Review > Mood Disorders > Flashcards

Mood Disorders Flashcards

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1
Q

Acute serotonin syndrome symptoms

A
  • sudden onset high fever
  • muscular rigidity
  • mental status changes
  • hyperreflexia/clonus
  • uncontrolled shivering
  • dilated pupils (mydriasis)
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2
Q

Malignant neuroleptic syndrome

A

-rare life-threatening idiopatchic reaction from typical and atypical antipsychotics

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3
Q

SSRIs first line for

A
  • major depression
  • OCD
  • GAD
  • panic disorder
  • social anxiety disorder
  • premenstrual dysphoric disorder
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4
Q

Atypical antipsychotic adverse effects

A
  • obesity

- T2DM

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5
Q

Atypical antipsychotic examples

A
  • olanzapine (Zyprexa)
  • Rispiradone (Risperdal)
  • Quetiapine (Seroquel)
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6
Q

Atypical antipsychotic monitoring

A
  • weight gain

- BMI q3 months

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7
Q

Typical antipsychotic examples

A
  • haloperidol (Haldol)

- Chlropromazine

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8
Q

typical antipsychotic adverse effects

A
  • elevated lipids/ TG

- malignant neuroleptic syndrome

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9
Q

Adverse effects of anticonvulsants

A

SJS

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10
Q

SSRI adverse effects

A
  • anxiety
  • insomnia
  • sexual side effects
  • serotonin syndrome
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11
Q

SSRI BBW

A

-increased SI in <25 yo

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12
Q

SSRI examples

A
  • Sertraline (Zoloft)
  • Paroxetine (Paxil)
  • Citalopram (Celexa)
  • Escitaprolam (Lexapro)
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13
Q

SNRI examples

A
  • Venlafaxine (Effexor)

- Duloxetine (Cymbalta)

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14
Q

SNRI adverse effects

A

-can precipitate acute narrow-angle glaucoma

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15
Q

TCA examples

A
  • amytripiline (Elavil)

- Nortripytline

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16
Q

TCA adverse effects

A
  • anticholinergic

- Category X

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17
Q

Longest half-life of all SSRI

A

Fluoxetine (Prozac)

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18
Q

Shortest half-life of SSRI

A

Paroxetine (Paxil)

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19
Q

Fewer drug interactions of SSRI

A

Citalopram (Celexa)

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20
Q

Can treat both depression and neuropathic pain

A

Duloxetine (Cymbalta)

