1
Q
__% of patients in primary care demonstrate some degree of somatization
A
25%
2
Q
Somatoform disorders definition
A
Physical symptoms suggesting a medical condition yet the symptoms are not fully explained by the medical condition, substance abuse, or other mental disorder that is severe enough to cause distress or impaired social, occupational, or other functioning despite not being intentionally produced
3
Q
Somatic symptom disorders etiology (3)
A
- idiopathic
- interpretation of symptoms as social communication
- Genetic component
4
Q
Somatic symptom disorder diagnostic criteria
A
- Age <30
- 4 pain symptoms from 4 different sites including 2 GI (other than pain), 1 sexual, and 1 pseudoneurological NONE of which are explained by physical or lab findings
5
Q
Factitious syndrome definition
A
Patients willingly** adopting physical symptoms for unconscious internal gain (patient desires to take on role of being sick)
6
Q
Malingering syndrome definition
A
Purposeful feigning of physical symptoms for external gain (financial or legal benefit)
7
Q
Somatic symptom disorder treatment (2)
A
- Psychotherapy/mindfulness therapy
- Single health care provider following them over time with regular appointments
8
Q
Conversion disorder/functional neurological symptom disorder definition
A
Characterized by presence of one or more neurologic symptoms (blindness, paralysis) that cannot be explained by known medical condition and psychological factors are known to be associated with the initiation of the disorder
9
Q
2 theorized etiologies of conversion disorder/functional neurological symptom disorder
A
- Psychoanalytic (repression of unconscious intrapsychic conflict and conversion of anxiety into a physical symptom)
- Biologic (hypometabolism in dominant hemisphere of brain and hyper in nondominant)
10
Q
conversion disorder/functional neurological symptom disorder diagnostic criteria (3)
A
- Symptoms affect voluntary motor or sensory function
- Inability to explain symptoms on basis of any neurologic disease
- Excludes symptoms of pain and sexual dysfunction
11
Q
conversion disorder/functional neurological symptom disorder clinical presentation (4)
A
- Paralysis or blindness
- Inconsistent anesthesia and paresthesia
- ataxia (wild staggering gait)
- reflexes intact, no fasciculations, no atrophy
12
Q
conversion disorder/functional neurological symptom disorder treatment (2)
A
- Usually spontaneously resolves, longer it persists worse prognosis
- Resolution facilitated by insight behavior therapy
13
Q
Illness Anxiety Disorder (hypochondriasis) definition
A
Preoccupation with the fear of contracting, or the belief of having, a serious disease that results from unrealistic or inaccurate interpretations of physical symptoms
14
Q
Illness Anxiety Disorder (hypochondriasis) etiology (3)
A
- Social learning theory
- variant of anxiety
- lower tolerance for physical discomfort
15
Q
Illness Anxiety Disorder (hypochondriasis) diagnostic criteria (2)
A
- Must hold preoccupation for at least 6 months
- does not have delusion but significant enough to cause emotional distress or impair ability to function
16
Q
Illness Anxiety Disorder (hypochondriasis) clinical presentation (2)
A
- Conviction of having yet undetected disease despite neg lab results and assurance
- accompanied by anxiety or depression
17
Q
Illness Anxiety Disorder (hypochondriasis) treatment (3)
A
- Improves over time (episodic)
- Group therapy
- Single provider
18
Q
Pain disorder definition
A
Symptoms of pain associated with emotional distress and funcitonal impairment where pain is predominant focus of clinical attention not fully accounted for by medical conditions
19
Q
Pain disorder etiology
A
-Psychodynamic, interpersonal, or biologic factors
20
Q
Pain disorder diagnostic criteria (1)
A
-Acute or chronic (6 month period) of pain causing emotional distress or functional impairment
21
Q
Pain disorder treatment (2)
A
- Behavioral therapy
- NO long term analgesics
22
Q
Response to significant loss may have criteria for major depression, but…
A
….only after a prolonged period beyond the normal response to significant loss judged clinically
23
Q
