Georgette Review PMHNP EXAM FREQUENTLY MOST TESTED QUESTIONS AND VERIFIED SOLUTIONS
Lithium Normal 0.6-1.2
Lithium toxicity occurs at levels > 1.5
Signs of Lithium toxicity severe nausea, diarrhea, vomiting, confusion, drowsiness, muscle weakness,
heart palpitation, coarse hand tremors, unsteady gait
Lithium is gold standard for MANIA
Lithium has evidence shown to reduce suicidal ideation
What does lithium cause in neonate, especially 1st Ebstein anomaly (congenital heart defect)
trimester
dehydration and hyponatremia cause lithium levels to rise
Baseline labs before initiation of lithium 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 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 staying hydrated
avoiding NSAIDS
compliance
Depakote normal level 50-125
Depakote toxicity level greater than 150
Teratogenic effects of Depakote spina bifida
Adverse effects of depakote alopecia
hepatotoxicity (RUQ pain or brown/red urine--order LFTs) AST 5-40, ALT 5-35,
yellowing of skin or eyes, fatigue
, Georgette Review PMHNP EXAM FREQUENTLY MOST TESTED QUESTIONS AND VERIFIED SOLUTIONS
Signs of Depakote toxicity disorientation, lethargy, respiratory depression, nausea/vomiting
Intervention for depakote toxicity DC med
check level
LFT
ammonia
MAOI + tyramine causes hypertensive crisis
Symptoms of hypertensive crisis elevated BP
sudden explosive like headache
facial flushing
palpitations
pupillary dilation
diaphoresis
fever
Hypertensive crisis occurs with MAOI + MEPERIDINE
STIMULANTS
decongestants
TCAs
atypicals
St. John's wart
L-tryptophan
asthma meds
Treatment for hypertensive crisis DC offending agent
Administer PHENTOLAMINE
Teratogenic effects of benzos floppy baby, cleft palate
Teratogenic effects of tegratol neural tube defect
teratogenic effects of lithium ebstein anomaly (heart defect) (avoid, especially 1st trimester)
teratogenic effects of depakote neural tube defects/spina bifida
Adverse reaction to Lamictal Steven Johnson's Syndrome
, Georgette Review PMHNP EXAM FREQUENTLY MOST TESTED QUESTIONS AND VERIFIED SOLUTIONS
Signs of SJS 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 sedation or weight gain
Carbamazepine (tegretol) black box warning agranulocytosis (decrease WBCs)
aplastic anemia (pallor, fatigue, HA, fever, nosebleeds, bleeding gums, skin
rash, SOA)
Carbamazepine and asians Screen for HLAB-1502 allele before initiating, due to high incidence of SJS if
positive for allele.
Child-bearing aged women 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 agranulocytosis and neutropenia
For monitoring neutropenia in Clozaril, monitor ANC
DC clozarli if ANC less than 1000
DC clozaril if WBC 2000-3000, risk of agranulocytosis
When on clozaril monitor for signs and symptoms of infection: sudden fever, chills, sore throat, weakness
Clozaril only known antipsychotic to decrease risk of suicide in patients with schizophrenia.
Lithium Normal 0.6-1.2
Lithium toxicity occurs at levels > 1.5
Signs of Lithium toxicity severe nausea, diarrhea, vomiting, confusion, drowsiness, muscle weakness,
heart palpitation, coarse hand tremors, unsteady gait
Lithium is gold standard for MANIA
Lithium has evidence shown to reduce suicidal ideation
What does lithium cause in neonate, especially 1st Ebstein anomaly (congenital heart defect)
trimester
dehydration and hyponatremia cause lithium levels to rise
Baseline labs before initiation of lithium 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 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 staying hydrated
avoiding NSAIDS
compliance
Depakote normal level 50-125
Depakote toxicity level greater than 150
Teratogenic effects of Depakote spina bifida
Adverse effects of depakote alopecia
hepatotoxicity (RUQ pain or brown/red urine--order LFTs) AST 5-40, ALT 5-35,
yellowing of skin or eyes, fatigue
, Georgette Review PMHNP EXAM FREQUENTLY MOST TESTED QUESTIONS AND VERIFIED SOLUTIONS
Signs of Depakote toxicity disorientation, lethargy, respiratory depression, nausea/vomiting
Intervention for depakote toxicity DC med
check level
LFT
ammonia
MAOI + tyramine causes hypertensive crisis
Symptoms of hypertensive crisis elevated BP
sudden explosive like headache
facial flushing
palpitations
pupillary dilation
diaphoresis
fever
Hypertensive crisis occurs with MAOI + MEPERIDINE
STIMULANTS
decongestants
TCAs
atypicals
St. John's wart
L-tryptophan
asthma meds
Treatment for hypertensive crisis DC offending agent
Administer PHENTOLAMINE
Teratogenic effects of benzos floppy baby, cleft palate
Teratogenic effects of tegratol neural tube defect
teratogenic effects of lithium ebstein anomaly (heart defect) (avoid, especially 1st trimester)
teratogenic effects of depakote neural tube defects/spina bifida
Adverse reaction to Lamictal Steven Johnson's Syndrome
, Georgette Review PMHNP EXAM FREQUENTLY MOST TESTED QUESTIONS AND VERIFIED SOLUTIONS
Signs of SJS 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 sedation or weight gain
Carbamazepine (tegretol) black box warning agranulocytosis (decrease WBCs)
aplastic anemia (pallor, fatigue, HA, fever, nosebleeds, bleeding gums, skin
rash, SOA)
Carbamazepine and asians Screen for HLAB-1502 allele before initiating, due to high incidence of SJS if
positive for allele.
Child-bearing aged women 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 agranulocytosis and neutropenia
For monitoring neutropenia in Clozaril, monitor ANC
DC clozarli if ANC less than 1000
DC clozaril if WBC 2000-3000, risk of agranulocytosis
When on clozaril monitor for signs and symptoms of infection: sudden fever, chills, sore throat, weakness
Clozaril only known antipsychotic to decrease risk of suicide in patients with schizophrenia.
