1
Q
Jose usually has the equivalent of 10 cups of a day. One day he cuts out caffeine “cold turkey”. Which of the following may NOT be characteristic of caffeine withdrawal?
a) Decrease in alertness
b) Decrease in heart rate
c) Vasodilation in brain
d) Vasoconstriction in brain
A
d) Vasoconstriction in brain
2
Q
Withdrawal symptoms are experiences upon termination of a drug by:
a) Everyone
b) Many people
c) Very few people
d) People with blood type O
A
b) Many people
3
Q
Caffeine undergoes biotransformation in the:
a) Brain
b) GI tract
c) Liver
b) Mouth
A
C) Liver
4
Q
Caffeine can be lethal in high enough doses
a) True
b) False
A
a) True
5
Q
Which of the following is Not a theory regarding the cause of Schizophrenia
a) Not enough dopamine
b) Too much dopamine
c) Too much dopamine in some parts of the brain and too little in others
A
a) Not enough dopamine
6
Q
Which of these is a negative symptom of schizophrenia
a) Delusions
b) Hallucinations
c) Flat affect
d) Lack of friends
A
c) Flat affect
7
Q
If someone is refusing to take medication or time release of the medication is desirable this route of administration maybe preferable:
a) Intramuscular
b) Intravenous
c) Oral
d) Topically (patch)
A
a) Intramuscular
8
Q
The long half-life of antipsychotics means the drug:
a) Dose not need to be taken often (daily)
b) Must be taken several times per day
c) Needs only to be taken weekly
d) Remains at half strength for a long period of time
A
a) Dose not need to be taken often (daily)
9
Q
Parkinson’s type symptoms may result from taking antipsychotic medication because these medications can result in:
a) Decrease in dopamine activity in the brain
b) Increase in dopamine activity in the brain
A
a) Decrease in dopamine activity in the brain
10
Q
The primary action of typical antipsychotics in the brain is to:
a) Block dopamine
b) Block serotonin
c) Partially block dopamine
d) Partially block serotonin
A
a) Block dopamine
11
Q
Which of these is NOT an EPS?
a) Akathesia
b) Dystonia
c) Vomitting
d) Tardive dyskinesia
A
c) Vomitting
12
Q
Neuroleptic
A
*Antipsychotics are often referred to as “neuroleptics” especially (but not exclusively) the typical, 1st generation drugs like thorazine, mellaril, halloo, navane, prolix, etc.
13
Q
Neurolepsis (Contd…..)
A
- In the early literature the drugs were said to cause “neuroleptic”, characterized by 3 major behavioral effects:
- Psychomotor slowing
- Emotional quieting
- Affective indifference
14
Q
Phenothiazines
A
- Most typical antipsychotics are phenothiazines - a name for a type of chemical structure
- Thorazine, Mellaril, Stelazine, Compazine, Serentil, Prolixin
- Other chemical structures are:
- Butyrophenones: Haldol
- Thioxanthenes: Navane
15
Q
A Little More on Side Effects of Antipsychotics
A
-Sum side effects common to some Specific typical & A-typical antipsychotics & discuss some clinical implication for BC analysts
16
Q
Side Effects: Both Typical & Atypical Antipsychotics
A
- Anticholingeric side-effects
- Dry mouth - thirsty
- Blurry vision - Trouble seeing
- Sedation - Sleepy
- Memory problems - Learning
- Constipation & difficulty urinating
- Anorgasmia -Private time….
17
Q
Clinical Implication of All Anticholinergic Drugs
A
- I need water Plydipsia
- Bx prob/medication adjustment or Both?
- Constipation, diet & toileting skills
- Anorgasmia & the prob it may cause
- Aggression, property destruction, SIB
18
Q
EPS and Typical Antipsychotics
A
- Extra-Pyramidal signs & symptoms
- These side effects are most often associated with typical antipsychotics, likely due to the relationship with dopamine (specifically the D2 receptor)
19
Q
EPS and Typical Antipsychotics
Contd…
A
- However, recent studies indicate that A-typical antipsychotics Also show a higher incidence of these side effects than initially suspected, especially with long term use. (D2 also & Serotonin)
- Also some atypical (e.g. Risperadal or Zyprexa) may show higher incidence than others (Clozapine, Seroquel)
20
Q
Parkinsonism, Dystonia, Dyskenesia or Akathisia?