Monoamine hypothesis of depression
A
Clinical observations that have provided evidence that maintains depression is caused by functional insufficiency of monoamine transmitters in the brain (serotonin, norepi) based on 2 observations -that depression was induced by reserpine (a drug that depletes monoamines from the brain) and -drugs that treat depression intensify monoamine induced neurotransmission
24
Q
Electroconvulsive therapy indications (2)
A
-When speed is critical, when a patient has failed to respond to antidepressants
25
Repetitive transcranial magnetic stimulation
Production of pulsed magnetic fields that can induce electrical currents in the brain and unlike electroconvulsive therapy does not require anesthesia or induction of seizures
26
Suicide risk with antidepressants
Patients taking antidepressants should be watched closely for suicide ideation, worsening mood, and behavioral changes particularly within the first one to two months of therapy or when dosage is changed (theorized to increase energy potentiating risk of acting on suicidal thoughts) most often seen in children thru young adults creating a blackbox warning for all antidepressants
27
Time of response to antidepressants and maintenance treatment
Initial responses develop in 1-3 weeks, max response not seen until 12 weeks, must take at least 1 month before considered a treatment failure, low doses used initially to reduce side effects and gradually increased, if not effective, can increase dosage, switch another drug in same class, switch to drug in different class, combine 2, ad supplemental, can withdraw only via taper but long term maintenance therapy can reduce risk of recurrence for patients with recurrent depressive episodes
28
Only SSRI approved by FDA for treatment of major depression in children
Fluoxetine (prozac)
29
SSRI mech of action, ADRs (3)
- selective inhibition of serotonin reuptake
- excessive CNS excitation, sexual dysfunction, nausea
30
Therapeutic uses for SSRI's (4)
- Major depressive disorder
- Generalized anxiety disorder
- OCD
- PTSD
31
Serotonin syndrome definition
Risk of often combining SSRI's with MAOI or from overdosing or from utilizing St John's wort, often starting 72 hours after starting drug resulting in altered mental status, agitation, confusion, hyperreflexia, tremor, and potentially death
32
Bruxism
Clenching or grinding of teeth usually occuring during sleep that can lead to headache, jaw pain, or dental problems, sometimes a bad side effect of SSRI's
33
SSRI drug interactions
- MAOI can potentiate risk of serotonin syndrome requiring withdrawal at least 14 days before starting fluoxetine
- Warfarin can increase effect
- St. John's wort can potentiate risk of serotonin syndrome
- small risk in pregnancy of neonatal absence syndrome (self resolving)
34
SNRI's function, drug metabolism
- Alongside SSRI considered first line option for treatment of major depression
- metabolized in the liver and excreted in the urine
35
Duloxetine (cymbalta) indications (2)
- Major depressive disorder in adults
- Depression in patients with prominent pain complaints (diabetic neuropathy or fibromyalgia)
36
Duloxetine (cymbalta) ADR's (3)
- Dry mouth
- somnolence
- hyperdiaphoresis
37
Tricyclic antidepressants mech of action, therapeutic uses (3), ADR's (4), drug interactions (3)
- Block reuptake of NE and serotonin alongside other mechanisms
- alternative for treatment of depression, enuresis (inability to control urination), pain management
- anticholinergic effects/sedation/orthostatic hypotension/overdosage
- Sympathomimetic drugs, anticholinergic drugs, MAOI's
38
Before moving a patient from an SSRI to a MAOI, need to have a ____
washout period
39
MAOI inhibitors function, mech of action, drug interactions (5), ADR's (3)
- 3rd line agents for patients not responding to SSRI's or TCA's for treatment of depression
- Prevents breakdown of NE and serotonin by MAO causing buildup in the brain
- tyramine (amino acid in food), TCA's, SSRI's, SNRI's, sympathomimetics
- Postural hypotension, CNS stimulation, liver damage
40
Selegiline (emsam) drug class and indication
- Transdermal MAOI
