Georgettes Module 1 & 2 With Complete Solutions

Lithium therapeutic level 0.6-1.2 Lithium toxicity level can occur at what level? 1.5 or higher Baseline labs for Lithium: TSH, Serum creat (.6-1.2), , BUN (10-20) HCG, ECG if over 50 (can cause cardiac s.e/ t wave inversion) MAOI with tyramine can cause life threatening HTN crisis. but MAOI with what else can cause it? Demerol, stimulants, sympathomemetics (L-tryptophan, TCAs, atypicals) What can you do if you have someone in HTN crisis? DC offending agent give phentolamine Taking benzos during pregnancy can cause what? floppy baby, cleft palate Taking Tegretol (carbamazepine) during pregnancy can cause what? neural tube defects Taking Lithim during pregnancy can cause what? Epsteins anomoly (avoid in FIRST trimester) Taking Depakote in pregnancy can cause what? Neural tube defect - ***spina bifida Sx of SJS FEVER sore throat facial swelling, tongue swelling rash skin sloughing prodromal HA, malaise, arthragia, painful mucus membrane before rash appears Tegretol (carbamazepine): Screen for what before starting a specific race - as it can cause SJS! HLAB-15023 allele in Asians What does Tegretol (carbamazepine) have a BB warning for? agranulocytosis and aplastic anemia (monitor for pallor, fatigue, HA, nosebleed, bleeding gums, skin rash, SOB ) This supplement (at what amount) support neural tube developement during 1st mo of pregnancy. All women of CB age should take it. Folic acid: 0.4-0.8 mg/ day For clozapine, the risk of neutropenia is monitored by what? ANC - NOT in conjunction with WBC count DB clozapine at ANC of? `less than 1,000 DC clozapine at WBC of? How often should you monitor ANC on clozaril? 1st 6 mo: weekly 2nd 6 mo: Q 2 weeks then monthly if nl ALWAYS check what lab when starting woman age 12-51 on a mood stabilizer? HCG What is different between bulemia and anorexia? BMI usually nl in bulemia BMI ususally low in anorexia What antidepressant is good for low energy and fatigue, and doesn't cause sexual dysfunction? Wellbutrin (NDRI) *contraindicated with sz or bulemic Clozaril is an atypical antipsychotic metabolized by what cytochrome P450 enzume? CYP1A2 cigarette smoking is an inducer (decreases level of drugs) Liver disease affects liver enzyme activity and first pass metabolism, resulting in? toxic plasma drug levels Kidney disease (or drugs that reduce renal clearance) like NSAIDs, Thiazides (HCTZ), and ACE inhibitors (lisinopril) can do what? increase the serum concentration of drugs excreted by the kidneys (like lithium) and decreases renal clearance What happens when someone on Lithium takes NSAIDs? can cause lithium toxicity Older adults are more sensitive to medication. Why? decreased intracellular water decreased protein binding decreased muscle mass decreased metabolism INCREASED body fat Common inducers include cigarette smoking OBCP Barbituates Carbamazepine alcohol (chronic) sulfonyureas Common inhibitors include: depakote ketoconazole fluticonazole erythrymycin cipro flagyl Where is Norepinephrine produced? locus coeruleus and reticular formation Where is serotonin produced? raphe nuclei Where is dopamine produced? substantia nigra, nucleus accumbus, VTA Where is ACH produced? Basal nucleus of Meynert What's the most inhibitory neurotransmitter? GABA bamma-ammobuteric acid) What;s the most abundant Excitatory neurotransmitter? Glutamate What can increased levels of CRH (corticotropin releasing hormone) in the amygdala, hippocampus and locus coeruleus do? increase anxiety Parents of a child with ASD may report what? no response when called by name little or no eye contact line up/stack/organize objects and toys self injurious behavior Screening tools for ASD: M-CHAT Ados-G ASQ Largest part of brain. Two halves left hemis controls Rt side and right hemis controls Lt normal Fxn: effective coordination of 2 hemispheres divided into lobes (frontal, Parietal, occipital, temporal, insula) Cerebrum corpus callosum the large band of neural fibers connecting the two brain hemispheres -carries messages between them Frontal lobe largest and most developed lobe executive function: working memory, intelligence, impulse control Broca's area Controls expressive language (an area of the frontal lobe) Temporal lobe Language (Wernickes) Speech and language comprehenision (process hearing) Occipital lobe where visual cortex is integrates vision and sensory (vision memory) (problems cause visual field defects, blindness, VH) parietal lobe think "pain" Smell/tase/temp/touch awareness of space and movement problems with this area cause sensory/perceptual disturbance and agnosia agnosia inability to interpret sensations and hence to recognize things Clock drawing test is a quick test - impairments could indicate issues with what lobe? Parietal Limbic system includes what? hypothalamus thalamus hippocampus amygdala Hypothalamus (LIttle hal) - the hormone monitor it directs several maintenance activities (eating, drinking, hunger/thirst, body temperature, circadian rhythm), helps govern the endocrine system via the pituitary gland Thalamus Mainframe Hal "Hello Hal" Processes incoming info EXCEPT SMELL Amygdala "Amy" processes smell and emotions (attaches emotion to stimulus) Hippocampus think "campus" (Library/google) memory Pituitary gland and Basal Ganglia "Bee Gees" - danger protection and hormone stimulation "Stayin alive" A client has problems with appetite, sleep, and change in libido. What part of the limbic system is responsible? hypothalamus Which serotonin receptor antangonist makes and anti-psychotic atypical? 