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Flashcards in Day 4.2 Psych Deck (161):
1

Manic episode

>1week
Distinct period of abnormal and persistently elevated, expansive, or irritable mood.
Can be happy or angry
Often disturbing to the pt, but can also be fun- v. productive

2

Dx of manic episode

3 or more of DIG FAST:
Distractibility
Irresponsibility- hedonistic
Grandiosity- inflated self-esteem, can be delusional
Flight of ideas- racing thoughts
Activity and agitation increased
Sleep less (decreased need)
Talkative, pressured speech

3

Hypomanic episode

Like manic except mood disturbance doesn't interfere with social/occupational function, and doesn't need hospitalization
No psychotic features.

4

Bipolar disorder

At least 1 manic or hypomanic episode.
(manic = bipolar I, hypomanic = bipolar II)
Always get depressive symptoms eventually.
Pt's mood/fn usu returns to normal bt episodes.
Use of anti-depressants can lead to mania (bc they increase serotonin, NE)
Engage in pleasurable activities w potentially painful consequences
High suicide risk

5

Rx for bipolar disorder

mood stabilizers:
lithium
valproate
lamotrigine
carbamazapine

atypical antipsychotics:
olanzipine
aripiprazole

6

Cyclothymic disorder

>2 years
milder form of bipolar- hypomania, mild depression

7

Lithium mech and use

mech unknown, may be related to inhibition of phosphoinositol cascade
Use: mood stabilizer for bipolar disorder, blocks relapse and acute manic events
also used in SIADH
DoC for bipolar, mania

8

What is SIADH

Syndrome of Inappropriate(ly high) Anti-Diuretic Hormone
Excess ADH = retain water and don't urinate; serum Na+ decreases.

9

Toxicity of lithium

LMNOP
Lithium side effects:
Movement (tremor)
Nephrogenic DI
hypOthyroidism
Pregnancy problems

Tremor, sedation, edema, heart block, hypothyroidism, polyuria (ADH antagonist, causes nephrogenic DI), teratogenesis (Ebstein's anomaly of the heart).

Narrow therapeutic window, requires close monitoring of serum levels

10

Ebstein's anomaly of the heart

Opening of tricuspid valve is directed toward the apex of the RV.
Assoc w lithium in 1st trimester and WPW

11

Which anti-depressants have no sexual side effects?

Bupropion (wellbutrin)- atypical antidepr NDRI
Nefadozone- SNRI

12

Mjr depressive episode characteristics

>2wks, need at least 5 of these and also must include pt-reported depressed mood or anhedonia:
SIG E CAPS (GAS C PIES)
Sleep disturbance
Interest loss
Guilt/feelings of worthlessness
Energy loss
Concentration loss
Appetite/weight chg
Psychomotor retardation/agitation (leaden/hard to get up off of couch)

13

Major depressive disorder- recurrent

2 or more major depressive episodes with a symptom-free interval of 2 months

14

Dysthymia

Milder form of depression, 2 criteria, lasting at least two years

15

Seasonal affective disorder

assoc'd w winter, improves w light

16

Lifetime prevalence of depression

5-12% male
10-25% female

17

Sleep patterns of depressed pts

Decreases slow wave sleep (Stg 3&4)
Decreased REM latency (get to REM faster)
Increased REM early in sleep cycle
Increased total REM
Repeated night time awakenings
Early morning awakening (imp screening question)

18

Atypical depression.

characterized by hypersomnia, hyperphagia (overeating), and mood reactivity- ability to experience improved mood in response to positive events, vs persistent sadness, and psychomotor retardation (feeling like lead)
Assocd w weight gain and sensitivity to rejection
Most common subtype of depression
Rx: MAOIs, SSRIs (NOT TCAs)

19

What are the 3 post-partum mood disturbances, epi

Postpartum blues: 50-85%
Postpartum depression: 10-15%
Postpartum psychosis: 0.1-0.2%

20

Postpartum blues

Mild depression for 10days/2wks
Increased tearfulness, tiredness.
Rx supportive care, usually resolves. follow up at postpartum visit
Educate pts about this before birth! 50-85% of pts!!

