LMR Georgette’s PMHNP Certification Exam

LMR Georgette’s PMHNP Certification Exam What drugs should be avoided with Kava Kava?ANS== Alprazolam CNS depressants (e.g., phenobarbital, zolpidem) What is the normal range for TSH?ANS== 0.5 - 5.0 mu/L What are lab values in HyperthyroidismANS== Decreased TSH Increased T4 and T3 What are labs in Hypothyroidism?ANS== Increased TSH Decreased T4 and T3 What are 5 primary symptoms of Hyperthyroidism?ANS== Heat intolerance Agitation, Anxiety, Irritability Tachycardia Mood swings Weight loss What are 4 primary symptoms of Hypothyroidism?ANS== Cold intolerance Lethargy Weight gain Decreased libido Hypothyroidism mimics symptoms of what psychiatric disorder?ANS== Depression Hyperthyroidism mimics symptoms of what psychiatric disorder?ANS== Mania Valproic acid produces what teratogenic effect?ANS== Spina bifida (neural tube defect) What is the primary organ where valproic acid is toxic?ANS== Liver (hepatoxicity) Abdominal pain in the URQ Reddish-brown urine Yellowing of the skin and sclera Fatigue What is the therapeutic range for valproic acid?ANS== 50-125 mcg/ml What is a toxic level of valproic acid?ANS== >150 mcg/ml What are 4 signs of valproic acid toxicity?ANS== Disorientation Lethargy Respiratory depression Nausea/vomiting A pt on Depakote C/O Abdominal pain in the URQ and Reddish-brown urine. What do you suspect? What do you do?ANS== Hepatotoxicity; hold med, draw LFT's (priority), DVP level With suspected toxicity with valproic acid, what steps/labs should be drawn?ANS== D/C drug Check drug level Obtain LFTs Obtain ammonia level A pregnant pt is taking accutane, zyprexa and abilify; what med needs to be d/c'd?ANS== Accutane (used for acne; Causes birth Defects!!!) What herbal supplement is used for anxiety, stress, and insomnia? What is the major side effect with Kava Kava?ANS== Kava Kava liver damage What are 5 symptoms of Stephen's Johnson Syndrome?ANS== Fever -Key sx to suspect SJS; high yield (HY) burning of mouth/eyes -HY Body aches Severe red rash Peeling skin Facial and tongue swelling Which mood stabilizer causes the least weight gain?ANS== Lamotrigine (Lamictal) Which 3 SGAs cause the least weight gain?ANS== Lurasidone (Latuda) Aripiprazole (Abilify) Ziprasidone (Geodon) Which SGA is the least sedating?ANS== Aripiprazole (Abilify) Your pt is taking Kava and you need to add an AS to manage their SCZ, which do you add?ANS== Aripiprazole (least sedating) What are 2 hallmark symptoms of delirium?ANS== Acute onset disturbance of LOC impaired cognition inattention How are agitation and psychotic symptoms treated in delirium?ANS== Low dose Haldol (QTc check first) 16 y/o C/O feeling funny after inhaling Acetone (nail polish remover). What is your action?ANS== Do UDS; chances are they may be abusing other substances What 4 drugs can cause mania?ANS== "SAID" Steroids Antidepressants (in BPD) Isoniazid (INH) Disulfiram (Antabuse) What 6 drugs can induce depression?ANS== "SIP BARB" Steroids Interferon, Progesterone Beta blockers Accutane, (Isotretinoin) Retroviral drugs, Antineoplastic drugs Benzodiazepines Steroids can induce what 3 psychiatric states?ANS== Mania Depression Psychosis REMEMBER SAFETY FIRST; pt s/p assault, 1st thing you do is . What is the best environment to interview this pt in?ANS== reassure safety, provide environment of safety private area with door open/partially open What is the therapeutic range for lithium?ANS== 0.6-1.2 mEq/L Many postpartum women have SI after delivery, yet they don't have psych evals before leaving the hospital, what could a possible solution be?ANS== collaborating care between psych and OBGYN to provide the best care for that pt If collaborating with a provider who is not in the same clinic or hospital, the informed consent [does/does not] apply?ANS== Does not, ie pt will need to sign consent for labs/ chart to be sent When discharging from inpatient you want [to fax/print off-give to pt.] labs for the outpatient provider before pt discharge?ANS== fax; so the new provider has them for follow-up appointment Before referring a pt out or discharging them, it is good to ask yourself what question?ANS== is there something that I could do for this patient first? What 3 things are MUST KNOWS about Lithium?ANS== has neuroprotective effect for bipolar disorder the gold standard for treating manic episodes the mood stabilizer w/ anti-suicidal effects What mood stabilizer has anti-suicidal effects?ANS== Lithium What 5 labs should be drawn with lithium?ANS== Thyroid panel (TSH) Serum creatinine BUN Urinalysis HCG What is a normal SerumCr range?ANS== 0.6-1.2 mg/dL What is the normal range for BUN?ANS== 10-20 mg/dL When should you suspect kidney disease with a urinalysis?ANS== 4+ protein; if pt on Lithium-->monitor closely toxicity What are 7 side effects of lithium?ANS== Hypothyroidism Fine hand tremors Maculopapular rash GI upset (N/V/D, cramps, anorexia) Polyuria, polydipsia, diabetes insipidus T-wave inversions Leucocytosis What are 7 signs of lithium toxicity?ANS== Severe nausea, vomiting, diarrhea Confusion Drowsiness Muscle weakness Heart palpitations Coarse hand tremor Unsteadiness while standing or walking Bold =must knows Which 3 drugs can increase lithium levels by decreasing renal clearance?ANS== NSAIDs (ibuprofen, indomethacin) Thiazides ACE-I What is a toxic level of lithium?ANS== 1.