MH701 Final Exam Study Guide Questions And
Answers Verified 100% Correct
Patient education for benzodiazepines. - ANSWER * Do not operate heavy machinery
due to drowsiness
* Elderly - increased risk of falls → fractures; also reduced hepatic clearance
* Do not take with other sedatives, such as alcohol, which can cause sedation and
respiratory depression and disinhibition.
* Hepatic insufficiency can cause toxicity, including hepatic coma.
* COPD and sleep apnea - can cause respiratory depression.
* Pregnancy - teratogenic; secreted in breastmilk and can cause dyspnea, bradycardia
and drowsiness in nursing infants.
* Do not use in patients with hx of substance abuse
* Caution in renal disease
Risk of discontinuation of long-term use of a benzodiazepine is: - ANSWER * Go slowly
and gradually.
* Reduction of ~ 25% of the initial dose every 2 weeks
OR decrease total daily dose by 25% the 1st week, another 25% the 2nd week, then
10% a week until discontinuation.
* Moderate reductions at higher doses and smaller reductions at lower doses.
* The specific dose reductions would vary as a function of patients'.
* readiness to discontinue and the presence or absence of withdrawal symptoms.
* Withdrawal symptoms
Rebound anxiety, restlessness, tremor, sweating, agitation, insomnia.
* Seizures when benzos are used greater than 8 weeks
Define bipolar I: - ANSWER must meet criteria of manic episode which may be
preceded by or followed by hypomanic or MDD; remember DIGFAST mnemonic for
mania- Distractibility, Indiscretion, Grandiosity, Flight of ideas, Activity increase, Sleep
deficit, Talkativeness.
Define bipolar II: - ANSWER must never have had manic episode and must have
history of at least one hypomanic episode and one MD episode.
Define cyclothymia: - ANSWER chronic (2 years-more than half the time) and
fluctuating mood disturbance of hypomanic symptoms and depressive symptoms that
does not meet criteria for MDD or hypomanic and never had episode of mania.
Difference between hypomania and mania: - ANSWER - time: hypomania lasts at least
4 days (less than a week) while mania lasts longer than a week
,Which medications/classes of meds would be avoided with treatment of bipolar? -
ANSWER Anti-depressants.
Therapeutic levels of lithium: - ANSWER Bipolar and unipolar depression - 0.8-1.0
mEq/L
Mania - 0.9-1.4 mEq/L
Therapeutic levels of Valproic Acid - ANSWER 50-100 mmol/mL
Therapeutic levels of Carbamazepine - ANSWER 4-12mcg/mL (>15 considered toxic)
What educational risks would you provide a woman regarding pregnancy, and birth
control with Lithium: - ANSWER does not interact with birth control; original evidence
showed increased risk of birth defects and cardiac anomalies (like Ebstein's anomaly)
but more recent evidence shows risk may be less, lower risk than other mood stabilizers
What educational risks would you provide a woman regarding pregnancy, and birth
control with Carbamazepine: - ANSWER * Lowers plasma levels of OCTs so may
become pregnant if no backup method used
* Increased risk of neural tube defects if used during 1st trimester- start patient on folate
if child bearing age
*May also cause fetal carbamazepine syndrome characterized by facial dysmorphism
and fingernail hypoplasia.
What educational risks would you provide a woman regarding pregnancy, and birth
control with Valproic acid: - ANSWER significant increased risk of neural tube defects,
craniofacial anomalies, fetal valproate syndrome, varying degrees of cognitive
impairment and acute neonatal risk including hepatotoxicity, coagulopathies, neonatal
hypoglycemia, and w/d syndrome
What educational risks would you provide a woman regarding pregnancy, and birth
control with Lamotrigine: - ANSWER OCT may decrease lamotrigine levels; prior
studies showed increased risk of cleft palate when used during pregnancy, but current
studies show risk is the same as general public; becoming more widely used due to
increased proof of pregnancy safety profile
What is the P450 effect between carbamazepine and birth control? - ANSWER P450
inducer → decreases effectiveness of BC → can lead to unplanned pregnancy
Signs and symptoms of lithium toxicity: - ANSWER :
LMNOP
L - Lithium
M - Movement--tremor is an early sign of toxicity
, N - Nephrotoxicity; it is metabolized by the kidney; causes acute kidney injury; chronic
kidney disease (stay hydrated)--increased concentration with NSAIDS or diuretics O -
HypOthyroidism is a common complication of long term lithium use; obtain baseline
TSH; may need treatment for thyroid hormone replacement
P - Pregnancy--first 5 weeks; known teratogen; Ebstein's anomaly
What would you do for your patient if they had any of the signs of lithium toxicity? (Mild,
moderate or severe?) - ANSWER * Mild to moderate (1.5-2.0mEq/L): vomiting,
abdominal pain, ataxia, dizziness, slurred speech, nystagmus, muscle weakness,
probably thirsty
* Moderate to severe (2.0-2.5mEq/L): anorexia, persistent N/V, blurred vision, clonic
limb movements, hyperactive DTRs, convulsions, delirium, coma, stupor
* Severe (>2.5mEq/L): convulsions, oliguria, renal failure, death
* Levels >4.0mEq/L= hemodialysis If toxicity is suspected:
Stop med and go to ED
VS, Neuro check, Electrolytes, Renal fx, EKG
Gastric lavage, activated charcoal, emesis
Patient education that is important related to lithium - ANSWER Pregnancy - can lead
to birth defects such as Epstein's Anomaly (low implanted tricuspid LIT)
watch for? Salt intake, sweating , NSAIDs stay hydrated. Caffeine and ETOH
What medication interactions would you educate your patient about when taking lithium
(What meds could increase lithium levels leading to toxicity)? - ANSWER * Level
(0.51.5)
* NSAIDs, thiazide diuretics, ACE inhibitors can increase level
* Monitor thyroid, renal function, electrolytes, EKG
* Monitor sodium intake and hydration
Lamotrigine - What significant patient education would you provide to a patient? -
ANSWER Rash - common and potentially severe - discontinue med if it appears; can be
a benign maculopapular rash within the first four months; even a benign rash can be a
precursor to Stevens-Johnson syndrome or toxic epidermal necrolysis; discontinuation
of med during severe hypersensitivity may not curb life-threatening rash; children under
16 yo are more susceptible to rash.
Lamotrigine - What is important to know about dosing this medication? - ANSWER
Start low and go slow to reduce risk of rash
25 mg/day for 2 weeks, then increase to 50 mg for 2 weeks (25 mg BID), then 100 mg
for two weeks; typically no more than 200 mg/day
Lamotrigine and valproic acid, how to dose: - ANSWER Valproic acid (Depakote)
increases plasma levels of Lamictal
Answers Verified 100% Correct
Patient education for benzodiazepines. - ANSWER * Do not operate heavy machinery
due to drowsiness
* Elderly - increased risk of falls → fractures; also reduced hepatic clearance
* Do not take with other sedatives, such as alcohol, which can cause sedation and
respiratory depression and disinhibition.
* Hepatic insufficiency can cause toxicity, including hepatic coma.
* COPD and sleep apnea - can cause respiratory depression.
* Pregnancy - teratogenic; secreted in breastmilk and can cause dyspnea, bradycardia
and drowsiness in nursing infants.
* Do not use in patients with hx of substance abuse
* Caution in renal disease
Risk of discontinuation of long-term use of a benzodiazepine is: - ANSWER * Go slowly
and gradually.
* Reduction of ~ 25% of the initial dose every 2 weeks
OR decrease total daily dose by 25% the 1st week, another 25% the 2nd week, then
10% a week until discontinuation.
* Moderate reductions at higher doses and smaller reductions at lower doses.
* The specific dose reductions would vary as a function of patients'.
* readiness to discontinue and the presence or absence of withdrawal symptoms.
* Withdrawal symptoms
Rebound anxiety, restlessness, tremor, sweating, agitation, insomnia.
* Seizures when benzos are used greater than 8 weeks
Define bipolar I: - ANSWER must meet criteria of manic episode which may be
preceded by or followed by hypomanic or MDD; remember DIGFAST mnemonic for
mania- Distractibility, Indiscretion, Grandiosity, Flight of ideas, Activity increase, Sleep
deficit, Talkativeness.
Define bipolar II: - ANSWER must never have had manic episode and must have
history of at least one hypomanic episode and one MD episode.
Define cyclothymia: - ANSWER chronic (2 years-more than half the time) and
fluctuating mood disturbance of hypomanic symptoms and depressive symptoms that
does not meet criteria for MDD or hypomanic and never had episode of mania.
Difference between hypomania and mania: - ANSWER - time: hypomania lasts at least
4 days (less than a week) while mania lasts longer than a week
,Which medications/classes of meds would be avoided with treatment of bipolar? -
ANSWER Anti-depressants.
