Family Med SG12 Flashcards
1
Q
Most common cause of sudden scrotal pain
A
Epidydimitis (but moderat pain deveoping gradually over a few days is also suggestive)
2
Q
Most common cause of painless scrotal swelling
A
hydrocele
3
Q
Torsion of testicular appendage happens in what age group
A
Prepubertal boys
4
Q
Varicocele sx
A
Pts can be asymptomatic or may complain of a dull ache or fullness of the scrotum upon standing. More common on the left side
5
Q
Cause of indirect versus direct inguinal hernia
A
Indirect is secondary to persistent process vaginalis. Direct is due to weakness in transversalis fascia area of Hasselbach’s triangle
6
Q
HSP
A
Nonthrombocytopenia purpura, arthralgias, renal disease, abdominal pain, GI bleeding, and occasionally scrotal pain. Onset of scrotal pain can be acute or insidious. Treatment is supportive
7
Q
What nerves travel to the scrotum and can be the cause of referred pain to the scrotum?
A
Genitofemoral, ilioinguinal, posterior scrotal
8
Q
Retrocecal appendicitis
A
is a rare cause of referred scrotal pain
9
Q
After surgical untwisting of the testicle, patient should avoid contact sports for how long?
A
1 month
10
Q
Differentiating COPD from asthma
A
Significant reversibility (greater than 12% increase in FEV1 with bronchodilator therapy)
11
Q
FEV1/FVC in asthma
A
May be normal to decreased in asthma. But is always less than 70% in COPD
12
Q
FVC in COPD and asthma
A
FVC is normal to decreased in COPD. FVC is always decreased in asthma
13
Q
Cells involved n COPD
A
Macrophages, T killer cells, and neutrophils
14
Q
Cells involved in asthma
A
Mast cells, T helper cells, and eosinophils (allergy things)
15
Q
Chronic bronchitis
A
Productive cough for at least 3 mos for the past 2 years
16
Q
Acute bronchitis
A
Cough and SOB of 2-3 week duration
17
Q
COPD exam findings
A
Increased AP diameter of the chest, Decreased diaphragmatic excursion. End expiratory wheezing. Prolonged expiratory phase. Max laryngeal height less than 4 cm at full inspiration
18
Q
Four items on history that are predictive of COPD
A
Smoking over 40 pack years. Self reported hx of COPD. Max laryngeal height less than 4 cm. Age over 45
19
Q
FVC
A
Total amt of air the patient can take INTO the lungs. Whereas FEV1 is amt the patient can blow out
20
Q
In COPD, why is amt of air not exhaled as much?
A
Either physical obstruction (mucus) or airway narrowing caused by inflammation
21
Q
The severity of COPD is based on what?
A
FEV1. Mild is over 80, moderate is 50-80, severe is 30-50, very severe is less than 30 OR less than 50 wth chronic respiratory failure
22
Q
CXR findings in COPD
A
Note: do not use xray to dx COPD. Findings include hyperinflation, hyperlucency, rapid tapering of vascular markings
23
Q
Treatment of COPD
A
Bronchodilators [Beta ags (short and long acting). Inhaled long acting anticholinergics (ipratroprium). Oral methylxanthines] Second, inhaled steroids. Third, systemic steroids. Fourth, smoking cessation
24
Q
For COPD patients, combining bronchodilators from different pharmacologic classes may improve efficacy and decrease side effects
A
right
25
How do you manage maintenance therapy of moderate COPD?
Maintenance therapy of inhaled anticholinergics (ipratroprium or tiotroprium) alone or in combo with SABA
26
MDI and spacer versus nebulizer
MDI and spacer achieves equal or better results than a nebulizer
27
Which COPD patients get inhaled steroids?
FEV1 less than 50 (severe) and repeat exacerbations. An inhaled steroid combined with LABA is more effective than the individual components
28
When are oral steroids useful for COPD patients?
During acute COPD exacerbation. May improve lung function for about 20% of patients with stable COPD. There are lots of side effects.
29
How does smoking cessation affect COPD?
