NR 547 Week 4 Midterm Study Guide; Medication Reviews & Mental Health Disorders

Clonazepam Benzodiazepine Anxiety, panic disorder Sedation, dependence Methylphenidat Stimulant ADHD Insomnia, decreased e appetite ✅ Example: A patient with depression and fatigue might benefit from bupropion over fluoxetine to avoid sedation. 3. Review of Enuresis (Bedwetting) ●Types: ○Primary enuresis – Never been dry for 6+ months. ○Secondary enuresis – Relapse after dryness. ● Causes: ○ Delayed bladder maturation ○ Low vasopressin levels (reduced night-time urine concentration) ○ Psychological stress ○ Genetics (family history is common) ● Treatment: ○ Behavioral – Limit fluids at night, bladder training. ○ Medications: ■ Desmopressin (DDAVP) – First-line for reducing urine output. ■ Imipramine (TCA) – Rarely used due to cardiac risks. ■ Oxybutynin – If bladder overactivity is suspected. ✅ Example: A 10-year-old with primary enuresis might respond to DDAVP after failed behavioral modifications. 4. Erectile Dysfunction (ED): Statistics, Causes, and Treatments ●Prevalence: ~30% in men aged 40–70. ●Causes: ○Vascular (hypertension, diabetes, atherosclerosis) ○Neurologic (MS, spinal cord injuries) ○Psychological (anxiety, depression) ○Medication-induced (SSRIs, beta-blockers) ○Hormonal (low testosterone) ■Flibanserin – HSDD treatment (pre-menopausal women). ■Bupropion – May help SSRI-induced dysfunction. ■Topical estrogen – Vaginal dryness. ✅ Example: A woman on sertraline with anorgasmia may benefit from a bupropion adjunct. 7. Sexual Dysfunction and Lack of Desire ●Medications that cause sexual dysfunction: ○SSRIs, antipsychotics, beta-blockers, opioids. ●Treatment strategies: ○Dose reduction or switching medications. ○Phosphodiesterase inhibitors (e.g., sildenafil) for men. ○Bupropion or buspirone for SSRI-induced dysfunction. ○Psychotherapy for performance anxiety. ✅ Example: A patient on fluoxetine with reduced libido may benefit from switching to bupropion. 8. Essential Features of Sexual Dysfunction ●Persistent symptoms for ≥6 months ●Causing significant distress ●Not explained by other medical or psychiatric conditions ●Not due to substance use ●DSM-5 Categories: ○Male hypoactive sexual desire disorder ○Erectile disorder ○Female orgasmic disorder ○Genito-pelvic pain disorder ✅ Example: A woman with lifelong anorgasmia without distress does not meet DSM-5 criteria for a disorder. 9. Circadian Rhythm Sleep-Wake Disorder Treatments ●Types: ○Delayed Sleep Phase Disorder (DSPD) – Difficulty falling asleep/waking late. ○Advanced Sleep Phase Disorder (ASPD) – Early sleep onset/wake time. ○No screens before sleep. ○Keep a consistent sleep schedule. ●Relaxation techniques: ○Progressive muscle relaxation. ○Meditation, mindfulness. ✅ Example: A patient who wakes up frequently worrying may benefit from cognitive therapy. 3. Stages of Sleep 1. NREM Stage 1 (Light Sleep) – Transition between wakefulness & sleep. 2. NREM Stage 2 – Theta waves, sleep spindles, and K-complexes. 3. NREM Stage 3 (Slow-Wave Sleep) – Delta waves, deep sleep, growth hormone release. 4. REM Sleep – Rapid eye movement, dreaming, muscle atonia, memory consolidation. ✅ Example: A patient with sleep apnea spends less time in slow-wave sleep. 4. Comorbidities of Sleep Disorders ●Insomnia – Depression, anxiety, PTSD. ●Obstructive Sleep Apnea (OSA) – Hypertension, cardiovascular disease, diabetes. ●Narcolepsy – Autoimmune disorders, cataplexy. ●Restless Legs Syndrome (RLS) – Iron deficiency, renal disease, Parkinson’s. ✅ Example: A patient with untreated OSA may have resistant hypertension. 5. Diagnostic Workup for Complex/Atypical Sleep Disorders ●Polysomnography (PSG) – Gold standard for OSA, REM behavior disorder. ● Multiple Sleep Latency Test (MSLT) – Diagnoses