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CMN574 > Unit 2: adhd, eating disorders, substance abuse > Flashcards

Unit 2: adhd, eating disorders, substance abuse Flashcards

1
Q

etiology of ADD/ADHD

A
  • genetics
  • metabolic issues
  • CNS trauma or infection
  • premature birth
  • sleep apnea & other organic causes
  • majority is unknown
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2
Q

ADD/ADHD is the most common _______

A

neurodevelopment disorder

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3
Q

ADD/ADHD can occur alone or with other comorbidities such as

A
  • learning disabilities
  • anxiety disorders (MOST COMMON)
  • depression
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4
Q

ADD/ADHD occurs in _____% of children and _____% of adults

A
  • 7-8% of children

* 2.5% of adults

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5
Q

triad of symptoms/characteristics for ADD/ADHD

A
  • hyperactive- impulsive = interrupting, taking risks, “bugs” people, hyperactive
  • inattentive = messy, not organized, no timg mgmt, fails deadlines, can occur with OSA
  • combined type
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6
Q

early diagnosis of ADD/ADHD and treatment is important for ______ outcomes

A

improved

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7
Q

major factors of ADD/ADHD treatment failure are (2)

A
  • improper dx

* failure to recognize comorbidities

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8
Q

symptoms need to be present before age _____ and in more than 1 _____

A
  • 12

* setting

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9
Q

mgmt ADD/ADHD

A
  • treat comorbidities
  • behavior modification techniques
  • social skill training
  • counseling
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10
Q

meds for ADD/ADHD are usually what class?

A

stimulants

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11
Q

CNS stimulants are a schedule _____ drug

A

2

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12
Q

stimulants have a high potential for ____ & _____ and therefore you must assess ______ risk before prescribing and monitor for symptoms during use

A
  • abuse and dependence

* abuse risk

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13
Q

every pt on stimulants needs a baseline _____ eval

A

cardiac

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14
Q

pts on stimulants with additional cardiac risk factors require _____ and _____ assessment (in addition to cardiac) at baseline and when else?

A
  • BP and HR

* after dose increase and periodically

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15
Q

in peds what other baseline assessment is needed prior to initiation of stimulants

A
  • height and weight

* required periodically as well

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16
Q

if pt is under prolonged tx with stimulants what other dx tests should you consider?

A

annual CBC w diff and platelets (why?)

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17
Q

stimulant names mentioned in pt

A

*methlyphenidate = concerta, ritalin, quillichew ER, etc…

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18
Q

ALWAYS check for _____ when rx’ing stimulants…. or anything really….

A

drug interactions

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19
Q

you must discuss ______ with pts on stimulants

A

safety

ppt says “can get jail time” meaning if they sell or if we dont discuss safety….?

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20
Q

non stimulant meds for ADD/ADHD

A
  • bupropion
  • clonidine Er
  • Guanfacine
  • Atomoxetine adjunct 2nd line
  • others when treating other comorbidities
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21
Q

non stimulants can be used _____ or with other _____ when treating ADD/ADHD

A

alone or in combo with other stimulants

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22
Q

eating disorders mentioned in ppt (5)

A
  • anorexica nervosa (AN)
  • bulimia nervosa (BN)
  • binge eating disorders (BED)
  • atypical AN
  • avoidant-restrictive food intake disorders (ARFID)
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23
Q

etio of eating disorders?

A

strong evidence in genetics
*other theories = environmental factors
psychological factors
societal factors (promotion of thinness)

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24
Q

science is unsure if neurotransmitters ______ to the development of EDs or if the changes are a ________ of the physiologic changes associated with the EDs

A
  • contribute to

* consequence of

25
Q

dx of AN in adolescents….

A

see ppt… vague but general stuff we’re all prob already aware of

26
Q

dx of AN in adults

A
  • disturbance of body image
  • intense fear of becoming fat
  • weight loss leading to body weight <15% below expected
  • absence of 3 consecutive menstrual cycles
27
Q

2 major types of AN are?

A
  • restricting
  • binge-eating/purging
  • can have combination
28
Q

atypical AN is defined as what?

A

someone having a type of AN but weight is normal or above normal

29
Q

what labs should you check on a pt w AN?