21

Postpartum depression

Depressed affect that doesn't resolve after 2 weeks
Anx, poor concentration
A mjr depressive episode, just in the postpartum period.
Lasts 2 wks to over a year
Rx: anti-depressants, CBT, psychotherapy, supportive therapy

22

Postpartum psychosis

delusions, confusion, unusual bhvr, homicidal or suicidal ideations or attempts
Days-over 1mo
High assoc w bipolar disorder
Rx antipsychotics, antidepressants, in-pt hospitalization if pt is a danger

23

ECT

Treatment option for mjr depressive disorder if other Rx doesn't work.
Cause painless seizure in an anesthetized pt.
Can cause disorientation and antero/retrograde amnesia (minimize by performing ECT unilaterally)

24

Risk factors for suicide completion

SAD PERSONS:
Sex (male)
Age (teen or elderly)
Depression
Prev attempt
Ethanol/drug use
Rational thinking
Sickness (medical illness, 3+ prescriptions)
Organized plan
No spouse (divorced/widowed/single, esp if childless)
Social support lacking

Also, schizophrenia, access to a gun, and borderline personality disorder
Women try more, men succeed more.

25

List the TCAs

-ipramines and -tylines:
Imipramine, amitriptyline, desipramine, nortryptiline, clomipramine, doxepin, amoxapine.

26

How do TCAs work?

They block the reuptake of NE and Serotonin.

27

Use for TCAs

Mjr depression.
Imipramine: bed-wetting
Clomipramine: OCD
Also used for fibromyalgia (sympt improve w improved ability to sleep). Use nortriptyline for elderly pt/pt w fibromyalgia bc less side effects on ACh.

28

Side effects of TCAs

Sedation
alpha-blocking effects (hypotension, sedation, dizziness)
atropine-like (anticholinergic) effects- tachycardia, urinary retention
Tertiary TCAs (amitriptyline) have more anticholinergic effects than Secondary TCAs (nortriptyline).
Desipramine is the least sedating and has a lower seizure threshold.

29

TCA toxicity

Tri-C's: convulsions, coma, cardiotoxicity (arrhythmias)
also, respiratory depression, hyperpyrexia-d/t convulsions.
Confusion and hallucinations in elderly d/t anticholinergic side effects (so use nortriptyline)
Rx: NaHCO3 for CV toxicity

30

List the SSRIs

Fluoxetine
Paroxetine
Sertraline
Citalopram
Fluvoxamine

31

How do SSRIs work?

Sertonin-specific reuptake inhibitors
Usu takes 2-3 wks for them to start working (bridge w amphetamines)

32

Clinical use for SSRIs

Depression
bulemia
basically any anx disorder:
generalized anx disorder
panic disorder
PTSD
OCD
social phobias
can also use for atypical depression

33

SSRI toxicity

Less toxicity than TCAs
Sexual dysfn #1 reason for discontinuation
GI distress
Serotonin syndrome w any other drug that increased serotonin (eg MAOI)

34

What is serotonin syndrome?

caused by taking multiple drugs that increase serotonin
hyperthermia, musc rigidity (contraction), CV collapse, flushing, diarrhea, seizures
Rx: cooling and benzos 1st, then cyproheptadine (serotonin receptor antagonist)

35

Drugs associated with Serotonin Syndrome (so don't give these with SSRIs)

Other SSRIs, SNRIs, MAOIs
St. John's Wort, kava kava
Sibutramine (SNRI for weight loss)
Tryptophan
Cocaine, amphetamines

36

SSRI withdrawal

dizziness, nausea, fatigue, musc aches, anx, irritibility- get all of these with short-acting SSRIs, so give long acting fluoxetine (t1/2 is 9 days) to gradually taper.

37

List the SNRIs

Venlafaxine
Duloxetine
Desvenlafaxine
Nefadozone (no sexual side effects)
Milnacipran
Sibutramine (for weight loss)

38

How do SNRIs work?

Inhibit reuptake of both serotonin and NE

39

What are SNRIs used for?

Depression
Velafaxine- also used in gen anx disorder
Duloxetine- used for diabetic peripheral neuropathy
Duloxetine has a greater effect on NE.

