Carbamazepine and asians - ANSWER-Screen for HLAB-1502 allele before
initiating, due to high incidence of SJS if positive for allele.
Child-bearing aged women - ANSWER-check for pregnancy before starting
mood stabilizer
start on folic acid to support neural tube development during the first month
that a woman is pregnant
Baseline labs before initiation of lithium - ANSWER-TSH
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 - ANSWER-hypothyroidism
coase hand tremors with toxicity
maculopapular rash
diarrhea, vomiting, cramps--signs of toxicity. Monitor closely.
anorexia
t wave inversions
leukocytosis
Pt education for lithimum - ANSWER-staying hydrated
avoiding NSAIDS
compliance
Depakote normal level - ANSWER-50-125
Depakote toxicity level - ANSWER-greater than 150
Teratogenic effects of Depakote - ANSWER-spina bifida
Adverse effects of depakote - ANSWER-alopecia
hepatotoxicity (RUQ pain or brown/red urine--order LFTs) AST 5-40, ALT 5-35,
yellowing of skin or eyes, fatigue
Symptoms of hypertensive crisis - ANSWER-elevated BP
sudden explosive like headache
facial flushing
palpitations
pupillary dilation
diaphoresis
fever
Hypertensive crisis occurs with MAOI + - ANSWER-MEPERIDINE
STIMULANTS
decongestants
TCAs
atypicals
St. John's wart
L-tryptophan
asthma meds
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