Diagnosis: MDD – Major Depressive Disorder/Unipolar DisorderAt least five symptoms every day for at least 2 weeks.Depressed mood = SIG E CAPS Sleep disturbances Interest in activities lost Guilt or worthlessness feelings Energy decreased Concentration decreased Appetite and weight changes Psychomotor retardation Suicidal ideation Rating Scales: HAM-D: Hamilton rating scale for depression – 18 moderate, 7 […]
Dementia
Cognitive Screening Mini – Mental Status Exam – MMSE Montreal Cognitive Assessment – MOCA St Louis University Mental Scale – SLUMS Mood screening: Geriatric Depression.ScaleIADL: Instrumental Activities Of Daily Living Diagnosing Dementia: Rule out delirium and drug-related causes. Other causes: vitamin B12 deficiency, hypothyroidism, depression, NPH, opioids, sedative-hypnotics, antidepressants, anticholinergics, antiparkinson’s drugs Treatment: Initiate a cholinesterase inhibitor in […]
Chemo Induced Nausea and Vomiting
Prophylactic therapy should be given prior to moderately to highly emetogenic agents or radiation They should be scheduled for after chemo to prevent delated N/V Lorazepam is useful for anticipatory nausea/vomiting, but can also just change routine Chemo agents with high emetic risks: Day 1 = 3 agents neurokinin-1 antagonist (fosaprepitant) serotonin 3 antagonist (ondansetron) […]
Bipolar Disorder
Manic Episode: 1 week of abnormal and persistently elevated mood. inflated self-esteem, irritability, decreased need for sleep, flights of ideas, poor attention span, high-risk behaviors. Bipolar 1: one or more manic or mixed episodes and major depressive episodes Bipolar 2: one or more major depressive episodes accompanied by at least one hypomanic episode Cyclothymic disorder: Periods […]
Best Tips and Random Info
Random things they ask: Names of tests for disease states (ie: Montreal Cognitive Assessment, for example) All names are generic Know drugs with REMS programs, NTIs and Black box warnings well.
Anxiety, OCD and PTSD
Generalized Anxiety Disorder (GAD): 6 months or more of excessive worry or anxiety. OCD – intrusive thoughts that can not be controlled PTSD: trauma related to avoidance of stimuli. Benzos are the first line therapy in anxiety. Can cause tolerance or dependence. Abrupt discontinuation can lead to withdrawal. Treat for 3-4 weeks until trial for […]
Respiratory Syncytial Virus
Treatment: Mostly supportive care Ribavirin – only in select patients (complicated congenital heart disease, chronic lung disease, bronchopulmonary dysplasia, immunocompromised patients) Beta-agonists or race epinephrine – not usually used Corticosteroids, hypertonic saline or antibiotics are also not usually used. Prophylaxis: Palivizumab: 15 mg/kg/dose; prophylaxis is not recommended if > 29 weeks gestation (risk factors not considered) Neonates […]
Meningitis
Signs and Symptoms: Tsai J, Nagel MA, Gilden D. Skin rash in meningitis and meningoencephalitis. Neurology. 2013 May 7;80(19):1808-11. doi: 10.1212/WNL.0b013e3182918cda. PMID: 23650233; PMCID: PMC3719428. Treatment: Age Antimicrobial Therapy < 1 month Ampicillin plus cefotaxime; OR ampicillin plus an aminoglycosideStreptococcus agalactiae, Escherichia coli, Listeria monocytogenes 1-23 months Vancomycin + Ceftriaxone 100 mg/kg/day IV divided every 12 to […]
ADHD
Stimulants: Try amphetamine or methylphenidate before giving up on stimulants Norepinephrine reuptake inhibitors or antidepressants if stimulants don’t work Atomoxetine, clonidine and guanfacine are also choices.***this one needs some flushing out***
Seizures: Epilepsy
*See the seizure medication table for quick reference.*Seizure Emergencies Epilepsy Treatment Options: Know doses for narrow therapeutic index drugs like phenytoin, but mostly need to know what kind of seizure and major side effects that would cause you to choose a different therapy. Also know REMS programs. Benzos can be used as adjunctive, short-term therapy (clorazepate, clonazepam, diazepam […]