10/4/24, 5:58 PM
DANIEL
Georgette Review PMHNP.WITH 10% SURE ANSWERS
When many answers are remarkably similar, wrong
they are usually _____________
Interprofessional collaboration is Collaborate is usually right.
encouraged. Delegate is usually wrong.
ADPIER Assessment, diagnosis, Plan, intervention, evaluate, refer out last.
Lithium Normal 0.6-1.2
Lithium toxicity occurs at levels > 1.5
severe nausea, diarrhea, vomiting, confusion, drowsiness, muscle weakness, heart
Signs of Lithium toxicity
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, Ebstein anomaly (congenital heart defect)
especially 1st trimester
dehydration and hyponatremia cause rise
lithium levels to
TSH
creatinine (0.6-1.2)
BUN (10-20)
Baseline labs before initiation of lithium
HCG (all psychotropics females 12-51)
EKG 50+
Urinalysis (check for proteins, 4+ may indicate kidney disease)
1/8
, 10/4/24, 5:58 PM
hypothyroidism
coase hand tremors with toxicity
maculopapular rash
Side Effects of Lithium diarrhea, vomiting, cramps--signs of toxicity. Monitor closely.
anorexia
t wave inversions
leukocytosis
staying hydrated
Pt education for lithimum avoiding NSAIDS
compliance
Depakote normal level 50-125
Depakote toxicity level greater than 150
Teratogenic effects of Depakote spina bifida
alopecia
Adverse effects of depakote hepatotoxicity (RUQ pain or brown/red urine--order LFTs) AST 5-40, ALT 5-35,
yellowing of skin or eyes, fatigue
Signs of Depakote toxicity disorientation, lethargy, respiratory depression, nausea/vomiting
DC med
check level
Intervention for depakote toxicity
LFT
ammonia
MAOI + tyramine causes hypertensive crisis
elevated BP
sudden explosive like headache
facial flushing
Symptoms of hypertensive crisis palpitations
pupillary dilation
diaphoresis
fever
MEPERIDINE
STIMULANTS
decongestants
TCAs
Hypertensive crisis occurs with MAOI +
atypicals
St. John's wart
L-tryptophan
asthma meds
DC offending agent
Treatment for hypertensive crisis
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
2/8
DANIEL
Georgette Review PMHNP.WITH 10% SURE ANSWERS
When many answers are remarkably similar, wrong
they are usually _____________
Interprofessional collaboration is Collaborate is usually right.
encouraged. Delegate is usually wrong.
ADPIER Assessment, diagnosis, Plan, intervention, evaluate, refer out last.
Lithium Normal 0.6-1.2
Lithium toxicity occurs at levels > 1.5
severe nausea, diarrhea, vomiting, confusion, drowsiness, muscle weakness, heart
Signs of Lithium toxicity
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, Ebstein anomaly (congenital heart defect)
especially 1st trimester
dehydration and hyponatremia cause rise
lithium levels to
TSH
creatinine (0.6-1.2)
BUN (10-20)
Baseline labs before initiation of lithium
HCG (all psychotropics females 12-51)
EKG 50+
Urinalysis (check for proteins, 4+ may indicate kidney disease)
1/8
, 10/4/24, 5:58 PM
hypothyroidism
coase hand tremors with toxicity
maculopapular rash
Side Effects of Lithium diarrhea, vomiting, cramps--signs of toxicity. Monitor closely.
anorexia
t wave inversions
leukocytosis
staying hydrated
Pt education for lithimum avoiding NSAIDS
compliance
Depakote normal level 50-125
Depakote toxicity level greater than 150
Teratogenic effects of Depakote spina bifida
alopecia
Adverse effects of depakote hepatotoxicity (RUQ pain or brown/red urine--order LFTs) AST 5-40, ALT 5-35,
yellowing of skin or eyes, fatigue
Signs of Depakote toxicity disorientation, lethargy, respiratory depression, nausea/vomiting
DC med
check level
Intervention for depakote toxicity
LFT
ammonia
MAOI + tyramine causes hypertensive crisis
elevated BP
sudden explosive like headache
facial flushing
Symptoms of hypertensive crisis palpitations
pupillary dilation
diaphoresis
fever
MEPERIDINE
STIMULANTS
decongestants
TCAs
Hypertensive crisis occurs with MAOI +
atypicals
St. John's wart
L-tryptophan
asthma meds
DC offending agent
Treatment for hypertensive crisis
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
2/8
