Georgette's LMR In-class activity

Georgette's LMR In-class activity What should you not do when advocating for a patient? - Judge or confront What class of medication is contraindicated with tics? - Stimulants What should you provide for prior to assessing abuse victims? - A safe environment What are your actions if a child reports abuse? - First interview separately from parents then report to CPS What should you do if a child plays with toys in a way that you suspect abuse? - Report to CPS In what setting as an inpatient provider should you interview a patient? - Use a private room with the door partially open How should you begin your interview with adolescents? - By building rapport with them by ensuring confidentiality absent exceptions Should you interview adolescents with or without parents? - Without What if an adolescent tells you they are homosexual and they don't want their parents to know? - This is confidential The patient is being discharged and would like their labs faxed to the rehab facility. What is your initial action? - Get informed consent/ROI What do you do if a medical evaluation is needed? - Refer out - this is out of scope What do you do if a patient is takes something and is feeling really funny/unwell in your office? - Collect UDS and then refer out Is it considered a mental illness if it is an expected response culturally? What do you offer as treatment? - No; brief supportive therapy - not medication A mother states her child is experiencing a cultural illness. What is your initial action? - Respect the mother's cultural understanding of illness prior to assessment Native Americans view mental illness and SUDs as? - An imbalance between the individual and the world What ethnic group has the highest rate of suicidality in the US? - Native Americans If a patient believes they need a healing stick in their room, but the staff nurses removed it from them - what should you do? - Teach cultural sensitivity and make accommodations for patient to have healing stick available such as 1:1 Psychoeducation should be based on? - Cultural context How do you promote health in a location with multiple ethnicities and education levels? - Multiple cultural education and ethnospecific assessment parameters What if a patient wants a traditional healer? - Allow this - remember ROI/informed consent Normal TSH? - 0.5-5.0 TSH 0.5 = ? - Hyperthyroidism TSH 5.0 = ? - Hypothyroidism Relationship between TSH & T3/T4? - Inverse Hyperthyroidism can present as? - Mania Hypothyroidism can present as? - Depression Normal depakote level? - 50-125 Toxic depakote level? - 150+ Birth defect caused by depakote? - Spina Bifida S/S of depakote toxicity? - Disorientation, lethargy, decreased respiratory rate, and N/V What to do if there is depakote toxicity? - D/C depakote and check VPA level, LFTs, and ammonia S/S of hepatotoxicity? - RUQ pain, reddish brown urine, jaundice, fatigue, and elevated LFTs Normal AST? - 5-40 Normal ALT? - 5-35 Kava kava can cause? - Liver damage and heavy sedation Kava kava is c/i with? - Benzos or sedatives Mood stabilizer most associated with SJS? - Lamictal Mood stabilizer with least weight gain? - Lamictal SGAs with least weight gain? - ziprasidone, abilify, and latuda Least sedating SGA? - Abilify Routine labs with SGAs? - BMI, hip to waist ratio, glucose, A1C, and lipid panel Management of metabolic syndrome with SGAs? - 1. Nonpharm = exercise or nutritional counseling 2. Pharm = switch to other SGA with lower chance of metabolic syndrome Carbamazepine can cause? - Agranulocytosis and aplastic anemia What should you screen for prior to starting Asians on carbamazepine and why? - HLAB1502 Allele; risk of SJS When should you d/c carbamazepine if agranulocytosis is suspected? - If ANC is 1000 with or without s/s of infection Lithium range? - 0.6 - 1.2 What to do if lithium is 1.3 or 1.4? - Monitor What to do if lithium is 1.5+? - D/C Benefits of lithium? - Gold standard for mania, neuroprotective, and antisuicidal effects S/S of lithium toxicity? - Severe N/V, polydipsia, polyuria, leukocytosis, palpitations, coarse tremor What to do if lithium toxicity is suspected? - D/C and check serum levels prior to checking VS Kidney disease and drugs that reduce renal clearance can raise lithium levels. What are these drugs? - NSAIDs, ace inhibitors for heart failure (-pril), and thiazides (HCTZ) What demonstrates understanding of education on lithium? - Taking extra water with patient when they go hiking NMS s/s? - Extreme muscle rigidity, mutism, elevated CPK (muscle contraction and destruction), myoglobinuria (breakdown of muscle cells, rhabdomyolysis), increased WBCs, and increased LFTs Treatment of NMS and MOAs? - D/C med, bromocriptine (D2 agonist), and dantrolene (muscle relaxant) Serotonin syndrome s/s? - Hyperreflexia and myoclonic jerks Serotonin syndrome causes? - SSRIs, SNRIs, MAOIs, -triptans (for migraines like sumatriptan/imitrex) Treatment for serotonin syndrome? - D/C med and administer cyproheptadine Wash out from SSRI to MAOI or vice-versa? - 14 days Wash out from Prozac to MAOI? - 5-6 weeks Drug choice for patient that is depressed and also has cancer? - Celexa or lexapro d/t fewer drug to drug interactions Drug choice for patient with low energy and fatigue with depression? - Wellbutrin