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84 Cards in this Set
- Front
- Back
IQ tests
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Wechsler Adult Intelligence Scale (WAIS) - ages 16-75
Stanford-Binet - ages 2-18 |
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Objective personality test
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Minnesota Multiphasic Personality Inventory (MMPI-2)
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DSM-IV Schizophrenia
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A)Two+ for at least 1 month:
1) Delusions 2) Hallucinations 3) Disorganized speech 4) Grossly disorganized or catatonic behavior 5) Negative symptoms B) Causes social/occupational deterioration C) At least six months (incl. prodromal or residual) D) Not due to medical, neuro, substance |
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Schizophrenia subtypes
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1) Paranoid
2) Disorganized 3) Catatonic 4) Undifferentiated 5) Residual |
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Criteria for Paranoid Type Schizophrenia
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A) Preoccupation with 1+ delusions or frequent AH
B) No predominance of disorganized speech, disorganized or catatonic behavior, or inappropriate affect |
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Criteria for Disorganized Type Schizophrenia
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A) Disorganized speech
B) Disorganized behavior C) Flat/inappropriate affect |
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Criteria for Catatonic Type Schizophrenia
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At least 2 of:
A) Motor immobility B) Excessive purposeless motor activity C) Extreme negativism or mutism D) Peculiar voluntary movements/posturing E) Echolalia or echopraxia |
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Schizophrenia:
1) Monozygotic concordance rate 2) Inheritance w/ 2 parents 3) Inheritance w/ one 1st degree relative |
1) 50%
2) 40% 3) 12% |
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Dopamine pathways
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1) Prefrontal cortical - negative sx
2) Mesolimbic - positive sx 3) Tuberoinfundibular - prolactin 4) Nigrostriatal - EPS when blocked |
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Neurotransmitter abnormalities in schizophrenia (non-dopamine)
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1) ↑ serotonin
2) ↑ NE 3) ↓ GABA |
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Serotonin-antigonizing antipsychotics
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risperidone
clozapine |
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In schizophrenia:
___ sx & ___ onset associated w/ better prognosis; ___ sx & ___ onset w/ worse. |
Mood sx & acute onset associated w/ better prognosis; negative sx & gradual onset w/ worse.
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SE of high potency neuroleptics
SE of low potency neuroleptics |
High: EPS
Low: anticholinergic |
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EPS SE in order of onset
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1) Dystonia
2) Akathisia 3) Parkinsonism 4) Tardive dyskinesia |
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Tx of EPS (except TD)
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Anticholinergics (benztropine, amantadine)
Benzos |
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Tx of TD
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Cholinomimetics
Benzos Beta-blockers |
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Most likely to cause NMS
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High-potency
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Sx of NMS
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Confusion
High fever HTN Tachycardia Lead pipe rigidity Sweating Elevated CPK |
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Which antipsychotic can cause irreversible retinal pigmentation?
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Clozapine
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Which antipsychotic can cause deposits in lens and cornea?
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Chlorpromazine
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DSM-IV for schizoaffective d/o
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A) Meet criteria for MDD, manic episode, or mixed episode, during which criteria for schizophrenia also met
B) Delusions/hall for 2 weeks WITHOUT mood sx C) Mood sx for substantial portion of psychotic illness D) Not due to medical condition or drugs |
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DSM-IV for Major Depressive Episode
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A) At least five (incl. 1 or 2) for at least 2 weeks:
1) Depressed mood 2) Anhedonia 3) Change in appetite or weight 4) Worthlessness/guilt 5) Insomnia/hypersomnia 6) ↓ concentration 7) PMA/PMR 8) Fatigue/↓ energy 9) Recurrent thoughts of death/suicide |
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DSM-IV for Manic Episode
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A) At least 1 week of abnormally and persistently elevated, expansive, or irritable mood w/ 3 (4 if irritable):
1) Distractibility 2) Inflated self-esteem/grandiosity 3) ↑ goal-directed activity 4) ↓ need for sleep 5) Flight of ideas/racing thoughts 6) Pressured speech/talkative 7) Risky activites |
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DSM-IV for Mixed Episode
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Criteria met for both manic and major depressive episode, nearly every day for at least 1 week.
