Georgette Review 2022 Graded A

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) 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 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 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 , risk of agranulocytosis When on clozaril monitor for - ANSWER signs and symptoms of infection: sudden fever, chills, sore throat, weakness Clozaril only known antipsychotic to - ANSWER decrease risk of suicide in patients with schizophrenia. Your patient with bipolar disorder is admitted to a medical hospital. The internist contacts your office and asks whether the lithium you prescribed him is effecting his ECG. How do you respond? A. Lithium can prolong the QT interval B. Lithium has no effect on his ECG C. Lithium can invert the t waves D. Lithium can shorten the PR interval - ANSWER Answer: Lithium can invert the t waves. Mary is a 45-year-old African American female who has been treated on Isocarboxazid (Marplan) for over 6 years. Mary is going in for a surgical procedure. Which medication is strictly contraindicated with Isocarboxazid? A. Morphine B. NSAIDS C. Methylphenidate D. Acetaminophen - ANSWER Answer: Methylphenidate You are treating a client with schizophrenia who takes clozapine. What lab values will indicate the client needs to discontinue treatment? A. WBC less than 1800 and ANC less than 1200 B. ANC less than 1,000 C. WBC less than 5,000 D. ANC less than 2000 - ANSWER Answer: ANC less than 1000 If given during pregnancy, socium valproate can cause which of the following medical problems in the baby? A. SJS B. Ebstein's anomaly C. Spina bifida D. Cleft palate - ANSWER A. Spina bifida Which mood stabilizer is associated with potential life-threatening rash in the Asian population? A. Carbamazepine (tegretol) B. Depakote C. Lithium D. Lamictal - ANSWER A. Carbamazepine Bulimia, weight is ___________ - ANSWER within the normal range. Pharm treatment for bulimia - ANSWER Fluoxetine SSRIs and TCAs effective in reducing binging and purging Signs of anorexia nervosa - ANSWER low BMI Amennorrhea Emaciation Bradycardua Hypotension Pharm treatment for anorexia - ANSWER there is none therapy Which of the following physical exam findings would help the PMHNP differentiate anorexia nervosa from bulimia nervosa? A. Russell sign B. Low BMI C. Erosion of dental enamel D. Hypertrophy of salivary glands - ANSWER Low BMI If a patient is depression, low energy, fatigued, you would prescribe - ANSWER Wellbutrin Wellbutrin is contraindicated in patients with - ANSWER seizure disorder or conditions that increase risk of seizures such as eating disorder. Which of the following medications has a unique mechanism that is both a norepinephrine and dopamine reuptake inhibitor? A. Bupropion (Wellbutrin) B. Sertraline (Zoloft) C. Clomipramine (Anafranil) D. Duloxetine (Cymbalta) - ANSWER bupropion CLozaril is metabolized by - ANSWER cytochrome P450 enzyme CYP1A2 INducers - ANSWER induce metabolism and therefore decrease serum levels of other drugs that are substrates Smoking will do what to drug levels - ANSWER decrease therapeutic levels of the drug Bull Shit CRAP GPS Induces my rage - ANSWER Barbituates St. Johns Wart Carbamazepine Rifampicin Alcohol Phenytoin Griseofulvin Phenobarbital Sulphonylureas If your patient is a smoker you will need ___________doses of their medication. - ANSWER higher Inhibitors - ANSWER inhibit metabolism and therefore increase levels of the drug. SICKFACES.com for Inhibitors - ANSWER Sodium valproate Isoniazid Cimetidine Ketoconazole Alcohol Chloramphenicol Erythromycin Sulfonamine Cipro Omeprazole Metronidazole Which cytochrome enzyme is implicated as a tobacco inducer when an individual is treated with clozapine a. 2D6 b. 1A2 c. 2C19 d. 2C9 - ANSWER 1A2 (want A 2 cigarette break) When treating older adults, you should keep in mind that they are more sensitive to issues of drug toxicity because of which of the following reasons? A. Decreased body fat B. Increased liver capacity C. Decreased protein binding D. Increased muscle concentration - ANSWER Decreased protein binding For 12 years, a 65 year old patient with bipolar affective disorder has been treated with lithium 900 mg daily. When oral HCTC 12.5 daily is added for hypertension, the patient develops nausea, vomiting, ataxia, and muscle weakness and the patient's serum lithium level is 2.0. The interaction of the lithium and the thiazide diuretic has induced: A. hypokalemia B. hyponatremia C. Increased renal clearance of lithium D. Decreased renal clearance of lithium - ANSWER A. decreased renal clearance of lithium Where is norepinephrine produced - ANSWER locus coeruleus and medullary reticular formation Norepinephrine is associated with - ANSWER mood disorders Serotonin is made where in the brain - ANSWER raphe nuclei of the brainsteam Serotonin is associated with - ANSWER sleep and mood disorder Dopamine is made in - ANSWER substantia nigra, central tegmental area, ventral tegmental area, Dopamine is associated with - ANSWER addiction and psychosis Acetylcholine is made - ANSWER basal nucleus of Meynert