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Flashcards in All other topics Deck (101):
1

What is necessary for a diagnosis of insomnia?

Impaired daytime functioning due to difficulty initiating sleep, maintaining sleep, or inability to return to sleep when adequate time and opportunity for sleep is provided

2

When is short term and long term insomnia separated?

Before or after ( 3x a week) 3 months

3

What drug classes can be used to treat insomnia?

-Benzos
-Non-benzodiazepine hypnotics
-Orexin receptor agonists
-Antihistamines
-Tricyclic antidepressants

4

What are risks of use of BZDs and no-BZD hypnotics in insomnia?

-Fetal malformation 1st trimester pregnancy
-Alcohol consumption= excessive sedation
-Renal or heaptic dz metabolic clearance
-Pulmonary dz as they are respiratory suppressants
-Nighttime decision makers as impair decision making abilities
-75+ adverse effects

5

How long should treatment last of insomnia with hypnotics?

6-8 weeks then taper off

6

What are ADRs common to hypnotics?

-residual daytime sedation
-drowsiness
-Cognitive/CNS impairment
-Dependence
-Respiratory depression

7

What are the non-BZD hypnotic drugs?

-Lunesta
-Sonata
-Ambien

8

What non-BZD hypnotic has the longest 1/2 life?

Lunesta

9

What non-BZD is the only one available for long term use?

Lunesta

10

If taking other drugs that are CYP 3A4 inhibitors, what drug is recommended?

Sonata

11

if a patient has a hard time falling asleep what drug based on 1/2 life is preferred?

Sonata

12

What is the Lunesta specific ADR?

Altered taste

13

What non-BZD hypnotic(s) are associated w/ next day impairment?

Lunesta and Ambien

14

What drug is an Orexin receptor antagonist?

Suvorexant

15

What is similar between Suxorexant and lunesta?

-CS 4
-Next day impairment
-Prominent 3A4 substrate

16

What is different about Suroxetant and Lunesta?

Mechanism of action

17

What drug is a melatonin agonist?

Ramelteon

18

What are important factors about Ramelteon?

-Not a controlled substance
-Pt must take 30 minutes before sleep (assist with sleep onset)

19

What warnings/ caution are associated with Ramelteon?

-Reproductive hormone disturbances
-Depression
-CNS depression

20

What antidepressant can be used to treat insomnia?

Doxepin

21

What drugs can be used in restless leg syndrome if iron supplementation does not fix it?

-Gabapentin/ Pregabalin
-Pramipexole/ Ropinirole

22

What is the 1st line treatment for narcolepsy?

Modafinil/ Armodafanil

23

Unless there is a C/I what approach is to be taken in helping patients quit smoking?

Behavioral and pharmalogical therapy

24

What are the 5 A's of tobacco use and smoking?

-Ask motivation to quit
-Advise most important factor for health now and in the future
-Assess determine patient willingness to quit
-Assist quit date, tell family, friends and coworkers to assist
-Arrange office F/U w/in week of quit date

25

What is the 6th A of tobacco use and smokign directed at pediatrics?

Anticipate, discuss avoidance early

26

What are the 3 pharm methods to quit smoking/ tobacco use?

-Nicotine replacement therapy
-Chantix
-Bupropion

27

What is the best approach to treat tobacco use by NRT?

Combo therapy: long term transdermal patch w/ short term formulation

28

What is dosing of NRT based on?

Number of cigarettes per day and timing of first cigarette

29

What is meant by chew and park?

NRT gum cannot be chewed continually otherwise GI upset, HA, hiccups, and mouth ulcers

30

What NRT product gives the best option to address behavior and sensory aspects?

Inhaler but can cause bronchospasm

31

What is different about Chantix vs. NRT therapy?

-Chantix start week before quitting
-NRT start use day of quitting

32

What safety issues may arise with the use of Chantix?

-Neuropsychiatric: Hostility, agaitation, SI
-CV risk those w/ CV dz
-Seizure risk
-CNS depression

33

What is similar about Chantix and Burpropion?

-Start before quit date
-taken for 12 weeks

34

What type of drug is preferred to treat most psych illness patients that smoke? Which D/O is C/I this drug?

-Bupropion
-Bipolar D/O

35

What drug regiment is best indicated for hospitalized smoking pts?

NRT

36

What treatment should be used in pregnant pts?

