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PC1 > Test 3 > Flashcards

Test 3 Flashcards

1
Q

what is the most common anxiety disorder

A

phobias

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2
Q

what should be done first for anxiety treatmetn

A

rule out organic causes

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3
Q

what is a physical complaint with no cause that may be psych

A

somataform disorder

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4
Q

what is a fear of public places b/c of fear of being trapped

A

agoraphobia

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5
Q

how is a panic disorder described

A

recurrent panic attacks, followed by 1 month of worry about another, significant change in behavior

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6
Q

What meds will not help OCD

A

benzos

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7
Q

what should be considered with somatoform disorder and how will the pt act when told.

A

they will deny and you may treat for depression

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8
Q

what is a preocupation with having a severe illness

A

hypochondriasis

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9
Q

describe seperation anxiety

A

excessive distress at least 4 weeks, normaly under 18yo and will impare social and occupation

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10
Q

describe generalized anxiety disorder

A

will happen all day long and the person is aware of it

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11
Q

describe adjustment disorders

A

within three months of stressor goes away after 6 months

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12
Q

what 3 have to be ruled out for psych then what 7

A

normal stress, medication reaction, alcohol and drug use, then do, hyper/hypo thyroid, pheochromocytoma, cv disorder, neoplasm, b12 low, parkinsons, major depression

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13
Q

what med is first line for anxiety disorder

A

ssri

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14
Q

what med is used for short term anxiety disorder

A

benzo

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15
Q

what med is used for long term anxiety

A

buspar

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16
Q

what med can be used for short term social anxiety

A

beta bloker

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17
Q

when will an ssri reach its full effectivness

A

4-6 weeks

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18
Q

what is a side effect of ssri if pt is bipolar

A

manic episodes

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19
Q

what will not help a panic attack

A

psychotherapy

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20
Q

how should ssri be dosed

A

1/2 at start

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21
Q

ssri is what class preg

A

c

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22
Q

can preg pts have benzos

A

no

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23
Q

how is depression dignosed

A

for 2 weeks they must have 5 of the following

depressed mood, anhedonia, sleep and appetite is wrong, low energy, agitation, suicidal thoughts

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24
Q

what is a side effect of ssri in men and what should you use insted

A

impotence, use wellbutrin

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25
Q

how is bipolar diagnosed

A

must have 7 consecutive days of, erratic mood, racing thoughts, less sleep, pressured speech, high risk behavior, inflated sense of self, flight of ideas

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26
Q

what are two old school bipolar meds, why are they not so great

A

lithium and depakote, bad side effects and not for preg

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27
Q

name three new school bipolar meds and what should be watched for

A

zyprexa, geodon, abilify, watch weight gain and blood sugar

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28
Q

name two keys with schizophrenia

A

loss of boundries and hallucinations

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29
Q

how is schizophrenia diagnosed

A

6 months of symptoms of, delusional thought, disorganized speech, disorganized behavior, hallucinations

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30
Q

three keys to add/ adhd

A

impulsivity, inattention, hyperactivity

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31
Q

before dx add/adhd check what three things first

A

hearing, eyes, and learning disorders

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32
Q

what are the three clusters of personality disorders, describe them

A

weirds- schizo, suspicious, paranoid
wild- narssasistic, antisocial
worried- avoident, ocd

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33
Q

who wont know there ocd is odd

A

OC personality disorder

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34
Q

what three dx will ssri help with

A

panic, OCD, anxiety

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35
Q

what to do about ssri overdose

A

it wont kill them

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36
Q

what is seartonin syndrome

A

tachy, sweating and need to go to the ED

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37
Q

how long should ssri’s be tappered for stopping

A

4 weeks

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38
Q

when are tricyclic antidepressants used, elavil

A

when ssri dosnt work

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39
Q

why use caution with elavil

A

it will kill as overdose, anticholenergic side effects, can cuase seizures, use caution in the elderly

