psychosocial

Question 1

acute serotonin syndrome

Answer 1

>serotonin dt new drug/increased dose
dilated pupils (mydriasis), fever, shivering. 
High risk if combo of SSRI, MAOI, TCA, triptans. wait 2 weeks before switching to another drug containing serotonin. life threatening

Question 2

baker act

Answer 2

72 hours of involuntary detention to evaluate/tx pt high risk for suicide or hurting others

Question 3

questionnaires in mental health

Answer 3

beck

geriatric depression scale

Question 4

SSRI

Answer 4

Fluoxetine (Prozac)- longest half life, may last up to 4 wks
Sertraline (Zoloft)
Citalopram (celexa)
Escitaprolam (Lexapro)
duloxetine (cymbalta)-depression and nueorpathic pain
amit

ADVERSE EFFECT: Steven johnson syndrome
black box: suicide

AVOID IF SUICIDE RISK ( as pt may hoard)- overdose causes sz/v tach

Do NOT combine with TCA or MAOI. risk for serotonin syndrome.

Question 5

Stevens-Johnson syndrome symptoms

Answer 5

Stevens-Johnson syndrome symptoms include:

Facial swelling
Tongue swelling
Hives
Skin pain
A red or purple skin rash that spreads within hours to days
Blisters on your skin and the mucous membranes of your mouth, nose, eyes and genitals
Shedding of your skin

Question 6

maoi

Answer 6

Phenelzine (Nardil)
Tranylcypromine (Parnate)

Selegiline (Emsam)
Isocarboxazid (Marplan)

avoid foods containing high levels of tyramine — an amino acid that regulates blood pressure —

aged cheese
 sauerkraut
cured meats
draft beer 
 fermented soy products, such as soy sauce, miso or tofu.  wine and bottled or canned beer

The interaction of tyramine with MAOIs can cause dangerously high blood pressure.

Question 7

major versus minor depression

Answer 7

minor: atleast 2 s/s but less than 5

both dt serotonin and norepi dysfxn.

Question 8

s/s of depression

Answer 8

mood
anhedonia- sleep
guilt

Question 9

depression differential dsg

Answer 9

hypothyroidism, autoimmune, anemia, b12 deficiency

Question 10

screening tools depression

Answer 10

beck-21 questions
2 item question:

1) past month have you felt down, depressed, hopeless
2) past month have you felt little interest or pleasure doing things

yes to both is +

Question 11

1st line depression rx

Answer 11

SSRI
my take 2 months. wait 4-8 wks bf changing medication

** CONTINUE SSRI for 4-9 moths after symptoms have resoled dt relapse

follow up in 2 weeks.

Question 12

2nd line depression

Answer 12

TCA

amitriptiline/elavil
nortriptyline/pamelor

DOse at HS dt sedation

category X
anticholinergic effects

Question 13

serotonin syndrome

Answer 13

too much serotonin causes symptoms that can range from mild (shivering and diarrhea) to severe (muscle rigidity, fever and seizures). Severe serotonin syndrome can be fatal if not treated.

Question 14

Black box warning for SSRI

Answer 14

suicide risk in young adults/adolescents

Question 15

rx for elderly depression

Answer 15

celexa and lexapro, dt

Question 16

pts with sexual dysfunction caused by SSRI

Answer 16

add bupropion (wellbutrin) to the SSRI

Question 17

depressed patient who wants to stop smoking, rx

Answer 17

bupropion (wellbutrin)

Question 18

depressed with with peripheral neuropathy

Answer 18

duloxetine (cymbalta)

Question 19

depressed patient with urinary incontinence

Answer 19

TCA

Question 20

antipsyhotics can lead to what?

Answer 20

obesity, 
DM 2
hyperlipidemia
hyPOthyerodism
metabolic syndrome

Question 21

kava kava and valerian root

Answer 21

used for anxiety/insomnia. Do NOT mix with benzo

Question 22

anticholingergic rx and s/s

Answer 22

rx: antipsychotics, TCA, decongestants, antihistamines (pseudoephedrine)

caution with BPH, narrow angle glaucoma, heart disease

s/s:
SADCUB
sedation, anorexia, dry mouth, confusion, constipation, urinary retention, bhp

Question 23

def if blood alcohol level

Answer 23

> .08%

Question 24

standard drink sizes

Answer 24

beer: 12 oz
wine: 5 oz
hard liquor: 1.5oz

Question 25

dietary guidelines for americans alcohol

Answer 25

women: 1 drink per day beer: ( 12 oz beer, wine: 5 oz
hard liquor: 1.5oz)

men: 2 drinks per day
binge: males more than 5 drinks, women more than 4 drinks on single occasion

Question 26

alcohol abuse labs

Answer 26

GGT Gamma glutamyl transaminate

**2:1 AST/ALT ( AST is double that of ALT)= alcohol abuse

Question 27

rx that

Answer 27

naltrexone (vivitrol)

Question 28

antabuse side effects

Answer 28

severe n/v

Question 29

korsakoff’s syndome (Wernicke-Korsakoff syndrome)

Answer 29

complication from chronic alcohol abuse.
HypOtension, visual impairement, coma

tx: vitamines, sep thiamine (b1)

korsakoff’s amnesic- type of amnesia from thiamine deficiency

Question 30

thiamine def can cause

Answer 30

kosakoff syndrome

Question 31

insomnia primary versus secondary

Answer 31

primary- NOT caused from disease, mental illness, environmental factors

secondary: caused from disease or environmental

Question 32

insomnia tx plan and rx

Answer 32

sleep routine
lab monitoring for apnea (polysomnography), ENT

rx: diphenhydramine (benadry), AVOID with elderly
benzodiazepine (xanac, halcion, versed, ativan, restoril, valium, klonipin, librium)

NON BENZO: ambien, lunesta, rozerem

alternatives:
kava kava, valerian root, melatonin, chamomile tea

Question 33

smoking cessation

Answer 33

discuss smoking cessation at EVERY visit for smokers
buproprion (zyban) decreases smoking cravings, CAN be combined with nicotine products and can continue to smoke on buproprion

Question 34

Long GGT sign of

Answer 34

alcohol abuse

Question 35

alcoholism ration of ast/alt

Answer 35

2:1

Question 36

korsakoff syndrome cause by why deficiency

Answer 36

thiamine (b1)

Question 37

natural supplants for insomnia/anxiety. don’t mix with what rx

Answer 37

kava kava, valerian root

don’t mix with benzo or hypnotics

Question 38

anorexia nervosa

Answer 38

> 15% weight loss, lanugo, ammenorrhea 3 months or longer
compications:
osteopenia (dt

Question 39

rx fo anorixia

Answer 39

wellbutrin/buproprion.

Question 40

paxil s/e

Answer 40

erectile dysfuntion

Question 41

SSRI Peroxitine/Paxil warning

Answer 41

pts need to be WEANED, careful with BPH, narrow angle glaucoma, heart disease

Question 42

best rx for elderly depression

Answer 42

citalopram ( celexa) SSRI

Question 43

when to MOST monitor depressed patient

Answer 43

when they start to feel better dt suicide risk

Question 44

always give the smallest and lowest possible dose of benzo, hypnotics, narcotic, tca etc to

Answer 44

true