Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Psychiatry > Substance Related disorders + Impulse Control Disorders + Eating Disorders > Flashcards

Substance Related disorders + Impulse Control Disorders + Eating Disorders Flashcards

(83 cards)

Start Studying
1
Q

Amphetamine toxicity vs anticholinergic poisoning

A

Anticholinergic poisoning has dry skin and mucous membranes, motor sx (myoclonic jerks, tremors), ileus, and urinary retention - these are not in amphetamine poisoning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Preggers w/ current or prev dx of anorexia nervosa are at risk for complications…

A 
Miscarriage
Intrauterine growth retardation
Hyperemesis gravidarum
Premature birth
C-section
Postpartum depression
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Alcohol Withdrawal progression

A

6 hrs = mild WD
- anxiety, tremulous, sweating, palps

12-48 hrs = WD seizures
- seizure!

12-24 hrs = EtOH hallucinosis
- AH, VH w/ nl VS and intact sensorium

48-96 hrs = Delirium tremens

  • 5% mortality rate
  • fever
  • Hypo TN
  • tachy
  • diaphoresis
  • hallucinations
  • disorientation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Substance abuse criteria

A

drug use in spite of adverse consequences related to the substance

WILD for at least 12 mo

Work, school, or home role obligation failure

Interpersonal or social consequences

Legal problems

Dangerous use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Substance dependence criteria

A

physical or psychological need to continue taking a drug

for at least 12 mo:

Tolerance
WD
Using substance more than orig intended
Persistent desire or unsuccessful to cut down
Try to get all the time
continued use despite health problems from substance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Can you have substance dependence w/o physio dependence?

A

YES!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

EtOH substance testing

A

Blood EtOH level

EtOH only in system fora few hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Cocaine substance testing

A

UDS + 2-4 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Amphetamines substance testing

A

UDS + 1-3 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

PCP substance testing

A

UDS + 3-8 days

CPK and AST usually elevated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Barbituates substance testing

A

IN blood and urine

Pentobarbital = short acting = 24 hrs

Phenobarbital = long acting = 3 wks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Benzos substance testing

A

Blood and urine

Lorazepam = short acting = 3 days

Diazepam = long acting = 30 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Opioids substance testing

A

UDS + 2-3 days

Methadone and oxycodone come up negative on general screen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Marijuana

A

UDS

Heavy users - 4 weeks

Single use - 3 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

EtOH bio effects

A

Activates:

  • GABA R
  • serotonin R

Inhibitis:

  • glutamine R
  • voltage gated calcium channels

EtOH is a depressant!!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Tx EtOH intoxication

A

Monitor ABCs, glucose, electrolytes, acid base

+ thiamine
+ folate

Naloxone for co-ingested oioids

CT to r/o subdural or TBI if fell

Only do gastric lavage if a significant amount of EtOH ingested in preceding 30-60 min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

EtOH Withdrawal progression

A

6 hrs = mild WD
- anxiety, tremulous, sweating, palps

12-48 hrs = WD seizures
- seizure!

12-24 hrs = EtOH hallucinosis
- AH, VH w/ nl VS and intact sensorium

48-96 hrs = Delirium tremens

  • 5% mortality rate
  • fever
  • Hypo TN
  • tachy
  • diaphoresis
  • hallucinations
  • disorientation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How many ppl w/ EtOH WD get DTs? What is mortality rate?

A

5% get DTs

Mortality rate = 15-25%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Sx DTs

A 
delirium
Hallucinations
Gross tremor
Autonomic instability
Fluctuating levels of psychomotor activity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Tx EtOH Withdrawal

A

Benzos, taper

Antipsychotics prn agitation

Thiamine, folic acid, MV

Correct electrolytes

Monitor WD w/ CIWA scale

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

At risk heavy drinking for men and women

A

Men:
>4 drinks / day
>14 drinks / week

Women:
> 3 drinks / day
> 7 drinks / week

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Lab values in EtOH abuse

A

AST: ALT > 2:1

Inc GGT

Macrocytosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Meds for EtOH dependence

A

Disulfiram

  • —| aldehyde dehydrogenase
  • not ok for severe heart dz, preggers, psychosis

Naltrexone

  • opioid blocker
  • dec desire/craving and high assoc w/ EtOH

Acamprosate

  • inhibits GABA system
  • start post detox for relapse prevention
  • can use in liver dz
  • DO NOT USE in renal dz

Topiramate

  • anticonvulsant potentiating GABA and —| glutamate R
  • reduces cravings for EtOH
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Wernicke’s encephalopathy

