PMHNP EXAM PREP
Study online at https://quizlet.com/_bd6frl
Process of quality improvement (PDSA-plan, do, study, act)
designed to improved systems, decrease
Quality Improvement :
cost, and improve productivity
ethnic group with highest suicide rate Native Americans
Thyroid-Stimulating Hormone TSH: level 0.5-5
depression
· Hypothyroidism mimic symptoms of
·T4 and T3 low= hypothyroidism
What labs would you see?
TSH above 5
= cold intolerance, lethargy, weight gain,
S&S of Hypothyroidism (Myxedema)
decreased libido
· Hyperthyroidism mimic symptoms of Mania
what? T4 and T3 are high= hyperthyroidism
What labs would you see? TSH decrease (below 0.5)
Same as hypermetabolism...
agitated,
nervous,
S/S of hyperthyroidism diarrhea,
heat Intolerant,
^HR, ^BP,
thin, hyperactive etc.
Depakote level 50-100
150
disorientation (rise in ammonia), lethera-
py, respiratory depression, nausea/ vom-
Depakote Toxicity level and s/s and treat-
iting
ment
check valporic acid level, LFT, AMMO-
NIA
Birth defect associated with depakote
spina bifida
during pregnancy
Organs affected with depakote Liver! Hepatoxicity
- elevated liver enzymes AST (5-40) &
ALT (5-35)
- abdominal pain
, PMHNP EXAM PREP
Study online at https://quizlet.com/_bd6frl
- anorexia
- unusual fatigue
s/s of hepatotoxicity - dark urine
- pale stools
- yellow eyes/skin
Kava anxiety , stress, and insomnia
·
· Can cause liver damage - DO LFT
KAVA s/e and contraindication · Can cause drowsiness- heavily seda-
tion
o AVOID : BENZO, CNS, SEDATIVES
Increased level of corticotrophin releas-
increase symptoms of anxiety come
ing hormone in the amygdala, hippocam-
from what in the brain
pus and locus coeruleus
· Mood stabilizer that causes the least
·Lamictal has what positive trait
weight gain/ metabolic syndrome
· SJS: Fever, body aches, red rash, peel-
most notable s/e of Lamitcal
ing skin, facial tongue swelling
Antipsychotic that cause least weigh Lurasidone, Aripiprazole (least sedating,
gain Ziprasidone -ZAL
· For those that can cause weight gain
check:
o BMI, hip-to-waist ratio, glucose, lipid
Management of Weight Gain in APS panel
meds
· If stable but gaining weight try nutritional
counseling, CBT, If ineffective switch to
ZAL
agranulocytosis, aplastic anemia:
·Angranuloxytois (decrease WBC)
Carbamazepine black box warning
aplastic anemia (pallor, fatigue, HA,
fever, bosebleeds/bleeding gums, skin
rash, SOB
CARBAMAZEPINE DRUG LEVEL 4-12 mcg/mL
, PMHNP EXAM PREP
Study online at https://quizlet.com/_bd6frl
When do you d/c Clozaril/Carba- ANC less than 1000
mazepine WBC less than 3000
· During first 6 months: weekly
Clozaril lab testing then during second 6 months: q 2 weeks
then monthly if ANC normal
Carbemazepine/Clozaril
What meds cause agranulocytosis and
s/s to watch for o Monitor for sign of infection (sudden
fever, chills, sore throat, weakness)
When on carbamazepine- SJS: par-
ticularly Asian population (screen for
Asians need testing for?
HLAB-1502 allelle) as they are higher
risk of SJS
mood stabilizer that is neuroprotective
and reduces risk of suicide in bipolar Lithium
disorder
Lithium level (0.6-1.2)
TSH (0.5-5)
Creatinine (o.6-1.2)
Labs to monitor when on Lithium BUN (10-20)
Urinalysis (4+ protein in urine)-kidney
disease=risk of toxicity
HCG for 12-51 yo women.
LMNOP:
Lithium side effects -
Movement (tremor)
Nephrogenic diabetes insipidus (ADH
antagonist)-polyuria, polydipsia
side effects of lithium hypOthyroidism
Pregnancy problems
T-wave inversion
leukocytosis
maculopapular rash
lithium toxicity s/s
, PMHNP EXAM PREP
Study online at https://quizlet.com/_bd6frl
o Severe nausea, vomiting, diarrhea,
confusion, drowsiness, muscle weak-
ness, heart palpitations, coarse hand
tremors, unsteadiness while standing or
walking
o 1.5 lithium level or higher= d/c Lithium
and check Lithium levels
birth defects caused by Lithium ebstein anomaly
Recommended Folic acid intake take 0.4-0.8mg of folic acid daily
A genetic disorder involving an abnor-
mality in the X chromosome, which be-
comes constricted and often breaks.
Fragile X Syndrome
short stature but large features: long
head
ears, hyperflexible joints
What electrolyte imbalance increase Dehydration and hyponatremia..... hyper-
Lithium kalemia
reduce renal clearance increase serum
Lithium and Kidney Disease concentrations of drugs that are excreted
by the kidneys (such as lithium)=toxicity
-thiazides
-NSAIDs
-ACE inhibitors
Drugs that increase Lithium levels
-Dehydration
-Elderly
-Renal Disease
· Extreme muscular rigidity
Distinct Neuroleptic Malignant Syn- · Mutism
drome s/s · Hyperthermia, tachycarida, diaphore-
sis, altered LOC
· Elevated CPK (creatine phospohoki-
nases)- muscles controntaction/muscle
destruction
Study online at https://quizlet.com/_bd6frl
Process of quality improvement (PDSA-plan, do, study, act)
designed to improved systems, decrease
Quality Improvement :
cost, and improve productivity
ethnic group with highest suicide rate Native Americans
Thyroid-Stimulating Hormone TSH: level 0.5-5
depression
· Hypothyroidism mimic symptoms of
·T4 and T3 low= hypothyroidism
What labs would you see?
