Test 3 Flashcards
what is the most common anxiety disorder
phobias
what should be done first for anxiety treatmetn
rule out organic causes
what is a physical complaint with no cause that may be psych
somataform disorder
what is a fear of public places b/c of fear of being trapped
agoraphobia
how is a panic disorder described
recurrent panic attacks, followed by 1 month of worry about another, significant change in behavior
What meds will not help OCD
benzos
what should be considered with somatoform disorder and how will the pt act when told.
they will deny and you may treat for depression
what is a preocupation with having a severe illness
hypochondriasis
describe seperation anxiety
excessive distress at least 4 weeks, normaly under 18yo and will impare social and occupation
describe generalized anxiety disorder
will happen all day long and the person is aware of it
describe adjustment disorders
within three months of stressor goes away after 6 months
what 3 have to be ruled out for psych then what 7
normal stress, medication reaction, alcohol and drug use, then do, hyper/hypo thyroid, pheochromocytoma, cv disorder, neoplasm, b12 low, parkinsons, major depression
what med is first line for anxiety disorder
ssri
what med is used for short term anxiety disorder
benzo
what med is used for long term anxiety
buspar
what med can be used for short term social anxiety
beta bloker
when will an ssri reach its full effectivness
4-6 weeks
what is a side effect of ssri if pt is bipolar
manic episodes
what will not help a panic attack
psychotherapy
how should ssri be dosed
1/2 at start
ssri is what class preg
c
can preg pts have benzos
no
how is depression dignosed
for 2 weeks they must have 5 of the following
depressed mood, anhedonia, sleep and appetite is wrong, low energy, agitation, suicidal thoughts
what is a side effect of ssri in men and what should you use insted
impotence, use wellbutrin
how is bipolar diagnosed
must have 7 consecutive days of, erratic mood, racing thoughts, less sleep, pressured speech, high risk behavior, inflated sense of self, flight of ideas
what are two old school bipolar meds, why are they not so great
lithium and depakote, bad side effects and not for preg
name three new school bipolar meds and what should be watched for
zyprexa, geodon, abilify, watch weight gain and blood sugar
name two keys with schizophrenia
loss of boundries and hallucinations
how is schizophrenia diagnosed
6 months of symptoms of, delusional thought, disorganized speech, disorganized behavior, hallucinations
three keys to add/ adhd
impulsivity, inattention, hyperactivity
before dx add/adhd check what three things first
hearing, eyes, and learning disorders
what are the three clusters of personality disorders, describe them
weirds- schizo, suspicious, paranoid
wild- narssasistic, antisocial
worried- avoident, ocd
who wont know there ocd is odd
OC personality disorder
what three dx will ssri help with
panic, OCD, anxiety
what to do about ssri overdose
it wont kill them
what is seartonin syndrome
tachy, sweating and need to go to the ED
how long should ssri’s be tappered for stopping
4 weeks
when are tricyclic antidepressants used, elavil
when ssri dosnt work
why use caution with elavil
it will kill as overdose, anticholenergic side effects, can cuase seizures, use caution in the elderly
Whatis the most likly single agent used to treat depression to remission
SNRI
what dose buspirone treat
anxiety, headache, and nervousness
when should you not use wellbutrin
with anorexia or bulemia
what is wellbutrin used with
ssri
what do MAo’s treat
atypical depression
What should be cautioned with MAOI use
eating cheese, wine, and some other stuff cuz of tyramine
what is blood level for lithium
.6-1.5
how long does it take valproic acid to kick in
3 days
what class is preg valproic acid
dont give it dumb dumb
what are the side effects of valproic acid
n/v, weight gain, liver problems, can increase other drug levels,
what is gabapentin for
mood stablaizer
what is a side effect of lamotrigine
rash
how should benzos be titrated
down 10% each week
What is the adolecent drug and alcohol abuse
CRAFFT
what is the thing for depression in teens
PHQ-9
what 5 things do hormones do
homeostasis, growth and development, reproduction, engery production storage and use, behavior
what is a halmark sign of addisons disease
hyperpigmentation
what is a physical sign of cushings syndrome
moon face
what does hypothyroidism do to the eyes
puffy eyes
what does hyperthyroidism do to the eyes
exopthalmous
what are the two types of parathyroid glands and what do they do
chief cells- produce PTH regulates circulating calcium
oxyphilic cells- not criticaly important
what is the main function of the thyroid
contooling body metabolism
what does the thyroid produce and what does it do
