psych SM

Question 1

screening tools for depression

Answer 1

PHQ-2 > PHQ-9

Question 2

First line medication classes for depression? Why will patients stop their medications?

Answer 2

SSRIs
SRNIs

weight gain and erectile dysfunction

Question 3

What herbal supplement OTC is used for depression? What should NOT be used if taking this supplement?

Answer 3

St. John’s wort

serotonin meds - serotonin syndrome: shivering, seizures, tremors, life threatening
contraceptives

Question 4

How long can it take to see effects of SSRIs/SRNIs? What if it is not working? What if the patient complains of nausea and diarrhea on SSRI?

Answer 4

4-6 weeks
increase dose or look at underlying causes (thyroid)

DO NOT STOP medication, usually goes away after first few weeks

Question 5

How do you approach suicidal ideation?

Answer 5

be direct

do you have a plan? How are you going to do it? REFER for 72 hour hold if they do

Question 6

What SSRI should be avoided in the elderly?

Answer 6

Fluoxetine (Prozac)

Question 7

What are common side effects of tricyclic antidepressants? Who should not be given this drug class?

Answer 7

anticholinergic effects (Amitriptyline, Nortriptyline)

elderly

Question 8

Atypical antipsychotics may lead to what 3 things? What should you do for this patient?

Answer 8

weight gain, hyperlipidemia issues, hyperglycemia

weigh pt, check lipid panel and blood glucose before and during treatment

(Olanzipine, Aripiprazole/Abilify, Risperdal, Clozapine/Clozaril)

Question 9

What 2 antidepressants are safe in the elderly?

Answer 9

Sertraline/Zoloft and Escitalopram/Lexapro

low side effect profile

Question 10

What SSRI is the most sedating?

Answer 10

Paroxetine/Paxil

Question 11

What SSRI is the most energizing and can cause a jittery feeling?

Answer 11

Fluoxetine/Prozac

Question 12

What are expected signs and symptoms of bipolar disorder? How is this treated?

Answer 12

episodes of mania and depression

lithium - narrow therapeutic range and side effects (thyroid)

Question 13

What are expected signs and symptoms of PTSD? How is this treated?

Answer 13

hyperviligence, exaggerated startle, insomnia, flashbacks (not always), nightmares

SSRIs

Question 14

What is seasonal affective disorder? Primarily effects the patient’s _______. How is it treated?

Answer 14

When a patient becomes depressed every year at the same time
effects the pt’s circadian rhythm
primary tx is exposure to light

Question 15

CYP2C19

Answer 15

Asian population - effects ability to metabolize pain medications (tramadol, codeine)

body does not metabolize drug in the correct way