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Georgette Review PMHNP.
When many answers are remarkably similar, they are usually _____________ *** wrong Interprofessional collaboration is encouraged. *** Collaborate is usually right. Delegate is usually wrong. ADPIER *** Assessment, diagnosis, Plan, intervention, evaluate, refer out last. Lithium *** Normal 0.6-1. Lithium toxicity occurs at levels *** > 1. Signs of Lithium toxicity *** severe nausea, diarrhea, vomiting, confusion, drowsiness, muscle weakness, heart palpitation, coarse hand tremors, unsteady gait Lithium is gold standard for *** MANIA Lithium has evidence shown to *** reduce suicidal ideation What does lithium cause in neonate, especially 1st trimester *** Ebstein anomaly (congenital heart defect) dehydration and hyponatremia cause lithium levels to *** rise Baseline labs before initiation of lithium *** 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 *** 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 *** staying hydrated avoiding NSAIDS compliance Depakote normal level *** 50- Depakote toxicity level *** greater than 150 Teratogenic effects of Depakote *** spina bifida Adverse effects of depakote *** alopecia
L-tryptophan asthma meds Treatment for hypertensive crisis *** DC offending agent Administer PHENTOLAMINE Teratogenic effects of benzos *** floppy baby, cleft palate Teratogenic effects of tegratol *** neural tube defect teratogenic effects of lithium *** ebstein anomaly (heart defect) (avoid, especially 1st trimester) teratogenic effects of depakote *** neural tube defects/spina bifida Adverse reaction to Lamictal *** Steven Johnson's Syndrome Signs of SJS *** FEVER --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 *** sedation or weight gain Carbamazepine (tegretol) black box warning *** agranulocytosis (decrease WBCs) aplastic anemia (pallor, fatigue, HA, fever, nosebleeds, bleeding gums, skin rash, SOA) Carbamazepine and asians *** Screen for HLAB-1502 allele before initiating, due to high incidence of SJS if positive for allele. Child-bearing aged women *** 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 Clozaril/clozapine can cause *** agranulocytosis and neutropenia For monitoring neutropenia in Clozaril, monitor *** ANC DC clozarli if ANC *** less than 1000 DC clozaril if WBC *** 2000-3000, risk of agranulocytosis When on clozaril monitor for *** signs and symptoms of infection: sudden fever, chills, sore throat, weakness Clozaril only known antipsychotic to *** decrease risk of suicide in patients with schizophrenia.
C. Spina bifida D. Cleft palate *** A. 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 *** A. Carbamazepine Bulimia, weight is ___________ *** within the normal range. Pharm treatment for bulimia *** Fluoxetine SSRIs and TCAs effective in reducing binging and purging Signs of anorexia nervosa *** low BMI Amennorrhea Emaciation Bradycardua Hypotension Pharm treatment for anorexia *** there is none therapy Which of the following physical exam findings would help the PMHNP differentiate anorexia nervosa from bulimia nervosa? A. Russell sign
B. Low BMI C. Erosion of dental enamel D. Hypertrophy of salivary glands *** Low BMI If a patient is depression, low energy, fatigued, you would prescribe *** Wellbutrin Wellbutrin is contraindicated in patients with *** seizure disorder or conditions that increase risk of seizures such as eating disorder. Which of the following medications has a unique mechanism that is both a norepinephrine and dopamine reuptake inhibitor? A. Bupropion (Wellbutrin) B. Sertraline (Zoloft) C. Clomipramine (Anafranil) D. Duloxetine (Cymbalta) *** bupropion CLozaril is metabolized by *** cytochrome P450 enzyme CYP1A INducers *** induce metabolism and therefore decrease serum levels of other drugs that are substrates Smoking will do what to drug levels *** decrease therapeutic levels of the drug Bull Shit CRAP GPS Induces my rage *** Barbituates St. Johns Wart Carbamazepine Rifampicin
c. 2C d. 2C9 *** 1A (want A 2 cigarette break) When treating older adults, you should keep in mind that they are more sensitive to issues of drug toxicity because of which of the following reasons? A. Decreased body fat B. Increased liver capacity C. Decreased protein binding D. Increased muscle concentration *** Decreased protein binding For 12 years, a 65 year old patient with bipolar affective disorder has been treated with lithium 900 mg daily. When oral HCTC 12.5 daily is added for hypertension, the patient develops nausea, vomiting, ataxia, and muscle weakness and the patient's serum lithium level is 2.0. The interaction of the lithium and the thiazide diuretic has induced: A. hypokalemia B. hyponatremia C. Increased renal clearance of lithium D. Decreased renal clearance of lithium *** A. decreased renal clearance of lithium Where is norepinephrine produced *** locus coeruleus and medullary reticular formation Norepinephrine is associated with *** mood disorders Serotonin is made where in the brain *** raphe nuclei of the brainsteam Serotonin is associated with *** sleep and mood disorder
