Georgettes LMR study set 2021/2022 COMPLETE SOLUTION

Georgettes LMR study set When questions ask for a priority action...think about... ans: ABC, airway breathing, circulation Maslows hierarchy If undecided on an answer due to high similarities, choose: ans: the umbrella answer What is the most common side effect of olanzapine/zyprexa ans: metabolic syndrome what is the difference between typical and atypical antipsychotics ans: Atypical 5HT2A specific 1st psychotic break... two actions to take ans: UDS and r/o sub Consider IM Geodon or Invega Three AP with least weight gain ans: Latuda, Abilify, Geodon Always encourage interprofessional collaboration ans: between therapists/pcps/SW/RN, the ENTIRE team TSH High, then....t3/t4 ans: T3, T4 low TSH low, then...t3/t4 ans: T3, T4 high cold/hot sensitivity with t3/t4 relationship ans: T3/T4 low, hypothyroid, cold, slow T3/T4 high, hyperthyroid, hot, flushed, tachy What birth defect can be caused by depakote? ans: Spina bifida What organ does depakote cause toxicity? and what sx would you expect to see? labs to run? ans: Hepatotoxicity: RUQ pain, reddish brown urine- Do LFTs kava kava is used to treat ans: anxiety and insomnia Rash and fever associated with tegretol, suspect ans: What allele is HLAB 1502 associated? ans: Asians. They CANNOT have tegretol. Test all asians for this allele. what rare and dangerous side effects are associated with tegretol ans: Aplastic anemia Agranulocytosis-DC at ANC less than 1000 Sx's of agranulocytosis ans: unusual bleeding or bruising, mouth sores, infections, fever, sore throat, fatigue if starting a woman on lithium what test should be done? why? ans: HCG--risk of ebstein anomaly adverse s/e of lamictal/lamotrigine ans: SJS labs to checke BEFORE starting on lithium ans: BUN CRE urine protein What does protein in urine indicate ans: kidney impairment; 4+ protein in urine=you cannot start on lithium best choice med for decreasing si in bipolar disorder. ans: lithium best choice med for si in schizophrenia ans: clozaril best choice med for SI in borderline ans: lithium What medications will INCREASE Li levels ans: NSAIDS ACE's Thiazides/HCTZ Besides medications, what else can cause increased Li levels ans: dehydration hyponatremia lithium s/e inc N/V, which will effect electrolytes, and dehydration status what type of tremors will you see with lithium toxicity? ans: course tremors lithium can cause what other comorbidities? ans: hypothyroidism maculopapular rash leukocytosis twave inversion what is a defining characteristic of NMS vs SS ans: muscle rigidity Sx's/labs associated with NMS ans: Inc CPK, WBC, LFT Rhabdomyolosis myoglobinuria Can lead to mutism myoglobinuria/rhabdo can cause cherry colored urine Treatment for NMS and what each does ans: DC the offending agent bromocriptin-D2 agonis dantrolene: muscle relaxant Make sure if ? is asking for agonist or relaxant Sx of SS ans: HYPERREFLEXIA myoclonic jerks treatment for SS ans: ciproheptadine how to best PREVENT SS ans: follow proper transition protocols SSRI to MAOI=14 days Prozac to MAOI=5-6 weeks Triptans can also cause SS due to serotonin increase with use Why are SSRIs considered the safest for use in depression ans: safest for OD depressed patient presents with fatigue and low energy, consider: ans: NDRI wellbutrin sexual s/e with ssri? try... ans: wellbutrin due to lower risk of sexual s/e What medication must be avoided if client has seizure history or eating disorder? why? ans: wellbutrin due to decreasing the seizure threshold if client has depression and neuropathic pain ans: SNRI or TCA for treatment of BOTH What med class treats neuropathic pain well ans: alpha 2 delta ligands Gabapentin Lyrica What medication class is good for depression with comorbid CA ans: SSRI least chance of drug drug interactions Celexa and lexapro are good choices Black box warning on SSRI ans: inc SI in kids, esp Required education for rx ssri ans: long time for effect side effects esp n/v/d NO ABRUPT stopping d/t Serotonin discontinuation syndrome Sx's of serotonin discontinuation syndrome ans: fever, shivering, muscle aches and nausea diarrhea, agitation, cog impairment... (think flu like sx's) disequilibrium What are some scenarios that place patients at risk of a hypertensive crisis? ans: MAOI and tyramine MAOI and TCA MAOI and Atypical AP MAOI and decongestant MAOI and stimulants MAOI and asthma meds Sx of Hypertensive crisis ans: HA Diaphoresis fever facial flushing pupillary dilation palpitation Treatment for HTN Crisis ans: DC Agent Give Phenolamine age of onset for male / female schizophrenia ans: male 18-25 female 25-35 schizophrenia has high rate of suicide ans: always be assessing for SI what is the cause of schizophrenia ans: inadequate synapse formation excessive pruning of synapses intrauterine insult (drugs/toxin/viral agent/malnutrition/substance use, mental illness, o2 deprivation) on MRI /PET schizonphrenia ans: ventrical enlargement positive sx of schizophrenia caused by... ans: excess DA in mesolimbic pathway positive sx of schizophrenia on a stimulant? ans: will potentiate DA release (worsening schizophrenias positive symtpoms) bc stimulants tap into the reward and addiction pathway inc dopamine What is ACT ans: Assertive community treatment Post hospital DC not in the hospital delusions, you respond how? ans: do not try to disprove If HARMFUL delusions, notify authority Also notify potential victim how to assess mental abstraction ans: interpret a proverb assess thought process why? and potential findings ans: to assess organization of patients thoughts tangential: no rip to a ? circumstantial: gets around to anss after going in circles with unnecessary details MMSE thought content include ans: SI HI plan Hallucinations delusions MMSE/ Folstein Test assesses? ans: tool used to assess cognitive status in adults concentration/attention/calculation assessed how? ans: spell a word backward or serial 7's Registration/ability to learn new material assessed how? ans: remember 3 words orientation is assessed by ans: Person place time fund of knowledge assessed how? ans: Who is the president? Governor? clock drawing assesses? ans: takes 1-2 minutes easy to administer tests right hemisphere health,cannot do it they have a prob in R side. First generation AP ans: haldol fluphenazine Chlorpromazine thioridazine 2nd gen AP ans: rispeidone olanzapine seroquel abilify ziprasidone lurasidone clozipine excess DA in mesolimbic pathway ans: positive sx of schizophrenia decreased DA in mesocoritcal pathway ans: negative sx of schizophrenia anhedonia mask face slow speech isolative nigrostriatal pathway ans: excess DA in this pathway but it doesn't cause any sx, but when DA is decreased in this pathway due to AP (dopamine blockade) increases acetylcholine=EPS sx Tuberoinfundibular pathway ans: excess DA is normal here but when it is decreased with AP leads to increased prolactin and hyperprolactinemia what does high prolactin levels lead to ans: breast DC amenorrhea osteoporosis breast enlargement which AP is most closely associated with hyperprolactinemia ans: risperidone Male prolactin female prolactin---normals ans: male less than 20ng/ml female less than 25ng/ml EPS caused by ans: DA blockade in the NS pathway acute dystonia ans: acute sustained contraction of muscles, usually of the head and neck spasms painful treatment of acute dystonia ans: cogentin/benztropine IM, but may need Oral follow up for several days akathisia ans: ANXIETY restless cannot sit still pacing rocking 1st line treatment for akathisia? And which population to AVOID use in? 2nd line? 3rd line? ans: propranolol/or beta blocker client with asthma on bronchodilators due to increased risk of bronchospasm when given beta blockers 2nd line: cogentin/benztropine 3rd line: benzos akanesia ans: difficulty iniating motion treatment for akanesia ans: cogentin/benztropin Sx of akinesia ans: DIFFICULTY INITIATING MOVEMENT; PSEUDO PARKINSONIAN SX'S: muscle rigidity shuffling gait mask like facial expression affect may be flat or blunted pill rolling tremors (motor slowing) Tardive dyskinesia (TD)/timeframes ans: chewing/lip smacking facial dyskinesia Treatment: dec dose of offending agent or switch to a different AP or can switch to clozaril. can have onset between a few weeks and 2 years post starting of medication Reglan (metoclopramide) and compazine (prochlorperazine) can both cause? ans: TD what medication can worsen TD? ans: benztropine/cogentin Inducers ans: cause low serum levels inhibitors ans: cause high serum levles reglan and compazine can both cause ans: TD Smoking and dosing of meds ans: smoking is a strong inducer. therefore smoking increases drug metablolism and you may need to dose higher. If they stop smoking serum levels will increase. Always assess for smoking/cessation of. Antibiotics/macroglides are INHIBITORS and greatly effect what medication ans: tegratol what meds can cause mania ans: disulfram steroids isoniazide antidepressants what meds can cause depression ans: steroids beta blockers interferon accutane-can cause birth defects too if patient taking meds for a mood disorder and is on flonase or prednisone. What do you do with your dose of oxcarbazepine ans: increase the dose to adjust for the medication (steroids) influencing mania treating a patient with zoloft and starts taking interferon. what do you do with zoloft dosing? ans: increase dose of zoloft to adjust for the increase in depression for the interferon addiction neurotransmitters ans: DA GABA Gamma-aminobutyric acid main function ans: major inhibitory neurotransmitter Sx's of stimulant abuse ans: irritability insomnia tremors delayed gastric emptying-feeling fullness/bloated Pt with anorexia complains of pain after eating/bloating/fullness ans: Signs of delayed gastric emptying what meds can delay gastric empying? ans: PROTON PUMP INHIBITORS famotidine omeprazole ranitidine ANTACIDS /PPI do what to psychotropic medications? ans: Decrease absorption of psychotropic medication advise client to take other meds 2 hours AFTER antacids/PPI Older adults and SSRIs for anxiety? ans: May increase anxiety paradoxical effect Older adults and benzos? ans: May increase agitation paradoxical effect apoptosis ans: neuronal loss or cell death BP1 pneumonic ans: DIGFAST DIGFAST ans: Distractible Impulsive choices Grandiosity Flight of ideas Active Sleep not needed Talkative Borderline sx in regard to impulsivity ans: impulsivity is often with associated with recurrent SI and self harming behavior Therapy for BPD/goal/founder ans: DBT to decrease recurrent SI Marsha Linehan Conversion Disorder (Functional Neurological Symptom Disorder) ans: can be result of a stressful experience present with neuro sx: parasthesia paralysis blindness Mutism adjustment disorder (anxiety/depressive/mixed) ans: an emotional disturbance caused by ongoing stressors within the range of common experiences (dx of a new disease) (recent move) (loss of loved one) factitious disorder ans: Condition in which a person acts as if he or she has a physical or mental illness when he or she is not really sick. Ie drinking contaminated urine Reactive Attachment Disorder ans: common in kids from foster care kid goes back to real parent and may appear withdrawn, no emotions toward caregiver, FOSTER is key word Doesn't seek comfort when distressed ODD ans: NO AGGRESSION in ODD defiant to authority deliberately annoy others treatment for ODD ans: • Family Therapy with emphasis on child management skills CD conduct disorder ans: no remorse