Can reduce the RATE of FEV1 decline. Complete abstinence (not just reduction in smoking) is needed. Lung function decreases at twice the rate in patients who continue to smoke versus those who quit. Quitting provides benefit whenever the person quits, however the major benefit is in the first year. Even if the person relapsed, there was a benefit to having stopped
30
Who should get the pneumococcal vaccine
All patients 65 and older. COPD patients less than 65 with FEV1 less than 40%
31
When are antibiotics given during a COPD exacerbation?
If the patient has all 3 of: increased dyspnea, increased sputum volume, increased sputum purulence. Or if the pt has 2 of the cardinal sx and increased sputum purelence is one. OR if the patient required mechanical ventilation (invasive or non-invasive)
32
Noninvasive mechanical ventilation during a COPD exacerbation has what benefits?
Improves respiratory acidosis, increased pH, decreases need for ET tube, reduces PaCO2, RR, severity of breathlessness, length of hospital stay, and mortality
33
Leading cause of death in the US
CAD
34
CHF is more common in what demographic?
Older women
35
All patients with systolic dysfunction also have concomitant diastolic dysfunction
But you can have diastolic dysfunction wihtout systolic dysfunction (preserved EF)
36
Number 1 and 2 causes of new onset CHF
Significant CAD is number 1. Uncontrolled hypertension leading to diastolic dysfunction is number 2
37
Types of non-ischemic cardiomyopathy
Dilated, hyperttrophic, arrhythmogenic RV dysplasia, restrictive cardiomyopathy
38
New onset CHF- what endocrine disorder must be ruled out?
Hypothyoridism because it can precipitate CHF. The heart muscle is weak and cannot relax normally. Hyperthyroidism can do it too but it is a much less common cause of CHF. In this case, leads to increased cardiac work
39
Cephalization of pulmonary vasculature
Typically, pulmonary vessels are not well seen in the upper lung fields. In CHF, however, they become engorged and can be seen extending from the hilum
40
Kerley B lines
Small linear densities 2-3 cm in length in the periphery of the lung fields on PA view. Represent interstitial fluid in the lung tissue
41
T wave inversions on EKG
Prior injury or acute ischemia
42
ST depressions with T wave inversions in lateral precordial leads
Signs of LVH
43
Diastolic dysfunctin
EF over 45% with sx of HF
44
Thalium or sestamibi as nuclear agent are more sens and specific than what?
Excerise tolerance test (AKA Exercise EKG)
45
CAC scoring
Coronary artery calcium score. Sensitivity similar to nuclear stress testing and stress ECHO. However, specificity is very low
46
First choice BP med in patients with DM, HTN, and albuminuria
Ace-I and thiazides
47
DM goal A1C
less than 7%
48
Cholesterol- the old LDL goals
If CAD, goal is LDL less than 100. If CAD plus ongoing risk factors, then LDL goal is less than 70
49
Aspirin
Reduces risk of MI in patients with CAD. In women, it is a preventative measure for stroke
50
Rapid changes in weight
Are assoc with increased risk of heart disease
51
Systolic HF management
ACE-I reduces mortality and hospitalizations. ARB reduces mortality. Beta blockers reduce mortality. Spironolactone improves mortality for class III and IV (not I or II). Digoxin, loop diuretics are used but do not decrease mortality
52
CCB in CHF?
