Georgette PMHNP.
When many answers are remarkably similar, they are usually _____________ correct answerswrong
Interprofessional collaboration is encouraged. correct answersCollaborate is usually right. Delegate is usually wrong.
ADPIER correct answersAssessment, diagnosis, Plan, intervention, evaluate, refer out last.
Lithium correct answersNormal 0.6-1.2
Lithium toxicity occurs at levels correct answers> 1.5
Signs of Lithium toxicity correct answerssevere nausea, diarrhea, vomiting, confusion, drowsiness, muscle weakness, heart palpitation, coarse hand tremors, unsteady gait
Lithium is gold standard for correct answersMANIA
Lithium has evidence shown to correct answersreduce suicidal ideation
What does lithium cause in neonate, especially 1st trimester correct answersEbstein anomaly (congenital heart defect)
dehydration and hyponatremia cause lithium levels to correct answersrise
Baseline labs before initiation of lithium correct answersTSH
creatinine (0.6-1.2)
BUN (10-20)
HCG (all psychotropics females 12-51)
EKG 50+
Urinalysis (check for proteins, 4+ may indicate kidney disease)
Side Effects of Lithium correct answershypothyroidism
coase hand tremors with toxicity
maculopapular rash
diarrhea, vomiting, cramps--signs of toxicity. Monitor closely. anorexia
t wave inversions
leukocytosis Pt education for lithimum correct answersstaying hydrated
avoiding NSAIDS
compliance
Depakote normal level correct answers50-125
Depakote toxicity level correct answersgreater than 150
Teratogenic effects of Depakote correct answersspina bifida
Adverse effects of depakote correct answersalopecia
hepatotoxicity (RUQ pain or brown/red urine--order LFTs) AST 5-40, ALT 5-35, yellowing of skin or eyes, fatigue
Signs of Depakote toxicity correct answersdisorientation, lethargy, respiratory depression, nausea/vomiting
Intervention for depakote toxicity correct answersDC med
check level
LFT
ammonia
MAOI + tyramine causes correct answershypertensive crisis
Symptoms of hypertensive crisis correct answerselevated BP
sudden explosive like headache
facial flushing
palpitations
pupillary dilation
diaphoresis
fever
Hypertensive crisis occurs with MAOI + correct answersMEPERIDINE
STIMULANTS
decongestants
TCAs
atypicals
St. John's wart
L-tryptophan
asthma meds
Treatment for hypertensive crisis correct answersDC offending agent
Administer PHENTOLAMINE
Teratogenic effects of benzos correct answersfloppy baby, cleft palate Teratogenic effects of tegratol correct answersneural tube defect
teratogenic effects of lithium correct answersebstein anomaly (heart defect) (avoid, especially 1st trimester)
teratogenic effects of depakote correct answersneural tube defects/spina bifida
Adverse reaction to Lamictal correct answersSteven Johnson's Syndrome
Signs of SJS correct answersFEVER --high yield
sore throat
facial swelling
tongue swelling
red rash
skin sloughing
body aches
prodromal headache
malaise
arthralgia
painful mucus membranes
Lamotrigine is least likely to cause correct answerssedation or weight gain
Carbamazepine (tegretol) black box warning correct answersagranulocytosis (decrease
WBCs)
aplastic anemia (pallor, fatigue, HA, fever, nosebleeds, bleeding gums, skin rash, SOA)
Carbamazepine and asians correct answersScreen for HLAB-1502 allele before initiating, due to high incidence of SJS if positive for allele.
Child-bearing aged women correct answerscheck for pregnancy before starting mood stabilizer
start on folic acid to support neural tube development during the first month that a woman is pregnant
Clozaril/clozapine can cause correct answersagranulocytosis and neutropenia
For monitoring neutropenia in Clozaril, monitor correct answersANC
DC clozarli if ANC correct answersless than 1000
DC clozaril if WBC correct answers2000-3000, risk of agranulocytosis
When on clozaril monitor for correct answerssigns and symptoms of infection: sudden fever, chills, sore throat, weakness Clozaril only known antipsychotic to correct answersdecrease risk of suicide in patients with schizophrenia.
Your patient with bipolar disorder is admitted to a medical hospital. The internist contacts your office and asks whether the lithium you prescribed him is effecting his ECG. How do you respond?
A. Lithium can prolong the QT interval
B. Lithium has no effect on his ECG
C. Lithium can invert the t waves
D. Lithium can shorten the PR interval correct answersAnswer: Lithium can invert the t waves.
Mary is a 45-year-old African American female who has been treated on Isocarboxazid (Marplan) for over 6 years. Mary is going in for a surgical procedure. Which medication is strictly contraindicated with Isocarboxazid?
A. Morphine
B. NSAIDS
C. Methylphenidate
D. Acetaminophen correct answersAnswer: Methylphenidate
You are treating a client with schizophrenia who takes clozapine. What lab values will indicate the client needs to discontinue treatment?
A. WBC less than 1800 and ANC less than 1200
B. ANC less than 1,000
C. WBC less than 5,000
D. ANC less than 2000 correct answersAnswer: ANC less than 1000
If given during pregnancy, socium valproate can cause which of the following medical problems in the baby?
A. SJS
B. Ebstein's anomaly
C. Spina bifida
D. Cleft palate correct answersA. Spina bifida
Which mood stabilizer is associated with potential life-threatening rash in the Asian population?
A. Carbamazepine (tegretol)
B. Depakote
C. Lithium
D. Lamictal correct answersA. Carbamazepine
Bulimia, weight is ___________ correct answerswithin the normal range.
Pharm treatment for bulimia correct answersFluoxetine
SSRIs and TCAs effective in reducing binging and purging