A

TSH, electrolytes, LFTs, cholesterol, CBC w diff, creatinine, phosphorus, calcium, magnesium, U/A, EKG, bone density

30
Q

_____ is a common side effect of AN, esp in females with amenorrhea

A

osteoporosis

31
Q

AN is associated with what thyroid disorder?

A

functional hypothyroid (euthyroid sick)

32
Q

name 3 s/s of hypothyroid

A
  • hair thins
  • brittle nails
  • dry skin
33
Q

AN is associated with what arrythmia? especially in what position?

A
  • brady

* supine

34
Q

AN is associated with what BP abnormality? what is the A&P behind this?

A
  • hypotension
  • LV mass decreased&raquo_space; stroke volume compromised&raquo_space; peripheral resistance increases&raquo_space;> all contribute to LV systolic dysfunction
35
Q

AN can develop what 2 cardiac irregularities?

A
  • prolonged QTc syndrome
  • increased QT dispersion (irregular QT intervals)
  • ***these put them at risk for cardiac arrythmias
36
Q

AN is associated with what circulatory abnormalities?

A
  • decreased peripheral circulation

* hands and feet maybe cold/blue

37
Q

AN is associated with what dermatologic abnormality?

A
  • lanugo

* primal response to starvation

38
Q

as the GI tract adapts to reduced intake associated with AN… what s/s might you see?

A
  • early satiety
  • GERD
  • inability take in normal amounts of food
39
Q

in AN normal _______ reflex may be ______ due to lack of stimulation by food. This can cause what 2 symptoms?

A
  • gastrocolic reflex
  • bloating and constipation
  • delayed gastric emptying may develop
40
Q

what labs should you check in a pt with BN?

A
  • electrolytes

* amylase (may be increased due to chronic parotid stimulation)

41
Q

treatment for enlarged parotid glands ST BN?

A

heat

suck tart candy

42
Q

what labs do you want to check in BED?

A
  • thyroid
  • cholesterol
  • trigs
43
Q

BED treatment?

A

psychotherapy, meds

44
Q

meds for BED?

A 
topamax
antidepressants
vyvyanse
wellbutrin
nutritional supps if needed
45
Q

for dx s/s of BED must occur at least _____ for how long?

A
  • 1x/week

* 3mo

46
Q

ARFID definition:

A

*avoidance or restriction of oral food intake

47
Q

ARFID definition:

A
  • avoidance or restriction of oral food intake
  • ABSENCE OF criteria for AN (disturbed body image, fear of weight gain/body fat)
  • **AN w/o distress of body shape or fears of fatness
48
Q

s/s of ARFID

A
  • lack of interest in eating
  • avoidance to sensory characteristics of food (?)
  • concern for aversive consequences of eating (?)
  • inadequate nutritional/energy needs met
49
Q

there is a lack of what AN feature in the ARFID dx?

A

*lack of drive for thinness

50
Q

treatment for ARFID?

A
  • brief medical hospitalizations

* long psychiatric or residential hospitalizations…. wtf

51
Q

labs to run on pts suspected of substance abuse?

A
  • urine & blood tests

* hair - can be false +

52
Q

treatment for SA?

A
  • office-based
  • inpt
  • outpt
  • individual/group
  • may need detox
53
Q

_____ is the gateway drug and usually begins in ______ school and occurs more in boys or girls? whites or other races?

A
  • alcohol
  • middle school
  • boys > girls
  • whites > other races
54
Q

______ is the most common illegal drug

A

marijuana

55
Q

nicotine addiction can occur as quickly as ______

A

one month

56
Q

smoking cessation referral sources:

A
  • 1-800-quitnow
  • tobacco cessation clinics
  • community programs
  • psychotherapies
57
Q

five A’s for tobacco cessation

A
  • ask
  • advise
  • assess
  • assist
  • arrange
58
Q

meds for tobacco cessation include (4) and can decrease relapse rates by _____x as those quitting without

A
  • sustianed release antidepressants
  • bupropion
  • clonidine
  • nortriptyline
  • 5x
59
Q

facility referrals for tobacco cessation

A
  • low-intensity
  • outpt
  • school based
  • residential
  • hospital based
  • day treatment
  • dual-diagnosis facilities

CMN574 (6 decks)

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