Georgettes LMR study set
When questions ask for a priority action...think about... ans: ABC, airway breathing, circulation
Maslows hierarchy
If undecided on an answer due to high similarities, choose: ans: the umbrella answer
What is the most common side effect of olanzapine/zyprexa ans: ...
What birth defect can be caused by depakote? ans: Spina bifida
What organ does depakote cause toxicity? and what sx would you expect to see? labs to run? ans:
Hepatotoxicity: RUQ pain, reddish brown urine-
Do LFTs
kava kava is used to treat ans: anxiety and insomnia
Rash and fever associated with tegretol, suspect ans:
What allele is HLAB 1502 associated? ans: Asians. They CANNOT have tegretol. Test all asians for this
allele.
what rare and dangerous side effects are associated with tegretol ans: Aplastic anemia
Agranulocytosis-DC at ANC less than 1000
Sx's of agranulocytosis ans: unusual bleeding or bruising, mouth sores, infections, fever, sore throat,
fatigue
if starting a woman on lithium what test should be done? why? ans: HCG--risk of ebstein anomaly
,adverse s/e of lamictal/lamotrigine ans: SJS
labs to checke BEFORE starting on lithium ans: BUN
CRE
urine protein
What does protein in urine indicate ans: kidney impairment; 4+ protein in urine=you cannot start on
lithium
best choice med for decreasing si in bipolar disorder. ans: lithium
best choice med for si in schizophrenia ans: clozaril
best choice med for SI in borderline ans: lithium
What medications will INCREASE Li levels ans: NSAIDS
ACE's
Thiazides/HCTZ
Besides medications, what else can cause increased Li levels ans: dehydration
hyponatremia
lithium s/e inc N/V, which will effect electrolytes, and dehydration status
what type of tremors will you see with lithium toxicity? ans: course tremors
lithium can cause what other comorbidities? ans: hypothyroidism
maculopapular rash
leukocytosis
twave inversion
what is a defining characteristic of NMS vs SS ans: muscle rigidity
Sx's/labs associated with NMS ans: Inc CPK, WBC, LFT
Rhabdomyolosis
myoglobinuria
Can lead to mutism
myoglobinuria/rhabdo can cause cherry colored urine
Treatment for NMS and what each does ans: DC the offending agent
bromocriptin-D2 agonis
dantrolene: muscle relaxant
Make sure if ? is asking for agonist or relaxant
Sx of SS ans: HYPERREFLEXIA
myoclonic jerks
treatment for SS ans: ciproheptadine
, how to best PREVENT SS ans: follow proper transition protocols
SSRI to MAOI=14 days
Prozac to MAOI=5-6 weeks
Triptans can also cause SS due to serotonin increase with use
Why are SSRIs considered the safest for use in depression ans: safest for OD
depressed patient presents with fatigue and low energy, consider: ans: NDRI wellbutrin
sexual s/e with ssri? try... ans: wellbutrin due to lower risk of sexual s/e
What medication must be avoided if client has seizure history or eating disorder? why? ans: wellbutrin
due to decreasing the seizure threshold
if client has depression and neuropathic pain ans: SNRI or TCA for treatment of BOTH
What med class treats neuropathic pain well ans: alpha 2 delta ligands
Gabapentin
Lyrica
What medication class is good for depression with comorbid CA ans: SSRI
least chance of drug drug interactions
Celexa and lexapro are good choices
Black box warning on SSRI ans: inc SI in kids, esp
Required education for rx ssri ans: long time for effect
side effects esp n/v/d
NO ABRUPT stopping d/t Serotonin discontinuation syndrome
Sx's of serotonin discontinuation syndrome ans: fever, shivering, muscle aches and nausea diarrhea,
agitation, cog impairment... (think flu like sx's)
disequilibrium
What are some scenarios that place patients at risk of a hypertensive crisis? ans: MAOI and tyramine
MAOI and TCA
MAOI and Atypical AP
MAOI and decongestant
MAOI and stimulants
MAOI and asthma meds
Sx of Hypertensive crisis ans: HA
Diaphoresis
fever
facial flushing
pupillary dilation
palpitation
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