t4- increase basal metobolic rate, more secreated
t3- increases basal metabloic rate is more active and increases heat production
what does the liver do in relation to the thyroid hormones
converts t4 to t3
what does PTH do
increase serum calcium
what is the term for a good thyroid function
euthyroidism
what is a goiter
any swelling of the thyroid
what is a toxic goiter
any goiter with increased thyroid hormone output
what is a non toxic goiter
normal hormone levels
what could be a thyroid tumor
focal noduar enlargment
what is characteristic of hashimotos disease
bosselated firm slightly symetrical nodualr enlargment
what is characteristic of graves disease
symetrical diffuse enlargment
what is most thyroid enlargment from , except hashimotos
hyperplasia of thyroid follicles and their cells
name five symptoms of hypothyroid
lethargy, tired, cold, edema, hair loss, amenorrhea
name five symptoms of hyperthyroid
nervousness, insomnia, tachycardia, exopthalmos, anxiety
what is the most common cause of hypothyroid
hashimotos
what is the most common cause of hyperthyroid
graves dz
what are two examples of autoimmune thyroiditis
hashimotos or graves
what is likly cause of thyroiditis in middle aged women
viral or de quervains
describe four keys to graves dz
autoimmune, constant thyroid hormone production, exopthalmos, fleshy large goiter
two keys to hashimotos dz
destructive thyroiditis, low thyroid hormone
what test is best for thyroid function
TSH
for diagnosis of thyroid function get what test
log/linear response with free t4 cuz tsh alone isnt good
what is the most sensitive test of a thyroid nodule
fine needle aspiration
what is myxedema crisis
severe life threatening hypothyroidism causing uncompensated low bp and blood shunting to core
s/s of myxedema crisis
confusion or coma, convulsions and abnormal neuological signs, hypothermia,
what should hypothyroidism be treated with
25-75mcg/day start low, increase over weeks
what is the goal of hypothyroid treatement
tsh of .4-2.0
what interfears with hypothyroid treatment
food, iron, and PPI’s
how should thyroid meds be taken
1 hour before meal
what is special about preg women with tyroid meds
may need 100-150 mcg/day
what is levothyroxine
synthetic t4
how often should levothyroxine be adjusted
every 3-6 weeks
how is hyperthyroidism treated
symptom releif, inderal is drug of choice until its resolved
how is inderal dosed
60-320mg increase 2-3 days
what med is used for preg hyperthyroid what are side effects
thiourea 30-60mg, jaundice and agranulocytosis
what is special about stopping hyperthyroid meds
must watch t4 level for months
what is the best treatment for hyperthyroidism
radioactive iodine tx then surgery
how oftnen are thyroid nodules cancerous
5%
who has an increased rate of thyroid cancer
males over 60 or under 20
how do most tyroid tumors present
greater than 4cm with invasion like hoarsness
what should be done with all thyroid nodules
follow up in 6-12 months and do a fine needle biopsy
what does the parathyroid do
controls calcium levels in the blood
what is most common parathyroid disorder
hyperparathyroidism
how does hyperparathyroidism present
more often in females, increased serum calcium, low serum phosphate, common vitamin d deficency
what are the common hyperparathyroidism s/s
bones, stones, groans, psych overtones,
what is high serum calcium
over 10.5
what is low serum phophate
under 2.5
with increased PTH, hypercalcemia, what could it be other than hyperparathyroidism
kidney dz
what is the test for vit d deficiency
25 OHD
what are the lab values for hypothyroidism
low calcium and high phosphate
what are the s/s of hypothyroidism
muscle issues and tinglining
what three things are made by the adrenal glands
cortisol, acth, renin angiotension
what does cortisol do
for stress response, stimulates gluconeogenesis, increases lipid and protein catabolism, drops glucose utilization, supresses immune response
what is conn syndrome
hyperaldosteronism
three keys to hyperaldosteronism labs
htn, low potassium, high sodium
what is hyperaldosteronism normaly from and what is the test for it
adenoma, use ct scan with thin cuts of the adrenal gland, the gold standard is adrenal vein sampling
what is hyperaldosteronism treated with
spironolactone, amiloride but can cause gynocomastia, surgical removal of the adenoma often will cause low BP
what does cortisol do
regulates carbohydrates and protein metabolism
what dz is too much cortisol
cushing syndrome
what is too little cortisol
addisons dz
4 points to cushings syndrome
muscle breakdown, amino acids turn to fat, calcium loss in urine, weakend muscles and elastic tissues
what is cushing syndrome normaly from
acth secreating tumor (pituitary)
6 s/s of cushings dz
central obesity, moon face, buffalo hump, DM, thin skin, increased hair growth
