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What medication INCREASES Lithium serum level up to double - CORRECT ANSWER Ibuprofen Why is Lithium used? - CORRECT ANSWER • First-line neuro-protective for bipolar
- Lab Values concerning for patient on Lithium: - CORRECT ANSWER • Leukocytosis
- Creatinine
- BUN
- NA+
- 4 + PORTEIN in Urine
- Lithium (Eskalith/Lithobid) Toxicity - CORRECT ANSWER • Normal Range of LITHIUM LEVEL - 0.5 - 1.2 mEq/L
- MONITOR for TOXICITY: Toxicity = > 1.2 mEq/l
- Slurred speech, confusion, severe GI effect - diarrhea/nausea/vomiting, metallic taste and SEVERE tremor. Common side effects of Lithium (Eskalith/Lithobid) - CORRECT ANSWER Nausea, fine-hand tremors (start monitoring for toxicity), increased urination and thirst What pregnancy category is Lithium (Eskalith/Lithobid) - CORRECT ANSWER CATEGORY D: AVOID in pregnancy, especially 1st trimester - Ebstein anomaly, cardiac defect What increases risk of lithium (Eskalith/Lithobid) toxicity? - CORRECT ANSWER NSAID, dehydration and Thiazides What is the best action for a 16 y/o with conduct disorder that refuses tx? - CORRECT ANSWER • Send to psych specialist for acting out kids - Referrals - Have to see if you are going to refer the same patient to the same provider - Cannot refer the patient to another provider that is the same as you (ie psych) - you must refer to a neurologist or another specialist or PCP What is a priority consideration for a 16 - year-old that shows up with mother for first therapy? - CORRECT ANSWER • Confidentiality (ex. mom sits in lobby) What is important to know about ACE inhibitors (Meds for Heart failure/HTN) - CORRECT ANSWER • This medication can cause increased lithium levels to
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toxic levels - must collaborate with PCP to determine whether to change ACE or change Lithium - Can't use both
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exposure to a major stressor, with SX of ANX, depression, dissociation, recurring nightmares, sleep disturbances, problems in concentrations, reliving the event, dreams, flashbacks - UP to ONE MONTH - Less than 1 month.
- If LONGER than 1 month = PTSD
- Symptoms that occur immediately after the event but resolve in less than 3 days would not meet criteria for acute stress disorder
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What would you do if a 5-year-old tells you his brother sodomized him? - CORRECT ANSWER • Tell mom don't leave him alone with patient and call CPS implement crisis If a child is playing with doll in a sexual way, what do you do first? - CORRECT ANSWER • You SUSPECT sexual abuse - Perform FURTHER ASSESSMENT and GATHER ENOUGH INFO BEFORE Calling CPS to report suspected Sexual Abuse - You HAVE to report but you have to have something (assessment data) to report - Assess = FIRST If a 13 - year-old tells you he want to smoke, what would be an appropriate response? - CORRECT ANSWER • Ask him of his plan to stop smoking If a 14 - year-old girl clenching her teeth, what cranial nerve would you suspect?
- CORRECT ANSWER • Cranial nerve V-Trigeminal nerve (FIVE) What cranial nerve is responsible for Bells Palsy? - CORRECT ANSWER 7 = Facial Paralysis What cranial nerves do you assess for corneal sensation - CORRECT ANSWER Nerves 5 & 7 What cranial nerves do you assess for papillary reaction to light and accommodation? - CORRECT ANSWER Nerves 3,4,& 6 What cranial nerves do you assess for 6 cardinal fields of gaze & extra-ocular movements? - CORRECT ANSWER Nerves 3, 4, & 6 What cranial nerves do you assess for corneal light reflex? - CORRECT ANSWER 3, 4, & 6 Cranial Nerve 1 - CORRECT ANSWER Olfactory (smell) Cranial Nerve 2 - CORRECT ANSWER Optic - vision Cranial Nerve 3 - CORRECT ANSWER Oculomotor (eye movement): The occulomotor nerve is responsible for motor enervation of upper eyelid muscle, extraocular muscle and pupillary muscle. Cranial Nerve 4 - CORRECT ANSWER Trochlear (eye movement): The trochlear nerve controls an extraocular muscle. Cranial Nerve 5 - CORRECT ANSWER Trigeminal: The trigeminal nerve is
