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 […]
Guideline Materials and Tips
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: Emergent and Codes
*See the seizure medication table for quick reference. Seizure overview. Head trauma: Early seizure – within first 7 days, prevent with 5/mg/kg day phenytoin (valproate has higher mortality) No prophylaxis for late seizures. Emergent: For emergent seizures, benzos are the drug of choice to stop seizing. Lorazepam – onset 2-3 minutes, 0.1 mg/kg up to 4 […]
Seizure Medication Table
Table: 1 – first line drug, 2 – second line drug, 3 – some effect, 4 – adjunctive therapy, 5 – used only when benefits outweigh risks Drug Focal Tonic-Clonic Absence Atypical Absence Atonic Myoclonic Infantile Spasms Status Epilepticus Lennox Gastaut Acetazolamide 4 4 3 3 Brivaracetam 3 […]
Ischemic Stroke
Risk factors: Age: risks double every decade over 55 Race: more risk in native Americans, second highest risk in African Americans then whites. Sex: risk higher in men Low birth weight Family History Diabetes Hypertension Oral contraceptive use Post-menopausal hormone use Atrial fibrillation Coronary artery disease Asymptomatic carotid stenosis Dyslipidemia Obesity Physical inactivity Sickle Cell Disease […]
Parkinson’s Disease
In patients who need to be initiation on dopaminergic agents, either levodopa or dopamine agonists can be used. Levodopa is better at improving motor functions, dopamine agonists are better at lessening motor complications. May also use a MAOI (rasagiline or selegiline only, they increase extracellular dopamine). Carbidopa/Levodopa is the mainstay of therapy, but often clinicians will use […]