PMNP Board Review 2024 Graded And Verified Exam
If taken while pregnant, Lithium can cause: - Correct Answer-Ebstein's Anomaly
Lithium Toxicity - Correct Answer-Levels > 1.5 mEq/L
S/S: severe nausea, vomiting, diarrhea, confusion, convulsions, drowsiness, blurred vision, slurred
speech, muscle weakness, palpitations, coarse hand tremors, ataxia
Tx: discontinue lithium. Check levels.
Hypertensive Crisis - Correct Answer-Occurs when MAOIs are taken with foods containing tyramine or
medications including: meperidine, stimulants, sympathomimetics, decongestants, atypical antipsychotics
S/S of hypertensive crisis - Correct Answer-sudden explosive headache in occipital region, facial
flushing, palpitations, pupillary dilation, diaphoresis, fever
Treatment of Hypertensive Crisis - Correct Answer-Discontinue MAOI, give phentolamine, stabilize fever
Teratogenic Risks of Common Psych Meds - Correct Answer-Benzos = floppy baby syndrome, cleft palate
Carbamazepine = neural tube defect
Lithium = Epstein anomaly
Divalproex = neural tube defects, spina bifida
Major side effects of Lamictal - Correct Answer-Steven-Johnson-Syndrome
,Fever, sore throat, facial swelling, tongue swelling, rash, skin sloughing, prodromal headache, malaise,
arthralgia, painful mucous membranes
Major side effects of valproic acid - Correct Answer-Hepatoxocity
Pancreatitis
Study Tips - Correct Answer-*Use only the information provided.
*Narrow down options to 2 possible right answers.
*Partially correct answers are NOT the correct answer.
*When 2 answer choices are the opposite of one another, one is usually the correct answer.
*When many response choices are remarkably similar in meaning, they're usually wrong.
*Be wary of absolutes: all, only, always, every, must, never, none, everything, nothing, etc. These are
usually wrong.
*Most of the time the questions do not want you to delegate.
*Collaboration is most likely the correct answer.
*Safety is #1
Lithium - Basics and Labs - Correct Answer-Range: 0.6-1.2 mEq/L
Gold standard for manic episodes
Anti-suicidal effects
Neuroprotective
Labs: Thyroid, creatinine, BUN, pregnancy test, and ECG for any patient older than 50
Lithium Side Effects - Correct Answer-Endo: hypothyroidism, weight gain
CNS: fine hand tremors, fatigue, mental cloudiness, headache, coarse hand tremors, nystagmus
Derm: macropapular rash, pruritus acne
GI: Diarrhea, N/V, cramps, anorexia
,Renal: Diabetes incepidus, polyuria, polydipsia, edema
Cardiac: T-wave inversion, dysrhythmia
Hematologic: Leukocytosis
Russell's Sign - Correct Answer-scarring or calluses on dorsal of hand
Treatment of Bulimia Nervosa - Correct Answer-Fluoxetine (Prozac)
SSRI, TCA reduce frequency of bingeing and purging
Anorexia Nervosa S/S - Correct Answer-low BMI, amenorrhea, emaciation, bradycardia, hypotension,
inversion of T waves, prolonged QT interval, hypertrophy of salivary glands, Russell's sign
Treatment of Anorexia Nervosa - Correct Answer-No medication is approved.
Hospitalization if BMI < 15
Therapy = CBT, behavior, family, group
Preferred medication for a patient that is depressed with low energy and fatigue. - Correct Answer-
Wellbutrin - norepinephrine dopamine reuptake inhibitor
*When energy is low increase norepinephrine
Contraindications for Wellbutrin - Correct Answer-Seizure disorder, history of seizures
Eating disorders - anorexia or bulimia d/t increased seizure risk
*Increases seizure risk by decreasing seizure threshold
, Chronic Neuropathic Pain treatment - Correct Answer-Choose SNRI over TCA due to safer side effect
profile
What are Enzyme Inducers - Correct Answer-Decrease the serum level of other drugs that are
substrates of that enzyme, thus possibly causing sub therapeutic drug levels
Example: tobacco is an inducer.
If patient is a smoker on carbamazepine = increase dose
If patient quits smoking on carbamazepine = decrease dose
What are Enzyme Inhibitors - Correct Answer-Can increase the serum level of other drugs that are
substrates of that enzyme, thus possibly causing toxic levels
How does liver disease affect medication levels? - Correct Answer-Liver disease will affect liver enzyme
activity and 1st pass metabolism
This can result in toxic plasma drug levels
Medications that reduce renal clearance - Correct Answer-NSAIDs, Thiazides, ACE Inhibitors
Older adults are more sensitive to psychotropics because of - Correct Answer-*decreased intracellular
waste
*decreased protein binding (*Decrease protein available for binding, freer (active) drug remains in body,
predisposing older adults to toxicity)
*Low muscle mass
*decrease metabolism
*Increased body fat concentration
If taken while pregnant, Lithium can cause: - Correct Answer-Ebstein's Anomaly
Lithium Toxicity - Correct Answer-Levels > 1.5 mEq/L
S/S: severe nausea, vomiting, diarrhea, confusion, convulsions, drowsiness, blurred vision, slurred
speech, muscle weakness, palpitations, coarse hand tremors, ataxia
Tx: discontinue lithium. Check levels.