5H2TA (this is why these meds are less likely to cause EPS) Excess Dopamine in the mesolimbic pathway can cause? postive sx schizophrenia The nigrostriatal dopamine pathway does what? mediates motor movement Think EPS Longstanding blockade of dopamine receptors can do what? lead to TD Blockage in the tuberoinfundibular dopamine pathway can do what? increase prolactin levels/lead to hyperprolactinemia, manifests as glacttorrhea acute dystonia facial grimacing acute sustained contraction of muscles, usually of the head and neck laryngeal spasms *also oculogyric crisis - prolonged upward deviation of eyes bilat Treatment for acute dystonia DC agent administer cogentin (Benztropine) - anti-cholinergic Pseudoparkinsonism stooped posture, shuffling gait, rigidity, bradykinesia, tremors at rest, pill-rolling motion of the hand Akathesia inability to remain still; motor restlessness and anxiety tardive dyskinesia protrusion and rolling of the tongue, sucking and smacking movements of the lips, chewing motion, facial dyskinesia, involuntary movements of the body and extremities Pharmacokinetics what the body does to the drug (absorbption, distribution, metabolism, excretion PharmacoDynamics what Drug Does to body Meds that cause Mania steroids disulfuram isonizid meds that cause depression steroids accutane beta blockers interferon some retrovirals anti-neoplastics benzos progesterone Fragile X mostly boys short stature large, long head and ears hyperextensible joints ID NMS -NMS is like S&M; -you get hot (hyperpyrexia) -stiff (increased muscle tone) extreme rigidity -sweaty (diaphoresis) -BP, pulse, and respirations go up & -you start to drool -mutism -increased CPK, rhabdo., Inc. WBC, Inc LFT Meds used to treat NMS muscular rigidity: Dantrolene Med used to treat NMS Bromocriptine (Parlodel) D2 agonist Serotonin Syndrome With any drug that increases 5-HT (e.g., MAO inhibitors, SNRIs, TCAs) hyperthermia, confusion, myoclonus, cardiovascular instability, flushing/sweating, diarrhea, seizures. Agent used to treat serotonin syndrome cyproheptadine (5-HT2 receptor antagonist) - anti-cholinergic When switch from SSRI to MAOI, wait how many days? Also wait this number of days when switch from MAOI to Prozac? 14 days How many days to wait when switch from Prozac to MAOI? 5-6 weeks Serotonin Discontinuation Syndrome syndrome caused by abrupt withdrawal of an antidepressant drug, resulting in flu like sx, fatigue, lethargy, muyalgia, decreased concentration, n/v, impaired memory, agitation Agonist drug binds to ion channel and activates a biological response inverse agonist causes opposite effect of agonist (closes ion channel) partial agonist a drug that binds to a receptor and causes a response that is less than that caused by a full agonist (does not fully activate receptors) antagonist binds to receptors and blocks - does not activate a biological response referential thinking ascribing personal meaning to random events (Person believes TV is talking to them) Delusions false beliefs, often of persecution or grandeur that persist despite evidence to the contrary MSE components 1. Appearance 2. Behavior 3. speech 4. Mood 5. Affect 6. Cognition 7. thought process 8. thought content 9. insight judgement 10. Concentration Serial 7s are assessing? concentration Thought Process assess the logic, relevance, organization, and coherence of patients thought processes (ex: logical, linear, goal directed, coherent) Thought content what the person thinks- specific ideas, beliefs, the use of words: SI, HI, Plan, AH/VH Asking Who the president is assesses? fund of knowledge Clock drawing test simple tool that assesses for signs of neurological issues. Impairments with the CDT can be associated with damage to which area of the brain? Rt parietal lobe Other screening tools to assess for cognitive impairments: MoCa (Montreal Cog. Assmt) Mini cog SLUM (St. Louis Mental) Name some suicide risk factors Previous SA 45 or if male 55 or if female Div, single, separated White Lives alone Psych d/o Physical illness SUD Fam hx suicide recent loss male Transference displacement of feelings for significant people in clients past - transferred onto PMHNP in present relationship Countertransference Circumstances in which a psychoanalyst develops personal feelings about a client because of perceived similarity of the client to significant people in the therapist's life. What score do you treat CIWA? And when do you give Valium/bzo? 8 or if symptom triggered method 15 or if on scheduled med Treating patient with liver disease for AUD. What med? Med with shorter half life (Ativan over Valium) How long after last drink can you give disulfuram? When stop disulfuram, how long to wait until you have a drink? 12 hours 2 weeks MMSE (Folstein) scores: 0-30 23-30 is nl 21-24 mild 10-20 moderate Remember about METHADONE can cause cardiac dysrhythmias SBIRT is guided by this acronym: FRAMES Feedback (tell them the risks of current use) Responsibility (reinforce decision to change) Advice (simple and direct based on facts about drinkin) Menu (options for behavior change) Empathetic interviewing, non-judgmental Self efficacy - encourage pt to believe they can change CAGE-aid Cut down Annoyed Guilty Eye opener (score of 1 or accurately detects 91% of ETOH or drug. Score 2 or is clinically signif.) Delerium ACUTE Change in cognition, altered LOC Inattention Poor prognosis (one yr mortality is 40%) (Is a symptom, not a disease)