No role for CCBs in CHF
53
Digoxin in CHF
Improves symptoms and reduces hospitalizations, but does not improve mortality
54
Loop diuretics in CHF
Minimize fluid overload and enhance effects of other meds
55
Beta blockers in CHF
Reduce mortality. Neg ionotropic and chronotropic effects acan worsen HF initially. Generally should not be started in setting of decompensated CHF
56
Amlodipine in CHF
Don't use it. It increases peripheral edema
57
Thiazoladinediones such as rosiglitazone (Avandia) and pioglitazone (Actos)
Worsen heart failure
58
Diastolic dysfunction management
No randomized trials. Either BB or non-dihydropyridine CCB (diltiazem) can be used. They slow HR, increase ventricular filling time, and decrease BP
59
Primary dysmenorrhea occurs in what age group
Women in their teens and twenties. Classically appears 1-2 years after menarche. Incidence decreases as a woman has more children. Birth control use and timing can impact symptoms
60
Risk factors for primary dysmenorrhea
Depression/anxiety, smoking, early onset menarche, Overall lower state of health or other social stressors
61
Menorhagia or menses
Blood loss greater than 80 mL or menses over 7 days
62
Features of PMS
Breast soreness, wt gain, bloating, diarrhea, constipation, fatigue, behavioral sx, easy crying. Diagnosic criteria: must affect a pt's life. Must rule out depression
63
Premenstrul dysphoric disorder
More severe than premenstural syndrome. Sx have to significantly impair a woman's life. PMDD is like PMS with even more severe emotional sx
64
Normal uterus
6-8 wks size (clenched fist), may be mildly tender just prior to or during menses, smooth in contour and mobile
65
Normal ovaries
Size of an oyster, May be slighlty larger during ovulation due to physiologic cysts. Mild tenderness on palpation of theovaries is normal
66
Normal cervix
Nabothian cysts are formed during the process of metaplasia where normal columnar glands are covered by squamous epithelium. It is not normal for the cervix or vagina to be blueish (may indicate endometriosis)
67
Racial prevalence for fibroids
More common in African Americans (3x)
68
What decreases the risk of fibroids?
OCP use, increased parity, and smoking
69
What increases the risk of fibroids?
Early menarche, family history of fibroids, and increased alcohol use
70
Symptoms of fibroids
Menorrhagia (most common), anemia, dysmenorrhia, increased urinary freq (secondary to pressure) and difficulty achieving pregnancy. Does NOT cause intermenstrual bleeding
71
Chronic PID
Can be a cause of menorrhagia in 1/3 of women. Lower abdominal pain, unrelated to menses, is usually associated
72
Adenomyosis
Endometrial tissue grows into the muscular wall of the uterus. More frequently in parous than nonparous women. Ultrasound shows heterogeneous boggy uterus (but symm and mobile). MRI is more spec for dx. Not currently any surgical treatment
73
Symptoms of adenomyosis
Menorrhagia, some urinary and GI sx secondary to mass effect
74
Cervical stenosis
Can be congenital or acquired (related to cryotherapy or LEEP). Uterus becomes distended with blood. Dysmenorrhea not responsive to NSAIDs. Minimal menstrual flow. Uterus will feel diffusely enlarged
75
Endometriosis
75% will have either chronic pelvic pain or dysmenorrhea. Dyspareunia is common in endometriosis and rare in fibroids. Bowel or bladder x that cycle with mesnese, fatigue, abnomal vaginal bleeding, and some effects on fertility
76
Sx of endometriosis
Pain in cul-de-sac, immobile and retroflexed uterus, nodules on uterosacral ligaments or pain with uterine motion
77
Symptoms of ovarian cysts
Recurrent and chronic lower quadrant non-midline pelvic pain either midcycle or assoc with menses. May come and go unrelated to ovulation
78
Uterine polyps
Do not typically cause pain. Women may have abnormal bleeding specifically intermenstrual or postcoital
79
Thyroid disorders causing abnormal bleeding
Tyroid disorders primarily affect freq of menses and should be considered if other causes of abnormal bleeding are excluded
80
CT and MRI looking for pelvic pathology
CT does not give good view an dis not used for gyn problems. MRI used for adenomyosis and fibroids, to more accurately asses change in tumor volume preop, better analysis of ovarian masses, expensive and time consuming. NOT used as initial study for anything
81
Management of dysmenorrhea secondary to fibroids
Ibuprofen (decr prostaglandins), IUD (Mirena works but paraguard is not a treatment for fibroids), Combined hormonal contraception (nuvaring, ortho-evra patch, oral pill), depo-provera, hysterectomy, myomectomy, uterine artery embolization
82
IUD (Progesterone Mirena) for fibroids?
