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NP Cert Exam > 5 psychiatric Disorders > Flashcards

5 psychiatric Disorders Flashcards

0
Q

Depression screen

A

Pick one. All have pros and cons.

Eval Hx, PE, labs to r/o med condition that mimics depression

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1
Q

Common side effects of SSRI

A

Decreased libido and weight gain

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2
Q

64 yo pt w low energy inc appetite and wt gain. Did depression screen. How else should she be evaluated?

A

Lab studies with TSH

Hypothyroidism is so common in women >50

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3
Q

Initial eval depression

A 
CBC
Electrolytes 
Glucose
BUN Creatinine, liver enzymes
TSH (esp females > 50)
Serum B12 and folate
EKG. Dysthymia
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4
Q

How do we diagnose?

A

DSM 5 Depression
MDD is unipolar
Bipolar is mania and depression

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5
Q

Anhedonia

A

Anythingthat made u happy before doesnt anymore (for atleast 2 wks)

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6
Q

MDD DX

A

Anhydonia or depressed mood for at least 2 wks PLUS 4 or more:

  • fatigue/low energy
  • insomnia or hypersomnia
  • loss/inc in appetite/weight change
  • psychomotor retardation or agitation
  • suicidal ideation
  • guilt or feelings of worthlessness

Every psychiatrist uses- SIG E CAPS
Minor depression have 2-4, or fewer than 5 SIG E CAPS(some pts have >4 but not present most of day nearly everyday

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7
Q

Every psychiatrist uses- SIG E CAPS for MDD Dx

A

S. Sleep issues. Time go to bed and wake up
I interest. Anhydonia
G. Guilt or worthlessness. Dont care if live or die
E energy. Low and they steal yours!
C concentration difficulties. Nothing sticks
A. Appetite. Get their wt every single visit
S. Suicidality

5 or more check=. Depression!

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8
Q

Classic sleep disorder found in depressed pts

A

Early morning wakening

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9
Q

What 3 neurotransmitters control mood?

A

Serotonin- produces happiness, deep breath, enjoy life

Dopamine and norepinephrine- makes u worry, increase vigilance and motivation/concentration

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10
Q

Explain how neurotransmitters work with SSRIs and Stratera

A

SSRI. Selective serotonin reuptake inhibitor. Serotonin betters mood

Stratera- selective norepinephrin reuptake inhibitor. Norepinephrine increases focus and concentration

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11
Q

DSM V. Four subtypes of depression

A

Melancholic- Mr. wilson! Exam- *elderly. 25-30% pts
Atypical- women>men. Mult suicide attempts, inter personal rejection sensitivity “nobody likes me”
Anxious depression-40-50% pts. Older, unemployed, restless, agitated, ruminate, difficult to tx
Psychotic depression-15-20% MDD pts.- smallest grp. Fxnal impairment. Diff to Tx. Refer

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12
Q

DSM V. Depressive subgrps

A

Seasonal affective disorder. Bupropion, light therapy

Postpartum depression/psychosis: w in 4 wks of delivery (most PP mood changes resolve w in 10 d). 13% of preg women. Edinburgh PP dep scale

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13
Q

Exam!

Depression vs normal grief

A

Normal grief:
Comes in waves w thoughts of the loss
Decreases intensity over time
* no specific window of time- e body diff

Bereavement does not include:
Persistent depressed mood
Pervasive unhappiness
Self critical/ pessimistic rumination
Suicidal thoughts
Feelings of worthlessness
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14
Q

Pharmocology of depression
First gen- 2. Safety a problem
Second gen- safer
Atypical antipsychotics

A

1st. MAOIS, TCAs
2nd. SSRI. SNRIs
Atypical antipsychotics Zyprexa, Seroquel, Risperdal, Abilify

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15
Q

Which drug for minor depressive disorder should be avoided in the elderly?
Name root letters from this class

A

TCAs!!! Bc of anticholinergic effects- dry mouth. Blurred vision. Constipation. Urinary retention. Tachycardia. Confusion. Delirium. - in elderly: confusion. Memory impairment, hallucinations

Tri, ipr, oxepin

Doxepin. Amitriptyline. Nortriptyline. Clomipramine. Desipramine. Imipramine

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16
Q

Pt needs depression med and is elderly. Which one should be avoided?

Sertraline
Paroxetine
Bupropion
Desipramine

A

Desipramine. No TCAs w elderly- anticholinergic

17
Q

SSRI mnemonics

A

A parrot serves citrus fruit
Paroxitine. Sertraline citalopram/escitalopram, fluoxetine

Effective for sadness, panic, and compulsions
Escitalopram. Fluoxetine. Sertraline. Paroxitine. Citalopram

18
Q

SSRI. Acronymn for adverse effects

A

S S S

Stomach upset
Sexual dysfunction
Serotonin syndrome

But generally safe

19
Q

MAOI drugs for depression mnemonic

A

Tranys use funnels

Tranylcypromine. Phenelzine

20
Q

If a depressed pt becomes suicidal and consumes 30 d of her antidepressant med, which one likely to result in death?

Paroxitine
Sertraline
Amitriptyline
Fluoxetine

A

TCA!!!! (Tri, ipr, oxepin). **Very dangerous!!

