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Behavioral Dynamics > Behavioral Dynamics Exam 2 Cards > Flashcards

Behavioral Dynamics Exam 2 Cards Flashcards

1
Q

Substance

A

Alcohol, tobacco, illicit drugs, or improperly used medication

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2
Q

Substance use

A

Sporadic consumption with no major adverse events

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3
Q

At-risk substance use

A
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4
Q

Codependency

A

Condition characterized by a person who is significantly affected by another person’s substance abuse or addiction

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5
Q

Substance abuse

A

Maladaptive use causing impairment or distress over a 12 month period - one of the substance abuse criteria must be met

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6
Q

4 Substance abuse criteria
CURFEW - But the EW doesn’t stand for anything

A

Failure to fulfill major role obligations
Use of drugs in hazardous situations
Recurrent legal problems due to substance use
Continued use despite persistent social of interpersonal problems resulting from use

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7
Q

Dependence

A

State of adaptation manifested by a substance-class specific withdrawal syndtrome

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8
Q

Addiction - 4Cs

A

Impaired control over use
Compulsive use
Continued use despite harm
Craving for substance

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9
Q

Line between use and addiction generally

A

When patients no longer have control over their use

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10
Q

Patients 12+ years old who report illicit drug use in the past month

A

1 in 10 (14%)

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11
Q

Percent of people with a substance abuse problem who are not aware of it

A

95%

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12
Q

Correlation between age at first use and probability of addiction

A

Younger age of first use=higher risk of later addiction

Late teens to early 20s are highest ages of risk

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13
Q

Lifetime prevalence of EtOH use

A

4 out of 5 patients

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14
Q

Prevalence of EtOH use within the past 12 months

A

2 out of 3 patients

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15
Q

Prevalence of EtOH use in the past 12 months in ages 12-20

A

1 in 10 patients

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16
Q

Prevalence of lifetime vaping 12 and up

A

1 out of 2 patients

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17
Q

Numbers of people abusing marajuana or pain killers respectively

A

Marijuana - 4.3 million
Pain killers - 1.9 million

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18
Q

What substance is the leading preventable cause of death in the US

A

Tobacco

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19
Q

Three core reasons why people use substances

A

To feel good (ie. experimentation)
To feel better (escape from anxieties)
To fit in

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20
Q

Anandamide
4 things it is involved in

A

Neurotransmitter involved in pain regulation, appetite, mood, and memory

Similar to THC

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21
Q

5 things stimulated by Dopamine

A

Movement, motivation, reward, addiction, well-being

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22
Q

4 things stimulated by serotonin

A

Mood, memory, sleep cognition

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23
Q

2 things stimulated by glutamate

A

Learning, memory

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24
Q

2 things stimulated by endorphins

A

Lessened pain, euphoria

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25
Q

2 things stimulated by GABA

A

relaxation, anxiolytic

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26
Q

What happens in the brain as we get addicted

A

Fewer dopamine receptors become available

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27
Q

Which should be treated first - mental illness or substance use?

A

Whichever is more pressing

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28
Q

Opponent-process theory

A

Every process has an opponent or opposite process that sets in after the primary process is over - on repetition the primary process gets weaker and secondary process gets stronger

Chronic drug use leads to lower highs and more severe withdrawals

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29
Q

Proportion of US adults who use alcohol in a risky manner

A

3 in 10

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30
Q

Average moderate and binge drinking for men

A

Average - 15 drinks per week
Moderate 1-2 per day
Binge 5+ on one occasion

Anything more than moderate is heavy drinking

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31
Q

Average, Moderate, and binge drinking for women

A

Average 8+ drinks per week
Moderate 1 per day
Binge 4+ drinks on 1 occasion

Anything more than moderate is heavy drinking

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32
Q

Excessive drinking criteria in the elderly

A

1+ per day or 7+ per week

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33
Q

How much alcohol makes up a drink
Beer
Wine
Malt Liquor
Hard Liquor

A

.5-.6 oz of alcohol
Beer - 12 oz
Malt 8 oz
Wine 5 oz
Hard Liquor 1.5 oz

Go down by ~3.5 oz each time

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34
Q

How much alcohol in ounces and drinks can the liver process in 1 hour

A

1 drink or .5 ounces

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35
Q

Telescoping effect and 4 factors that lead to it

A

Faster timeline from first drink to alcohol dependence - often in women
Lower EtOH dehydrogenase
Lower total body water
Smaller volume of distribution
Drink like (possibly male) partner

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36
Q

Male to female ratio for alcohol use

A

4 to 1

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37
Q

CAGE Questions

A

Have you ever felt you ought to cut down on your drinking?
Have people annoyed you by criticizing you for your drinking
Have you felt guilty about your drinking
Do you need a drink in the morning to steady your nerves (Eye Opener)?

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38
Q

How many CAGE questions raise a red flag? Prompt a more in depth assesment?

A

Even one yes is a red flag
2+ prompts a more in-depth assesment

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39
Q

Apraxia

A

Inability to have coordinated movements

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40
Q

Agnosia

A

Inability to process physical input - can be irreversible

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41
Q

MOA of EtOH

A

Crosses blood brain barrier and acts as a sedative/hypnotic
Stimulates GABA, Glutamate, and Serotonin receptors

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42
Q

Blood alcohol level at which motor actions become clumsy

A

0.1%

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43
Q

Delirium Tremens

A

Effect of Alcohol Withdrawal in which GABA receptors are reduced - causes sensory hyperacuity, halucinations, hyperreflexia, anxiety, agitation, etc.