Effective for reducing menstrual flow in addition to pain; Can decrease overall uterine volume (though not the size of the fibroids) by fostering endometrial atrophy. After one cycle, RTO to have string checked
83
Side effects of the Mirena IUD
Expulsion, pain with intercourse, irreg bleeding, partner may feel the string
84
Depo-provera
One shot q 12 weeks. Side effectsare bone density loss after several years of use, may take 9-18 mos for a woman to regain regular menses. Higher rate of irreg bleeding when initiated. Potential weght gain
85
What intervention reduces bleeding more at one year than any other medical treatment?
hysterectomy. Indicated when the uterus is enlarged 14-16 wks with or without symptoms or when there is any fibroid that is growing rapidly or any time a pt has failed other management
86
Uterine artery embolization as a treatment for fibroids
there are complications! Risk of urgent hysterectomy, post procedural pelvic pain, postembolization syndrome (pain, cramping, fever), potential ovarian failure, necrosis of fibroids. Reserved for women who cannot tolerate other hormonal tx. NOT an option for just dysmenorrhia or menorrhagia without uterine fibroids
87
Paraguard IUD
Increases risk of dysmenorrhea and menorrhagia. This is NOT a treatment for fibroids
88
Treatment of dysmenorrhea without uterine pathology
acupuncture (improves QOL), TENS (transcutaneous electric nerve stimulation), thiamine plus vit E, presacral neurectomy and ulnar nerve ablation (insufficient evidence)
89
Management of PMS
SSRIs (works for both psych and physical sx), OCP, Danazol, Other GnRH agonists (leuprolide), oopharectomy, spironolactone (inconsistent effectiveness), vit B6 (inconsistent), regular exercise (mildly effective)
90
SSRIs for PMS
Works for both psych and physical sx. Most effective treatment. Intermittent treatment just as effective as daily treatment. You can start 14 days before period and continue until menses start OR start on first day of sx and continue until start of menses or 3 days later. If one med doesn't work, another in the same class might. Follow up after 2-4 cycle
91
OCPs for PMS
Effective for dysmenorrhea, anovulation and in some cases menorrhagia
92
Danazol for PMS
Androgen with progesterone effects. Inhibits ovulation. Side effects are weight gain, suppressed HDL and hirsutism
93
Other GnRH agonists for PMS
Leuprolide is an example. Ovulation inhibitor. Anti-estrogen effects (hot flashes) make this not as popular
94
Oopharectomy for PMS?
Only in severe refractory cases
95
Spironolactone for PMS
inconsisten effectiveness for bloating and breast tenderness
96
Vit B6 for PMS
inconsistent effectiveness. Overdose can cause a peripheral neuropathy
97
Regular exercise, decrease carbs in the luteal phase, and relaxation therapy
these all have a mild effect on PMS
98
Frenzel glasses
prevent fixation and bring out nystagmus (particularly peripheral, bc it can be inhibited by fixating on something)
99
Head thrust test
Normal head thrust test in the presence of vertigo measn the peripheral vestibular system is intact and that the lesion is central
100
Peripheral versus central nystagmus
Peripheral exampls are Meniere's disease, vestibular neuritis, BPPV, positive head thrust, unidirectional nystagmus that does not change direction, nystagmus resolves with gaze fixation. Central is a CNS problem (stroke, TIA, vestibular migraine), head thrust is normal and nystagmus changes direction, nystagmus does not resolve with gaze fixation
101
Meniere's disease classic triad
unilateral hearing loss, tinnitus, vertigo
102
Treatment of Meniere's disease
Diuretics and low salt diet to decrease endolymphatic pressure and abate symptoms
103
Second most common cause of vertigo
Most common is BPPV. Second most common is vestibular neuritis. Commonly assoc with recent URI. Caused by inflamm of vestibular branch of CN 8. Labrynthitis is when the infection ALSO affects the hearing branch of CN8 so you get tinnitus and/or hearing loss in addition to the vertigo
104
Treat with Abx versus watchful watiitng versus don't treat with abx
Treat: OM in t treat with abx OM over 2 yo (well, abx are optional), maxillary sinusitis, viral URIs
105
OM treat with antibiotics?