Amitriptyline no!

21
Q

Atypical antipsychotics mnemonic

A

Rich clumsy old queens are fat

Risperidone- Risperdol
Clozapine- clozaril. (Dont confuse w Benzo Clonazepam-Klonipin)
Olanzapine- zyprexa
Quetiapine- Seroquel
Aripiprazole- Abilify

Fat is to link these w s.e.- wt gain!!!!

22
Q

Which atypical antidepressent has a great side effect profile?

A

Bupropion (Wellbutrin)

Works with Dopamine
No serotonin so no libido and wt gain issues!

No wt gain, drowsiness, orthostatic hypotension, or sex dysfxn!

Watch B/P - may go up early in course

23
Q

How long is pharm mngt in depression necessary?

A

Should cont 4-12 m after sxs relieved

Or, if 2 or more episodes, consider 15m-2yrs

Also w therapy

24
Q

Highest suicide risk

A

Elderly male with gun in home

25
Q

3 suicide screen questions

A
  1. R u thinking of hurtin urself?
  2. If yes do u hv plan?
  3. If yes. Do u hv means?

Risk factors

Prior attempt
Dual dx
Inc age. Male gender

26
Q

Suicide mngt

A

Estab. Safe enviroment
Negotiate do not harm contract
Provide resources, suicide hotline

27
Q

A pt w depression has begun cycling and has manic episodes 1 wk after starting Fluoxetine. What is causing sxs?

Drug dgug interaction
Adverse drug effect
Bipolar disorder
Serotonin syndrome

A

Bipolar!

28
Q

If bipolar is treated as unipolar

A

MUCH worse!

Mood switches
Cycling- goes back n forth quickly
Agitated states

29
Q

Tx for bipolar

A

Refer! Just make sure u dont treat them for unipolar!

Need mood stabilizer- Lithium
Atypical antipsychotic or combo. Plus antidepressant
Or ECT

30
Q

Pharm mngt for Anxiety

A

Benzodiazepines
Buspirone (Buspar). An anioxolitic psychotropic
Antidepressants ssri. Tcas
Beta blockers

31
Q

Benzos end in

What schedule?

A

Lam or pam

Sched 4 Work grt if used well- but cause dependance

32
Q

Name brand names of benzos

A

Valium
Xanax
Atavan
Ambien

33
Q

What drug best for exam anxiety?

A

Beta blocker

Good for when u need to keep ur wits about u (Benzo not good)

Also good for tremors and palpitations (adrenergic excess)

Propranolol 10 mg

34
Q

Which med is associated w lowest rate of sex dysfxn when used in a pt being treated for depression?

Paroxetine
Buproprion
Duloxetine
Venlafaxine

A

Buproprion. Only one that is not a SSRI

35
Q

With depression dx, what other disease should be screened for?

Diabetes
Hypertension
Arrhythmias
Bipolar disorder

A

Bipolar- ask and document!!!!

36
Q

Exam**. Herb ???s

What herb is communly used to treat depression?

Echinacea
Black Cohosh
St. John’s wart
Milk thistle

A

St. John’s wart

The herb that gives herbs a bad name bc many drug-drug interactions
A “3a4” inhibitor- it prevents cytochrome P450 system from metabolizing drugs. Can cause an acceleration of drug metabolism- so other drugs pt is taking have decreased potency

Ex. People on HIV antiviral drugs took St. john’s wart and their viral load shot way up bc herb decreased efficacy of antiviral….

37
Q

A patient takes alprazolam prn for anxiety. She started taking St. john’s wart for depression. What effect will this have?

No effect will be realized
Increased potency of alprazolam
Decreased potency of alprazolam
Increased effect of St. John’s wart

A

Decreased potency of alprazolam

bc St. john’s wart metabolizes other drugs very rapidly so u need them again quickly
Ie. Like a wart growing over something so it covers it up and can’t work….

38
Q

A pt is taking fluoxetine for depression. She develops a cough and takes dextromethorphan OTC. What is she at inc risk for?

Hepatotoxicity
Serotonin syndrome
Suicide
Manis

A

Serotonin syndrome

Serotonin can’t be metabolized- sxs- sleepy, irritable, or coma or cardiac arrest
Lawsuit with college girl that died from being given something for tremors in hosp and she was on a SSRI and she got 108d fever and cardiac arrest

39
Q

An NP student has severe test anxiety. What med could he take to relieve his anxiety prior to the exam?

50 mg Sertraline (Zoloft) for 6-8 wks prior to exam
Low dose alprazolam 45 min before exam
Propanolol 60 min before exam
200 mg Sertraline daily for 6-8 wks before exam

A

Propanolol 60 min before exam.

Only one 10 mg dose -will last

40
Q

If the test anxiety NP student took Alprazolam(benzo) before exam and slept through it and subsequently failed, what could happen legally to you as the prescriber?

You could be sued for negligence
You could be sued
You could be sued for malpractice
You are not responsible for legally for his exam failure
Y
A

*this- You could be sued for malpractice- “professional” negligence is malpractice

You could be sued for negligence.- no this is not for professionals
You could be sued
You are not responsible for legally for his exam failure

NP Cert Exam (9 decks)

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