GEORGETTE UPDATED EXAM SCRIPT QUESTIONS AND
ANSWERS GRADED A+
✔✔Signs of hepatotoxicity (depakote) level >150 - ✔✔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 - ✔✔HCG human chorionic gonadotropin
always check before placing on mood stabilizer for women childbearing age (12-51)
✔✔Kava kava - ✔✔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? - ✔✔BZN
TCA
Depakote
✔✔Lithium level - ✔✔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 - ✔✔they reduce renal clearance:
NSAIDs
hydrochlorothiazide
ACE inhibitors
Also- dehydration/hyponatremia can increase lithium. Make sure they stay hydrated.
✔✔Treatment of NMS - ✔✔D/C med
bromocriptine (parlodel)- D2 agonist
,or
dantrolene- muscle relaxant (muscle rigidity)
✔✔Serotonin syndrome - ✔✔D/C med
cyproheptadine
✔✔When switching antidepressenats - ✔✔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.
✔✔Triptans
Sumatriptan (Imitrex) - ✔✔don't give w/ antidepressants- increased risk of serotonin
syndrome
✔✔If cancer and depressed - ✔✔citalopram/escitalopram
least drug drug interactions
✔✔NDRI - ✔✔NE and DA reuptake inhibitor
Wellbutrin
best for those that don't want sexual s/e
depressed, low energy, fatigue- wellbutrin best
contraindicated in hx of seizures or eating disorders (because electrolyte levels being
off can cause seizures)
✔✔Chronic Pain and antidepressants - ✔✔SNRI
Duloxetine (cymbalta)
✔✔Fluoxetine (prozac) - ✔✔can cause insomnia
take in morning, not evening.
many SSRIs can cause insomnia- take in morning, worst insomnia is w/ prozac
, ✔✔schizophrenia - ✔✔onset 18-25 M
25-35 F
highest of all mental illnesses to cause thoughts of self harm (SI)
✔✔Which disorder causes the highest amount of homicidal ideation (HI) - ✔✔antisocial
personality highest
✔✔Brain PET scan of schizophrenia - ✔✔everything decreased in size except ventricles
(ventricles are holes anyway, obviously they are bigger)
✔✔Don't given stimulants to: - ✔✔schizophrenics- would exacerbate dopamine levels.
potentiates DA release
✔✔What causes aggression/impulsivity/abstract thinking issues in schizophrenia? -
✔✔abnormal prefrontal cortex, amygdala, basal ganglia, hippocampus and limbic
regions of brain
✔✔What type of exercise is best for schizophrenia? - ✔✔aerobic- improves cognition,
quality of life and long term health.
ACT team- case management in the home
✔✔High risk of relapse on oral haldol - ✔✔switch to deconate
deconate should be 20x the daily oral dose.
If elderly or stable on lower dose- it's only 10-15x oral dose.
If conversion is >100, give balance in 3-7 days.
✔✔MMSE - ✔✔also known as Folstein scale includes:
Concentration (serial 7's, or months backwards)
orientation (year, date, state)
registration/ability to learn new material (3 objects, then ask to repeat (recall/memory)
who is presedent/governor (fund of knowledge)
✔✔clock drawing test - ✔✔assesses for neurological problems..dementia or AD
ANSWERS GRADED A+
✔✔Signs of hepatotoxicity (depakote) level >150 - ✔✔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 - ✔✔HCG human chorionic gonadotropin
always check before placing on mood stabilizer for women childbearing age (12-51)
✔✔Kava kava - ✔✔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? - ✔✔BZN
TCA
Depakote
✔✔Lithium level - ✔✔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 - ✔✔they reduce renal clearance:
NSAIDs
hydrochlorothiazide
ACE inhibitors
Also- dehydration/hyponatremia can increase lithium. Make sure they stay hydrated.
✔✔Treatment of NMS - ✔✔D/C med
bromocriptine (parlodel)- D2 agonist
,or
dantrolene- muscle relaxant (muscle rigidity)
✔✔Serotonin syndrome - ✔✔D/C med
cyproheptadine
✔✔When switching antidepressenats - ✔✔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.
✔✔Triptans
Sumatriptan (Imitrex) - ✔✔don't give w/ antidepressants- increased risk of serotonin
syndrome
✔✔If cancer and depressed - ✔✔citalopram/escitalopram
least drug drug interactions
✔✔NDRI - ✔✔NE and DA reuptake inhibitor
Wellbutrin
best for those that don't want sexual s/e
depressed, low energy, fatigue- wellbutrin best
contraindicated in hx of seizures or eating disorders (because electrolyte levels being
off can cause seizures)
✔✔Chronic Pain and antidepressants - ✔✔SNRI
Duloxetine (cymbalta)
✔✔Fluoxetine (prozac) - ✔✔can cause insomnia
take in morning, not evening.
many SSRIs can cause insomnia- take in morning, worst insomnia is w/ prozac
, ✔✔schizophrenia - ✔✔onset 18-25 M
25-35 F
highest of all mental illnesses to cause thoughts of self harm (SI)
✔✔Which disorder causes the highest amount of homicidal ideation (HI) - ✔✔antisocial
personality highest
✔✔Brain PET scan of schizophrenia - ✔✔everything decreased in size except ventricles
(ventricles are holes anyway, obviously they are bigger)
✔✔Don't given stimulants to: - ✔✔schizophrenics- would exacerbate dopamine levels.
potentiates DA release
✔✔What causes aggression/impulsivity/abstract thinking issues in schizophrenia? -
✔✔abnormal prefrontal cortex, amygdala, basal ganglia, hippocampus and limbic
regions of brain
✔✔What type of exercise is best for schizophrenia? - ✔✔aerobic- improves cognition,
quality of life and long term health.
ACT team- case management in the home
✔✔High risk of relapse on oral haldol - ✔✔switch to deconate
deconate should be 20x the daily oral dose.
If elderly or stable on lower dose- it's only 10-15x oral dose.
If conversion is >100, give balance in 3-7 days.
✔✔MMSE - ✔✔also known as Folstein scale includes:
Concentration (serial 7's, or months backwards)
orientation (year, date, state)
registration/ability to learn new material (3 objects, then ask to repeat (recall/memory)
who is presedent/governor (fund of knowledge)
✔✔clock drawing test - ✔✔assesses for neurological problems..dementia or AD