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Hypomanic Episode
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-At least 4 days
-No marked social/occupational impairment -Does not require hospitalization -No psychotic features |
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Sleep problems in MDD
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1) Multiple awakenings
2) Initial & terminal insomnia 3) Hypersomnia 4) REM earlier in night 5) ↓ 3&4 |
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Neuroendocrine abnormalities in MDD
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1) High cortisol; failure to suppress in dexamethasone suppression test
2) Abnormal thyroid axis; blunted TSH response to TRH |
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Monozygotic and dizygotic concordance for MDD
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50% and 10-25%
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DSM-IV for Bipolar I
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One manic or mixed episode
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Monozygotic and dizygotic concordance for Bipolar I
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75% and 5-25%
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DSM-IV for Bipolar II
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One+ MDE and 1+ hypomanic episode
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DSM-IV for Dysthymic Disorder
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A) Depressed mood most of the time on most days for at least 2 years (1 in chilren)
B) 2+ of: 1) Poor concentration/decision-making 2) Hopelessness 3) Poor appetite or overeating 4) Insomnia/hypersomnia 5) Low energy/fatigue 6) Low self-esteem C) During the 2-year period: 1) Not without the sx for >2 months at a time 2) No MDE |
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DSM-IV for Cyclothymic Disorder
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A) Numerous periods w/ hypomanic sx and periods w/ depressive sx for at least 2 years
B) Never sx-free for >2 months C) No hx of MDE or manic episode |
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Neurotransmitter changes in anxiety
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-↑ NE
-↓ GABA -↓ serotonin |
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DSM-IV for panic attacks
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Discrete period of intense fear and discomfort with at least 4 of:
-Palpitations -Sweating -Shaking -Shortness of breath -Choking sensation -Chest pain -Nausea -Light-headedness -Depersonalization -Fear of losing control/going crazy -Fear of dying -Numbness or tingling -Chills or hot flushes |
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DSM-IV for Panic Disorder
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1) Spontaneous recurrent panic attacks
2) At least one followed by at least one month of: -Persistent concern about having further attacks -Worry about implications of attack -Significant change in behavior |
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Pharm tx for Panic Disorder w/w/o Agoraphobia
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SSRIs first-line
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DSM-IV for Specific and Social Phobias
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1) Persistent excessive fear
2) Exposure causes immediate anxiety response 3) Pt recognizes fear is excessive 4) Situation avoided or tolerated w/ intense anxiety 5) If under 18, lasts at least 6 months |
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Pharm tx for social phobia
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Paroxetine, beta-blockers
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DSM-IV for OCD
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1) Either obsessions or compulsions
2) Pt is aware are unreasonable/excessive 3) Obsessions cause marked distress, are time consuming, or interfere w/ ADLs |
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Pharm & behavioral tx for OCD
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Pharm: SSRIs, clomipramine
Behav: Exposure and response prevention (ERP) |
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DSM-IV PTSD
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-Traumatic, potentially harmful or fatal event; initial reaction intense fear or horror
-Persistent re-experiencing -Avoidance of stimuli associated w/ the trauma -Numbing of responsiveness -Persistent sx of increased arousal -At least one month |
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Pharm tx for PTSD
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TCAs (imipramine, doxepin); SSRIs; MAOIs; anticonvulsants (for flashbacks and nightmares)
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Time lengths in acute stress disorder
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Event occurred <1 month ago
Symptoms last <1 month |
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DSM-IV for GAD
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1) Excessive anxiety & worry for at least 6 months
2) Difficult to control the worry 3) At least three of: -Restlessness -Fatigue -Difficulty concentrating -Irritability -Muscle tension -Sleep disturbance |
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Pharm tx of GAD
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Buspirone; short course of benzos (clonazepam, diazepam); SSRIs; venlafaxine ER
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DSM-IV of Adjustment Disorder
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1) Development of emotional or behavioral sx w/in 3 months of a stressful (not life-threatening) event, producing either
-Severe distress -Significant impairment in daily fx 2) Sx are not those of bereavement 3) Sx resolve w/in 6 months |
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DSM-IV for personality d/o
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1) Pattern of behavior/inner experience manifested in 2+ of:
-Cognition -Affect -Personal relations -Impulse control 2) The pattern: -Is pervasive & inflexible in a broad range of situations -Is stable; onset no later than adolescence/early adulthood -Causes sig. distress in fx -Not accounted for otherwise |
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Cluster A
-Types -Family assoc |
-Types: schizoid, schizotypal, paranoid
-Assoc: psychotic d/os |
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Cluster B
-Types -Family assoc |
