psychosocial Flashcards
acute serotonin syndrome
>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
baker act
72 hours of involuntary detention to evaluate/tx pt high risk for suicide or hurting others
questionnaires in mental health
beck
geriatric depression scale
SSRI
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.
Stevens-Johnson syndrome symptoms
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
maoi
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.
major versus minor depression
minor: atleast 2 s/s but less than 5
both dt serotonin and norepi dysfxn.
s/s of depression
mood
anhedonia- sleep
guilt
depression differential dsg
hypothyroidism, autoimmune, anemia, b12 deficiency
screening tools depression
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 +
1st line depression rx
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.
2nd line depression
TCA
amitriptiline/elavil
nortriptyline/pamelor
DOse at HS dt sedation
category X
anticholinergic effects
serotonin syndrome
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.
Black box warning for SSRI
suicide risk in young adults/adolescents
rx for elderly depression
celexa and lexapro, dt
pts with sexual dysfunction caused by SSRI
add bupropion (wellbutrin) to the SSRI
depressed patient who wants to stop smoking, rx
bupropion (wellbutrin)
depressed with with peripheral neuropathy
duloxetine (cymbalta)
depressed patient with urinary incontinence
TCA
antipsyhotics can lead to what?
obesity, DM 2 hyperlipidemia hyPOthyerodism metabolic syndrome
kava kava and valerian root
used for anxiety/insomnia. Do NOT mix with benzo
anticholingergic rx and s/s
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
def if blood alcohol level
> .08%
standard drink sizes
beer: 12 oz
wine: 5 oz
hard liquor: 1.5oz
dietary guidelines for americans alcohol
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
alcohol abuse labs
GGT Gamma glutamyl transaminate
**2:1 AST/ALT ( AST is double that of ALT)= alcohol abuse
rx that
naltrexone (vivitrol)
antabuse side effects
severe n/v
korsakoff’s syndome (Wernicke-Korsakoff syndrome)
complication from chronic alcohol abuse.
HypOtension, visual impairement, coma
tx: vitamines, sep thiamine (b1)
korsakoff’s amnesic- type of amnesia from thiamine deficiency
thiamine def can cause
kosakoff syndrome
insomnia primary versus secondary
primary- NOT caused from disease, mental illness, environmental factors
secondary: caused from disease or environmental
insomnia tx plan and rx
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
smoking cessation
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
Long GGT sign of
alcohol abuse
alcoholism ration of ast/alt
2:1
korsakoff syndrome cause by why deficiency
thiamine (b1)
natural supplants for insomnia/anxiety. don’t mix with what rx
kava kava, valerian root
don’t mix with benzo or hypnotics
anorexia nervosa
> 15% weight loss, lanugo, ammenorrhea 3 months or longer
compications:
osteopenia (dt
rx fo anorixia
wellbutrin/buproprion.
paxil s/e
erectile dysfuntion
SSRI Peroxitine/Paxil warning
pts need to be WEANED, careful with BPH, narrow angle glaucoma, heart disease
best rx for elderly depression
citalopram ( celexa) SSRI
when to MOST monitor depressed patient
when they start to feel better dt suicide risk
always give the smallest and lowest possible dose of benzo, hypnotics, narcotic, tca etc to
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