PMHNP test LMR
Lurasidone (Latuda)
atypical antipsychotic
Lithium Normal levels
0.6-1.2 mEq/l,
Lithium toxic level
1.5 mEq/l (D/C lithium and check levels)
Benefits of lithium
Evidence of anti suicidal effect, Neuroprotective (protects nerve cells from damage)
Lithium Baseline labs before initiation
Thyroid panel, Serum creatinine (0.6-1.2), Blood urea nitrogen (BUN)(10-20), Pregnancy test,
UA for protein, ECG for clients older than age 50
Lithium Clinically significant side effects
impaired thyroid functioning, fine hand tremors (can see it, not fine), maculopapular rash, GI
symptoms, T-wave inversion, leukocytosis, polyuria, polydipsia
Gold standard treatment for manic episodes
lithium
Lithium Signs of toxicity
severe GI, confusion, drowsiness, weakness, palpitations, coarse hand tremor
What can increase serum levels of lithium
Kidney disease or drugs that reduce renal clearance can increase serum concentration:
NSAIDS, thiazides, ACE inhibitors
Dehydration and hyponatremia can increase?
lithium levels
Causes Ebstein anomaly (cardiac defect) not recommended in first trimester
lithium
Hypertensive Crisis
occurs when MAOIs are taken in conjunction with foods
containing tyramine, a dietary precursor to norepinephrine.
Meds that cause hypertensive crisis
Meperidine, Decongestants, TCAs, Atypical antipsychotics, St. John's wort, L-tryptophan,
Stimulants and other sympathomimetics, Asthma medications
•
Symptoms of hypertensive crisis
Sudden, explosive-like headache, usually in occipital region , Elevated blood pressure, Facial
flushing, Palpitations, Pupillary dilation. Diaphoresis, Fever (think about what happens with
hypertension)
•
Treatment of hypertensive crisis
Discontinue the MAOI, Give phentolamine (binds with norepinephrine receptor sites, blocks
norepinephrine).
, •
Floppy baby syndrome, cleft palate caused by,
Benzodiazepines
•
Neural tube defects caused by
Carbamazepine (Tegretol):
Neural tube defects specifically spina bifida and atrial septal defect and cleft palate and possible
long-term developmental deficits caused by
Divalproex sodium (Depakote)
Signs/symptoms of SJS
• Fever
• facial swelling
• tongue swelling
• macules, papules, and "burning," confluent erythematous rash
• skin sloughing
Carbamazepine BBW
Agranulocytosis - decreased WBC
o
Monitor for signs of infection (fever, chills, ST, weakness) with what meds
Clozaril/Tegretol
D/C Clozaril/Tegretol if
ANC < 1,000 whether signs of infection or not
Aplastic anemia signs and symptoms
pallor, fatigue, H/A, fever, nosebleeds, bleeding gums, skin rash, SOB
• SJS is a higher risk in what group of people=
asian higher risk- screen with HLA-B 1502 allele
Folic Acid dose
: 0.4-0.8mg daily
important for neural tube during first month,
Clozapine DC criteria
d/c if ANC levels < 1,000 not 500
Bulimia presentation=
Weight usually within normal range (different from anorexia), Erosion of dental enamel, Russell's
sign (calluses on hands), Hypertrophy of salivary glands, Rectal prolapse
Bulimia TX
Fluoxetine is FDA-approved for bulimia nervosa, SSRIs and tricyclic antidepressants (TCAs)
effective in reducing the frequency of binging and purging
Anorexia Nervosa S/S
Low body mass index, Amenorrhea, Emaciation, Bradycardia, Hypotension, Electrocardiogram
(ECG) changes (Inversion of T-waves, ST segment depression, Prolonged QT interval),
Hypertrophy of the salivary glands, Russell's sign
Anorexia TX
CBT (if medically stable, if not then send to hospital)
Lurasidone (Latuda)
atypical antipsychotic
Lithium Normal levels
0.6-1.2 mEq/l,
Lithium toxic level
1.5 mEq/l (D/C lithium and check levels)
Benefits of lithium
Evidence of anti suicidal effect, Neuroprotective (protects nerve cells from damage)
Lithium Baseline labs before initiation
Thyroid panel, Serum creatinine (0.6-1.2), Blood urea nitrogen (BUN)(10-20), Pregnancy test,
UA for protein, ECG for clients older than age 50
Lithium Clinically significant side effects
impaired thyroid functioning, fine hand tremors (can see it, not fine), maculopapular rash, GI
symptoms, T-wave inversion, leukocytosis, polyuria, polydipsia
Gold standard treatment for manic episodes
lithium
Lithium Signs of toxicity
severe GI, confusion, drowsiness, weakness, palpitations, coarse hand tremor
What can increase serum levels of lithium
Kidney disease or drugs that reduce renal clearance can increase serum concentration:
NSAIDS, thiazides, ACE inhibitors
Dehydration and hyponatremia can increase?
lithium levels
Causes Ebstein anomaly (cardiac defect) not recommended in first trimester
lithium
Hypertensive Crisis
occurs when MAOIs are taken in conjunction with foods
containing tyramine, a dietary precursor to norepinephrine.
Meds that cause hypertensive crisis
Meperidine, Decongestants, TCAs, Atypical antipsychotics, St. John's wort, L-tryptophan,
Stimulants and other sympathomimetics, Asthma medications
•
Symptoms of hypertensive crisis
Sudden, explosive-like headache, usually in occipital region , Elevated blood pressure, Facial
flushing, Palpitations, Pupillary dilation. Diaphoresis, Fever (think about what happens with
hypertension)
•
Treatment of hypertensive crisis
Discontinue the MAOI, Give phentolamine (binds with norepinephrine receptor sites, blocks
norepinephrine).
, •
Floppy baby syndrome, cleft palate caused by,
Benzodiazepines
•
Neural tube defects caused by
Carbamazepine (Tegretol):
Neural tube defects specifically spina bifida and atrial septal defect and cleft palate and possible
long-term developmental deficits caused by
Divalproex sodium (Depakote)
Signs/symptoms of SJS
• Fever
• facial swelling
• tongue swelling
• macules, papules, and "burning," confluent erythematous rash
• skin sloughing
Carbamazepine BBW
Agranulocytosis - decreased WBC
o
Monitor for signs of infection (fever, chills, ST, weakness) with what meds
Clozaril/Tegretol
D/C Clozaril/Tegretol if
ANC < 1,000 whether signs of infection or not
Aplastic anemia signs and symptoms
pallor, fatigue, H/A, fever, nosebleeds, bleeding gums, skin rash, SOB
• SJS is a higher risk in what group of people=
asian higher risk- screen with HLA-B 1502 allele
Folic Acid dose
: 0.4-0.8mg daily
important for neural tube during first month,
Clozapine DC criteria
d/c if ANC levels < 1,000 not 500
Bulimia presentation=
Weight usually within normal range (different from anorexia), Erosion of dental enamel, Russell's
sign (calluses on hands), Hypertrophy of salivary glands, Rectal prolapse
Bulimia TX
Fluoxetine is FDA-approved for bulimia nervosa, SSRIs and tricyclic antidepressants (TCAs)
effective in reducing the frequency of binging and purging
Anorexia Nervosa S/S
Low body mass index, Amenorrhea, Emaciation, Bradycardia, Hypotension, Electrocardiogram
(ECG) changes (Inversion of T-waves, ST segment depression, Prolonged QT interval),
Hypertrophy of the salivary glands, Russell's sign
Anorexia TX
CBT (if medically stable, if not then send to hospital)