-Types: antisocial, borderline, histrionic, narcissistic
-Assoc: mood d/os |
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Cluster C
-Types -Family assoc |
-Types: avoidant, dependent, obsessive compulsive
-Assoc: anxiety d/os |
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DSM-IV for substance abuse
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1+ year w/ 1+ of:
1) Failure to fulfill obligations 2) Use in dangerous situations 3) Recurrent substance-related legal problems 4) Continued use despite social or interpersonal problems due to the substance use |
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DSM-IV for substance dependence
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W/in a 12-month period, 3+ of:
1) Tolerance 2) Withdrawal 3) Using more than originally intended 4) Persistent desire or unsuccessful efforts to cut down 5) Significant time spent getting, using or recovering 6) Decreased social, occupational, recreational activities |
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Legal limit for intoxication in most states
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BAL 80-100 mg/dL
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Tx of acute EtOH intoxication
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1) ABCs, electrolytes & acid-base
2) FSBG 3) Thiamine, naloxone, folate |
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Pharm tx for EtOH dependence
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Disulfiram, SSRIs, naltrexone (reduces cravings)
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Tx of EtOH withdrawal
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1) Tapering benzo
2) Thiamine, folic acid, MVI 3) MgSulfate for postwithdrawal sz |
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Sx of Wernicke's encephalopathy
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1) Ataxia
2) Confusion 3) Ocular abnormalities (nystagmus, gaze palsies) |
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Sx of Korsakoff's syndrome
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1) Impaired recent memory
2) Anterograde amnesia 3) +/- confabulation |
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Order of nutrients in Wernicke-Korsakoff
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Thiamine BEFORE glucose
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Effect of cocaine
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Blocks dopamine reuptake
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Pharm tx of
-Cocaine intoxication -Cocaine dependence |
-Intox: benzos, Haldol, sx tx
-Dependence: TCAs, dopamine agonists (amantadine, bromocriptine) |
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-Classic amphetamines
-Substituted ("designer") amphetamines |
-Dextroamphetamine (Dexedrine), methylphenidate (Ritalin), methamphetamine (crystal meth)
-MDMA (ecstasy), MDEA (eve) |
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Effect of
-Classic amphetamines -Substituted amphetamines |
-Release dopamine from nerve endings
-Release dopamine and serotonin from nerve endings; stimulant & hallucinogenic |
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How long is urine drug screen + after cocaine use?
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3 days; longer in heavy users
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How long is urine drug screen + after amphetamine use?
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1-2 days
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Effects of PCP
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-Antagonizes NMDA glutamate receptors
-Activates dopaminergic neurons |
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Drug similar to PCP
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Ketamine
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Pathognomonic sx of PCP intox
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Rotatory nystagmus
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How long is urine drug screen + after PCP use, and what else is often elevated?
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>1 week; CPK & AST
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Effect of
-benzos -barbiturates |
-Increase frequency of Cl channel opening
-Increase duration of Cl channel opening |
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How long is urine drug screen + after sedative-hypnotic use?
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1 week
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Tx of barbiturate intoxication
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Alkalinize urine w/ sodium bicarb to promote renal excretion
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Tx for benzo intoxication
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Flumazenil
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What is the date rape drug?
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GHB (gamma-hydroxybutyrate)
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What is dextromethorphan?
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An opiate
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What can meperidine + MAOIs together cause?
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Serotonin syndrome
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How long is urine test + after opiate use?
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12-36 hours
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Sx of opiate withdrawal include
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-Dysphoria
-Lacrimation, rhinorrhea -Yawning -Piloerection -Muscle ache |
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Which opiate does not cause miosis?
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Meperidine
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How long is urine test + after MJ use?
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Up to 4 weeks in heavy users
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How long is serum test + after inhalant use?
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4-10 hours
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Effect of caffeine
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-Adenosine antagonist → ↑ cAMP
-Stimulant effect (dopaminergic) |
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Pharm tx for smoking cessation
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Zyban (bupropion), clonidine
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