PMHNP REVIEWS CORE ANSWERS AND QUESTIONS
SET A+
✔✔activities that present executive functioning - ✔✔judgement and planning
- manage money and appointments, calendar, prioritize
✔✔discontinuation of SSRI - ✔✔flu like symptoms (due to cholinergic rebound,
particularly with TCA)
- fatigue and lethargy
-N/V
- decreased concentration
- parasthesia
- anxiety , irritability, crying without provocation
✔✔MAO + serotonergic agent = - ✔✔serotonin syndrome - maybe give benzos
✔✔MAO + tyramine = - ✔✔hypertensive crisis - give phentolamine
✔✔difference between grief and MDD - ✔✔in greif, self-esteem is usually preserved
✔✔when do symptoms begin in premenstrual dysphoric disorder? - ✔✔during the luteal
phase, 1 weeks before onset of menses . sx go away after 1-2 days of bleeding - MUST
be sx free period in the follicular phase
✔✔adjustment disorder timing - ✔✔- develops within 3 months of stressor
- persists no longer than 6 months ( can be chronic if longer than 6 months
- different than MDD by sx profile
✔✔BD etiology - ✔✔GABA deregulation, increased noradrenergic activity, voltage
gated ion channel abnormalities
- kindling when brain becomes overly sensitive to electrical stimulation and neuronal
misfiring occurs -- brain starts firing without stimuli
,✔✔BD prevalence - ✔✔- equal in men and women
- risk factors is first degree relative with BD or MDD
✔✔BD I criteria - ✔✔- abnormally elevated , expansive or irritable mood for at least 1
week
✔✔rapid cycling timing and more common in which gender? - ✔✔4 or more mood
episodes in 12 month period
- more common in WOMEN (90%) - antidepressants accelerate cycling, suggest poorer
prognosis
* rapid cycling seldomly responds to lithium monotherpay
✔✔Drugs that cause mania - ✔✔cimetidine
steroids
catopril
cyclosporine
disulfiram
✔✔ECG for lithium > - ✔✔only for age 50 and older -- can cause T wave inversion and
dysthrythmias
✔✔Lithium hemotolical abnormalities - ✔✔leukocytosis
✔✔lithium renal abnormalities - ✔✔Diabetes insipidus
polyuria/ polydypsia
microscoptic tubular changes
✔✔lithium skin changes - ✔✔acne
macupapular rash
itching - alopecia more common in Valproate
✔✔lithium tremors? - ✔✔can have fine hand tremor, course hand tremor is indicative of
toxicity
✔✔lithium baseline labs - ✔✔BUN/ Cr
thyroid
CBC
ECG over 50
pregnancy test
✔✔Carbamezapine risks? - ✔✔aplastic anemia (bleeding, purpura) and agranulocytosis
(fever - ANC less than 500)
✔✔Valproic acide/depakote black box warning? - ✔✔pancreatitis and hepatotoxicity
, ✔✔baseline labs for carbamezapine and val acid? - ✔✔LFTs
CBC
✔✔What medications may double lithium level? - ✔✔NSAIDs and ace inhibitors (pril)
✔✔signs of lithium toxicity - ✔✔slurred speech, severe GI, severe confusion, course
hand tremor
✔✔Carbamezapine common side effects - ✔✔GI, tremor, sedation
✔✔Depakote distinguishing features - ✔✔more effective for rapid cycling
less GI side effects
don't need to screen for HLA-B antigen
still carries risk for SJS
✔✔special screening for carbamezapine - ✔✔in asian people must screen for HLA-B
allele before initiation-- risk for SJS
✔✔Lamotrigine titration? - ✔✔slow
- 25 mg for 2 weeks
- 50 mg for 2 weeks
etc
✔✔What doubles lamotrigine level? - ✔✔concurrent use with Depakote , use with
carbamezapine may decrease level
✔✔When to draw labs with anti-epileptics? - ✔✔1 week after inititation
✔✔adolescent mania? - ✔✔more psychotic features
more substance use
usually prodrome
often seen with antisocial behavior
✔✔BD rating scale for adolescents - ✔✔Young Mania Rating Scale (higher is worse)
✔✔normal WBC - ✔✔4000 to 11,000
✔✔group that has highest rate of suicide? - ✔✔WHITE MALES OVER 85
✔✔brain abnormalities in Autism - ✔✔decreased purkinje fibers in cerebellum
- decreased hippocampus, amygdala, cerebellum
- imbalances in GABA, glutamate, serotonin
