

A

1-2 weeks sleep appetite agitation initial + symptoms

235
Q

length of antipsychotic tx

A

1-2 years but likely lifelong

236
Q

TX location of alcohol withdrawal

A

seizure/delirium: inpatient CIWA 0-15 outpatient CIWA >15 inaptient

237
Q

non-opiods (4)

A

APAP ASA SNAID Tramadol

238
Q

monitoring SZP annually

A

same as baseline PRN TSH PRN pRN EKG PRN pregnancy

239
Q

Non-genetic causes of SZP (3)

A

* random developmental processes

* malnutrition

* in utero viral infection

240
Q

Tardive dyskinesia Tx (2)

A

Valbenzine Deutetetraevnzine

241
Q

symptoms of schizophrenia (4)

A

impaired cognition

active psychosis

non-logical thought process

dec. social/occupational function

242
Q

MOA cocaine

A

competively inhibit monoamine reuptake block DA reuptake 100%

243
Q

opioid receptors MOA

A

all G coupled -hlep open K channels -help close Ca channels -inhibit adenylate cyclase -dec. cAMP

244
Q

FGA low potency (2)

A

chlorpromazine Thioridazine

245
Q

T/F SZP have small ventricles

A

False

246
Q

NMS signs anagram

A

FEVER fever encephalopathy vitals unstable elevated enzymes rigidity of muscles

247
Q

Delta receptor endogenous NT

A

Enkephalin

248
Q

opioid withdrawal will cause death y/n

A

no

IP3 (7 decks)

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