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44
Q

Wernike encephalopathy
With 3 classic symptoms

A

From chronic alcohol use - Confusion, ataxia, opthalmoplegia
Can be reversed with thiamine and B vitamins

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45
Q

Korsakoff Psychosis
Remember the 4As

A

Antero and retrograde amnesia, Aphasia, apraxia, agnosia
Treat with thiamine and B vitamins BUT only 20 percent are reversible

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46
Q

Onset timing of alcohol withdrawal

A

8-12 hours after the last drink

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47
Q

3 Benzodiazepams used for alcohol withdrawal

A

Diazepam (Valium), Lorazepam (Ativan), Chlordiazepoxide (Librium)

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48
Q

2 antihypertensives for alcohol withdrawal

A

Clonidine and Atenolol

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49
Q

3 Things to use for alcohol withdrawal

A

Benzos
Anti-HTN
Nutrition

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50
Q

Nutrition to give for alcohol withdrawal

A

B vitamins
Thiamine BEFORE IV glucose
Fluid replacement if needed

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51
Q

Scoring to assess alcohol withdrawal

A

CIWA scoring

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52
Q

Treatment for Mild and Non-Mild EtOH withdrawal

A

Mild - short course of tapering PO BZD
Moderate or Severe - Hospital admission with regular IV BZD until stable

Seek to involve social work/psych to treat underlying cause

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53
Q

2 common side effects and 1 uncommon for thiamine administration for alcohol withdrawal

A

Common - Low BP, May effect glucose metabolism
May rarely see anaphylaxis/bronchospasm

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54
Q

Naltrexone for chronic alcohol use

A

Blocks dopamine release in the brain - lack of reward for drinking - good for +hx and +craving
Hard on Liver

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55
Q

Acamprosate (Campral)
MOA
and Metabolism

A

Works to restore glutamate action and effects for chronic alcoholism
Hard on kidneys
666mg orally TID

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56
Q

Disulfiram (Antabuse)

A

Inhibits aldehyde dehydrogenase, makes any alcohol contact awful including mouthwash sometimes
Makes drinking an awful experience
Not very effective

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57
Q

4 other alternative drugs for chronic alcohol use

A

Anticonvulsants, Muscle relaxants, Antidepressants, Antinausea

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58
Q

Proportion of US deaths that are tobacco related

A

1 in 5

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59
Q

EVALI

A

Acute lung injury associated with vaping, involves the lungs filling with fluid

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60
Q

Ciggarette Pack to E-cig cartridge conversion

A

1 cartridge=1pack

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61
Q

Effect of nicotine on the body

A

Increases dopamine and epinephrine. Acts as a stimulant

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62
Q

Why does nicotine tolerance occur

A

Upregulation of nicotinic receptors

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63
Q

cigarette withdrawal timeframe

A

As early as 2 hrs after last cigarette, peaks at 72 hours can last 3-4 weeks

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64
Q

6 acute toxic affects of smoking

A

Nausea, salivation, pallor tachycardia, poor concentration, poor REM sleep

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65
Q

3 indicators of smoking that may not be readily obvious

A

Pharyngeal erythema, Continine (can also be from secondhand smoke), Anabasine (not usually from secondhand smoke)

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66
Q

Recommended treatment for tobacco use

A

Nicotine replacement - Vapes NOT recommended as therapy
Combo patch (LA) with Oral (SA)

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67
Q

Pro, Con and side effects of transdermal nicotine patch

A

Good compliance d/t simplicity
No chance to adjust dose - continuous
Skin irritation, insomnia, vivid dreams

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68
Q

Nicotine gum

A

Diminishes rather than stops withdrawal
Excessive salivation, HA, Mouth irritation
Avoid those with TMJ or poor dentition issues

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69
Q

4 steps for using nicotine gum

A

Chew
Stop when mouth begins to tingle
Resume chewing when tingling/minty taste fades
Repeat

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70
Q

Nicotine replacement option with the highest nicotine content and 4 side effects it has

A

Oral nicotine lozenge

Palpitations, HA, irritation, insomnia

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71
Q

Benefits and drawbacks of a nicotine inhaler

A

Helps satisfy behavioral cravings - same absorption as lozenge or gum
Can lead to irritation and bronchospasm - don’t use in asthmatic patients

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72
Q

Two drugs used to treat tobacco use

A

Bupropion
Varenicline (Chantix)

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73
Q

MOA of bupropion for smoking and SEs and CIs

A

Blocks dopamine and NE reuptake and antagonizes nicotinic and cholinergic receptors - sustained release recommended

SE - insomnia, agitation, dry mouth, headache
CI - epilepsy, anorexia

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74
Q

MOA of Varencycline (Chantix), SEs and CIs

A

MOA - Partial antagonist for nicotinic cholinergic receptors, partially stimulates receptor and also blocks nicotine from binding

SE - vivid dreams, nausea, insomnia
CI-Hypersensitivity to tx

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75
Q

Potentail MOA for a nicotine vaccine

A

Would stop antibodies from crossing the BBB

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76
Q

Three things that usually happen after smoking cessation

A

Weight gain (1-2 kg in the first two weeks, 2-3 kg later on)
Depression and anxiety
Increased cough and mouth ulcers

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77
Q

Nicotine gum equivalent to 1 pack per day

A

4mg

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78
Q

Mu receptors

A

Mediate pain, respiratory depression, constipation and physical dependance

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79
Q

Kappa receptors

A

Analgesia, diuresis, sedation, psychological dependance

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80
Q

5 effects of a mild opioid intoxication

A

Pupillary constriction, Constipation, Slurred words, Drowsiness, Mood change

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81
Q

2 effects of severe opioid intoxication

A

Pinpoint pupils, respiratory depression

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82
Q

How much naloxone should be given for cardiorespiratory arrest?

A

2mg

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83
Q

What happens in long-term opioid use?

