George e Review PMHNP 2026 complete
solu on
When many answers are remarkably similar, they are usually _____________
wrong
Interprofessional collabora on is encouraged.
Collaborate is usually right.
Delegate is usually wrong.
ADPIER
Assessment, diagnosis, Plan, interven on, evaluate, refer out last.
Lithium
Normal 0.6-1.2
Lithium toxicity occurs at levels
> 1.5
Signs of Lithium toxicity
severe nausea, diarrhea, vomi ng, confusion, drowsiness, muscle weakness, heart
palpita on, coarse hand tremors, unsteady gait
Lithium is gold standard for
MANIA
Lithium has evidence shown to
reduce suicidal idea on
What does lithium cause in neonate, especially 1st trimester
Ebstein anomaly (congenital heart defect)
dehydra on and hyponatremia cause lithium levels to
rise
Baseline labs before ini a on of lithium
TSH
crea nine (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, vomi ng, cramps--signs of toxicity. Monitor closely.
anorexia
t wave inversions
leukocytosis
Pt educa on 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, fa gue
Signs of Depakote toxicity
disorienta on, lethargy, respiratory depression, nausea/vomi ng
Interven on 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
palpita ons
pupillary dila on
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, cleE 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 reac on 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
seda on or weight gain
Carbamazepine (tegretol) black box warning
agranulocytosis (decrease WBCs)
aplas c anemia (pallor, fa gue, HA, fever, nosebleeds, bleeding gums, skin rash, SOA)
Carbamazepine and asians
Screen for HLAB-1502 allele before ini a ng, due to high incidence of SJS if posi ve for
allele.
Child-bearing aged women
check for pregnancy before star ng 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
2000-3000, risk of agranulocytosis
solu on
When many answers are remarkably similar, they are usually _____________
wrong
Interprofessional collabora on is encouraged.
Collaborate is usually right.
Delegate is usually wrong.
ADPIER
Assessment, diagnosis, Plan, interven on, evaluate, refer out last.
Lithium
Normal 0.6-1.2
Lithium toxicity occurs at levels
> 1.5
Signs of Lithium toxicity
severe nausea, diarrhea, vomi ng, confusion, drowsiness, muscle weakness, heart
palpita on, coarse hand tremors, unsteady gait
Lithium is gold standard for
MANIA
Lithium has evidence shown to
reduce suicidal idea on
What does lithium cause in neonate, especially 1st trimester
Ebstein anomaly (congenital heart defect)
dehydra on and hyponatremia cause lithium levels to
rise
Baseline labs before ini a on of lithium
TSH
crea nine (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, vomi ng, cramps--signs of toxicity. Monitor closely.
anorexia
t wave inversions
leukocytosis
Pt educa on 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, fa gue
Signs of Depakote toxicity
disorienta on, lethargy, respiratory depression, nausea/vomi ng
Interven on 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
palpita ons
pupillary dila on
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, cleE 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 reac on 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
seda on or weight gain
Carbamazepine (tegretol) black box warning
agranulocytosis (decrease WBCs)
aplas c anemia (pallor, fa gue, HA, fever, nosebleeds, bleeding gums, skin rash, SOA)
Carbamazepine and asians
Screen for HLAB-1502 allele before ini a ng, due to high incidence of SJS if posi ve for
allele.
Child-bearing aged women
check for pregnancy before star ng 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
2000-3000, risk of agranulocytosis
