Seratonin & GABA are responsible for?
Norepinephrine & Dopamine are responsible for what?
The #1 complaint of people who take SSRIs is what?
Decreased Libido (sex drive)
-Gain Weight (appetite is increased)
Common screening tool for Depression?
8 symptoms of Depression?
- Sleep issues
- Interests loss
- Energy low
- Concentration poor
- Appetite change
- Psychomotor agitation
Diagnosis for Major Depression?
5 or more symptoms present most every day
Diagnosis for moderate depression?
At least 2-4 symptoms present most of the day
What is the Black Box warning for antipsychotics & SSRIs?
Increased risk of suicide
Kava-kava & Valerian root are used for what 2 things?
Anxiety & Insomnia
Kava-Kava & Valerian root should not be mixed with what?
- CNS depressants
Asking a patient to spell a world backwards is known as what type of exam?
MAOIs are rarely used due to their serious side effect with what type of food? Examples?
High Tyramine (beer, cheese, wine, & fava beans)
Antipsychotics lead to an increase in what?
Obesity, DMII, hyperlipidemia, metabolic syndrome, hypothyroidism
What herb can be used for Depression & menopausal symptoms?
St. John’s Wart
Major consideration if prescribing St. John’s wart?
A lot of medication interactions
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?
What AST/ALT ratio is suspicious for alcoholism?
What is Karsakoff’s syndrome caused by?
Chronic Thiamine Deficiency
What should a patient be educated if on nicotine gum/patches?
Do not smoke while using patches
Do not use gum & patches both
How many drinks a day are men/women allowed?
Patients can smoke on what smoking cessation drug?
A complication from chronic alcohol abuse that causes a neurological disorder with signs that include hypotension, visual impairment, & coma.
Treated by high dose parenteral vitamins especially thiamine (vitamin B1)
Smoking cessation should be discussed how often with patients?
A patient presents with lanugo, peripheral edema (due to poor protein intake), weight loss >10%, and amenorrhea. What are you concerned for?
What are patients with Anorexia Nervosa at high risk for?
Why is Bupropion contraindicated in patients with anorexia?
Increases seizure threshold
What is a common side effect of Paroxetine (Paxil)?
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
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
What 2 things are TCAs commonly used for?
- Herpetic Neuralgia
- Migraine Headache Prophylaxis
First line medication for depression?
- -Sertaline (Zoloft)
- -Escitalopram (Lexapro)
- -Fluoxetine (Prozac)
- -Paroxetine (Paxil)
What is first line for depressive patients?
Common side effect of SSRIs other than decreased libido? Why?
GI side effects - nausea, vomitting, diarrhea, weight gain, sleepiness
Seratonin receptors in gut.
When starting SSRIs in the elderly what should you do with their starting dose of medication?
1/2 the dose
What do we know about treating depression in older adults?
It may take them longer to get better than adolescents
What type of depression medication should you not prescribe the elderly?
TCAs because they cause anti-cholinergic side effects & can cause arrhythmias
Which depression drug class can patients overdose on by consuming a large Amount of pills?
What is the approach to treating bi-polar patients?
Must treat both poles by prescribing a - mood stabilizer & anti-depressant
What is bi-polar defined by?
Depression + Manic Episodes
What is the most common side effect of lithium therapy?
Diabetes Insipidus (polydipsia/polyuria)
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
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
TCAs can be taken when to avoid side effects?
Bed time (drowsiness)
What lab must you always make sure to get in a newly diagnosed adolescent depressed patient?
Urine Drug Screen
When starting antidepressant in an older adult what should you always get as a baseline measure?
What 4 labs should you get in an older adult with depression?
- Chem Panel
How long must depression persist after delivery to be considered postpartum depression?
>10 days (anything less is considered postpartum “blues”)
What labs need to be monitored in patients who take atypical antipsychotics?
Fasting BG, lipid profile & Weight (atypical antipsychotics increase risk of gaining weight)