NRT or Bupropion w/ behavioral therapy

37

What classification is alcohol?

CNS depressant

38

What occurs when there is abrupt cessation of alcohol use?

CNS overactivity; chronic ETOH exposure induces insensitivity to GABA

39

What are minor ETOH withdrawal sx?

-Tremor
-Mild anxiety
-HA
-Insomnia
-Palpitations

40

What are severe ETOH withdrawal symptoms?

-Withdrawal seizures
-Withdrawal hallucinations
-Delirium Tremens

41

When is the typical onset of withdrawal seizures?

12-48 hours after last drink

42

What is dangerous about withdrawal seizures?

1/3 lead to delirium tremens

43

When is the onset of alcoholic hallucinations and when do they resolve?

-Onset w/in 12-24 hours from last drink
-Resolve w/in 24-48 hours

44

What kind of hallucinations are most common during alcoholic hallucinosis?

Visual

45

How does alcoholic hallucinosis differ from delirium tremens?

In alcoholic hallucinosis VS are normal and there is no global clouding of sensorium

46

What signs/sx can be experienced in delirium tremens?

-Hallucinations
-Disorientation
-Tachycardia
-HTN
-Fever
-Agitation
-Diaphoresis
-Cardiac abnormalities

47

What is the onset and duration for delirium tremens?

-Onset 48-96 hours from last drink
-Duration of up to 7 days

48

What are risk factors for delirium tremens?

-Hx sustained drinking
-Hx prior DT
-> 30 yo
-Significant w/drawal in presence of elevated BAC
->Longer period (2days) last drink

49

What is the mortality risk associated w/ DTs?

5% mainly due to cardiac arrhythmia

50

What is hallmark sx control and supportive care?

-BZDs agitation and prevent progression
-IV fluids
-Nutritional supplementation
-Frequent clinical reassessment

51

What is given to DT patients to prevent Wernicke's encephalopathy?

-Thiamine
-Glucose

52

What BZDs are preferred for DT tx?

-Lorazepam or Diazepam
-In case of advanced cirrhosis Lorazepam or Oxazepam

53

When hospitalizing pts that have Hx of seizures, DT, or prologned heavy drinking tx prophylactically with what?

Chlordiazepoxide

54

What score from the clinical institute withdrawal assessment from alcohol-revised is consistent with no detoxification needed?

<8

55

What score from the clinical institute withdrawal assessment from alcohol-revised is consistent with ambulatory detoxification needed?

8-15

56

What score from the clinical institute withdrawal assessment from alcohol-revised is consistent with inpatient detoxification needed?

>15

57

What criteria must be met for a pt to undergo ambulatory detox?

-CIWA 8-15 no DT sx
-Able to take PO meds
-Reliable support monitor pt continuously 3-7 days
-Commit to daily medical visits
-No unstable medical or psychiatric conditions
-Not pregnant
-No concurrent other substance abuse
-No hx DTs or ETOH-related seizures

58

What are alternatives to BZDs in ambulatory detox?

Anticonvulsants Carbamazepine and Valproate

59

What other type of tx do these ambulatory detox pts receive?

-multivitamin
-Thiamine
-Folate
"banana bag"

60

What is required for alcohol tx?

Pts that are MOTIVATED to reduce alcohol consumption

61

What are the drugs for treating chronic ETOH?

Naltrexone, Antabuse, Campral

62

What are requirements of a patient using Naltrexone?

-Pt can not be taking opioids (MOA block mu receptor)
-C/I in acute heptatits or liver failure

63

What ADRs associated with Naltrexone use?

-Nausea
-HA
-Dizziness

64

What are options in Naltrexone use?

-Depot formulation (monthly)
-PO daily

65

What is advantageous about the use of Campral?

Safe for liver dysfunction pts

66

What are CIs for antabuse?

-Severe myocardial disease
-Psychosis
-Pregnant
-Nursing mothers

67

How does Antabuse work?

Causes unpleasant physiologic reactions when alcohol is consumed

68

What type of immunity is vaccine?

Active (takes 2 weeks)

69

What vaccinations are Subcutaneous?

-MMR
-Varicella
-Zoster

70

What are rules for giving SubQ vaccination?

-Use tricep
-23-25 gauge, 5/8 needle
-pinch up skin and insert 45 degree angle
-Separate multi-injection >1 inch

71

What rules for giving IM injection?

