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Flashcards in Psych - First Aid Deck (308):
1

Classical conditioning

Learning in which a natural response is elicited by a conditioned stimulus that previously was presented in conjunction with an unconditioned stimulus. Ex. Pavlov's dogs

2

Classical conditioning usually deals with...

involuntary responses.

3

Operant conditioning

learning in which a particular action is elicited becasue it produces a punishment or reward

4

Operant conditioning usually deals with...

voluntary responses.

5

Positive reinforcement

desired reward produces action (mouse presses button to get food)

6

Negative reinforcement

target behavior (response) is followed by removal of averse stimulus (mouse presses button to turn off continuous loud noise)

7

Punishment

repeated application of aversive stimulus extinguishes unwanted behavior

8

Extinction

discontinuation of reinforcement (positive or negative) eventually eliminates the behavior. Can occur in operant or classical conditioning

9

Transference

pt projects feelings about formative or other importnat persons onto physician (ex. psychiatrist is seen as a parent)

10

Countertransference

doctor projects feelings about formative or other important persons onto pt (ex. pt reminds physician of younger sibling)

11

Acting out

expressing unacceptable feelings and thoughts through actions Ex. tantrums

12

Dissociation

temporary, drastic change in personality, memory, consciousness or motor behavior to avoid emotional stress ex. extreme forms can result in dissociative identity disorder

13

Denial

avoiding the awareness of some painful reality ex. a common rxn in newly diagnosed AIDS and cancer pts

14

Displacement

transferring avoided ideas and feelings to some neutral person or object Ex. mother yells at her child bc her husband yelled at her

15

Fixation

partially remaining at a more childish level of development Ex. men fixating on sports games

16

Identification

modeling behavior after another person who is more powerful ex. abused child identifies with abuser

17

Isolation

separating feelings from ideas and events ex. describing murder in graphic detail with no emotional response

18

Projection

attributing an unacceptable internal impulse to an external source ex. a man who wants another woman thinks his wife is cheating on him

19

Rationalization

proclaiming logical reasons for actions actually performed for other reasons, usually to avoid self-blame Ex. after getting fired, claiming that the job was not important anyway

20

Reaction formation

replacing a warded-off idea or feeling by an (unconsciously derived) emphasis on its opposite ex. a pt with libidinous thoughts enters a monastery

21

Regression

turning back the maturational clock and going back to earlier modes of dealing with the world ex. seen in children under stress (illness, punishment, new sibling) - bedwetting in a previously toilet-trained child

22

Repression

involuntary witholding an idea or feeling from conscious awareness Ex. not remembering a conflictual/traumatic experience; pressing bad thoughts into the unconscious

23

Splitting

believing that people are either all good or all bad at different times due to intolerance of ambiguity ex. pt says that all nurses were cold/insensitive but the doctors were warm/friendly

24

Splitting is often seen in...

borderline personality disorder.

25

Altruism

alleviating guilty feelings by unsolicited generosity towards others Ex. mafia boss makes large donation to charity

26

Humor

appreciating the amusing nature of an anxiety-provoking or adverse situation Ex. nervous med student jokes about boards

27

Sublimation

replacing an unacceptable wish with a course of action that is similar to the wish but does not conflict with one's value system Ex. teen's aggression toward his father is redirected to perform well in sports

28

Suppression

intentional witholding of an idea or feeling from conscious awareness ex. choosing not to worry about the big game until it is time to play

29

Long-term deprivation of affection in infants leads to...

-decreased muscle tone -poor language skills -poor socialization skills -lack of basic trust -anaclitic depression -weight loss -physical illness

30

Deprivation in an infant for more than 6 months can...

lead to irreversible changes. Severe deprivation can result in death.

31

The main physical abuser of children is usually...

the biological mother and usually occurs before the age of 3.

32

Peak age of sexual abuse in children

9-12 (signs: genital, anal or oral trauma, STDs, UTIs)

33

Evidence of physical abuse

-healed fractures on x-ray (esp. spinal) -burns -subdural hematomas -pattern marks/bruising -rib fractures -retinal detachment/hemorrhage

34

The most common form of child maltreatment is...

child neglect which is the failure to provide a child with food, shelter, supervision, education and affection.

35

Evidence of child neglect

-poor hygiene -malnutrition -withdrawal -impaired social/emotional development -FTT

36

Attention Deficit Hyperactivity Disorder (ADHD)

-onset before 12 -poor impulse control -normal intelligence but has difficulty in school

37

ADHD is associated with...

decreased frontal lobe volume/metabolism

38

Treatment for ADHD

-methylphenidate -amphetamines -atomoxetine -behavioral interventions

39

Conduct Disorder

-repetitive, pervasive behavior violating the basic rights of others (physical aggresion, property destruction, theft)

40

After the age of 18, many with conduct disorder will meet the criteria for...

antisocial personality disorder.