Less than 6 mos treat, 6 mos-2 yr watchful waiting, over 2 yrs don't treat (but optional really)
106
Vestibular suppressant meds
Can be effective in the short term treatment of vertigo. Anticholinergics (mezclizin and dimenhydramine) also have anti-emetic effects. Nonselective phenothiazine anti-emetics (metoclopramide and promethazine) can be useful adjuncts. All these meds can cause sedation so should be avoided in elderly
107
RF for obesity in kids
Prader-Willi syndrome, Bardet-Biedl syndrome, Cohen Syndrome, high birthweight, maternal DM, FH of obestity (one parent incr x3, two parents, x 10), family dynamics, lack of safe place for physical activity, low cognitive stimulation at home, low SES
108
Three critical periods of excessive weight gain
Infancy, Adolescence, Early menarche
109
Infancy weight gain and breast milk
More breast milk, less obesity
110
Sequelae of childhood obestity
Pickwickian syndrome, restictive lung disease (but not asthma), Blount disease, SCFE, and all the others (HTN, OSA, etc)
111
SCFE and puberty
typically happens in obese patients with delayed puberty
112
SCFE on plain xray of the pelvis
widening of the physis
113
DM dx in kids
the three criteria (the four of adult minus the hga1c)
114
Criteria for testing for DM type 2 in kids
BMI over 85%ile or weight to height ratio over 85%ile or weight over 120% ideal for height plus 2 of any: FH of DM2 in first or second degree relative, race/ethnicity non-white, signs of insulin resistance (PCOS, HTN, HLD, acanthosis nigricans). Start screening at age 10 or onset of puberty. Screen every 2 years with fasting glucose
115
Hypertension in kids cut offs
Normal is less than 90%ile. PreHTN is 90-95. Stage 1 is 95-99 plus 5 mmHg. Stage 2 is 99+ plus 5 mm Hg
116
Most BP elevation in kids over 6 yo is due to what?
primary hypertension
117
Flu vaccine for kids
The first year of immunization, kids less than 9 yo need 2 doses 1 month apart. Thereafter, annual single dose of vaccine
118
Hep A vaccine
Routinely recommended at 12 and 18 mos
119
Weight age
Age at which weight plots at 5oth percentile
120
Mood disorders prevalence and age
Prevalence increases with age
121
Kids with ADHD and mood disorders
Kids with ADHD have a higher rate of mood disorders. Oppositional defiance disorder and conduct disorder have high comorbidity rates with ADHD
122
Screening in kids
85 to 95%ile get fasting lipid panel. 85-95%ile and RFs- obtain fasting lipid plus LFTs plus fasting glucose, Above 95%ile with or without RF get above plus BUN/Cr
123
Weightloss maximum rate
Not more than 1 lb/month in preteens. Not more than 1 lb/week in teens
124
Management of preHTN in kids
Therapeutic lifestyle changes, ask school nurse to record weekly blood pressure, follow up in office q 6 mos. Reserve treatment with meds to kids whose BPs are consistently very high or evidence of target organ damage (LVH), some say low sodium diet
125
Management of ADHD
80% of kids with ADHD will respond to stimulants.
126
Are kids with ADHD on stimulants at any higher risk for substance abuse?
No
127
Tic disorder is a side effect of stimulants
Seen in less than 1% of kids. In most cases, tic resolves when med is stopped.
128
Slight decrease in growth velocity is SE of stimulants
Effect resolves when meds are stopped
129
American Academy of Peds mandates developmental screening at what ages?
9 mos, 18 mos, and 30 mos check up. Specific autism screening is recommended at 18 mos and 2 years
130
Formulas
Ready to feed formula, powder, formula concentrate
131
Never give cows milk to infant under what age?
1 yr. Could collitis, leading to anemia
132
Most babies regain birthweight by when?