A
- All of these are characterized by:
- Movement disorders, some involuntary
- Muscle stiffness (all but akathisia)
- Cogwheeling (both in Parkinsonism & Tardive dyskinesia)
- How can you tell them apart?
21
Q
Dyskenesia, Dystonia
A
- Tardive dyskenesia: Involuntary lip smacking, tongue thrusting, grimacing, chewing, walking in place, pelvic thrusts, hums or grunts
- Dystonia:
- Sustained muscle contractions
- Involuntary movements of whole body
22
Q
Parkinsonism, Akathisia
A
- Parkinsonism:
- Shuffling gait, stooped posture, drooling, pill rolling, tremors, masked expression
- Akathisia:
- Restless motion
- Leg crossing & Uncrossing
- Pacing
23
Q
Dyskinesia Vs Akathisia
A
- Dyskinesia: You cannot sit still
- Akathisia: You cannot sit down
24
Q
Some Possible Life Threatening Idiosyncratic Reactions
A
- NMS (Neuroleptic malignant syndrome): Stiffness, Flu-like, fever.
- Antipsychotics & the elderly
- Mellaril & heart issues
- Clozapine & agranulocytosis
- Any medication can potentially cause an allergic/immune response
25
Non-life Threatening but some Imp-to-know Side Effects
* Risperdal - weight, gynecomastia
- Clinically - Food EO, heavier & hard to block/redirect; embarrassment
* Haldol (and others) -Akathesia
- Clinically - increased "agitation"
* Mellaril - Highest anticholingeric side effects
- Clinically - Thirst, constipation, etc.
26
Withdrawal effects are generally not problematic with anti-psychotic drugs because the drug:
a) Has a very short half-line
b) Is eliminated quickly from the body
c) Is retained in fat cells & slowly released
d) Rapidly results in tolerance
c) Is retained in fat cells & slowly released
27
Anti-psychotic function as positive reinforcers and are therefore often drugs of abuse
a) True
b) False
b) False
28
Which of the following is not a behavioral function of antipsychotic drugs?
a) AO for food and fluids
b) EP for food and fluids
a) AO for food and fluids
29
Anti-anxiety/sedative drugs can be administered _________ for fast acting effects
a) As as inhalent
b) IV
c) IM
d) Orally
b) IV
30
Withdrawal syndrome maybe dependent upon:
a) The dose of the drug
b) The gender of the person taking the drug
c) The number of other drugs in the bloodstream
d) The weight of the person taking the drug
a) The dose of the drug
31
This develops rapidly with anti-anxiety drugs:
a) Tolerance
b) Lethality
c) Withdrawal
d) Wright gain
a) Tolerance
32
The Gellar procedure used this schedule to screening for anxiolytic drugs:
a) Chained
b) Concurrent
c) Mixed
d) Multiple
d) Multiple
33
The Gellar procedure demonstrates that anxiolytics have this behavioral effect:
a) AO for punishment
b) AO for sleep
c) AO for food
d) EO for punishment
a) AO for punishment
34
Addictive Potential
* Benzodiazepines are considered to have a very high potential for addiction & it can happen quickly, or almost certainly occur over extended use
- Thus missed doses can result in behavioral episodes
- Rapid Tolerance: can develop rapidly esp to hypnotic effects of medication, may lead to taking higher doses
35
Benzos & Alcohol
* This can be lethal combination
* Both metabolic & dis-inhibitory effects combine & lead to overdose & death
* Bx analysts working with individuals who seek out alcohol in the community must be sure the prescribing physician is fully informed
36
Other issues
* Cognitive impairment: esp problematic with elderly patients who are at high risk for falls/hip fractures
* Chronic use results in lengthy withdrawal effects, including months of anxiety, depression, insomnia, gastrointestinal prob
37
Likely Functions Related to Anxiety
* All functions are in play as always, but the likely functional relations inherent in anxiety-related Bx are:
1) Escape/ Avoidance (esp avoidance)
2) Respondent conditioning (e.g. phobias)
38
Anxiety as a Cause of BX?
