Nurs 663- Exam 1 QUESTION AND CORRECT ANSWER

Nurs 663- Exam 1 QUESTION AND CORRECT ANSWER Patient comes in with symptoms of mania followed by periods of depression; what is it? - CORRECT ANSWER-bipolar 1 patient comes in with hypomania/regular mood (euthymic) followed by periods of depression, what is it? - CORRECT ANSWER-bipolar 2 how many symptoms of mania must you have to have "full" mania? - CORRECT ANSWER-seven of thirteen what is the difference between mania and hypomania? - CORRECT ANSWERhypomania has less severe symptoms; 3 symptoms over shorter period of time (hypomania) Cyclothymia - CORRECT ANSWER-a disorder that consists of mood swings from moderate depression to hypomania and lasts two years or more moods are always irregular- not ever to a full extreme Dysthymia - CORRECT ANSWER-a form of depression that is not severe enough to be diagnosed as major depression "eeyore" always kind of down and depressed SIADH - CORRECT ANSWER-syndrome of inappropriate antidiuretic hormone will retain water hyponatremia will be observed what is something you should watch out for if a patient is on multiple antidepressants? - CORRECT ANSWER-SIADH what medical problems mimic mood disorders? - CORRECT ANSWER-hypothyroiddepression hyperthyroid- mania involuntary admission - CORRECT ANSWER-hurt yourself hurt someone else inability to care for self Carbamazepine (Tegretol) - CORRECT ANSWER-mood stabilizer indication: bipolar disorder major side effects: CYP 450: (inducer- speeds up metabolism of other drugs) patient education: what 3 medications must have blood draws associated with them? - CORRECT ANSWER-carbamazepine, lithium, valproic acid Mood Disorder Questionnaire - CORRECT ANSWER-Screens for Bipolar Disorder 7+ is a positive screening 4-5 might be hypomania how is the PHQ-9 scored - CORRECT ANSWER-1-4 minimal depression 5-9 mild depression 10-14 moderate depression 15-19 moderately severe 20 + severe PHQ-9 - CORRECT ANSWER-assessment that evaluates the degree of depression What is the DSM criteria for Major Depressive Disorder? - CORRECT ANSWER-**no history of mania, hypo, or mixed symptoms symptoms 2 weeks must have: sadness, anhedonia (loss pleasure/interest) 4 of following: - appetite/sleep changes, psychomotor retardation, lack of energy, guilt/worthlessness, issues w/ concentration, thoughts suicide/death What are the "frequency" modifiers for MDD? - CORRECT ANSWER-episodic: symptoms dissipate over time recurrent: likely to reappear in future subclinical: sadness + 3 symptoms 10 days (full criteria not met) how is the severity of depression rated? - CORRECT ANSWER-- Mild: no suicidal thoughts/death wishes - Moderate: some thoughts of death/self-harm - Severe: plan/attempted what other modifiers might be present with diagnosis of MDD? - CORRECT ANSWER-- With psychotic features: hallucinations, paranoia - In partial remission: some symptoms still present, but full criteria not met; period without any significant symptoms lasting less than 2 months - In full remission: no signs/symptoms 2 months - Unspecified: symptoms vague, hard to tell DSM 5 for bipolar I disorder - CORRECT ANSWER-depression + mania DSM 5 for bipolar 2 disorder - CORRECT ANSWER-depression + hypomania what is the #1 predictor of suicide? - CORRECT ANSWER-Hopelessness and loneliness what are risk factors for suicide? - CORRECT ANSWER-- Gender: men are more likely to complete suicide - Age: men 45 years +; women 55 years + o Suicide is the 3rd leading cause of death in 15-24-year-olds - Race: Caucasian, Native American, Alaskan native, and immigrants - Divorce - Widows - High-ranking jobs and unemployment - Physicians - MDD most common mental illness associated, schizophrenia, and alcohol use disorder - Past suicide attempt (might be the best indicator) what is the criteria for involuntary commitment? - CORRECT ANSWER-Danger to self (suicide) Danger to others (homicide) Gravely disabled d/t mental illness (unable to provide food, clothing, shelter) - Courts must have probable case hearing within 96 hours of admission What is vagus nerve stimulation? - CORRECT ANSWER---For Tx of treatment-resistant MDD implantation of a device that causes intermittent electrical stimulation of vagus nerve What is TMS (transcranial magnetic stimulation)? - CORRECT ANSWER-noninvasive procedure for treatment resistant depression, uses magnetic pulses what is ECT used for? - CORRECT ANSWER-severe depression mania catatonia severe agitation in dementia How is ECT performed? - CORRECT ANSWER-premedication with atropine, followed by general anesthesia and administration of a