41

Oppositional Defiant Disorder

-enduring pattern of hostile, defiant behavior toward authority figures in the absence of serious violations of social norms

42

Tourette Syndrome

-onset before 18 -sudden, rapid, recurrent, nonrhythmic, stereotyped motor and vocal tics that persist for more than 1 year

43

Coprolalia is...

involuntary obscene speech. Seen in only 10-20% of those with Tourette's.

44

Tourette's is associated with...

OCD and ADHD.

45

Treatments for Tourette's

-antipsychotics -behavioral therapy

46

Separation anxiety disorder

-onset 7-9 yrs -overwhelming fear of separation from home or loss of attachment figure -may lead to factitious physical complaints to avoid going to school

47

Treatment for Separation anxiety disorder

-SSRIs -relaxation/behavioral interventions

48

Pervasive developmental disorders are characterized by...

difficulties with language and failure to acquire or early loss of social skills.

49

Pervasive developmental disorders

1. Autism spectrum disorder 2. Rett Disorder

50

Autism is characterized by...

poor social interactions, communication deficits, repetitive behaviros and restricted interests.

51

Autism must present in...

early childhood and may or may not be accompanied by intellectual disability. More common in boys.

52

Rett disorder

-X-linked disorder almost exclusively in girls -symptoms appear at 1-4 yrs old -regression, loss of development and verbal abilities -ataxixa -intellectual disability -sterotyped hand-wrigning

53

Alzheimer NT changes

decreased ACh

54

Anxiety NT changes

increased NE decreased GABA and serotonin

55

Depression NT changes

decreased NE, serotonin and dopamine

56

Huntington NT changes

decreased GABA and ACh increased dopamine

57

Parkinson NT changes

decreased dopamine increased serotonin and ACh

58

Schizophrenia NT changes

increased dopamine

59

Common causes of loss of orientation

-alcohol/drugs -fluid/electrolyte imbalance -head trauma -hypoglycemia -infxn -nutritional deficiencies

60

Order of loss of orientation

1st - time 2nd - place last - person

61

Retrograde amnesia

inability to remember things that occurred before a CNS insult

62

Anterograde amnesia

inability to remember things that occured after a CNS insult (no new memories)

63

Korsakoff amnesia

-classic anterograde amnesia caused by thiamine deficiency and the associated destruction of mammillary bodies -seen in alcoholics and associated with confabulations

64

Dissociative amnesia

inability to recall important personal information, usually subsequent to severe trauma or stress

65

Dissociative amnesia may be associated by...

dissociative fugae (abrupt travel or wandering during a period of dissociative amnesia)

66

Cognitive disorder

-significant changes in cognition (memory, attention, language, judgement)

67

Cognitive disorder includes...

delirium and dementia.

68

Delirium

-waxing and waning level of consciousness with acute onset -rapid decrease in attention span and level of arousal -disorganized thinking, hallucinations, illusions, misperceptions, disturbance in sleep, cognitive dysfunction -abnormal EEG

69

Delirium is usually secondary to...

another illness: -CNS disease -infxn -trauma -substance abuse/withdrawal -metabolic/electroly disturbances -hemorrhage -urinary/fecal retention

70

If a patient has delirium, check for...

drugs with anticholinergic effects. Usually reversible.

71

Dementia is a...

gradual decrease in intellectual ability or cognition without affecting levels of consciousness.

72

Dementia is characterized by...

memory deficits, aphasia, apraxia, agnosia, loss of abstract thought, behavioral/personality changes, impaired judgement. (EEG usually normal)

73

A patient with dementia can develop...

delirium. Ex. a pt with AD who develps pneumonia is at increased risk for delirium.

74

Irreversible causes of dementia

-Alzheimer disease -Lewy body dimentia -Huntington disease -Pick disease -cerebral infarcts -Creutzfeldt-Jakob disease -chronic substance abuse

75

Reversible casues of dementia

-NPH -vitamin B12 deficiency -hypothyroidism -neurosyphilis -HIV

76

In elderly pts, depression may present...

like dementia (pseudodementia).

77

Psychosis

a distorted perception of reality characterized by delusions, hallucinations, and/or disorganized thinking

78

Hallucinations

perceptions in the absence of external stimuli (seeing a light that is not actually present)

79

Delusions

unique, false beliefs about oneself or others that persist despite the facts (thinking aliens are communicating with you)

80

Disorganized speech

words and ideas are strung together based on sounds, puns or loose associations

81

Visual hallucinations are more commonly a feature of...

medical illness (drug intoxication) than psychiatric illness.