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21
Q

Common side effect of Paxil

A

erectile dysfunction

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22
Q

who to avoid SSRIs with

A
  • anorexic

- undernourished elderly

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23
Q

Overdose with ___ can be fatal

A

TCA

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24
Q

MAOI contraindications

A

high tyramine foods

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25
Which benzo is indicated for severe alcohol withdrawal and seizures
Diazepam (Valium)
26
Major vs minor depression
minor needs 2 criteria while major needs 5
27
depression is caused by
dysfunction of neurotransmitters serotonin and norepinephrine
28
Patient with real threat of harm to self or others
- refer to psychiatric hospital - must be driven by family member or friend - if not available, call 911
29
Depression first line medication
-SSRI
30
How long until SSRIs are effective
4-8 weeks
31
Follow up for initiating SSRI
recheck in 2 weeks for compliance and side effects
32
How long to continue SSRI
at least 4-9 months after symptoms have resolved
33
Best method for treating depression
psychotherapy with medications
34
SSRI for elderly patients
-consider citalopram or escitalopram due to low drug interactions
35
Patients with sexual dysfunction caused by SSRI
consider adding bupropion (Wellbutrin) to SSRI
36
Depressed patients with post-herpetic neuralgia or chronic pain
consider TCA
37
depressed patient with stress urinary incontinence
consider TCA
38
St. JOhn's wort used for
depression | menopausal symptoms
39
Drug interactions with St.Johns wort
-antivirals -cyclosporine OC -SSRIs -TCAs
40
Kava-kava / valerian root
- used for anxiety and insomnia | - do not mix with antidepressants
41
Amino acid supplement: 5-HTP L-tryptophan interactions
- SSRIs - MAOIs - Dextromethorphan - Triptans
42
High dose of omega-3 fish oil can cause
increase risk of bleeding | -stop 1 week before surgery
43
antipsychotic adverse effects
``` extrapyramidal symptoms akinesia akathisia bradykinesia tardive dyskinesia ```
44
extrapyramidal symptoms
- tremor - slurred speech - akathesia - dystonia - anxiety - distress
45
Akinesia
inability to initate movement
46
Akathisia
strong inner feeling to move | inner restlessness
47
Bradykinesia
slowlness in movement
48
Tardive dyskiensia
involuntary movements of lips, tongue, face, trunk, extremities
49
Anticholinergic effects
- SAD CUB - Sedation - Anorexia - Dry mouth - Confusion and constipation - Urinary retention - BPH
50
Anticholinergics should be used with caution in
- BPH - narrow-angle glaucoma - pre-existing heart disease
51
Depression symptoms
``` SIGECAPS Sleep issues Interests Guilt Energy Concentration Appetite Psychomotor agitation or irritation Sucidality ```
52
MDD criteria
>5 present symptoms for at least 2 weeks | one symptom must be depressed mood or anhedonia
53
Mild to moderate depression criterai
- minimum of 2-4 symptoms | - not present most of day and not present everyday
54
1st generation SSRIs
- tine - stimulates P450 enzymes - caution with older adults, drug interactions
55
2nd generation SSRIs
- pram - does not stimulate P450 enzymes - safer with older adults - fewer drug interactions
56
Most common SSRI side effects
GI related
57
Contraindication for bupropion
Uncontrolled hypertension seizure history anorexia or bulimia
58
Bupriopion class
Norepinephrine-dopamine reuptake inhibtors | NDRI
59
Highest suicide rate in men or women
men
60
#1 method for suicide
firearms
61
Marital status with highest suicide risk
never married
62
Orientation test
what day, location?
63
Immediate recall
recall three objects
64
attention and calculation
starting at 100, count backwards by 7 | spell "WORLD" backwards
65
Writing and copying
write a sentence | copy a figure
66
How long to wait before changing antidepressant
4-8 weeks
67
Depressed patient who wants to quit smoking
-Bupropion (Zyban) | can be combined with nicotine products
68
Alcoholism
complusive desire to drink despite personal, financial, social consequences - strong craving for alcohol - unable to limit drinking
69
Pharm management for anxiety
-SSRIs
70
Anxiety symptoms
- excessive worry - panic attacks - autonomic hyperactivity - muscle tension - exaggerated startle response
71
Medications to relieve acute anxiety symptoms
benzos
72
Medication to treat testing/social anxiety
propanolol
73
DSM V criteria for alcoholism
- mild: 2-3 sx - mod: 4-5 sx - severe: >6
74
Legal blood alcohol level for driving
<0.08%
75
Alcohol limit for women
one drink per day
76
Alcohol limit for men
2 drinks per day
77
Binge drinking
-pattern of alcohol consumption with BAL >0.08% generally within 2 hours
78
Gamma Glutamyl Transaminase
lone elevation possible sign of occult alcohol abuse
79
LFTs in alcoholism
elevated | AST/ALT 2:1 --> alcoholic hepatitis
80
Where is AST found
liver, cardiac, skeletal, kidneys, lungs
81
CBC for alcoholics
present with macrocytic anemia due to folate deficiency
82
screening for alcoholism
CAGE - do you feel the need to cut down? - are you annoyed when people comment about your drinking? - do you feel guilty about drinking? - do you need to drink early in the morning?
83
AUDIT
alcoholic screening for women, minorities, adolescents
84
acute delirium tremens
sudden onset of confusion, delusions, transient auditory, tactile, or visual HA< tachycardia, HTN, hand tremors, disturbed psychomotor behavior, grand mal seizures -ED
85
Acute delirium tremens treatment
- benzos - antipsychotics - IV vitamins
86
Medication to decrease alcohol cravings
Naltrexone (Vivitrol)
87
Complication from chronic alcohol abuse
Korsakoff's Syndrome (Wernicke-Korsakoff syndrome)
88
What is Korsakoff's syndrome
- neuro disorder - hypotension - visual impairment - coma
89
Korsakoff's amnesic syndrome
- amensia caused by chronic thiamine deficiency - problems with acquiring new information and retrieving older information - can damage brain permanently
90
Nicotine gum use
"chew and park" - chew gum until nicotine flavor appears - park next to cheeks until taste disappears - repeat and discard after 30 minutes
91
Can patients smoke while on nicotine patch
no, will overdose on nicotine
92
Can nicotine products be used with bupropion
yes
93
Varencicline (Chantix)
- 12-week course | - advise to quit smoking within 1-4 weeks of starting
94
Short-term insomnia
<3 months
95
chronic insomnia
>3 months
96
First-line treatment for insomnia
sleep hygiene
97
Gold standard for sleep apnea
sleep lab polysomnography | refer to otolaryngologist after diagnosis of sleep apnea
98
Zolpidem
Ambien used for sleep onset or inability to stay asleep
99
Ramelteon
Rozeram Melatonin agonist for sleep-onset insomnia
100
Alternative medications for insomnia
- kava-kava - valerian root - melatonin - chamomile - medication, yoga, tai chi
101
Al-Anon
-support group for alcoholic's family and friends
102
Can nicotine patches be mixed with nicotine gum
NO
103
Bipolar type 2
hypomania and depression
104
Bipolar type 1
mania and depression
105
Medications for bipolar
- lithium - anticonvulsants - antipsychotics
106
Labs to monitor with lithium
-thyroid and kidney
107
Schizophrenia presentation
hallucinations - loss of ego boundaries - flat - poor executive function (ability to plan) - onset around second decade
108
Schizophrenia treatment
REFER
109
BMI for anorexia
<18.5
110
Anorexia complicatiosn
- osteopenia/osteoporosis from prolonged estrogen depletion - peripheral edema (low protein intake) - cardiac complications
111
First line medication for PTSD
-SSRIs
112
Munchausen syndrome
false symptoms of factitious disorders to seek treatment
113
Munchausen by proxy
parent using a child to obtain medical care
114
Which SSRI needs to be tapered off
Paroxetine due to short half life
115
Physical exam for abuse patients must have what
another health provider (witness) in the same room
116
spiral fractures are also known as
greenstick fractures
117
Reassurance should be provided to patients
ALWAYS WRONG
118
Delaying an action is always wrong
TRUE
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