GEORGETTE REVIEW. QUESTIONS WITH ANSWERS
Native americans - answers- ethnic group w/ the highest rate of si in the us
If cultural question - answers- make an accommodation for them even if against policy
Respect also important
Contextualize their situation/clarify the meaning of their illness in their culture
If it's a cultural syndrome, it's not mental illness--provide supportive psychotherapy
Education w/ cultural consideration - answers- teach education based on cultural.
If multiple cultures present during education- provide multicultural ethonospecific
assessment parameters
Answering tips - answers- if part of quesiton wrong, whole question wrong.
If 3 of the same and one different usually answer is the one that's different
Answering tips - answers- priority is airway, breathing, circulation.
What do you do first?
Reduce calorie, exercise..if not
Then switch to lurasidone, abilify, or geodon
First psychotic episodes? - answers- atypicals...especially im injections because fastest
mode of action
Zyprexa, invega, abilify or geodon
Normal tsh - answers- 0.5 - 5.0
Hyperthyroid - answers- anxiety, irritable, heat intolerance, tachy, mood swings, wt loss,
increased appetite
Hypothyroid - answers- cold intolerance, lethargy, wt gain, decreased lbido
Steven johnson (lamictal, lamotrigine) - answers- fever
Rash
Burning eyes/mucosa
Ha
,Lamictal - answers- mood stabilizer that causes the least amount of wt gain
Carbamazepine (tegretol) - answers- also can cause sjs or rash
Especially in asians
Must screen for hlab-1502 allele first for all asains (if positive, means at increased risk
for sjs, don't give)
Which meds cause agranulocytosis - answers- tegretol and clozaril
Dc if anc <1000 whether or not signs of infection
Monitor for signs of infection which indicate granulocytosis- fever, sore throat, fatigue,
chills.
Valproic acid (depakote) - answers- can cause:
-spina bifida
-hepatotoxicity (ruq pain, reddish-brown urine- check lfts)
Signs of hepatotoxicity (depakote) level >150 - answers- confusion
Disorientation
Lethargy
Respiratory depression
Priority- d/c depakote
Get lfts, ammonia levels --high ammonia causes confusion
50-125, toxicity occurs if >150
Pregnancy test - answers- hcg human chorionic gonadotropin
Always check before placing on mood stabilizer for women childbearing age (12-51)
Kava kava - answers- herbal supplement
Taken for insomnia, anxiety
Most important is to check lfts
Also drug drug interaction w/ kava and benzos
Which meds can effect liver? - answers- bzn
Tca
Depakote
Lithium level - answers- 0.6-1.2
, If reaches 1.5- discontinue lithum...
If 1.3 or 1.4---monitor for toxicity, but once reaches 1.5- immediately d/c
Which drugs increase lithium levels - answers- they reduce renal clearance:
Nsaids
Hydrochlorothiazide
Ace inhibitors
Also- dehydration/hyponatremia can increase lithium. Make sure they stay hydrated.
Treatment of nms - answers- d/c med
Bromocriptine (parlodel)- d2 agonist
Or
Dantrolene- muscle relaxant (muscle rigidity)
Serotonin syndrome - answers- d/c med
Cyproheptadine
Then maslows heirchy-- safety, needs, culture
Then assessment before intervention if needed.
Don't choose to delegate, always chose to collaborate/do it yourself
3 antipscyhotics that are least likely to cause wt gain - answers- lurasidone, abilify, and
ziprasidone (geodon)
Abilify least sedating
Pt develops metabolic syndrome: - answers- elevated a1c, lipid, glucose, hip to waist
ratio, bmi
When switching antidepressenats - answers- wait 14 days when ssri -> maoi
Wait 5-6 wks from fluoxetine to maoi
Wait 2 wks if switching from maoi -> fluoxetine.
Due to fluoxetine (prozac) having longer halflife.
Native americans - answers- ethnic group w/ the highest rate of si in the us
If cultural question - answers- make an accommodation for them even if against policy
Respect also important
Contextualize their situation/clarify the meaning of their illness in their culture
If it's a cultural syndrome, it's not mental illness--provide supportive psychotherapy
Education w/ cultural consideration - answers- teach education based on cultural.
If multiple cultures present during education- provide multicultural ethonospecific
assessment parameters
Answering tips - answers- if part of quesiton wrong, whole question wrong.
If 3 of the same and one different usually answer is the one that's different
Answering tips - answers- priority is airway, breathing, circulation.
What do you do first?
Reduce calorie, exercise..if not
Then switch to lurasidone, abilify, or geodon
First psychotic episodes? - answers- atypicals...especially im injections because fastest
mode of action
Zyprexa, invega, abilify or geodon
Normal tsh - answers- 0.5 - 5.0
Hyperthyroid - answers- anxiety, irritable, heat intolerance, tachy, mood swings, wt loss,
increased appetite
Hypothyroid - answers- cold intolerance, lethargy, wt gain, decreased lbido
Steven johnson (lamictal, lamotrigine) - answers- fever
Rash
Burning eyes/mucosa
Ha
,Lamictal - answers- mood stabilizer that causes the least amount of wt gain
Carbamazepine (tegretol) - answers- also can cause sjs or rash
Especially in asians
Must screen for hlab-1502 allele first for all asains (if positive, means at increased risk
for sjs, don't give)
Which meds cause agranulocytosis - answers- tegretol and clozaril
Dc if anc <1000 whether or not signs of infection
Monitor for signs of infection which indicate granulocytosis- fever, sore throat, fatigue,
chills.
Valproic acid (depakote) - answers- can cause:
-spina bifida
-hepatotoxicity (ruq pain, reddish-brown urine- check lfts)
Signs of hepatotoxicity (depakote) level >150 - answers- confusion
Disorientation
Lethargy
Respiratory depression
Priority- d/c depakote
Get lfts, ammonia levels --high ammonia causes confusion
50-125, toxicity occurs if >150
Pregnancy test - answers- hcg human chorionic gonadotropin
Always check before placing on mood stabilizer for women childbearing age (12-51)
Kava kava - answers- herbal supplement
Taken for insomnia, anxiety
Most important is to check lfts
Also drug drug interaction w/ kava and benzos
Which meds can effect liver? - answers- bzn
Tca
Depakote
Lithium level - answers- 0.6-1.2
, If reaches 1.5- discontinue lithum...
If 1.3 or 1.4---monitor for toxicity, but once reaches 1.5- immediately d/c
Which drugs increase lithium levels - answers- they reduce renal clearance:
Nsaids
Hydrochlorothiazide
Ace inhibitors
Also- dehydration/hyponatremia can increase lithium. Make sure they stay hydrated.
Treatment of nms - answers- d/c med
Bromocriptine (parlodel)- d2 agonist
Or
Dantrolene- muscle relaxant (muscle rigidity)
Serotonin syndrome - answers- d/c med
Cyproheptadine
Then maslows heirchy-- safety, needs, culture
Then assessment before intervention if needed.
Don't choose to delegate, always chose to collaborate/do it yourself
3 antipscyhotics that are least likely to cause wt gain - answers- lurasidone, abilify, and
ziprasidone (geodon)
Abilify least sedating
Pt develops metabolic syndrome: - answers- elevated a1c, lipid, glucose, hip to waist
ratio, bmi
When switching antidepressenats - answers- wait 14 days when ssri -> maoi
Wait 5-6 wks from fluoxetine to maoi
Wait 2 wks if switching from maoi -> fluoxetine.
Due to fluoxetine (prozac) having longer halflife.