muscle relaxant. a generalized seizure is then induced by passing a current of electricity across the brain. seizure lasts 1min - 8 treatments over 2-3 weeks Side effects of ECT - CORRECT ANSWER-temporary memory loss and confusion, headache can increase HR and BP what are distinguishing characteristics of serotonin syndrome? - CORRECT ANSWERHyperreflexia Clonus Dilated pupils (mydriasis) MAOIs - CORRECT ANSWER-Block enzyme monoamine oxidase MAO break down monoamines into inactive metabolites ** directly increase the neurotransmission of all 3 NT (DA, 5ht, NE) A lot of dietary restrictions (tyramine) A lot of drug- drug interactions "Not Popular Meds" Phenelzine (nardil) Tranylcypromine (parnate) Isocarboxazide (marplan) TCAs - CORRECT ANSWER-- "dirty" because affect many receptor sites - H1: sedation/weight gain - M1: anticholinergic - A1: orthostatic hypotension - TCA overdose: WIDE QRS, respiratory depression, hypotension ***** no anecdote; treat with supportive care Imipramine Nortriptyline Amitriptyline Lithium - CORRECT ANSWER-Therapeutic window: 0.6 - 1.2 Steady state generally achieved in 5 days Check lithium dosing 8-12 hours after previous dose Signs of toxicity: T wave flattening, renal toxicity, hyperreflexia, coarse tremor, nystagmus, delirium Treat toxicity: HEMODIALYSIS Valproic Acid (Depakote) - CORRECT ANSWER-Antiseizure med. Precautions/interactions: contraindicated in liver disease, pregnancy. Side effects: hepatotoxicity, teratogenic effects, pancreatitis. Therapeutic window: 50-100 Peak plasma concentration: 1-4hours Collect trough level just before the next dose (24 hours) Collecting at the 12-hour mark can lead to false high trough level Signs of Depakote toxicity: Cerebral edema, hyperammonemia, hepatotoxicity, electrolyte abnormalities · Supportive therapy for toxicity What is rapid cycling bipolar disorder? - CORRECT ANSWER--four or more distinct mood episodes within a 12 month period -can occur in any order -up to 20% of all bipolar pts -risk factors: longer length of illness, female, ANTIDEPRESSANT USE, thyroid disease, older age what birth defects might be seen with valproic acid? - CORRECT ANSWER-cleft palate what medications are safe in postpartum depression? - CORRECT ANSWERwhy is lithium XR a good option for some patients? - CORRECT ANSWER-it might help decrease stomach upset Paroxetine (Paxil) - CORRECT ANSWER-SSRI antidepressant -short half life (good in case mania pops up) - can be sedating, so consider dosing at night to help sleep SE: most anticholinergic SSRI, ↑↑sexual dysfunction Inhibits antipsychotics ***SIGNIFICANT 2D6 inhibition can cause discontinuation syndrome (nausea, vertigo) Sertraline (Zoloft) - CORRECT ANSWER-SSRI antidepressant treats major depressive disorder, panic disorder, OCD, PTSD, social phobia, PMDD contraindicated with MAOI Adverse reactions: neuroleptic malignant syndrome, suicidal thoughts, seratonin syndrome common side effects: dizziness, drowsiness, fatigue, headache, insomnia diarrhea, dry mouth, nausea, sexual dysfunction,sweating, tremors Pros: ** short half-life ** less sedating than paroxetine ** very weak CYP 450 interactions (very slight 2d6) Cons: ** requires full stomach for max absorption ** lots of GI affects Fluoxetine (Prozac) - CORRECT ANSWER-Antidepressant, SSRI's - long half life (must have 5 weeks between this and MAOI) can be activating, which can help with energy can use when tapering off other SSRI to help minimize discontinuation syndrome not a good option for hepatic patients (d/t long half life) *** a lot of cyp 450 interactions, so not a good option with other meds watch for mania since activating Escitalopram (Lexapro) - CORRECT ANSWER-Antidepressant, SSRI: 10-20 mg qd can cause QT prolongation (especially in doses 20mg) minimal drug-drug interactions what medications can cause SIADH? - CORRECT ANSWER-carbamazepine SSRIs amitriptyline morphine how is SIADH reflected in lab values? - CORRECT ANSWER-decreased serum osmolality (increased serum volume) increased urine osmolality (decreased urine volume) what two medications are most likely to cause discontinuation syndrome? - CORRECT ANSWER-paroxetine (paxil) and venlafaxine (effexor) -- short half lives which SSRIs have no sexual side effects - CORRECT ANSWER-mirtazapine, nefazadone, buproprion which antidepressants are more activating? - CORRECT ANSWER-bupropion, venlafaxine, fluoxetine which antidepressants are more sedating? - CORRECT ANSWER-trazodone, TCAs, paroxetine, mirtazapine which antidepressants are more associated with weight gain? - CORRECT ANSWERMirtazapine Paroxetine TCA's