what test is used to diagnose cushings dz
overnight low dose dexamethasone suppresion test
what is normal cortisol supresion
less than 5
if the overnight low dose dexamethasone suppression test is positive then what
do a 24 hour urine free cortisol and ck test
what is the the most common cause of cushings syndrome
extra steroid use
how is cushings treated
remove the adenoma, if that fails then use metyrapone
describe addisons dz
usually autoimmune, low cortisol
what are s/s of addisons dz
weak, weight loss, apathy, confusion, n/v, salt craving, hyperpigmintation, low bp, loss of body hair
what is used for dx of addisons dz
baseline cortisol/acth before steroids, acth stimulation test if possible, , 8am cortisol level less than 3 if greater than 11 then it isnt addisons
what is used for long term tx of addisons
daily glucocorticoid replacement with hypocortisone 15-30 mg/day bid 2/3 in am and 1/3 in pmand eludrocortisone .05-.3 mg/day do IM hydrocortisone for emergency
what is a pheochromocytoma
tumor in the adrenal medula that secreates norepinephrine, and epi
what are s/s of pheochromocytoma
headaches, tachy, sustained htn, n/v, flushing, raynauds
what is special with pheochromocytoma
do not do a fine needle biopsy, do a thin cut ct, treat with surgery
what is the diagnositc feature of osteoporosis
t score less than -2.5, that is 2.5 standard deviations below normal
what is a first sign of osteroporosis
loss of height
how often should a bone desity be done with a postmenopausel women with a t score of -1 to -1.5
every 5 years, life style changes
how often should a bone desity be done with a postmenopausel women with a t score of -1.5 to -2
every 3-5 years, life style changes
how often should a bone desity be done with a postmenopausel women with a t score of -2 or greater
every 1-2 years consider prophylactic tx
what is a prophylactic tx for osteoporosis
biphosphates and estrogen
how is calcitonin dosed for osteoporosis
200 nasal spray in alternating nostrils
what is polycystic ovary syndrome
anovulation is often a symptom
what labs are done for polycystic ovary syndrome
FSH, TSH, testosterone, glucose
what med will help polycystic ovary syndrome
metformin
what is prediabetic fasting glucose
100-125
what is DM fasting glucose
over 125
what is pre DM A1C
5.7-6.4
what is the main tx for DM
diet and exercise
what do thiazolinedines do
control hepatic glucose production, sensitize you to insulin
name three TZD drugs
metformin, actos, nemenda
what drugs stimulate the pancrease to produce more inslulin
sulfonyureas and meglinides
what drugs slow the absorption of starches
alpha glucosidase inhibitors
what is a side effect of sulfonauria
weight gain
what is a side effect of TZD
swelling so start low and increase it
what is basal insulin and what are the meds
long all day base insulin, lantus, glargy, deadamire, levamire
name three sulfonylureas
glipizide, glimepiride, amaryl
what can sulfonulureas cause
low blood sugar especialy at night, eat protein before bed
what is important about long term sulfonylureas
most will gain weight and the effects decrease over time
what do biguanides do
increase insulin sensitivity
name the primary biguanide
metformin
what is normal side effect of metformin
GI upset
what will metformin increase the risk of
lactic acidosis
when should metfromin be stoped
3 days before contrast, or if creatinin is over 1.4 or GFr less than 30, 1/2 the dose if it is between 30-50
how is metformin dosed
500-2550mg a day in 2-3 doses or once start with 500 once a day and increase
when should TZDs be used but what should be watched
for DM if kidney problems are present but can make CHF worse and watch kidney function
how long does TZD take to make a diffrence
3-4 weeks
name a dpp4 inhibitor
januvia
what do dpp4 meds do
stops destruction of glp1 and gip the enzymes that increase icterin and drop glucagon
how should januvia be dosed
100mg a day with metformin
how should insulin be started
take basil in the morning like lantus or detemir
what should be done with insulin injections if they are more than 50u
split them into two shots
what med should not be used with insulin
sulfonuria
name 3 rapid insulins how long is the peak
lispro, aspart, glulisine 1 hour
name 1 short acting insulin and how long is peak
regular, 2 hours
name 1 intermediate insulin and when is peak
NPH 6 hours
name 1 long insulin and when is peak
detemir 20 hours long
name 1 long long insulin and duration
glargine or lantus lasts 24 hours
how much basal insulin should be started
10u then get fasting correct
how is meal time insulin done
basal dose divided by 10 is the dose at the largest meal of humalog, then add this at other meals and subtract from the basal dose
whats the better way to dose insulin
1/2 as basal bolus, 1/2 split into 1/3 for meal doses
