Georgette Review PMHNP.
When many answers are remarkably similar, they are usually _____________ ANS: wrong
Interprofessional collaboration is encouraged. ANS: Collaborate is usually right.
Delegate is usually wrong.
ADPIER ANS: Assessment, diagnosis, Plan, intervention, evaluate, refer out last.
Lithium ANS: Normal 0.6-1.2
Lithium toxicity occurs at levels ANS: > 1.5
Signs of Lithium toxicity ANS: severe nausea, diarrhea, vomiting, confusion, drowsiness, muscle
weakness, heart palpitation, coarse hand tremors, unsteady gait
Lithium is gold standard for ANS: MANIA
Lithium has evidence shown to ANS: reduce suicidal ideation
What does lithium cause in neonate, especially 1st trimester ANS: Ebstein anomaly (congenital heart
defect)
dehydration and hyponatremia cause lithium levels to ANS: rise
Baseline labs before initiation of lithium ANS: 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 ANS: 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 ANS: staying hydrated
avoiding NSAIDS
compliance
Depakote normal level ANS: 50-125
Depakote toxicity level ANS: greater than 150
Teratogenic effects of Depakote ANS: spina bifida
Adverse effects of depakote ANS: 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 ANS: disorientation, lethargy, respiratory depression, nausea/vomiting
Intervention for depakote toxicity ANS: DC med
check level
LFT
ammonia
MAOI + tyramine causes ANS: hypertensive crisis
Symptoms of hypertensive crisis ANS: elevated BP
sudden explosive like headache
facial flushing
palpitations
pupillary dilation
diaphoresis
fever
Hypertensive crisis occurs with MAOI + ANS: MEPERIDINE
STIMULANTS
decongestants
TCAs
atypicals
St. John's wart
, L-tryptophan
asthma meds
Treatment for hypertensive crisis ANS: DC offending agent
Administer PHENTOLAMINE
Teratogenic effects of benzos ANS: floppy baby, cleft palate
Teratogenic effects of tegratol ANS: neural tube defect
teratogenic effects of lithium ANS: ebstein anomaly (heart defect) (avoid, especially 1st trimester)
teratogenic effects of depakote ANS: neural tube defects/spina bifida
Adverse reaction to Lamictal ANS: Steven Johnson's Syndrome
Signs of SJS ANS: FEVER --high yield
sore throat
facial swelling
tongue swelling
red rash
skin sloughing
body aches
prodromal headache
malaise
When many answers are remarkably similar, they are usually _____________ ANS: wrong
Interprofessional collaboration is encouraged. ANS: Collaborate is usually right.
Delegate is usually wrong.
ADPIER ANS: Assessment, diagnosis, Plan, intervention, evaluate, refer out last.
Lithium ANS: Normal 0.6-1.2
Lithium toxicity occurs at levels ANS: > 1.5
Signs of Lithium toxicity ANS: severe nausea, diarrhea, vomiting, confusion, drowsiness, muscle
weakness, heart palpitation, coarse hand tremors, unsteady gait
Lithium is gold standard for ANS: MANIA
Lithium has evidence shown to ANS: reduce suicidal ideation
What does lithium cause in neonate, especially 1st trimester ANS: Ebstein anomaly (congenital heart
defect)
dehydration and hyponatremia cause lithium levels to ANS: rise
Baseline labs before initiation of lithium ANS: 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 ANS: 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 ANS: staying hydrated
avoiding NSAIDS
compliance
Depakote normal level ANS: 50-125
Depakote toxicity level ANS: greater than 150
Teratogenic effects of Depakote ANS: spina bifida
Adverse effects of depakote ANS: 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 ANS: disorientation, lethargy, respiratory depression, nausea/vomiting
Intervention for depakote toxicity ANS: DC med
check level
LFT
ammonia
MAOI + tyramine causes ANS: hypertensive crisis
Symptoms of hypertensive crisis ANS: elevated BP
sudden explosive like headache
facial flushing
palpitations
pupillary dilation
diaphoresis
fever
Hypertensive crisis occurs with MAOI + ANS: MEPERIDINE
STIMULANTS
decongestants
TCAs
atypicals
St. John's wart
, L-tryptophan
asthma meds
Treatment for hypertensive crisis ANS: DC offending agent
Administer PHENTOLAMINE
Teratogenic effects of benzos ANS: floppy baby, cleft palate
Teratogenic effects of tegratol ANS: neural tube defect
teratogenic effects of lithium ANS: ebstein anomaly (heart defect) (avoid, especially 1st trimester)
teratogenic effects of depakote ANS: neural tube defects/spina bifida
Adverse reaction to Lamictal ANS: Steven Johnson's Syndrome
Signs of SJS ANS: FEVER --high yield
sore throat
facial swelling
tongue swelling
red rash
skin sloughing
body aches
prodromal headache
malaise