- Approved for treatment of major depression
41
Trazodone (desyrel) function
Moderate blockade of serotonin reuptake that is not effective when used alone but often as an adjunct to an SSRI in patients with insomnia
42
Amoxapine function and drug class
-Similar to antipsychotic agent loxapine, has both antidepressant and neuroleptic properties but can block dopamine receptors inducing parkinson like side effects, tetracyclic antidepressant
43
Buproprion (Wellbutrin) function
Antidepressant similar in structure to amphetamines that has stimulant properties and suppresses appetite, is generally well tolerated and devoid of ADR's associated with TCA's including weight gain and sexual dysfunction
44
Adjunctive antipsychotics for major depression
Augmentation with second gen atypical antipsychotic is treatment option for major depressive disorder in those whose symptoms persist following antidepressant monotherapy, even available in combo such as symbyax (fluoxetine and olanzapine)
45
Bipolar individuals have __x the rate of suicide of the general population
20x
46
Pathophysiology of bipolar disorder
Etiology unknown, but evident symptoms are caused by altered brain physiology with abnormalities in neuroendocrine, neurotransmitter, etc
47
Clinical manifestation patterns of mood episodes in bipolar disorder
-Mood episodes can occur in variety of patterns, not all patients alternate repeatedly between mania and depression, episodes can last typically a few months
48
3 major types of bipolar disorder
I - Manic or mixed episode usually with major depressive episodes
II - hypomanic episodes with greater major depressive episode, no manic episodes
Mixed - manic and depressive symptoms occur simultaneously
49
Drug therapy alone is not optimal for treatment of bipolar disorder, typically needs a combo of psychotherapy and drugs. Drug therapy generally consists of....
Non drug therapy consists of....
....Mood stabilizing drugs, antidepressants, antipsychotics (during manic phase), and adjuncts such as fish oil
....Education and family counseling, ECT
50
Lithium function, mech of action, pharmacokinetics
- Mainstay in treatment for all episodes and subtypes of bipolar disorder highly effective for stabilizing acute mania by reducing euphoria and hyperactivity without causing sedation
- Unknown mech of action
- Short half life and low therapeutic index, sodium depletion decreases renal excretion of lithium therefore requires sodium levels remain normal
51
Alternative therapeutic uses of lithium (4) and ADR's (4)
- Alcoholism
- schizophrenia
- migraine
- SIADH
-Extremely toxic when out of therapeutic range, polyuria, tremor, teratogen in 1st trimester or breast feeding
52
Valproic acid function (bipolar meds)
Alternative drug normally used as an antiepileptic effective for first line treatment of acute mania with efficacy similar to lithium
53
Carbamazepine function (bipolar meds)
Alternative drug approved for treatment and prevention of manic episodes in patients with bipolar disorder, like valporate but appears to be less effective in treatment and prevention of depression
54
Second gen antipsychotics function
Used to acutely control symptoms during manic episodes and long term to hep stabilize mood used often in combo with a mood stabilizer such as valproate or lithium
55
Second gen antipsychotics ADR's (3)
- Somnolence
- Metabolic disorders
- lowered risk of movement disorder compared to older antipsychotics
56
Extrapyramidal effects and common types
Physical symptoms, including tremor, slurred speech, akathesia, dystonia, anxiety, distress, paranoia, and bradyphrenia, that are primarily associated with improper dosing of or unusual reactions to neuroleptic (antipsychotic) medications.
-akanthisia (inability to sit still)
-dystonia (involuntary muscle contractions)
-parkinsonism (tremors, rigidty)
-tardive dyskinesia (involuntary movement of face mouth or tongue can become permanent)
57
In patients with bipolar disorder, antidepressants are always combined with...
....a mood stabilizer because of long held belief that when used alone antidepressants may elevate mood so much that a hypomanic or manic episode may result
