GEORGETTES LMR STUDY SET
When questions ask for a priority action...think about... - ✔ABC, airway breathing,
circulation
Maslows hierarchy
If undecided on an answer due to high similarities, choose: - ✔the umbrella answer
What is the most common side effect of olanzapine/zyprexa - ✔metabolic syndrome
what is the difference between typical and atypical antipsychotics - ✔Atypical 5HT2A
specific
1st psychotic break... two actions to take - ✔UDS and r/o sub
Consider IM Geodon or Invega
Three AP with least weight gain - ✔Latuda, Abilify, Geodon
Always encourage interprofessional collaboration - ✔between therapists/pcps/SW/RN,
the ENTIRE team
TSH High, then....t3/t4 - ✔T3, T4 low
TSH low, then...t3/t4 - ✔T3, T4 high
cold/hot sensitivity with t3/t4 relationship - ✔T3/T4 low, hypothyroid, cold, slow
T3/T4 high, hyperthyroid, hot, flushed, tachy
What birth defect can be caused by depakote? - ✔Spina bifida
What organ does depakote cause toxicity? and what sx would you expect to see? labs
to run? - ✔Hepatotoxicity: RUQ pain, reddish brown urine-
Do LFTs
kava kava is used to treat - ✔anxiety and insomnia
Rash and fever associated with tegretol, suspect - ✔
What allele is HLAB 1502 associated? - ✔Asians. They CANNOT have tegretol. Test all
asians for this allele.
what rare and dangerous side effects are associated with tegretol - ✔Aplastic anemia
Agranulocytosis-DC at ANC less than 1000
Sx's of agranulocytosis - ✔unusual bleeding or bruising, mouth sores, infections, fever,
sore throat, fatigue
,GEORGETTES LMR STUDY SET
if starting a woman on lithium what test should be done? why? - ✔HCG--risk of ebstein
anomaly
adverse s/e of lamictal/lamotrigine - ✔SJS
labs to checke BEFORE starting on lithium - ✔BUN
CRE
urine protein
What does protein in urine indicate - ✔kidney impairment; 4+ protein in urine=you
cannot start on lithium
best choice med for decreasing si in bipolar disorder. - ✔lithium
best choice med for si in schizophrenia - ✔clozaril
best choice med for SI in borderline - ✔lithium
What medications will INCREASE Li levels - ✔NSAIDS
ACE's
Thiazides/HCTZ
Besides medications, what else can cause increased Li levels - ✔dehydration
hyponatremia
lithium s/e inc N/V, which will effect electrolytes, and dehydration status
what type of tremors will you see with lithium toxicity? - ✔course tremors
lithium can cause what other comorbidities? - ✔hypothyroidism
maculopapular rash
leukocytosis
twave inversion
what is a defining characteristic of NMS vs SS - ✔muscle rigidity
Sx's/labs associated with NMS - ✔Inc CPK, WBC, LFT
Rhabdomyolosis
myoglobinuria
Can lead to mutism
myoglobinuria/rhabdo can cause cherry colored urine
Treatment for NMS and what each does - ✔DC the offending agent
bromocriptin-D2 agonis
, GEORGETTES LMR STUDY SET
dantrolene: muscle relaxant
Make sure if ? is asking for agonist or relaxant
Sx of SS - ✔HYPERREFLEXIA
myoclonic jerks
treatment for SS - ✔ciproheptadine
how to best PREVENT SS - ✔follow proper transition protocols
SSRI to MAOI=14 days
Prozac to MAOI=5-6 weeks
Triptans (Imitrex sumatriptan) can also cause SS due to serotonin increase with the use
give any NDRI welbutrin
Why are SSRIs considered the safest for use in depression - ✔safest for OD first line
treatment for depression
antidepressant for cancer - ✔citalopram and escitalopramless drug to drug interactions
depressed patient presents with fatigue and low energy, consider: - ✔NDRI wellbutrin
sexual s/e with ssri? try... - ✔wellbutrin due to lower risk of sexual s/e
What medication must be avoided if client has seizure history or eating disorder? why? -
✔wellbutrin due to decreasing the seizure threshold
if client has depression and neuropathic pain - ✔SNRI or TCA for treatment of BOTH
What med class treats neuropathic pain well - ✔alpha 2 delta ligands
Gabapentin
Lyrica
What medication class is good for depression with comorbid CA - ✔SSRI
least chance of drug drug interactions
Celexa and lexapro are good choices
Black box warning on SSRI - ✔increase SH kids, and young adult
Required education for rx ssri - ✔long time for effect
side effects esp n/v/d
NO ABRUPT stopping d/t Serotonin discontinuation syndrome
what to ask when client is depressed (additional question) - ✔alcohol use