Therapeutic levels of lithium: - ANSWER Bipolar and unipolar depression - 0.8-1.0
mEq/L
Mania - 0.9-1.4 mEq/L
Therapeutic levels of Valproic Acid - ANSWER 50-100 mmol/mL
Therapeutic levels of Carbamazepine - ANSWER 4-12mcg/mL (>15 considered toxic)
What educational risks would you provide a woman regarding pregnancy, and birth
control with Lithium: - ANSWER does not interact with birth control; original evidence
showed increased risk of birth defects and cardiac anomalies (like Ebstein's anomaly)
but more recent evidence shows risk may be less, lower risk than other mood stabilizers
What educational risks would you provide a woman regarding pregnancy, and birth
control with Carbamazepine: - ANSWER * Lowers plasma levels of OCTs so may
become pregnant if no backup method used
* Increased risk of neural tube defects if used during 1st trimester- start patient on folate
if child bearing age
*May also cause fetal carbamazepine syndrome characterized by facial dysmorphism
and fingernail hypoplasia.
What educational risks would you provide a woman regarding pregnancy, and birth
control with Valproic acid: - ANSWER significant increased risk of neural tube defects,
craniofacial anomalies, fetal valproate syndrome, varying degrees of cognitive
impairment and acute neonatal risk including hepatotoxicity, coagulopathies, neonatal
hypoglycemia, and w/d syndrome
What educational risks would you provide a woman regarding pregnancy, and birth
control with Lamotrigine: - ANSWER OCT may decrease lamotrigine levels; prior
studies showed increased risk of cleft palate when used during pregnancy, but current
studies show risk is the same as general public; becoming more widely used due to
increased proof of pregnancy safety profile
What is the P450 effect between carbamazepine and birth control? - ANSWER P450
inducer → decreases effectiveness of BC → can lead to unplanned pregnancy
Signs and symptoms of lithium toxicity: - ANSWER :
LMNOP
L - Lithium
M - Movement--tremor is an early sign of toxicity
, N - Nephrotoxicity; it is metabolized by the kidney; causes acute kidney injury; chronic
kidney disease (stay hydrated)--increased concentration with NSAIDS or diuretics O -
HypOthyroidism is a common complication of long term lithium use; obtain baseline
TSH; may need treatment for thyroid hormone replacement
P - Pregnancy--first 5 weeks; known teratogen; Ebstein's anomaly
What would you do for your patient if they had any of the signs of lithium toxicity? (Mild,
moderate or severe?) - ANSWER * Mild to moderate (1.5-2.0mEq/L): vomiting,
abdominal pain, ataxia, dizziness, slurred speech, nystagmus, muscle weakness,
probably thirsty
* Moderate to severe (2.0-2.5mEq/L): anorexia, persistent N/V, blurred vision, clonic
limb movements, hyperactive DTRs, convulsions, delirium, coma, stupor
* Severe (>2.5mEq/L): convulsions, oliguria, renal failure, death
* Levels >4.0mEq/L= hemodialysis If toxicity is suspected:
Stop med and go to ED
VS, Neuro check, Electrolytes, Renal fx, EKG
Gastric lavage, activated charcoal, emesis
Patient education that is important related to lithium - ANSWER Pregnancy - can lead
to birth defects such as Epstein's Anomaly (low implanted tricuspid LIT)
watch for? Salt intake, sweating , NSAIDs stay hydrated. Caffeine and ETOH
What medication interactions would you educate your patient about when taking lithium
(What meds could increase lithium levels leading to toxicity)? - ANSWER * Level
(0.51.5)
* NSAIDs, thiazide diuretics, ACE inhibitors can increase level
* Monitor thyroid, renal function, electrolytes, EKG
* Monitor sodium intake and hydration
Lamotrigine - What significant patient education would you provide to a patient? -
ANSWER Rash - common and potentially severe - discontinue med if it appears; can be
a benign maculopapular rash within the first four months; even a benign rash can be a
precursor to Stevens-Johnson syndrome or toxic epidermal necrolysis; discontinuation
of med during severe hypersensitivity may not curb life-threatening rash; children under
16 yo are more susceptible to rash.
Lamotrigine - What is important to know about dosing this medication? - ANSWER
Start low and go slow to reduce risk of rash
25 mg/day for 2 weeks, then increase to 50 mg for 2 weeks (25 mg BID), then 100 mg
for two weeks; typically no more than 200 mg/day
Lamotrigine and valproic acid, how to dose: - ANSWER Valproic acid (Depakote)
increases plasma levels of Lamictal