58
__% of the population is affected with anxiety at any given time, is it more common in males or females?
15%, females
59
All anxiety disorders characteristics (4)
- Marked by excessive worry or fear
- more physical symptoms (chest tightness, sweating, shaking, etc)
- cannot be better explained by another condition
- interferes with some domain of life
60
Generalized anxiety disorder definition
Excessive anxiety and worry (apprehensive expectation) occurring more days than not for at least 6 months about a number of events or activities such as work or school performance, difficulty controlling the worry, anxiety and worry associated with other physical symptoms, focus of anxiety and worry not confined to features of another psychiatric disorder
61
Generalized Anxiety Disorder clinical presentation (5)
- worry
- feeling on edge
- SOB
- sweating
- enuresis
62
Generalized Anxiety Disorder Diagnostic testing (4)
- CBC
- Thyroid function panel
- EKG
- Toxicology screen
63
Panic attack definition
Abrupt surge of intense fear or discomfort that reaches a peak within minutes during which time many other symptoms occur such as palpitations, sweating, chest pain, etc that occurs as part of another underlying condition (such as generalized anxiety disorder with panic attacks)
64
Panic disorder definition
Recurrent unexpected panic attacks with persistent concern or worry about additional panic attacks and their consequences and significant maladaptive behavioral changes related to attacks
65
Specific phobia definition
Marked fear or anxiety about specific object or situation providing immediate fear or anxiety out of proportion of actual danger posed by specific object or situation, causing fear, anxiety, or avoidance resulting in clinically significant distress or impairment in social, occupational, or other important areas of functioning not better explained by another disorder
66
Social anxiety disorder definition
Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others OF THE SAME age group. Must be completely unrelated to another medical condition present
67
Separation anxiety definition
Developmentally inappropriate and excessive fear or anxiety concerning separation from those whom the individual is attached, sees recurrent excessive stress when anticipating or experiencing separation from home or from major attachment figures
68
Selective Mutism definition
Consistent failure to speak in specific social situations in which there is an expectation for speaking despite speaking in other situations, over 1 month and interfering with educational or occupational achievement or with social communication
69
1st line treatment for anxiety disorders and 4 alternatives
SSRI's
- SNRI's
- Antihistamines
- Antihypertensives (propranolol)
- Benzodiazepines (don't use more than 4 months, highly addictive)
70
Depression epidemiology
-20.6% lifetime prevalence in adults, named #1 cause of disability world wide, among most common complaints in primary care
71
Premenstrual dysphoric disorder and how is it treated
Sees condition similar to major depressive disorder but symptoms ONLY present around menses and not any other time and always resolve at day 4 of menstruation starting, and sees marked depressed mood, irritability, and anxiety around the time frame around menses
Treated with antidepressants just on the effected days (if have MDD and it worsens with menstrual cycle, then treat with higher dosages around menstruation. If actually have PDD then treat with antidepressants only on the effective days)
72
Dysruptive mood dysregulation disorder
Child only between 8-16 diagnosis involving recurrent temper outbursts manifested verbally or behaviorally that are out of proportion in intensity or duration to situation or provocation, outbursts in at least 2-3 settings with irritability in between them, age of onset before 10 not attributed to other condition
73
Mania definition
Distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal directed activity or energy lasting at least 1 week*** and present most of the day, nearly every day with at least 3 other associated symptoms present
74
Mania associated symptoms (6)
- Inflated self esteem and grandiosity
- Decreased need for sleep
- Talkative
- Increased goal oriented activity
- Distractibility
- Excessive involvement in activities with high potential of consequence
75
Hypomania definition
Distinct period of abnormally and persistently elevated, expanisve or irritable mood and abnormally persistently increased activity or energy lasting at least 4 consecutive days*** most of the day
76
Physical abuse
Hurting another using physical methods resulting in bruising, broken bones, permanent scars, or even death
77
Verbal/emotional abuse
Acts such as brainwashing, sleep deprivation, verbal battering, diminished self worth, threats of harm and death, destruction of property and pets, and isolating the victim from other family or friends
78
Sexual abuse
Any forced sexual act including unwanted touching, rape, marital rape, often during or after a battering incident where other types of physical violence are used
79
Economic abuse
Mantaining absolute control over a victims use of personal, marital, or otherwise shared financial resources that can limit their access to medical care, transportation, or relationships with others
80
__% of women murdered by their intimate partner had visited an ED 2 years prior to the homicide, __% had at least 1 injury related to the visit to an ED which represents an opportunity to intervene
44%, 93%
81
SAFE screening questions often used in ED or OB office
Safety - feel safe in relationship?