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40
Q

Whatis the most likly single agent used to treat depression to remission

A

SNRI

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41
Q

what dose buspirone treat

A

anxiety, headache, and nervousness

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42
Q

when should you not use wellbutrin

A

with anorexia or bulemia

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43
Q

what is wellbutrin used with

A

ssri

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44
Q

what do MAo’s treat

A

atypical depression

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45
Q

What should be cautioned with MAOI use

A

eating cheese, wine, and some other stuff cuz of tyramine

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46
Q

what is blood level for lithium

A

.6-1.5

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47
Q

how long does it take valproic acid to kick in

A

3 days

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48
Q

what class is preg valproic acid

A

dont give it dumb dumb

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49
Q

what are the side effects of valproic acid

A

n/v, weight gain, liver problems, can increase other drug levels,

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50
Q

what is gabapentin for

A

mood stablaizer

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51
Q

what is a side effect of lamotrigine

A

rash

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52
Q

how should benzos be titrated

A

down 10% each week

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53
Q

What is the adolecent drug and alcohol abuse

A

CRAFFT

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54
Q

what is the thing for depression in teens

A

PHQ-9

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55
Q

what 5 things do hormones do

A

homeostasis, growth and development, reproduction, engery production storage and use, behavior

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56
Q

what is a halmark sign of addisons disease

A

hyperpigmentation

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57
Q

what is a physical sign of cushings syndrome

A

moon face

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58
Q

what does hypothyroidism do to the eyes

A

puffy eyes

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59
Q

what does hyperthyroidism do to the eyes

A

exopthalmous

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60
Q

what are the two types of parathyroid glands and what do they do

A

chief cells- produce PTH regulates circulating calcium

oxyphilic cells- not criticaly important

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61
Q

what is the main function of the thyroid

A

contooling body metabolism

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62
Q

what does the thyroid produce and what does it do

A

t4- increase basal metobolic rate, more secreated

t3- increases basal metabloic rate is more active and increases heat production

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63
Q

what does the liver do in relation to the thyroid hormones

A

converts t4 to t3

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64
Q

what does PTH do

A

increase serum calcium

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65
Q

what is the term for a good thyroid function

A

euthyroidism

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66
Q

what is a goiter

A

any swelling of the thyroid

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67
Q

what is a toxic goiter

A

any goiter with increased thyroid hormone output

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68
Q

what is a non toxic goiter

A

normal hormone levels

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69
Q

what could be a thyroid tumor

A

focal noduar enlargment

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70
Q

what is characteristic of hashimotos disease

A

bosselated firm slightly symetrical nodualr enlargment

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71
Q

what is characteristic of graves disease

A

symetrical diffuse enlargment

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72
Q

what is most thyroid enlargment from , except hashimotos

A

hyperplasia of thyroid follicles and their cells

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73
Q

name five symptoms of hypothyroid

A

lethargy, tired, cold, edema, hair loss, amenorrhea

74
Q

name five symptoms of hyperthyroid

A

nervousness, insomnia, tachycardia, exopthalmos, anxiety

75
Q

what is the most common cause of hypothyroid

A

hashimotos

76
Q

what is the most common cause of hyperthyroid

A

graves dz

77
Q

what are two examples of autoimmune thyroiditis

A

hashimotos or graves

78
Q

what is likly cause of thyroiditis in middle aged women

A

viral or de quervains

79
Q

describe four keys to graves dz

A

autoimmune, constant thyroid hormone production, exopthalmos, fleshy large goiter

80
Q

two keys to hashimotos dz

A

destructive thyroiditis, low thyroid hormone

81
Q

what test is best for thyroid function

A

TSH

82
Q

for diagnosis of thyroid function get what test

A

log/linear response with free t4 cuz tsh alone isnt good

83
Q

what is the most sensitive test of a thyroid nodule

A

fine needle aspiration

84
Q

what is myxedema crisis

A

severe life threatening hypothyroidism causing uncompensated low bp and blood shunting to core

