· Stimulant abuse and ADHD= screen all kids (T/F) -
ANSWER :
True
Suicide risk factors -
ANSWER :
***Count risk factor
-age 45 yrs of older if male
-55 yrs or older is female
-Male
-Divorced/Single/Separated
-White
-Living alone
-Psychiatric disorder
-Substance abuse
-Physical illness
-Previous suicide
-Family hx of suicide
-Recent loss/death
1
,Highest Suicide risk -
ANSWER :
-previous attempt
-elderly
-male
-Plan
Lithium (Li) -
ANSWER :
Normal: 0.6-1.2
Lithium toxicity can occur at 1.5 or higher
Gold standard for treating manic episodes
Has anti-suicide effects in bipolar
Neuroprotective tx of choice for Bipolar
Before Rx, Check: TSH, Creatinine,BUN, UA (4+ protein = kidney disease), HCG for females of
childbearing age (12-51 years)
Lithium s/e: hypothyroidism, find hand tremors, maculopapular rash, GI upset, diabetes in-
sipidus (polyuria, polydipsia), , T-wave inversions, leukocytosis (increased WBC's), Ebstein
anomaly
----- Ebstein anomaly (congenital heart defect), Do a pregnancy test!!
2
,Dehydration can increase Li level
Hyponatremia can increase Li level
**Pt shows understanding if the say "I will take extra water with me on a hike"
Lithium toxicity -
ANSWER :
Lithium toxicity can occur at 1.5 or higher
-severe nausea, vomiting, diarrhea, confusion, drowsiness, muscle weakness, heart palpita-
tions, coarse hand tremors, unsteady walking (ataxia)
Intervention:
-D/C Lithium and check Li levels
Meds that increase lithium level by reducing renal clearance leading to toxicity:
---kidney disease, NSAIDS, thiazides, ACE inhibitors (used for cardiac failure)
Women of childbearing should get what test before starting any AP -
ANSWER :
HCG
Clozaril reduces suicide risk in what disorder? -
ANSWER :
-schizophrenia
3
, Neuroleptic Malignant Syndrome (NMS) -
ANSWER :
Caused by antipsychotics
-----such as haloperidol, fluphenazine, chlorpromazine, trifluoperazine, and prochlorperazine
-Extreme muscular rigidity
-Mutism
-Hyperthermia
-Tachycardia
increased CPK (creatinine phosphokinase) d/t muscle contraction/muscle destruction
-myoglobinuria d/t breakdown of muscle cells (RHABDOMYOLYSIS)
-INcreased WBC (leukocytosis)
-Increased LFT (liver function test)
Tx: D/C offending agent
-Bromocriptine -(Dopamine 2 agonist
-Dantrolene- muscle relaxant (for rigidity)
Tx for NMS -
ANSWER :
1. Tx: D/C offending agent (AP)
2.
-Bromocriptine -(Dopamine 2 agonist)
4
ANSWER :
True
Suicide risk factors -
ANSWER :
***Count risk factor
-age 45 yrs of older if male
-55 yrs or older is female
-Male
-Divorced/Single/Separated
-White
-Living alone
-Psychiatric disorder
-Substance abuse
-Physical illness
-Previous suicide
-Family hx of suicide
-Recent loss/death
1
,Highest Suicide risk -
ANSWER :
-previous attempt
-elderly
-male
-Plan
Lithium (Li) -
ANSWER :
Normal: 0.6-1.2
Lithium toxicity can occur at 1.5 or higher
Gold standard for treating manic episodes
Has anti-suicide effects in bipolar
Neuroprotective tx of choice for Bipolar
Before Rx, Check: TSH, Creatinine,BUN, UA (4+ protein = kidney disease), HCG for females of
childbearing age (12-51 years)
Lithium s/e: hypothyroidism, find hand tremors, maculopapular rash, GI upset, diabetes in-
sipidus (polyuria, polydipsia), , T-wave inversions, leukocytosis (increased WBC's), Ebstein
anomaly
----- Ebstein anomaly (congenital heart defect), Do a pregnancy test!!
2
,Dehydration can increase Li level
Hyponatremia can increase Li level
**Pt shows understanding if the say "I will take extra water with me on a hike"
Lithium toxicity -
ANSWER :
Lithium toxicity can occur at 1.5 or higher
-severe nausea, vomiting, diarrhea, confusion, drowsiness, muscle weakness, heart palpita-
tions, coarse hand tremors, unsteady walking (ataxia)
Intervention:
-D/C Lithium and check Li levels
Meds that increase lithium level by reducing renal clearance leading to toxicity:
---kidney disease, NSAIDS, thiazides, ACE inhibitors (used for cardiac failure)
Women of childbearing should get what test before starting any AP -
ANSWER :
HCG
Clozaril reduces suicide risk in what disorder? -
ANSWER :
-schizophrenia
3
, Neuroleptic Malignant Syndrome (NMS) -
ANSWER :
Caused by antipsychotics
-----such as haloperidol, fluphenazine, chlorpromazine, trifluoperazine, and prochlorperazine
-Extreme muscular rigidity
-Mutism
-Hyperthermia
-Tachycardia
increased CPK (creatinine phosphokinase) d/t muscle contraction/muscle destruction
-myoglobinuria d/t breakdown of muscle cells (RHABDOMYOLYSIS)
-INcreased WBC (leukocytosis)
-Increased LFT (liver function test)
Tx: D/C offending agent
-Bromocriptine -(Dopamine 2 agonist
-Dantrolene- muscle relaxant (for rigidity)
Tx for NMS -
ANSWER :
1. Tx: D/C offending agent (AP)
2.
-Bromocriptine -(Dopamine 2 agonist)
4
