1 / 4

Initiate therapy with SSRI - ! fluoxetine 20 mg (10 -80 mg) or citalopram 20 mg (10 -60 mg)

Adult (>18) Depression. A. MU FCM 8/17/07 Version 1. PHQ9 Assess (including suicide risk & bipolar MDQ ref), select and initiate therapy A. Mild / Moderate - Pharmacotherapy or psychotherapy (PHQ9 10-19) Major - Pharmacotherapy with psychotherapy (PHQ9 > 20). B.

vesta
Télécharger la présentation

Initiate therapy with SSRI - ! fluoxetine 20 mg (10 -80 mg) or citalopram 20 mg (10 -60 mg)

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Adult (>18) Depression A MU FCM 8/17/07 Version 1 • PHQ9 Assess (including suicide risk & bipolar MDQ ref), select and initiate therapy • A. Mild / Moderate - Pharmacotherapy or psychotherapy (PHQ9 10-19) • Major - Pharmacotherapy with psychotherapy (PHQ9 > 20) B Initiate therapy with SSRI - !fluoxetine 20 mg (10 -80 mg) or citalopram 20 mg (10 -60 mg) Exercise, Pt education: response expectations, followup ~ 1 week, at least 4 total contacts/12 weeks, referral options 4-6 weeks followup Clearly better: PHQ decrease > 5 or more Somewhat better: PHQ decrease 2-4 Not better: PHQ decrease < 1 Not Better Continue Therapy, reassess ~ 4-12 weeks Adjust therapy Increase dose and/or psychotherapy change Reassess 1-6 weeks Adjust therapy, assess adherence Maximize dose , consider psychotherapy change, reassess 1-6 weeks Not Better Better Full Symptom Remission? (PHQ < 10) Better Not Better Continue Treatment Total ~ 6-9 months Add medication bupropion 200-450 mg/day or change to venlafaxine 150-375 mg/day ?? Consider referral Full Symptom Remission? (PHQ < 10) Discontinue Treatment, Educate re: relapse, or maintenance if > 3 total depressive episodes ! Reassess suicide risk, Not for Bipolar patients, Consider lower dosages for elderly

  2. MU FCM 8/17/07 Version 1 A Osteoarthritis Non- Pharmacologic methods: Self management, Exercise or Physical therapy, Weight loss Pain & functional assessment each visit Acetaminophen up to 1 gm po QID ! Knee - Consider Orthotics (lateral wedge [podiatry], taping [PT]), consider trial of glucosamine 1500 mg/d Hands – splint for thumbs Consider topical Capsaicin – 0.025 % cream to skin TID/QID Knee - If knee joint effusion present, consider aspiration and intra-articular corticosteroids 40 mg Triamcinolone NSAID: Naproxen 250 - 500 mg po BID or Naproxen Sodium 220-550 mg po BID or Salsalate 1500 mg po BID If GI risk factors (Age > 65, Hx PUD/GI Bleed, Steroid, ASA, or warfarin use, smoker, EtOH use) may add omeprazole 20 mg po daily If renal ds, no response, or age > 65, consider Tramadol 50 mg daily to QID, or Opiates: Acetaminophen/codeine 30 mg QID or Acetaminophen/hydrocodone 5 mg 1-2 tabs QID If no response, consider change of NSAID (Diclofenac 50 mg BID) or EC Aspirin 650 mg TID or COX 2 inhibitor (Celecoxib 200 mg daily) Knee – consider intra-articular Synvisc 2 ml weekly X 3 weeks Specialist referral ! –Caution with long term use/liver ds

  3. Still in draft, obviously....

  4. COPD (FEV1/FVC < 70%)Smoking Cessation, Education (activities, MDI, SX, breathing), Immunizations Ref: ACP and Gold

More Related