-Use deltoid
-Long needle 22-25 gauage and 1-1.5 inch wide
-Insert needle 90 degrees
-Separate multi-injection >1 inch

72

Should live viruses and immune globulins be administered on the same day?

No

73

What is required of a practitioner in regard to vaccines?

-Provide pt with vaccination information statement prior to vaccine
-Report adverse events

74

What are examples of reportable events?

-Anaphylaxis shock w/in 7 days
-Encephalopathy, encephalitis, or seizures

75

What are the type of allergic reactions to vaccines?

-Immediate (w/in 1 hour IgE mediated)
-Delayed (several hours to days rarely IgE)

76

What specific drugs should be given to mothers prior to conception?

-Live attenuated (MMR & Varicella)

77

What drugs can be given to mothers during pregnancy?

Tdap and Influenza

78

When is Tdap/ Td recommended in adults?

-Tdap: once every pregnancy and one dose as an adult
-Td every 10 years

79

When is MMR given and how many times?

-2 times
-12 to 15 months & 4 to 6 years

80

When is varicella vaccination given?

Adults w/o evidence of immunity receive 2 doses

81

Herpes zoster immunization given?

Single dose 60+ regardless of whether prior episode

82

How many doses of HPV are given in males/females? Age ranges?

-3 doses
- 11-26 yo

83

At what age are PPSV23 and PCV13 given?

1 dose each at 65+ or <65 w/ immunocompromising conditions including smoking!

84

How does alcohol progress through the brain?

Highest cortical structures to the lowest

85

What receptors does alcohol work on?

GABA-A Receptors (depressant)

86

What does rate of absorption change due to?

Food in the stomach

87

How much of alcohol is absorbed by the stomach? What organ absorbs the rest?

-10%
-Small intestines

88

What short term effects does mairjuana cause?

-Distorted perception
-Problems w/ memory or learning
-Loss of coordination
-Trouble w/ thinking and problem solving
- Increased heart rate

89

What effects do marijuana cause on different organs?

-Lungs: similar to cigarettes burning and stinging of throat, mouth
-Brain: Hallucinations, delusions, impaired memory, and disorientation
-Heart: increased 20-50 BPM increasing risk of heart attack

90

What is cannaboid hyperemesis syndrome?

-Recurrent N/V
-Colicky abdominal pain
-Results from at least weekly use of marijuana

91

What effects do K2/ spice have?

-loss of control
-decreased pain sensitivity
-Agitation
-Pale skin
-Sweating
-Spastic movements
-Dysphoria
-Paranoia

92

What major effects does K2/spice have?

-Similar sx withdrawls to heroin withdrawls
-Worsen previously stable psychotic disorders
-Trigger chronic psychosis
-Cause myocardial infarction

93

What effects do opioids cause on different systems?

-PNS: reduce heart rate, BP, and respiration rate, constipation, dry mouth
-CNS: Drowsiness, Euphoria, delirium, disorientation, analgesia
-Withdrawl: sweating, anxiety, depression, crying, diarrhea, goose flesh, cramps, fever

94

What kind of effects do methamphetamine cause?

-Degeneration of dopamine terminals
-Cognitive effects
-Meth mouth (dental erosion)

95

What are consequences/ signs of meth abuse?

-Heart failure
-Cardiac hypertrophy
-Stroke
-Kidney failure
-Paranoia, delusions, hallucinations
-Premature aging
-Death from hyperthermia or dehydration

96

What effects on systems does cocaine cause?

-Systemic: increased HR, BP, vasoconstriction, and platelet aggregation
-CNS: Euphoria, hyperactivity, increased alertness, decreased appetite
-Withdrawal: Irritability, agitation, depression, insomnia, tremors, muscle pain, and drug cravings

97

What are long term effects of cocaine use?

-Decreased brain metabolism
-Cognitive impairments
-Heart attacks
-Stroke
-Psychosis
-Oral and skin necrosis

98

How does ecstasy work?

It promotoes serotonin release and blocks the reuptake of serotonin

99

What signs/ sx does Ecstasy cause?

-Increased energy
-Euphoria
-Emotional warmth
-Self acceptance

100

What are side effects of ecstasy?

-Jaw clenching
-Long lasting confusion
-Inability to regulate body temp
-Kidney damage
-Down regulation of serotonin receptors

101

What effect do salvia and bath salts have?

Both are hallucinogenic effects