40

Toxicity of SNRIs

Increased BP is most common
Also, stimulant effects, sedation, nausea

41

List MAOIs

Phenelzine
Tranylcypromine
Isocarboxazid
Selegiline (an MAO-B inhibitor, but not an anti-depressant. used for parkinsons)

42

Mechanism of MAOI

Nonselective MAO inhibition, leading to increased levels of amine NTs (Dopa, NE, Epi, Serotonin) bc MAO is inhibited and doesn't break them down as usual

43

Clinical use for MAOIs

Atypical depression
Anx
Hypochondriasis (hypochondriac)

44

Toxicity for MAOIs

HTN crisis when ingesting food with tyramine (wine, cheese, beer, soy sauce, any food that's aged)
HTN crisis with Beta-agonists
CNS stimulation
Contraindicated with SSRIs or meperidine (narcotic analgesic) to prevent serotonin syndrome
MAOI washout period- wait 2 wks before starting or after finishing MAOIs to avoid any interactions w other antidepressants

45

What are the atypical antidepressants?

Bupropion (wellbutrin) NDRI
Mirtzapine (a tetracyclic)
Trazodone (a tetracyclic)
Maprotiline

46

What atypical antidepressants are often used with SSRIs?

Buproprion (NDRI) and Trazodone

47

Buproprion

NDRI, Atypical antidepressant
Also used for smoking cessation
Increases NE and dopamine by unknown mech (so good w SSRI to increase serotonin and therefore cover all NTs)
Toxicity: stimulant effects (tachycardia, insomnia- so take in morning); headache. No sexual side effects.
Can cause seizure in bulemics or in anyone w hx of seizures or when given w anything that lowers the seizure threshold

48

Mirtzapine

Atypical antidepressant, tetracyclic.
Alpha2 antagonist (so increases rls of NE and serotonin), and potent serotonin receptor antagonist
Good for elderly pt w decreased appetite and insomnia (use side effects to advantage)
Toxicity: sedation, decreased appetite, weight gain, dry mouth (there are anti-histamine side effects)

49

Maprotiline

Atypical antidepressant
Blocks NE reuptake
Toxicity: sedation, orthostatic hypotension

50

Trazodone

Atypical antidepressant, tetracyclic.
Primarily inhibits serotonin reuptake.
Used for insomnia (esp in elderly) and at high doses for antidepressant
Toxicity: sedation, nausea, priapism (trazoBONE), postural hypotension

51

Amytriptylline side effects

Amytriptylline = TCA
dry mouth
tinnitus
blurred vision
mania
these are mostly due to amytriptylline's anti-cholinergic activity

52

Cyclothymia vs dysthymia

Cyclothymia - milder form of bipolar, >2 years (think cyclic)
Dysthymia - milder form of depression >2 years (D for depression)

53

Mech of action for benzodiazapines

facilitate GABA by increasing frequency of Cl- chnl opening

54

Mech of action for barbituates

Facilitate GABA by increasing duration of Cl- chnl opening

55

NDRI

NE Dopamine Reuptake Inhibitor
Bupropion (atypical antidepressant)

56

Nortryptilline

TCA

57

Selegiline

MAOI (for parkinsons, not for depression)

58

Buproprion

NDRI, atypical antidepressant

59

Mirtazapine

Tetracyclic, atypical antidepressant

60

Fluvoxamine

SSRI

61

Doxepin

TCA

62

Phenelzine

MAOI

63

Fluoxetine

SSRI

64

Clomipramine

TCA

65

Imipramine

TCA

66

Amitryptilline

TCA

67

Nefazodone

SNRI

68

Milnacipran

SNRI

69

Desipramine

TCA

70

Sertraline

SSRI

71

Venlafaxine

SNRI

72

Paroxetine

SSRI

73

Tranylcypromine

MAOI

74

Duloxetine

SNRI

75

Citalopram

SSRI

76

Desvenlafaxine

SNRI

77

Trazodone

Tetracycline, Atypical antidepressant

78

Panic disorder

Recurrent periods of intense fear and discomfort peaking in 10min
Must have at least 4:
PANICS (PPANIICCCCSSS)
Palpitations
Paresthesia
Abd distress
Nausea
Intense fear of dying/losing control
LIght-headedness
Chest pain
Chills
Choking
disConnectedness
Sweating
Shaking
Shortness of breath

