Mental Health Critical Safety Cram Sheet
Key Normal Range / Critical Red Flag Nurse Head Tip
Concept/Drug/Lab Class
Lithium 0.6 – 1.2 mEq/L > 1.5 mEq/L: Coarse "Lithium & Sodium are
(Therapeutic) tremors, confusion, enemies." Low Na+ = High
polyuria, seizures. Lithium Toxicity. Never
restrict salt intake.
Clozapine (Clozaril) Atypical Sore throat, fever, Causes Agranulocytosis
Antipsychotic leukopenia (ANC < 1,000). (no immune system). If
they report a "cold,"
check a CBC immediately.
MAOIs (Phenelzine) Antidepressant Throbbing headache, stiff Avoid Tyramine (aged
neck, HTN crisis. cheese, wine, cured
meats). The headache
means a stroke is
imminent.
Neuroleptic Reaction to High Fever (>104°F), "Hot & Stiff." Immediate
Malignant Syndrome Antipsychotics muscle rigidity ("lead action: Stop the drug,
(NMS) pipe"), BP spikes. ICU, hydrate, and give
Dantrolene.
Serotonin Syndrome Reaction to Hyperreflexia (twitching), Often happens when
SSRIs sweating, agitation, dilated mixing SSRIs + St. John's
pupils. Wort. NMS = Rigid;
Serotonin = Twitchy.
Benzodiazepines Anxiolytic Respiratory rate < 10, Antidote: Flumazenil. Fall
(sedative) unarousable sedation. risk is huge in the elderly.
Never mix with alcohol.
Key Normal Range / Critical Red Flag Nurse Head Tip
Concept/Drug/Lab Class
Lithium 0.6 – 1.2 mEq/L > 1.5 mEq/L: Coarse "Lithium & Sodium are
(Therapeutic) tremors, confusion, enemies." Low Na+ = High
polyuria, seizures. Lithium Toxicity. Never
restrict salt intake.
Clozapine (Clozaril) Atypical Sore throat, fever, Causes Agranulocytosis
Antipsychotic leukopenia (ANC < 1,000). (no immune system). If
they report a "cold,"
check a CBC immediately.
MAOIs (Phenelzine) Antidepressant Throbbing headache, stiff Avoid Tyramine (aged
neck, HTN crisis. cheese, wine, cured
meats). The headache
means a stroke is
imminent.
Neuroleptic Reaction to High Fever (>104°F), "Hot & Stiff." Immediate
Malignant Syndrome Antipsychotics muscle rigidity ("lead action: Stop the drug,
(NMS) pipe"), BP spikes. ICU, hydrate, and give
Dantrolene.
Serotonin Syndrome Reaction to Hyperreflexia (twitching), Often happens when
SSRIs sweating, agitation, dilated mixing SSRIs + St. John's
pupils. Wort. NMS = Rigid;
Serotonin = Twitchy.
Benzodiazepines Anxiolytic Respiratory rate < 10, Antidote: Flumazenil. Fall
(sedative) unarousable sedation. risk is huge in the elderly.
Never mix with alcohol.