82

Auditory hallucinations are more commonly a feature of...

psychiatric illness (schizophrenia) than medical illness.

83

Olfactory hallucinations often occur as...

an aura of psychomotor epilepsy and in brain tumors.

84

Tactile hallucinations are common in...

alcohol withdrawal (formicatin = sensation of bugs crawling on one's skin); also seen in cocaine abuse.

85

Hypnagogic hallucinations occurs...

while going to sleep.

86

Hypnopompic hallucinations occur...

when waking from sleep.

87

Schizophrenia is a...

chronic mental disorder with periods of psychosis, disturbed behavior and thought, and decline in functioning that lasts more than 6 months.

88

Schizophrenia is associated with...

increased dopaminergic activity and decreased dendritic branching.

89

Diagnosis of Schizophrenia requires 2 or more of the following:

1. delusions 2. hallucinations 3. disorganized speech (loose associations) 4. disorganized or catatonic behavior 5. negative symptoms (flat affect, social withdrawal, lack of motivation, lack of speech/thought)

90

Brief sychotic disorder

less than one month, usually stress related

91

Schizophreniform disorder

1-6 months

92

Schizoaffective disorder

at least 2 wks of stable mood with psychotic symptoms plus a major depressive, manic or mixed episode

93

In teens, psychosis/schizophrenia is associated with...

frequent cannabis use.

94

Schizophrenia presents in men...

earlier (late teens to early 20s) than women (late 20s to early 30s).

95

Delusional Disorder

fixed, persistent, untrue belief system lasting more than one month Ex. woman who genuinely believes she is married to a celebrity

96

Dissociative Identity Disorder

presence of 2 or more distinct identities or personality states; more common in women

97

Dissociative Identity Disorder is associated with...

hx of sexual abuse, PTSD, depression, substance abuse, borderline personality disorder and somatoform conditions

98

Depersonalization/Derealization Disorder

persistent feelings of detachment or estrangement from one's own body, thoughts, perceptions and actions (depersonalization) or one's environment (derealization)

99

Mood disorder

characterized by an abnormal range of moods or internal emotional states and loss of control over them; severity of mood causes distress and impairment in social and occupational functioning

100

Mood disorders include...

major depressive disorder, bipolar disorder, dysthymic disorder and cyclothymic disorder

101

Manic episode

distinct period of abnormally, persistently elevated, expansive or irritable mood and increased activity/energy lasting at least one week

102

Diagnosis of Manic episode requires hospitalization or at least three of the following:

manics DIG FAST 1. Distractibility 2. Irresponsibility 3. Grandiosity 4. Flight of Ideas 5. increase in goal-directed Activity/psychomotor Agitation 6. decreased need for sleep 7. Talkativeness

103

Hypomanic episode

like manic episode except mood disturbance is not severe enough to cause marked impairment in social and/or occupational functioning or to necessitate hospitalization; lasts at least 4 consecutive days

104

Bipolar I is defined by...

the presence of at least 1 manic episode with or without a hypomanic or depressive episode.

105

Bipolar II is defined by...

the presence of a hypomanic and a depressive episode.

106

Between episodes in bipolar, pts mood and functioning usually...

returns to normal.

107

Use of antidepressants can lead to...

increased mania. High suicide risk in bipolar.

108

Treatment for Bipolar

-mood stabilizers (lithium, valproic acid, carbamazepine) -atypical antipsychotics

109

Cyclothymic disorder

-dysthymia and hypomania -milder form of bipolar lasting at least 2 yrs

110

In major depressive disorder (MDD), episodes usually last...

6-12 months.

111

MDD episodes are charachterized by at least 5 of the following 9 symptoms for 2 or more weeks

-sleep disturbance -loss of interest (anhedonia) -guilt or feelings of worthlessness -energy loss and fatigue -concentration problems -appetite/weight changes -psychomotor retardation or agitation -suicidal ideations -depressed mood

112

Pts with depression typically have the following changes in their sleep stages:

-decreased slow wave sleep -decreaesd REM latency -increased REM early in sleep cycle -increased total REM -repeated nighttime awakenings -early-morning awakening

113

Persistent, depressive disorder (dysthymia)

depression, often milder, lasting at least 2 yrs

114

Seasonal affective disorder

symptoms usually associated with winter season; improves in response to full-spectrum bright-light exposure

115

Atypical depression is characterized by...

mood reactivity, reversed vegetative symptoms (hypersomnia and weight gain), leaden paralysis, and interpersonal rejection sensitivity

116

Treatment of Atypical Depression

-MAO inhibitors -SSRIs

117

Postpartum mood disturbances has onset within...