Described in context of occurance (eg panic disorder w agorophobia)
Assocd w persistent fear of having another attack

79

Rx for panic disorder

Rx CBT (identifying underlying thought processes), SSRIs, TCAs, benzodiazepines (only when needed- simply having them can reduce incidence), B blockers (decrease HR)

80

Specific phobia

Excessive/unreasonable fear that interferes w normal function
Cued by presence or anticipation of specific object/situation (eg fear of heights)
Pt recognizes fear is excessive
Rx systematic desensitization

81

Social phobia (social anx disorder)

Exaggerated fear of embarassment in social situations (eg public speaking, using public restrooms)
Rx SSRIs

82

OCD

Recurring intrusive thoughts, feelings, sensations (obsessions) that cause severe distress; relieved in part by the performance of repetitive actions (compulsions)
Ego-DYStonic: behvr is NOT consistent with one's own beliefs/attitudes (vs O-C PERSONALITY disorder)
Ego-dystonic- the pt doesn't like it
Assoc w Tourette's
Rx: SSRIs, clomipramine (TCA)

83

PTSD

Persistent reexperiencing of prev traumatic event.
Nightmares, flashbacks, intense fear, helplessness, horror
Avoidance of stimuli assocd w trauma, persistant increased arousal
Lasts >1mo w onset any time after event. Causes significant distress or impaired fn
Rx Psychotherapy, SSRIs

84

Acute stress disorder

Sympt of PTSD but lasting bt 2 days to 1 mo
(Actual PTSD is >1mo)

85

Generalized anx disorder

>6mo
Anx that doesn't fit into any other category
Uncontrollable anx that is NOT related to a specific person, situation, event.
Assoc w sleep disturbance, fatigue, difficulty concentrating
Rx: Buspirone, SSRIs, benzos

86

Adjustment disorder

6mo in presence of a chronic stressor)

87

Buspirone

Used for Generalized Anx Disorder (>6mo)
Stims serotonin receptors
Does not cause sedation, addiction, tolerance
Does not interact w alcohol (vs barbituates, benzos, which do)

88

Malingering

Pt consciously fakes or claims to have a disorder in order to attain a specific secondary gain (eg avoiding work, obtaining drugs)
Avoids treatment by medical personnel
Complaints stop after pt gets what they want (not the case in factitious disorder)
Motivation is conscious- pt knows why they are doing it.

89

Factitious disorder

Pt consciously creates physical/psychological sympt in order to assume "sick role" and to get medical attention (primary gain)
But their motivation for doing this is UNconscious- pt doesn't know why they are doing it.

90

Munchausen's syndrome

Chronic factitious disorder w predominantly physical signs and symptoms.
Hx of multiple hospitalizations, willingness to receive invasive procedures

91

Munchausen's syndrome by proxy

Caregiver causes illness in child
Motivation is to assume a sick role by proxy
This is child abuse

92

Faking illness to get out of work

Malingering

93

Imagining going through the steps of a scary exam

Systematic desensitization (somatic desensitization)

94

Somatoform disorders

Physical sympt w no identifiable physical cause. Illness production and motivation are unconscious drives. Sympt not intentionally produced or feigned. More common in women.
Types: somatization disorder, conversion, hypochondriasis, body dysmorphic disorder, pain disorder, pseudocyesis

95

Somatization disorder

variety of complaints in multiple organ systems over a period of years
at least 4 pain, 2 GI, 1 sexual, 1 pseudoneurologic

96

Conversion

motor or sensory symptoms- paralysis, blindness, mutism, pseudoseizures), often after acute stressor.
Pt is aware of sympt but unusually indifferent- la belle indifferance

97

Hypochondriasis

preoccupation and fear of having a serious illness despite medical eval and reassurance

98

Body dysmorphic disorder

preoccupation w minor or imagined defect in appearance, leading to significant emotional distress/impaired functioning
Pts often repeatedly seek cosmetic surgery

99

Pain disorder

prolonged pain w no physical findings

100

Pseudocyesis

false belief of being pregnant

101

Motivation unconscious, creation of sympt conscious

Factitious disorder (incl munchausen's)

102

Motivation conscious, creation of symp conscious

Malingering

103

Motivation unconscious, creation of sympt unconscious

Somatization

104

Personality trait

enduring repetitive pattern of perceiving, relating to, thinking abt the env and oneself
exhibited in a wide range of imp social and personal contexts

105

Personality disorder

inflexible, maladaptive, rigidly pervasive pattern of behavior causing subjective distress and/or impaired functioning
pt is usu not aware of problem
usu NOT dx'd in children, stable by early adulthood
can't change them.

