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IPT: Neuro > Block 4 > Flashcards

Block 4 Flashcards

1
Q

Which antidepressants are used in PTSD? Which one is for long-term?

A

Sertraline + Paroxetine

Sertraline is for long-term use

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2
Q

How do SSRIs affect PTSD symptoms that other rx dont?

A

“Numb” the symptoms

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3
Q

Remission of PTSD is defined as…

Adequate? Partial?

A

Remission: >70% reduced symptoms

Adequate: >50

Partial: 25-50%

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4
Q

What are the FDA approved Rx for OCD?

A

Sertraline, Paroxetine

Clomipramine, fluvoxamine, fluoxetine

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5
Q

Cognitive behavioral therapy is recommended for whom in OCD? Meds?

A

Everyone

Meds for moderate-severe OCD

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6
Q

Why are SSRIs picked over clomipramine for OCD?

A

Clomipramine has anticholinergic effects, wt gain, CV issues, and sedation

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7
Q

If SSRI failed for OCD, whats next?

A

Another SSRI

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8
Q

Treatment resistance in OCD is defined as…

A

Decrease 25% from baseline YBOCS score

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9
Q

Which Rx should be avoided in special pop for OCD?

A

Clomipramine

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10
Q

PK of which Rx for OCD is not altered by renal failure pt?

A

Sertraline

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11
Q

Pregnancy and OCD, whats recommended?

A

Behavioral therapy first, then fluoxetine

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12
Q

What is a typical regimen for OCD?

A

SSRI + antipsychotic

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13
Q

Where does clomipramine fall in the regimen for OCD?

A

Second line treatment

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14
Q

Clomipramine monitoring?

A

LFTs

BP

If they have fever or sore throat, WBC

Seizures (dose dependent)

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15
Q

What are the major groups found in the sleep cycle? How long is it?

A

REM + NonREM

70-120 min

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16
Q

DMS-5 of Primary insomnia

A

Difficulty or maintaining sleep for at least 3 months AND 3 nights/week

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17
Q

Which Rx is FDA approved for insomnia maintenance?

A

Doxepin

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18
Q

Which antidepressants can be used in insomnia?

A

Amitriptyline and trazodone

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19
Q

Zolpidem MOA? Zaleplon?

A

Both binds to BZ-1 receptors, Zaleplon has shorter half life

Zolpidem only; Lower doses in women vs men

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20
Q

What special about Eszopiclone vs zolpidem and zaleplon?

A

FDA approved for up to 6 months

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21
Q

Special counseling info for ramelteon?

A

Take within 30 min before you sleep + do NOT take w/ food

Same w/ OX-1 antagonists

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22
Q

What is sleep apnea?

A

Doesnt breathe for at least 10 sec while sleep

Mild: 5-15/hr
Moderate: 15-30/hr
Severe: >30

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23
Q

Narcolepsy monitoring and genes?

A

Hypocretin : <110

Chromo 4p13-q21, HLA antigen

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24
Q

Which stimulants are used for cataplectic symptoms of narcolepsy?

