Georgette Review In-class activity

Georgette Review In-class activity When many answers are remarkably similar, they are usually _____________ - wrong Interprofessional collaboration is encouraged. - Collaborate is usually right. Delegate is usually wrong. ADPIER - Assessment, diagnosis, Plan, intervention, evaluate, refer out last. Lithium - Normal 0.6-1.2 Lithium toxicity occurs at levels - 1.5 Signs of Lithium toxicity - severe nausea, diarrhea, vomiting, confusion, drowsiness, muscle weakness, heart palpitation, coarse hand tremors, unsteady gait Lithium is gold standard for - MANIA Lithium has evidence shown to - reduce suicidal ideation What does lithium cause in neonate, especially 1st trimester - Ebstein anomaly (congenital heart defect) dehydration and hyponatremia cause lithium levels to - rise Baseline labs before initiation of lithium - 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 - 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 - staying hydrated avoiding NSAIDS compliance Depakote normal level - 50-125 Depakote toxicity level - greater than 150 Teratogenic effects of Depakote - spina bifida Adverse effects of depakote - 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 - disorientation, lethargy, respiratory depression, nausea/vomiting Intervention for depakote toxicity - DC med check level LFT ammonia MAOI + tyramine causes - hypertensive crisis Symptoms of hypertensive crisis - elevated BP sudden explosive like headache facial flushing palpitations pupillary dilation diaphoresis fever Hypertensive crisis occurs with MAOI + - MEPERIDINE STIMULANTS decongestants TCAs atypicals St. John's wart L-tryptophan asthma meds Treatment for hypertensive crisis - DC offending agent Administer PHENTOLAMINE Teratogenic effects of benzos - floppy baby, cleft palate Teratogenic effects of tegratol - neural tube defect teratogenic effects of lithium - ebstein anomaly (heart defect) (avoid, especially 1st trimester) teratogenic effects of depakote - neural tube defects/spina bifida Adverse reaction to Lamictal - Steven Johnson's Syndrome Signs of SJS - FEVER --high yield sore throat facial swelling tongue swelling red rash skin sloughing body aches prodromal headache malaise arthralgia painful mucus membranes Lamotrigine is least likely to cause - sedation or weight gain Carbamazepine (tegretol) black box warning - agranulocytosis (decrease WBCs) aplastic anemia (pallor, fatigue, HA, fever, nosebleeds, bleeding gums, skin rash, SOA) Carbamazepine and asians - Screen for HLAB-1502 allele before initiating, due to high incidence of SJS if positive for allele. Child-bearing aged women - check for pregnancy before starting mood stabilizer start on folic acid to support neural tube development during the first month that a woman is pregnant Clozaril/clozapine can cause - agranulocytosis and neutropenia For monitoring neutropenia in Clozaril, monitor - ANC DC clozarli if ANC - less than 1000 DC clozaril if WBC - , risk of agranulocytosis When on clozaril monitor for - signs and symptoms of infection: sudden fever, chills, sore throat, weakness Clozaril only known antipsychotic to - decrease risk of suicide in patients with schizophrenia. Your patient with bipolar disorder is admitted to a medical hospital. The internist contacts your office and asks whether the lithium you prescribed him is effecting his ECG. How do you respond? A. Lithium can prolong the QT interval B. Lithium has no effect on his ECG C. Lithium can invert the t waves D. Lithium can shorten the PR interval - Answer: Lithium can invert the t waves. Mary is a 45-year-old African American female who has been treated on Isocarboxazid (Marplan) for over 6 years. Mary is going in for a surgical procedure. Which medication is strictly contraindicated with Isocarboxazid? A. Morphine B. NSAIDS C. Methylphenidate D. Acetaminophen - Answer: Methylphenidate You are treating a client with schizophrenia who takes clozapine. What lab values will indicate the client needs to discontinue treatment? A. WBC less than 1800 and ANC less than 1200 B. ANC less than 1,000 C. WBC less than 5,000 D. ANC less than 2000 - Answer: ANC less than 1000 If given during pregnancy, socium valproate can cause which of the following medical problems in the baby? A. SJS B. Ebstein's anomaly C. Spina bifida D. Cleft palate - A. Spina bifida Which mood stabilizer is associated with potential life-threatening rash in the Asian population? A. Carbamazepine (tegretol) B. Depakote C. Lithium D. Lamictal - A. Carbamazepine Bulimia, weight is ___________ - within the normal range. Pharm treatment for bulimia - Fluoxetine SSRIs and TCAs effective in reducing binging and purging Signs of anorexia nervosa - low BMI Amennorrhea Emaciation Bradycardua Hypotension Pharm treatment for anorexia - there is none therapy Which of the following physical exam findings would help the PMHNP differentiate anorexia nervosa from bulimia nervosa? A. Russell sign B. Low BMI C. Erosion of dental enamel D. Hypertrophy of salivary glands - Low BMI If a patient is depression, low energy, fatigued, you would prescribe - Wellbutrin Wellbutrin is contraindicated in patients with - seizure disorder or conditions that increase risk of seizures such as eating disorder. Which of the following medications has a unique mechanism that is both a norepinephrine and dopamine reuptake inhibitor? A. Bupropion (Wellbutrin) B. Sertraline (Zoloft) C. Clomipramine (Anafranil) D. Duloxetine (Cymbalta) - bupropion CLozaril is metabolized by - cytochrome P450 enzyme CYP1A2 INducers - induce metabolism and therefore decrease serum levels of other drugs that are substrates Smoking will do what to drug levels - decrease therapeutic levels of the drug