Georgette Review PMHNP GUARANTEED PASS !!
When many answers are remarkably similar, they are usually _____________ - (ANSWER)wrong
Interprofessional collaboration is encouraged. - (ANSWER)Collaborate is usually right.
Delegate is usually wrong.
ADPIER - (ANSWER)Assessment, diagnosis, Plan, intervention, evaluate, refer out last.
Lithium - (ANSWER)Normal 0.6-1.2
Lithium toxicity occurs at levels - (ANSWER)> 1.5
Signs of Lithium toxicity - (ANSWER)severe nausea, diarrhea, vomiting, confusion, drowsiness, muscle
weakness, heart palpitation, coarse hand tremors, unsteady gait
Lithium is gold standard for - (ANSWER)MANIA
Lithium has evidence shown to - (ANSWER)reduce suicidal ideation
What does lithium cause in neonate, especially 1st trimester - (ANSWER)Ebstein anomaly (congenital heart
defect)
dehydration and hyponatremia cause lithium levels to - (ANSWER)rise
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)
Page 1 of 44
,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
Signs of Depakote toxicity - (ANSWER)disorientation, lethargy, respiratory depression, nausea/vomiting
Intervention for depakote toxicity - (ANSWER)DC med
check level
LFT
ammonia
MAOI + tyramine causes - (ANSWER)hypertensive crisis
Page 2 of 44
,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
Treatment for hypertensive crisis - (ANSWER)DC offending agent
Administer PHENTOLAMINE
Teratogenic effects of benzos - (ANSWER)floppy baby, cleft palate
Teratogenic effects of tegratol - (ANSWER)neural tube defect
teratogenic effects of lithium - (ANSWER)ebstein anomaly (heart defect) (avoid, especially 1st trimester)
teratogenic effects of depakote - (ANSWER)neural tube defects/spina bifida
Adverse reaction to Lamictal - (ANSWER)Steven Johnson's Syndrome
Page 3 of 44
, Signs of SJS - (ANSWER)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 - (ANSWER)sedation or weight gain
Carbamazepine (tegretol) black box warning - (ANSWER)agranulocytosis (decrease WBCs)
aplastic anemia (pallor, fatigue, HA, fever, nosebleeds, bleeding gums, skin rash, SOA)
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
Clozaril/clozapine can cause - (ANSWER)agranulocytosis and neutropenia
For monitoring neutropenia in Clozaril, monitor - (ANSWER)ANC
DC clozarli if ANC - (ANSWER)less than 1000
DC clozaril if WBC - (ANSWER)2000-3000, risk of agranulocytosis
Page 4 of 44
When many answers are remarkably similar, they are usually _____________ - (ANSWER)wrong
Interprofessional collaboration is encouraged. - (ANSWER)Collaborate is usually right.
Delegate is usually wrong.
ADPIER - (ANSWER)Assessment, diagnosis, Plan, intervention, evaluate, refer out last.
Lithium - (ANSWER)Normal 0.6-1.2
Lithium toxicity occurs at levels - (ANSWER)> 1.5
Signs of Lithium toxicity - (ANSWER)severe nausea, diarrhea, vomiting, confusion, drowsiness, muscle
weakness, heart palpitation, coarse hand tremors, unsteady gait
Lithium is gold standard for - (ANSWER)MANIA
Lithium has evidence shown to - (ANSWER)reduce suicidal ideation
What does lithium cause in neonate, especially 1st trimester - (ANSWER)Ebstein anomaly (congenital heart
defect)
dehydration and hyponatremia cause lithium levels to - (ANSWER)rise
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)
Page 1 of 44
,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
Signs of Depakote toxicity - (ANSWER)disorientation, lethargy, respiratory depression, nausea/vomiting
Intervention for depakote toxicity - (ANSWER)DC med
check level
LFT
ammonia
MAOI + tyramine causes - (ANSWER)hypertensive crisis
Page 2 of 44
,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
Treatment for hypertensive crisis - (ANSWER)DC offending agent
Administer PHENTOLAMINE
Teratogenic effects of benzos - (ANSWER)floppy baby, cleft palate
Teratogenic effects of tegratol - (ANSWER)neural tube defect
teratogenic effects of lithium - (ANSWER)ebstein anomaly (heart defect) (avoid, especially 1st trimester)
teratogenic effects of depakote - (ANSWER)neural tube defects/spina bifida
Adverse reaction to Lamictal - (ANSWER)Steven Johnson's Syndrome
Page 3 of 44
, Signs of SJS - (ANSWER)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 - (ANSWER)sedation or weight gain
Carbamazepine (tegretol) black box warning - (ANSWER)agranulocytosis (decrease WBCs)
aplastic anemia (pallor, fatigue, HA, fever, nosebleeds, bleeding gums, skin rash, SOA)
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
Clozaril/clozapine can cause - (ANSWER)agranulocytosis and neutropenia
For monitoring neutropenia in Clozaril, monitor - (ANSWER)ANC
DC clozarli if ANC - (ANSWER)less than 1000
DC clozaril if WBC - (ANSWER)2000-3000, risk of agranulocytosis
Page 4 of 44
