Case Files 25-30 (C) Flashcards Preview

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Flashcards in Case Files 25-30 (C) Deck (55)
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1

Dysthymic Disorder

A chronic depression of mood which does not meet the criteria for major depression, in terms of either severity or duration of individual episodes, yet the patient still has loss of interest, lack of appetite or pleasure, and low energy

2

When a patient presents with multiple unrelated physical symptoms, what diagnosis needs to be considered?

Depression

3

How do antidepressant agents work?

  1. Enhance neurotransmitter release
  2. Reduce neurotransmitter breakdown
  3. Inhibit the reuptake of the neurotransmitter by the presynaptic neuron

4

Persons with depression have a greater chance of developing or dying from...

Cardiovascular disease (even after controlling traditional risk factors such as smoking, blood pressure, and lipid levels)

5

Women, especially those younger than age __, attempt suicide more frequently than men, but men are __ likely to complete suicide.

30

more

6

Why do all antidepressants carry an FDA "black box" warning?

Because they increase the risk of suicidal thoughts and behaviors especially in the first months of treatment (patients should be treated for at least 6-9 months during their first episode of major dpression)

7

Fluoxetine (Prozac)

Paroxetine (Paxil)

Sertraline (Zoloft)

Fluvoxamine (Luvox)

Citalopram (Celexa)

Escitalopram (Lexapro)

SSRIs (increase the amount of serotonin by blocking the presynaptic neuron's ability to reuptake serotonin)

 

Considered first-line agents for the treatment of depression because they have a low toxicity

 

Side effects: sexual dysfunction, weight gain, GI disturbance, fatigue, and agitation

8

Venlafaxine (Effexor)

Duloxetine (Cymbalta)

Mirtazapine (Remeron)

Desvenlafaxine (Pristiq)

SNRIs (affect both the serotonergic and noradrenergic systems)

 

Can be used as first-line treatment for depression and, because of their effects on two neurotransmitter systems, may be used as second-line agents in SSRI failure

 

 

9

Amitriptyline (Elavil)

Nortriptyline (Pamelor)

Desipramine (Norpramin)

Clomipramine (Anafranil)

Doxepin (Sinequan)

Imipramine (Tofranil)

TCAs (affect, to varying degrees, the reuptake of NE and serotonin)

 

They have numerous side effects and are highly toxic (potentially fatal) in overdose

10

Phenelzine (Nardil)

Tranylcypromine (Parnate)

Selegiline (Eldepryl)

MAOIs (caused increased amounts of serotonin and NE to be released during nerve stimulation)

 

Patients must be on a tyramine-restricted diet to reduce the risk of severe, and sometimes fatal, hypertensive crisis

11

Bupropion (Wellbutrin)

Amoxapine (Asendin)

Trazodone (Desyrel)

Atypical Agents (act similarly to SSRIs, TCAs, and MAOIs)

 

Their primary benefit is a lower incidence of sexual disturbance as a side effect

12

When is Bupropion contraindicated?

In patients with a history of seizure disorder

13

How is bipolar disorder medically managed?

Valproate, carbamazepine, or lithium

 

*A single episode of mania is sufficient for the diagnosis of bipolar disorder

*The use of antidepressant agents in bipolar disorder may precipitate acute manic behaviors

 

14

How is the postpartum period defined?

6-12 weeks after the delivery of the placenta

15

Postpartum fever is most often a sign of...

endometritis

 

*can also be caused by urinary tract or wound infections, thromboembolic disease, and mastitis

16

Lochia

Yellow-white discharge, consisting of blood cells, decidual cells, and fibrinous products, that occurs following delivery

17

In women who are not breast-feeding, menstruation usually restarts by...

the 3rd postpartum month

18

The most common causes of postpartum hemorrhage

"The Four Ts"

  1. Tone (uterine atony)
  2. Trauma (lacerations or uterine inversion)
  3. Tissue (retained placenta or membranes)
  4. Thrombin (coagulopathies)

19

Initial management of uterine atony includes:

IV administration of oxytocin

Initiation of bimanual uterine massage

 

Methylergonovine (Methergine) IM

Prostaglandin F (Hemabate) IM

Misoprostol (Cytotec) rectally or orally

20

When are Methergine and Hemabate contraindicated?

Methergine contraindicated in pts with HTN

 

Hemabate (prostaglandin F) contraindicated in pts with asthma

21

Benefits of breastfeeding

Maternal benefits: bonding, uterine involution, quicker return to prepregnant body weight, reduced risks of ovarian and breast cancer

 

Neonatal benefits: ideal nutrition, resistance to infection, reduced risk of GI difficulties

22

Which OCPs should be given to breast-feeding women and when?

The progestin-only pills (combination OCPs might reduce lactation) after 6 weeks postpartum

 

*Non-breast-feeding women should wait 3 weeks after delivery to start combined OCPs

*Lactation-induced amenorrhea provides a high level of natural contraception in the first 6 months postpartum

23

Most cases of CHF are caused by either ____ or ____

CAD or HTN

24

Two main categories of CHF

Systolic: dilated LV with impaired contractility

 

Diastolic: normal or intact LV that has an impaired ability to relax, fill, and eject blood

25

Fluid retention

Weight gain

Peripheral edema

JVD

Abdominojugular relux

Hepatic ascites

Splenomegaly

Common signs of R-sided heart failure

26

Dyspnea on exertion

Paroxysmal nocturnal dyspnea

Orthopnea

Wheezing

Tachypnea

Cough

Common signs of L-sided heart failure

27

In a dyspneic patient, a level of BNP less than ___ suggests that the symptoms are unlikely to be caused by CHF; a BNP level greater than ___ is consistent with the diagnosis of CHF

< 100 pg/mL

> 500 pg/mL

28

One of the earliest chest x-ray findings in CHF is...

cephalization of the pulmonary vasculature

29

What is considered the gold-standard diagnostic modality for CHF?

Echocardiography

 

The most useful diagnostic tool for evaluating patients with HF is 2-dimensional echocardiography with Doppler to assess LVEF, LF size, ventricular compliance, wall thickness, and valve function

30

What are the two most widely used classification systems for CHF?

New York Heart Association (NYHA): I-IV

 

American Heart Association (AHA): A-D