Dopamine is made in *** substantia nigra, central tegmental area, ventral tegmental area, Dopamine is associated with *** addiction and psychosis Acetylcholine is made *** basal nucleus of Meynert Most abundant inhibitory neurotransmitter in the brain *** GABA I don't have enough GABA, my anxiety is high Med used to increase GABA *** benzos Fred flinstone needs a Zanny, Gabba dabba do. Most excitatory neutransmitter *** glutamate Increased level of corticotropin releasing hormone in the amygdala, hippocampus and locus coeruleus *** increases symptoms of anxiety. Autism *** deficits in social communication and social interaction across multiple settings Parents of kids with autism may report *** No response when called by name Little or no eye contact Children with autism often like to line up, stack, or organize objects and toys. Screenings for autism *** ADOS M-CHAT
Problems in the frontal lobe can lead to *** personality changes, emotional changes, and intellectual changes, social skills problems, and behavior changes Area for receptive speech and language comprehension *** Temporal lobe Wernicke's area Problems in the temporal lobe can lead to *** auditory hallucinations, aphasia, and amnesia Occipital lobe *** primary visual area problems in the occipital lobe can lead to *** Visual field deficits, blindness and visual hallucinations. primary sensory area of the brain *** parietal lobe problems in the parietal lobe can lead to *** Sensory-perceptual disturbances and agnosia(inability to perceive objects) R-L confusion Difficulty writing (agraphia) Aphasia(difficulty of language) Cerebellum is responsible for *** gross motor skills fine motor skills balance A client experiencing difficulties with working memory, planning, and prioritizing, insight into his problems, and impulse control presents for assessment. In planning his care, the PMHNP should apply his knowledge that these symptoms represent problems with the
A. frontal lobe B. Temporal lobe C. Parietal lobe D. Occipital lobe *** frontal lobe Impairments in the clock drawing test can be associated with *** damage to the right parietal lobe What part of the brain is responsible for regulating emotions? A. Wernicke's area B. Occipital lobe C. Hippocampus D. Parietal lobe *** Hippocampus Limbic system responsible for *** emotions and memory Hypothalamus *** appetite, hunger, water balance, circadian rhythms, libido, hormonal regulation thalamus *** sensory relay for smell emotions, memory, and regulated affective behaviors amygdala *** regulated emotion mediates mood emotional memories/meanings, fear, anxiety, stress emotion, aggression substantia nigra *** motor movements
Restlessness, inability to sit still. Pacing. Mistaken for anxiety. *** Akathisia Commonly used rating scale for akathisia is *** Barnes Akathisia rating scale and extrapyramidal symptom rating scale. Treatment for akathisis 1st line 2nd line 3rd line *** 1st: beta blocker 2nd: Cogentin 3rd: bnzodiazepine Absence of movement or difficulty initiating movement *** akinesia Treatment: cogentin Presence of symptoms of Parkinson's produced by D2 blockade in the nigrostriatal pathway *** Pseudo- Parkinsonism Signs of Parkinsons *** muscle rigidity shuffling gait mask like facial expression pill rolling tremors cogwheel rigidity
Treatment for pseudo parkinsonism *** cogentin Involuntary abnormal muscle movement of the mouth tongue face and jaw that may progress to limbs. Can take 1-2 years to occur. *** Tardive dyskinesia Signs of tar dive dyskinesia *** lip smacking protrusion of the tongue chewing motion facial dyskinesia involuntary movement. Treatment for TD *** Stop offending antipsychotic, reduce the dose, or switch to clozapine. COGENTIN WORSENS IT Ingrezza or Austedo approved Non-psych med that can cause TD *** Reglan A patient has been treated for the past several years with fluphenazine (Prolixin). You tonic that he is drooling and has a slight pill rolling movement of the fingers. These are EPS symptoms known as A. pseudo parkinsonism b. anticholinergic effects C. Tardive dyskinesia D. Acute dystonia *** A. Pseudoparkinsonism
The study of what the drug does to the body. *** Pharmacodynamics When studying pharmacodynamics involving receptor, you know that an agonist produces the following effect? A. Does not fully activate the receptor B. Blocks the agonist from opening the channel C. Causes the opposite effect D. Activates a biological response and opens the ion channel. *** Activates a biological response and opens the channel. Medications that can cause mania (very high yield) *** Steroids Antabuse Isoniazid Antidepressants in persons with bipolar Flonase Medications causing depression *** steroids beta blockers interferon accutate some retroviral drugs antineoplastic drugs benzos progesterone
Fragile X syndrome *** all their facial structures are larger. Severe adverse effect caused by antipsychotics *** neuroleptic malignant syndrome Extreme muscle regidity Mutism elevated CPK Myoglobinura (cherry colored urine) Elevated WBCs Elevated LFts *** signs of NMS Treatment for NMS *** DC Offending agent Bromcriptine (parlodel) Dantrolene (muscle relaxant Serious effect of SSRIs *** serotonin syndrome hyperreflexia, myoclonic jerks, sweating *** serotonin syndromeq Treatment for serotonin syndrome *** DC offending agent Cyprophentadine Drugs/classes that can cause serotonin syndrome *** SSRI/TCA/MAOI/SNRI When switching to an SSRI to MAOI, *** wait 14 days