85
Q

s/s of myxedema crisis

A

confusion or coma, convulsions and abnormal neuological signs, hypothermia,

86
Q

what should hypothyroidism be treated with

A

25-75mcg/day start low, increase over weeks

87
Q

what is the goal of hypothyroid treatement

A

tsh of .4-2.0

88
Q

what interfears with hypothyroid treatment

A

food, iron, and PPI’s

89
Q

how should thyroid meds be taken

A

1 hour before meal

90
Q

what is special about preg women with tyroid meds

A

may need 100-150 mcg/day

91
Q

what is levothyroxine

A

synthetic t4

92
Q

how often should levothyroxine be adjusted

A

every 3-6 weeks

93
Q

how is hyperthyroidism treated

A

symptom releif, inderal is drug of choice until its resolved

94
Q

how is inderal dosed

A

60-320mg increase 2-3 days

95
Q

what med is used for preg hyperthyroid what are side effects

A

thiourea 30-60mg, jaundice and agranulocytosis

96
Q

what is special about stopping hyperthyroid meds

A

must watch t4 level for months

97
Q

what is the best treatment for hyperthyroidism

A

radioactive iodine tx then surgery

98
Q

how oftnen are thyroid nodules cancerous

A

5%

99
Q

who has an increased rate of thyroid cancer

A

males over 60 or under 20

100
Q

how do most tyroid tumors present

A

greater than 4cm with invasion like hoarsness

101
Q

what should be done with all thyroid nodules

A

follow up in 6-12 months and do a fine needle biopsy

102
Q

what does the parathyroid do

A

controls calcium levels in the blood

103
Q

what is most common parathyroid disorder

A

hyperparathyroidism

104
Q

how does hyperparathyroidism present

A

more often in females, increased serum calcium, low serum phosphate, common vitamin d deficency

105
Q

what are the common hyperparathyroidism s/s

A

bones, stones, groans, psych overtones,

106
Q

what is high serum calcium

A

over 10.5

107
Q

what is low serum phophate

A

under 2.5

108
Q

with increased PTH, hypercalcemia, what could it be other than hyperparathyroidism

A

kidney dz

109
Q

what is the test for vit d deficiency

A

25 OHD

110
Q

what are the lab values for hypothyroidism

A

low calcium and high phosphate

111
Q

what are the s/s of hypothyroidism

A

muscle issues and tinglining

112
Q

what three things are made by the adrenal glands

A

cortisol, acth, renin angiotension

113
Q

what does cortisol do

A

for stress response, stimulates gluconeogenesis, increases lipid and protein catabolism, drops glucose utilization, supresses immune response

114
Q

what is conn syndrome

A

hyperaldosteronism

115
Q

three keys to hyperaldosteronism labs

A

htn, low potassium, high sodium

116
Q

what is hyperaldosteronism normaly from and what is the test for it

A

adenoma, use ct scan with thin cuts of the adrenal gland, the gold standard is adrenal vein sampling

117
Q

what is hyperaldosteronism treated with

A

spironolactone, amiloride but can cause gynocomastia, surgical removal of the adenoma often will cause low BP

118
Q

what does cortisol do

A

regulates carbohydrates and protein metabolism

119
Q

what dz is too much cortisol

A

cushing syndrome

120
Q

what is too little cortisol

A

addisons dz

121
Q

4 points to cushings syndrome

A

muscle breakdown, amino acids turn to fat, calcium loss in urine, weakend muscles and elastic tissues

122
Q

what is cushing syndrome normaly from

A

acth secreating tumor (pituitary)

123
Q

6 s/s of cushings dz

A

central obesity, moon face, buffalo hump, DM, thin skin, increased hair growth

124
Q

what test is used to diagnose cushings dz

A

overnight low dose dexamethasone suppresion test

125
Q

what is normal cortisol supresion

A

less than 5

126
Q

if the overnight low dose dexamethasone suppression test is positive then what

A

do a 24 hour urine free cortisol and ck test

127
Q

what is the the most common cause of cushings syndrome

A

extra steroid use

128
Q

how is cushings treated

A

remove the adenoma, if that fails then use metyrapone

129
Q

describe addisons dz

A

usually autoimmune, low cortisol

130
Q

what are s/s of addisons dz

A

weak, weight loss, apathy, confusion, n/v, salt craving, hyperpigmintation, low bp, loss of body hair

131
Q

what is used for dx of addisons dz

A

baseline cortisol/acth before steroids, acth stimulation test if possible, , 8am cortisol level less than 3 if greater than 11 then it isnt addisons

