Fatigue Flashcards

1
Q

Classification (timeline) of fatigue

A

Acute <1 mo
Chronic >6 mo

Subacute is between 1 and 6 months

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2
Q

MDD a/w chronic fatigue

A

Which came first?

Depression or Fatigue?

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3
Q

Chronic Fatigue Syndrome- CFS

A

Worse w activity or Mental exertion

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4
Q

CFS- chronic fatigue synd

A

usually high fx individual- then all of a sudden they are hit hard with fatigue

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5
Q

Chronic Fatigue Synd triggers

A
Infections
Immune dysfx
Neurally mediated hypotension
Depression
Sleep disruption
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6
Q

Infections that can lead to Fatigue

A
Endocarditis
TB
Mono
Hepatitis
HIV
Parasitic
PNA
Cytomegalovirus
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7
Q

Endocrine/Metabolic

A
Hypothyroid
DM
Pituitary insuff
Adrenal insuff
Hypercalcemia
Kidney or Liver failure
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8
Q

Cardio/pulm

A
CHF
COPD
Emphysema
Periph vascular dz
Coronary artery dz
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9
Q

Neuro

A
MS
Myasth gravis
Myositis
Parkinson
Dementia
TBI
STroke
Migraine
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10
Q

Inflamm/Rheum

A
RA
Lupus
IBS
Sarcoidosis
Sjogren
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11
Q

CA

A

CA

severe anemia

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12
Q

Meds that can cause fatigue as SE

A
Hypnotics
HTN meds
Muscle relaxant
Antidepressant
1st gen Antihist
Opioids
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13
Q

Q about fatigue

A

Was it gradual or sudden onset?

Daily?

Patterns of fatigue?

Affect ADL?

What do you mean by fatigue?

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14
Q

ROS with nose

A

Runny/congested

Antihistamine use!

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15
Q

HEENT ROS Qs that are important

A

head: HA, trauma
eyes: change in vision, visual fields
ears: pain, loss
throat: sore throat, diff swallowing, hoarse voice
neck: swelling, stiff, lymph nodes
resp: cough, SOB, CP, hx infections, CXR

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16
Q

More ROS

A

Neuro: numb, tingling, LOC, hx stroke

Endocrine: thirsty

Blood: easy bruising, bleeding, +FH genetic disorder

17
Q

GI

A

make sure to ask about rectal bleeding

18
Q

Reasonable labs to order

A

CBC w diff
CMP
TSH (thyroid)
ESR (inflammation)

19
Q

Tx options for Chronic fatigue

A
CBT
Graded exercise therapy
Sleep hygiene
Education
Support group
Med trial
Special testing
Referral- social work, psychological evaluation
20
Q

Sleep Hygiene

A
Sleep only as much necessary
Regular sleep schedule
Don't try to sleep unless tired
Exercise at least 4-5 hours before bed
Avoid caffine after lunch
Avoid alc before bed
Dont go to bd hungry
Make bedroom comfy
Avoid screen 30 min before
Deal w worries before bed
21
Q

Thyroid disease

A
Abn HR
Fatigue
Weak
HA, depression
Cold sens
wt gain

Thin hair
Thick tongue

TSH increased
Low T3/T4

22
Q

Thyroid replacement meds

A

Levothyroxine

Synthroid, Levothroid, Levoxyl

23
Q

MDD

DSM-5

A

at least 2 weeks with >5 of the symptoms

no hx of mania

24
Q

Caution with SSRI, SNRI, and TCA

A

can predispose Manic episode

25
SSRI side effects
``` dry mouth anorexia diarrhea fatigue insomnia loss libido ```
26
SNRI
Cymbalta | Effexor
27
Duloxetine (Cymbalta) caution
w LIVER DISEASE contra if hepatic dysfx
28
Venlaxafine (Effexor) caution
increase in BP
29
Cymbalta can also be used for
Peripheral neurop | Fibromyalgia
30
TCA common use for
Depression (not 1st line) Neuropathic pain Migraine proph
31
Depression secondary to meds
``` Opioids Anticonvulsant B-blocker CCB Benzos NuvaRing ```
32
Less stressed body better controls hormones that
control appetite SLEEP IS GOOD
33
Obstructive sleep apnea pts are at higher risk for
HTN Stroke Heart attack
34
Meds used for Fibro
Duloxetine (Cymbalta) Pregabalin (Lyrica)