4 wks of delivery

118

Maternal (postpartum) blues are characterized by...

depressed affect, tearfulness, and fatigue starting 2-3 days after delivery.

119

Maternal blues usually resolves...

within 10 days. Treatment is supportive and requires follow-up.

120

Postpartum depression is characterized by...

depressed affect, anxiety and poor concentration starting within 4 wks after delivery. It lasts 2 wks to a year or more.

121

Postpartum psychosis is characterized by...

delusions, hallucinations, confusion, unusual behavior and possible homicidal/suicidal thoughts/attempts. Usually lasts days to wks.

122

Pathologic grief is...

normal bereavement characterized by shock, denial, guilt and somatic symptoms. Duration varies (up to 6-12 months). May experience simple hallucinations (ex. hearing name called).

123

Electroconvulsive therapy

treatment option for MDD refractory to other treatment and pregnant women with MDD; also considered when immediate response is necessary, in depression with psychotic features and for catatonia.

124

ECT produces...

a relatively painless seizure in an anesthetized pt.

125

Adverse effects of ECT include...

disorientation, temporary HA and partial amnesia (resolves).

126

Risk factors for suicide completion

SAD PERSONS -sex (male) -age (teen or elderly) -depression -previous attempt -ethanol or drug use -loss of rational thinking -sickness -organized plan -no spouse -social support lacking

127

Symptoms of anxiety disorder will...

interfere with daily functioning.

128

Anxiety disorder includes...

panic disorder, phobias, and generalized anxiety disorder.

129

Panic Disorder is defined by...

the presence of recurrent panic attacks (periods of intense fear and discomfort peaking in 10 min with at least 4 of the following): 1. palpitations 2. paresthesias 3. Abdominal distress 4. Nausea 5. intesnse fear of dying or losing control 6. light-headedness 7. chest pain 8. chills 9. choking 10 disconnectedness 11. sweating 12. shaking 13. shortness of breath *strong genetic component

130

Treatment for Panic Disorder

-behavioral therapy -SSRIs -venlafaxine -benzodiazepines

131

Diagnosis of Panic Disorder requires an attack followed by 1 month of at least 1 of the following:

1. persistent concern of additional attacks 2. worrying about the consequences of the attack 3. behavioral change related to the attacks

132

Specific phobias can be treated with...

systematic desensitization.

133

Types of specific phobia

-social anxiety disorder -agoraphobia

134

Social Anxiety Disorder can be treated with...

SSRIs.

135

Agoraphobia is...

exaggerated fear of open or enclosed places, using pulbic transportation, being in line or in crowds or leaving home.

136

Generalized anxiety disorder is a pattern of...

uncontrollable anxiety for at least 6 months that is unrelated to a specific person, situation or event.

137

Generalized anxiety disorder is associated with...

sleep disturbance, fatigue, GI disturbance and difficulty concentrating.

138

Treatment for Generalized Anxiety Disorder

-SSRIs -SNRIs -Buspirone -Cognitive behavioral therapy

139

Ego dystonic obsessive-compulsive disorder is...

inconsistent with one's own beliefs and attitudes.

140

Treatment of OCD

-SSRIs -Clomipramine

141

In PTSD, the disturbance lasts...

more than one month causing significant distress, negative cognitive alterations and/or impaired functioning.

142

Treatment of PTSD

-psychotherapy -SSRIs

143

Acute stress disorder lasts...

between 3 days and 1 month.

144

Malingering

patient consciously fakes, profoundly exaggerates or claims to have a disorder in order to attain a specific secondary (external) gain (avoiding work or obtaining compensation)

145

Pts who are malingering have...

poor compliance with treatment and follow-up tests and their complaints stop after the gain.