Hypertensive Crisis - Correct Answer-Occurs when MAOIs are taken with foods containing tyramine or
medications including: meperidine, stimulants, sympathomimetics, decongestants, atypical antipsychotics
S/S of hypertensive crisis - Correct Answer-sudden explosive headache in occipital region, facial
flushing, palpitations, pupillary dilation, diaphoresis, fever
Treatment of Hypertensive Crisis - Correct Answer-Discontinue MAOI, give phentolamine, stabilize fever
Teratogenic Risks of Common Psych Meds - Correct Answer-Benzos = floppy baby syndrome, cleft palate
Carbamazepine = neural tube defect
Lithium = Epstein anomaly
Divalproex = neural tube defects, spina bifida
Major side effects of Lamictal - Correct Answer-Steven-Johnson-Syndrome
,Fever, sore throat, facial swelling, tongue swelling, rash, skin sloughing, prodromal headache, malaise,
arthralgia, painful mucous membranes
Major side effects of valproic acid - Correct Answer-Hepatoxocity
Pancreatitis
Study Tips - Correct Answer-*Use only the information provided.
*Narrow down options to 2 possible right answers.
*Partially correct answers are NOT the correct answer.
*When 2 answer choices are the opposite of one another, one is usually the correct answer.
*When many response choices are remarkably similar in meaning, they're usually wrong.
*Be wary of absolutes: all, only, always, every, must, never, none, everything, nothing, etc. These are
usually wrong.
*Most of the time the questions do not want you to delegate.
*Collaboration is most likely the correct answer.
*Safety is #1
Lithium - Basics and Labs - Correct Answer-Range: 0.6-1.2 mEq/L
Gold standard for manic episodes
Anti-suicidal effects
Neuroprotective
Labs: Thyroid, creatinine, BUN, pregnancy test, and ECG for any patient older than 50
Lithium Side Effects - Correct Answer-Endo: hypothyroidism, weight gain
CNS: fine hand tremors, fatigue, mental cloudiness, headache, coarse hand tremors, nystagmus
Derm: macropapular rash, pruritus acne
GI: Diarrhea, N/V, cramps, anorexia
,Renal: Diabetes incepidus, polyuria, polydipsia, edema
Cardiac: T-wave inversion, dysrhythmia
Hematologic: Leukocytosis
Russell's Sign - Correct Answer-scarring or calluses on dorsal of hand
Treatment of Bulimia Nervosa - Correct Answer-Fluoxetine (Prozac)
SSRI, TCA reduce frequency of bingeing and purging
Anorexia Nervosa S/S - Correct Answer-low BMI, amenorrhea, emaciation, bradycardia, hypotension,
inversion of T waves, prolonged QT interval, hypertrophy of salivary glands, Russell's sign
Treatment of Anorexia Nervosa - Correct Answer-No medication is approved.
Hospitalization if BMI < 15
Therapy = CBT, behavior, family, group
Preferred medication for a patient that is depressed with low energy and fatigue. - Correct Answer-
Wellbutrin - norepinephrine dopamine reuptake inhibitor
*When energy is low increase norepinephrine
Contraindications for Wellbutrin - Correct Answer-Seizure disorder, history of seizures
Eating disorders - anorexia or bulimia d/t increased seizure risk
*Increases seizure risk by decreasing seizure threshold
, Chronic Neuropathic Pain treatment - Correct Answer-Choose SNRI over TCA due to safer side effect
profile
What are Enzyme Inducers - Correct Answer-Decrease the serum level of other drugs that are
substrates of that enzyme, thus possibly causing sub therapeutic drug levels
Example: tobacco is an inducer.
If patient is a smoker on carbamazepine = increase dose
If patient quits smoking on carbamazepine = decrease dose
What are Enzyme Inhibitors - Correct Answer-Can increase the serum level of other drugs that are
substrates of that enzyme, thus possibly causing toxic levels
How does liver disease affect medication levels? - Correct Answer-Liver disease will affect liver enzyme
activity and 1st pass metabolism
This can result in toxic plasma drug levels
Medications that reduce renal clearance - Correct Answer-NSAIDs, Thiazides, ACE Inhibitors
Older adults are more sensitive to psychotropics because of - Correct Answer-*decreased intracellular
waste
*decreased protein binding (*Decrease protein available for binding, freer (active) drug remains in body,
predisposing older adults to toxicity)
*Low muscle mass
*decrease metabolism
*Increased body fat concentration
