LMR - Georgette's flashcard 2023/2024

LMR - Georgette's flashcard 2023/2024 Terms in this set (526) What drugs should be avoided with Kava Kava? Alprazolam CNS depressants (e.g., phenobarbital, zolpidem) What is the normal range for TSH? 0.5 - 5.0 mu/L What are lab values in Hyperthyroidism Decreased TSH Increased T4 and T3 What are labs in Hypothyroidism? Increased TSH Decreased T4 and T3 Heat intolerance What are 5 primary symptoms of Agitation, Anxiety, Irritability Hyperthyroidism? Tachycardia Mood swings Weight loss Cold intolerance What are 4 primary symptoms of Lethargy Hypothyroidism? Weight gain Decreased libido Hypothyroidism mimics symptoms of what psychiatric disorder? Depression Hyperthyroidism mimics symptoms of what psychiatric disorder? Mania Valproic acid produces what teratogenic effect? Spina bifida (neural tube defect) What is the primary organ where valproic acid is toxic? Liver (hepatoxicity) What are 4 signs of hepatoxicity? Abdominal pain in the URQ Reddish-brown urine Yellowing of the skin and sclera Fatigue What is the therapeutic range for valproic acid? 50-125 mcg/ml What is a toxic level of valproic acid? >150 mcg/ml Disorientation What are 4 signs of valproic acid toxicity? Lethargy Respiratory depression Nausea/vomiting A pt on Depakote C/O Abdominal pain in the URQ and Reddish-brown urine. What do you suspect? What do you do? Hepatotoxicity; hold med, draw LFT's (priority), DVP level With suspected toxicity with valproic acid, what steps/labs should be drawn? D/C drug Add to class or folder Check drug level Print Obtain LFTs Combine Obtain ammonia level Embed A pregnant pt is taking accutane, zyprexa and abilify; what med needs to be d/c'd? Report Accutane (used for acne; Causes birth Defects!!!) What herbal supplement is used for anxiety, stress, and insomnia? What is the major side effect with Kava Kava? Kava Kava liver damage What are 5 symptoms of Stephen's Johnson Syndrome? Fever -Key sx to suspect SJS; high yield (HY) burning of mouth/eyes -HY Body aches Severe red rash Peeling skin Facial and tongue swelling Which mood stabilizer causes the least weight gain? Lamotrigine (Lamictal) Which 3 SGAs cause the least weight gain? Lurasidone (Latuda) Aripiprazole (Abilify) Ziprasidone (Geodon) Which SGA is the least sedating? Aripiprazole (Abilify) Your pt is taking Kava and you need to add an AS to manage their SCZ, which do you add? Aripiprazole (least sedating) Acute onset What are 2 hallmark symptoms of delirium? disturbance of LOC impaired cognition inattention How are agitation and psychotic symptoms treated in delirium? Low dose Haldol (QTc check first) LMR - Georgette's 16 y/o C/O feeling funny after inhaling Acetone (nail polish remover). What is your action? Do UDS; chances are they may be abusing other substances "SAID" Steroids What 4 drugs can cause mania? Antidepressants (in BPD) Isoniazid (INH) Disulfiram (Antabuse) "SIP BARB" Steroids Interferon, Progesterone What 6 drugs can induce depression? Beta blockers Accutane, (Isotretinoin) Retroviral drugs, Antineoplastic drugs Benzodiazepines Steroids can induce what 3 psychiatric states? Mania Depression Psychosis REMEMBER SAFETY FIRST; pt s/p assault, 1st thing you do is _. What is the best environment to interview this pt in? reassure safety, provide environment of safety private area with door open/partially open What is the therapeutic range for lithium? 0.6-1.2 mEq/L Many postpartum women have SI after delivery, yet they don’t have psych evals before leaving the hospital, what could a possible solution be? collaborating care between psych and OBGYN to provide the best care for that pt If collaborating with a provider who is not in the same clinic or hospital, the informed consent [does/does not] apply? Does not, ie pt will need to sign consent for labs/ chart to be sent When discharging from inpatient you want [to fax/print off-give to pt.] labs for the outpatient provider before pt discharge? fax; so the new provider has them for follow-up appointment Before referring a pt out or discharging them, it is good to ask yourself what question? is there something that I could do for this patient first? What 3 things are MUST KNOWS about Lithium? has neuroprotective effect for bipolar disorder the gold standard for treating manic episodes the mood stabilizer w/ anti-suicidal effects Thyroid panel (TSH) Serum creatinine What 5 labs should be drawn with lithium? BUN Urinalysis HCG What is a normal SerumCr range? 0.6-1.2 mg/dL What is the normal range for BUN? 10-20 mg/dL When should you suspect kidney disease with a urinalysis? 4+ protein; if pt on Lithium-->monitor closely toxicity Hypothyroidism Fine hand tremors Maculopapular rash What are 7 side effects of lithium? GI upset (N/V/D, cramps, anorexia) Polyuria, polydipsia, diabetes insipidus T-wave inversions Leucocytosis Severe nausea, vomiting, diarrhea Confusion Drowsiness What are 7 signs of lithium toxicity? Muscle weakness Heart palpitations Coarse hand tremor Unsteadiness while standing or walking Bold =must knows Which 3 drugs can increase lithium levels by decreasing renal clearance? NSAIDs (ibuprofen, indomethacin) Thiazides ACE-I What is a toxic level of lithium? 1.5 mEq/L or higher At what level do you monitor lithium closely (but not discontinue)? 