Georgette Review PMHNP.
When many answers are remarkably similar, they are usually
Correct
answers
wrong
Interprofessional collaboration is encouraged. Correct answers Collaborate
is usually
righ
t.
Delegate is usually
wrong.
ADPIER Correct answers Assessment, diagnosis, Plan, intervention, evaluate,
refer out
last
.
Lithium Correct answers Normal
0.6-1.2
Lithium toxicity occurs at levels Correct
answers > 1.5
Signs of Lithium toxicity Correct answers severe nausea, diarrhea, vomiting,
confusion,
drowsiness, muscle weakness, heart palpitation, coarse hand tremors,
unsteady gait
Lithium is gold standard for Correct answers
MANIA
Lithium has evidence shown to Correct answers reduce suicidal
ideation
What does lithium cause in neonate, especially 1st trimester Correct
answers
anomaly Ebstein
(congenital heart
defect)
dehydration and hyponatremia cause lithium levels to Correct
answers rise
Baseline labs before initiation of lithium Correct
answers 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 Correct answers
hypothyroidism
coase hand tremors with
toxicity
maculopapular
rash
diarrhea, vomiting, cramps--signs of toxicity. Monitor
closely.
anorexi
a
t wave
inversions
leukocytos
is
,Pt education for lithimum Correct answers staying
hydrated
avoiding
NSAIDS
complianc
e
Depakote normal level Correct answers
50-125
Depakote toxicity level Correct answers greater
than 150
Teratogenic effects of Depakote Correct answers
spina bifida
Adverse effects of depakote Correct answers
alopecia
hepatotoxicity (RUQ pain or brown/red urine--order LFTs) AST 5-40,
ALT 5-35, of skin or eyes,
yellowing
fatigue
Signs of Depakote toxicity Correct answers disorientation, lethargy,
respiratory
depression,
nausea/vomiting
Intervention for depakote toxicity Correct answers
DC med
check
level
LFT
ammoni
a
MAOI + tyramine causes Correct answers
hypertensive crisis
Symptoms of hypertensive crisis Correct answers
elevatedexplosive
sudden BP like
headache
facial
flushing
palpitatio
ns
pupillary
dilation
diaphoresi
feve
s
r
Hypertensive crisis occurs with MAOI + Correct answers
MEPERIDINE
STIMULANTS
decongestan
ts
TCAs
atypical
s
St. John's
wart
L-
tryptophan
asthma
meds
Treatment for hypertensive crisis Correct answers DC
offending agent
Administer
PHENTOLAMINE
Teratogenic effects of benzos Correct answers floppy baby,
cleft palate
,Teratogenic effects of tegratol Correct answers neural
tube defect
teratogenic effects of lithium Correct answers ebstein anomaly (heart
defect) (avoid,
especially 1st
trimester)
teratogenic effects of depakote Correct answers neural tube
defects/spina bifida
Adverse reaction to Lamictal Correct answers Steven Johnson's
Syndrome
Signs of SJS Correct answers FEVER --high
yield
sore
throat
facial
swelling
tongue
swelling
red
rash
skin
sloughing
body
aches
prodromal
headache
malais
e
arthralgi
a
painful mucus
membranes
Lamotrigine is least likely to cause Correct answers sedation or
weight gain
Carbamazepine (tegretol) black box warning Correct answers
agranulocytosis
(decrease
WBCs)
aplastic anemia (pallor, fatigue, HA, fever, nosebleeds, bleeding gums, skin
rash, SOA)
Carbamazepine and asians Correct answers Screen for HLAB-1502
allele before
initiating, due to high incidence of SJS if positive
for allele.
Child-bearing aged women Correct answers check for pregnancy before
starting mood
stabiliz
er
start on folic acid to support neural tube development during the first
month that
woman is a
pregnant
Clozaril/clozapine can cause Correct answers agranulocytosis and
neutropenia
For monitoring neutropenia in Clozaril, monitor Correct
answers ANC
DC clozarli if ANC Correct answers less than
1000
DC clozaril if WBC Correct answers 2000-3000, risk of
agranulocytosis
When on clozaril monitor for Correct answers signs and symptoms of
infection:
fever, sudden
chills, sore throat,
weakness
, Clozaril only known antipsychotic to Correct answers decrease risk of suicide
in patients
with
schizophrenia.