Afraid - ever been in relationship where hurt, abused, or afraid?
Friends/family - are your friends/family aware you have been hurt?
Emergency - Do you have a safe place to go in an emergency?
82
Clinical presentation of intimate partner violence (4)
- Inconsistent explanation of injuries
- Delay seeking treatment
- Frequent ED visits
- Partner answers questions and refuses to leave room
83
Adverse childhood experiences (ACE score) correlation with disease states
Direct correlation to likelihood of developing chronic lifetime illness, often due to (but not completely) behavioral changes which are in turn due to brain developmental issues such as nucleus accumbans delay, prefrontal cortex shrinkage, etc. seen as the greatest health threat facing the country according to the American Academy of Pediatrics
84
Most common type of child abuse
Neglect
85
4 main types of abuse in children
- Physical
- Sexual
- Emotional
- Child neglect (hygiene, failure to love, failure to enroll in school, delay in seeking medical care)
86
Classic indicators of child abuse (3)
- Bruises on uncommonly injured surfaces
- human hand marks or bite marks
- unexplained retinal hemorrhages
87
Abnormal bruising areas that raise red flags for child abuse (6)
- Buttocks
- back
- trunk
- cheeks
- neck
- earlobes
88
Can you date bruises?
No, but should document details anyways
89
Mandated reporter
Refers to how providers are required to make a report to CPA if any suspected child abuse, do not have to make diagnosis but have to report otherwise can be blatant malpractice (if reported in false situations protected by good faith laws) even if not at work
90
Personality definition
Habits, behaviors, cognition, and emotional patterns that evolve from biological and environmental factors
91
Personality disorder vs trait
Disorder is maladaptive personality and defense mechanisms that affect patterns of daily living vs traits do not reach that threshold of being pathological
92
General differential diagnosis in patients with personality disorders (3)
- PTSD
- Substance abuse
- Personality change due to another medical condition
93
Critical risk factors to assess in psychiatric eval (5)
- Suicidal risk
- Homicidal risk
- Criminal activity
- Substance abuse
- high risk behavior
94
Cluster A personality disorders (3) and general trend
- Paranoid personality disorder
- Schizoid personality disorder
- Schizotypal personality disorder
-Does not occur exclusively during course of schizophrenia or any psychotic disorder, are odd or eccentric disorders
95
Paranoid personality disorder and treatment (1)
- Cluster A personality disorder associated with marked distrust and suspicion, interpretation of actions from others as deliberately threatening/demeaning
- psychotherapy
96
Schizoid personality disorder and treatment (1)
- Cluster A personality disorder characterized by indifference to social relationships, limited range of emotional expression and experience, unable to have close meaningful relationships, but always maintain contact with reality***
- group therapy
97
Schizotypal personality disorder and treatment (2)
- Cluster A personality disorder characterized by social and interpersonal difficulties, discomfort in close relationships, and unusual thought and perceptions of reality as well as magical*** thinking
- antipsychotic medications and psychotherapy
98
Cluster B personality disorders (4) and general trend
-Antisocial personality disorder
-borderline personality disorder
-histrionic personality disorder
-narcissistic personality disorder
Are dramatic or erratic disorders
99
Antisocial personality disorder and treatment (1)
Cluster B personality disorder characterized by disregard for the violation of rights of others, dangerous behavior patterns with lack of consciousness (sociopathic) or lack regarding others (psychopathic), must be at least 18 to diagnose but evidence of conduct disorder before the onset of age 15
-no treatment
100
Borderline personality disorder and treatment (2)
- Cluster B personality disorder characterized by mood instability, difficulty with interpersonal relationships, poor self image, high rates of self injury, and border psychosis and neurosis, 75% females
- group and individual psychotherapy
101
Histrionic personality disorder and treatment (1)
- Cluster B personality disorder characterized by dramatics, attention seeking, emotional overreaction, draw to be center of attention, and sexual seductiveness in inappropriate situations
- psychotropic meds only indicated if depression
102
Narcissistic personality disorder and treatment (1)
- Cluster B personality disorder characterized by grandiosity, lack of empathy, need for admiration, inflated sense of self importance, rarely isolated condition
- Individual and group therapy
103
Cluster C personality disorders (3) and general trend
-Avoidant personality disorder
-Dependent personality disorder
-Obsessive compulsive personality disorder
Anxious or fearful disorders
104
Avoidant personality disorder and treatment (2)
- Cluster C disorder characterized by extreme shyness, fear of rejection or disappointment, lifelong pattern of extreme social inhibition, and feelings of inadequacy
- antidepressant for sensitivity to rejection and talk therapy
105
Dependent personality disorder and treatment (1)
- Cluster C personality disorder characterized by overreliance on other people to meet ones emotional and physical needs, fears separation and has difficulty making daily decisions
- cognitive behavioral therapy
106
Obsessive compulsive personality disorder and treatment (1)
- Cluster C personality disorder characterized by excessive attention to detail, perfectionist type A's that does NOT have to do with OCD
- Psychotherapy
107
OCD vs OCPD
while OCD is characterized by intrusive, distressing thoughts and behaviors that the person wants to stop, OCPD involves rigid personality traits like perfectionism and a need for control that the person often sees as normal, making it less likely to seek treatment.
