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s/s of depression in adolescents
anger, irritability
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Meds for depression + cancer
- Ex. on tamoxifen + depression
- = sertraline, citalopram, escitalopram
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how the brain changes in depression
- amygdala= enlarged
- hippocampus, thalamaus = reduce
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Neurotransmitter in depression
- dopamine: decrease = anhedonia
- serotonin: decrease= depression
- norepi= depression
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Meds for depression + chronic neuropathic pain ex. fibromylagia
SNRI or TCA
- SNRI ex. end in lafaxine
- TCA - end in ptyline , amine
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depression + chronic neuropathic pain meds
alpha 2 d ( gabapentin, pregablin)
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What to assess when on an SNRI
Ex. cymbalta = assess BP
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drug classes that cause sexual problems
better alternatives
SNRI, SSRI, TCA, MAOI = sex prob
wellbutrin, remeron= less sex prob
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Side effect of prozac
insomnia ( switch to AM dose)
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5-HT2C receptor ( subtype of serotonin receptor) regulates what?
mood, anxiety, individual antidepressant response
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Which SSRI can increase serotonin levels without affecting 5-HT2C receptors?
zoloft, prozac, lexapro
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Schizophrenia onset
male vs female
hallmark s/s
- male: 18-25y
- female: 25-35
( most start mid 30s)
hallmark s/s: impaired proverb interpretation
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Schizophrenics have a low tolerability to which drugs?
Schizophrenics are associated with what disorder ?
- Alpha 2 adrenergic agonist
- Ex. guanfacine, clonidine
Stimulants = make things worst ( increase dopamine)
Associated with lipid dis ( reduc HDL, increase triglycerides)
abnormalities/brain changes = aggression/impulsivity, abstract thinking
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Tertiary prevention for schizophrenics
- social skills training
- Ex. excercise program to improve brain function/cognition
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How to switch PO haldol--> IM
20 x daily PO dose
( 10-15 if elderly, not used to haldol..etc)
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Schizophreniform s/s
- s/s of schizophrenia for 1+ month
- but less than 6 months
-
Sterognostic exam
- neuro to identify objects by touch with no visual cues
- - assess integrity of sensory pathway particularly parietal lobe
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Mthfr gene mutation
- role in metabolizing what
metabolize folate ( B9), homocystein
- B12 requires the active form of folate to be absorbed
- folate def= b12 def
- 1) increase folate intake
- 2) methyl folate supp
- 3) b12
-
Medications FDA approved to tx TD
- deutretrabenzene ( austedo)
- valbenazine ( ingrezza)
-
Least likely meds to cause prolactin
normal men vs women level
seroquel, abilify ( low), high risperidal
- prolactin men: less than 20
- prolactin women: less than 25
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Atypical antipsychotics vs typical
- neurotransmitter
- atypical: serotonin, dopamine antagonist
- - less EPS
- - 1st psychotic episode is better ( IM abilify, invega, geodon)
typical: dopamine antagonist only
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What is clozapine metabolized by?
what about nicotine
- clozapine: CUP1A2
- nictonine: CYP2A6
-
Inhibitors take over inducers
what to do?
- Inducer + inhibitor
- Ex. tegretor = inducer
- doxy= inhibitor
- inhibitor takes over inducer = tegretol goes up ---> should lower tegretol dose
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Pregnancy safe meds
- buspar, sertraline
- pregnant + mood dis = lamictal
-
neurotransmitter for addiction
dopamine + GABA
-
neurotransmitter for nightmares
serotonin, NE, ACH, glutamate, GABA, dopamien
-
neurotransmitter for alcohol
GABA
-
neurotransmitter for stimulant
dopamine, NE, serotonin
-
neurotransmitter for heroine ( opioid)
ACH, dopamine, NE
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Pt with anorexia has pain/bloating after eating due to delayed gastric emptying
What meds can also delay gastric emptying
rantidine, famotidine, omeprazole
-
which meds decrease absorption of psychotropics
- antacids/PPI
- Ex. protonix, omperazole ( wait 2 hrs)
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Cause of bipolar?
- no single bipolar gene
- family hx = contributing factor
- but no specific genetic test
-
DIG FAST for bipolar
- Distractability
- Indiscretion
- Grandiosity
- Flight of Ideas
- Activity increase
- Sleep Dist
- Talkative
-
Bipolar 1 vs Bipolar 2
- 1: full manic= extreme mood/energy change
- - s/s interfere with life, 1+ wk
- 2: less severe during hypomanic
- - less severe s/s , shorter 4d
-
borderline personality pharm tx
- irritabile, anger, self harm -= lithium
- depress, labile, aggressive= depakote
DBT - keep journal before dx
-
Schizoid personality s/s
- voluntary social isolation
- indifferent to other people **
- no interest in sexual activity/friends
-
Avoidant personality
- ( wants to socialize but doesnt feel like they have the skills)
- - fears criticism, unwillingness to get involved unless theyre liked
-
Schizotypal Personality
like schizophrenia but no hallucination/delusions
- think theyre psychic
-
ADHD neurotransmitter, brain
dopamine, NE dysfunct
- abnormal: frontal cortex, basal ganglia
- abnormal: reticular activating system
abnormalities in prefrontal cortex-inattentive type
-
How old to give straterra ( atomoxetine ) , guanfacine, or clonidine for ADHD
6y+
-
dorsolateral prefrontal cortex
- executive function
- cognitive process: plan, work mem, prob solv
- how to direct/maintain attention to a task
-
Rheumatoid arthritis test
- what increases
ESR
-
Infant with shrill ( high pitch) cry whats a sign of ?
increase ICP
-
Orbito frontal cortex
learning, reward, punishment, process
assign value, response to inhibition
-
Post menopausal female hormonal change
decrease sex drive --> less testosterone and less blood flow to pelvic region
-
What can help post menopausal women with depression
estrogen + progesterone replacement therapy
-
Enzyme that metabolizes alcohol
- alcohol dehydrogenase
- - women have less ( easier to get drunk)
-
Labs to check in macrolytic normochromic anemia
B12, folic acid
-
Whats rooting reflex
when it should disappear
birth--> 4-6m
corner of baby mouth when touch = baby mouth opens
-
whats landau reflex
when starts to disappear
3m-> 12-24m
hold the baby prone the baby extends legs and looks up
-
Grasp/Palmar reflex
when starts and disappears
- birth-5-6m
- stroke palm, baby grabs hand
-
Microlytic anemia
s/s
more prone
- iron def
- vegetarians are more prone
- s/s: fatigue, weak, anxiety
-
Histamine receptor in insomnia
brain wave activity for insomnia
H1
brain wave: alpha brain wave activity
-
What to do if your trying to implement a policy nation wide? for colleague?
how to ensure continuous improvement in quality of care outpatient
nationwide for NP: host online forum/survey
for colleague: discuss how policy can improve care
outpt: develop an instrument to measure clinical outcomes
-
Labs for infection
what about autoimmune
increase in WBC and C reactive protein ( normal is under 1)
autoimmune: increase cytokines
-
Moro/Startle relfex
starts -> end
- birth to 5-6 m
- baby is startled by loud sound, throws head back and extends limbs
-
Med for enuresis, other tx
- desmopressin ( reduce urine production)
- - moisture alarm , alarm to pee at night
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