A

None; use TCAs, SSRI, SNRIs, Selegiline

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25
Low to moderate drinkers consume how much alcohol?
<20g/day
26
Consumption of how much alcohol has a higher risk of CHD?
>70g/day Or binge drinking >5 drinks in less than 2hrs
27
Are toxic alcohols directly toxic?
No, they are inebriating except for isopropanol
28
Metabolism of Ethylene glycol?
Via alcohol dehydrogenase, forms glycolaldehyde and then to glycolate via aldehyde dehydrogenase then to oxlate via thiamine, magnesium and pyridoxine
29
Metabolism of methanol?
Via alcohol dehydrogenase forms formaldehyde and then Formate via aldehyde dehydrogenase
30
Metabolism of isopropanol?
Via alcohol dehydrogenase forms acetone
31
Osmolarity equation
2Na + (BUN/2.8) + (Glucose/18) +(EtOH/4.6) if alcohol toxicity
32
Anion gap equation
Na - Cl - HCO3 Gap present if >12
33
How to calculate osmol gap?
Measured-Calculated Normal MEASURED = 285-300 Normal gap = 10-20
34
How do you interpret which alcohol toxicity is given with anion and osmolar gap?
Anion AND Osmolar gap exist? Any toxicity except isopropyl Just osmolar gap? Isopropyl toxicity
35
Ethylene glycol is typically found in what?
Antifreeze, brake fluid Fluorescein in antifreeze is what is detectable in urine
36
How much ethylene glycol should someone be sent to a hospital?
10-30ml, but 100ml is considered "toxic"
37
Ethylene glycol toxicity phases?
I = CNS (30min to 12hrs) II = Metabolic (12-24hrs) III = Renal (2-3days)
38
How do you treat early ethylene toxicity?
Nasogastric aspiration (if less than one hr) Sodium bicarb if acidosis is life-threatening
39
How do you manage ethylene glycol toxicity?
Ethanol and fomepizole (adjust fomepizole if HD) to inhibit alcohol dehydrogenase (lvls have to be >20) Shunting therapy Hemodialysis
40
How much methanol is considered toxic?
Found in windshield fluid 15ml (cell death, increases formic acid and blindness) Methanol level >25
41
How does formic acid transform to water and carbon dioxide?
Via folate
42
How does acetone cause acidosis?
It doesnt by its own It does form ketones and that itself can cause acidosis tho
43
Antidote + alcohol toxicity, which alcohol doesnt have one?
Isopropanol
44
How is ethanol metabolised?
Through 3 ways (and is subject to genetic polymorphisms) Alcohol dehydrogenase CYP2E1 Peroxidase-catalase system
45
How do you treat acute intoxication of ethanol?
Nasogastric aspiration, supportive care (D5NS, banana bag)
46
What is a main concern of acute intoxication of ethanol?
Wernicke's encephalopathy due to thiamine deficiency Starvation ketosis Dehydration
47
What role does NAD+/NADH play with gluconeogenesis and glycolysis in ethanol metabolism?
Increased NADH/NAD+ ratio (used NAD+, reduced) Decreased gluconeogenesis and increased glycolysis Hypoglycemia
48
What role does NAD+/NADH play with pyruvate in ethanol metabolism?
Increased NADH/NAD+ ratio (used NADH, increased) Increases pyruvate, which is converted to lactate Lactic acidosis
49
What role does NAD+/NADH play with fat breakdown and synthesis in ethanol metabolism?
Increased NADH/NAD+ ratio (used NAD+, reduced) Less breakdown and increased synthesis Steatosis of liver
50
Patho of ethanol homeostasis in: Non-alcoholics Intoxication (non regular) Chronic/regular use Withdrawal
Non alcoholics; balance of GABA and Glutamate Non regular drinkers; GABA is upregulated Chronic/regular drinkers; both are upregulated, but is at "homeostasis" Withdrawal; Glutamate is upregulated
51
What Rx can you use for ethanol withdrawal?
BZD; lorazepam, diazepam, chlordiazepoxide
52
Lorazepam Diazepam Chlordiazepoxide Routes of each?
IV, IM, PO for lorazepam and diazepam Chlordiazepoxide is PO only
53
Lorazepam Diazepam Chlordiazepoxide Active metabolites?
Lorazepam is the only one that doesnt have one
54
Lorazepam Diazepam Chlordiazepoxide Onset and half life?
Diazepam has shortest onset and longest half life Lorazepam has 10-20 min onset with 12 hr half life Chlordiazepoxide has longest onset with 12-24hr half life
55
Isopropyl Methanol Ethylene glycol Ethanol Oxalic acid metabolite
Ethylene glycol
56
Isopropyl Methanol Ethylene glycol Ethanol Formic acid metabolite
Methanol
57
Isopropyl Methanol Ethylene glycol Ethanol Doesnt have a metabolite
Ethanol
58
Isopropyl Methanol Ethylene glycol Ethanol Acetone metabolite
Isopropyl
59
Isopropyl Methanol Ethylene glycol Ethanol Found in liquor
Ethanol
60
Isopropyl Methanol Ethylene glycol Ethanol Windshield fluid
