psychosocial Flashcards
(44 cards)
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
baker act
72 hours of involuntary detention to evaluate/tx pt high risk for suicide or hurting others
questionnaires in mental health
beck
geriatric depression scale
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.
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
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.
major versus minor depression
minor: atleast 2 s/s but less than 5
both dt serotonin and norepi dysfxn.
s/s of depression
mood
anhedonia- sleep
guilt
depression differential dsg
hypothyroidism, autoimmune, anemia, b12 deficiency
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 +
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.
2nd line depression
TCA
amitriptiline/elavil
nortriptyline/pamelor
DOse at HS dt sedation
category X
anticholinergic effects
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.
Black box warning for SSRI
suicide risk in young adults/adolescents
rx for elderly depression
celexa and lexapro, dt
pts with sexual dysfunction caused by SSRI
add bupropion (wellbutrin) to the SSRI
depressed patient who wants to stop smoking, rx
bupropion (wellbutrin)
depressed with with peripheral neuropathy
duloxetine (cymbalta)
depressed patient with urinary incontinence
TCA
antipsyhotics can lead to what?
obesity, DM 2 hyperlipidemia hyPOthyerodism metabolic syndrome
kava kava and valerian root
used for anxiety/insomnia. Do NOT mix with benzo
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
def if blood alcohol level
> .08%
standard drink sizes
beer: 12 oz
wine: 5 oz
hard liquor: 1.5oz