106

Cluster A personality disorders

A = Weird- accusatory, aloof, awkward.
Odd, eccentric. Inability to devp meaningful social relationships
Not psychotic, but genetic assoc w schizophrenia
3 Types: paranoid, schizoid, schizotypal (ssp=scary street people)

107

Cluster B personality disorders

B = Wild- bad, borderline, bubbly, best
Dramatic, emotional, or erratic
Genetic assoc w mood disorders and substance abuse.
4 types: antisocial, borderline, histrionic, narcissistic

108

Cluster C personality disorders

C = Worried (cowardly, compulsive, clingy)
Anxious or fearful
Genetic assoc w anx disorders
3 types: avoidant, OC personality disorder (not OCD!), dependent

109

Borderline personality disorder

Cluster B (bad, BORDERLINE, bubbly, best)
Unstable mood and interpersonal relationships, impulsiveness, self-mutilation, suicide ideation, sense of emptiness
F>M
Splitting is a mjr defense mech (all gd or all bad)

110

Schizoid

Cluster A (accusatory, ALOOF, awkward)
Schizoid = Avoid
Voluntary social withdrawal, limited emotional expression, content w social isolation (vs avoidant, cluster c who is hps to rejection and wants relationships)

111

Narcissistic personality disorder

Cluster B (bad, borderline, bubbly, BEST)
Grandiosity, sens of entitlement, lacks empathy and req's excessive admiration
often demands the best and reacts to criticism with rage

112

Dependent personality disorder

Cluster C (cowardly, compulsive, CLINGY)
submissive and clinging
excessive need to be taken care of
low self-confidence

113

Paranoid personality disorder

Cluster A (ACCUSATORY, aloof, awkward)
pervasive distrust and suspiciousness
projection is a mjr defense mech

114

Obsessive compulsive personality disorder

Cluster C (cowardly, COMPULSIVE, clingy)
Pre-occupation w order, perfectionism, and control. Ego-syntonic- the behavior IS consistent w own beliefs and attitudes (vs OCD, where it's not)

115

Avoidant personality disorder

Cluster C (COWARDLY, compulsive, clingy)
HPS to rejection, socially inhibited, timid, feelings of inadequacy
Desires relationships w others, but afraid. (vs schizoid, which avoids)

116

Antisocial personality disorder

Cluster B (BAD, borderline, bubbly, best)
Disregard for and violation of rights of others, criminality
M>F
if s conduct disorder
antiSOCial = SOCiopath

117

Schizotypal

Cluster A (accusatory, aloof, AWKWARD)
Eccentric appearance, odd beliefs or magical thinking, interpersonal awkwardness
Schizotypal, dress like a pickle!

118

Histrionic

Cluster B (bad, borderline, BUBBLY, best)
Excessive emotionality and excitability, attention seeking, sexually provacative, overly concerned w appearance

119

What are the genetic associations with cluster A, B, C

A: schizophrenia
B: mood disorders, substance abuse
C: anx disorders

120

Substance dependence

Maladaptive pattern of substance use, 3 or more of the following signs in 1 year:
Tolerance (need more to get same effect)
Withdrawal
Substance taken in lgr amts and over longer time than desired
Persistent desire/unsuccessful attempts to cut down
Significant energy used to obtain, use, recover from substance
Reduced number of imp social, job-related, fun activities d/t substance use
Continued use even tho know it's bad

121

Substance abuse

Maladaptive pattern leading to clinically significant impairment/distress.
Sympt have NEVER met criteria for dependencs.
Recurrent use, leading to failure to fulfill mjr obligations at work/school/home
Recurrent use in physically dangerous situations
Recurrent legal problems bc of substance abuse
Keep using it in spite of persistent problems caused by use

122

Substance withdrawal

Bhvrl, physiologic, cognitive state caused by cessation or reduction of heavy/prolonged use.
Sympt/signs often opposite of those seen in intoxication.

