1
PMHNP Quizlet with Answers
Stimulant abuse and ADHD= screen all kids (T/F)
True
Suicide risk factors
***Count risk factor
-age 45 yrs of older if male
-55 yrs or older is female
-Male
-Divorced/Single/Separated
-White
-Living alone
-Psychiatric disorder
-Substance abuse
-Physical illness
-Previous suicide
-Family hx of suicide
-Recent loss/death
Highest Suicide risk
-previous attempt
-elderly
-male
-Plan
Lithium (Li)
Normal: 0.6-1.2
Lithium toxicity can occur at 1.5 or higher
Gold standard for treating manic episodes
Has anti-suicide effects in bipolar
Neuroprotective tx of choice for Bipolar
Before Rx, Check: TSH, Creatinine, BUN, UA (4+ protein = kidney disease), HCG for
females of childbearing age (12-51 years)
Lithium s/e: hypothyroidism, find hand tremors, maculopapular rash, GI upset, diabetes
insipidus (polyuria, polydipsia), T-wave inversions, leukocytosis (increased WBC's),
Ebstein anomaly
----- Ebstein anomaly (congenital heart defect), Do a pregnancy test!!
Dehydration can increase Li level
Hyponatremia can increase Li level
**Pt shows understanding if the say "I will take extra water with me on a hike"
, 2
Lithium toxicity
Lithium toxicity can occur at 1.5 or higher
-severe nausea, vomiting, diarrhea, confusion, drowsiness, muscle weakness, heart
palpitations, coarse hand tremors, unsteady walking (ataxia
Intervention:
-D/C Lithium and check Li levels
Meds that increase lithium level by reducing renal clearance leading to toxicity:
---kidney disease, NSAIDS, thiazides, ACE inhibitors (used for cardiac failure)
· Lithium TOXICITY (1.5+) :
SEVERE GI EFFECTS nystagmus, ataxia, increased deep tendon reflexes, altered
mental status, cardiac arrhythmias
· Greater than 2.5 SEIZURES AND DEATH
· ACE, ARB, NSAID, Tetracycline, metronidazole can INCREASE LITHIUM
thiazide diuretics, theophylline INCREASE LITHIUM
· Use diuretics cautiously
Women of childbearing should get what test before starting any Antipsychotic
HCG
Clozaril reduces suicide risk in what disorder?
-schizophrenia
Neuroleptic Malignant Syndrome (NMS)
Caused by antipsychotics
-----such as haloperidol, fluphenazine, chlorpromazine, trifluoperazine, and
prochlorperazine
-Extreme muscular rigidity
-Mutism
-Hyperthermia
-Tachycardia
increased CPK (creatinine phosphokinase) d/t muscle contraction/muscle destruction
-myoglobinuria d/t breakdown of muscle cells (RHABDOMYOLYSIS)
-INcreased WBC (leukocytosis)
-Increased LFT (liver function test)
Tx: D/C offending agent
-Bromocriptine -(Dopamine 2 agonist)
-Dantrolene- muscle relaxant (for rigidity)
Tx for NMS
1. Tx: D/C offending agent (AP)
2.-Bromocriptine -(Dopamine 2 agonist)
, 3
---if question wants a tx to be dopamine agonist
-Dantrolene- muscle relaxant (for rigidity)
---if question wants tx for muscle rigidity
Serotonin Syndrome causes
What classes can increase serotonin levels
-SSRI/SRNI/TCA/MAOI .....
----don't give more than 1 drug in each class at any time
----when switching from one class to another, wait 2 weeks for drug to degenerate
(completely clear from body)
---when switching ssri to a maoi wait 2 weeks
----when switching fluoxetine (prozac) to MAOI wait 5-6 weeks
-----when switching MAOI to fluoxetine wait 2 weeks
Washout period of 5 half lives between cessation of previous drug and introduction of
new drug is the safest strategy to avoid drug interactions
Triptans for migraines (i.e. Sumatriptan) increase serotonin levels, thus cannot be taken
with SSRI/SRNI/TCA/MAOI = Serotonin Syndrome
-----give NDRI
St John Wort increase serotonin levels, thus cannot be taken with
SSRI/SRNI/TCA/MAOI =
Serotonin Syndrome
What disorders increase thoughts of self harm...
-Depression, bipolar, ETOH abuse, eating disorder, & schizophrenia
Serotonin Syndrome
-caused by antidepressants
S/E
-hyperreflexia
-myoclonic jerks
Tx: D/C offending agent
-Cyproheptadine
SSRIs is safe for....
-Ist line Tx for depression d/t low risk of overdose
-has fewer drug-drug interaction-- safe for Cancer pt.
Fluoxetine, paroxetine, sertraline, citalopram.
