PMHNP Psychiatric-Mental Health Nurse
Practitioner LMR - Dr. Georgette Review
2024 NEW SOLUTION GUIDE
According to Erikson what stage of development involves ability to learn how things work, to
understand an organize. Ability to work with a sense of competency and achievement.
School age (6 - 12 yrs.)
Industry vs inferiority
Children with inattentive ADHD are most likely to have an abnormality in which part of the cortex?
prefrontal
What drugs should be avoided with Kava Kava (piper Methysticum)?
-Alprazolam (benzos)
-CNS depressants (e.g., phenobarbital, zolpidem, alcohol).
-Medications metabolized by the liver
What is the normal range for TSH?
0.5-5.0 mu/L
What are lab values in Hyperthyroidism
Decreased TSH
Increased T4 and T3
What are labs in Hypothyroidism?
Increased TSH
Decreased T4 and T3
What are 5 primary symptoms of Hyperthyroidism?
Heat intolerance
Agitation, Anxiety, Irritability
Tachycardia
Mood swings
Weight loss
,What are 4 primary symptoms of Hypothyroidism?
Cold intolerance
Lethargy
Weight gain
Decreased libido
Hypothyroidism mimics symptoms of what psychiatric disorder?
Depression
Hyperthyroidism mimics symptoms of what psychiatric disorder?
Mania
Valproic acid produces what teratogenic effect?
Spina bifida (neural tube defect)
What is the primary organ where valproic acid is toxic?
Liver (hepatoxicity), followed by pancreas
What are 4 signs of hepatoxicity?
Abdominal pain in the URQ,
Reddish-brown urine
Yellowing of the skin and sclera
Fatigue
What are the symptoms of pancreatitis induced by Depakote or Valporic acid?
Qily stools
Upper abdominal pain
Abdominal pain that radiates to your back
Tenderness when touching the abdomen
Fever
Rabbit pulse
Nausea vomiting
What are symptoms of depakote induced hyperammonemia?
What is the therapeutic range for valproic acid?
50-125 mcg/ml
,What is a toxic level of valproic acid?
>150 mcg/ml
What are 4 signs of valproic acid toxicity?
Disorientation
Lethargy
Respiratory depression
Nausea/vomiting
A pt on Depakote C/O Abdominal pain in the URQ and Reddish-brown urine. What do you suspect?
What do you do?
Hepatotoxicity; DC offending agent and do a LFT. Checking AST 5-40, ALT 5-35. Also do VPA level,
ammonia levels.
With suspected toxicity with valproic acid, what steps/labs should be drawn?
D/Cdrug
Check drug level
Obtain LFTs
Obtain ammonia level
A pregnant pt is taking accutane, zyprexa and abilify; what med needs to be d/c'd?
Accutane (used for acne; Causes birth Defects!!!)
What herbal supplement is used for anxiety, stress, and insomnia? What is the major side effect with
Kava Kava (piper Methysticum)?
Kava Kava (piper Methysticum)
liver damage
What are 5 symptoms of Steven Johnson Syndrome?
Fever -Key sx to suspect SJS; high yield (HY)
burning of mouth/eyes -HY
Body aches
Severe red rash
Peeling skin
, Facial and tongue swelling
Mood stabilizer most likely to cause Steven Johnson syndrome.
Lamotrigine
(Also tegretol in Asians with specific gene type HLB. Noted that Tramadol can also cause SIS)
Which mood stabilizer causes the least weight gain?
Lamotrigine (Lamictal)
Which 3 SGAs cause the least weight gain?
Lurasidone (Latuda)
Aripiprazole (Abilify)
Ziprasidone (Geodon)
Which SGA is the least sedating?
Aripiprazole (Abilify)
Your ptis taking Kava (piper Methysticum) and you need to add an AS to manage their SCZ, which do
you add?
Aripiprazole (least sedating)
What are 2 hallmark symptoms of delirium?
Acute disturbance of
Loc
impaired cognition
inattention
How are agitation and psychotic symptoms treated in delirium?
Low dose Haldol (QTc check first)
16 y/o C/O feeling funny after inhaling Acetone (nail polish remover). What is your action?
Do UDS; chances are they may be abusing other substances
What 4 drugs can cause mania?
