SM Psych/Mental Health Flashcards
what tool is used to screen for depression?
PHQ-2
if PHQ-2 is positive, what should the provider do next?
give patient PHQ-9
what are the first line medications for depression (type of meds)?
SSRI
SNRI
what SSRI is approved for pediatric patients?
Fluoxetine
what are the adverse SE of depression medications (SSRI/SNRI)?
sexual dysfunction and weight gain
what herbal medication can be used to treat depression?
St. Johns Wort
what should we be thinking about when taking St Johns Wort with other SSRI medications?
Do not do that… SJW increases risk of serotonin syndrome if taken alongside SNRI or SSRI
Serotonin Syndrome:
-sx
-treated inpatient or outpatient?
-shivering, sweating, shaking (tremors); tachycardia and agitation
-refer to ED! emergency!
how long does it take for anti-depressant medications (ie SSRI/SNRI) to start to have an effect?
-4-6 weeks
what should the provider do if no sx relief in 4-6 weeks after starting SSRI/SNRI?
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
after sx relief, how long do we allow patient to stay on medication?
after 6MO of being at therapeutic level, can try to taper off
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?
-male sex, hx of underlying psych disorders (ie depression), chronic pain, access to firearms, significant chronic/terminal
-older adults
-very straightforward
what antidepressant medication should not be prescribed to elderly patients? why?
-TCAs
-many anticholinergic SE
what antidepressants are safe in older adults?
Sertraline (Zoloft) and escitalopram (Lexapro); fairly low SE profile
what SSRI is most sedating?
Paxil (paroxetine)
what antidepressant medication should be avoided in patients with anxiety?
Prozac
-jitteriness is a known SE
when are atypical antipsychotics used to treat depression?
used with atypical or refractory depression
-when medications are utilized as atypical antipsychotics?
-SE of atypical antipsychotics
-olanzapine or Zyprexa, or quetiapine (Seroquel)
-wt gain, hyperlipidemia
due to side effects associated with atypical antipsychotics, what lab work/data should be obtained?
lipid profile, blood glucose, and assess wt before giving prescription
S/S of bipolar disorder
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
what is the tx for bipolar?
lithium
what are things to consider regarding lithium use for bipolar tx?
-long term SE
-narrow therapeutic effect
-S/S of lithium toxicity
-what organ system should be monitored while taking this drug long-term
-N/V, tremors, hyperactive reflexes, confusion, vision changes
-thyroid (when taking this med long-term); can lead to hypothyroidism
what can lithium toxicity lead to (what disease)?
hypothyroidism