- This is a classic explanatory fiction
- But calling it that is probably why ppl do not usually come to us to seek relief for their anxiety!
- We need to change this
39
Anxiety & BX Analysis
* Bx analysts must operationalize those target responses that are agreed upon as "Anxiety" by both individuals seeking treatment & the medical professionals who manage medication
- We then collect data on Those targets
40
Measurement Tools
- While data maybe collected by observers on external responses such as Pacing, Refusals to go out, Running away, hyperventilating Confusion etc., "Anxiety" is typically experienced as a pvt event
- Thus, self-reporting is helpful, esp during assessment (for individuals with verbal repertoires)
41
Treatments
- Everyone is different, but besides anxiolytic drugs...
- Systematic desensitization (related to anxiety producing situations)
- Teaching other relaxation techniques
- Search the literature for more
42
Other Concerns Related to Anxiolytics & Behavior Analysis
- Anxiolytics work, initially
- They have very low toxicity
- But btw addiction potential, tolerance, paradoxical side effects & withdrawal effects, anxiolytics can actually result in an increase anxiety responses over time
43
Other Concerns Related to Anxiolytics & BX analysis
| contd
*Add to these prob the issues of potential lethality when some of the most common anxiolytic are combined with alcohol or other drugs of abuse potential (e.g. opioids)
44
Bx Analysis & Anxiety
*One way or the other with/without medication, Bx analysis is necessary in the treatment of anxiety
45
SSRIs are:
a) First generation
b) Second generation
c) Third generation
d) Fourth generation
b) Second generation
46
The half-line of antidepressants:
a) Are very short
b) Are very long
c) Have a wide variation depending on the drug
d) Nonexistent (have zero order kinetics)
c) Have a wide variation depending on the drug
47
Biotransformation of antidepressants occurs in:
a) Both GI tract and Liver
b) GI tract only
c) Liver only
a) Both GI tract and Liver
48
Anti-depressants are administered:
a) Orally
b) IV
c) IM
d) All of these
a) Orally
49
Antidepressants have all of the following behavioral functions Except:
a) AO for sleep
b) AO for food
c) EO for food in some drugs
d) Positive reinforcer
d) Positive Reinforcer
50
Its All in The Name
* Welbutrin Vs Zyban
* An excellent e.g. of main effects Vs. side effects
* For Welbutrin, the main effect is as an antidepressant, the side effect is the reduction of addictive urges
* For Zyban, just the opposite is true
51
Anti-depressants and Therapeutic Effects
*For many anti-depressants there is a time delay btw when the drug is first taken & when therapeutic effects are detectible......