Methanol
61
Isopropyl Methanol Ethylene glycol Ethanol Rubbing alcohol
Isopropyl
62
Isopropyl Methanol Ethylene glycol Ethanol Antifreeze
Ethylene glycol
63
Isopropyl Methanol Ethylene glycol Ethanol Has no anion gap
Isopropyl
64
Isopropyl Methanol Ethylene glycol Ethanol Ketosis exist
Only is isopropyl and ethanol
65
Isopropyl Methanol Ethylene glycol Ethanol Hypoglycemia occurs
Ethanol
66
Isopropyl Methanol Ethylene glycol Ethanol Blindness
Methanol
67
Isopropyl Methanol Ethylene glycol Ethanol Gastritis
Isopropyl
68
Isopropyl Methanol Ethylene glycol Ethanol Renal failure
Ethylene glycol
69
Isopropyl Methanol Ethylene glycol Ethanol Is osmotically active
All of them
70
What is the most common assay method for drug test?
EI
71
What are the federal (DHHS) guidelines that workplace must test for?
Marijuana Cocaine Opiates PCP Amphetamines Methamphetamines
72
What medications would cause a false positive value of amphetamines on the EI?
Selegine, bupropion, pseudoephedrine, metformin
73
What medications would cause a false positive value of BZDs on the EI?
Sertraline, efavirenz Only measures nordiazepam and oxazepam
74
What medications would cause a false positive value of opiates on the EI?
FQs, naltrexone, poppy seeds Only detects morphine and codeine
75
Does passive smoke or ingestion of hemp food cause a positive test on EI?
No
76
Estimated detection time in urine of amphetamine? Pseudoephedrine? Methylphendiate?
Amphetamine - 3 days Pseudoephedrine - 5 days Methylphenidate - 1 to 2 days
77
Estimated detection time in urine of BZD?
Diazepam - 10 days Others = 5 days
78
Estimated detection time in urine of opiates?
Morphine and codeine - 3 days
79
Estimated detection time in urine of buprenorphine?
7 days
80
Estimated detection time in urine of LSD?
<1 days Metabolite = 5 days
81
Estimated detection time in urine of marijuana?
Single use - 3 days 4-6x/week = 5 days Daily = 10 days Heavy use = 30 days
82
Estimated detection time in urine of PCP?
8 days
83
How are hair samples stored?
Dark room temp w/ gentle air to be dried if needed (not blow dry)
84
What makes a good test in regards to sensitivity and specificity?
Both >95%
85
How long does it take for the breath test?
2 minutes
86
Does physical dependence constitute addiction?
No, but often accompanies it
87
What is the only actual evidence of physical dependence?
Withdrawal syndrome
88
In addiction, what pathway is mostly affected?
Mesolimbic / Nucleus Accumbens Dopamine and glutamate
89
Opioid withdrawal sx?
Not life-threatending ``` Pupil dilation Sweat Tachycardia V/D Yawn Increase BP ```
90
BZD withdrawal sx?
High doses - seizures and delirium Moderate doses - anxiety, light sensitivity, cramps, sleep issues
91
Barbiturate withdrawal sx?
Tremors, hallucinations, hyperthermia, seizures, respiratory depression and arrest, coma, death
92
Order of potency Carfentanil, Fentanyl, Heroin, Morphine, Sufentanil
Morphine (1) Heroin (2) Fentanyl (100) Sufentanil (500) Carfentanil (10,000)
93
Which body systems are affected by amphetamine toxicity?
CV + CNS Same as cocaine
94
How is heroin metabolized? Codeine?
Converts to diacetylmorphine then hydrolyzed to morphine Codeine (an inactive prodrug) also is converted to morphine via 2D6
95
Opioid dependent vs opioid naive pt on heroin and PK
Naive = less concentration Dependent = heroin concentration is much higher
96
Non Pharm AUD - Mild Tx
AA Set goals Drink less, alternate alcoholic with non alcoholic Basic stuff
97
Non Pharm AUD - Moderate/severe Tx
Make recovery your priority in first few months Avoid triggers (pubs, friends) Sleep regular schedule Contingency plan for relapse, contact someone if this occurs
98
What is the delay, distract, and urge surfing technique?
Delay: wait x min to act on craving Distract: prepare list of distraction ahead of time Urge surfing: Picture urge as something else and imagine doing that instead
99
What are the 3 FDA Rx for alcohol cessation?
Disulfiram, Acamprosate, Naltrexone
100
Disulfiram MOA?
Metabolites of DSF inhibit aldehyde dehydrogenase Leads to facial flushing, N/V, tachycardia Enzyme inhibition is IRREVERSIBLE Used cautiously in mild/moderate Avoid in SEVERE cases
101
Acamprosate MOA?
Used after detoxification to decreases craving
102
Naltrexone MOA?
Similar to Acamprosate in that it reduces craving
103
Buprenorphine MOA?
Partial mu agonist and kappa antagonist

IPT: Neuro (4 decks)

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