(2024) Georgette Review PMHNP.
When many answers are remarkably similar, they are usually _____________
Answer - wrong
Interprofessional collaboration is encouraged. Answer - Collaborate is usually right.
Delegate is usually wrong.
ADPIER Answer - Assessment, diagnosis, Plan, intervention, evaluate, refer out last.
Lithium Answer - Normal 0.6-1.2
Lithium toxicity occurs at levels Answer - > 1.5
Signs of Lithium toxicity Answer - severe nausea, diarrhea, vomiting, confusion,
drowsiness, muscle weakness, heart palpitation, coarse hand tremors, unsteady gait
Lithium is gold standard for Answer - MANIA
Lithium has evidence shown to Answer - reduce suicidal ideation
What does lithium cause in neonate, especially 1st trimester Answer - Ebstein
anomaly (congenital heart defect)
dehydration and hyponatremia cause lithium levels to Answer - rise
Baseline labs before initiation of lithium Answer - TSH
creatinine (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 Answer - hypothyroidism
coase hand tremors with toxicity
maculopapular rash
diarrhea, vomiting, cramps--signs of toxicity. Monitor closely.
anorexia
t wave inversions
,leukocytosis
Pt education for lithimum Answer - staying hydrated
avoiding NSAIDS
compliance
Depakote normal level Answer - 50-125
Depakote toxicity level Answer - greater than 150
Teratogenic effects of Depakote Answer - spina bifida
Adverse effects of depakote Answer - alopecia
hepatotoxicity (RUQ pain or brown/red urine--order LFTs) AST 5-40, ALT 5-35,
yellowing of skin or eyes, fatigue
Signs of Depakote toxicity Answer - disorientation, lethargy, respiratory depression,
nausea/vomiting
Intervention for depakote toxicity Answer - DC med
check level
LFT
ammonia
MAOI + tyramine causes Answer - hypertensive crisis
Symptoms of hypertensive crisis Answer - elevated BP
sudden explosive like headache
facial flushing
palpitations
pupillary dilation
diaphoresis
fever
Hypertensive crisis occurs with MAOI + Answer - MEPERIDINE
STIMULANTS
decongestants
TCAs
atypicals
St. John's wart
L-tryptophan
asthma meds
Treatment for hypertensive crisis Answer - DC offending agent
Administer PHENTOLAMINE
Teratogenic effects of benzos Answer - floppy baby, cleft palate
Teratogenic effects of tegratol Answer - neural tube defect
, teratogenic effects of lithium Answer - ebstein anomaly (heart defect) (avoid,
especially 1st trimester)
teratogenic effects of depakote Answer - neural tube defects/spina bifida
Adverse reaction to Lamictal Answer - Steven Johnson's Syndrome
Signs of SJS Answer - 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 Answer - sedation or weight gain
Carbamazepine (tegretol) black box warning Answer - agranulocytosis (decrease
WBCs)
aplastic anemia (pallor, fatigue, HA, fever, nosebleeds, bleeding gums, skin rash,
SOA)
Carbamazepine and asians Answer - Screen for HLAB-1502 allele before initiating,
due to high incidence of SJS if positive for allele.
Child-bearing aged women Answer - check for pregnancy before starting mood
stabilizer
start on folic acid to support neural tube development during the first month that a
woman is pregnant
Clozaril/clozapine can cause Answer - agranulocytosis and neutropenia
For monitoring neutropenia in Clozaril, monitor Answer - ANC
DC clozarli if ANC Answer - less than 1000
DC clozaril if WBC Answer - 2000-3000, risk of agranulocytosis
When on clozaril monitor for Answer - signs and symptoms of infection: sudden
fever, chills, sore throat, weakness
Clozaril only known antipsychotic to Answer - decrease risk of suicide in patients
with schizophrenia.
When many answers are remarkably similar, they are usually _____________
Answer - wrong
Interprofessional collaboration is encouraged. Answer - Collaborate is usually right.
Delegate is usually wrong.
ADPIER Answer - Assessment, diagnosis, Plan, intervention, evaluate, refer out last.
Lithium Answer - Normal 0.6-1.2
Lithium toxicity occurs at levels Answer - > 1.5
Signs of Lithium toxicity Answer - severe nausea, diarrhea, vomiting, confusion,
drowsiness, muscle weakness, heart palpitation, coarse hand tremors, unsteady gait
Lithium is gold standard for Answer - MANIA
Lithium has evidence shown to Answer - reduce suicidal ideation
What does lithium cause in neonate, especially 1st trimester Answer - Ebstein
anomaly (congenital heart defect)
dehydration and hyponatremia cause lithium levels to Answer - rise
Baseline labs before initiation of lithium Answer - TSH
creatinine (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 Answer - hypothyroidism
coase hand tremors with toxicity
maculopapular rash
diarrhea, vomiting, cramps--signs of toxicity. Monitor closely.
anorexia
t wave inversions
,leukocytosis
Pt education for lithimum Answer - staying hydrated
avoiding NSAIDS
compliance
Depakote normal level Answer - 50-125
Depakote toxicity level Answer - greater than 150
Teratogenic effects of Depakote Answer - spina bifida
Adverse effects of depakote Answer - alopecia
hepatotoxicity (RUQ pain or brown/red urine--order LFTs) AST 5-40, ALT 5-35,
yellowing of skin or eyes, fatigue
Signs of Depakote toxicity Answer - disorientation, lethargy, respiratory depression,
nausea/vomiting
Intervention for depakote toxicity Answer - DC med
check level
LFT
ammonia
MAOI + tyramine causes Answer - hypertensive crisis
Symptoms of hypertensive crisis Answer - elevated BP
sudden explosive like headache
facial flushing
palpitations
pupillary dilation
diaphoresis
fever
Hypertensive crisis occurs with MAOI + Answer - MEPERIDINE
STIMULANTS
decongestants
TCAs
atypicals
St. John's wart
L-tryptophan
asthma meds
Treatment for hypertensive crisis Answer - DC offending agent
Administer PHENTOLAMINE
Teratogenic effects of benzos Answer - floppy baby, cleft palate
Teratogenic effects of tegratol Answer - neural tube defect
, teratogenic effects of lithium Answer - ebstein anomaly (heart defect) (avoid,
especially 1st trimester)
teratogenic effects of depakote Answer - neural tube defects/spina bifida
Adverse reaction to Lamictal Answer - Steven Johnson's Syndrome
Signs of SJS Answer - 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 Answer - sedation or weight gain
Carbamazepine (tegretol) black box warning Answer - agranulocytosis (decrease
WBCs)
aplastic anemia (pallor, fatigue, HA, fever, nosebleeds, bleeding gums, skin rash,
SOA)
Carbamazepine and asians Answer - Screen for HLAB-1502 allele before initiating,
due to high incidence of SJS if positive for allele.
Child-bearing aged women Answer - check for pregnancy before starting mood
stabilizer
start on folic acid to support neural tube development during the first month that a
woman is pregnant
Clozaril/clozapine can cause Answer - agranulocytosis and neutropenia
For monitoring neutropenia in Clozaril, monitor Answer - ANC
DC clozarli if ANC Answer - less than 1000
DC clozaril if WBC Answer - 2000-3000, risk of agranulocytosis
When on clozaril monitor for Answer - signs and symptoms of infection: sudden
fever, chills, sore throat, weakness
Clozaril only known antipsychotic to Answer - decrease risk of suicide in patients
with schizophrenia.
