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PMHNP Diagnosis and Treatment III graded A+
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What is phentolamine used for? Hypertensive crisis associated with MAOI administration - it blocks norepinephrine receptor sites What is the therapeutic range of Lithium? 0.6 to 1.2 mEq/L What labs should be checked before initiation of lithium? Thyroid panel Serum Creatinine Blood Urea Nitr...

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  • February 1, 2024
  • 9
  • 2023/2024
  • Exam (elaborations)
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  • pmhnp diagnosis and treatment iii graded a

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PMHNP Diagnosis and Treatment III
graded A+
What is phentolamine used for?

Hypertensive crisis associated with MAOI administration - it blocks norepinephrine receptor sites

What is the therapeutic range of Lithium?

0.6 to 1.2 mEq/L

What labs should be checked before initiation of lithium?

Thyroid panel
Serum Creatinine
Blood Urea Nitrogen
Pregnancy Test
ECG for clients older than age 50

Adverse effects associated with Lithium

- Endocrine: hypothyroidism, weight gain

- CNS: fine hand tremors, fatigue, brain fog, headaches, coarse hand tremors w/toxicity, nystagmus

- Derm: maculopapular rash, pruritus, acne

- GI: severe GI upset w/toxicity, diarrhea, vomiting, cramps, anorexia

- Renal: diabetes insipidus: polyuria, polydipsia; edema, microscopic tubular changes

- Cardiac: T-wave inversions, dysrhythmia

- Hematologic: Leukocytosis (increased WBCs)

Signs of Lithium Toxicity

- Severe nausea, vomiting, diarrhea, confusion, convulsions, drowsiness, blurred vision, slurred speech,
muscle weakness, heart palpitations, coarse hand tremors, and unsteadiness while standing or walking
(ataxia)

--> DC lithium and check serum drug level

Teratogenic Risk of Lithium

Epstein Anomaly (congenital heart defect)

Teratogenic Risk of Depakote

, Neural tube defects, particularly spina bifida, atrial septal defect, cleft palate, and long-term
developmental deficits

Teratogenic Risk of Benzodiazepines

floppy baby syndrome, cleft palate

Teratogenic Risks of Carbamazepine (Tegretol)

Neural tube defects

FDA Pregnancy Categories for Medications

A: controlled studies show no risk
B: no evidence of risk in humans
C: Risk cannot be ruled out
D: Positive evidence of risk
X: Absolutely contraindicated in pregnancy

Black Box Warning for Lamictal

Stevens Johnson Syndrome (severe rash)

Signs and Symptoms of Stevens Johnson Syndrome

Fever

Sore Throat

Facial Swelling

Tongue Swelling

Rash

Skin Sloughing

Prodromal: headache, malaise, arthralgia (joint stiffness) and painful mucous membranes

Black Box Warning for Depakote

hepatotoxicity and pancreatitis
(may also cause SJS)

Black Box Warning for Carbamazepine (Tegretol)

Agranulocytosis (decreased white blood cells) and aplastic anemia (pallor fatigue, headache, fever,
nosebleeds, bleeding gums, skin rash, shortness of breath.)
(may also cause SJS)

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