CL Flashcards
What plot/chart to check in event of OD on Tylenol?
Rumack Matthew Normogram
Activating SSRI
prozac, buproprion, venlefaxine, duloxetine (GOOD FOR CHRONIC PAIN!)
common psych meds used to help with sleep
trazodone (+melatonin), mirtazapine, quetiapine, doxepin (TCA), Benadryl maybe (watch out for side fx)
general safety plan for all patients?
- take meds
- sleep 8 hours
- exercise
4 45 minutes of social activity - therapy
do 3/5 of these EVERYDAY or you will decomp
What to do after make a general safety plan?
Weekly review (have you been keeping up with general safety plan?)
see if you need accountability
need to reach out
call doctor if you can’t keep up
three weight neutral antipsychotics
abilify, Geodon, haldol
another way to view depression aside from just SIG E CAPS symptoms
think of a person’s schedule throughout the day…there is a decline in all those activities
2nd gens with most anticholinergic side effects
THE -PINES!
olanzapine
quetiapine
clozapine
what to talk about when starting SSRI
- sexual side effects (delayed ejaculation which can be positive)…these go away when med dc’d or switched
- GI side effects; go away in a week, take with food
- headache
- black box warning: increased suicidal thoughts in children/adolescents…question validity of study, if you stop SSRIs, huge spike in reported suicides
cardiac side effect venlefaxine
increases DBP
TCA for OCD
clomipramine
TCA vs venlefaxine?
TCA more sedating, can increase hungry (use anticholinergic effects)…but make sure they don’t have medical contraindications
duloxetine vs venlefaxine
dulox- more expensive but with small doses, already get good noadrenergic reuptake
venlefaxine - less expensive but need to use higher doses to get good noradrenergic reuptake…at low doses this is essentially just an SSRI
If patient feels emotionally more “blunted” on SSRI, what can you do?
add on more doparminergic antidepressant like wellbutrin
why is h/o gastric bypasses relevant in social hx? (particularly roux en y)
problems with absorption -> chronic brain resorption -> can resemble TBI
someone who is depressed who has history of gastric bypass is at risk for treatment refractory depression requiring ECT!
parts of affect
- perceived emotion that is observable by you in patient (patient looks dysphoric, euphoric, )
- range (flat, constricted, labile, reactive, blunted)
- appropriateness with stated mood
- appropriateness relative to content of interview/context of their situation
how to ask for hx bipolar disorder
- has there been a period where you were completely sober off all drugs/substances?
- during that time, was there ever a period where you didn’t sleep for a week at a time, where you felt like you were on a special mission, had special powers?, where you didn’t feel tired even though you didn’t sleep
why are escitalopram and citalopram better used for patients with multiple medical comorbidities?
Lexapro and celexa both have renal metabolism which means less competition for hepatically cleared medications…also something to do with cytochrome p450 metabolism
criteria to be cleared to go to inpatient psych
- patient able to ambulate
- patient able to tolerate food PO
- if event of recent OD, make sure patient has had BM
for casts, hard materials, ACE bandaging…usually by case by case basis depending on how agitated patient has been or risk for using these materials in violence towards self/others
