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Flashcards in psychosocial Deck (44):
1

acute serotonin syndrome

>serotonin dt new drug/increased dose
dilated pupils (mydriasis), fever, shivering.
High risk if combo of SSRI, MAOI, TCA, triptans. wait 2 weeks before switching to another drug containing serotonin. life threatening

2

baker act

72 hours of involuntary detention to evaluate/tx pt high risk for suicide or hurting others

3

questionnaires in mental health

beck
geriatric depression scale

4

SSRI


Fluoxetine (Prozac)- longest half life, may last up to 4 wks
Sertraline (Zoloft)
Citalopram (celexa)
Escitaprolam (Lexapro)
duloxetine (cymbalta)-depression and nueorpathic pain
amit

ADVERSE EFFECT: Steven johnson syndrome
black box: suicide

AVOID IF SUICIDE RISK ( as pt may hoard)- overdose causes sz/v tach

Do NOT combine with TCA or MAOI. risk for serotonin syndrome.

5

Stevens-Johnson syndrome symptoms

Stevens-Johnson syndrome symptoms include:

Facial swelling
Tongue swelling
Hives
Skin pain
A red or purple skin rash that spreads within hours to days
Blisters on your skin and the mucous membranes of your mouth, nose, eyes and genitals
Shedding of your skin

6

maoi


Phenelzine (Nardil)
Tranylcypromine (Parnate)

Selegiline (Emsam)
Isocarboxazid (Marplan)

avoid foods containing high levels of tyramine — an amino acid that regulates blood pressure —

aged cheese
sauerkraut
cured meats
draft beer
fermented soy products, such as soy sauce, miso or tofu. wine and bottled or canned beer

The interaction of tyramine with MAOIs can cause dangerously high blood pressure.

7

major versus minor depression

minor: atleast 2 s/s but less than 5
both dt serotonin and norepi dysfxn.

8

s/s of depression

mood
anhedonia- sleep
guilt

9

depression differential dsg

hypothyroidism, autoimmune, anemia, b12 deficiency

10

screening tools depression

beck-21 questions
2 item question:

1) past month have you felt down, depressed, hopeless
2)past month have you felt little interest or pleasure doing things

yes to both is +

11

1st line depression rx

SSRI
my take 2 months. wait 4-8 wks bf changing medication

** CONTINUE SSRI for 4-9 moths after symptoms have resoled dt relapse


follow up in 2 weeks.

12

2nd line depression

TCA

amitriptiline/elavil
nortriptyline/pamelor

DOse at HS dt sedation

category X
anticholinergic effects

13

serotonin syndrome

too much serotonin causes symptoms that can range from mild (shivering and diarrhea) to severe (muscle rigidity, fever and seizures). Severe serotonin syndrome can be fatal if not treated.

14

Black box warning for SSRI

suicide risk in young adults/adolescents

15

rx for elderly depression

celexa and lexapro, dt

16

pts with sexual dysfunction caused by SSRI

add bupropion (wellbutrin) to the SSRI

17

depressed patient who wants to stop smoking, rx

bupropion (wellbutrin)

18

depressed with with peripheral neuropathy

duloxetine (cymbalta)

19

depressed patient with urinary incontinence

TCA

20

antipsyhotics can lead to what?

obesity,
DM 2
hyperlipidemia
hyPOthyerodism
metabolic syndrome

21

kava kava and valerian root

used for anxiety/insomnia. Do NOT mix with benzo

22

anticholingergic rx and s/s

rx: antipsychotics, TCA, decongestants, antihistamines (pseudoephedrine)

caution with BPH, narrow angle glaucoma, heart disease

s/s:
SADCUB
sedation, anorexia, dry mouth, confusion, constipation, urinary retention, bhp

23

def if blood alcohol level

>.08%

24

standard drink sizes

beer: 12 oz
wine: 5 oz
hard liquor: 1.5oz

25

dietary guidelines for americans alcohol

women: 1 drink per day beer: ( 12 oz beer, wine: 5 oz
hard liquor: 1.5oz)

men: 2 drinks per day

binge: males more than 5 drinks, women more than 4 drinks on single occasion

26

alcohol abuse labs

GGT Gamma glutamyl transaminate


**2:1 AST/ALT ( AST is double that of ALT)= alcohol abuse



27

rx that

naltrexone (vivitrol)

28

antabuse side effects

severe n/v

29

korsakoff's syndome (Wernicke-Korsakoff syndrome)

complication from chronic alcohol abuse.
HypOtension, visual impairement, coma


tx: vitamines, sep thiamine (b1)

korsakoff's amnesic- type of amnesia from thiamine deficiency

30

thiamine def can cause

kosakoff syndrome

31

insomnia primary versus secondary

primary- NOT caused from disease, mental illness, environmental factors

secondary: caused from disease or environmental

32

insomnia tx plan and rx

sleep routine
lab monitoring for apnea (polysomnography), ENT

rx: diphenhydramine (benadry), AVOID with elderly
benzodiazepine (xanac, halcion, versed, ativan, restoril, valium, klonipin, librium)

NON BENZO: ambien, lunesta, rozerem

alternatives:
kava kava, valerian root, melatonin, chamomile tea

33

smoking cessation

discuss smoking cessation at EVERY visit for smokers
buproprion (zyban) decreases smoking cravings, CAN be combined with nicotine products and can continue to smoke on buproprion

34

Long GGT sign of

alcohol abuse

35

alcoholism ration of ast/alt

2:1

36

korsakoff syndrome cause by why deficiency

thiamine (b1)

37

natural supplants for insomnia/anxiety. don't mix with what rx

kava kava, valerian root
don't mix with benzo or hypnotics

38

anorexia nervosa

>15% weight loss, lanugo, ammenorrhea 3 months or longer
compications:
osteopenia (dt

39

rx fo anorixia

wellbutrin/buproprion.

40

paxil s/e

erectile dysfuntion

41

SSRI Peroxitine/Paxil warning

pts need to be WEANED, careful with BPH, narrow angle glaucoma, heart disease

42

best rx for elderly depression

citalopram ( celexa) SSRI

43

when to MOST monitor depressed patient

when they start to feel better dt suicide risk

44

always give the smallest and lowest possible dose of benzo, hypnotics, narcotic, tca etc to

true