146

Factitious disorders

pt consciously creates physical and/or psychological symptoms in order to assume "sick role" and to get medical attention (primary (internal) gain)

147

Munchausen Syndrome

Chronic factitious disorder with predominantly physical signs and symptoms

148

Munchausen Syndrome is characterized by...

a history of multiple hospital admissions and willingness to receive invasive procedures

149

Munchausen Syndrome by proxy

when illness in a child or elderly pt is caused by the caregiver; motivation is to assume a sick role by proxy

150

Somatic symptom, etc. is a category of disorders characterized by...

physical symptoms with no identifiable phyical cause; both the illness production and motivation are unconscious drives; symptoms are not intentionally produced or feigned

151

Conversion disorder

-sudden loss of sensory or motor function, often following an acute stressor; pt is aware of but sometimes indifferent toward symptoms (la belle indifference)

152

Illness anxiety disorder (hypochondriasis)

preoccupation with and fear of having a serious illness despite medical evaluation and reassurance

153

Cluster A Personality Disorders (Weird)

1. Paranoid 2. Schizoid 3. Schizotypal (Accusatory, Aloof, Awakward)

154

Cluster A Personality Disorders Features

-odd/eccentric -inability to develop meaningful social relationships -no psychosis -genetic association with schizophrenia

155

Paranoid Personality Disorder

pervasive distrusta nd suspiciousness; projection is the major defense mechanism

156

Schizoid Personality Disorder

Voluntary social withdrawal, limited emotional expression, content with social isolation

157

Schizotypal Personality Disorder

eccentric appearance, odd beliefs or magical thinking, interpersonal awkwardness

158

Cluster B Personality Disorder Features

-dramatic, emotioinal or erratic -genetic association with mood disorders and substance abuse

159

Antisocial Personality Disorder

-disregard for and violation of rights of others, criminality, impulsivity *must be older than 18 and have a hx of conduct disorder before age 15

160

Borderline Personality Disorder

-unstable mood and interpersonal relationships -impulsiveness -self-mutilation -boredome -sense of emptiness **more common in females

161

A major defense mechanism of borderline personality disorder is...

splitting.

162

Histrionic personality disorder

excessive emotionality and excitability attention seeking sexually provocative overly concerned with appearance

163

Narcissistic personality disorder

-grandiosity -sense of entitlment -lackes empathy and requires excessive admiration -often demands the "best" and reacts to criticism with rage

164

Cluster C personality disorder features

-anxious or fearful -genetic association with anxiety disorders

165

Avoidant Personality Disorder

-hypersensitive to rejection, socially inhibited, timid, feelings of inadequacy, desires relationships with others

166

Dependent Personality Disorder

-submissive and clinging -excessive need to be taken care of -low self-confidence

167

Anorexia is associated with...

decreased bone density metatarsal stress fractures amenorrhea lanugo anemia electrolyte disorders

168

The osteoporosis seen in anorexia is partly due to...

decreased estrogen over time.

169

Bulimia nervosa is associated with...

parotitis enamel erosion electrolyte disturbances alkalosis dorsal hand calluses (Russel sign)

170

DDx for Sexual Dysfunction Disorders include:

-drugs (antihypertensives, neuroleptics, SSRIs and ethanol) -diseases (depression, diabetes, STDs) -psychological (performance anxiety)

171

Sleep terror disorder occurs during...

slow-wave sleep, non-REM (thus, no memory upon arousal); most commonly in children.

172

Nightmares occur during...

REM sleep (and thus, you have a memory of it).

173

Triggers of sleep terror disorder include...

emotional stress, fever or lack of sleep.

174

Narcolepsy is...

disordered regulation of sleep-wake cycles with the primary characteristic being excessive daytime sleepiness. *strong genetic component

175

Narcolepsy is caused by a decrease in...

orexin production in the lateral hypothalamus.

176

Narcolepsy is associated with (3):

1. hypnagogic/hypnopompic hallucinations 2. nocturnal and narcoleptic episodes that begin with REM 3. cataplexy

177

Cataplexy is...

loss of all muscle tone following a strong emotional stimulus, such as laughter)

178

Treatment for Narcolepsy:

-daytime stimulants (amphetamines, modafinil) -nighttime sodium oxybate (GHB)

179

Substance use disorder is defined as a maladaptive pattern of substance use defined as 2 or more of the following signs in one year:

-tolerance -withdrawal -substance taken in larger amounts or over longer time, than desired -persistant desire/unsuccessful attempts to cut down -significant energy spent obtaining, using or recovering from substance -importnat social, occupational or recreational activities reduced -continued use in spite of the knowledge that it causes a problem -craving -recurrent use in physically dangerous situations -failure to fulfill major obligations at work, school, home -social/interpersonal conflicts

180

6 Stages of Change in overcoming substance abuse

1. Precontemplation 2. Contemplation 3. Preparation/determination 4. Action/willpower 5. Maintenance 6. Relapse

181

Nonspecific symptoms of intoxication with a depressant

-mood elevation -decreased anxiety -sedation -behavioral disinhibition -respiratory depression

182

Nonspecific symptoms of withdrawal from a depressant

-anxiety -tremor -seizures -insomnia

183

Depressants (4)

-alcohol -opioids -barbituates -benzodiazepines

184

Symptoms of alcohol toxicity

-emotional lability -slurred speech -ataxia -coma -blackouts

185

A sensitive indicator of alcohol use is...

serum gamma-glutamyltransferase (GGT).

