California Association of PAPGPC

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California Association of PA/PG/PC

• March 20, 2008

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Substance use-pretest

• Methamphetamine induced psychosis is usually
  characterized by
• Intense visual hallucinations
• Intense auditory hallucinations
• Paranoid ideation with well forms delusions

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Substance use pretest

• Hepatitis C can be associated with
• Depression
• Anxiety
• Insomnia
• All of the above

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Adhd pretest

• The deficit in the brain in adhd is a deficiency
  of dopamine at the D2 receptor
• T
• F

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Adhd pretest

• Adhd symptoms disappear by the age of 18 in
• 10 per cent of patients
• 25 percent of patients
• 40 percent of patients

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Adhd pretest

• Stimulants should never be used in patients with
  a history of stimulant addiction
• T
• F

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Adhd pretest

• Which of the following is not an accepted
  medication treatment for adhd
• Clonidine
• Wellbutrin
• Strattera
• Provigil

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Depression pretest

• Which of the following ssri antidepressants has
  the least potential for drug interactions?
• Prozac
• Effexor
• Lexapro
• Paxil

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Depression pretest

• Which two of the following antidepressants have
  no inhibition of sexual functioning?
• Paxil
• Remeron
• Cymbalta
• Wellbutrin

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Pretest for substance use

• Methamphetamine causes more damage to brain cells
  than cocaine.
• T
• F

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Substance use pretest

• Symptoms of benzodiazepine withdrawal typically
  include all of the following except
• Hallucinations
• Seizures
• Insomnia
• Tremor

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Substance abuse pretest

• Symptoms of opiate withdrawal include all of the
  following except
• GI distress
• Insomnia
• Myalgias
• Seizures

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Substance use pretest

• Methadone can be used for pain management as well
  as for opiate replacement therapy.
• T
• F

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Substance use -pretest

• Alcohol use drastically
• accelerates the progression of hepatitis C.
• T
• F

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Substance use pretest

• The most commonly associated mental health
  diagnosis associated with alcohol use disorders
  is
• Major depression
• Schizophrenia
• Bipolar disorder
• Panic

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Pretest

• A patient presents on Tylenol with codeine,
  Paxil, Combivir and Norvir. They are complaining
  of nausea, insomnia, excessive sweating and
  worsening of the pain that had previously been
  controlled on Tylenol 4.
• What questions could you ask to clarify causes of
  this?
• What drug interaction may be at work?

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Pretest contd

• Your pt is on Retonavir and your pt had been on
  Elavil at 100 mg for peripheripheral neuropathy
  for several months. Three weeks after the
  Ritonavir is added your pts mother calls you and
  tells you he is stuporous and confused.
• What is happening here?

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Pretest

• Your pt is on oral birth control pills and does
  not wish to become pregnant due to recent
  diagnosis of HIV.
• She is placed on tegretol (carbamazepine) for
  peripheral neuropathy and now presents with
  nausea and vomiting and fatigue two months later.
• Ideas?

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Pretest

• Your pt has been stable on retrovirals for
  several months.
• Prozac is added and two months later pt begins to
  experience symptoms of toxicity from
  antiretrovirals.
• What's happening here?

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Antipsychotic pretest

• Metabolic syndrome refers to a set of
  abnormalities caused by atypical antipsychotics.
• Which of the following is the best indicator of
  the development of the metabolic syndrome?
• Increased BMI, increased blood sugar, increased
  triglycerides, increased cholesterol, weight
  gain. (circle the correct answer)

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Pretest continued

• Your pts cd4 had been progressively improving
  however over the last three months they have
  dropped significantly. She tells you she was just
  visited by her friend from Mendocino who gave her
  a herbal remedy for her sadness.
• What may we be dealing with?

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Pretest continued

• Your methadone pt has a seizure after abruptly
  stopping xanax. He has been placed on dilantin
  and presents with increased craving for heroine,
  nausea/ vomiting and insomnia.
• What's wrong?

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Psychological crisis points

• New diagnosis
• Newly starting antiretrovirals
• Relationship issues

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New diagnosis

• Intensive support
• Monitor mood
• Assess suicidality

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Who am I?

• Psychiatrist with added qualifications in
  addiction psychiatry
• Psychiatrist at CARES in Sacramento
• Medical Dir of New Dawn Recovery in Orangevale
• Medical Director of Treatment Associates Opiate
  replacement clinic aka Methadone Clinic
• Assistant Clinical Professor of Psychiatry At UC
  Davis
• Graduate of UCLA undergrad medical school
  internship and residency.