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
When a patient presents with multiple unrelated physical symptoms, what diagnosis needs to be considered?
How do antidepressant agents work?
- Enhance neurotransmitter release
- Reduce neurotransmitter breakdown
- Inhibit the reuptake of the neurotransmitter by the presynaptic neuron
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)
Women, especially those younger than age __, attempt suicide more frequently than men, but men are __ likely to complete suicide.
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)
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
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
TCAs (affect, to varying degrees, the reuptake of NE and serotonin)
They have numerous side effects and are highly toxic (potentially fatal) in overdose
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
Atypical Agents (act similarly to SSRIs, TCAs, and MAOIs)
Their primary benefit is a lower incidence of sexual disturbance as a side effect
When is Bupropion contraindicated?
In patients with a history of seizure disorder
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
How is the postpartum period defined?
6-12 weeks after the delivery of the placenta
Postpartum fever is most often a sign of...
*can also be caused by urinary tract or wound infections, thromboembolic disease, and mastitis
Yellow-white discharge, consisting of blood cells, decidual cells, and fibrinous products, that occurs following delivery
In women who are not breast-feeding, menstruation usually restarts by...
the 3rd postpartum month
The most common causes of postpartum hemorrhage
"The Four Ts"
- Tone (uterine atony)
- Trauma (lacerations or uterine inversion)
- Tissue (retained placenta or membranes)
- Thrombin (coagulopathies)
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
When are Methergine and Hemabate contraindicated?
Methergine contraindicated in pts with HTN
Hemabate (prostaglandin F) contraindicated in pts with asthma
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
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
Most cases of CHF are caused by either ____ or ____
CAD or HTN
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
Common signs of R-sided heart failure
Dyspnea on exertion
Paroxysmal nocturnal dyspnea
Common signs of L-sided heart failure
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
One of the earliest chest x-ray findings in CHF is...
cephalization of the pulmonary vasculature
What is considered the gold-standard diagnostic modality for CHF?
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
What are the two most widely used classification systems for CHF?
New York Heart Association (NYHA): I-IV
American Heart Association (AHA): A-D