A

Desensitization and Downregulation of opioid receptors
Leads to both physical and psychological dependance

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84
Q

Grade 0 opioid withdrawal

A

Craving, anxiety

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85
Q

Grade 1 Opioid withdrawal

A

Yawning, Lacrimation, Rhinorrhea, persperation

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86
Q

Grade two opioid withdrawal

A

First treatable grade

mydriasis, piloerection, anorexia, tremors, hot and cold flashes, itching

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87
Q

Grade 3 opioid withdrawal

A

Increased temp, HTN, Tachycardia, tachypnea

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88
Q

Grade 4 opioid withdrawal

A

Vomiting, Diarrhea, Weight loss, hemoconcentration, spontaneous orgasm/ejaculation

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89
Q

Length of opioid withdrawal for morphine or heroin

A

7-10 days

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90
Q

2 opioid-like drugs that can be given for ACUTE opioid withdrawal

A

Methadone and Buprenorphine

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91
Q

2 drugs that can treat symptoms of ACUTE opioid withdrawal

A

Clonidine, Lofexidine

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92
Q

Difference between Buprenorphine, other opioids and nalaxone

A

Nalaxone is an antagonist
Buprenorphone is a partial agonist
Heroin is a full agonist

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93
Q

Drug indicated for chronic opioid use treatment but not for acute

A

Naltrexone - opioid antagonist

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94
Q

Black Box warning for naltrexone

A

Hepatocellular injury

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95
Q

MOA and side effects of methadone

A

Opioid agonist

Constipation, drowsiness, edema, reduced libido

Greater chance for lethal OD than buprenorphine

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96
Q

4 criteria a patient must meet at least one of to qualify for methadone

A

One year of continuous use or intermittent use for over 1 year
Have been on methadone mainainance within the past to years and show signs of imminent return to opioids
Recently released from prison or hospital and show signs of imminent return
Pregnant and opioid dependant

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97
Q

MOA and SEs of buprenorphine

A

Available as long acting implant

Partial opioid agonist

HA, Nausea, insomnia

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98
Q

Best long term outcomes for opioid withdrawal

A

Therapy COMBINED with medication

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99
Q

5 symptoms of meth use

A

Picking at skin, Aggression, Dilated pupils, Dry mouth leading to tooth decay, Rhabdomyolosis

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100
Q

Treatment for amphetamine intoxication

A

Treat symptoms:
Antihypertensives, airway management, Fluids, Cooling for hyperthermia

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101
Q

Timeframe for meth withdrawal

A

develop in a few hours, peak in 1-2 days, resolve in two weeks

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102
Q

3 acute and 3 subacute amphetamine withdrawal symptoms

A

Acute: dysphoria, anhedonia, vivid drems/insomnia
Subacute: Depression, suicidal thoughts, insomnia/hypersomnia

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103
Q

Treatment for amphetamine withdrawal (4)

A

None proven some possibilities are:
Benzodiazepines, antidepressants, antipsychotics, behavioral therapy

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104
Q

First line for chronic amphetamine use treatment

A

Bupropion and naltrexone

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105
Q

Second line treatment for chronic amphetamine use

A

Mirtazapine

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106
Q

Adjunct or alternative treatment for chronic amphetamine use

A

Methylphenidate (stimulant) Topiramate (anticonvulsant

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107
Q

What causes a high temperature in meth users

A

muscle rigidity

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108
Q

Antipsycotic that might be used for meth addiction

A

Haldol

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109
Q

MOA of benzodiazepines

A

enhance the effect of GABA
Causes sleep, relaxation of muscles, etc.

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110
Q

What happens with chronic BZD use?

A

GABA receptors change and BZD has less affinity for them

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111
Q

Sign of BZD overdose and what it might be combined with

A

CNS depression with normal vital signs
Often overdose with other substances especially alcohol

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112
Q

Anxiolytic overdose treatment

A

Flumazenil - competitive antagonist of GABA receptor
Use with caution, can precipitate withdrawal seizures side effects may not be worth it

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113
Q

BZD treatment for withdrawal from BZDs

A

Titrate to effect IV, slowly wean over a period of months

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114
Q

4 potential adjunct medications for BZD withdrawal

A

Beta blockers, antipsychotics, SSRIs, antihisthamines

All shown to be inferior treatments for acute withdrawal

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115
Q

4 aspects of treating chronic BZD use
4 Anticonvulsants used

A

Treat underlying anxiety
Treat other substance abuse issues
6-12 month taper
Anticonvulsants (valproic acid, gabapentin, topiramate, lamotrigine)

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116
Q

Psychosis

A

Seeing/Hearing things that aren’t there

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117
Q

MOA of cocaine

A

Blocks dopamine reuptake

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118
Q

Treatment for cocaine use

A

No set treatment
Dopamine agonist Bromocriptine
Antipsychotics for psychoses

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119
Q

Incidental effect of cocaine that could make it clinically useful

A

Causes vasoconstriction - can stop nosebleeds but also cause a heart attack

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120
Q

3 long term treatments for chronic cocaine use

A

Topiramate, Dopamine agonists/Stimulants, Disulfiram

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121
Q

THC in marajuana now compared to the 60’s

A

was 1-5% now is 10-15%

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122
Q

MOA of THC

A

Mimics anandamide and increases dopamine levels

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123
Q

4 symptoms of acute marijuana use

A

Euphoria, Disinhibition, Hunger, Conjunctival infection

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124
Q

5 Long term effects of marijuana use

A

Increase in pulmonary cancer risk, EKG changes, infertility, brain volume loss, Cannabis hyperemesis syndrome

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125
Q

Tx for marijuana use and its goal

A

Sustained abstinence rather than controlled low level use
Psychosocial interventions are preferred over pharmacy

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126
Q

4 drugs that MAY be helpful for treating marijuana use

A

acetylcysteine, gabapentin, topiramate, varenicline

Antidepressants and synthetic THC have NO effect

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127
Q

Mood

A

Overall state of emotion at a given time

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128
Q

3 Criteria that must be met for all DSM psychiatric conditions

A

Condition is not cause by the direct effect of any drug or external exposure
The psychiatric disorder is not caused by the effects of a medical condition
There is significant impairment of social functioning, occupational functioning or both

