Substance Use
What class of medications is used to treat symptoms of alcohol withdrawal?
Benzos
What does ARFID stand for?
Avoidant/Restrictive Food Intake Disorder
What antipsychotic medication is less likely to have EPS?
Clonzapine
What class of medications can cause metabolic disorder?
second generation antipsychotics
What is the difference between grief and mourning?
Grief: internal response to the loss of someone or something
Mourning: outward expression of grief
What are the two screening tools used for determining substance use?
CAGE Questionnaire - Alcohol
B-DAST - Brief Drug Abuse Screening Test
S/S of Anorexia Nervosa
Cognitive: belief that you are fat even when emaciated, control over food, may have rigorous exercise routine, cognitive distortions about appearance, terror about gaining weight
Physical: amenorrhea, lanugo, osteoporosis, BMI <18, cold intolerance, bradycardia, hypotension
Which personality disorders are most likely to commit suicide?
Borderline & antisocial PD's more likely to attempt suicide
What is the therapeutic range for lithium?
0.6-1.2 mEq/L
What classes of medications are used to treat akathisia?
anticholinergics, benzodiazepines, beta-blockers
Name 6 early symptoms of alcohol withdrawal
Diaphoresis, headache, GI symptoms, tremors, irritability, elevated VS (HR, BP, temp), jerky movements, ataxia, startle easily, seizures
What is refeeding syndrome?
The body shifts from a catabolic state to an anabolic state which can cause a shift in fluid and electrolytes. This can lead to heart failure, respiratory failure, arrythmias, muscle breakdown and death.
What are possible treatments for opioid withdrawal?
Substitution Therapy: Methadone for tapering off opioids; Buprenorphine: acts as an opioid substitute that can be tapered
Clonidine for Autonomic symptoms
What anticonvulsants can be used to treat chronic aggression?
Valproic Acid, Carbamazepine, Lamotrigine
What are the symptoms of ADHD?
trouble concentrating, difficulty remaining focused, easily distracted, struggling with organizational and time management skills, and forgetfulness
children may fidget, squirm, be impulsive, have poor grades and poor social relationships
adults may be internally restless
What is the tool used to assess alcohol withdrawal? opioid withdrawal?
CIWA-AR - Clinical Institute Withdrawal from Alcohol Assessment Revised
COWS - Clinical Opioid Withdrawal Scale
Physical Signs of Bulimia Nervosa
dental erosion, cuts/abrasions over knuckles, fluid and electrolyte imbalance, esophageal tears, cardiac arrythmias, cardiac arrest from hypokalemia
What is the major intervention used for Borderline Personality Disorder? What are the components?
Dialectical Behavior Therapy
Mindfulness—living in the moment
Interpersonal effectiveness—skills that maximize the chance of achieving a goal without damaging a relationship or one's self-respect
Distress tolerance—learning to bear emotional pain skillfully by accepting self and the current situation
Emotional regulation—recognizing and coping with negative emotions in a healthy manner
Name 3 Sedative-Hypnotics, MOA, and 1 teaching point
Zolpidem (Ambien), Eszopiclone (Lunesta), Zalepione (Sonata)
GABA-receptor agonists, prevent GABA binding thus boosting its effects
May be habit forming; short term use, risk of complex behaviors after taking, no antianxiety, anticonvulsant, antihypertensive effects
What are the symptoms of NMS?
FEVER
F: Fever (Hyperpyrexia: >103°F or >38°C)
E: Elevated CPK/WBC
V: Vital sign instability (autonomic instability)
• Fluctuating BP, pallor, tachycardia
• Excessive sweating, salivation, tremors, incontinence
E: Encephalopathy
• Confusion, agitation, altered level of consciousness
R: Rigidity (Muscles)
Name 5 co-dependent behaviors
• Attempting to control someone else's drug use
• Spending most of your time thinking about the other person
• Finding excuses for the person's continued use
• Covering up or lying about the person's use
• Feeling responsible for the person's use
• Feeling guilty about the other person's behavior
• Avoiding family and social events because of concerns or shame about the member's behavior
• Making threats about substance use behaviors while failing to follow through
• Forcing promises for change
• Feelings of "walking on eggshells" to avoid causing problems
• Allowing own moods to be influenced by the behavior of the person
• Hiding or eliminating drug or alcohol supply
• Assuming duties and responsibilities of the person who is using
• Controlling the family's finances or protecting the person from financial or legal problems
Interventions for Bulimia Nervosa
Assess mood and presence of suicidal thoughts/behaviors of self harm
Monitor physiological parameters (VS, electrolytes)
Monitor pt's weight as needed
Explore dysfunctional thoughts that maintain the binge-purge cycle
Educate the pt that fasting can lead to continuation of bingeing and the binge-purge cycle
Monitor the pt during and after meals to prevent throwing away food and/or purging
Acknowledge the pt's overvalued ideas of body shape and size without minimizing or challenging the pt's perceptions
Encourage the pt to keep a journal of thoughts and feelings
Name all the personality clusters, the disorders within, and the major characteristics of each
Type A: Patients have odd and eccentric behaviors and can be anti-social and paranoid (Paranoid, Schizotypal, Schizoid)
Type B: Patients have dramatic, emotional, and erratic behaviors (Antisocial, Narcissistic, Borderline, Histrionic)
Type C: Patients have anxious and/or fearful behaviors (Avoidant, Dependent, Obsessive-Compulsive)
Name 5 Medications Used in MAT Therapy
Disulfiram (Antabuse), Naltrexone (ReVia), Vivitrol (Naltrexone ER - IM), Acamprosate (Campral), Buprenorphine Hydrochloride (Buprenex, Subutex); Buprenorphine Hydrochloride and Naloxone Hydrochloride (Suboxone), Methadone
Name all of the EPS disorders and their treatments
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