52
Antidepressants: Delayed Effects
- Newer anti-depressants (e.g. SSRIs) take many days to reach a therapeutic level in the blood
- Clinical improvement maybe delayed by 2 weals/more as the medication takes effect slowly
- This reduces their abuse potential, since they are not immediately reinforcing
53
Behavior Analysis & Depression
- Many of the same points made in the section on Bx analysis & anxiety pertain to depression as well
- Depression is not a cause of Bx, but a category of behavioral responses that can be operationalized
54
Depression and Medication
* Studies are quite mixed on the efficacy of anti-depressant medication in changing Bx related to most types of depression
* The Bx analyst MUST be involved in tracking target behaviors, operationalized as markers of depression & charting those data
55
The two main categories of Seizures are:
a) First and second generation
b) Complete and incomplete
c) Generalized and complex
d) Partial and generalized
d) Partial and generalized
56
Anticonvulsants work by:
a) Reducing neuronal activity only
b) Enhance GABA only
c) Enhancing GABA or reducing activity of the neuron
d) Non of these
c) Enhancing GABA or reducing activity of the neuron
57
Anticonvulsants cross the placental barrier
a) True
b) False
a) True
58
Charlott's Web Oil Update
-In Nov of 2014, Gov. Rick Scott of Florida signed a bill legalizing of the use of Charlotte's web oil for both seizures in children and other medical uses
59
Seizures and Behavior Analysis
| *Seizure activity in an individual is imp for Bx analysis services for 5 main reasons
1) Bx before the Seizure
2) Bx during the seizure
3) Bx after the seizure
4) Staff training related to seizures
5) Tracking medication effectiveness
60
Behavior Before the Seizure
* The BX analyst maybe able to help identify behavioral signs of the onset of a seizure
* The Bx analyst maybe able to help the individual identity & recognize "aura" signs that a seizure episode maybe about to begin
61
Behavior During the Seizure
* There are many types of Seizures
* Most involve Tonic/Clonic involuntary movements ("Grand Mal"), or brief periods of "absence"
* Caregivers must be trained to recognize & track these episodes, by collecting "seizure data"
62
Atonic Seizures and Protective Devices
* Atonic Seizures, where muscle control is totally lost and during which an individual can simply drop to the floor without warning, poses a safety hazard to the individual (e.g., head injuries when failing)
* Helmets or other safety devices maybe needed, & usually a Bx analyst is involved in training and tracking these interventions
63
Frontal and Temporal Lobe Seizures
- Some literature indicates temporal lobe (or frontal lobe) seizure activity maybe tied to aggressive/violent Bx
- As such, this Bx may or may not be good candidate for behavioral intervention. The Bx analyst must assess this
64
Behavior After the Seizure
- Often right after a seizure, the individual is tired, irritable, not talkative & otherwise exhibiting a different behavioral profile than usual
- Efficient learning maybe temporarily compromised
- Automatonisms (robot-like responses after a seizure) maybe mistaken for a Bx prob - these must be behaviorally assessed
65
Seizure-related Behavior
- These & other patterns of responding may not be under full operant control - or may at the very least be functionally related to the physical act of having gone through a seizure
- Bx analysts are responsible for training caregivers how to respond to these types of post-seizure behaviors
66
Staff Training re: Seizures
*Staff must be trained on all 3 of these phases: what to do before a seizure if one is identified as coming: what to do during a seizure, including special medication administration for rapidly cycling & high freq seizure activity (usually per rectal)
67
Taking Medication Effectiveness
- Seizures can be counted and times, and data maybe collected on those events. Each can be a condition line
- Frequency/duration charts on seizure-based bx provide an imp tool for determine the effectiveness of a particular does of a particular drug (or drugs)
68
Drugs typically used for blood pressure control may also be used for ADHD
a) True
b) False
a) True
69
Which of the following is NOT a class of drug used for ADHD
a) Amphetamine-related Stimulus
b) Non-amphetamine stimulus
c) Non-stimulent
d) SSRIs
d) SSRIs
70
Correlational studies often use:
a) Random assignment of individuals to groups
b) Non-random assignment based on the independent variable
b) Non-random assignment based on the independent variable
71
This type of study introduces biases & it is harder draw conclusions based upon them
a) Correlational studies
b) True experiment
a) Correlational studies
72
There is no systematic bias in this type of experiment:
a) Correlational studies
b) True experiment
b) True experiment
73
Systematic bias is controlled for through:
a) Random assignment
b) Non-random assignment
a) Random assignment
74
This condition helps to isolate drug effects Vs. extraneous variable better then the baseline condition in drug evaluation:
a) Component analysis
b) Drug
c) Intervention
d) Placebo
d) Placebo
75
A Placebo effect is demonstrated when Bx changes:
a) In the direction of the drug effect during BL
b) In the direction of the drug effect during the placebo condition
c) In the direction of the drug effect during the drug condition
d) In the opposite direction of the drug effect during the BL condition
b) In the direction of the drug effect during the placebo condition
76
The appearance of negative symptoms as a result of drug administration minus the active ingredient is the:
a) Placebo effect
b) Nocebo effect
b) Nocebo effect
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