186

Symptoms of alcohol withdrawal

-if severe, can cause autonomic hyperactivity and DTs

187

Treatment for DTs from alcohol withdrawal

benzodiazepines

188

Symptoms of opioid intoxication

-euphoria -respiratory/CNS depression -decreased gag reflex -pupillary constriction -seizure

189

Treatment for Opioid intoxication

Naloxone, Naltrexone

190

Symptoms of Opioid withdrawal

-sweating -dilated pupils -piloerection -fever -rhinorrhea -yawning -nausea -stomach cramps -diarrhea

191

Treatment for opioid withdrawal

-methadone -buprenorphine

192

Symptoms of Barbituate intoxication

-low safety margin -marked respiratory depression

193

Treatment of Barbituate intoxication

-assist respiration -increase BP

194

Symptoms of Barbituate withdrawal

-delirium -CV collapse

195

Symptoms of benzodiazepine intoxication

-greater safety margin -ataxia -minor respiratory depression

196

Treatment of benzodiazepine intoxication

supportive; consider flumazenil (competitive benzodiazepine antagonist)

197

Symptoms of withdrawal from Benzodiazepines

-sleep disturbance -depression -rebound anxiety -seizure

198

Nonspecific symptoms of stimulant intoxication

-mood elevation -psychomotor agitation -insomnia -cardiac arrhythmias -tachycardia -anxiety

199

Nonspecific symptoms of stimulant withdrawal

-post-use "crash" including depression, lethargy, weight gain and headache

200

Stimulants (4)

1. amphetamines 2. cocaine 3. caffeine 4. nicotine

201

Symptoms of Amphetamine intoxication

-euphoria -grandiosity -pupillary dilation-prolonged wakefulness and attention -HTN -tachycardia -anorexia -paranoia -fever -severe: cardiac arrest, seizure

202

Symptoms of Amphetamine Withdrawal

-andhedonia -increased appetite -hypersomnolence -existential crisis

203

Symptoms of Cocaine Intoxication

-impaired judgement -pupillary dilation -hallucinations -paranoid ideations -angina -sudden cardiac death

204

Treatment of Cocaine intoxication

benzodiazepines

205

Symptoms of cocaine withdrawal

-hypersomnolence -severe psychologic craving -depression/suicide

206

Symptoms of caffeine intoxication

-restlessness -increased diuresis -muscle twitching

207

Symptoms of caffeine withdrawal

-lack of concentration -HA

208

Symptoms of nicotine intoxication

-restlessness

209

Symptoms of nicotine withdrawal

-irritability -anxiety -craving

210

Treatment for nicotine withdrawal

-nicotine patch, gum, etc. -buproprion/varenicline

211

Hallucinogens (3)

-PCP -LSD -Marijuana

212

Symptoms of marijuana intoxication

-belligerence -impulsiveness -fever -psychomotor agitation -analgesia -nystagmus -tachycardia -homicidality -psychosis -delirium -seizures

213

Treatment for PCP intoxication

-benzodiazepines -rapid acting antipsychotic

214

Symptoms of PCP withdrawal

-depression -anxiety -irritability -restlessness -anergia -disturbances of thought and sleep

215

Symptoms of LSD intoxication

-perceptual distortion -depersonalization -anxiety -paranoia -psychosis

216

Symtpoms of marijuana toxicity

-euphoria -anxiety -paranoid delusions -perception of slowed time -impaired judgment -social withdrawal -increased appetite -dry mouth -conjunctival injection -hallucinations

217

Prescription form of marijuana is...

Dronabinol which is used as antiemetic (chemo) and appetite stimulant in AIDS.

218

Symptoms of marijuana withdrawal

-irritability -depression -insomnia -nausea -anorexia *most peak at 48 hrs and last 5-7 days

219

Marijuana is generally detectable in the urine for...

4-10 days.

220

Heroin addicted pts are at increased risk for...

hepatitis, abscesses, overdose, hemorrhoids, AIDS, and right-sided endocarditis.

221

If you suspect heroin addiction, look for...

track marks (needle sticks in vein).

