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Review > Mood Disorders > Flashcards

Mood Disorders Flashcards

1
Q

Acute serotonin syndrome symptoms

A
  • sudden onset high fever
  • muscular rigidity
  • mental status changes
  • hyperreflexia/clonus
  • uncontrolled shivering
  • dilated pupils (mydriasis)
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2
Q

Malignant neuroleptic syndrome

A

-rare life-threatening idiopatchic reaction from typical and atypical antipsychotics

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3
Q

SSRIs first line for

A
  • major depression
  • OCD
  • GAD
  • panic disorder
  • social anxiety disorder
  • premenstrual dysphoric disorder
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4
Q

Atypical antipsychotic adverse effects

A
  • obesity

- T2DM

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5
Q

Atypical antipsychotic examples

A
  • olanzapine (Zyprexa)
  • Rispiradone (Risperdal)
  • Quetiapine (Seroquel)
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6
Q

Atypical antipsychotic monitoring

A
  • weight gain

- BMI q3 months

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7
Q

Typical antipsychotic examples

A
  • haloperidol (Haldol)

- Chlropromazine

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8
Q

typical antipsychotic adverse effects

A
  • elevated lipids/ TG

- malignant neuroleptic syndrome

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9
Q

Adverse effects of anticonvulsants

A

SJS

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10
Q

SSRI adverse effects

A
  • anxiety
  • insomnia
  • sexual side effects
  • serotonin syndrome
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11
Q

SSRI BBW

A

-increased SI in <25 yo

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12
Q

SSRI examples

A
  • Sertraline (Zoloft)
  • Paroxetine (Paxil)
  • Citalopram (Celexa)
  • Escitaprolam (Lexapro)
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13
Q

SNRI examples

A
  • Venlafaxine (Effexor)

- Duloxetine (Cymbalta)

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14
Q

SNRI adverse effects

A

-can precipitate acute narrow-angle glaucoma

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15
Q

TCA examples

A
  • amytripiline (Elavil)

- Nortripytline

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16
Q

TCA adverse effects

A
  • anticholinergic

- Category X

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17
Q

Longest half-life of all SSRI

A

Fluoxetine (Prozac)

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18
Q

Shortest half-life of SSRI

A

Paroxetine (Paxil)

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19
Q

Fewer drug interactions of SSRI

A

Citalopram (Celexa)

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20
Q

Can treat both depression and neuropathic pain

A

Duloxetine (Cymbalta)

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21
Q

Common side effect of Paxil

A

erectile dysfunction

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22
Q

who to avoid SSRIs with

A
  • anorexic

- undernourished elderly

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23
Q

Overdose with ___ can be fatal

A

TCA

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24
Q

MAOI contraindications

A

high tyramine foods

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25
Q

Which benzo is indicated for severe alcohol withdrawal and seizures

A

Diazepam (Valium)

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26
Q

Major vs minor depression

A

minor needs 2 criteria while major needs 5

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27
Q

depression is caused by

A

dysfunction of neurotransmitters serotonin and norepinephrine

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28
Q

Patient with real threat of harm to self or others

A
  • refer to psychiatric hospital
  • must be driven by family member or friend
  • if not available, call 911
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29
Q

Depression first line medication

A

-SSRI

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30
Q

How long until SSRIs are effective

A

4-8 weeks

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31
Q

Follow up for initiating SSRI

A

recheck in 2 weeks for compliance and side effects

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32
Q

How long to continue SSRI

A

at least 4-9 months after symptoms have resolved

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33
Q

Best method for treating depression

A

psychotherapy with medications

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34
Q

SSRI for elderly patients

A

-consider citalopram or escitalopram due to low drug interactions

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35
Q

Patients with sexual dysfunction caused by SSRI

A

consider adding bupropion (Wellbutrin) to SSRI

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36
Q

Depressed patients with post-herpetic neuralgia or chronic pain

A

consider TCA

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37
Q

depressed patient with stress urinary incontinence

A

consider TCA

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38
Q

St. JOhn’s wort used for

A

depression

menopausal symptoms

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39
Q

Drug interactions with St.Johns wort

A

-antivirals
-cyclosporine
OC
-SSRIs
-TCAs

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40
Q

Kava-kava / valerian root

A
  • used for anxiety and insomnia

- do not mix with antidepressants

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41
Q

Amino acid supplement: 5-HTP L-tryptophan interactions

A
  • SSRIs
  • MAOIs
  • Dextromethorphan
  • Triptans
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42
Q