1.3 -1.4 mEq/L or higher With suspected lithium toxicity, what do you do first? D/C Li and draw Lithium level (not VS) What is the appropriate action if lithium level is 1.5 mEq/L? D/C lithium Check lithium level What 2 conditions can increase lithium levels? Dehydration Hyponatremia If this pt is going on a hike, what would you recommend ? LMR - Georgette's What birth defect can lithium cause? Ebstein anomaly (congenital heart defect) When working with adolescents, parents often feel they have a right to know what is going on with their child, but the teen has a right to confidentiality. This can create an Ethical dilemma confidentiality; When building a therapeutic alliance w/ what they say remains confidential unless they are wanting to harm self/ adolescents, it is important to stress someone else, [or they are in a relationship with someone much older (like 14 y/o seeing a 30 y/o)] if an adolescent C/O abuse, even if they make the claim in the presence of the parents, what should you do? interview the teen w/o the parents; call CPS What 3 neurotransmitters are associated with ADHD? DA, NE, 5HT aka serotonin -->(DNS) The Frontal cortex, Basal ganglia, Reticular Activating System are associated with which psychiatric disorder? ADHD Inattentive Type ADHD demonstrates abnormalities in which part of the brain? Prefrontal cortex What should be done before placing a patient on stimulants for ADHD (priority)? Cardiac history Excessive worry, apprehension, or anxiety about events or activities that occurs more days than not for a period of at least 6 months is GAD if ADHD and tic both present, what is contraindicated? Stimulants if a stimulant was tried and provided some but not enough benefit (helped, but not long enough) what can this mean? the medication has been cleared from the body What are the lower age limits for stimulants for ADHD? AMPH = 3yrs MPH = 6yrs When considering Clonidine or Guanfacine for a pt, the PMHNP knows? Clonidine is more sedating than Guanfacine; Guanfacine lasts longer than Clonidine What does thought process assess? thoughts and ideas Logical A normal thought process is described as Linear Coherent Goal-oriented Moving from thought to thought and never getting to the point is called Tangentiality ("goes on tangent") Providing unnecessary detail but eventually getting to the point is called Circumstantiality ("goes in circles") Themes that occupy a patient's thoughts and perceptual disturbances is called Thought content Thought content includes 3 items Suicidal ideation Homicidal ideation Hallucinations/Delusions Asking a patient to count backward from 100 by seven (serial 7s), or anything going backwards measures what? Concentration Attention Asking the year, season, date, month, and location measures Orientation Asking a patient to repeat "bed, red, ball" measures Registration (ability to learn new material) Asking a patient to repeat objects 5 minutes later measures Recall (memory) Asking the patient who is the president of the US or governor of state is measuring Fund of Knowledge What is a simple test that can be administered in a minute or two to measure possible dementia? Clock Drawing Test Impairments in the clock drawing test (CDT) can be associated with damage to Right parietal lobe (right hemisphere) Hyperactivity of dopamine in the mesolimbic pathway to the dorsolateral prefrontal cortex (DLPFC) modulates positive psychotic symptoms The safest drug switch strategy is to have a "washout period" of half-lives between cessation of old med and the introduction of the new med. 5 1/2 Decreased dopamine in the mesocortical pathway (dorsolateral prefrontal cortex) leads to what 2 symptoms? Negative symptoms: affect, anhedonia, asociality, alogia, apathy, avolition, Depressive symptoms The nigrostriatal pathway modulates motor movements Dopamine has what type of relationship with acetycholine Inverse Acute dystonia: stiff neck, muscle spasms neck/back, painful Dopamine blockage in the nigrostriatal pathway Parkinsonism syndromes leads to what 4 side effects? Akathisia Tardive dyskinesia Blocking DA in the tuberoinfundibular pathway leads to Increased prolactin Amenorrhea Galactorrhea What are 5 symptoms of hyperprolactinemia? Sexual dysfunction Gynecomastia Osteoporosis (Long-term) What antipsychotic has the greatest effect on prolactin? Risperidone What is the black box warning for carbamazepine? Agranulocytosis and SJS in Asians (+) for HLA-B*1502 allele Pallor Fatigue Headache What are 8 symptoms of aplastic anemia? Fever Nosebleeds Bleeding gums Skin rash SOB In which ethnic group must you screen for the HLA-B*1502 allele before initiating CBZ (Tegretol) therapy? Why is it necessary? Asians risk for SJS in Asians (+) for HLA-B*1502 allele Which 2 drugs have the highest likelihood of causing agranulocytosis? Clozaril Carbamazepine A sudden fever, chills, a sore throat, and weakness are symptoms of Agranulocytosis LMR - Georgette's At what ANC should clozapine be stopped (even if asymptomatic)? <1000 What is neutropenia? <2000 PMNs or WBC <2000 What is agranulocytosis? <500 ANC Distractibility Indiscretion Grandiosity What does DIGFAST stand for? FOI Activity increased Sleep decreased Talkativeness Blindness What neurological symptoms might one see in Mutism Paralysis Conversion Disorder? Paresthesia (glove stocking syndrome) Seizures When do symptoms typically begin with Conversion Disorder? After a stressful experience (suddenly) Family move What are 5 stressful events in a child's life that can Parent divorce/separation Loss of pet cause adjustment disorder? Birth of sibling Sudden or chronic illness A child with an Adjustment Disorder with disturbances of conduct may have what symptoms? Not going to school, destroying property, driving recklessly, or fighting NOT aggressive (key difference vs CD) loses temper easily annoys others What are some key sx of Oppositional Defiant angry/resentful Disorder (ODD)? argues with authority easily annoyed blames others spiteful refuses to comply with rules/requests from authority figures What is the mainstay treatment of Oppositional Defiant Disorder (ODD)? Therapy, individual and family What is the primary therapy used to treat Oppositional Defiant Disorder (ODD)? Child and parent problem-solving skills training, boundary setting