Georgettes LMR study set Exam

ABC, airway breathing, circulation Maslows hierarchy If undecided on an answer due to high similarities, choose: the umbrella answer What is the most common side effect of olanzapine/zyprexa metabolic syndrome what is the difference between typical and atypical antipsychotics Atypical 5HT2A specific 1st psychotic break... two actions to take UDS and r/o sub Consider IM Geodon or Invega Three AP with least weight gain Latuda, Abilify, Geodon Always encourage interprofessional collaboration between therapists/pcps/SW/RN, the ENTIRE team TSH High, then....t3/t4 T3, T4 low TSH low, then...t3/t4 T3, T4 high cold/hot sensitivity with t3/t4 relationship T3/T4 low, hypothyroid, cold, slow T3/T4 high, hyperthyroid, hot, flushed, tachy What birth defect can be caused by depakote? Spina bifida What organ does depakote cause toxicity? and what sx would you expect to see? labs to run? Hepatotoxicity: RUQ pain, reddish brown urine- Do LFTs kava kava is used to treat anxiety and insomnia Rash and fever associated with tegretol, suspect What allele is HLAB 1502 associated? Asians. They CANNOT have tegretol. Test all asians for this allele. what rare and dangerous side effects are associated with tegretol Aplastic anemia Agranulocytosis-DC at ANC less than 1000 Sx's of agranulocytosis unusual bleeding or bruising, mouth sores, infections, fever, sore throat, fatigue if starting a woman on lithium what test should be done? why? HCG--risk of ebstein anomaly adverse s/e of lamictal/lamotrigine SJS labs to checke BEFORE starting on lithium BUN CRE urine protein What does protein in urine indicate kidney impairment; 4+ protein in urine=you cannot start on lithium best choice med for decreasing si in bipolar disorder. lithium best choice med for si in schizophrenia clozaril best choice med for SI in borderline lithium What medications will INCREASE Li levels NSAIDS ACE's Thiazides/HCTZ Besides medications, what else can cause increased Li levels 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? course tremors lithium can cause what other comorbidities? hypothyroidism maculopapular rash leukocytosis twave inversion what is a defining characteristic of NMS vs SS muscle rigidity Sx's/labs associated with NMS Inc CPK, WBC, LFT Rhabdomyolosis myoglobinuria Can lead to mutism myoglobinuria/rhabdo can cause cherry colored urine Treatment for NMS and what each does DC the offending agent bromocriptin-D2 agonis dantrolene: muscle relaxant Make sure if ? is asking for agonist or relaxant Sx of SS HYPERREFLEXIA myoclonic jerks treatment for SS ciproheptadine how to best PREVENT SS follow proper transition protocols SSRI to MAOI=14 days Prozac to MAOI=5-6 weeks Triptans (Imitrex sumatriptan) can also cause SS due to serotonin increase with the use give any NDRI welbutrin Why are SSRIs considered the safest for use in depression safest for OD first line treatment for depression antidepressant for cancer citalopram and escitalopramless drug to drug interactions depressed patient presents with fatigue and low energy, consider: NDRI wellbutrin sexual s/e with ssri? try... wellbutrin due to lower risk of sexual s/e What medication must be avoided if client has seizure history or eating disorder? why? wellbutrin due to decreasing the seizure threshold if client has depression and neuropathic pain SNRI or TCA for treatment of BOTH What med class treats neuropathic pain well alpha 2 delta ligands Gabapentin Lyrica What medication class is good for depression with comorbid CA SSRI least chance of drug drug interactions Celexa and lexapro are good choices Black box warning on SSRI increase SH kids, and young adult Required education for rx ssri long time for effect side effects esp n/v/d NO ABRUPT stopping d/t Serotonin discontinuation syndrome what to ask when client is depressed (additional question) alcohol use Sx's of serotonin discontinuation syndrome 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? MAOI and tyramine MAOI and TCA MAOI and Atypical AP MAOI and decongestant MAOI and stimulants MAOI and asthma meds Sx of Hypertensive crisis HA Diaphoresis fever facial flushing pupillary dilation palpitation Treatment for HTN Crisis DC Agent Give Phenolamine age of onset for male / female schizophrenia male 18-25 female 25-35 schizophrenia has high rate of suicide always be assessing for SI what is the cause of schizophrenia inadequate synapse formation excessive pruning of synapses intrauterine insult (drugs/toxin/viral agent/malnutrition/substance use, mental illness, o2 deprivation) on MRI /PET schizonphrenia ventrical enlargement positive sx of schizophrenia caused by... excess DA in mesolimbic pathway positive sx of schizophrenia on a stimulant? will potentiate DA release (worsening schizophrenias positive symtpoms) bc stimulants tap into the reward and addiction pathway inc dopamine What is ACT Assertive community treatment Post hospital DC not in the hospital delusions, you respond how? do not try to disprove If HARMFUL delusions, notify authority Also notify potential victim how to assess mental abstraction interpret a proverb assess thought process why? and potential findings 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 SI HI plan Hallucinations delusions MMSE/ Folstein Test assesses? tool used to assess cognitive status in adults concentration/attention/calculation assessed how? spell a word backward or serial 7's Registration/ability to learn new material assessed how? remember 3 words orientation is assessed by Person place time fund of knowledge assessed how? Who is the president? Governor? clock drawing assesses? takes 1-2 minutes easy to administer tests right hemisphere health,cannot do it they have a prob in R side. First generation AP haldol fluphenazine Chlorpromazine thioridazine 2nd gen AP rispeidone olanzapine seroquel abilify ziprasidone lurasidone clozipine excess DA in mesolimbic pathway positive sx of schizophrenia decreased DA in mesocoritcal pathway negative sx of schizophrenia anhedonia mask face slow speech isolative nigrostriatal pathway 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 excess DA is normal here but when it is decreased with AP leads to increased prolactin and hyperprolactinemia