"SAID"
Steroids
Practitioner LMR - Dr. Georgette Review
2024 NEW SOLUTION GUIDE
According to Erikson what stage of development involves ability to learn how things work, to
understand an organize. Ability to work with a sense of competency and achievement.
School age (6 - 12 yrs.)
Industry vs inferiority
Children with inattentive ADHD are most likely to have an abnormality in which part of the cortex?
prefrontal
What drugs should be avoided with Kava Kava (piper Methysticum)?
-Alprazolam (benzos)
-CNS depressants (e.g., phenobarbital, zolpidem, alcohol).
-Medications metabolized by the liver
What is the normal range for TSH?
0.5-5.0 mu/L
What are lab values in Hyperthyroidism
Decreased TSH
Increased T4 and T3
What are labs in Hypothyroidism?
Increased TSH
Decreased T4 and T3
What are 5 primary symptoms of Hyperthyroidism?
Heat intolerance
Agitation, Anxiety, Irritability
Tachycardia
Mood swings
Weight loss
,What are 4 primary symptoms of Hypothyroidism?
Cold intolerance
Lethargy
Weight gain
Decreased libido
Hypothyroidism mimics symptoms of what psychiatric disorder?
Depression
Hyperthyroidism mimics symptoms of what psychiatric disorder?
Mania
Valproic acid produces what teratogenic effect?
Spina bifida (neural tube defect)
What is the primary organ where valproic acid is toxic?
Liver (hepatoxicity), followed by pancreas
What are 4 signs of hepatoxicity?
Abdominal pain in the URQ,
Reddish-brown urine
Yellowing of the skin and sclera
Fatigue
What are the symptoms of pancreatitis induced by Depakote or Valporic acid?
Qily stools
Upper abdominal pain
Abdominal pain that radiates to your back
Tenderness when touching the abdomen
Fever
Rabbit pulse
Nausea vomiting
What are symptoms of depakote induced hyperammonemia?
What is the therapeutic range for valproic acid?
50-125 mcg/ml
,What is a toxic level of valproic acid?
>150 mcg/ml
What are 4 signs of valproic acid toxicity?
Disorientation
Lethargy
Respiratory depression
Nausea/vomiting
A pt on Depakote C/O Abdominal pain in the URQ and Reddish-brown urine. What do you suspect?
What do you do?
Hepatotoxicity; DC offending agent and do a LFT. Checking AST 5-40, ALT 5-35. Also do VPA level,
ammonia levels.
With suspected toxicity with valproic acid, what steps/labs should be drawn?
D/Cdrug
Check drug level
Obtain LFTs
Obtain ammonia level
A pregnant pt is taking accutane, zyprexa and abilify; what med needs to be d/c'd?
Accutane (used for acne; Causes birth Defects!!!)
What herbal supplement is used for anxiety, stress, and insomnia? What is the major side effect with
Kava Kava (piper Methysticum)?
Kava Kava (piper Methysticum)
liver damage
What are 5 symptoms of Steven Johnson Syndrome?
Fever -Key sx to suspect SJS; high yield (HY)
burning of mouth/eyes -HY
Body aches
Severe red rash
Peeling skin
, Facial and tongue swelling
Mood stabilizer most likely to cause Steven Johnson syndrome.
Lamotrigine
(Also tegretol in Asians with specific gene type HLB. Noted that Tramadol can also cause SIS)
Which mood stabilizer causes the least weight gain?
Lamotrigine (Lamictal)
Which 3 SGAs cause the least weight gain?
Lurasidone (Latuda)
Aripiprazole (Abilify)
Ziprasidone (Geodon)
Which SGA is the least sedating?
Aripiprazole (Abilify)
Your ptis taking Kava (piper Methysticum) and you need to add an AS to manage their SCZ, which do
you add?
Aripiprazole (least sedating)
What are 2 hallmark symptoms of delirium?
Acute disturbance of
Loc
impaired cognition
inattention
How are agitation and psychotic symptoms treated in delirium?
Low dose Haldol (QTc check first)
16 y/o C/O feeling funny after inhaling Acetone (nail polish remover). What is your action?
Do UDS; chances are they may be abusing other substances
What 4 drugs can cause mania?
"SAID"
Steroids
