042815 fatigue Flashcards
(20 cards)
hyponatremia can cause fatigue: true or false
true
essential ques to ask pt w fatigue
what do you mean by fatigue/tired
sleep?
meds?
psych/mood?
these 3 are the most common causes
PMH
alcohol (won’t sleep soundly)
what tests do you want to do on someone w fatigue
BMP CBC glucose thyroid polysomnography
grief resolves by
1 yr
meds to tx depression
SSRIs (onset of action can take 4-6 wks) SNRIs TCAs MAOIs bupropion (inhibits dopamine and NE reuptake)-no sexual side effects
mirtazapine (alpha 2 blocker, 5HT2 and 5HT3 receptor antagonist)
list SSRIs
fluoxtine, sertraline, paroxetine, citalopram, escitalopram, fluvoxamine
list SNRIs
venlafaxine, desvalafaxine, duloxetine, milnacipran, sibutramine
list TCAs
amitriptyline, nortriptyline, imipramine, desipraimne, clomipramine, doxepin, amoxapine
list MAOIs
tranylcypromine, phenelzine, isocarboxazid, selegiline
eating tyramine foods can cause HTN crisis
serotonin syndrome
high fever, autonomic instability, seizures, confusion, myoclonus, flushing
can be caused by combining SSRI with MAOI or TCA or SNRI or meperidine or tramadol or St John’s Wort
risk of seizures esp in eating disorder pts
bupropion
list 3 possible endocrine causes for fatigue and the order in which you would evaluate them
adrenal insufficiency
hypothyroidism
hypercalcemia
how would you evaluate for adrenal insufficency
do ACTH stimulation
if cortisol low, then get lab ACTH
how would you evaluate for hypothyroidism
lab TSH
how would you evaluate for hypercalcemia
get serum Ca look at possible causes: albumin level vit D phosphorous urine Ca (rules out familial hypocalciuric hypercalcemia) PTH (if LOW, PTHrP) abd XR (kidneys) bone mineral density study
where is Ca absorbed in gut
duodenum
jejunum
signs and symptoms of hypercalcemia
fatigue and weakness
constipation, nausea/vomiting, abd pain/ulcers
osteoporosis
renal stones, polyuria and polydipsia
neuro/cogn: impaired memory, drowsiness, coma, etc
PTH dependent causes of hypercalcemia
primary hyperPTH (common, could also be due to MENs) FHH (mutation in Ca sensing receptor of parathyroid) parathyroid carcinoma (EXTREMELY RARE)
PTH independent causes of hypercalcemia
sarcoidosis lytic lesions vit D toxicity (extremely hard) PTHrP MALIGNANCY (PTHrP, osteolytic mets)
tx for hyperparathyroidism
surgery if symptomatic
medical management: hydration, avoid Ca sparing diuretics, normal Ca intake, optimize vit D, use calcimimeitc like cinacalcet