123

S&S depressant:
Alcohol intoxication

Disinhibition
Emotional lability
Slurred speech
Ataxia
Coma
Blackouts
Serum gamma-glutamyltransferase (GGT)- sensitive indicator of alch use
Fatty chg of liver
AST = 2xALT (A Scotch & Tonic)
Rx: time! (naltrexone, disulfiram are for prevention)

124

S&S depressant:
Alcohol withdrawal

Alch withdrawal is life threatening!
Tremor
Tachycardia
HTN
Malaise
Nausea
Seizures
DTs- delirium tremens
Tremulousness
Agitation
Hallucinations (incl tactile- ants)

Rx for DTs: benzodiazapines (or alcohol)

125

S&S depressants:
opioid intoxication
eg morphine, heroin, methadone

CNS depression
Naus/vom
constipation
pupillary constriction (pinpoint pupils)
seizures (OD is life-threatening)
Rx: naloxone, naltrexone

126

S&S depressants:
opioid withdrawal
eg morphine, heroin, methadone

uncomfortable, but NOT life threatening like alch withdrawal)
anx
insomnia
anorexia
sweating
dilated pupils
piloerection (cold turkey)
fever
rhinorrhea
nausea, stomach cramps, diarrha (flu-like sympt)
yawning

Rx: treat sympt; naloxone + buprenorphone (suboxone); methadone

127

S&S depressants:
Barbituate intoxication

Respiratory depression.
Have a low safety margin
Rx: manage sympt (assist breathing, increase BP)

128

S&S depressants:
Barbituate withdrawal

Anx
seizures
delirium
life-threatening CV collapse

129

S&S depressants:
Benzodiazapine intoxication

Greater safety margin than barbituates.
Amnesia
ataxia
somnolence (that's why ppl use them)
minor respi depression
additive effects w alcohol.

RX: flumazenil (competitive GABA antagonist)

130

S&S depressants:
Benzodiazapine withdrawal

Rebound anx
seizures
tremor
insomnia

131

Prevention of relapse in alcoholics

AA
disulfiram
naltraxone
topiramate (anti-seizure drug)
acamprosate

132

Delirium Tremens

life-threatening alch withdrawal syndrome
peaks 2-5 days after last drink
in order of appearance:
autonomic system hyperactivity (tachycardia, tremors, anx, seizures)
psychotic symptoms (hallucinations, delusions)
confusion

RX: benzos

133

Alcoholism

physiological tolerance and dependence w sympt of withdrawal (tremor, tachycardia, HTN, malaise, nausea, DTs) when intake is interrupted
complications - alcoholic cirrhosis, hepatitis, pancreatitis, peripheral neuropathy, testicular atrophy, sat night palsy (compress radial nerve), aspiration pneumonia
Alch is a diuretic, so it causes tubular dysfn and will decrease Mg2+ levels- give alcoholics Mg2+ in the ER, esp if they are having heart problems.

134

Wernicke-Korakoff syndrome

Seen in alcoholics.
Caused by thiamine/B1 deficiency
Triad: confusion, opthalmoplegia, ataxia (Wernicke's encephalopathy)
May progress to irreversible memory loss, confabulation, personality chg (Korsakoff's psychosis)
Assoc w periventricular hemorrhage/necrosis of mammillary bodies.
RX: IV thiamine/B1

135

Mallory-Weiss syndrome

See in alcoholism
Longitudinal lacerations at the GE junction, caused by excessive vomiting.
Often presents w hematemesis
Assoc w pain (vs esophageal varices, which bleed but are painless)

136

Heroin addiction

Users at incrsd risk for hepatitis, liver abscess, overdose, hemorrhoids, AIDS, right-sided endocarditis, tricuspid valve endocarditis. Many of risks are due to needle use, not heroin itself
Look for needle sticks in veins (track marks)
Will have sympt of opioid intoxication (pinpoint pupils, respi depression, coma)

Rx: Naloxone, naltrexone, methadone, suboxone

137

Nalxone, naltrexone

Competitively inhibit opioids
Used in cases of opioid OD
If unconscious pt in ER, often give these just in case it's OD.