222

Treatment for heroin addiction

-Methadone -Naloxone + Buprenorphine -Naltrexone

223

Methadone is a...

long-acting oral opiate; used for heroin detoxification

224

Naloxone + Buprenorphine is a...

partial opioid agonist; long-acting with fewer withdrawal symptoms than methadone

225

Naltrexone is...

a long-acting opioid antagonist used for relapse prevention once a pt is detoxified from heroin

226

Complications of Alcoholism (5)

1. alcoholic cirrhosis 2. hepatitis 3. pancreatitis 4. peripheral neuropathy 5. testicular atrophy

227

Treatment for Alcoholism

-Disulfiram

228

Wernicke-Korsakoff syndrome is caused by..

thiamine deficiency. It has a triad of confusion, ophthalmoplegia and ataxia. May progress to irreversible memory loss, confabulation and personality change.

229

Wernicke-Korsakoff is associated with...

periventricular hemorrhage/necrosis of the mammillary bodies.

230

Treatment for Wernicke-Korsakoff is...

IV vitamin B1 (thiamine).

231

Mallory-Weiss Syndrome is...

longitudinal, partial thickness tear at the GE junction caused by excessive vomiting. Often presents with hematemesis. Associated with pain.

232

Delirium tremens is...

a life-threatening alcohol withdrawal syndrome that peaks 2-5 days after the last drink.

233

Symptoms of Delirium tremens in order of appearance

-autonomic system hyperactivity (tachycardia, tremors, anxiety, seizures) -psychotic symptoms (hallucinations, delusions) -confusion

234

Treatment for Delirium tremens

-benzodiazepines

235

Preferred drug for ADHD

Methylphenidate

236

Preferred drug for alcohol withdrawal

benzodiazepines

237

Preferred drugs for anxiety

-SSRIs -SNRIs -Buspirone

238

Preferred drugs for bipolar

-mood stabilizers (lithium, valproic acid, carbamazepine) -atypical antipsychotics

239

Preferred drug for bulimia

SSRI

240

Preferred drugs for depression

-SSRIs -SNRIs -TCAs -Bupropion -Mirtazapine (esp. with insomnia)

241

Preferred drugs for OCD

SSRIs clomipramine

242

Preferred drugs for panic disorder

-SSRIs -venlafaxine -benzodiazepines

243

Preferred drug for PTSD

SSRIs

244

Preferred drug for schizophreina

antipsychotics

245

Preferred drug for social phobias

-SSRIs -beta-blockers

246

Preferred drug for tourette's

-antipsychotics (haloperidol, risperidone)

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CNS Stimulants (4)

1. methylphenidate 2. dextroamphetamine 3. methamphetamine 4. phentermine

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Mechanism of CNS Stimulants

-increase catecholamines at the synaptic cleft, esp. NE and DA.

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Clincial use of CNS stimulants

ADHD Narcolepsy Appetite control

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Antipsychotics (neuroleptics) (5)

1. Haloperidol 2. Trifluoperazine 3. Fluphenazine 4. Thioridazine 5. Chlorpromazine

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Mechanism of Antipsychotics

All typical antipsychotics block dopamine D2 receptors (increase cAMP).

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Clinical use of antipsychotics

-schizophrenia (mainly + symptoms) -psychosis -acute mania -Tourette's

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Antipsychotics are very slow to be removed from the body because...

they are highly lipid soluble and are stored in body fat.

254

Toxicity of antipsychotics

-extrapyramidal system effects (dyskinesias) -endocrine side effects (galactorrhea) -dry mouth, constipation (from blocking muscarinic receptors) -hypotension (from blocking alpha-1 receptors -sedation (from blocking histamine receptors)

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Neuroleptic malignant syndrome

toxicity of antipsychotics causing rigidity, myoglobinuria, autonomic instability and hyperpyrexia

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Treatment forNeuroleptic malignant syndrome

-dantrolene -D2 agnoists (bromocriptine)

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Tardive dyskinesia

toxicity of antipsychotics casuing oral-facial movements

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High potency antipsychotics

-Trifluoperazine, Fluphenazine, Haloperidol *these cause neurologic side effects (EPS system)

259

Low potency antipsychotics

-Chlorpromazine, Thioridazine *these cause non-neurologic side effects

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Chlorpromazine can also cause...

cornela deposits.

261

Thioridazine can cause...

retinal deposits.

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Haloperidol can also cause...

NMS or tardive dyskinesia.

263

Evolution of EPS side effects

-4 hr acute dystonia -4 day akathisia -4 wk bradykinesia -4 month tardive dyskinesia

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Atypical Antipsychotics (6)

1. Olanzpaine 2. Clozapine 3. Quetiapine 4. Risperidone 5. Aripiprazole 6. Ziprasidone

265

Clinical use of atypical antipsychotics

-schizophrenia (+ and - symptoms) -Bipolar -OCD -anxiety disorder -depression -mania -tourette's

266

Olanzapine/Clozapine may cause...

significant weight gain.

