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S Michelle > SM Psych/Mental Health > Flashcards

SM Psych/Mental Health Flashcards

1
Q

what tool is used to screen for depression?

A

PHQ-2

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2
Q

if PHQ-2 is positive, what should the provider do next?

A

give patient PHQ-9

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3
Q

what are the first line medications for depression (type of meds)?

A

SSRI
SNRI

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4
Q

what SSRI is approved for pediatric patients?

A

Fluoxetine

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5
Q

what are the adverse SE of depression medications (SSRI/SNRI)?

A

sexual dysfunction and weight gain

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6
Q

what herbal medication can be used to treat depression?

A

St. Johns Wort

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7
Q

what should we be thinking about when taking St Johns Wort with other SSRI medications?

A

Do not do that… SJW increases risk of serotonin syndrome if taken alongside SNRI or SSRI

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8
Q

Serotonin Syndrome:
-sx
-treated inpatient or outpatient?

A

-shivering, sweating, shaking (tremors); tachycardia and agitation
-refer to ED! emergency!

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9
Q

how long does it take for anti-depressant medications (ie SSRI/SNRI) to start to have an effect?

A

-4-6 weeks

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10
Q

what should the provider do if no sx relief in 4-6 weeks after starting SSRI/SNRI?

A

can increase dose or prompt further investigation
-ie fatigue - eval thyroid or any other underlying possible causes
-ie GI sx - common SE of SSRI/SNRI –> continue at same dose; takes a few weeks for GI SE to subside

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11
Q

after sx relief, how long do we allow patient to stay on medication?

A

after 6MO of being at therapeutic level, can try to taper off

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12
Q

suicide risk related to anti-depression medication
-what are the risk factors associated with increased suicide risk?
-are younger or older adults at higher risk?
-how should suicidal ideation be approached?

A

-male sex, hx of underlying psych disorders (ie depression), chronic pain, access to firearms, significant chronic/terminal
-older adults
-very straightforward

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13
Q

what antidepressant medication should not be prescribed to elderly patients? why?

A

-TCAs
-many anticholinergic SE

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14
Q

what antidepressants are safe in older adults?

A

Sertraline (Zoloft) and escitalopram (Lexapro); fairly low SE profile

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15
Q

what SSRI is most sedating?

A

Paxil (paroxetine)

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16
Q

what antidepressant medication should be avoided in patients with anxiety?

A

Prozac
-jitteriness is a known SE

17
Q

when are atypical antipsychotics used to treat depression?

A

used with atypical or refractory depression

18
Q

-when medications are utilized as atypical antipsychotics?
-SE of atypical antipsychotics

A

-olanzapine or Zyprexa, or quetiapine (Seroquel)
-wt gain, hyperlipidemia

19
Q

due to side effects associated with atypical antipsychotics, what lab work/data should be obtained?

A

lipid profile, blood glucose, and assess wt before giving prescription

20
Q

S/S of bipolar disorder

A

often has phases
-mania: few weeks - lack of sleep, racing thoughts, impulse purchases, very excited/easily distracted
THEN FLIPS
-can’t get out of bed, can’t do daily activities

21
Q

what is the tx for bipolar?

A

lithium

22
Q

what are things to consider regarding lithium use for bipolar tx?

A

-long term SE
-narrow therapeutic effect

23
Q

-S/S of lithium toxicity
-what organ system should be monitored while taking this drug long-term

A

-N/V, tremors, hyperactive reflexes, confusion, vision changes
-thyroid (when taking this med long-term); can lead to hypothyroidism

24
Q

what can lithium toxicity lead to (what disease)?

A

hypothyroidism

25
Q

PTSD
-S/S
-TX

A

-nightmares, insomnia, hypervigilance, exaggerated startle response; stereotypical flashbacks (occasionally occurs)
-meds and cognitive behavioral therapy are both first-line tx
*SSRI’s preferred

26
Q

Seasonal affective disorders
-def
-cause
-tx

A

-experiences depression routinely at same time every year; most common in winter
-change of seasons affects the pt’s circadian rhythm
-meds, talk-therapy; exposure to light to reset circadian rhythm

27
Q

-where are a bunch of medications metabolized in the body?
-what helps to metabolize medications (what enzymes)?
-what should the provider consider in regards to CYP450 and different substances/meds (effect on each other)?

A

-liver
-CYP450
-different substances or meds can make CYP450 enzyme work faster, slower, or not at all

28
Q

-what medications should be avoided when talking St Johns Wort simultaneously?

A

-avoid taking with other meds that inc serotonin (SSRIS)
-avoid taking w/ drugs metabolized via CYP3A4 (one of the most important enzymes in CYP450 family)
*SJW can dec efficacy of some of these drugs ie Warfarin, digoxin, psychiatric meds

29
Q

how does the activity of the CYP2C19 enzyme vary?

A

-activity of this enzyme varies significantly across various populations = affects how person metabolizes certain meds, including pain meds and SSRIs

30
Q

-what are some common SSRIs?
-what conditions are SSRIs the first line treatment for therapy?

A

-paroxetine (paxil), escitalopram (lexapro), sertraline (zoloft), etc.
-depression, OCD, PTDS, anxiety

31
Q

-how do SSRIs work (patho)?
-how do we know which SSRI to start with?

A

-increase serotonin in brain (serotonin affects mood)
-trial and error

32
Q

-how long does it take for SSRI to go into full effect?
-what are the short-term SE of SSRI’s?
-what are the long-term SE of SSRI’s?
-what are the most common reasons patients stop taking SSRI’s?

A

-4-6wks
-N, diarrhea, HA, insomnia
-decreased libido/sexual dysfunction, weight gain
-decreased libido/sexual dysfunction, weight gain

33
Q

-how is goal treatment reached when utilizing SSRI’s?
-what SSRI is also used to treat GAD?
-which SSRI has a quick onset?
-which SSRI’s have a good safety profile?

A

-get patient to therapeutic dose, then stay there for 6 months; can then begin to taper off
-escitalopram (lexapro)
-escitalopram (lexapro)
-escitalopram (lexapro)

34
Q

-what SSRI is a good choice for OCD patients?
-what SSRI is good to use for bulimic patients?
-what SSRI is a good choice for elderly patients?

A

-paroxetine (paxil)
-fluoxetine (prozac)
-sertraline (zoloft)

35
Q

-what is paroxetine use for off-label?
-which SSRI can make patients feel jittery?
-which SSRI do we worry most about weight gain and sedation?

A

-pre-menstrual disorders/menopause sx
-fluoxetine (prozac)
-paroxetine

36
Q

-what population(s) should not be prescribed fluoxetine?
-what is the black box warning regarding SSRI use?

A

-for those at risk for falls (elderly)/anxiety
-increased risk of suicidal ideation

S Michelle (18 decks)

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