High dose of omega-3 fish oil can cause

A

increase risk of bleeding

-stop 1 week before surgery

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43
Q

antipsychotic adverse effects

A 
extrapyramidal symptoms
akinesia
akathisia
bradykinesia
tardive dyskinesia
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44
Q

extrapyramidal symptoms

A
  • tremor
  • slurred speech
  • akathesia
  • dystonia
  • anxiety
  • distress
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45
Q

Akinesia

A

inability to initate movement

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46
Q

Akathisia

A

strong inner feeling to move

inner restlessness

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47
Q

Bradykinesia

A

slowlness in movement

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48
Q

Tardive dyskiensia

A

involuntary movements of lips, tongue, face, trunk, extremities

49
Q

Anticholinergic effects

A
  • SAD CUB
  • Sedation
  • Anorexia
  • Dry mouth
  • Confusion and constipation
  • Urinary retention
  • BPH
50
Q

Anticholinergics should be used with caution in

A
  • BPH
  • narrow-angle glaucoma
  • pre-existing heart disease
51
Q

Depression symptoms

A 
SIGECAPS
Sleep issues
Interests
Guilt
Energy
Concentration 
Appetite
Psychomotor agitation or irritation
Sucidality
52
Q

MDD criteria

A

> 5 present symptoms for at least 2 weeks

one symptom must be depressed mood or anhedonia

53
Q

Mild to moderate depression criterai

A
  • minimum of 2-4 symptoms

- not present most of day and not present everyday

54
Q

1st generation SSRIs

A
  • tine
  • stimulates P450 enzymes
  • caution with older adults, drug interactions
55
Q

2nd generation SSRIs

A
  • pram
  • does not stimulate P450 enzymes
  • safer with older adults
  • fewer drug interactions
56
Q

Most common SSRI side effects

A

GI related

57
Q

Contraindication for bupropion

A

Uncontrolled hypertension
seizure history
anorexia or bulimia

58
Q

Bupriopion class

A

Norepinephrine-dopamine reuptake inhibtors

NDRI

59
Q

Highest suicide rate in men or women

A

men

60
Q

1 method for suicide

A

firearms

61
Q

Marital status with highest suicide risk

A

never married

62
Q

Orientation test

A

what day, location?

63
Q

Immediate recall

A

recall three objects

64
Q

attention and calculation

A

starting at 100, count backwards by 7

spell “WORLD” backwards

65
Q

Writing and copying

A

write a sentence

copy a figure

66
Q

How long to wait before changing antidepressant

A

4-8 weeks

67
Q

Depressed patient who wants to quit smoking

A

-Bupropion (Zyban)

can be combined with nicotine products

68
Q

Alcoholism

A

complusive desire to drink despite personal, financial, social consequences

  • strong craving for alcohol
  • unable to limit drinking
69
Q

Pharm management for anxiety

A

-SSRIs

70
Q

Anxiety symptoms

A
  • excessive worry
  • panic attacks
  • autonomic hyperactivity
  • muscle tension
  • exaggerated startle response
71
Q

Medications to relieve acute anxiety symptoms

A

benzos

72
Q

Medication to treat testing/social anxiety

A

propanolol

73
Q

DSM V criteria for alcoholism

A
  • mild: 2-3 sx
  • mod: 4-5 sx
  • severe: >6
74
Q

Legal blood alcohol level for driving

A

<0.08%

75
Q

Alcohol limit for women

A

one drink per day

76
Q

Alcohol limit for men

A

2 drinks per day

77
Q

Binge drinking

A

-pattern of alcohol consumption with BAL >0.08% generally within 2 hours

78
Q

Gamma Glutamyl Transaminase

A

lone elevation possible sign of occult alcohol abuse

79
Q

LFTs in alcoholism

A

elevated

AST/ALT 2:1 –> alcoholic hepatitis

80
Q

Where is AST found

A

liver, cardiac, skeletal, kidneys, lungs

81
Q

CBC for alcoholics

A

present with macrocytic anemia due to folate deficiency

82
Q

screening for alcoholism

A

CAGE

  • do you feel the need to cut down?
  • are you annoyed when people comment about your drinking?
  • do you feel guilty about drinking?
  • do you need to drink early in the morning?
83
Q

