Georgette's Modules 1 and 2 : Scientific Foundation and Advanced
Practice Skills - Pharmacodynamics and Drug Emergencies
What is the Gold Standard for treating manic episodes? - correct answer Lithium
What are the additional benefits of Lithium? - correct answer It has anti-suicidal effects and is
neuroprotective
What is the most neuroprotective treatment for bipolar disorder? - correct answer Lithium
What is the normal range for Lithium? - correct answer 0.6-1.2 mEq/L
When does Lithium toxicity occur? - correct answer 1.5 mEq/L
When do you draw a Lithium level? - correct answer Trough - 12 hours after last dose
What labs must you order before initiating Lithium? - correct answer Thyroid panel (TSH)
Serum Creatinine
BUN
Pregnancy test
ECG if >50 years old
What is the normal range for creatinine? - correct answer 0.6-1.2 mg/dL
What is the normal range for BUN? - correct answer 10-20 mg/dL
What are some of the ENDOCRINE side effects of lithium? - correct answer Hypothyroidism
Weight gain
Diabetes Insipidus (polydipsia, polyuria)
What are some of the CENTRAL NERVOUS SYSTEM side effects of Lithium? (6) - correct answer
Fine hand tremor
Fatigue
Mental cloudiness
Headaches
Nystagmus
Coarse hand tremors - with Toxicity
What are some of the DERMATOLOGICAL side effects of Lithium? (3) - correct answer
Macropapular rash
,Pruritis
Acne
What are some of the GASTROINTESTINAL side effects of Lithium? (4) - correct answer Diarrhea
Vomiting
Cramps
Anorexia
What are some misc side effects of lithium? - correct answer T-wave inversion
Leukocytosis (increased WBCs)
Signs of Lithium toxicity - correct answer Severe nausea, vomiting, diarrhea
Confusion
Convulsions
Drowsiness
Blurred vision
Slurred speech
Muscle weakness
Heart palpitations
Coarse hand tremors
Unsteadiness while standing or walking (ataxia)
What do you do if someone presents with signs of Lithium toxicity? - correct answer DC the
Lithium and check serum Lithum levels
What do you do is a patient has a lithium level of 1.3 or 1.4 without symptoms of toxicity? -
correct answer Continue to monitor the patient
What do you do if a patient has a lithium level of 1.3 or 1.4 with signs of toxicity? - correct
answer DC lithium
How is Lithium excreted? - correct answer Kidneys
What drugs reduce renal clearance of drugs excreted by the kidneys? - correct answer NSAIDs -
Ibuprofen, Indomethacin
Thiazide diuretics - hydrochlorothiazide
,ACE inhibitors - Lisinopril
Important patient education for Lithium? - correct answer Signs and symptoms of toxicity
What is the mechanism of action which makes lithium a good choice for bipolar in a depressive
stage with a history of suicide attempts? - correct answer It modulates glutamate, reducing
impulsivity and aggressive behavior, making it a great choice for patients at risk for suicide
Chemistry of most psychotropic drugs - correct answer Most drugs are lipophilic (lipid-loving)
and highly protein-bound.
Why are older adults more sensitive to psychotropic drugs? - correct answer Decreased:
- intercellular water
- protein-binding
- muscle mass
- metabolism
and
Increased body fat concentration
If someone develops Lithium toxicity, why is it crucial to DC the drug? - correct answer To
prevent further elevation of Lithium levels
If you suspect a patient has developed Lithium toxicity, why do you order a serum Lithium
level? - correct answer To confirm the diagnosis of Lithium toxicity and assess the severity of
the condition. This allows the PMHNP to determine the appropriate treatment approach based
on the Lithium level.
Why are VS and ECG not the most immediate priority when dealing with Lithium toxicity? -
correct answer Though VS and an ECG are important assessments in the management of
Lithium toxicity, these do not address the PRIMARY issue of elevated Lithium levels.
For 12 years, a 65-year-old patient with bipolar affective disorder has been treated with Lithium
(Eskalith) 900mg daily. When oral hydrochlorothiazide (HCTZ) 12.5 mg daily is added for
hypertension, the patient develops nausea, vomiting, ataxia, muscle weakness, and the
patient's serum Lithium level is 2.0 mEq/L. The interaction of the Lithiium and the Thiazide
diuretic has induced what? - correct answer Reduced renal clearance of the Lithium
What occurs when a person taking an MAOI in conjunction with foods containing tyramine? -
correct answer Hypertensive crisis
, What drugs are MAOIs? (4) - correct answer Isocarboxazid (Marplan)
Phenelzine (Nardil)
Selegiline (patch) (EMSAM)
Tranylcypromine (Parnate)
What is tyramine? - correct answer A dietary precursor to norepinephrine
Tyramine acts as a - correct answer Catecholamine releasing agent
This causes Epi/Norepi to be released
What happens when Monoamine oxidase is inhibited? - correct answer Tyramine can exert a
strong vasopressor effect, stimulating the release of catecholamines, epinephrine, and
norepinephrine = increased blood pressure and heart rate
Hypertensive crisis is life-threatening and cannot be reversed unless - correct answer More
MAO is produced by the body
What other drugs may cause a hypertensive crisis when taken with MAOIs? - correct answer
Meperidine (Demerol)
Stimulants
Decongestants - OTC cold and allergy meds
TCAs
Atypical antipsychotics
St. John's Wart
Asthma medications
What other class of drugs is contraindicated for use with an MAOI and why? - correct answer
Seratonin agents:
SSRIs
SNRIs
Increased risk of serotonin syndrome
What are the signs and symptoms of hypertensive crisis? - correct answer - ELEVATED BLOOD