TSH above 5
= cold intolerance, lethargy, weight gain,
S&S of Hypothyroidism (Myxedema)
decreased libido
· Hyperthyroidism mimic symptoms of Mania
what? T4 and T3 are high= hyperthyroidism
What labs would you see? TSH decrease (below 0.5)
Same as hypermetabolism...
agitated,
nervous,
S/S of hyperthyroidism diarrhea,
heat Intolerant,
^HR, ^BP,
thin, hyperactive etc.
Depakote level 50-100
150
disorientation (rise in ammonia), lethera-
py, respiratory depression, nausea/ vom-
Depakote Toxicity level and s/s and treat-
iting
ment
check valporic acid level, LFT, AMMO-
NIA
Birth defect associated with depakote
spina bifida
during pregnancy
Organs affected with depakote Liver! Hepatoxicity
- elevated liver enzymes AST (5-40) &
ALT (5-35)
- abdominal pain
, PMHNP EXAM PREP
Study online at https://quizlet.com/_bd6frl
- anorexia
- unusual fatigue
s/s of hepatotoxicity - dark urine
- pale stools
- yellow eyes/skin
Kava anxiety , stress, and insomnia
·
· Can cause liver damage - DO LFT
KAVA s/e and contraindication · Can cause drowsiness- heavily seda-
tion
o AVOID : BENZO, CNS, SEDATIVES
Increased level of corticotrophin releas-
increase symptoms of anxiety come
ing hormone in the amygdala, hippocam-
from what in the brain
pus and locus coeruleus
· Mood stabilizer that causes the least
·Lamictal has what positive trait
weight gain/ metabolic syndrome
· SJS: Fever, body aches, red rash, peel-
most notable s/e of Lamitcal
ing skin, facial tongue swelling
Antipsychotic that cause least weigh Lurasidone, Aripiprazole (least sedating,
gain Ziprasidone -ZAL
· For those that can cause weight gain
check:
o BMI, hip-to-waist ratio, glucose, lipid
Management of Weight Gain in APS panel
meds
· If stable but gaining weight try nutritional
counseling, CBT, If ineffective switch to
ZAL
agranulocytosis, aplastic anemia:
·Angranuloxytois (decrease WBC)
Carbamazepine black box warning
aplastic anemia (pallor, fatigue, HA,
fever, bosebleeds/bleeding gums, skin
rash, SOB
CARBAMAZEPINE DRUG LEVEL 4-12 mcg/mL
, PMHNP EXAM PREP
Study online at https://quizlet.com/_bd6frl
When do you d/c Clozaril/Carba- ANC less than 1000
mazepine WBC less than 3000
· During first 6 months: weekly
Clozaril lab testing then during second 6 months: q 2 weeks
then monthly if ANC normal
Carbemazepine/Clozaril
What meds cause agranulocytosis and
s/s to watch for o Monitor for sign of infection (sudden
fever, chills, sore throat, weakness)
When on carbamazepine- SJS: par-
ticularly Asian population (screen for
Asians need testing for?
HLAB-1502 allelle) as they are higher
risk of SJS
mood stabilizer that is neuroprotective
and reduces risk of suicide in bipolar Lithium
disorder
Lithium level (0.6-1.2)
TSH (0.5-5)
Creatinine (o.6-1.2)
Labs to monitor when on Lithium BUN (10-20)
Urinalysis (4+ protein in urine)-kidney
disease=risk of toxicity
HCG for 12-51 yo women.
LMNOP:
Lithium side effects -
Movement (tremor)
Nephrogenic diabetes insipidus (ADH
antagonist)-polyuria, polydipsia
side effects of lithium hypOthyroidism
Pregnancy problems
T-wave inversion
leukocytosis
maculopapular rash
lithium toxicity s/s
, PMHNP EXAM PREP
Study online at https://quizlet.com/_bd6frl
o Severe nausea, vomiting, diarrhea,
confusion, drowsiness, muscle weak-
ness, heart palpitations, coarse hand
tremors, unsteadiness while standing or
walking
o 1.5 lithium level or higher= d/c Lithium
and check Lithium levels
birth defects caused by Lithium ebstein anomaly
Recommended Folic acid intake take 0.4-0.8mg of folic acid daily
A genetic disorder involving an abnor-
mality in the X chromosome, which be-
comes constricted and often breaks.
Fragile X Syndrome
short stature but large features: long
head
ears, hyperflexible joints
What electrolyte imbalance increase Dehydration and hyponatremia..... hyper-
Lithium kalemia
reduce renal clearance increase serum
Lithium and Kidney Disease concentrations of drugs that are excreted
by the kidneys (such as lithium)=toxicity
-thiazides
-NSAIDs
-ACE inhibitors
Drugs that increase Lithium levels
-Dehydration
-Elderly
-Renal Disease
· Extreme muscular rigidity
Distinct Neuroleptic Malignant Syn- · Mutism
drome s/s · Hyperthermia, tachycarida, diaphore-
sis, altered LOC
· Elevated CPK (creatine phospohoki-
nases)- muscles controntaction/muscle
destruction
