NURS 663 Exam 1 Actual Exam Questions And Answers

NURS 663 Exam 1 Actual Exam Questions And Answers Manic Episode - ANSWER- -Elevated, expansive, or irritable mood for at least 1 week -Usually hospitalization -Severe impairment -3 of the following symptoms (4 if the mood is only irritable): D-distractibility I-indiscretion or irresponsibility G-grandiosity or inflated self-esteem F-flight of ideas, racing thoughts A-activity increased S-sleep need is decreased T-talkative, pressure of speech DIGFAST - ANSWER- D-distractibility I-indiscretion or irresponsibility G-grandiosity or inflated self-esteem F-flight of ideas, racing thoughts A-activity increased S-sleep need is decreased T-talkative, pressure of speech Hypomanic episode - ANSWER- Manic symptoms that don't meet full criteria -Same symptoms but only 4 days instead of a week -No hospitalization -No severe impairment Bipolar Type 1 - ANSWER- At least 1 manic episode (can have a major depressive episode but not required) Bipolar Type 2 - ANSWER- At least 1 hypomanic episode, and at least 1 major depressive episode -NO manic episodes ever Cyclothymia - ANSWER- Less severe/intense bipolar -At least 2 years, periods of hypomania and depressive symptoms -Never without symptoms for more than 2 months Dysthymia - ANSWER- Less severe MDD that's more chronic -Always sad baseline -Depressed mood for at least 2 years but not full MDD criteria (only 2 symptoms needed) -Never without symptoms for more than 2 months Major Depressive Disorder (MDD) - ANSWER- -At least 2 weeks and is a change from baseline -At least 1 symptom is either depressed mood, or anhedonia (lack of interest/pleasure) -4 or more other symptoms: -Weight loss/gain, appetite change -Psychomotor agitation/retardation -Insomnia/hypersomnia -Fatigue/lack of energy -Decreased concentration -Suicidal ideation Bipolar - Rapid Cycling - ANSWER- 4 or more mood episodes in a year Treatment for Bipolar (quick list) - ANSWER- Mood stabilizers 1st choice - lithium 2nd - anticonvulsants (valproic acid, carbamezapine, lamotrigine) 3rd - antispychotics Big things to know with mood stabilizers - ANSWER- Indicated for: bipolar, cyclothymia, schizoaffective, impulse control, intermittent explosive disorders -Check pregnancy test for all! -Lab work for levels of most of the meds -Steven Johnson's syndrome common side effect -Tremors common side effect -Liver or kidney toxicity (depending which med) 1st choice med for Bipolar - ANSWER- Lithium 2nd choice med for Bipolar - ANSWER- Anticonvulsants as mood stabilizers Valproic acid Lamotrigine Carbamazepine 3rd choice med for Bipolar - ANSWER- Antipsychotics Lithium - Indication - ANSWER- "Gold standard" treatment for bipolar depression Manic episodes Maintenance treatment for bipolar with history of mania - prophylaxis for manic AND depressive episodes *Only med to reduce suicide rate in bipolar* Lithium - MOA - ANSWER- Exact MOA is unknown Alters serotonin & catecholamines Lithium - Starting Doses - ANSWER- 300mg BID or TID Adjust upward as indicated by plasma levels Acute Mania: 1.0-1.5 mEq/L Maintenance: 0.6-1.2 mEq/L Lithium - Side Effects - ANSWER- LITHIUMS L - levels (0.6-1.2) I - increased urination T - thirsty, tremors H - hair thinning, hypothyroidism I - interactions - NSAIDS, ACE/ARBs, diuretics U - upset stomach (N/V/D) M - muscle weakness S - skin effects (acne, psoriasis) Pregnancy 1st trimester - ebstein's anomaly Leukocytosis Lithium - Drug to drug interactions - ANSWER- **Does NOT have any liver drug-drug interactions - processed thru kidneys ONLY!!** Drugs that may increase lithium levels: NSAIDs ACE/ARBs Diuretics Lithium - Patient Education - ANSWER- Toxicity Lab draws Be cautious with pregnancy