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When many answers are remarkably similar, they are wrong
usually _____________
Interprofessional collaboration is encouraged. Collaborate is usually right.
Delegate is usually wrong.
ADPIER Assessment, diagnosis, Plan, intervention, evaluate, refer out last.
Lithium Normal 0.6-1.2
Lithium toxicity occurs at levels > 1.5
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 Ebstein anomaly (congenital heart defect)
trimester
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)
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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 50-125
Depakote toxicity level greater than 150
Teratogenic effects of Depakote spina bifida
Adverse effects of depakote alopecia
hepatotoxicity (RUQ pain or brown/red urine--order LFTs) AST 5-40, ALT 5-35,
yellowing of skin or eyes, fatigue
Signs of Depakote toxicity disorientation, lethargy, respiratory depression, nausea/vomiting
Intervention for depakote toxicity DC med
check level
LFT
ammonia
MAOI + tyramine causes hypertensive crisis
Symptoms of hypertensive crisis elevated BP
sudden explosive like headache
facial flushing
palpitations
pupillary dilation
diaphoresis
fever
Hypertensive crisis occurs with MAOI + MEPERIDINE
STIMULANTS
decongestants
TCAs
atypicals
St. John's wart
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
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