Fatigue Flashcards
Classification (timeline) of fatigue
Acute <1 mo
Chronic >6 mo
Subacute is between 1 and 6 months
MDD a/w chronic fatigue
Which came first?
Depression or Fatigue?
Chronic Fatigue Syndrome- CFS
Worse w activity or Mental exertion
CFS- chronic fatigue synd
usually high fx individual- then all of a sudden they are hit hard with fatigue
Chronic Fatigue Synd triggers
Infections Immune dysfx Neurally mediated hypotension Depression Sleep disruption
Infections that can lead to Fatigue
Endocarditis TB Mono Hepatitis HIV Parasitic PNA Cytomegalovirus
Endocrine/Metabolic
Hypothyroid DM Pituitary insuff Adrenal insuff Hypercalcemia Kidney or Liver failure
Cardio/pulm
CHF COPD Emphysema Periph vascular dz Coronary artery dz
Neuro
MS Myasth gravis Myositis Parkinson Dementia TBI STroke Migraine
Inflamm/Rheum
RA Lupus IBS Sarcoidosis Sjogren
CA
CA
severe anemia
Meds that can cause fatigue as SE
Hypnotics HTN meds Muscle relaxant Antidepressant 1st gen Antihist Opioids
Q about fatigue
Was it gradual or sudden onset?
Daily?
Patterns of fatigue?
Affect ADL?
What do you mean by fatigue?
ROS with nose
Runny/congested
Antihistamine use!
HEENT ROS Qs that are important
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
More ROS
Neuro: numb, tingling, LOC, hx stroke
Endocrine: thirsty
Blood: easy bruising, bleeding, +FH genetic disorder
GI
make sure to ask about rectal bleeding
Reasonable labs to order
CBC w diff
CMP
TSH (thyroid)
ESR (inflammation)
Tx options for Chronic fatigue
CBT Graded exercise therapy Sleep hygiene Education Support group Med trial Special testing Referral- social work, psychological evaluation
Sleep Hygiene
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
Thyroid disease
Abn HR Fatigue Weak HA, depression Cold sens wt gain
Thin hair
Thick tongue
TSH increased
Low T3/T4
Thyroid replacement meds
Levothyroxine
Synthroid, Levothroid, Levoxyl
MDD
DSM-5
at least 2 weeks with >5 of the symptoms
no hx of mania
Caution with SSRI, SNRI, and TCA
can predispose Manic episode
SSRI side effects
dry mouth anorexia diarrhea fatigue insomnia loss libido
SNRI
Cymbalta
Effexor
Duloxetine (Cymbalta) caution
w LIVER DISEASE
contra if hepatic dysfx
Venlaxafine (Effexor) caution
increase in BP
Cymbalta can also be used for
Peripheral neurop
Fibromyalgia
TCA common use for
Depression (not 1st line)
Neuropathic pain
Migraine proph
Depression secondary to meds
Opioids Anticonvulsant B-blocker CCB Benzos NuvaRing
Less stressed body better controls hormones that
control appetite
SLEEP IS GOOD
Obstructive sleep apnea pts are at higher risk for
HTN
Stroke
Heart attack
Meds used for Fibro
Duloxetine (Cymbalta)
Pregabalin (Lyrica)