A

Caused by thiamine deficiency

Acute and reversed w/ thiamine

Ataxia
Confusion
Ocular abnormalities (nystagmus, gaze palsies)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Korsakoff syndrome
Confabulations - Pts unaware that they are making these up Anterograde amnesia Reversible in 20%
26
Dopamine bio effects
---| dopamine reuptake STIMULANT!
27
Cocaine intoxication
``` Euphoria Tachy or brady Mydriasis Wt loss Agitation Cihlls Sweating ``` ``` Death 2/2 Cardiac arrhythmia MI Seizure Respiratory depression ```
28
Tx cocaine intoxication
Benzos Severe agitation or psychosis --> haloperidol Symptomatic support (HTN, arrhythmias) > 102 F = med emergency --> ice bath, cooling blanket
29
Tx cocaine dependence
Off label drugs - disulfiram - aripiprazole Narcotics anonymous
30
Cocaine withdrawal sx
``` Malaise Fatigue constricted pupils depression hunger ```
31
Amphetamines bio effect
Block reuptake adn facilitate release of dopamine and norepi STIMULANT
32
MDMA bio effect
THis is ecstasy Type of amphetamine Release dopamine, norepi, and serotonin from nerve endings Stimulant and hallucinogenic properties
33
Amphetamine intoxication
``` Dilated pupils Increased libido Diaphoresis Resp depression Chest pain ``` OD: Hyperthermia Dehydration Rhabdo --> renal failure
34
Chronic meth use
Acne | Accelerated tooth decay
35
Tx amphetamine intoxication
Rehydrate Correct electolytes Tx hyperthermia
36
PCP bio effects
AKA angel dust antagonizes NMDA glutamate receptor Activates dopaminergic neurons STIMULATE OR DEPRESS CNS depending on dose
37
PCP intoxication
RED DANES ``` Rage Erythema of skin Dilated pupils Delusions Amnesia Nystagmus (horizontal, vertical, or rotary = pathognomonic) Excitation Skin dryness ```
38
Tx PCP intoxication
Monitor vitals, electolytes Benzos for agitation Antipsyhotics for severe agitation PCP can be stored in fat so watch out for "flashbacks" = recurrence of PCP intoxication sx
39
Which drug withdrawal has highest mortality rate?
Barbituates
40
Sedatives-hypnotics | - ex
``` Benzos Barbituates Zolpidem Zaleplon GHB meprobamate ```
41
Sedatives-hypnotics intoxication
``` Drowsiness Confusion HYPO TN slurred speech ataxia respiratory depression ``` Sx synergistic when combo w/ EtOH
42
Tx sedatives-hypnotics intoxication
Maintain ABCs Activated charcoal + gastric lavage to prevent more GI absorb (if last dose 4-6 hrs ago) BARBS only --> + Na bicarb to urine to get more renal excretion BENZOS only --> + flumazenil in OD
43
Tx sedatives-hypnotics withdrawal
Benzo taper Carbamazepine or valproate taper for seizure ppx
44
Which opioid + MAOI can cause serotonin syndrome
Meperidine
45
What's abused more - heroin or opioid medications?
Opioid medications
46
Opioid intoxication
``` N/V Sedation Dec pain perception Dec GI motility Miosis Respiratory depression ``` Meperidine is exception to miosis --> will dilate Demerol Dilates pupils
47
Tx opioid intoxication
ABCs OD --> + naloxone or naltrexone can help with resp depression but may cause severe WD
48
Opioid OD signs
Respiratory depression AMS Miosis
49
What do you come up + for on UDS after eat poppy seed bagels?
Opioids
50
Tx opioid dependence
Methadone Buprenorphine Naltrexone
51
Opioid withdrawal sx
Flu like sx - not life threatening can start within 8 to 12 hours after the last dose and generally reach peak severity 48 hours after the last dose ``` Anxiety Insomnia Anorexia Fever Rhinorrhea PIloerection ``` Myalgias Tachy HTN
52
Tx opioid withdrawal
Clonidine for autonomic issues NSAIDs for pain Dicyclomine for ab cramps If severe: - detox w/ buprenorphine or methadone
53
Hallucinogen intoxication
LSD, psilocybin (shrroms), mescaline (peyote) Believed to act on serotonergic sx ``` Perceptual changes Labile affect DILATED pupils Tachy, HTN Hyperthermia ``` Can have bad trip: anxiety panic psychosis
54
Tx hallucinogen intoxication
Monitor dangerous behavior Benzos or antipsychotics prn
55
Hallucinogen withdrawal
No WD syndrome With long term use, pts can experience "flashbacks" later in life
56
Marijuana bio effects
Active component = THC Cannabanoid R in brain ---| adenylate cyclase Can tx: - Nausea in chemo - inc appetite in AIDS pts - dec intraocular pressure Dronabinol is pill form of THC
57
Marijuana intoxication
``` Euphoria Anxiety Dry mouth Conjunctival injection Increased appetite ```
58
Tx marijuana intoxication
Supportive Psychosocial interventions
59
Marijuana WD + Tx
``` Irritability Anxiety Restlessness dec appetite HA Diaphoresis ``` Tx: supportive + symptomatic
60
Inhalants bio effects
CNS depressants
61
Inhalants - intoxication - OD - Tx
INtoxication - paranoia - perceptual disturbances - hyporeflexes - ataxia - acute intoxication lasts minutes. Stupor may last hours OD - respiratory depression - cardiac arrhythmias Tx - ABCs - figure out solvent as some may need chelation WD sx rare
62
Caffeine bio effects
Adenosine antagonist --> increases cAMP Stimulant effect via dopamine system