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129
Q

4 physical symptoms of depression

A

Sleep changes, Fatigue, Appetite changes, Activity changes

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130
Q

3 psychological symptoms of depression

A

Feelings of worthlessness or guilt, concentration, Thoughts of death or suicide

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131
Q

2 drugs that can cause depression

A

Steroids and interferons

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132
Q

Atypical depression

A

Reactivity to pleasurable stimuli, hyperphagia and hypersomnia

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133
Q

What must a patient have to be diagnosed with MDD

A

At least ONE major depressive episode

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134
Q

3 screening tools for MDD

A

PHQ-2 - Initial screening for depression asks about key symptoms
PHQ-9 Further evaluation used as a follow up to PHQ-2
Zung self rated depression scale - allows for a more in-depth rating of current symptoms

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135
Q

Disthymia

A

Persistent depression

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136
Q

MC population for depression

A

Women, younger age groups

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137
Q

Preferred approach to depression

A

Combination of pharmacotherapy and psychotherapy

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138
Q

Diagnostic criteria for depression

A

A depressed mood or anhedonia for over two weeks and 4+ SIG E CAPS symptoms

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139
Q

5 criteria that indicate inpatient treatment of depression

A

Suicidal/homicidal ideation with intent and plan, Psychosis, Catatonia, Impaired judgement - dangerous
Unable to care for self d/t impaired functioning

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140
Q

Indications for ECT

A

Severe refractory depression and patients who cannot tolerate other therapies

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141
Q

Vagal nerve stimulation

A

Devide is implanted on the chest wall with contact to the left vagal nerve - used for epilepsy but may also aid in depression

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142
Q

Indications and Contraindications for transcranial magnetic stimulation

A

For treatment refractory depression, contraindicated in high seizure risk patients for patients with metal implants
Less effective than ECT

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143
Q

S-adenosylmethionine

A

Naturally occurring in the body, may raise dopamine levels and safe in pregnant patients with MDD
May trigger manic episodes

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144
Q

5-hydroxytryptophan

A

Natural precursor to serotonin. Risk of GI upset and serotonin syndrome

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145
Q

Omega-3 fatty acids for MDD

A

May work better when combined with antidepressants, may increase risk of bleeding

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146
Q

St. John’s Wort for MDD

A

Increases serotonin and possibly NE and Dopamine causes photosensitivity and many Drug interactions

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147
Q

Saffron for MDD

A

Unclear MOA, can be fatal at high doses

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148
Q

Ginko for MDD

A

Improved mood in memory loss patients, may increase sensitivity to serotonin and bleeding risk

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149
Q

4 classes of oral antidepressants

A

SSRIs, SNRIs, Serotonin modulators, TCAs

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150
Q

3 1st gen antidepressants

A

MOAIs, TCAs, TeCAs

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151
Q

Presentation of an ECT seizure

A

May not be a full seizure - just foot tapping

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152
Q

Time required between an SSRI and a MOAI

A

2 weeks normally
5 weeks for prozac

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153
Q

Dosing for SSRIs

A

QAM with a typical half life of 24 hours

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154
Q

6 potential side effects of SSRIs

A

GI upset, Sleep changes, Headache, Anxiety, ED, Serotonin syndrome and prolonged QT

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155
Q

How is serotonin syndrome diagnosed

A

Clinical dx only

156
Q

3 treatment options for serotonin syndrome

A

D/C serotonergic medications
Sedation with Benzodiazepines
Normalize vitals and hydration status

157
Q

7 symptoms of Serotonin Syndrome

A

Agitation
Clonus
Diaphoresis
Hypertonicity
Hyperreflexia
Temperature over 38
Tremor

158
Q

Sertraline class

A

SSRI

159
Q

Two sertraline side effects

A

Insomnia and Diarrhea

160
Q

Citalopram class

A

SSRI

161
Q

Side effect of citalopram

A

QT prolongation

162
Q

Benefit of citalopram

A

Least inhibition of hepatic cytochrome enzymes of all SSRIs

163
Q

SSRI with the shortest half life

A

Fluvoxamine 15 hours

164
Q

2 side effects of fluvoxamine

A

Somnolence
Cytochrome inhibitor

165
Q

Class of fluvoxamine

A

SSRI

166
Q

SSRI with the longest half life

A

Fluoxetine 3 days

167
Q

3 side effects of fluoxetine

A

Insomnia
Anxiety
Contraindicated with tamoxifen

168
Q

Class of paroxetine

A

SSRI

169
Q

7 side effects of Paroxetine

A

Anticholinergic (cant see, cant pee…)
Orthostatic hypotension
Weight gain
Sexual dysfunction
CYP 450 inhibition
Contindicate with tamoxifen

170
Q

MOA of SNRIs

A

Blocks reuptake of 5HT AND Norepinephrine

171
Q

2 SNRIs with a greater effect on NE

A

Milnacipran
Levomilnacipran

172
Q

4 non-MDD indications for SNRIs

A

Anxiety, Fibromyalgia, Neuropathy, Menopausal s/s

173
Q

1 contraindication of SNRIs

A

Angle closure glaucoma

174
Q

5 general side effects of SNRIs

A

GI
Sleep Change
Neuro
Sexual disfunction
Psych

175
Q

2 main side effects of Venlafaxine

A

N/V
Elevated BP

176
Q

How is desvenlafaxine different than venlafaxine

A

Synthetic metabolite, less pronounced side effects

177
Q

Class of venlafaxine and desvenlafaxine

A

SNRI

178
Q

Only SNRI with Cytochrome interaction

A

Duloxetine

179
Q

2 benefits of duloxetine

A

Least associated with elevated BP
Indicated for chronic pain relief

180
Q

Class of Milnacipran and Levomilnacipram

A

SNRI

181
Q

Side effect and more common use for Milnacipram

A

Anticholinergic activity (Can’t see…)
Marketed more for pain releif than depression

182
Q

MOA of Bupropion

A

Acts as a dopamine-norepinephrine reuptake inhibitor and antagonizes nicotinic receptors

183
Q

MOA of mirtazipine

A

Antagonizes A2 adrenergic, 5HT2 and 5HT3 receptors, causing increased release of Serotonin and NE

184
Q

2 atypical antidepressants

A

Bupropion and Mirtazipine

185
Q

4 side effects of wellbutrin

A

Dry mouth, insomnia, nausea, risk of seizures

186
Q

1 benefit of bupropion

A

Can help with tobacco cessation

187
Q

3 side effects of mirtazipine

A

Drowsiness, weight gain, sexual dysfunction

188
Q

2 benefits of mirtazipine

A

Good for patients with insomnia, No hepatic cytochrome inhibition unlike Wellbutrin

189
Q

Serotonin Modulators

A

2nd line therapy for those who cannot tolerate SSRIs may be first line
Block reuptake of 5HT

190
Q

4 Serotonin modulators

A

Nefazodone
Trazodone
Vilazodone
Vortioxetine

191
Q

2 Serotonin modulators that also antagonize 5HT receptors

A

Nefazodone and trazodone

192
Q

2 serotonin modulators that also agonize 5-HT receptors

A

Vilazodone, vortioxetine

193
Q

Clearance of serotonin modulators

A

Hepatic

194
Q

3 side effects of serotonin modulators

A

Headache, diarrhea, nausea

195
Q

Nefazodone class

A

Serotonin modulator

196
Q

3 Side effects of Nefazodone

A

Hepatotoxicity, drowsiness, hypotension

197
Q

2 side effects of trazodone

A

sedation, sexual dysfunction

198
Q

class of vilazodone

A

Serotonin modulator

199
Q

1 benefit of vilazodone

A

Faster onset than other SSRIs/SNRIs

200
Q

2 side effects of vilazodone

A

headache and sexual dysfunction

201
Q

Serotonin modulator not associated with sexual side-effects

A

Nefazodone

202
Q

2 side effects of vortioxetine

A

Dizziness and sexual dysfunction

203
Q

Indication for Ketamine/Esketamine

A

Severe refractory depression without psychosis

204
Q

Route of Ketamine and Esketamine respectively

A

Ketamine - Usually IV
Esketamine - Nasal Spray

205
Q

3 downsides of Ketamin/Esketamine

A

Abuse potential - short term therapy only!
Neurotoxicity
Psychotomimetic effects

206
Q

MOA of Ketamin/Esketamine

A

Opioid agonist - exact MOA for depression not clear

207
Q

3 shorter term, less serious effects of Ketamine/Esketamine

A

HTN, Anxiety, tachycardia

208
Q

2 drug interactions of ketamine/esketamine

A

CNS depressants, other nasal sprays

209
Q

MOA of MAOIs

A

Inhibit Monoamine Oxidases a and b which break down serotonin and norepinephrine and dopamine respectively

210
Q

indication for MAOIs

A

Treatment resistant or atypical depression

211
Q

4 MAOIs

A

Tranylcypromine
Phenelzine
Isocarboxazid
Selegiline

212
Q

2 contraindications for MAOIs

A

CV disease, Pheochromocytoma

213
Q

What can create a hypertensive crisis when combined with MAOIs

A

Foods with tyramine
Aged cheese, soy sauce, tofu, etc. (Pretty much anything fermented)

214
Q

4 side effects of MAOIs

A

Hypotension, Urinary hesitancy, myoclonic jerks, edema

215
Q

MOA of TCAs

A

Inhibit reuptake of 5 HT and NE but are second line due to side effects

216
Q

2 TCAs more potent for blocking 5-HT reuptake

A

Tertiary amines
Amitriptyline, Doxepin

217
Q

2 TCAs more potent in blocking NE reuptake

A

Secondary amines
Nortryptiline
Desipramine (Norpramine)

218
Q

4 Side effects of TCAs

A

Easily overdosed w/ increased suicidal thoughts, Prolonged QT, weight gain, sexual dysfunction

219
Q

Two TeCAs

A

Maprotiline
Amoxapine

220
Q

MOA of TeCA

A

Block reuptake of NE
Still have risk for suicidal ideation

221
Q

Use of lithium for MDD

A

Not as effective as other drugs and has numerous side effects and risks of toxicity

222
Q

Use of antipsychotics for MDD

A

Typically an add-on to antidepressants

223
Q

Criteria for dysthymia

A

Patients with ongoing depressive symptoms for TWO years or longer with no more than 2 months free of s/s

224
Q

Other name for dythymia

A

Persistent Depressive Disorder (PDD)

225
Q

6 criteria for dysthymia and how many must be met

A

Meet two of these:
Appetite changes
Sleep changes
Loss of energy
Can’t think/concentrate
Low self esteem
Feelings of hopeless ness

226
Q

Treatment for Dysthymia

A

1st line - SSRI
2nd line - TCA/MAOI

227
Q

adjustment disorder with depressed mood

A

Low mood, tearfulness or feelings of hopeless ness in response to a stressor within three months of onset that either exceeds the expected distress given the stressor OR impairs functioning

Must resolve in 6 months

228
Q

Two types of seasonal affective disorder

A

MC - Fall onset
Spring Onset

229
Q

General presentation of fall onset and spring onset depression

A

Fall - increased everything (sleep, weight, appetite)
Spring decreased everything (sleep, weight, appetite)

