Substance Use Disorders and Treatment, Exams of Medicine

Download Substance Use Disorders and Treatment and more Exams Medicine in PDF only on Docsity! PMHNP Board Review (2024) Exam | Questions and Complete Answers Positive Romberg Sign - ANSWER - (r/t etoh) loss of balance that occurs when closing the eyes ETOH withdrawal delirium may result in? - ANSWER - Seizures or death DSM Severity for ETOH - ANSWER - Mild = 2-3 sx Moderate = 4-5 sx Severe = >= 6 sx DSM ETOH Remission Criteria - ANSWER - Early = >3 mos & <12 mos Substantial Remission = >12 mos Screening & Early Intervention scale for SUD - ANSWER - SBIRT Screening, Brief Intervention & Refereal to Treatment CAGE - ANSWER - Cut down Annoyed Guilty Eye-Opener >=2 is clinically significant Labs for AUD - ANSWER - ETOH/SUD Blood & urine BAC Ele. AST, ALT, MCV, CDT (Carb deficit transfer) Dec. Hgb, B12, folic acid ETOH W/D Sx - ANSWER - Most common = tremors (w/i hours of cessation) Ele. b/p. tachy, n/v, poss. hyperthermia Sx of ETOH W/D Emergency - ANSWER - Hallucinations = 7 - 48 hours DTs - 48 - 72 hours, peaks on 4th day, can last for 2 weeks CIWA - ANSWER - Clinical Institute Withdrawal Assessment 0-8 Support &Monitoring w/o meds! (NO meds unless >=8) 8-14 = Pharm Intervention 15 = IMMEDIATE Pharm Int! Disulfiram (Antabuse) Dosage for ETOH - ANSWER - Usually 250 mg/day NO perfumes or mouthwash! Meds Used for ETOH W/D Sx including Seizures - ANSWER - Benzos & Carbamazepine (Tegretol) Vitamin to be given during ETOH detox - ANSWER - Thiamine >300 mg/day CRAFFT - ANSWER - SUD screening tool for adolescents (12-21) COWS - ANSWER - Clinical Opiate Withdrawal Scale 5-12 = mild 13-24 = moderate 25-36 = moderately severe >36 = severe withdrawal Meds used for Opiod Detox & Maintenance - ANSWER - Buprenorphine (Suboxone) Naloxone (Naltrexone) Methadone Clonidine (use with care! may mask VS changes & inc. seizure risk!) Phenobarbital Cannabis W/D Symptoms Timeline - ANSWER - Sx begin w/in 24 - 48 hours Peak 4 - 6 hours Duration 1 - 3 weeks Cannabis Treatment - ANSWER - Motivational Enhancement Therapy (MET) Best Tx is MET + CBT + Contingency Management When to Start & Stop CIWA - ANSWER - Start: Last ETOH w/i past 12 hours Hx of: w/d sx, large amt of etoh over long time Stop: When score is <10 after 3 consecutive assessments CIWA Measurement Guideline - ANSWER - N/V Tremors Paroxysmal Sweats Anxiety Agitation Tactile, Auditory, Visual Disturbances H/As or "fullness in head" Orientation/Sensorium Neurological Factors of Addiction - ANSWER - "Feel good" rewards by Dopamine Pathways Ele. Dopamine Ele. Glutamate Dec. GABA Choriform Movements - ANSWER - Jerking or writhing movements (SOFT SIGN) Agraphesthesia - ANSWER - Inability to recognize symbols, letters or numbers traced on the skin (SOFT SIGN) Stereognosis - ANSWER - Ability to recognize an object by feel Alogia - ANSWER - Poverty of speech (Negative Sx of Schizophrenia) Avolition - ANSWER - Lack of motivation to begin or complete a task (Negative Sx of Schizophrenia) Hypnopompic - ANSWER - Hallucinations upon WAKING Hypnagogic - ANSWER - Hallucinations when GOING to SLEEP Adrenaline - ANSWER - "Fight or Flight" Where is adrenaline produced? - ANSWER - Adrenal Glands Catecholamine NTs - ANSWER - Adrenaline Norepinephrine Dopamine Monoamine - Indole NT - ANSWER - Serotonin Amino Acid NT - ANSWER - GABA (universal inhibitory NT) Glutamate (universal excitatory NT) Cholinergic NT - ANSWER - Acetylcholine Noradrenaline role - ANSWER - Concentration - affects attention Dopamine role - ANSWER - Pleasure Serotonin role - ANSWER - Mood, affects well being and happiness GABA role - ANSWER - Calming Glutamate role - ANSWER - Memory and learning Most common NT - ANSWER - Glutamate Acetylcholine role - ANSWER - Learning, thought, & memory, involved in physical muscle action Where is acetylcholine synthesized? - ANSWER - Basal nucleus of Meynert Acetylcholine receptors - ANSWER - Nicotinic & Muscarinic Effects of Acetylcholine - ANSWER - Increased heart rate, secretions, sweating, salivation, memory & muscle contractions Where is Dopamine produced - ANSWER - Substantia Nigra & Ventral Tegmental Dopamine is removed from (?) by (?) - ANSWER - Synaptic Cleft & MAO (monoamine oxidase) Dopamine Pathways - ANSWER - Mesocortical Mesolimbic Nigrostriatal Tuberoinfundibular Effects of Dopamine - ANSWER - Increased sense of well being & satiety Decreased hunger & cravings Effects of GABA - ANSWER - Increased sleepiness Decreased anxiety, alertness, memory & muscle tension Effects of Glutamate - ANSWER - Heightens perceptions (usually taste) Where is Norepinephrine produced? - ANSWER - Locus Ceruleus of Pons Effects of Norepinephrine - ANSWER - Increased heart rate, alertness & well-being Decreased pain sensitivity & circulation Where is Serotonin produced - ANSWER - Raphe Nuclei of the Brain Stem Effects of Serotonin - ANSWER - Increases well-being & satiety Decreases pain perception High Risk Factors of Suicide - ANSWER - SI Plan w/details & means Hopelessness/Desperation Previous attempt Suicide of significant person in their life Mental Status Exam (MSE) - ANSWER - "All Bad Subjects Are Tough Troubled Characters" Appearance Behavior Speech Affect Thought Content Thought Process Cognitive Exam Mini-Mental Status Exam (MMSE) - ANSWER - ORAL 23 RWD Orientation to place & time Recognition (repeat 3 objects)/Recall (repeat 5 minutes later) Attention (Serial 7's backwards from 100) Language Identify 2 objects Follow 3-step command Reading (Read & Do "close your eyes) Writing (Write a sentence) Drawing (copy a design) MMSE Scoring - ANSWER - 0 - 7 = Severe Delirium/Dementia 18 - 23 = Mild Delirium/Dementia 24 - 30 = NO Cognitive Impairment Hallucinations - ANSWER - Hear, feel, see, taste, smell Delusions - ANSWER - Fixed belief that isn't real Illusions - ANSWER - Something that is real that is believed to be something that it isn't St. Louis University Mental Status Exam (SLUMS) Scale - ANSWER - 0 - 20 = Dementia 21 - 26 = Mild Neurocognitive Dx 27 - 30 = WNL Patient Health Questionnaire (PHQ-9) (Depression) - ANSWER - 1 - 4 = Minimal Depression 5 - 9 = Mild Depression 10 - 14 = Moderate Depression 15 - 19 = Moderately Severe Depression 20 - 27 = Severe Depression Generalized Anxiety Disorder Screening Tool (GAD-7) - ANSWER - 5 - 9 = Mild Anxiety 10 - 14 = Moderate Anxiety 15 - 21 = Severe Anxiety Scales for ADHD - ANSWER - Connors & Vanderbilt DASH diet A TSH of (?) indicates Hypothyroid - ANSWER - > 4.2 Primary Hypothyroidism is caused by - ANSWER - Thyroid disease (LITHIUM, thyroid surgery, Hashimoto's, Low Fe, postpartum) Secondary Hypothyroidism is cause by - ANSWER - Pituitary or Hypothalamus disease Thyroid Function Cascade - ANSWER - H - AP - T Hypothalamus secretes TRH TRH stimulates Anterior Pituitary to secrete TSH TSH stimulates the Thyroid to release T3 & T4 The main thyroid hormone is (?) and is controlled by (?) - ANSWER - T4 = main thyroid hormone TSH controls T4 productions Clinical Symptoms of Hypothroidism - ANSWER - Fatigue (usually 1st sx) Depression & Anxiety Cold intolerance Sleep problems Constipation Memory impairment Decreased libido Menorrhagio Myxedema (swelling of skin/waxy looking) Wt. gain Lab tests for HIV - ANSWER - ELISA for initial screening (>99.9% sensitivity) Western Blot for confirmation #1 Cause of Preventable Blindness - ANSWER - Chlamydia Treatment for Syphilis - ANSWER - PCN G STDs - Mandatory Reporting to Health Department - ANSWER - HIV, Hep B, Hep C, Chlamydia, Gonorrhea, Syphilis Treatment for HIV - ANSWER - Antiretrovirals & treat opportunistic infections Cognitive Theory (Piaget) - ANSWER - Development R/T cognition, learning & understanding 0 - 2: Sensorimotor (Object Permanence) 2 - 7: Perioperational (Symbolic Play & Magical Thinking) 8 - 12: Concrete Operational (Uses logic, values others, reversibility & conservation) >=13: Formal Operational (Abstract thinking, complex problem-solving) Maslow's Heirarchy of Needs - ANSWER - Self-actualization Self-esteem Love & Belonging Safety Physiological Needs Health Belief Model (Becker) - ANSWER - Explains that people don't always prevent/screen due to: Perceived susceptibility, severity, benefits, barriers, cues to action, or self-efficacy Gestalt Therapy (Perls) - ANSWER - Must find own way in life "Good enough mother" allows for interpersonal safety for developing true self Interpersonal Relationship Theory (Peplau) - ANSWER - Therapeutic nurse-client relationship is central! Phases: Orientation, Working, Termination Dialectical Behavioral Therapy (DBT) - ANSWER - Tx of Borderline & Narcissistic Focus: Emotional regulation, tolerance for distress, self-management skills, interpersonal efficacy & mindfulness Boundaries are KEY!!! Change & Acceptance are essential!!! Time consuming! Weekly 1 hour sessions Weekly Group Skills Training Skills Couching PRN Team Consult for Therapist Motivational Interviewing (MI) - ANSWER - "Change Talk" - client statements revealing motivation for change Types of motivation: Amotivation (helplessness/passive, self-critical) Extrinsic (pay off) Intrinsic (Task itself is rewarding) Skills: OARS Open-ended questions Affirmations Reflections Summaries Motivational Interviewing (MI) mnemonic to hear "Change-Talk" - ANSWER - DARN CAT Desire Ability Reason Need Committment Activation Taking Steps Stages in Motivational Interviewing (MI) - ANSWER - Precontemplation - Not considering change Contemplation - Ambivalent re: change Preparation - Planning to act in 1 month Action - Practicing new behavior for 3 - 6 months Maintenance - Continued commitment 6 months - 5 years Replapse - Resuming old behaviors 3 Main Approaches to Behavioral Therapy - ANSWER - ABA - all behavior is r/t consequences