When questions ask for a priority action...think about... - ✔ABC, airway breathing,
circulation
Maslows hierarchy
If undecided on an answer due to high similarities, choose: - ✔the umbrella answer
What is the most common side effect of olanzapine/zyprexa - ✔metabolic syndrome
what is the difference between typical and atypical antipsychotics - ✔Atypical 5HT2A
specific
1st psychotic break... two actions to take - ✔UDS and r/o sub
Consider IM Geodon or Invega
Three AP with least weight gain - ✔Latuda, Abilify, Geodon
Always encourage interprofessional collaboration - ✔between therapists/pcps/SW/RN,
the ENTIRE team
TSH High, then....t3/t4 - ✔T3, T4 low
TSH low, then...t3/t4 - ✔T3, T4 high
cold/hot sensitivity with t3/t4 relationship - ✔T3/T4 low, hypothyroid, cold, slow
T3/T4 high, hyperthyroid, hot, flushed, tachy
What birth defect can be caused by depakote? - ✔Spina bifida
What organ does depakote cause toxicity? and what sx would you expect to see? labs
to run? - ✔Hepatotoxicity: RUQ pain, reddish brown urine-
Do LFTs
kava kava is used to treat - ✔anxiety and insomnia
Rash and fever associated with tegretol, suspect - ✔
What allele is HLAB 1502 associated? - ✔Asians. They CANNOT have tegretol. Test all
asians for this allele.
what rare and dangerous side effects are associated with tegretol - ✔Aplastic anemia
Agranulocytosis-DC at ANC less than 1000
Sx's of agranulocytosis - ✔unusual bleeding or bruising, mouth sores, infections, fever,
sore throat, fatigue
,GEORGETTES LMR STUDY SET
if starting a woman on lithium what test should be done? why? - ✔HCG--risk of ebstein
anomaly
adverse s/e of lamictal/lamotrigine - ✔SJS
labs to checke BEFORE starting on lithium - ✔BUN
CRE
urine protein
What does protein in urine indicate - ✔kidney impairment; 4+ protein in urine=you
cannot start on lithium
best choice med for decreasing si in bipolar disorder. - ✔lithium
best choice med for si in schizophrenia - ✔clozaril
best choice med for SI in borderline - ✔lithium
What medications will INCREASE Li levels - ✔NSAIDS
ACE's
Thiazides/HCTZ
Besides medications, what else can cause increased Li levels - ✔dehydration
hyponatremia
lithium s/e inc N/V, which will effect electrolytes, and dehydration status
what type of tremors will you see with lithium toxicity? - ✔course tremors
lithium can cause what other comorbidities? - ✔hypothyroidism
maculopapular rash
leukocytosis
twave inversion
what is a defining characteristic of NMS vs SS - ✔muscle rigidity
Sx's/labs associated with NMS - ✔Inc CPK, WBC, LFT
Rhabdomyolosis
myoglobinuria
Can lead to mutism
myoglobinuria/rhabdo can cause cherry colored urine
Treatment for NMS and what each does - ✔DC the offending agent
bromocriptin-D2 agonis
, GEORGETTES LMR STUDY SET
dantrolene: muscle relaxant
Make sure if ? is asking for agonist or relaxant
Sx of SS - ✔HYPERREFLEXIA
myoclonic jerks
treatment for SS - ✔ciproheptadine
how to best PREVENT SS - ✔follow proper transition protocols
SSRI to MAOI=14 days
Prozac to MAOI=5-6 weeks
Triptans (Imitrex sumatriptan) can also cause SS due to serotonin increase with the use
give any NDRI welbutrin
Why are SSRIs considered the safest for use in depression - ✔safest for OD first line
treatment for depression
antidepressant for cancer - ✔citalopram and escitalopramless drug to drug interactions
depressed patient presents with fatigue and low energy, consider: - ✔NDRI wellbutrin
sexual s/e with ssri? try... - ✔wellbutrin due to lower risk of sexual s/e
What medication must be avoided if client has seizure history or eating disorder? why? -
✔wellbutrin due to decreasing the seizure threshold
if client has depression and neuropathic pain - ✔SNRI or TCA for treatment of BOTH
What med class treats neuropathic pain well - ✔alpha 2 delta ligands
Gabapentin
Lyrica
What medication class is good for depression with comorbid CA - ✔SSRI
least chance of drug drug interactions
Celexa and lexapro are good choices
Black box warning on SSRI - ✔increase SH kids, and young adult
Required education for rx ssri - ✔long time for effect
side effects esp n/v/d
NO ABRUPT stopping d/t Serotonin discontinuation syndrome
what to ask when client is depressed (additional question) - ✔alcohol use
