MH701 Safety Exam # 3

MH701 Safety Exam # 3

Compulsive drug craving, seeking use that persists even in the face of negative consequences?

Addiction
-Dopamine is the neurotransmitter related to addiction. Stimulants, methamphetamine, adderall can be addictive.

Maladaptive pattern of substance use with tolerance, withdraw, and persistent desire to obtain?

Substance dependence
Will do anything to obtain. Use CAGE questionaire for assessing alcohol dependence.
C-Cut down
A-Annoyed by others
G-Guilty about drinking
E-“Eye-Opener”
Assessment tool for withdrawal is CIWA, will tell us if they need medication, benzo, valium or ativan to help with withdrawal. S/S: shaking, anxiety, tremors. CIWA gives a score and depending on that score if medication is needed.

Educating a male patient on low-risk drinking?

No more than 4 drinks on one occasion or 14 drinks per week.
-For females, no more than 3 drinks on one occasion or 7 drinks per week.

Deficiency leading to decrease mental functioning, weakness, ataxia, and nystagmus?

Thiamine B-1
Seen a lot in alcoholics. With low thiamine increases risk/factor, withdrawal Wernicke-Korskoff encephalopathy.

Patient presents restless, increased HR, BP, and dilated pupils, intoxication of what substance?

Stimulants
Stimulated, bug eyed, awake, big eyes. i.e. amphetamine, PCP, LSD.
On the opposite end of the spectrum, with opioids, eyes will be pinpoint or small constricted pupils, v/s will be decreased BP, HR.

Most common cause of death with ecstay (MDMA)?

dehydration and hyperthermia
Clinching teeth, sweating but dehydrated, depletes out serotonin neurotransmitters with constant use of ecstasy 2-3 days later depressed, looking for that high or euphoria. SSRI is not going to help if there is nothing there.

Insomnia, runny nose, diaphoresis, muscle aches, nausea, chills, fever withdrawal from?

Heroin (opioid) not a stimulant
Flu-like symptoms
-withdrawal from benzos or alcohol risk of seizures. Cocaine or PCP are stimulants, person is awake, can run, do not want to eat. Stimulant is hitting the dopamine telling the body to produce more.

Mu opioid receptor that blocks the effects of opioids while suppressing withdrawal symptoms?

Methadone (synthetic opioid)
Have to be mindful in the way that it works. Patient must go to the methadone clinic.

Does not stimulate mu receptors, it just blocks them from being capable of stimulation?

Naltrexone (vivitrol)
Keeps from getting the enjoyment, no taste or crave of alcohol.
-Naloxone or Narcan is a reversal agent
-Antabuse or disulfirum reaction-Makes them very sick if they drink, get violently sick, flushing, vomiting. Educate patient on the need to avoid alcohol, cold medications, no cough syrups, mouthwash, read all medication labels.

Aversion therapy medication that treats chronic alcoholism?

Disulfirum (antabuse)
Patient teaching-Drinking will make them very sick. Avoid all products with alcohol like cold medications, mouthwash, cough syrups.
Acamprosate-Negative aspect to taking costly, have to take 3 times daily vs 2 times a day.

Inhibits the reuptake of dopamine and norepinephrine to treat ADHD?

Mehtylphenidate (concerta, ritalin, focalin)
Tells the brain to hold on, keep in the body and utilize longer. Vs. amphetamine causes the body to make more or produce more.
Atomoxetine (straterra)-Norepinephrine Reuptake Inhibitor or NRI does not hit the dopamine. Holds on to what the body has already; non-stimulant ADHD medication, good for focus/concentration.

Prodrug activated by lysine portion of molecule by enzymes resulting in gradual release of drug? (has to go thru the gut for it to work) slow

lisdexamphetamine (vyvanse)
Less abuse potential option for adults w/ADHD. More risk with weight. Long release 12 hrs.

Only $3.99/month

First non-stimulant approved by FDA for ADHD, inhibits presynaptic norepinephrine transport?

atomoxetine (straterra)
-Buproprion (wellbutrin), Guafacine (tenex), and clonidine. These can be added to a child vs. a stimulant, but will not do a lot for focused attention.

Reduces hyperactivity and/or impulsivity, also used for TIC disorder/Tourette’s?

alpha-adrenergic agonists

Child on Adderall seems more irritable and emotional in afternoon?

All of the above are options.

i.Add additional short-acting dose in afternoon
ii.Add adjunctive dose of alpha-adrenergic agonist
iii.Change to long-acting medication

Rapid onset, hours to weeks in duration, fluctuating attention, impaired recent & immediate memory?

Delirium
UTI’s, lack of oxygen, and infection can lead to delirium.
-Dementia is slow progressive, 5-10 years continual decline. Important to check V/S, labs, not always just psych.

Reduced inactivation acetylcholine and thus potentiate cholinergic neurotransmitter for memory?

Donepizil (aricept, exelon) cholinase inhibitor
For mild to moderate
Memantine (namenda) for moderate to severe
Up to 6 month benefit or delay, will pick back up to chronic. Not a treatment, just a delay.
Tool used to help determine where they are at with memory loss use “MMSE” during admission. If they are college degree level, use the SLUMS scoring. scores 0-30. What score is considered normal? 27-30 with high school education, 20-26 mild neurocognitive disorder, 1-19 Dementia

Produces effects by blockade of NMDA receptors-indicated for moderate to severe memory?

Memantine (namenda)
Can take aricept at the same time.

Benzo option-elderly that has no active metabolites, half-lives that do not increase with age?

Lorazepam
Safer, less fall risk, more tolerated, and short-acting.
-Want to avoid clonazepam and diazepam due to long-acting, more risk, toxic, fall risk. Beers criteria-to avoid with elderly 65 y/o. The BEERS criteria for potentially inappropriate medication use in older adults are guidelines for healthcare professionals to help improve the safety of prescribing medications for older adults.

Often avoided in elderly due to significant orthostatic hypotension and anticholinergic effects?

TCAs tetracyclic antidepressants
Drying effects, constipation. Two of the most safest TCAs to give are nortriptyline and desipramine.

Two mood stabilzers used with the elderly with neuroprotective benefits?

Lithium and Depakote (valproate) are commonly used

BBW w antipsychotics

Can worsen cognition-Dementia
-If hallucinating, will need an antipsychotic along with mood stabilizer.

Atypicals with children

SSRI
Lowest S/E profile, drug class to start with.
Associated with children, due to brain development not completed before age 25. Do not know hoe will react. Need to have an eye on that child with medication. SSRI does not actually cause SI.

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