1-2 weeks old
133
What is the caloric requirement of a 1-2 month old
100-120 cal/kg/day. Preterm infants require 115-130
134
Average daily weight gain for a term infant
20-30 grams per day
135
Moro reflex
Symmetric abduction and extension of arms, followed by adduction of the arms. Present birth until 4 mos. Can be used to detect peripheral problems like congenital MSK abnormalities or neural plexus problems
136
Four domains of developmen
gross motor, fine motor, language, social
137
Patient's Evaluation of Developmental Status
Parents are asked to answer 10 questions on PEDs response form. Used for kids 0-8yo. Evidence based
138
Two months milestones
Lift head, follow past midline, laugh, smile spontaneously
139
Four months
Roll over/sit, follow to 180 degrees, turn to rattling sound
140
Six months
Sit without support, look for dropped yam, turn to voice, feed self, babbles, feeds self, stranger recognition (prelude to stranger anxiety)
141
Nine months
Pull to stand, take 2 cubes, dada/mama, wave bye bye
142
Twelve mos
Pull to stand, stand alone, first steps, put a block in a cup, bag 2 cubes, 1 or 2 more words than mama/dada, play patacake
143
Fifteen mos
Stoops and recovers, walks well, few words, drinks from a cup
144
Eighteen mos
Walks backward, run, scribble, build a tower of 2 cubes ,3-6 word vocab, remove clothes
145
2.5 years
jump, throw a ball, tower of 6-8 cubes, point to 6 body parts, name 1 picture, put on clothing, wash hands
146
Two month anticipatory guidance
Solid foods (around 4 mos can start rice cereal); vit D (400 units/day, esp those on mostly breast milk), childcare, sleep (most sleep through the night by 4-6 mos), safety
147
Children under what age should not be in the front?
13 years old
148
Immunizations at 2 month visit
first dose of the following: Dtap, Hib, IPV, PCV-13, rotavirus, hep B (second dose now, first was given in nursery)
149
MMR and Hep A are not given until 12 mos of age
Right
150
Hep A and Rota
Rota is 2 or 3 doses. Hep A is 2 doses
151
Pneumoccocal number of doses
four
152
Kids should double bithweight by when?
5 mos. Triple by 12 mos
153
Kids should double birth legnth by when
4 years
154
Absence of red reflex may indicate
Cataracts, glaucoma, retinoblastoma, chorioretinitis
155
Six month anticipatory guidance
Childproof the home. Car seat placement. Use of walker is recommended against. New foods can be added every 5 to 7 days. Developmental change (stranger anxiety, start reading to her, 2 naps per day and will prob sleep through the night)
156
Acetomoniphen and vaccines
Acetominophen can lower antibody response for some immunizations. It should be administered only if completely necessary
157
Nine month old
Wave bye bye. Sit without support
158
Most frequently diagnoised neoplasm in infants
Neoblastoma. More than half of patients present before age 2
159
Neuroblastoma
May present as painless mass in neck, chest, or abdomen. May have pain from mets to bone marrow or skeleton. Fever, pallor and weight loss are common presenting symptoms
160
Teratoma
Rare, malignant tumor. May present as painless abdominal mass without other sx or may cause pressure effects on neighboring structures resulting in pain
161
Wilms tumor
AKA nephroblastoma. Asymp RUQ mass. May present with abdominal pain and/or vomitting. Patients may be hypertensive. Median age at dx is 3 yo
162
Most common cause of left sided abdominal mass in an infant
constipation. Usually mobile on palpation
163
First imaging study to evaluate for this baby's mass
abdominal ultrasound. Purely cystic masses are less likely to be malignant
164
Prognosis of neuroblastoma
In infants less than 1 yo, these tumors may spontaneously regress, even if they have already metastasized. Non-amplification of the n-myc gene is favorable prognostic factor
165
Genetics of neuroblastoma
There are familial forms but these account for only 1% of cases
166
Beckwidth-Weidemann syndrome
Assoc with Wilms tumor, omphalocele, hemihypertrophy, hypoglycemia, LGA
167
Any patient presenting with insomnia
should be screened for depression and anxiety
168
Treatments for insomnia in the elderly
CBT forinsomnia, medication treatments (zolpidem=ambien and melatonin receptor agonists)
169
CBT for insomnia
Includes sleep hygeine instruction and sleep restriction with cognitive restructuring. CBT is the most effective treatment (better than meds!).