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Cranial Nerve 8 - CORRECT ANSWER Vestibulocochlear (hearing and balance): The vestibulocochlear nerve is responsible for the sense of hearing and balance (body position sense). Cranial Nerve 9 - CORRECT ANSWER Glossopharyngeal: The glossopharyngeal nerve enervates muscles involved in swallowing and taste. Lesions of the ninth nerve result in difficulty swallowing and disturbance of taste. Cranial Nerve 10 - CORRECT ANSWER vagus nerve: The vagus nerve enervates the gut (gastrointestinal tract), heart and larynx. Cranial Nerve 11 - CORRECT ANSWER accessory: The accessory nerve enervates the sternocleidomastoid muscles and the trapezius muscles. Cranial Nerve 12 - CORRECT ANSWER Hypoglossal (tongue movement): The hypoglossal nerve enervates the muscles of the tongue. What do symptoms of hyperthyroidism (decreased TSH & increased T4) mimic? - CORRECT ANSWER Bipolar affective disorders
- motor restlessness
- emotional lability
- short attention span
- compulsive movements
- fatigue
- tremor
- insomnia
- impotence
- weight loss
- increased appetite
- abdominal pain
- excessive sweating
- flushing
- elevated upper eyelid leading to decreased blinking, starring, and fine tremor
- tachycardia
- dysrhythmias What does ADPIE stand for? - CORRECT ANSWER • Assessment
- Diagnosis
- Planning
- Implementation
- Evaluation
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Recommend CBT for - CORRECT ANSWER Depression & Anxiety (keep a daily log) pg 209 and every PB pages for each dx - CORRECT ANSWER all thing for each disorder
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- SNRIs: long term maintenance
- Venlafaxine (Effexor) TCAs: long term maintenance
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- Beta blockers (off-label use) used for discrete episodes of social anxiety - contraindicated for clients with asthma Alprostadil (PGE1) - CORRECT ANSWER • Ductal-dependent Congenital Heart disease (all forms)
- Prostaglandin E1 (PGE1), also known as alprostadil, is a naturally occurring prostaglandin which is used as a medication. In babies with congenital heart defects, it is used by slow injection into a vein to open the ductus arteriosus until surgery can be carried out. By injection into the penis or placement in the urethra, it is used to treat erectile dysfunction.
- 0.05-0.1 mg/kg/min IV/IO infusion initially, then 0.01-0.05 mg/kg/min IV/IO Amygdala - CORRECT ANSWER • A limbic system structure involved in memory and emotion, anxiety, particularly fear and aggression Anorexia nervosa - CORRECT ANSWER • Anorexia (SAFETY = KEY)
- BMI less than 18.
- BMI < 16 = AUTOMATIC ADMISSION
- An eating disorder in which an irrational fear of weight gain leads people to starve themselves
- Anorexia admission criteria for hospitalization
- Weight loss over 30 % over 6 months, severe hypothermia (temp lower than 36 C or 96.8 F), heart rate less than 40 beats per minute, systolic blood pressure less than 70 mm hg, and hypokalemia (less than 3 mEq/L).
- Set up family therapy (especially adolescent pts since they have no control over food choices)
- ANOVA (analysis of variance) - CORRECT ANSWER • 3 or more
- An inferential statistical test for comparing the means of three or more groups PROZAC Causes What? - CORRECT ANSWER • Increase Anxiety in Elderly
- Apoptosis - CORRECT ANSWER • Cell death in aging/elderly
- Appreciative inquiry - CORRECT ANSWER • An organizational change philosophy and process building organizations around what works, rather than focusing on and trying to fix what doesn't work
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- Identify the problem
- Analyze the problem
- Generate solutions
- Implement best solution
- Assertive Community Treatment (ACT) - CORRECT ANSWER • Community- based programs that provide many of the services that are necessary for successful community living; include case management, problem solving, social skills training, support teaching on a 24/7 basis
- Assertive questions - CORRECT ANSWER • Use "I want", "I need", or "I feel" to convey basic assertions and get your point across firmly. For example "I feel strongly that we need to bring in a third party to medicate this disagreement" another example "Dave, your request has caught me off guard. I'll get back to you within the half hour". Transtheoretical Model of Change - CORRECT ANSWER • States that change such as in health behaviors occurs in six predictable stages
- Precontemplation: The person has no intention to change.
- Contemplation: The person is thinking about changing; is aware that there is a problem but not committed to changing.
- Preparation: The person has made the decision to change; is ready for action.
- Action: The person is engaging in specific, overt actions to change.