Your patient with bipolar disorder is admitted to a medical hospital.
The internist
contacts your office and asks whether the lithium you prescribed him is
effecting
ECG. Howhis do you
respond?
A. Lithium can prolong the QT
interval
B. Lithium has no effect on his
ECG
C. Lithium can invert the t
waves
D. Lithium can shorten the PR interval Correct answers Answer: Lithium can
invert the t
waves
.
Mary is a 45-year-old African American female who has been treated on
Isocarboxazid
(Marplan) for over 6 years. Mary is going in for a surgical procedure. Which
medication
is strictly contraindicated with
Isocarboxazid?
A.
Morphine
B.
NSAIDS
C.
Methylphenidate
D. Acetaminophen Correct answers Answer:
Methylphenidate
You are treating a client with schizophrenia who takes clozapine. What lab
values will
indicate the client needs to discontinue
treatment?
A. WBC less than 1800 and ANC less than
1200
B. ANC less than
1,000
C. WBC less than
D. ANC less than 2000 Correct answers Answer: ANC less
5,000
than 1000
If given during pregnancy, socium valproate can cause which of the
following medical
problems in the
baby?
A. SJS
B. Ebstein's
anomaly
C. Spina
bifida
D. Cleft palate Correct answers A. Spina
bifida
Which mood stabilizer is associated with potential life-threatening rash
in the Asian
population
A. Carbamazepine
?
(tegretol)
B.
C.
Depakote
Lithium
D. Lamictal Correct answers A.
Carbamazepine
Bulimia, weight is Correct answers within the normal
range.
Pharm treatment for bulimia Correct answers
SSRIs and TCAs effective in reducing binging and
Fluoxetine
purging
When many answers are remarkably similar, they are usually
Correct
answers
wrong
Interprofessional collaboration is encouraged. Correct answers Collaborate
is usually
righ
t.
Delegate is usually
wrong.
ADPIER Correct answers Assessment, diagnosis, Plan, intervention, evaluate,
refer out
last
.
Lithium Correct answers Normal
0.6-1.2
Lithium toxicity occurs at levels Correct
answers > 1.5
Signs of Lithium toxicity Correct answers severe nausea, diarrhea, vomiting,
confusion,
drowsiness, muscle weakness, heart palpitation, coarse hand tremors,
unsteady gait
Lithium is gold standard for Correct answers
MANIA
Lithium has evidence shown to Correct answers reduce suicidal
ideation
What does lithium cause in neonate, especially 1st trimester Correct
answers
anomaly Ebstein
(congenital heart
defect)
dehydration and hyponatremia cause lithium levels to Correct
answers rise
Baseline labs before initiation of lithium Correct
answers 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 Correct answers
hypothyroidism
coase hand tremors with
toxicity
maculopapular
rash
diarrhea, vomiting, cramps--signs of toxicity. Monitor
closely.
