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Seratonin & GABA are responsible for?
Pleasure/Relaxation
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Norepinephrine & Dopamine are responsible for what?
Worry
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The #1 complaint of people who take SSRIs is what?
Decreased Libido (sex drive)
-Gain Weight (appetite is increased)
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Common screening tool for Depression?
PHQ-9
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8 symptoms of Depression?
- Sleep issues
- Interests loss
- Guilt
- Energy low
- Concentration poor
- Appetite change
- Psychomotor agitation
- Suicidality
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Diagnosis for Major Depression?
5 or more symptoms present most every day
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Diagnosis for moderate depression?
At least 2-4 symptoms present most of the day
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What is the Black Box warning for antipsychotics & SSRIs?
Increased risk of suicide
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Kava-kava & Valerian root are used for what 2 things?
Anxiety & Insomnia
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Kava-Kava & Valerian root should not be mixed with what?
- Benzodiazepines
- Hypnotics
- CNS depressants
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Asking a patient to spell a world backwards is known as what type of exam?
MME
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MAOIs are rarely used due to their serious side effect with what type of food? Examples?
High Tyramine (beer, cheese, wine, & fava beans)
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Antipsychotics lead to an increase in what?
Obesity, DMII, hyperlipidemia, metabolic syndrome, hypothyroidism
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What herb can be used for Depression & menopausal symptoms?
St. John’s Wart
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Major consideration if prescribing St. John’s wart?
A lot of medication interactions
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When are hallucinations common?
Between 16/30 years of age and patient has poor social skills and executive function
-
Lone GGT elevation is a sign of what?
Alcohol Abuse
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What AST/ALT ratio is suspicious for alcoholism?
>2.0
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What is Karsakoff’s syndrome caused by?
Chronic Thiamine Deficiency
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What should a patient be educated if on nicotine gum/patches?
Do not smoke while using patches
Do not use gum & patches both
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How many drinks a day are men/women allowed?
-
Patients can smoke on what smoking cessation drug?
Bupropion (Zyban)
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A complication from chronic alcohol abuse that causes a neurological disorder with signs that include hypotension, visual impairment, & coma.
Treatment?
Korsakoff’s Syndrome
Treated by high dose parenteral vitamins especially thiamine (vitamin B1)
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Smoking cessation should be discussed how often with patients?
Every visit
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A patient presents with lanugo, peripheral edema (due to poor protein intake), weight loss >10%, and amenorrhea. What are you concerned for?
Anorexia Nervosa
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What are patients with Anorexia Nervosa at high risk for?
Osteopenia/Osteoporosis
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Why is Bupropion contraindicated in patients with anorexia?
Increases seizure threshold
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What is a common side effect of Paroxetine (Paxil)?
Erectile Dysfunction
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What do patients needs to know regarding Paroxetine (Paxil) when discontinuing the medication?
It has a short half life & the patient should be weaned slowly from the medication
Category D
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What is s good drug to start an older depressed patient who has a lot of medications on?
Citalopram (Celexa) because it has less side effects than other SSRIs
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What 2 things are TCAs commonly used for?
- Herpetic Neuralgia
- Migraine Headache Prophylaxis
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First line medication for depression?
- SSRI
- -Sertaline (Zoloft)
- -Escitalopram (Lexapro)
- -Fluoxetine (Prozac)
- -Paroxetine (Paxil)
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What is first line for depressive patients?
Psychotherapy first
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Common side effect of SSRIs other than decreased libido? Why?
GI side effects - nausea, vomitting, diarrhea, weight gain, sleepiness
Seratonin receptors in gut.
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When starting SSRIs in the elderly what should you do with their starting dose of medication?
1/2 the dose
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What do we know about treating depression in older adults?
It may take them longer to get better than adolescents
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What type of depression medication should you not prescribe the elderly?
TCAs because they cause anti-cholinergic side effects & can cause arrhythmias
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Which depression drug class can patients overdose on by consuming a large Amount of pills?
TCAs
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What is the approach to treating bi-polar patients?
Must treat both poles by prescribing a - mood stabilizer & anti-depressant
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What is bi-polar defined by?
Depression + Manic Episodes
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What is the most common side effect of lithium therapy?
Diabetes Insipidus (polydipsia/polyuria)
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What is typical after a person has a loved one die?
Searching behavior where they hear the persons voice/see them but is not a psych illness, it will resolve
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What are the 4 Criteria even diagnosing anorexia nervosa?
- -intense fear of weight gain
- -weight below 85% of ideal body weight
- -severe body image disturbance
- -amenorrhea
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TCAs can be taken when to avoid side effects?
Bed time (drowsiness)
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What lab must you always make sure to get in a newly diagnosed adolescent depressed patient?
Urine Drug Screen
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When starting antidepressant in an older adult what should you always get as a baseline measure?
EKG
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What 4 labs should you get in an older adult with depression?
- CBC
- TSH
- B12/Folate
- Chem Panel
-
How long must depression persist after delivery to be considered postpartum depression?
>10 days (anything less is considered postpartum “blues”)
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What labs need to be monitored in patients who take atypical antipsychotics?
Fasting BG, lipid profile & Weight (atypical antipsychotics increase risk of gaining weight)
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