267

Clozapine may cause...

agranulocytosis (requires weekly WBC monitoring) and seizure.

268

Risperidone may increase...

prolactin (lactation/gynecomastia) leading to decreased GnRH, LH and FSH (irregular menstruation/fertility).

269

Ziprasidone may...

prolong the QT interval.

270

Clinical use of Lithium

-mood stabilizer for bipolar disorder -blocks relapse and acute manic episodes -SIADH

271

Toxicity of Lithium

-tremor -sedation -edema -heart block -polyuria -teratogenesis

272

Lithium causes polyuria because...

it is an ADH antagonist causing nephrogenic DI.

273

Fetal cardiac defects from lithium include...

Ebstein anomaly and malformation of the great vessels.

274

Buspirone mechanism

stimulates 5-HT(1A) receptors

275

Use of Buspirone

-generalized anxiety disorder (1-2 wks to take effect) (does not interact with alcohol)

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SSRIs (4)

1. Fluoxetine 2. Paroxetine 3. Sertraline 4. Citalopram

277

Mechanism of SSRIs

5-HT specific reuptake inhibitors

278

Use of SSRIs

-depression -GAD -Panic disorder -OCD -bulimia -social phobias -PTSD

279

Toxicity of SSRIs

-GI distress -sexual dysfunction -serotonin syndrome w/ any drug that increases 5HT (MAO inhibitors, SNRIs, TCAs)

280

Serotonin Syndrome

-hyperthermia -confusion -myoclonus -CV collapse -flushing -diarrhea -seizures

281

Serotonin Syndrome is treated with...

Cyproheptadine (5-HT2 receptor antagonist)

282

For SSRIs to start taking effect, it takes...

4-8 wks.

283

SNRIs (2)

Venlafaxine Duloxetine

284

Mechanism of SNRIs

inhibit 5-HT and NE reuptake

285

Use of SNRIs

depression -Venlafaxine also for GAD and panic disorder -Duloxetine also for diabetic peripheral neuropathy

286

Toxicity of SNRIs

increased BP stimulant effects sedation nausea

287

Tricyclic Antidepressants (7)

1. amitriptyline 2. nortriptyline 3. imipramine 4. desipramine 5. clomipramine 6. doxepin 7. amoxapine

288

TCAs mechanism

block reuptake of NE and 5-HT

289

Uses of TCAs

-depression -OCD (clomipramine) -fibromyalgia

290

Toxicity of TCAs

-sedation -alpha-1 blocking effects (postural hypotension) -atropine-like effects (anticholinergic - tachycardia, urinary retention, dry mouth) -convulsions -coma -cardiotoxicity -respiratory depression -hyperpyrexia

291

Tertiary TCAs (amitriptyline) have more...

anticholinergic effects than secondary TCAs (nortriptyline) have.

292

Desipramine is less...

sedating but has higher seizure incidence.

293

In the elderly, TCAs can cause...

confusion and hallucinations due to anticholinergic side effects (use nortriptyline).

294

Treatment for cardiotoxicity from TCAs

NaHCO3.

295

Monoamine oxidase inhibitors (4)

1. Tranylcypromine 2. Phenelzine 3. Isocarboxazid 4. Selegine (slective MAO-B inhibitor)

296

Mechanism of MAO inhibitors

inhibition of MAO leading to increased levels of amine neurotransmitters (NE, 5-HT, DA)

297

use of MAO inhibitors

-atypical depression -anxiety -hypochondria

298

Toxicity of MAOIs

-hypertensive crisis (typically w/ ingestion of tyramine) -CNS stimulation

299

MAOIs are contraindicated with...

SSRIs TCAs St. John's wort Meperidine Dextromethorphan

300

Atypical Antidepressants

1. Buproprion 2. Mirtazapine 3. Trazodone

301

Buproprion increases...

NE and DA

302

Besides depression, buproprion is also used for...

smoking cessation.

303

Toxicity of Buproprion

-stimulant effects -HA -seizure in bulimic pts

304

Mirtazapine MOA

-alpha2-antagonist (increased release of NE and 5-HT) -potent 5-HT2 and 5-HT3 antagonist

305

Toxicity of Mirtazapine

-sedation -increased appetite -weight gain -dry mouth

306

Trazodone mechanism

-blocks 5-HT2 and alpha1-adrenergic receptors

307

Trazodone is primarily used for...

insomnia.

308

Toxicity of Trazodone

sedation nausea priapism postural hypotension