AUDIT

A

alcoholic screening for women, minorities, adolescents

84
Q

acute delirium tremens

A

sudden onset of confusion, delusions, transient auditory, tactile, or visual HA< tachycardia, HTN, hand tremors, disturbed psychomotor behavior, grand mal seizures
-ED

85
Q

Acute delirium tremens treatment

A
  • benzos
  • antipsychotics
  • IV vitamins
86
Q

Medication to decrease alcohol cravings

A

Naltrexone (Vivitrol)

87
Q

Complication from chronic alcohol abuse

A

Korsakoff’s Syndrome (Wernicke-Korsakoff syndrome)

88
Q

What is Korsakoff’s syndrome

A
  • neuro disorder
  • hypotension
  • visual impairment
  • coma
89
Q

Korsakoff’s amnesic syndrome

A
  • amensia caused by chronic thiamine deficiency
  • problems with acquiring new information and retrieving older information
  • can damage brain permanently
90
Q

Nicotine gum use

A

“chew and park”

  • chew gum until nicotine flavor appears
  • park next to cheeks until taste disappears
  • repeat and discard after 30 minutes
91
Q

Can patients smoke while on nicotine patch

A

no, will overdose on nicotine

92
Q

Can nicotine products be used with bupropion

A

yes

93
Q

Varencicline (Chantix)

A
  • 12-week course

- advise to quit smoking within 1-4 weeks of starting

94
Q

Short-term insomnia

A

<3 months

95
Q

chronic insomnia

A

> 3 months

96
Q

First-line treatment for insomnia

A

sleep hygiene

97
Q

Gold standard for sleep apnea

A

sleep lab polysomnography

refer to otolaryngologist after diagnosis of sleep apnea

98
Q

Zolpidem

A

Ambien used for sleep onset or inability to stay asleep

99
Q

Ramelteon

A

Rozeram
Melatonin agonist
for sleep-onset insomnia

100
Q

Alternative medications for insomnia

A
  • kava-kava
  • valerian root
  • melatonin
  • chamomile
  • medication, yoga, tai chi
101
Q

Al-Anon

A

-support group for alcoholic’s family and friends

102
Q

Can nicotine patches be mixed with nicotine gum

A

NO

103
Q

Bipolar type 2

A

hypomania and depression

104
Q

Bipolar type 1

A

mania and depression

105
Q

Medications for bipolar

A
  • lithium
  • anticonvulsants
  • antipsychotics
106
Q

Labs to monitor with lithium

A

-thyroid and kidney

107
Q

Schizophrenia presentation

A

hallucinations

  • loss of ego boundaries
  • flat
  • poor executive function (ability to plan)
  • onset around second decade
108
Q

Schizophrenia treatment

A

REFER

109
Q

BMI for anorexia

A

<18.5

110
Q

Anorexia complicatiosn

A
  • osteopenia/osteoporosis from prolonged estrogen depletion
  • peripheral edema (low protein intake)
  • cardiac complications
111
Q

First line medication for PTSD

A

-SSRIs

112
Q

Munchausen syndrome

A

false symptoms of factitious disorders to seek treatment

113
Q

Munchausen by proxy

A

parent using a child to obtain medical care

114
Q

Which SSRI needs to be tapered off

A

Paroxetine due to short half life

115
Q

Physical exam for abuse patients must have what

A

another health provider (witness) in the same room

116
Q

spiral fractures are also known as

A

greenstick fractures

117
Q

Reassurance should be provided to patients

A

ALWAYS WRONG

118
Q

Delaying an action is always wrong

A

TRUE

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