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Georgettes LMR study set | PMHNP Review
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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
What medications will INCREASE Li levels - NSAIDSACE'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? - hypothyroidismmaculopapular rash leukocytosis twave inversion what is a defining characteristic of NMS vs SS - muscle rigidity Sx's/labs associated with NMS - Inc CPK, WBC, LFTRhabdomyolosis myoglobinuria Can lead to mutism myoglobinuria/rhabdo can cause cherry colored urine Treatment for NMS and what each does - DC the offending agent bromocriptin-D agonis dantrolene: muscle relaxant
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 ofBOTH What med class treats neuropathic pain well - alpha 2 delta ligandsGabapentin 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 - inc SI in kids, esp Required education for rx ssri - long time for effectside effects esp n/v/d NO ABRUPT stopping d/t Serotonin discontinuation syndrome Sx's of serotonin discontinuation syndrome - fever, shivering, muscle aches and nausea diarrhea, agitation, cog impairment... (think flu like sx's) disequilibrium
What are some scenarios that place patients at risk of a hypertensive crisis? - MAOI and tyramine MAOI and TCA MAOI and Atypical AP MAOI and decongestant MAOI and stimulants MAOI and asthma meds Sx of Hypertensive crisis - HA
not in the hospital delusions, you respond how? - do not try to disprove If HARMFUL delusions, notify authority Also notify potential victim how to assess mental abstraction - interpret a proverb
assess thought process why? and potential findings - to assess organization of patients thoughts tangential: no rip to a? circumstantial: gets around to anss after going in circles with unnecessary details MMSE thought content include - SI HIplan Hallucinationsdelusions MMSE/ Folstein Test assesses? - tool used to assess cognitive status in adults concentration/attention/calculation assessed how? - spell a word backward or serial 7's Registration/ability to learn new material assessed how? - remember 3 words orientation is assessed by - Person place time fund of knowledge assessed how? - Who is the president? Governor? clock drawing assesses? - takes 1 - 2 minuteseasy to administer tests right hemisphere health,cannot do it they have a prob in R side. First generation AP - haldolfluphenazine Chlorpromazine thioridazine
lurasidoneclozipine excess DA in mesolimbic pathway - positive sx of schizophrenia decreased DA in mesocoritcal pathway - negative sx of schizophreniaanhedonia mask face slow speechisolative nigrostriatal pathway - excess DA in this pathway but it doesn't cause any sx, but when DA is decreased in this pathway due to AP (dopamine blockade) increases acetylcholine=EPS sx Tuberoinfundibular pathway - excess DA is normal here but when it is decreased with AP leads to increased prolactin andhyperprolactinemia what does high prolactin levels lead to - breast DCamenorrhea osteoporosis breast enlargement which AP is most closely associated with hyperprolactinemia - risperidone Male prolactin female prolactin---normals - male less than 20ng/ml female less than 25ng/ml EPS caused by - DA blockade in the NS pathway
acute dystonia - acute sustained contraction of muscles, usually of the head andneck spasmspainful
can have onset between a few weeks and 2 years post starting of medication
Reglan (metoclopramide) and compazine (prochlorperazine) can both cause? - TD what medication can worsen TD? - benztropine/cogentin Inducers - cause low serum levels inhibitors - cause high serum levles reglan and compazine can both cause - TD Smoking and dosing of meds - smoking is a strong inducer. therefore smoking increases drug metablolism and you may need to dose higher. If they stop smoking serum levels will increase. Always assess for smoking/cessation of. Antibiotics/macroglides are INHIBITORS and greatly effect what medication - tegratol what meds can cause mania - disulframsteroids isoniazide antidepressants what meds can cause depression - steroidsbeta blockers interferon accutane-can cause birth defects too if patient taking meds for a mood disorder and is on flonase or prednisone. What do you do with your dose of oxcarbazepine - increase the dose to adjust for the medication (steroids) influencing mania
addiction neurotransmitters - DAGABA Gamma-aminobutyric acid main function - major inhibitory neurotransmitter Sx's of stimulant abuse - irritability insomnia tremors delayed gastric emptying-feeling fullness/bloated Pt with anorexia complains of pain after eating/bloating/fullness - Signs of delayed gastric emptying what meds can delay gastric empying? - PROTON PUMP INHIBITORSfamotidine omeprazoleranitidine ANTACIDS /PPI do what to psychotropic medications? - Decrease absorption of psychotropic medication advise client to take other meds 2 hours AFTER antacids/PPI Older adults and SSRIs for anxiety? - May increase anxietyparadoxical effect Older adults and benzos? - May increase agitationparadoxical effect apoptosis - neuronal loss or cell deathBP1 pneumonic - DIGFAST
DIGFAST - DistractibleImpulsive choices Grandiosity
