Georgettes LMR study set/PMHNP
Review items
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
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
Review items
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
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