108
Psychosis definition
Severe disruption of thought, perception, and behavior resulting in loss of reality caused by conditions, sleep deprivation, abuse of alcohol or other drugs
109
Key features of psychotic disorders (5)
- delusions
- hallucinations
- disordered thinking/speech
- grossly disorganized or abnormal motor behavior
- negative symptoms
110
Bizarre and non bizarre delusions
Bizarre are completely not based in reality, nonbizarre could be conceivable but are likely not true (could be validated or disproven by family member)
111
Most common delusion type in psychosis
Persecutory - that one is going to be harmed/harassed by an individual, organization, or other group
112
Most common hallucination type in schizophrenia
Auditory
113
Referential delusions
A common delusion type in psychosis characterized by certain gestures, comments, environmental cues directed at oneself
114
Hallucinations definition
Perception like experiences that occur without external stimulus, are vivid and clear but not under voluntary control
115
Negative symptoms (common in psychotic disorders)
Account for substantial portion of morbidity associated with schizophrenia but are less common with other psychotic disorders, include diminished emotional expression and avolution (decrease in motivated self initiated purposeful activities)
116
Schizophrenia definition
Chronic recurrent psychosis associated with impairments in social and occupational functioning for at least 6 months**, strongly associated with both genetic factors and environmental ones, much higher suicide rate than general population
117
Schizophrenia pathophysiology
Overactive dopaminergic and serotonin pathways that lead to psychosis
118
Schizophrenia positive symptoms (4)
- Fixed false delusions either bizarre or nonbizarre
- hallucinations (auditory hallucinations most common)
- disorganization of behaviors and thoughts interpreted from speech
- cognitive impairment early on
119
Cotard's delusion definition
Delusional belief that one is already dead, does not exist, or have lost their blood and internal organs
120
Catatonic definition
A state of immobility and stupor from abnormality of movement and behavior arising from disturbed mental state
121
Schizophrenia first rank symptoms (4)
- audible thoughts
- somatic passivity (feeling of being touched or unusual sensation)
- thought insertion (feeling external force putting thoughts in mind)
- voices arguing about the patient
122
Schizophrenia recovery
Only 20% achieve complete recovery, many reach no more than mild psychotic symptoms
123
Schizophreniform vs schizophrenia
Schizophreniform is the same criteria met but has not lasted for more than 6 months
124
Schizoaffective disorder vs schizophrenia
Schizoaffective disorder is the same criteria met but has a prominent mood component that occurs in the absence of a mood episode
125
Delusional disorder definition
Presence of 1 or more delusions for a month or longer, but absent hallucinations or other marked mood symptoms
126
Brief psychotic disorder and example
Presence of one or more psychotic symptoms with sudden onset and full remission within one month
such as post partum psychoses
127
Insomnia definition
Defined as inability to fall or maintains sleep, majority do not have predisposing psychaitric disease but untreated may be risk factor for development of psych problems, can be due to medical conditions, anxiety, or other factors
128
Indication for hypnotic drug uses
Reserved for patients whose insomnia cannot be managed by nondrug means
129
Sleep cycle
- NREM Stage 1 to 4 characterized by growing deeper taking 60-90 min
- Stage 1 aware of surroundings but relaxed
- Stage 2 unaware of surroundings but easily awakened
- Stage 3-4 slow wave sleep important for physical rest and restoration