anorexi
a
t wave
inversions
leukocytos
is
,Pt education for lithimum Correct answers staying
hydrated
avoiding
NSAIDS
complianc
e
Depakote normal level Correct answers
50-125
Depakote toxicity level Correct answers greater
than 150
Teratogenic effects of Depakote Correct answers
spina bifida
Adverse effects of depakote Correct answers
alopecia
hepatotoxicity (RUQ pain or brown/red urine--order LFTs) AST 5-40,
ALT 5-35, of skin or eyes,
yellowing
fatigue
Signs of Depakote toxicity Correct answers disorientation, lethargy,
respiratory
depression,
nausea/vomiting
Intervention for depakote toxicity Correct answers
DC med
check
level
LFT
ammoni
a
MAOI + tyramine causes Correct answers
hypertensive crisis
Symptoms of hypertensive crisis Correct answers
elevatedexplosive
sudden BP like
headache
facial
flushing
palpitatio
ns
pupillary
dilation
diaphoresi
feve
s
r
Hypertensive crisis occurs with MAOI + Correct answers
MEPERIDINE
STIMULANTS
decongestan
ts
TCAs
atypical
s
St. John's
wart
L-
tryptophan
asthma
meds
Treatment for hypertensive crisis Correct answers DC
offending agent
Administer
PHENTOLAMINE
Teratogenic effects of benzos Correct answers floppy baby,
cleft palate
,Teratogenic effects of tegratol Correct answers neural
tube defect
teratogenic effects of lithium Correct answers ebstein anomaly (heart
defect) (avoid,
especially 1st
trimester)
teratogenic effects of depakote Correct answers neural tube
defects/spina bifida
Adverse reaction to Lamictal Correct answers Steven Johnson's
Syndrome
Signs of SJS Correct answers FEVER --high
yield
sore
throat
facial
swelling
tongue
swelling
red
rash
skin
sloughing
body
aches
prodromal
headache
malais
e
arthralgi
a
painful mucus
membranes
Lamotrigine is least likely to cause Correct answers sedation or
weight gain
Carbamazepine (tegretol) black box warning Correct answers
agranulocytosis
(decrease
WBCs)
aplastic anemia (pallor, fatigue, HA, fever, nosebleeds, bleeding gums, skin
rash, SOA)
Carbamazepine and asians Correct answers Screen for HLAB-1502
allele before
initiating, due to high incidence of SJS if positive
for allele.
Child-bearing aged women Correct answers check for pregnancy before
starting mood
stabiliz
er
start on folic acid to support neural tube development during the first
month that
woman is a
pregnant
Clozaril/clozapine can cause Correct answers agranulocytosis and
neutropenia
For monitoring neutropenia in Clozaril, monitor Correct
answers ANC
DC clozarli if ANC Correct answers less than
1000
DC clozaril if WBC Correct answers 2000-3000, risk of
agranulocytosis
When on clozaril monitor for Correct answers signs and symptoms of
infection:
fever, sudden
chills, sore throat,
weakness
, Clozaril only known antipsychotic to Correct answers decrease risk of suicide
in patients
with
schizophrenia.
Your patient with bipolar disorder is admitted to a medical hospital.
The internist
contacts your office and asks whether the lithium you prescribed him is
effecting
ECG. Howhis do you
respond?
A. Lithium can prolong the QT
interval
B. Lithium has no effect on his
ECG
C. Lithium can invert the t
waves
D. Lithium can shorten the PR interval Correct answers Answer: Lithium can
invert the t
waves
.
Mary is a 45-year-old African American female who has been treated on
Isocarboxazid
(Marplan) for over 6 years. Mary is going in for a surgical procedure. Which
medication
is strictly contraindicated with
Isocarboxazid?
A.
Morphine
B.
NSAIDS
C.
Methylphenidate
D. Acetaminophen Correct answers Answer:
Methylphenidate
You are treating a client with schizophrenia who takes clozapine. What lab
values will
indicate the client needs to discontinue
treatment?
A. WBC less than 1800 and ANC less than
1200
B. ANC less than
1,000
C. WBC less than
D. ANC less than 2000 Correct answers Answer: ANC less
5,000
than 1000
If given during pregnancy, socium valproate can cause which of the
following medical
problems in the
baby?
A. SJS
B. Ebstein's
anomaly
C. Spina
bifida
D. Cleft palate Correct answers A. Spina
bifida
Which mood stabilizer is associated with potential life-threatening rash
in the Asian
population
A. Carbamazepine
?
(tegretol)
B.
C.
Depakote
Lithium
D. Lamictal Correct answers A.
Carbamazepine
Bulimia, weight is Correct answers within the normal
range.
Pharm treatment for bulimia Correct answers
SSRIs and TCAs effective in reducing binging and
Fluoxetine
purging
