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What is occurring in the thought process when someone is in the contemplation state of Prochaskas change theory?
Considering the change. Looking at pros and cons of change. Feeling the sense of being stuck with the problem.
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What is occurring in the thought process when someone is in the preparation state of Prochaskas change theory?
Starting to exhibit change behaviors
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What effects do ETOH cessation drugs work upon?
Modify ETOH intoxicating effects, such as Naltrexone. Modify ETOH craving, such as Acamprosate. Meds that cause vomiting if ingested with ETOH, Disulfiram. Also SSRIs are helpful.
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What do you need to keep in mind in RX writing to avoid substance abuse?
Longer acting drugs that dont cause highs and lows. Avoid PRN use so they do not get Highs.
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What are the s/s of opiate withdrawal?
HTN, tachycardia, elevated temp, nausea, diarrhea, restlessness,
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What is Buprenorphine with naloxone?
An opioid agonist and antagonist together to replace addictive drug use.
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What are the qualifiers that must be present for diagnosis of depression?
Duration: greater than 2 weeks. Depressed mood or decreased pleasure or decreased interest. PLUS: 4 or more changes in appetite, sleeping, irritability, psychomotor changes, concentration, fatigue, suicide thoughts
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Are cognitive changes noted in depression?
Yes
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What is dysthymia?
Depressed mood, low level depression
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Delirium vs. dementia onset?
Delirium abrupt. Dementia slowly progressing
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Delirium vs. dementia memory loss?
Memory loss in Dementia for recent events mostly. Delirium is variable memory loss
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Reversibility of Delirium vs. dementia ?
Dementia irreversible. Delirium is often reversible with fixing problem
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Change in motor activity Delirium vs. dementia ?
Change noted in Delirium. No psychomotor changes in dementia.
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D-E-L-I-R-I-U-M-S
Drugs (anticholinergics, opioids), emotional, electrolytes (hyponatremia), low oxygen, Lack of Drugs (ETOH withdraw), Infection (often UTI, CAP), Retention of urine or feces, Reduced sensory input, Ictal or post ictal, Under-nutrition (B vitamin deficiencies, dehydration), Metabolic (DM, thyroid), Myocardium, Subdural hematoma
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Drug causes of delirium?
Anticholinergics, haldol, anti psychotics, opioid, Benzodiazepines, alcohol
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Memory loss in Depression vs. Dementia?
In Depression: Difficulty in concentrating, and is aware of memory problem Dementia: unaware of memory problems
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Major cause of dementia?
Alzheimers type is most common, next is vascular, then parkinsonism
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What is the Anticholinesterase medication role in AD care?
Donepezil (Aricept) does not reverse, but can help diminish progression of symptoms. But has limited duration of use before no longer has receptors to work on
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Early AD treatment?
Vitamin E high dose OR Selegiline (Eldepryl)
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Mild to moderate AD treatment?
Cholinesterase inhibitor (Aricept)
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Moderated to Severe AD treatment?
Can continue Aricept, add an NMDA Memantine (Nameda)
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Generalized anxiety disorder criteria?
Need 3 or more, excessive worry, irritability, sleep disturbance, restlessness, fatigue, muscle tension
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Drugs for treatment of mood disorder?
SSRIs, SNRIs, or Anxiolytics (Benzodiazepines - Buspar)
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SSRI best for elderly?
Something with a short half-life. Sertraline, Escitalopram, or Citalopram. Paxil not as good due to most anticholinergic SSRI.
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Reason Prozac isnt good for elderly?
Long half life, 7 to 15 days. And many drug-drug interacts.
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What is good about prescribing Buspirone (Buspar)?
Anxiolytic with a Low abuse potential.
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How long do symptoms have to be present before diagnosis of dysthymia is made?
TWO years
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What if patient does not meet minimum of 5 criteria for major depression disorder?
It is minor depressive disorder
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What is anhedonia?
Red flag for depression. Not enjoying things that you used to enjoy.
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Demographic risk factors for suicide?
Male, recently widowed, elderly, living alone
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Most common side effect of lithium?
Nephrogenic Diabetes Insipidus. Lithium accumulates in kidneys and causes release of ADH, hypercalcemia, and sodium abnormalities.
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What tests need to be performed for patient on Lithium that has increased urination?
BUN, Cr, and Urine specific gravity, as well as Lithium level
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What are typical symptoms of SSRI initiation?
Mild headache, nausea, insomnia, restlessness and agitation. All should resolve in two weeks
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When should Trazodone be taken?
It is a TCA. Should be taken at night, due to drowsiness effect
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What is suicide rate for bipolar patients?
Half of all patients will attempt suicide at least once.\
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Side effects of Valproate and who is it monitored?
Liver toxicity and failure, thrombocytopenia are noted. Side effects are nausea, vomiting, easy bruising, and tremor. Levels should be 50-125.
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What is the caution in Carbamazepine?
Many drug-drug reactions due to CYP 450 isoenzyme pathway
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How much lower than ideal body weight is it for anorexia nervosa?
15 percent
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