SET A+
✔✔activities that present executive functioning - ✔✔judgement and planning
- manage money and appointments, calendar, prioritize
✔✔discontinuation of SSRI - ✔✔flu like symptoms (due to cholinergic rebound,
particularly with TCA)
- fatigue and lethargy
-N/V
- decreased concentration
- parasthesia
- anxiety , irritability, crying without provocation
✔✔MAO + serotonergic agent = - ✔✔serotonin syndrome - maybe give benzos
✔✔MAO + tyramine = - ✔✔hypertensive crisis - give phentolamine
✔✔difference between grief and MDD - ✔✔in greif, self-esteem is usually preserved
✔✔when do symptoms begin in premenstrual dysphoric disorder? - ✔✔during the luteal
phase, 1 weeks before onset of menses . sx go away after 1-2 days of bleeding - MUST
be sx free period in the follicular phase
✔✔adjustment disorder timing - ✔✔- develops within 3 months of stressor
- persists no longer than 6 months ( can be chronic if longer than 6 months
- different than MDD by sx profile
✔✔BD etiology - ✔✔GABA deregulation, increased noradrenergic activity, voltage
gated ion channel abnormalities
- kindling when brain becomes overly sensitive to electrical stimulation and neuronal
misfiring occurs -- brain starts firing without stimuli
,✔✔BD prevalence - ✔✔- equal in men and women
- risk factors is first degree relative with BD or MDD
✔✔BD I criteria - ✔✔- abnormally elevated , expansive or irritable mood for at least 1
week
✔✔rapid cycling timing and more common in which gender? - ✔✔4 or more mood
episodes in 12 month period
- more common in WOMEN (90%) - antidepressants accelerate cycling, suggest poorer
prognosis
* rapid cycling seldomly responds to lithium monotherpay
✔✔Drugs that cause mania - ✔✔cimetidine
steroids
catopril
cyclosporine
disulfiram
✔✔ECG for lithium > - ✔✔only for age 50 and older -- can cause T wave inversion and
dysthrythmias
✔✔Lithium hemotolical abnormalities - ✔✔leukocytosis
✔✔lithium renal abnormalities - ✔✔Diabetes insipidus
polyuria/ polydypsia
microscoptic tubular changes
✔✔lithium skin changes - ✔✔acne
macupapular rash
itching - alopecia more common in Valproate
✔✔lithium tremors? - ✔✔can have fine hand tremor, course hand tremor is indicative of
toxicity
✔✔lithium baseline labs - ✔✔BUN/ Cr
thyroid
CBC
ECG over 50
pregnancy test
✔✔Carbamezapine risks? - ✔✔aplastic anemia (bleeding, purpura) and agranulocytosis
(fever - ANC less than 500)
✔✔Valproic acide/depakote black box warning? - ✔✔pancreatitis and hepatotoxicity
, ✔✔baseline labs for carbamezapine and val acid? - ✔✔LFTs
CBC
✔✔What medications may double lithium level? - ✔✔NSAIDs and ace inhibitors (pril)
✔✔signs of lithium toxicity - ✔✔slurred speech, severe GI, severe confusion, course
hand tremor
✔✔Carbamezapine common side effects - ✔✔GI, tremor, sedation
✔✔Depakote distinguishing features - ✔✔more effective for rapid cycling
less GI side effects
don't need to screen for HLA-B antigen
still carries risk for SJS
✔✔special screening for carbamezapine - ✔✔in asian people must screen for HLA-B
allele before initiation-- risk for SJS
✔✔Lamotrigine titration? - ✔✔slow
- 25 mg for 2 weeks
- 50 mg for 2 weeks
etc
✔✔What doubles lamotrigine level? - ✔✔concurrent use with Depakote , use with
carbamezapine may decrease level
✔✔When to draw labs with anti-epileptics? - ✔✔1 week after inititation
✔✔adolescent mania? - ✔✔more psychotic features
more substance use
usually prodrome
often seen with antisocial behavior
✔✔BD rating scale for adolescents - ✔✔Young Mania Rating Scale (higher is worse)
✔✔normal WBC - ✔✔4000 to 11,000
✔✔group that has highest rate of suicide? - ✔✔WHITE MALES OVER 85
✔✔brain abnormalities in Autism - ✔✔decreased purkinje fibers in cerebellum
- decreased hippocampus, amygdala, cerebellum
- imbalances in GABA, glutamate, serotonin
