NP3 Final Exam Flashcards
S&S of Depression
SIGECAPS
- Sleep; Interest; Guilt; Energy; Concentration; Appetite; Psychomotor; Suicide
S&S of Anxiety
WATCHERS
- Worry; Anxiety; Tension in Body; Concentration; Hyperarousal; Energy Loss; Restlessness; Sleep Disturbance
S&S of PTSD
- Flashbacks
- Hyperarousal
OCD
- Obsessions: unwanted thoughts
vs
- Compulsions/ unwanted behaviors
Depression & Anxiety Tx
- SSRIs
- Starting medication and weekly f/u
Primary Care Tx Modalities
- Refer to Counseling
- 2w = rescreen d/t highest risk of suicide attempt
- Best Tx = psychotherapy & medication
Purpose of DSM-V
- Provides descriptions, symptoms, and other criteria for diagnosing mental disorders
SSRIs
- First line treatment = blocks reuptake
- Prozac, Zoloft, Celexa, Lexapro, Paxil
- Side effects = decrease libido, ED, anorexia, insomnia, fatigue, G.I. (G.I., bleed with Prozac)
** Wellbutrin = least likely to affect libido **
TCAs
- Amitriptyline: hot flashes, sleep, pain QT elongation
- Imipramine, nortriptyline
- Other uses: PHN, stress incontinence
- Avoid high risk suicide
- OD will be fatal
MAOIs
- Rarely used due to severe food and drug interactions (high tyramine)
- Phenelzine and tranylcypromine
- Do not use with SSRI or TCA
- Wait at least two weeks before initiation of either
- Avoid fermented foods
ETOH Screening
CAGE
- Cut down?
- Annoyed with comments about your drinking?
- Guilty?
- Early drinking?
Depression Screening
- GAD7
- PHQ2 & PHQ9
- Beck’s
- Geriatric depression scale
Best Tx for SUD
- Benzodiazepines
- Refer to AA
- Decrease EtOH cravings = naltrexone
Tx for Opioid OD
- Naloxone
- Inpatient treatment
- methadone; Suboxone
Life-Threatening Delirium
WHHHIMPS
- Wernicke’s
- Hypoxia or hypercarbia
- Hypertensive encephalopathy
- Hyperthermia or Hypothermia
- Intracerebral hemorrhage
- Meningitis or encephalitis
- Poisoning
- Status epilepticus
Hospice vs. Palliative
Hospice
- Last six months or less
- Includes palliative care
Palliative
- Comfort care
- Component of hospice care
Roles of the Care Team
- MOLST & DNR = NP can initiate and sign
- Initiation of hospice = MD only
- NPs can be hospice attending
- NP cannot authorize certification for hospice
Management Goals of Acute vs. Chronic Pain
Acute Pain
- Maintain alertness and function
- Minimize adverse effects
- Prevent chronic development
Chronic Pain
- Goal = increase quality of life
- Refer to pain management
4 Pillars of Pain Therapy
- Anti-inflammatories
- Anticonvulsants
- Mood modulators
- Opiates
First-Line Tx for Mild Pain
- Tylenol
- Topicals
- NSAIDs
Over-Rx of Pain Medications
- Misuse
- Overuse
- Abuse
- OD
Best Tx for Neuropathic Pain
- Gabapentin
- Non-opioids
- Calcium channel blockers
- TCAs
- Antiarrhythmics
- Local anesthetics
Indication for Opioid Pain Therapy
- Moderate to severe pain
- Avoid extended release
- Avoid in the elderly
Opioid Tx Time Frame
- No opioid Rx over timeframe greater than three months
DEA Requirements
- Keep documents for six years at a minimum
- Retake training every three years and must resign attestation
S&S of Parkinson’s
TRAP
- Asymmetric resting tremor
- Rigidity
- Akinesia or bradykinesia
- Postural changes
Headaches: Different Types
Tension
- Nausea/vomiting, bilateral pressure or band like pain
Cluster
- Periorbital, unilateral, photophobia, tearing, nasal stuffiness
Headaches: First-Line Tx
- Tylenol
- NSAIDs
- Triptans for migraines
S&S of Shingles
- Unilateral, linear, erythematous, vesicular, painful, itchy, tingly, rash
Tx for ADHD
Stimulants
- Adderall, Vyvanse, Ritalin, Concerta, clonidine, Strattera, Intuniv
Risk Factors for Alzheimer’s
- Age, family, history, genetics, head, injury, health and comorbidities
Seizures: Different Types
Focal = unilateral
- Complex partial and simple partial
Generalized = bilateral
- Absence and tonic clonic
What is considered a cure?
- Seizure free for 10 years without use of medications
Factors to Determine the Type of Seizure
- Idiopathic, EtOH intoxication or withdrawal, metabolic, hypoxia, head, injury, meningitis, migraines
Seizures: Medications & Contraindications
ALL ARE TERATOGENIC
Focal = Carbamazepine & Lamictal
Generalized = Depakene
Absence = Zarontin & Depakene
S&S of Bell Palsy
- Rapid onset = hours or days
- Facial droop and difficulty making facial expressions
- Pain around the jaw of the affected side
Recovery time: if mild, one month
TIA/CVA
ABCD2 Prognosis Score
- Age
- BP (<140/90)
- Clinical features
- Duration
- Diabetes
<4 = two day risk <1%
>5 = two day risk 8.1%
CVA
How do previous TIAs impact CVA prediction?
- Short term = 3-10% @D2; 5% @D7; 9-17% @3m
Criteria for administering thrombolytic therapy:
- ER within three hours of symptom onset
- CT brain to rule out, intracerebral hemorrhage
Inflammatory Etiology
- Read, warmth, swelling, pain, loss of function
Osteoporosis Dx Criteria
- T-scores less than or equal to -2.5.
Urgent Care: Tetanus Considerations
- If none within the past five years, then recommended within 48 hours of the bite or injury
- New = Adacel: includes whooping cough
Risk Factors for Falls
- Polypharmacy
- Weakness
- Unbalanced gait
S&S of Infection
- Memory: delirium and confusion
Factors to Promote Change
- Age-appropriate screening
- Provide education and resources
- Address, treatment, barriers, and health disparities
Resources & Tx Barriers
- Vision, hearing, language
- Stigmas, financial or insurance coverage