138

Methadone

long-acting oral opiate, used for heroin detox or long-term maintenance

139

Suboxone

naloxone + buprenorphine (partial agonist)
long-acting w fewer withdrawal sympt than methadone.
naloxone is not active when taken orally, so withdrawal sympt occur only if injected. (lower abuse potential)

140

Rx for benzo OD

Flumazenil

141

What drug categories cause pupillary constriction (miosis)

Opiods
Organophosphates, any Anti-AChE (stigmines)

142

What drug categories cause pupillary dilation (mydriasis)

Stimulants- amphetamines, cocaine
Muscarinic antagonists- atropine
Withdrawal of Opioids
Hallucinogens- LSD

143

CAGE questionnaire

Alch screening:
Cut back
Annoyed (when ppl ask you abt it)
Guilty
Eye-opener

144

Rx for alcoholic with hypoglycemia

Give B1/Thiamine BEFORE giving glucose.
Alcoholics have impaired gluconeogenesis- they can't generate glucose. But, if you just give them glucose, will cause Werenke-Korsakoff. So give B1 first, then can give glucose.

145

What's in a banana bag?

thiamine (B1), folate, multivitamines, Mg2+
give to alcoholics

146

B1/thiamine deficiency

Causes Wereke-Korsakoff or Beri Beri (dry/wet)

147

Rx for alcoholics (prophylaxis)

AA, disulfiram, etc
HBV, HAV, pneumonia, influenza vaccines
Warn abt tylenol use- 4g is toxic to liver.

148

S&S stimulants:
Amphetamines intoxication/OD

Psychomotor agitation
Impaired judgement
Pupillary dilation
HTN
Tachycardia
Euphoria
Prolonged wakefulness and attn
Cardiac arrhythmias
Delusions, hallucinations
Fever

149

S&S stimulants:
Amphetamine and Cocaine withdrawal

Post-use "crash"
severe depression, suicidality
lethargy, hypersomnulence, fatigue, malaise
stomach cramps, hunger
severe psychological craving

150

S&S stimulants:
Cocaine OD

Euphoria
Psychomotor agitation
impaired judgement
tachycardia
pupillary dilation
HTN
hallucinations (tactile)
paranoid ideations
angina
sudden cardiac death

151

Rx for cocaine OD

benzos, haloperidol

152

S&S stimulants:
Caffeine OD

Restlessness, insomnia, increased diuresis, muscle twitching, cardiac arrhythmia- PACs, PVCs (premature atrial, ventricle contractions)

153

S&S stimulants:
Caffeine withdrawal

Headache, lethargy, depression, weight gain

154

S&S stimulants:
Nicotine OD

Restlessness, insomnia, anx, arrhythmias- PACs, PVCs

155

S&S stimulants:
Nicotine Withdrawal and RX

Irritability, headache, craving, weight gain
RX: nicotine replacement (gum, patch, losenge)
help prevent relapse w bupropion/varenicline

156

S&S hallucinogens:
PCP intoxication/OD

Belligerence (!)
impulsiveness
fever
psychomotor agitation
vertical and horizontal nystagmus
tachycardia
ataxia
Violence- homicidality
psychosis, delirium

157

Rx for PCP intoxication

Benzos, haloperidol

158

S&S hallucinogens:
PCP withdrawal

Depression, anx
irritability, restlessness
anergia, disturbances in thought and sleep
violence (can have with both OD and withdrawal)

159

S&S hallucinogens:
LSD OD

marked anx or depression
delusions
visual hallucinations
flashbacks (even years later)
pupillary dilation

160

S&S hallucinogens:
MJ intoxication

euphoria, anx, paranoid delusions
perception of slowed time
impaired judgement
increased appetite
dry mouth, hallucinations
red eyes (conjunctivitis)
long term: social withdrawal
teens who use have incrsd risk for schizophrenia

161

S&S hallucinogens:
MJ withdrawal

Irritability, depression
insomnia
nausea, anorexia
Most sympt peak in 48 hrs and last 5-7 days
Can detect in urine up to 1mo after use