230
Q

Recommended light therapy for SAD

A

10,000 lux for 30 minutes in the morning

231
Q

3 potential side effects from light therapy

A

Photophobia, HA, fatigue

232
Q

Criteria for a major depressive episode

A

2+ weeks of:
Depressed Mood and Anhedonia with 5+ of the following
Weight/Appetite change
Sleep change
Activity change
Fatigue
Guilt
Lack of Concentration
Suicidal thoughts

233
Q

Manic episode criteria

A

7+ days of expansive elevated or irritable mood and increased energy/activity with 3+ of the following (4 if mood is only irritable)
Grandiosity
Decreased sleep need
Pressured speach
Flight of ideas
Goal directed activity
Risky behavior

234
Q

Hypomanic episode

A

Only 4 days with classic manic symptoms - must be a change from baseline and cannot cause functional impairment

235
Q

Bipolar 1

A

Depression with 1+ manic episodes

236
Q

Bipolar 2

A

Depression with 1+ hypomanic episodes

237
Q

Cyclothymia

A

Periods of mania and depression that fall short of diagnostic criteria

238
Q

Eight subtypes of Depression and Bipolar disorders

A

Anxiety
Atypical
Catatonic
Melancolic
Mixed
Peripartum
Psychotic
Seasonal

239
Q

Normal gender presentations of bipolar

A

Men = Manic
Women = Damsel in distress (Depressive)

240
Q

Resolution time for hypomanic, manic, and major depressive episodes

A

Hypomanic - 4-8 weeks
Manic - 15-20 weeks
Major depressive - Over 20 weeks

241
Q

Mixed episodes

A

Qualify for one end of the spectrum with 3+ criteria from the opposite end (ie. Manic episode with guilt, suicidal thoughts, and lethargy)

242
Q

Rapid cycling BPD

A

4+ mood episodes per year

243
Q

Screening tool for mania

A

Mood Disorder Questionnaire (MDQ)

244
Q

3 goals of bipolar treatment

A

Control acute mood symptoms, Induce remission of mood symptoms, Prevent recurrence of symptoms

245
Q

3 types of antimanic drugs

A

Lithium, Anticonvulsants, Antipsychotics

246
Q

4 factors to evaluate severity of a manic episode

A

Suicide/homicide risk, Psychotic features, poor insight, aggression

247
Q

Therapy for severe acute manic episodes

A

Antipsychotic (not lamotrigine) with lithium or valproate

248
Q

Treatment for mild to moderate acute manic episodes

A

Monotherapy with Lithium, and antipsycotic or anticonvulsant

249
Q

2 antipsycotics for manic episodes

A

Risperidone and Olanzapine

250
Q

3 anticonvulsants for acute manic episodes

A

Carbamazepine, Valproate, Divalproex

251
Q

Anticonvulsant that DOES NOT work for acute manic episodes but can treat bipolar

A

Lamotrigine - Okay for depressive episodes

252
Q

Antipsychotics for depressive episodes of bipolar (3)

A

Lurasidone, Quetiapine, Olazapine

253
Q

First, Second and Third line meds for Bipolar mantainance therapy

A

1st - Same med that managed the acute episode
2nd - Lithium, Quetiapine, Valproate, or Lamotrigine
3rd - Other antipsychotics or combo therapy

254
Q

When should lithium levels be checked

A

5 days after dose change and 12 hrs after last dose

255
Q

5 contraindications of Lithium

A

CKD, Dehydration, Sodium depletion, CV disease, Pregnancy

Caution in psoriasis and myasthenia gravis

256
Q

Side effects of lithium

A

LITH-PA
Leukocytosis
Insipidus
Tremor/Teratogenesis
Hypothyroidism
Parathyroid
Arrhythmia

257
Q

Lithium Baseline Labs (5)

A

Pregnancy, Renal function, Calcium, Urinalysis, Thyroid

258
Q

Lithium maintanance labs

A

Baseline labs plus lithium

259
Q

How frequently should lithium levels be checked

A

q 1-2 weeks until desired serum level is reached
q 2-3 months for first 6 months

260
Q

Early and Late symptoms of Lithium Toxicity

A

Early - GI symptoms
Late - tremor, ataxia, confusion, encephalopathy, seizures

261
Q

4 supportive care measures for lithium toxicity

A

ABC, IV hydration, Benzos for seizure, HD if severe

262
Q

MOA of valproate

A

Anticonvulsant - increases GABA levels and effectiveness

263
Q

3 contraindications of valproate

A

Liver disease, mitochondrial disease, pregnancy

264
Q

2 Drug interactions of valproate

A

TCAs, other anticonvulsants

265
Q

4 Side effects of valproate

A

Hair loss, bruising, weight gain, tremor

266
Q

MOA of lamotrigine

A

Anticonvulsant - inhibits the release of glutamate
NOT for acute mania

267
Q

Lamotrigine and oregnancy

A

Safer than lithium and other anticonvulsants

268
Q

4 Side effects of lamotrigine

A

Nausea, drowsiness, pruritis, Steven-Johnson Syndrome and Toxic epidermal necrolysis

269
Q

Steven Johnson Syndrome

A

Painful rash that turns into dead skin - treat like a burn patient
Result of a RAPID dose increase of Lamotrigine