132
Q

what is used for long term tx of addisons

A

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

133
Q

what is a pheochromocytoma

A

tumor in the adrenal medula that secreates norepinephrine, and epi

134
Q

what are s/s of pheochromocytoma

A

headaches, tachy, sustained htn, n/v, flushing, raynauds

135
Q

what is special with pheochromocytoma

A

do not do a fine needle biopsy, do a thin cut ct, treat with surgery

136
Q

what is the diagnositc feature of osteoporosis

A

t score less than -2.5, that is 2.5 standard deviations below normal

137
Q

what is a first sign of osteroporosis

A

loss of height

138
Q

how often should a bone desity be done with a postmenopausel women with a t score of -1 to -1.5

A

every 5 years, life style changes

139
Q

how often should a bone desity be done with a postmenopausel women with a t score of -1.5 to -2

A

every 3-5 years, life style changes

140
Q

how often should a bone desity be done with a postmenopausel women with a t score of -2 or greater

A

every 1-2 years consider prophylactic tx

141
Q

what is a prophylactic tx for osteoporosis

A

biphosphates and estrogen

142
Q

how is calcitonin dosed for osteoporosis

A

200 nasal spray in alternating nostrils

143
Q

what is polycystic ovary syndrome

A

anovulation is often a symptom

144
Q

what labs are done for polycystic ovary syndrome

A

FSH, TSH, testosterone, glucose

145
Q

what med will help polycystic ovary syndrome

A

metformin

146
Q

what is prediabetic fasting glucose

A

100-125

147
Q

what is DM fasting glucose

A

over 125

148
Q

what is pre DM A1C

A

5.7-6.4

149
Q

what is the main tx for DM

A

diet and exercise

150
Q

what do thiazolinedines do

A

control hepatic glucose production, sensitize you to insulin

151
Q

name three TZD drugs

A

metformin, actos, nemenda

152
Q

what drugs stimulate the pancrease to produce more inslulin

A

sulfonyureas and meglinides

153
Q

what drugs slow the absorption of starches

A

alpha glucosidase inhibitors

154
Q

what is a side effect of sulfonauria

A

weight gain

155
Q

what is a side effect of TZD

A

swelling so start low and increase it

156
Q

what is basal insulin and what are the meds

A

long all day base insulin, lantus, glargy, deadamire, levamire

157
Q

name three sulfonylureas

A

glipizide, glimepiride, amaryl

158
Q

what can sulfonulureas cause

A

low blood sugar especialy at night, eat protein before bed

159
Q

what is important about long term sulfonylureas

A

most will gain weight and the effects decrease over time

160
Q

what do biguanides do

A

increase insulin sensitivity

161
Q

name the primary biguanide

A

metformin

162
Q

what is normal side effect of metformin

A

GI upset

163
Q

what will metformin increase the risk of

A

lactic acidosis

164
Q

when should metfromin be stoped

A

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

165
Q

how is metformin dosed

A

500-2550mg a day in 2-3 doses or once start with 500 once a day and increase

166
Q

when should TZDs be used but what should be watched

A

for DM if kidney problems are present but can make CHF worse and watch kidney function

167
Q

how long does TZD take to make a diffrence

A

3-4 weeks

168
Q

name a dpp4 inhibitor

A

januvia

169
Q

what do dpp4 meds do

A

stops destruction of glp1 and gip the enzymes that increase icterin and drop glucagon

170
Q

how should januvia be dosed

A

100mg a day with metformin

171
Q

how should insulin be started

A

take basil in the morning like lantus or detemir

172
Q

what should be done with insulin injections if they are more than 50u

A

split them into two shots

173
Q

what med should not be used with insulin

A

sulfonuria

174
Q

name 3 rapid insulins how long is the peak

A

lispro, aspart, glulisine 1 hour

175
Q

name 1 short acting insulin and how long is peak

A

regular, 2 hours

176
Q

name 1 intermediate insulin and when is peak

A

NPH 6 hours

177
Q

name 1 long insulin and when is peak

A

detemir 20 hours long

178
Q

name 1 long long insulin and duration

A

glargine or lantus lasts 24 hours

179
Q

how much basal insulin should be started

A

10u then get fasting correct

180
Q

how is meal time insulin done

A

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

181
Q

whats the better way to dose insulin

A

1/2 as basal bolus, 1/2 split into 1/3 for meal doses

PC1 (3 decks)

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