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ANCC Review > Psych > Flashcards

Psych Flashcards

1
Q

Depression:

How do we screen for it?

What are the first line medications?

A

PHQ2 –> +?

then do PHQ9

> 5? = depression DX

SSRI’s/ SNRI’s

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2
Q

name some SSRI’s

black box warning?

how long to see effects?

how long will pt be on medication?

A
  • Types of SSRIs

esCITALOpram (Cipralex)
CITALOpram (Celexa)
EsCITALOpram (Lexapro)

fluoxeTINE (Prozac or Oxactin)
paroxeTINE (Paxil),

SertraLINE (Zoloft)

fluvoxaMINE (Faverin)

VilazoDONE

“SSorRIy PrAM!! your TINE on the ‘starters’ LINE is DONE! the position is MINE”

***black box warning: SSRI’s can cause suicidal ideation in pts <24 yrs old

-can induce mania in bipolar pts

how long to see effects? –> 4-6 weeks

how long will pt be on medication?
@ least 6 months

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3
Q

Name some SNRI’s

avoid in pt’s with:

A

SNRI
“So…No RI RI? - she has evil CYMBAL’s”
“the CYMBAL has an EFFEct on depression. the CYMBAL also has a DULe effect on neuro pain”…. what cymbal? I cant see it! this is too much pressure”

duloxetine (Cymbalta)
-helps w/neuropathic pain

venlafaxine (Effexor)
-BP issues may occur

avoid in pt’s with uncontrolled narrow-angle glaucoma

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4
Q

things to know about:

fluoxeTINE (ProZAC or Oxactin)

paroxeTINE (Paxil)

EscitaloPRAM (Lexapro)

SertraLINE (Zoloft)

A

fluoxeTINE (Prozac or Oxactin)
-Jittery, long 1/2 life
“zac is so jittery”

paroxeTINE (Paxil)
-sedating, ED
-short half life; needs to be weaned off slowly to prevent withdrawal symptoms

“your dic is short and looks like its sedated Paxman”

EscitaloPRAM (Lexapro)
-works quickly
“lex is a pro, she works quickly”

SertraLINE (Zoloft)
-best choice for the elderly (low SE profile)

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5
Q

Anxiety

screening?

tx?

A

GAD-7

5 points = mild anxiety
10 points = moderate anxiety
15 + = severe anxiety

“oh GAWD! 5/ 10/ 15 …? ah”

tx:
-cognitive therapy
-SSRI, SNRI
-Benzodiazepines

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6
Q

Difficulty falling asleep =

this can be caused by:

A

Difficulty falling asleep = Onset Insomnia

this can be caused by: GERD, Restless leg syndrome, depression

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7
Q

Insomnia

3 main categories:
-transient:
-short term:
-chronic:

Tx?

A

Transient:
-lasts < 1 wk

Short term:
-2-3 months

Chronic
3 months- to a lifetime

tx:
-Sleep Hygiene (no caffeine, bed used only for sleep, cog. behav therapy)

-Benzo’s:
*lorazepam (Ativan)
*diazepam (Valium)
*alprazolam (Xanax)

-Non-Benzo’s
*Ambien (Zolpidom)
*Lunesta

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8
Q

Atypical Antipsychotics

Ex:

Adverse effects:

Monitor:

Avoid in pts w/:

A

Ex:
quetiapine (SeroQUEL)
risperidone (RISPERdal)
Olanzapine (Zyprexa)

“be vewy quiet you fat SQUrEL- i wike to wISPER…. O LANni you are not a typical girl”

Adverse effects:
wt gain
hyperlipidemia
hyperglycemia
galactorrhea

Monitor:
BMI (check wt Q 3 months)

Avoid in pts w/:
Metabolic syndrome

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9
Q

Tricyclic antidepressants (TCA)

used for:

Ex:

Adverse effects:

Monitor:

Avoid in pt’s w/:

A

used for:
-depression (not first line)
-postherpetic/herpetic neuralgia (chronic pain after shingles)
-urinary incontinence
-migraine prophylaxis

Ex:
-amiTRIPtyLINE (Elavil)
-norTRIPtyLINE (Pamelor)
-DOXEpIN (Sinequan)

{Kaylee DOXy IN- is going to ride a TRICYCLe while playing volleyball
well… this is just DEPRESSING… its breaking my HEART and giving me a massive migrane…
ugh, it just hurts to watch (Neuralgia)
“oh DOXEPoo! your TRIPT on the LINE”
more like DOXE cant poo…}

Adverse effects:
-anticholinergic
-category X

Monitor:
**Cardiac evaluation needed BEFORE prescribing these

-overdose will cause fatal cardiac event

Avoid in pt’s w/:
-the elderly
-those taking SSRI’s/ MAOI’s (serotonin syndrome)
-suicidal pts (may hoard to overdose)

take at night (sedation)

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10
Q

Buspirone (Buspar)

used for:

warn pt’s about:

do not use with:

off label use:

A

“non-benzo”

used for:
-Anxiety

{I don’t want to SPAR! I’ve only trained for 4 weeks! scared/panic attack/dizzy/pooping himself….

well that was disappointing… put some maoi on this will ya? }

warn pt’s about:
-full effect in 4 weeks
-GI S.E. and dizziness

do not use with:
-grapefruit juice
-MAOIs

off label use:
-panic attacks

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11
Q

Benzodiazepines:

Drug ending:

great for treating:

commonly causes:

big safety concern:

A

Drug ending:
“-ZPAM’s”
“-ZLAM’s”

CLONOzepam (Klonopm)
alpraZOLAM (xanax)

{ “your BENZ is ZO LAMe…”
{remember? you have AMNESIA or are TIRED or something, because that german guy CLONO was ADDICTED to saying that, homeboy was drunk….alot, its a shame because he’s CUTE. too bad he gives me anxiety. }

great for treating:
-acute anxiety
also
-seizures
-alcohol withdrawal
-insomnia (short term)

commonly causes:
-sedation
-memory loss

big safety concern:
-addictive (remember Jordan Peterson!)
-dont use with Kava Kava (anxiety) or valerian root (insomnia)

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12
Q

Haloperidol (Haldol)

used for:

adverse effects:

Monitor:

do not use with:

A

used for:
antipsychotic
{HODOR! HORDOR! went psycotic because he saw things… you know- fat guy… cant be still, a reTARD with whos heart skips a beat every time he see’s Mal’s Naughty Spot}

adverse effects:
-wt gain
-hyperlipidemia
-hyperglycemia
Tardive Dyskinesia
-QT prolongation

-AKAthisia
-***Malignant Neuroleptic Syndrome: life-threatening idiosyncratic reaction to antipsychotic drugs characterized by fever, altered mental status, muscle rigidity, and autonomic dysfunction.

Monitor:
-fasting blood glucose/lipid profile

do not use with:
frail elderly

HALDOL (or any other psyc med) is contraindicated in patients with Parkinson’s Disease or Dementia with Lewy Bodies

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13
Q

Lithium carbonate

Used for:

Therapeutic range:

Long-term concerns:

How does it work

S.E.:

Do not use with:

Monitor:

A

Used for: Bipolar disorder

{LITH drink thum SODa’s (the crazy mike tyson said in a lisp) , but, not mwor than 2, becauth thaths toxic!”

Tyson, was known as “Epstein’s anomaly”- until the emotional numbing wore off, and now he is as fat as a HYPO}

Therapeutic range:
0.6-1.2
>2g = toxic

Long-term concerns:
-emotional numbing
-**hypothyroid
-wt gain

How does it work?
-regulates sodium (NA) in nerve and muscle cells

S.E.:
-**“ebstine’s anomaly” congenital heart defect caused by Lithium
-hypothyroidism
-altered sodium (Na) levels

Do not use with:
grapefruit juice

Monitor:
serum trough level (12 hours after last dose)

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14
Q

Atypical Antidepressants:

Bupropion (Wellbutrin)

Buproprion (zyban)

adverse effects:

contraindicated:

A

depression

Wellbutrin can help PAXIL w/sexual dysfunction side effect

Zyban used for: smoking cessation
(pt are able to smoke while on it)

adverse effects:
Seizures

contraindicated:
-seizure disorders
-anorexia
-bulimia

{is having a coniption (seizure) the PROP you brought?
ZY BANned smoking in the ED. It can help you get WELL BUT not if you have an eating disorder

