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PMHNP > Depression > Flashcards

Depression Flashcards

1
Q

Diagnosing MDD SIGECAPS

A

sleep disturbances
interest reduced
guilt and self blame
energy loss and fatigue
concentration problems
appetite changes
psychomotor changes
suicidal thoughts

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2
Q

Med management

A

First line: SSRI
Serious side effects are rare
Much safer than TCAS

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3
Q

What critical information should be given to a patient when starting meds for MDD

A

4-6 week therapeutic effect
Continue medication for a minimum 6-12 months

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4
Q

when do you consider medication management indefinitely

A

More than 2 prior episodes of MDD consider

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5
Q

Rebound is when

A

stopping abruptly especially with short half lives
Prozac has a longer half-life

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6
Q

which medication has a particularly short half life

A

Sertraline

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7
Q

What medication is most likely to have the least amount of sexual dysfunction

A

mirtazapine

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8
Q

Wellbutrin is contraindicated for

A

for seizure hx or eating disorder (increases seizure risks) electrolyte imbalances cause seizure increase

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9
Q

When client is depressed, low energy, fatigue what is a good medication option

A

NDRI Wellbutrin

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10
Q

S/E of SSRI (3) (SSS)

A

stomach upset
sexual dysfunction
serotonin syndrome

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11
Q

SSRIs can also be used for (4)

A

panic
OCD
anxiety
PTSD

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12
Q

common drug for panic disorder

A

paroxetine

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13
Q

common drug for compulsion

A

citalopram

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14
Q

EFFECTIVE FOR SADNESS PANIC COMPULSIONS

A

Effective- escitalopram
For-Fluoxetine Fluvoxamine
Sadness-Sertraline
Panic-Paroxetine
Compulsions-Citalopram

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15
Q

Duloxetine is a ()

A

SNRI

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16
Q

SNRI’s can help with

A

neuropathic pain

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17
Q

Second line for depression is

A

TCAs

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18
Q

TCA potential risks 156 (4)

A

electrocardiogram changes
cardiac dysrhythmias possible
monitor EKG before tx and annually for older adults

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19
Q

TCA should not be d/c abruptly because of

A

risk of discontinuation syndrome

20
Q

avoid TCA prescription for clients at high risk of

A

SI

21
Q

Black box warning for antidepressants

A

all antidepressants carry a black box warning for increased SI, agitation, aggression

22
Q

ECT is indicated for (2)

A

MDD with psychotic features and treatment-resistant depression

23
Q

Contraindications of ECT (4)

A

Cardiac disease
compromised pulmonary status
Hx of brain injury or tumor
anesthesia medical compliations

24
Q

Safety plan includes and is not a

A

not a contract
includes crisis number
support system
provider to call
coping skills
case manager
CHART SAFETY PLAN

25
Q

Prozac can effect sleep by? What should you do if client reports sleep distrubances?

A

Can cause insomnia, advise them to take it in the morning

26
Q

How does depression manifest for adolescents? (2)

A

anger, irritability

27
Q

What neurotransmitters are involved in depression?

A

Dopamine, NE, Serotonin

28
Q

Parts involved in depression (3)

A

Amygdala (enlarged), hippocampus, thalamus (reduced)

29
Q

If a client with depression is on chemo-medication what depression medications should you choose? (3)

A

Citalopram, escitalopram, sertraline (SSRIs less chance of reactions)

30
Q

What type of drugs should you use for a client with chronic neuropathic pain (Fibromyalgia) (2)

A

SNRIs and TCA

31
Q

For chronic neuropathic pain what drugs can you give a client with depression (2)

A

Gabapentin and pregabalin (PGR) (alpha delta ligands)

32
Q

Rare side effect of serotonin- norepinephrine inhibitors

A

Interstitial lung disease

33
Q

What do you need to monitor for clients taking SNRIs like Duloxetine or venlafaxine

A

BP

34
Q

SSRIs like citalopram and SNRIs duloxetine can cause

A

hyponatremia

35
Q

symptoms of duloxetine-induced hyponatremia (8)

A

onset is days after starting or up to months
fatigue
weakness
lethargy
headache
nausea
dizziness
aloc
seizure

36
Q

What type of drugs can cause sexual problems (4)

A

SSRIS, SNRIs, TCAs, MAOIs

37
Q

what drugs are less likely to cause sexual dysfunction (2)

A

wellbutrin and remeron

38
Q

If client is depressed, has low energy, fatigue (anergia) what type of medication may be best for them

A

Wellbutrin because it increases energy levels

39
Q

Wellbutrin contraindications (3)

A

seizure d/o
contraindications that can increased seizure risk such as anorexia or bulimia

40
Q

Why does wellbutrin increase seizure risk

A

by decreasing seizure threshold

41
Q

antidepressants used for insomnia include (4)

A

trazodone, mirtazapine, amitriptyline, doxepin

42
Q

5-HT2C receptor is a subtype of _____

A

serotonin receptor

42
Q

5-HT2C receptors play a role in regulating (3)

A

mood, anxiety, and can influence response to antidepressants

43
Q

if a client has a genetic dysfunction regarding the 5HT2C receptor it can

A

impact the serotonin signaling pathways- making tx less effective

44
Q

What medications to consider if client has 5HT2C genetic dysfunction and SSRIs are not effective (3)

A

SNRIS- venlafaxine, duloxetine
atypical antidepressants Remeron (mirtazapine) or bupropion (Wellbutrin)
TCAs such as amitriptyline and nortriptyline

45
Q

What medications can cause depression?

A

Steroids*** can also cause psychosis (flonase/prednisone)
liothyronine
beta-blockers
interferon
isotretinoin (accutane)
some retroviral drugs
antineoplastic drugs
benzodiazepines
progesterone

46
Q

SSRIS can cause what in older adults

A

increase anxiety

PMHNP (46 decks)

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