270
Q

MOA of Carbamazapine

A

Anti-convulsant, cholinergic, manic, depressant, diuretic, neuralgic

Similar to TCAs chemically

271
Q

3 contraindications of carbamazepine

A

Bone marrow suppression, recent MAOI use, Not recommended in pregnancy

272
Q

4 Side effects of Carbamazepine

A

Pruritis, Hyponatremia, leukopenia, SJS

273
Q

MOA of antipsychotics

A

Serotonin and dopamine agonists

274
Q

Use of antipsychotics for depression and bipolar disorder

A

Can be adjunct for depression, can be add-on OR initial therapy for bipolar

275
Q

2 antipsychotics commonly used for Bipolar disorder

A

Quetiapine and Lurasidone

276
Q

3 SEs of antipsychotics in general

A

Tardive dyskinesia, Dyslipidemia, Hyperglycemia

277
Q

Side effect of Quetiapine

A

HTN

278
Q

Side effect of Lurasidone

A

Akathasia

279
Q

Akathasia

A

Restlessness

280
Q

AIMS score

A

Abnormal Involuntary Rapid Movement score for tardive diskenesia

281
Q

Severe AIMS score

A

4

282
Q

Mild/Moderate AIMS score

A

2/3

283
Q

Criteria for cyclothymia

A

experience symptoms for 2+ years with no more than 2 months free of symptoms

284
Q

Treatment for cyclothymia

A

Mood stabilizer such as lithium and potential antidepressant if refractory

285
Q

Disruptive Mood Dysregulation Disorder

A

Persistently abnormal mood with frequent temper tantrums that interfere with ability to function at school/home

286
Q

Requirements for diagnosis of DMDD

A

1 year of symptoms
3+ severe outbursts per week
At least 6 years old and before 10
Symptoms in multiple settings

287
Q

Suicide risk rating tool

A

Colombia Suicide Severity Rating Scale (CSSR)

288
Q

3 things that make anxiety pathologic

A

No reasonable cause
Excessive
Causes distress

289
Q

Desensitization

A

Exposing a patient to an anxiety invoking stimulus in small doses

290
Q

Modeling

A

An anxious patient observes others doing things that they find anxiety inducing

291
Q

Flooding

A

A patient is exposed to anxiety at its worst and must use relaxation techniques to work through it

292
Q

2 short term therapies for anxiety

A

Benzodiazepines, Hydroxyzine

293
Q

First line long term therapy for anxiety

A

SSRIs or SNRIs

294
Q

MOA of bezodiazepines

A

Enhance effect of GABA at the GABA receptor

295
Q

3 side effects of benzodiazepines

A

Drowsiness, dizziness, dependance

296
Q

2 Interactions of Benzodiazepines

A

ETOH and opioids

297
Q

4 contraindications for benzodiazepines

A

Pregnancy, myasthenia gravis, respiratory depression, narrow angle glaucoma

298
Q

Midazolam

A

Short acting BZD for procedural sedation

299
Q

Triazolam

A

Short acting BZD for Insomnia

300
Q

Alprazolam

A

XANAX
Intermediate acting BZD for anxiety
High abuse potential

301
Q

Temazepam

A

Intermediate acting BZD for Insomnia

302
Q

Oxazepam

A

Intermediate BZD for Insomnia and EtOH withdrawal

303
Q

Lorazepam

A

Intermediate acting BZD for pretty much anything

304
Q

Clonazepam

A

Intermediate acting BZD for seizures, panic anxiety

305
Q

Diazepam

A

Valium
Long acting BZD for many things

306
Q

Chlordiazepoxide

A

Long acting BZD for EtOH withdrawal

307
Q

Flurazepam

A

Long acting BZD for insomnia

308
Q

How should BZDs be used

A

PRN for 1-4 weeks

309
Q

MOA of hydroxizine

A

Histamine H1 receptor agonist

310
Q

Considerations for giving hydroxazine

A

Can be addictive, cause drowsiness, and interact with potassium

311
Q

Buspirone

A

Second line - More for cognitive symptoms of anxiety, acts on 5HT and dopamine receptors - use with SSRI

312
Q

Criteria for generalized anxiety disorder

A

Worry about multiple things for 6 months with 3+ diagnostic characteristics

313
Q

Presentation of anxiety disorder

A

Persistent worry coupled with hyperarousal

314
Q

Initial screening for anxiety

A

GAD-7

315
Q

Self reported anxiety screening

A

Beck anxiety inventory

316
Q

Panic disorder

A

recurrent episodes of panic attacks (intense fear/discomfort with multiple accompanying symptoms)

317
Q

Agoraphobia

A

Avoidance of situations where help may be unavailable and leaving would be difficult

318
Q

Number of additional symptoms needed to classify a panic attack

A

4+

319
Q

Panic disorder criteria

A

1+ panic attacks followed by 1+ months of worry about additional attacks or maladaptive change

320
Q

1st line treatment for panic disorder

A

CBT and SSRI - Paroxetine recommended

321
Q

2nd line treatment for panic disorder

A

SNRIs or TCAs

322
Q

2 Adjunct meds for panic disorder

A

Alprazolam - short onset, more rebound
Clonazepam - Less rebound less frequent dosing

323
Q

Criteria for agoraphobia

A

6+ months of fear/anxiety with 2+ diagnostic criteria

324
Q

Agoraphobia treatment

A

Treat similar to panic disorder

325
Q

Criteria for social anxiety

A

6+ months of fear about 1+ social situations in which pt is exposed to potential scrutiny

326
Q

First line treatment for generalized social anxiety

A

CBT, SSRI, SNRI possibly with a PRN BZD

327
Q

First line treatment for performance only social anxiety disorder

A

PRN BZD before performance
PRN beta blocker such as propranolol

328
Q

Acute stress disorder

A

Acute stress reaction occurring in the initial month after a patient experiences trauma

329
Q

3 ways a person can experience trauma in acute stress disorder

A

Direct experience
Witnessing it
Having it happen to a close family member/friend

330
Q

Treatment for acute distress disorder

A

Trauma oriented CBT with exposure therapy
BZDs may help - Antidepressants not usually used because they take time to work

331
Q

Post traumatic stress disorder

A

Same criteria as Acute distress disorder, but lasts over 1 month

332
Q

Medication recommendations for PTSD

A

SSRIs or SNRIs

333
Q

3 potential add ons for PTSD

A

Atypical antipsycotics
Prazosin
BZDs

334
Q

OCD

A

Characterized by obsessions, compulsions, or both

335
Q

Obsessions and compulsions

A

Obsessions are a mental event (ie. thoughts) that cause distress
Compulsions are behaviors that pt feels driven to perform to make obsession stop