- REM for 20 minutes, characterized by dreaming and mental restoration, is a state of deep sleep
- Return to NREM
130
Barbituates mech of action
- Nonspecific suppression of CNS through binding to GABA receptor complexes at the reticular formation and cerebral cortex causing sedation with no ceiling to amount of CNS depression can produce resulting in death when overdosage
- suppresses REM sleep and increases stage 2 sleep resulting in rebound effect upon discontinuation
- Tolerance develops to sedative hypnotic effects but not to toxic effects making likelihood of overdose dangerous
131
Barbituate therapeutic uses (3)
- Distant 2nd choice to benzodiazepines for relieving insomnia
- low dose for seizure suppression
- induction of anesthesia
132
Barbituate ADR's (4)
- Respiratory depression
- abuse and overdose
- fetal harm
- hangover effect with residual effects following day
133
Triad of acute barbituate overdosage
- Respiratory depression
- pinpoint pupils
- coma
134
Benzodiazepines function and popular examples (3)
Drug of choice for anziety and insomnia
-Diazepam (valium), lorazepam (ativan), and alprazolam (xanax)
135
Benzodiazepines mech of action
-Decrease functional activity of specific areas of the brain and spinal cord by potentiating activity of inhibitory neurotransmitters in the CNS affecting primarily the limbic system (emotion), reticular formation (sleep and wakefulness), cerebral cortex (stop convulsions and seizures), and spinal cord (decrease skeletal muscle tone in injury)
136
Benzodiazepines therapeutic uses (4)
- Anxiety drug of choice (short term typically while antidepressant is long term)
- insomnia drug of choice
- seizure disorders (diazepam is DOC for status epilepticus)
- Induction of anesthesia
137
Benzodiazepines ADR's (3)
- CNS depression
- rare respiratory depression if combined with other drugs
- physical dependence
138
Flumazenil (romazicon) function
Competitive benzodiazepine receptor antagonist approved for treatment of benzodiazepine overdosage and for reversing effects of benzos following general anesthesia
139
Flurazepam (dalmane) function
Long acting benzodiazepine for treatment of insomnia, has long half life resulting in hangover effect
140
Temazepam (restoril) function
Short acting hypnotic administered 1-2 hours before bedtime
141
Zopidem drug class, function
- Benzodiazepine receptor agonists function
- Act rapidly to decrease sleep latency, relatively safe with low potential for tolerance, abuse, or dependence, called the nonbenzo benzo as it acts through a different mechanism but helps treat insomnia
142
Zalepon (sonata) drug class, function
- Benzodiazepine receptor agonists function
same chemical class as zolpidem that is short acting and fast onset only lasting 4 hours for those who take in middle of night if cannot sleep
143
Ramelton (rozerem) drug class, function, and mech of action
- Melatonin receptor agonist
- rapid onset short duration for inducing sleep in patients
- highly selective for melatonin receptors that upon their activation inhibit cAMP activation
144
Suvorexant (belsomra) drug class, mech of action, function
- Orexin receptor antagonoist
- orexin neurons are active during wakefulness and silent during sleep, loss of signaling associated with narcolepsy, blocking peptides allows for deep sleep
- Treatment for sleep onset or maintenance insomnia
145
2 antihistamines currently approved as sleep aids OTC
- diphenhydramine in advil and tylenol pm
- doxylamine
146
Buspar (buspirone) function
A non benzoanxiolytic used for the short term treatment of generalized anxiety as alternative because it does not cause sedation, has no abuse potential, and although takes weeks to peak effects has proven equally effective for short term GAD treatment
147
drug used to withdraw a patient from barbituates?