PRESSURE = or > THAN 180/120 mm Hg
Practice Skills - Pharmacodynamics and Drug Emergencies
What is the Gold Standard for treating manic episodes? - correct answer Lithium
What are the additional benefits of Lithium? - correct answer It has anti-suicidal effects and is
neuroprotective
What is the most neuroprotective treatment for bipolar disorder? - correct answer Lithium
What is the normal range for Lithium? - correct answer 0.6-1.2 mEq/L
When does Lithium toxicity occur? - correct answer 1.5 mEq/L
When do you draw a Lithium level? - correct answer Trough - 12 hours after last dose
What labs must you order before initiating Lithium? - correct answer Thyroid panel (TSH)
Serum Creatinine
BUN
Pregnancy test
ECG if >50 years old
What is the normal range for creatinine? - correct answer 0.6-1.2 mg/dL
What is the normal range for BUN? - correct answer 10-20 mg/dL
What are some of the ENDOCRINE side effects of lithium? - correct answer Hypothyroidism
Weight gain
Diabetes Insipidus (polydipsia, polyuria)
What are some of the CENTRAL NERVOUS SYSTEM side effects of Lithium? (6) - correct answer
Fine hand tremor
Fatigue
Mental cloudiness
Headaches
Nystagmus
Coarse hand tremors - with Toxicity
What are some of the DERMATOLOGICAL side effects of Lithium? (3) - correct answer
Macropapular rash
,Pruritis
Acne
What are some of the GASTROINTESTINAL side effects of Lithium? (4) - correct answer Diarrhea
Vomiting
Cramps
Anorexia
What are some misc side effects of lithium? - correct answer T-wave inversion
Leukocytosis (increased WBCs)
Signs of Lithium toxicity - correct answer Severe nausea, vomiting, diarrhea
Confusion
Convulsions
Drowsiness
Blurred vision
Slurred speech
Muscle weakness
Heart palpitations
Coarse hand tremors
Unsteadiness while standing or walking (ataxia)
What do you do if someone presents with signs of Lithium toxicity? - correct answer DC the
Lithium and check serum Lithum levels
What do you do is a patient has a lithium level of 1.3 or 1.4 without symptoms of toxicity? -
correct answer Continue to monitor the patient
What do you do if a patient has a lithium level of 1.3 or 1.4 with signs of toxicity? - correct
answer DC lithium
How is Lithium excreted? - correct answer Kidneys
What drugs reduce renal clearance of drugs excreted by the kidneys? - correct answer NSAIDs -
Ibuprofen, Indomethacin
Thiazide diuretics - hydrochlorothiazide
,ACE inhibitors - Lisinopril
Important patient education for Lithium? - correct answer Signs and symptoms of toxicity
What is the mechanism of action which makes lithium a good choice for bipolar in a depressive
stage with a history of suicide attempts? - correct answer It modulates glutamate, reducing
impulsivity and aggressive behavior, making it a great choice for patients at risk for suicide
Chemistry of most psychotropic drugs - correct answer Most drugs are lipophilic (lipid-loving)
and highly protein-bound.
Why are older adults more sensitive to psychotropic drugs? - correct answer Decreased:
- intercellular water
- protein-binding
- muscle mass
- metabolism
and
Increased body fat concentration
If someone develops Lithium toxicity, why is it crucial to DC the drug? - correct answer To
prevent further elevation of Lithium levels
If you suspect a patient has developed Lithium toxicity, why do you order a serum Lithium
level? - correct answer To confirm the diagnosis of Lithium toxicity and assess the severity of
the condition. This allows the PMHNP to determine the appropriate treatment approach based
on the Lithium level.
Why are VS and ECG not the most immediate priority when dealing with Lithium toxicity? -
correct answer Though VS and an ECG are important assessments in the management of
Lithium toxicity, these do not address the PRIMARY issue of elevated Lithium levels.
For 12 years, a 65-year-old patient with bipolar affective disorder has been treated with Lithium
(Eskalith) 900mg daily. When oral hydrochlorothiazide (HCTZ) 12.5 mg daily is added for
hypertension, the patient develops nausea, vomiting, ataxia, muscle weakness, and the
patient's serum Lithium level is 2.0 mEq/L. The interaction of the Lithiium and the Thiazide
diuretic has induced what? - correct answer Reduced renal clearance of the Lithium
What occurs when a person taking an MAOI in conjunction with foods containing tyramine? -
correct answer Hypertensive crisis
, What drugs are MAOIs? (4) - correct answer Isocarboxazid (Marplan)
Phenelzine (Nardil)
Selegiline (patch) (EMSAM)
Tranylcypromine (Parnate)
What is tyramine? - correct answer A dietary precursor to norepinephrine
Tyramine acts as a - correct answer Catecholamine releasing agent
This causes Epi/Norepi to be released
What happens when Monoamine oxidase is inhibited? - correct answer Tyramine can exert a
strong vasopressor effect, stimulating the release of catecholamines, epinephrine, and
norepinephrine = increased blood pressure and heart rate
Hypertensive crisis is life-threatening and cannot be reversed unless - correct answer More
MAO is produced by the body
What other drugs may cause a hypertensive crisis when taken with MAOIs? - correct answer
Meperidine (Demerol)
Stimulants
Decongestants - OTC cold and allergy meds
TCAs
Atypical antipsychotics
St. John's Wart
Asthma medications
What other class of drugs is contraindicated for use with an MAOI and why? - correct answer
Seratonin agents:
SSRIs
SNRIs
Increased risk of serotonin syndrome
What are the signs and symptoms of hypertensive crisis? - correct answer - ELEVATED BLOOD
PRESSURE = or > THAN 180/120 mm Hg