170
Meds for insomnia in the elderly
Zolpidem (Ambien) and melatonin receptor agonists. Combining CBT and meds can be very efficacious in some patients.
171
Exercise as treatment for insomnia
Not very good evidence
172
Medical conditions assoc with depression
Hypothyroidism, Parkinson's disease, dementia
173
Factors that increase a patient's risk for COMPLETED suicide
Male, older, having a previous SA
174
Factors that make you more likely to attempt suicide
Being a widow, living alone, perceive health status as poos, poor sleep quality, lack confidante, stressful life event
175
Most common means of suicide in the elderly
Drug overdose
176
What is special about depression in the elderly?
Increased risk of diabilities in mobility and ADL. Completed suicide is more common in older depressed patients. The chance of spontaneous remission of depression is much lower in the elderly than in younger kids
177
MDD versus bereavement
MDD dx not given unless sx present 2 mos after the loss.
178
Dementia screening tools
Mini cognitive exam (faster and more sens/specific) and mini mental status exam
179
SSRIs
Citalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, escitalopram
180
TCAs
Block reuptake of norepi and seratonin. Nortriptyline, amitryptiline, clomipramine, doxepin
181
MAO-Is
Block reuptake and catabolism of norepi and seratonin. Phenelzine. Tanylcypramine
182
SNRIs
Venlafaxine, duloxetine
183
Norepi and dopamine reuptake inhib
Burproprion
184
Serotonin antage and reuptake inhib
Nefazadon, trazadone
185
Norepi and seratonin antag, antihistaminic effects
mirtazapine (Remeron)
186
Seratonin partial agonist and reuptake inhib
Vilazadone HCl
187
Common side effects associated with SSRIs and SNRIs
HA, insomnia/drowsiness, nausea/diarrhea, hyponatremia due to SIADH, seratonin syndrome, increased risk of GI bleed, increased risk of falls in the elderly
188
TCAs cause arrhythmias
yes
189
Psychotherapy and meds
Psychotherapy (CBT nad interpersonal therapy) are as effective as psychotropic
190
Exercise as treatment for depression
Small but statistically signig positive effect
191
How long do you keep a person on SSRI trial for depression?
In first episode, trial of med for at least 9-12 mos. Recurrent episodes of depression are treated for 2-3 years
192
SSRIs and pregnancy
Paxil is pregnancy D, but the rest are category C
193
Fluoxetine (prozac)
Long half life, so efects last for weeks after discontinuation. Most problematic side effects are agitation, restlessness, decreased libido in women, and insomnia
194
Sertraline (Zoloft)
Frequently used in pregnancy and breast feeding. Approved specifically for OCD, panic, and PTSD. More GI side effects than the other SSRIs
195
Paroxetine (Paxil)
Strong anti-anxiety effects, best studied SSRI in kids, side effects are signif weight gain, impotence, sedation, and constipation. Due to its short half life, needs to be tapered
196
Fluvoxamine (Luvox)
Particularly useful in OCD, greater freq of vomitting compared to other SSRIs
197
Citalopram (Celexa)
Side effects are nausea, dry mouth, and somnolence
198
Ecitalopram (Lexapro)
Approved specifically fo GAD. Fewer side effects than citalopram
199
Hispanics and depression
Hispanics (and Af am) have their depression identified less frequently. They more freq present with somatic than mood complaints. US born hispanics experience depression at similar rates to other ethnic groups but rates of depression in immigrant histpanics is 50% lower than US born hispanics. Psychosis is no more common but sx of perceptual distortion (celajes) are more common and must be differentiated
200
Risk factors for elder abuse
dementia, shared living situation of elder and abuser, care giver substance abuse or mental illness, heavy dependence of caregiver on elder (but not opp), social isolation of the elder
201
Adherence to anti-depressant meds in the eldery
Is only 50%