63
How long for caffeine WD sx to resolve?
1 week
64
Nicotine bio effets
Stimulate Nicotine R in autonomic ganglia Highly addictive through effects in dopaminergic system Smoking --> tolerance and physical dependence
65
Cigarette smoking while preggers
Assoc w/ low birth weight and persistent pulm HTN of newborn
66
Tx nicotine dependence
Varenicline --> nicotinic cholinergic receptor (nAChR) partial agonist; mimics action of nicrotine and prevents WD sx Bupropion --> partial agonist at nAChR and inhibits dopamine reuptake Nicotine replacement therapy (patch, gum)
67
Core qualities of impulse control disorders
Repetitive or compulsive engagement in behavior despite adverse consequences Little control over negative behavior Anxiety or craving prior to doing impulsive behavior Relief or satisfaction during or after completion of behavior
68
Associated lab findings in impulsive individuals
Low 5-HIAA concentration in CSF Nonspecific EEG findings or abnormalities on neuropsych testing
69
Intermittent explosive disorder
Recurrent outbursts of aggression --> assault against ppl or property Outburst out of proportion to triggering event Episode stops quickly and spontaneously; pt feels remorse Men > women
70
Tx intermittent explosive disorder
SSRI Anticonvulsants Lithium Propanolol Individual psychotherapy usually not helpful Group therapy may be helpful to create plans to help manage episodes
71
Kleptomania
- can't resist urges to steal things that are not needed for personal use or monetary reasons - shame and guilt after stealing Women > men Sx often in times of stress 1/4 pts w/ bulimia have comorbid kleptomania Tx: insight oriented psychotherapy, behavior therapy, SSRI - naltrexone?
72
Kleptomania DDx
Shoplifting = theft for personal gain Antisocial Bipolar, manic episodes Psychotic DO
73
Pathological gambling
Men > women inc incidence of mood DO, anxiety DO, OCD 1/3 get recovery without treatment Tx: - Gamblers Anonymous most effective - insight oriented psychotherapy after 3 months of NO GAMBLING - tx comorbid mood disorders, anxiety DO, and substance abuse problems
74
Trichotillomania
Uncontrollable urge to pull hair --> relief after pulling Women > men Tx: - SSRIs - antipsychotics - lithium - behavioral interventions
75
Pyromania
Deliberate firesetting on more than 1 occasion Feeling of tension or emotional arousal before setting fires Fascination w/ fire or curiosity about situations concerning fire Feeling of relief or pleasure from setting fires and witness their aftermath No motive for setting fires, including financial, revenge, political, or impaired judgement from other factors (eg substance) Not a part of conduct disorder, antisocial personality disorder, or manic episode Tx: behavior therapy supervision SSRIs
76
Anorexia clinical features
- Body wt < 85% of expected or BMI =< 17 kg/m2 - Anxiety about gaining wt - Distorted views of body wt and shape High serum BUN Osteoporosis Elevated cholesterol and carotene levels Cardiac arrhythmias (prolonged QT) Cardiomyopathy Mitral valve prolapse Euthyroid sick syndrome (hypothyroid) H-P axis dysfunction --> anovulation, amenorrhea, estrogen deficiency increased cortisol Hypo Na 2/2 excess water drinking most common
77
Tx anorexia nervosa
Outpatient unless: - > 20% below ideal body wt - Hospitalization if dehydration, electrolyte disturbances, or bradycardia Cognitive behavioral therapy Family therapy Nutritional rehab Pharm: - SSRIs - Olanzapine - if no response to above - Benzos before meals to relive anxiety
78
What do you worry about in hospitalized anorexics?
Onset of anabolism, can get refeeding syndrome - electrolyte depletion (decreased Mg, P, Ca) - arrhythmias - heart failure Monitor closely! Replace electolytes, slow feedings
79
Bulimia
Recurrent episodes of binge eating Binge eating followed by compensatory behavior to prevent wt gain (at least 2x/wk for 3 mo) Excess worrying about body shape + wt Maintains normal body wt ``` Hypochloremic hypokalemic alkalosis metabolic acidosis (laxative abuse) elevated bicarb Hyper Na Elevated BUN, amylase ``` Esophagities
80
Tx bulimia
Cognitive behavioral therapy (#1) Nutritional rehab SSRI antidepressants 1st line med - fluoxetine Avoid buproprion b/c lower seizure threshold
81
Russel's sign
Scars or calluses on hand from contact with teeth in people who have chronic purging
82
Difference between bulimia vs. anorexia w/ binging/purging
Anorexia is severely underweight Bulimia has normal weight; bulimia also more ego-dystonic - sx are distressing and more likely to seek help
83
Binge eating disorder
Binge eating at least 2 d/wk for 6 months NO compensatory behaviors Tx: individual psychotherapy + CBT + strict diet and exercise - stimulants to suppress appetite - Orlistat (---| pancreatic lipase --> dec amt of fat absorbed from GI) - Sibutramine ( --| reuptake of norepi, serotonin, dopamine)

Psychiatry (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions