Mood Disorders Flashcards
(137 cards)
1
Q
Older people who have lost a spouse, plan to use a gun or other lethal weapon, history of attempted suicide or family history of suicide, mental illness such as depression or bipolar disorder, history of sexual emotional or physical abuse, terminal illness, chronic illness, chronic pain, alcohol abuse, substance-abuse, are all riskFactors for what
A
Suicide
2
Q
Mood cycles between mania and depression
A
Bipolar disorder
3
Q
Labile moods, euphoria, talkativeness, flight of ideas, grandiosity, and less need for sleep are symptoms of what
A
Manic symptoms of bipolar disorder
4
Q
Classic manic episodes is what type of bipolar disorder
A
Type one
5
Q
Hypomanic episodes is what type of bipolar
A
Type two
6
Q
Occurs from high levels of serotonin accumulating in the body due to the introduction of a new drug and an increase in the dose
A
Acute serotonin syndrome
7
Q
Sudden onset of high fever, muscular rigidity, mental status changes, hyperreflexia, uncontrolled shivering, mydriasis (dilated pupils) Are all signs of
A
A cute serotonin syndrome
8
Q
What increases the risk of serotonin syndrome
A
Combining to drugs that block serotonin such as SSRI, MAOI, and TCA.
9
Q
How long do you need to wait if switching to another drug affecting serotonin
A
Two weeks because it is potentially life-threatening reaction
10
Q
Rare life-threatening idiopathic reaction from typical and atypical antipsychotics
A
Malignant neuroleptic syndrome
11
Q
Allows 72 hours of involuntary detention for evaluation and treatment of persons who are considered at very high risk for suicide or hurting others
A
The Baker act
12
Q
A multiple-choice self report inventory for evaluating depression. Based on the theory that negative conditions about the self and the world in general can cause depression
A
Beck depression inventory
13
Q
The diagnostic manual for mental and emotional disorders by the American a Psychiatric Association
A
DSM-V
14
Q
A questionnaire that is used to evaluate and individual for confusion and dementia
A
Mini mental state exam
15
Q
A 30 item questionnaire that is used to assess depression in the elderly
A
Geriatric Depression scale
16
Q
What is the most common side effect of SSRI
A
Weight gain
17
Q
Nine questions used to screen and monitor response to treatment
A
PH Q9
18
Q
If a patient has a positive screen for depression what do you do next
A
Order lab studies: T-SHIRT Urine drug screens Fasting blood glucose B12 Folate EKG prior to medication administration
19
Q
What kind of psycho tropic medication can prolong QT interval’s in older adults
A
SSRI
20
Q
What is another word for depressed mood
A
Dysphoria
21
Q
What is another word for loss of interest or pleasure in most or all activities
A
Anhedonia
22
Q
What acronym do you use For diagnosing depression
A
SIG: E Caps
Need five or more to diagnose major depression
23
Q
What does Sig: E Caps stand for
A
Sleep issues Interests (loss) Guilt (or worthlessness) Energy (no energy) Concentration difficulties Appetite Psychomotor agitation Suicidality
24
Q
What medication the class is considered first line and a patient who has major depressive disorder her
A
SNRI
25
What are some examples of an SNRI
Prestique, Effexor, Cymbalta
26
If 2 to 4 of the symptoms for depression Are present then the patient has
Mild to moderate depressive disorder
27
What medication class is considered first line in adults who has mild to moderate depressive disorder
SSRI
28
Sertraline (Zoloft), Escitalopram (Lexapro), Fluoxetine (Prozac) are all
SSRI
29
When an antidepressant medication is initiated when will the patient start seeing results
Usually observe some improvement within 2 to 4 weeks. If not, then increase dose
30
When starting an antidepressant medication when should a patient see a full relief of symptoms
6 to 12 weeks if not, switch, augment
31
An 85-year-old patient was diagnosed with moderate depression. What medication classes considered first line
SSRI
32
In an older adult with depression how long does it take for there to be an improvement with medication
There should be some improvement in 4-6 weeks
33
In how many weeks will an older adult see a complete relief of symptoms after taking medications for depression
12 to 16 weeks
34
Parkinsonism, anorexia, sinus bradycardia, hyponatremia, bleeding and fragility are all side effects of
SSRI
35
What is the first line treatment for moderate depression in the older adult and younger adults
SSRI
36
What is the Beers list
Geriatric guide to prescribing. Tells what drugs stay away from in older adults
37
What is almost twice as high in the elderly, and highest in white males
Suicide rates
38
What type of antidepressant is deadly with suicide overdose
TCA
| Amytriptiline
39
Which SSRI has the longest half life and may last up to four weeks
Prozac
40
Which SSRI has the shortest half-life
Paxil
41
Which SSRI has fewer drug interactions compare to others
Celexa
42
Which SSRI can also treat neuropathic pain
Cymbalta
43
Loss of libido, erectile dysfunction, women with sexual dysfunction, anorexia and insomnia are side effects of
SSRI
44
What antidepressant should be avoided in anorexic patients and undernourished elderly
SSRI
45
What is a common side effect of Paxil
Erectile dysfunction
46
For how many days should SSRI be avoided after taking a MAOI
14 days
47
Can SSRI induce mania in bipolar patients
Yes
48
If a patient is on a TCA can they take an SSRI
No
49
Phenelzine (Nardil) and tranylcypromine (Parnate) are rarely used and what type of antidepressants
MAOI
50
If taking an MAOI what foods should be avoided
Beer, Chianti wine, some aged cheeses, and favs beans
51
What medication is indicated for anxiety disorders, panic disorder, and insomnia
Benzodiazepine
52
What type of benzodiazepine is used for severe alcohol withdrawal and seizures
Diazepam or Valium
53
Are you able to Discontinue benzodiazepines abruptly? Why?
No because it causes seizures. Wean slowly
54
Midazolam (Versed), triazolam (Halcion), Pam suffix are all
Benzodiazepine
55
What benzodiazepine should be avoided in the elderly
Diazepam i.e. Valium, Librium, tenazepam (Restoril), and clonazepam (Klonopin) Because they are all long acting
56
What type of medication for depression has an increased risk of suicidal thinking and behavior in children, Adolescents , and young adults
SSRI
57
If a patient is on an SSRI and experiences sexual dysfunction what should be added to the prescription
Bupropion (Wellbutrin)
58
If a patient is depressed and wants to quit smoking what medication can be given
Bupropion (Zyban)
59
If a depressed patient has post herpatic neuralgia and chronic pain, what antidepressant can be considered
TCA
60
If a patient is depressed and has stress urinary incontinence what antidepressant medication can be considered
TCA
61
What type of medication lead to an increased risk of obesity, type two diabetes, hyperlipidemia, metabolic syndrome, and hypothyroidism
Antipsychotics
62
What herbal supplement is used for depression, menopausal symptoms
St. John’s wort
63
What herb drug interactions occur with johns wort
Indinavir, cyclosporine, oral contraceptives, SSRI, TCA
64
What is kava kava and or valerian root used for
Anxiety and insomnia. Do not mix with benzo diazepam’s, hypnotics were any central nervous system depressants
65
Asking the patient to spell the word world backwards is part of which examination
Mini mental state exam
66
Delusions and paranoia such as disorganized speech and behavior are symptoms of
Psychotic symptoms
67
When do psychotic symptoms usually occur in life and what is the peak incidence of Age
Onset is usually around the second decade and peak incidence is between 16 and 30 years of age
68
Extrapyramidal symptoms, pull rolling, shuffling gait, and bradykinesia are all adverse effects of
Antipsychotics
69
Inability to initiate movement
Akinesia
| Adverse effect of antipsychotic
70
Hey strong inner feelings to move, unable to stay still
Akathesia
| Adverse effects of antipsychotic
71
Bradykinesia when initiating activities or actions that require successive steps such as buttoning a shirt
Adverse effect of antipsychotic
72
Involuntary movements of the lips, tongue, face, trunk and extremities i.e. more common in schizophrenics
Tardive dyskinesia. Adverse affects of antipsychotics
73
Antipsychotics, TCA, decongestants, antihistamines all have what type of the effect
Anticholinergic
74
BPH, narrow angle glaucoma, pre-existing heart disease need to be careful with
Drugs that have an anti-cholinergic effect
75
What is sad cub mnemonic for anti-cholinergic side effects
Sedation, anorexia, dry mouth, confusion, constipation, urinary retention, BPH
76
Elevated blood level greater than what number is illegal for driving
0.08%
77
How many ounces is one beer
12 ounces
78
How many ounces is one glass of wine
5 ounces
79
How many ounces is a shot of alcohol
1.5 ounces
80
How many drinks per day can women have
One
81
How many drinks per day can a man have
Two drinks per day
82
What lab test would show a possible sign of occult alcohol abuse
GGT
83
What is the AST/ALT ratio associated with alcohol abuse
2 to 1
84
What type of anemia do alcoholics have
Macrocytic
85
What is the screening test for alcohol abuse
Cage test
86
Sudden onset of confusion, delusions, transient auditory, tactile or visual hallucinations, tachycardia, hypertension, hand tremors, disturbed psycho motor behavior and grand mal seizures or symptoms of what
Acute delirium tremens
87
How do you treat acute delirium tremens
Medical emergency refer to the ED
88
What is the treatment plan for alcoholics
Benzodiazepines such as Librium or Valium and antipsychotics if needed such as Haldol. Vitamins such as thiamine 100 mg, folate 1 mg PO daily and multivitamins with high caloric intake. Refer to Alcoholics Anonymous, therapist or recovery program. Avoid prescribing recovering alcoholic addict drugs with abuse potential such as narcotics or any medication that contains alcohol such as cough syrup.
89
What medications help alcoholics
Antabuse which causes severe nausea and vomiting, and headache. Vivitrol decreases alcohol cravings
90
A complication from chronic alcohol abuse. A neurologic disorder with signs that include hypotension , visual impairment, and coma. Signs include mental confusion, ataxia, stupor, coma, and hypotension. Treated with high dose parenteral vitamins especially thiamine.
Korsakoff syndrome
91
A type of amnesia. Problems with acquiring and learning new information and retrieving older information. Symptoms include confabulation, disorientation, attention deficit’s and visual impairment
Korsakoffs amnesic syndrome
92
What causes Korsakoffs amnesic syndrome
Chronic thiamine deficiency damages the brain permanently
93
Depression, severe anxiety, GERD, female gender, illicit drug use, musculoskeletal illness, pain, chronic health problems, shiftwork, alcohol, caffeine and nicotine are all risk factors for
Insomnia
94
SSRI, cardiac, blood pressure, allergy, steroids can cause
Insomnia
95
Insomnia not caused by disease, mental illness, or environmental factors is called
Primary insomnia
96
Insomnia caused by disease or environmental factors is called
Secondary insomnia
97
How do you treat insomnia
Sleep hygiene, avoid caffeine tobacco and heavy meals before bedtime, get out of there in 30 minutes if not asleep and use bed only for sex and sleep.
98
What medications treat insomnia
Benadryl but do not use in the elderly.
Benzodiazepines such as Xanax, and non-benzo hypnotics such as ambien or lunesta (do not take if unable to get from 7-8 hours of sleeping time).
99
What are some complementary alternative treatments for insomnia
Kava Kava avoid mixing with alcohol, tranquilizers, Hypnotics as it will increase sedation. Do not give Valerian root or herbal supplements to children and lactating pregnant women. Melatonin, chamomile tea and meditation
100
Can a patient smoke with a nicotine patch on
No patient will overdose with nicotine
101
What does nicotine overdose cause
Acute myocardial infarction, hypertension, and agitation
102
What antidepressant decreases smoking cravings
Bupropion (Zyban)
103
What is A laboratory sign of occult alcohol abuse
Lone GGT elevation
104
AST/ALT Ratio of what number is more likely an alcoholism
2.0 or higher
105
What causes Korsakoff’s syndrome
Chronic thiamine deficiency
106
Can you mix nicotine patches and nicotine gum
No
107
Can a patient smoke while on Zyban?
Yes
108
How often do you discuss smoking cessation with patients
At every visit
109
Marked weight loss i.e. greater than 15% of body weight, Lanugo, amenorrhea for 3 months or longer, are all signs of
Anorexia nervosa
110
What are some complications of anorexia nervosa
Osteopenia/osteoporosis due to prolonged estrogen depletion from amenorrhea and low calcium intake. Higher risks of stress factors. Peripheral edema, and cardiac complications such as arrhythmias, cardiomyopathy, and hypokalemia.
111
What antidepressant medication is contra indicated for anorexic or bulimic patience because it increases the seizure threshold
Bupropion (Wellbutrin)
112
What type of antidepressant has a common side effect of erectile dysfunction
Paroxetine (Paxil)
113
Does Paroxetine have a long or short half life compared with other SSRIs?
Short half-life so patients need to be weaned. Do not discontinue abruptly. It is FDA category D
114
If an elderly patient is depressed what medication should be prescribed even if they are on multiple medications
Citalopram i.e. Celexa because it has less drug interactions than other SSRI
115
What medication can be used for hepatic neuralgia and migraine headache prophylaxis
TCA
116
What type of bipolar disorder consists of manic episodes, nearly always hypomania, major depression
Bipolar one
117
What type of bipolar disorder is more prevalent and has at least one hypomanic disorder, absence of media, and major depression
Bipolar II
118
What medications are used to treat mania or hypomania
Lithium, anticonvulsants, antipsychotics, and benzodiazepines to treat insomnia, agitation, anxiety.
119
What medications are used to treat bipolar disorder
Mood stabilizer, atypical antipsychoticor combo, plus antidepressant or ECT
120
Generalized anxiety disorder is caused by excessive worry that causes significant distress, impairment and a occurs on more days than not for at least how many months
For at least six months
121
How do you treat generalized anxiety disorder
SSRI, and give a limited duration of a benzo diazepine until the SSRI kicks in. No refills.
122
How do you treat situational and anxiety
Benzodiazepine for short term
123
The most common side effects of lithium therapy is
Nephrogenic diabetes insipidus
124
The most common mental disorder in older adults is
Anxiety
125
What is a common side effect of trazodone i.e. tricyclic antidepressant
Drowsiness
126
What type of antidepressant has an anti-cholinergic reaction
TCA
127
Hey patient reports that she takes kava kava regularly for anxiety with good results. What should be evaluated
Liver function studies
128
If a patient is taking valproate what labs must be monitored in this patient
Valproate levels, platelet count, liver function studies
129
What tool diagnoses ADHD
DSM five
130
What geriatric condition is characterized by Production and physical or mental capacity sufficient to interfere with managing day-to-day tasks
Functional impairment
131
What occurs in depression, Parkinson’s disease, orAlzheimer’s disease
Flat affect
132
What type of medication is used for OCD
Antidepressants such as Paxil
133
The CAGE, MAST, and AUDIT questionnaires to detect a problem drinking should be used
As supplements to the standard patient history
134
What is the most frequent cause of death in patients with anorexia nervosa
Cardiac arrest
135
A significant barrier to treatment of depression in the elderly population is
The believe that depression is an inevitable part of aging
136
The intervention known it to be most effective in the treatment of severe depression, with or without psychosis is
ECT
137
The type of assessment found to be most effective when screening for domestic violence is
Routine questioning about abuse