The two are not necessarily related

336
Q

Two aspects of s/s of OCD

A

time consuming
Cause distress or functional impairment

337
Q

Good/fair insight into OCD

A

Patient recognizes OCD beliefs may not be true

338
Q

Poor insight OCD

A

Pt thinks beliefs are probably true

339
Q

Treatment for OCD

A

CBT with exposure therapy and potential SSRI use (may need higher dose than usual)

340
Q

3 things that might trigger a phobia

A

Anticipation
Exposure
Reminders

341
Q

Criteria of a phobia

A

6+ months of disorder - out of proportion with functional impairment

342
Q

Treatment for Phobia

A

First line - CBT with exposure therapy

Second line: BZD for infrequently encountered stimuli; SSRI/SNRI for frequently encountered stimuli

343
Q

Dissociation

A

Segregation of any group of mental processes from the rest of someones psychological activity

344
Q

5 core symptoms of dissociative disorders

A

Amnesia
Depersonalization
Derealization
Identity confusion
Identity alteration

345
Q

Depersonalization

A

Feeling like a stranger in ones body - disconnected from ones self

346
Q

Derealization

A

Sense of disconnection from one’s surroundings - feels unfamiliar

347
Q

Dissociative amnesia

A

Potentially reversible memory impairment that primarily affects autobiographical memory

348
Q

Dissociative fugue

A

Sudden unexpected travel or wandering in a dissociative state

349
Q

Criteria for dissociative amnesia

A

Inability to recall autobiographical information that is TRAUMATIC in nature

350
Q

Localized amnesia

A

Inability to recall events related to a circumscribed period of time

351
Q

Continuous amnesia

A

Failure to recall successive events as they occur

352
Q

Generalized amnesia

A

Failure to recall one’s entire life

353
Q

Selective amnesia

A

Ability to remember some but not all of the events occurring during a circumscribed period of time

354
Q

Systematized amnesia

A

Failure to remember a category of information such as memories relating to a specific person

355
Q

Treatment for Dissociative amnesia

A

Psychotherapy - Meds may help some with recalling dissociated information

356
Q

Criteria for DID

A

Must have two or more distinct personality states

357
Q

Treatment for DID

A

Psychotherapy is the mainstay of treatment, however pharmacotherapy can be used to treat comorbid conditions

358
Q

Impulse control disorder

A

Compulsion to perform obviously harmful behavior brings relief and then guilt

359
Q

5 step cycle of Impulse control disorder

A

Urge-Tension-Act-Relief-Guilt

360
Q

2 impulse control disorders more common in MEN

A

Gambling and Pyromania

361
Q

Kleptomania

A

Involves compulsive theft of items that are NOT needed

362
Q

Pharmacotherapy for Kleptomania

A

SSRIs, Lithium

363
Q

Therapy for pyromania

A

Early intervention

364
Q

2 pharmacotherapies for Pathologic gambling

A

SSRIs, Opiate antagonists

365
Q

Pharmacotherapy

A

Clomipramine

366
Q

Intermittent Explosive Disorder

A

Episodes of loosing control that are grossly disproportionate to stimulus followed by genuine regret - MALES more common

367
Q

Infection that might lead to IED

A

Toxoplasmosis gondii

368
Q

Criteria for IED

A

Aggression twice weekly for 3 months
3+ outbursts with damage to property, etc. in 12 months
At least six
Actions CANNOT be premeditated

369
Q

Difference between conduct disorder and explosive disorder

A

Conduct disorder is persistent and repetitive while explosive disorder consists of outbursts

370
Q

Pharmacotherapy for IED

A

Combo treatment of serotonergic, mood stabilizer (ie. lithium) and other drugs

371
Q

Oppositional Defiant DIsorder

A

Frequent arguments with authority figures and misconduct while placing the blame on others - verbal rather than physical aggression
Reactive and Overt aggression

372
Q

Reactive aggression

A

In response to rules not proactive (ie. bullying)

373
Q

Overt aggression

A

Direct (shouting) rather than covert (spreading rumors

374
Q

3 types of ODD

A

Angry/Irritable
Argumentative/Defiant
Vindictive

375
Q

ODD criteria

A

6 months with 4+ symptoms

376
Q

Frequncy/Age criteria for ODD

A

Most days for under 5
Once per week for over 5

377
Q

Severity criteria for ODD

A

Mild - 1 setting
Moderate - 2 settings
Severe - 3+ settings

378
Q

Treatment for ODD

A

Pharmacotherapy only indicated for comorbid conditions
Family or individual therapy 1st line

379
Q

Conduct Disorder

A

More serious than ODD
Characterized by aggression and violation of the rights of others with violation of age-appropriate rules

380
Q

Criteria for CD

A

3+ diagnostic criteria in 12 months and 1 in 6 months

381
Q

4 general categories for CD criteria

A

Aggression to people/Animals
Destruction of property
Deceitfulness/Theft
Serious rule violations

382
Q

4 characteristics of CD with lack of prosocial emotions

A

Lack of remorse or guilt
Lack of empathy
Unconcerned about performance
Shallow or deficient affect

DONT care about consequences

383
Q

One disorder that should be considered as a possible comorbidity to conduct disorders

A

ADHD

384
Q

Therapy for CD

A

EARLY therapy
Antipsycotics, Anticonvulsants, and SSRIs

385
Q

Particularaly promising antipsychotic for conduct disorder

A

Risperidone

385
Q

5 categories of acute trauma symptoms

A

Intrusion, Negative Mood, Dissociative symptoms, Avoidance symptoms, Arousal symptoms

Behavioral Dynamics (3 decks)

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