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15
Q

Major depression vs minor depression

A

minor depression = <5 but @ least 2 depression symptoms

major depression = 5+ depression symptoms

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16
Q

MAO-I drugs

A

Tranylcypromine (Parnate)
Phenelzine (Nard)
Isocarboxazid
Selegiline

{whie putting MAO on some bread for a sandwhich: Nate “Trany Phrenzy! I SO carbo loaded- and was very selective with stockings with a LEG LINE”}

do not mix with Triptans / or SSRI’s

17
Q

Herbal supplement that helps w/depression?

warning

A

St Johns wort

-depression
-menopausal symptoms

don’t take anything w/serotonin.
Risk for serotonin syndrome

18
Q

increased risk of suicidal thinking in ages 18-24 the first 1-2 months of using

A

SSRI

19
Q

best SSRI’s to use for elderly

A

citalopram (celEXA)
escitalopram (LEXaPRO)

“EXAlent! this is my nurse LEXy, she’s a PRO with us oldies”

20
Q

depressed pt w/peripheral neuropathy

A

consider:

duloxetine (Cymbalta)
-which can also tx neuro pain

21
Q

Postherpetic neuralgia

A

is the most common complication of shingles. It causes a burning pain in nerves and skin

22
Q

depression pt w/Postherpetic neuralgia and chronic pain?

A

consider:

TCA’s

23
Q

depression pt w/ stress urinary incontinence

A

consider:

TCA’s

24
Q

MAOI foods to avoid?

A

Foods high in tyramine

Cured, smoked, or processed meats include dried sausages like pepperoni and salami, hot dogs, bologna, bacon, and smoked fish. Sauerkraut, kimchi, pickled beets, pickled cucumbers, and pickled peppers have high tyramine levels. Also, fermented soy products like tofu, miso, and soy sauce contain tyramine.

25
Q

Anticholinergic meds (antipsychotics)- use caution in pt’s with

A

BPH (urinary retention)
narrow-angle glaucoma
preexisting heart dz

26
Q

MMSE
cognitive skills / actions required?

hint: where you at?

A

O IM AT a CALifornia WRITING COnference

Orientation:
-date/location?

Immediate Recall:
-recall 3 objects

Attention and Calculation
-counting backward
-backward spelling

writing and Copying
-writing a sentence
-copying a figure

27
Q

patients starting to recover from depression may

A

commit suicide (from increase in psychic energy)

28
Q

Lone GGT (gamma-glutamyl transferase) elevation (with or w/out AST/ALT ) is indicative of

A

alcoholism

29
Q

when AST is double the level of ALT

A

Ratio of 2:1 AST/ALT =

alcohol abuse (alcoholic hepatitis)

30
Q

AST and ALT levels are ________ elevated in alcoholism

A

Usually

we see this most often

31
Q

Labs that indicate alcoholism

A

Lone GGT (gamma-glutamyl transferase) elevation (with or w/out AST/ALT )

AST/ALT both elevated (most common)

Ratio of 2:1 AST/ALT

(ALT more specific to the liver)

32
Q

Korsakoff’s syndrome looks like:

and its caused by:

A

disorientation, confusion, ataxia, stupor, coma, hypotension

caused by Chronic Thiamine deficiency

33
Q

AA

Al-Anon

Alateen

A

AA:
-support for alcoholics

Al-Anon
-support for family/friends of alcoholics

Alateen
-support for teen children of alcoholics

34
Q

a male who drinks one glass of wine or one beer per day is

A

not considered an alcoholic

-men allowed 2 drinks per day

-women allowed 1 drink per day

35
Q

Do not mix Kava Kava and valerian root (used for anxiety and insomnia) with

A

Benzos, hypnotics, or CNS depressants

Phenobarbitol
Ambien
Lunesta

36
Q

smoking cessation should be discussed when?

A

at every visit

37
Q

female athlete triad

A

-amenorrhea
-low bone mass
-low BMI

38
Q

How do anorexia pt’s present?

higher risk for?

meds to avoid?

A

-lanugo
-peripheral edema
-amenorrhea
-BMI <18.5

higher risk for:
-osteopenia/osteoporosis

meds to avoid?
-Wellbutrin: it increases the seizure threshold

39
Q

Enzyme Pathways:

CYP3A4:

CYP2C19:

A

CYP3A4:
+ ST.Johns Wort = serotonin syndrome

CYP2C19:
in Asian population
-impacts how they metabolize pain medication
-AKA:
Tramadol and codeine may not work

ANCC Review (19 decks)

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