SSRIs (selective serotonin reuptake inhibitors)
PMHNP Quizlet with Answers
Stimulant abuse and ADHD= screen all kids (T/F)
True
Suicide risk factors
***Count risk factor
-age 45 yrs of older if male
-55 yrs or older is female
-Male
-Divorced/Single/Separated
-White
-Living alone
-Psychiatric disorder
-Substance abuse
-Physical illness
-Previous suicide
-Family hx of suicide
-Recent loss/death
Highest Suicide risk
-previous attempt
-elderly
-male
-Plan
Lithium (Li)
Normal: 0.6-1.2
Lithium toxicity can occur at 1.5 or higher
Gold standard for treating manic episodes
Has anti-suicide effects in bipolar
Neuroprotective tx of choice for Bipolar
Before Rx, Check: TSH, Creatinine, BUN, UA (4+ protein = kidney disease), HCG for
females of childbearing age (12-51 years)
Lithium s/e: hypothyroidism, find hand tremors, maculopapular rash, GI upset, diabetes
insipidus (polyuria, polydipsia), T-wave inversions, leukocytosis (increased WBC's),
Ebstein anomaly
----- Ebstein anomaly (congenital heart defect), Do a pregnancy test!!
Dehydration can increase Li level
Hyponatremia can increase Li level
**Pt shows understanding if the say "I will take extra water with me on a hike"
, 2
Lithium toxicity
Lithium toxicity can occur at 1.5 or higher
-severe nausea, vomiting, diarrhea, confusion, drowsiness, muscle weakness, heart
palpitations, coarse hand tremors, unsteady walking (ataxia
Intervention:
-D/C Lithium and check Li levels
Meds that increase lithium level by reducing renal clearance leading to toxicity:
---kidney disease, NSAIDS, thiazides, ACE inhibitors (used for cardiac failure)
· Lithium TOXICITY (1.5+) :
SEVERE GI EFFECTS nystagmus, ataxia, increased deep tendon reflexes, altered
mental status, cardiac arrhythmias
· Greater than 2.5 SEIZURES AND DEATH
· ACE, ARB, NSAID, Tetracycline, metronidazole can INCREASE LITHIUM
thiazide diuretics, theophylline INCREASE LITHIUM
· Use diuretics cautiously
Women of childbearing should get what test before starting any Antipsychotic
HCG
Clozaril reduces suicide risk in what disorder?
-schizophrenia
Neuroleptic Malignant Syndrome (NMS)
Caused by antipsychotics
-----such as haloperidol, fluphenazine, chlorpromazine, trifluoperazine, and
prochlorperazine
-Extreme muscular rigidity
-Mutism
-Hyperthermia
-Tachycardia
increased CPK (creatinine phosphokinase) d/t muscle contraction/muscle destruction
-myoglobinuria d/t breakdown of muscle cells (RHABDOMYOLYSIS)
-INcreased WBC (leukocytosis)
-Increased LFT (liver function test)
Tx: D/C offending agent
-Bromocriptine -(Dopamine 2 agonist)
-Dantrolene- muscle relaxant (for rigidity)
Tx for NMS
1. Tx: D/C offending agent (AP)
2.-Bromocriptine -(Dopamine 2 agonist)
, 3
---if question wants a tx to be dopamine agonist
-Dantrolene- muscle relaxant (for rigidity)
---if question wants tx for muscle rigidity
Serotonin Syndrome causes
What classes can increase serotonin levels
-SSRI/SRNI/TCA/MAOI .....
----don't give more than 1 drug in each class at any time
----when switching from one class to another, wait 2 weeks for drug to degenerate
(completely clear from body)
---when switching ssri to a maoi wait 2 weeks
----when switching fluoxetine (prozac) to MAOI wait 5-6 weeks
-----when switching MAOI to fluoxetine wait 2 weeks
Washout period of 5 half lives between cessation of previous drug and introduction of
new drug is the safest strategy to avoid drug interactions
Triptans for migraines (i.e. Sumatriptan) increase serotonin levels, thus cannot be taken
with SSRI/SRNI/TCA/MAOI = Serotonin Syndrome
-----give NDRI
St John Wort increase serotonin levels, thus cannot be taken with
SSRI/SRNI/TCA/MAOI =
Serotonin Syndrome
What disorders increase thoughts of self harm...
-Depression, bipolar, ETOH abuse, eating disorder, & schizophrenia
Serotonin Syndrome
-caused by antidepressants
S/E
-hyperreflexia
-myoclonic jerks
Tx: D/C offending agent
-Cyproheptadine
SSRIs is safe for....
-Ist line Tx for depression d/t low risk of overdose
-has fewer drug-drug interaction-- safe for Cancer pt.
Fluoxetine, paroxetine, sertraline, citalopram.
SSRIs (selective serotonin reuptake inhibitors)