Phenobarbital
148
Control center of sleep and 5 other anatomical structures involved
- Suprachiasmatic nucleus of hypothalaus
- brain stem, amygdala, thalamus, pineal gland, forebrain
149
Circadian rhythm definition
Directs a wide variety of functions from daily fluctuations in wakefulness to body temp, metabolism, and release of hormones, synchronize the environmental cues with the actual time of day
150
NREM stage 1
Muscles are relaxed but can have hypnic contractions, consciousness is decreased yet easily awakened
151
NREM stage 2
Muscles more relaxed and consciousness somewhat more decreased
152
NREM stage 3
Muscles relaxed with no activity, very decreased consciousness and difficult to awaken, talk in sleep or sleep walk
153
REM sleep
Majority of typical dreams, cycle thru night every 90-120 minutes, high frequency lower voltage brain activity theta waves, limbs are temporarily paralyzed
154
Aging and percentage of sleep stages
Newborns sleep majority of day and enter REM first, changing by 3 months of age, middle aged and beyond percentage of REM is stable thru adulthood but percentage of N3 decreases and percentage of wake and N1 increases
155
Dyssomnias
Abnormal amount, quality, or timing of sleep
156
Parasomnias
Abnormal behavioral or physiological events occurring in association with sleep
157
Hypoglossal nerve stimulator
Surgically implanted nerve stimulator that senses each breath and activities and sends pulses to tongue base causing it to lurch forward and open airway implanted on the right side to not be confused for a pacemaker for treatment of sleep apnea
158
Cataplexy definition
Emotionally triggered transient muscle weakness often triggered by strong generally positive emotions
159
Narcolepsy definition
Clinical syndrome of daytime sleepiness with cataplexy, hypnagogic hallucinations, and sleep paralysis
160
Diagnosis of narcolepsy (2)
- Polysomnogram
- Multiple sleep latency test (seeing if REM sleep entered during nap and fall asleep in less than 8 min, essential features of narcolepsy)
161
Kleine-levin syndrome
Sleeping beauty syndrome, recurrent episodes of severe hypersomnia associated with cognitive and behavioral disturbances, episodes last a few days to several weeks and are separated by weeks or months of normal sleep behavior, no treatment available
162
Circadian rhythm sleep wake disorder
Chronic or recurrent sleep disturbance due to alteration of circadian rhythm or misallignment between environment and individual sleep wake cycle lasting 3 months in duration
163
Delayed sleep wake phase disorder and advanced sleep wake phase disorder
- Night owl (stay up late and sleep in late)
- early bird (go to bed early and get up early)
164
Sleep/night terrors definition
Usually occurring between 4-12 years of age involving awakening from a sleep with loud scream, sweating, etc despite not remembering episode later
165
Restless leg syndrome treatment (2)
- Iron replacement
- behavioral modifications
Professional Development
flashcards
Decks in class (62)
# Cards
-
Part 1122
-
Part 2123
-
Part 3120
-
Part 4150
-
Part 5124
-
Part 6125
-
Part 7148
-
Part 8160
-
Part 9198
-
Part 10119
-
Part 11131
-
Part 12119
-
Part 13126
-
Part 14123
-
Part 15133
-
Part 16142
-
Part 17124
-
Part 18135
-
Part 19127
-
Part 20108
-
Part 21160
-
Part 22125
-
Part 23145
-
Part 24160
-
Part 25170
-
Part 26120
-
Part 27130
-
Part 28153
-
Part 29124
-
Part 30144
-
Part 31181
-
Part 32121
-
Part 33165
-
Part 34133
-
Part 35116
-
Part 36175
-
Part 37170
-
Part 38191
-
Part 39222
-
Part 40150
-
Part 41124
-
Part 42154
-
Part 43183
-
Part 44132
-
Part 45103
-
Part 46125
-
Part 47165
-
Part 48126
-
Part 49114
-
Part 50155
-
Part 51151
-
Part 52101
-
Part 53128
-
Part 54151
-
Part 55130
-
Part 56132
-
Part 57149
-
Part 58131
-
Part 59151
-
Part 60151
-
Part 61136
-
Part 62111