- Maintenance: The person is engaging in behaviors to prevent relapse. erectile dysfunction medications - CORRECT ANSWER • Avanafil (Stendra) 15 minutes prior to sex
- Tadalafil (Cialis) 45 minutes prior to sex
- Vardenafil (Levitra) 45 minutes prior to sex
- Sildenafil (Viagra) 1 hour prior to sex - brand-name version of the generic drug. It is a phosphodiesterase type 5 (PDE5) inhibitor.
- Beck depression inventory - CORRECT ANSWER • A questionnaire useful for determining the level of depression
- 0 - 13 minimal depression
- 14 - 19 mild depression
- 19 - 29 Moderate depression
- 30 - 63 severe depression Intimate therapy for child with a score 10
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Big Freaking Problems - CORRECT ANSWER • Bupropion Fluoxetine Paxil
- Those are strong inhibitors of 2D
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- Child reports Sexual abuse - CORRECT ANSWER • Interview the young child and infants with parent TRICYCLIC ANTIDEPRESSANTS (TCAs) - CORRECT ANSWER Not commonly used due to side effects and overdose toxicity risk; however, TCAs should be considered for appropriate patients who do not respond to other antidepressants.
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There are nine TCAs approved by the FDA for depression (amitriptyline, amoxapine, desipramine, doxepin, imipramine, maprotiline, nortriptyline, protriptyline, trimipramine), and one approved for OCD - clomipramine (Anafranil). Tertiary TCAs (more sedating): Amitriptyline tablets (G): 10 mg, 25 mg, 50 mg, 75 mg, 100 mg, 150 mg. Imipramine tablets and capsules (G): 10 mg, 25 mg, 50 mg, 75 mg, 100 mg, 125 mg, 150 mg. Secondary TCAs (less sedating): Desipramine tablets (Norpramin, [G]): 10 mg, 25 mg, 50 mg, 75 mg, 100 mg, 150 mg. Nortriptyline capsules (Pamelor, [G]): 10 mg, 25 mg, 50 mg, 75 mg, and 10 mg/5 mL oral solution. Side Effects: Most common: Sedation, dry mouth, constipation, weight gain, sexual side effects, urinary hesitation, blurred vision. Serious but rare: Seizure; cardiac effects including orthostasis, arrhythmias, QT prolongation, AV block. Clozaril (Clozapine) - CORRECT ANSWER • DC Clozapine at
- ANC < 1000
- WBC 2000 - 3000 ANC & WBC WEEKLY for 6 months:
- When a patient is on Clozapine monitor for signs for agranulocytosis such as:
- Sores in the mouth, throat,
- Chronic infections of the gums, throat, or skin,
- Fever
- Chills
- Co-morbidities of bipolar - CORRECT ANSWER • Anxiety, alcohol and substance abuse
- Inducer; Pushes the substrate out of the exit pathways, < the serum level of other drugs, < therapeutic effect. - CORRECT ANSWER I'll Come See Pumpkin Pie Tomorrow or Monday And Chow
- Carbamazepine/Oxcarba (1A2, 2C19 and 3A4)
- St. John's Wart (3A4)
- Phenytoin
- Phenobarbital
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Or Bull Shit CRAPGPS
- Barbiturates
- St. Johns Wart
- Carbamazepine
- Rifampin
- Alcohol (chronic use)
- Phenytoin
- Griseofulvin
- Phenobarbital
- Sulfonylureas
- Inhibitors : Blocks the enzymatic pathways, limiting substrate excretion, Increase the serum level of other drugs, Increase toxic risk - CORRECT ANSWER Sickfaces.com
- Sodium Valproate
- Isoniazid
- Cimetidine
- Ketoconazole
- Fluconazole
- Alcohol
- Chloramphenicol
- Erythromycin
- Sulfonamides
- Ciprofloxacin
- Omeprazole
- Metronidazole Plus Grapefruit juice
- DBT (Dialectical behavior therapy) - CORRECT ANSWER • Relaxation muscle prior to DBT
- Borderline Patients - NO meds - DBT therapy what therapy uses a diary log - CORRECT ANSWER • CBT what medication is used for ENURESIS - CORRECT ANSWER • DDAVP (Desmopressin) Works in the SAME manner of ANTIDIEURTIC HORMONE
- Makes less urine - Used for ENURESIS what medications increase INR? - CORRECT ANSWER Depakote and Disulfiram What medication causes Spina bifida? - CORRECT ANSWER Depakote, so check
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HCG level
- DIGFAST for Mania - CORRECT ANSWER • Distractibility
- Indiscretion
- Grandiosity
- Flight of ideas
- Activity increase
- Sleep deficit
