Georgette Review. Questions With Correct Solutions

Native americans - ANS ethnic group w/ the highest rate of SI in the US If cultural question - ANS make an accommodation for them even if against policy RESPECT also important contextualize their situation/clarify the meaning of their illness in their culture if it's a cultural syndrome, it's not mental illness--provide supportive psychotherapy Education w/ cultural consideration - ANS teach education based on culture. if multiple cultures present during education- provide multicultural ethno specific assessment parameters Answering tips - ANS if part of the question is wrong, the whole question is wrong. If 3 of the same and one different usually answer is the one that's different Answering tips - ANS Priority is airway, breathing, circulation. Then maslow's hierarchy-- safety, needs, culture then assessment before intervention if needed. don't choose to delegate, always chose to collaborate/do it yourself 3 antipsychotics that are least likely to cause wt gain - ANS lurasidone, abilify, and ziprasidone (geodon) abilify least sedating Pt develops metabolic syndrome: - ANS elevated A1C, lipid, glucose, hip to waist ratio, BMI What do you do first? reduce calorie, exercise..if not then switch to lurasidone, abilify, or geodon First psychotic episodes? - ANS atypicals...especially IM injections because fastest mode of action Zyprexa, Invega, Abilify or Geodon Normal TSH - ANS 0.5 - 5.0 hyperthyroid - ANS anxiety, irritable, heat intolerance, tachy, mood swings, wt loss, increased appetite Hypothyroid - ANS cold intolerance, lethargy, wt gain, decreased lbido Steven Johnson (lamictal, lamotrigine) - ANS Fever rash burning eyes/mucosa HA Lamictal - ANS mood stabilizer that causes the least amount of wt gain Carbamazepine (tegretol) - ANS also can cause SJS or rash especially in asians must screen for HLA B-1502 allele first for all asians (if positive, means at increased risk for SJS, don't give) Which meds cause agranulocytosis - ANS tegretol AND clozaril DC if ANC 1000 whether or not signs of infection monitor for signs of infection which indicate granulocytosis- fever, sore throat, fatigue, chills. Valproic Acid (depakote) - ANS can cause: -spina bifida -hepatotoxicity (RUQ pain, reddish-brown urine- check LFTS) Signs of hepatotoxicity (depakote) level 150 - ANS confusion disorientation lethargy respiratory depression priority- D/c depakote get LFTs, ammonia levels --high ammonia causes confusion 50-125, toxicity occurs if 150 pregnancy test - ANS HCG human chorionic gonadotropin always check before placing on mood stabilizer for women childbearing age (12-51) Kava kava - ANS herbal supplement taken for insomnia, anxiety MOST important is to check LFTs also drug drug interaction w/ kava and benzos Which meds can affect liver? - ANS BZN TCA Depakote Lithium level - ANS 0.6-1.2 If reaches 1.5- discontinue lithium... if 1.3 or 1.4---monitor for toxicity, but once reaches 1.5- immediately d/c Which drugs increase lithium levels - ANS they reduce renal clearance: NSAIDs hydrochlorothiazide ACE inhibitors Also- dehydration/hyponatremia can increase lithium. Make sure they stay hydrated. Treatment of NMS - ANS D/C med bromocriptine (parlodel)- D2 agonist or dantrolene- muscle relaxant (muscle rigidity) Serotonin syndrome - ANS D/C med cyproheptadine When switching antidepressants - ANS wait 14 days when SSRI - MAOI wait 5-6 wks from fluoxetine to MAOI wait 2 weeks if switching from MAOI - fluoxetine. Due to fluoxetine (prozac) having a longer halflife. Triptans Sumatriptan (Imitrex) - ANS don't give w/ antidepressants- increased risk of serotonin syndrome If cancer and depressed - ANS citalopram/escitalopram least drug drug interactions NDRI - ANS NE and DA reuptake inhibitor Wellbutrin best for those that don't want sexual s/e depressed, low energy, fatigue- wellbutrin best contraindicated in hx of seizures or eating disorders (because electrolyte levels being off can cause seizures) Chronic Pain and antidepressants - ANS SNRI Duloxetine (cymbalta) Fluoxetine (prozac) - ANS can cause insomnia take in the morning, not evening.