PMHNP Review (Georgette) + ANCC Questions and
Answers
>1.5
Lithium Toxicity
Narrow therapeutic window
Manic Episodes
Lithium Gold Standard has some slight effects on depressive symptoms
Long-standing history
Thyroid Panel (TSH)
Serum Creatinine (.06-1.2)
Baseline Labs for Lithium Blood Urea Nitrogen (BUN) 10-20
Pregnancy test (HCG) - all females 12-51 on psychotropics
EKG 50+
Endo (wt gain, hypothyroid)
CNS (fine hand tremor, fatigue, brain fog, HA, nystagmus)
Dermatological (maculopapular rash, acne, pruritis)
GI (Diarrhea, vomiting, cramps, anorexia)
Side effects of Lithium
Renal (Diabetes insipidus, polyuria/polydypsia, edema, tubular changes in the
kidneys)
Cardiac (T wave inversion, dysrhythmia)
Hematologic (leukocytosis - increased WBC)
Kidney disease
NSAIDS (Ibuprophen, Indocin)
Thiazides (HCTZ)
Drugs that reduce renal clearance
Ace Inhibitors (Lisinopril)
these drugs cause an increase in serum concentration of the drugs excreted by the
kidney such as Lithium
Lithium excretion Kidney - impacted by drugs that reduce renal clearance
First: DC med, Check serum levels
Treatment for Lithium Toxicity
Management secondary: Vital signs, ekg,
, Narrow therapeutic window
Therapeutic effect of Lithium Draw at trough level, 12 hours post dose
Level at 1.2 and above is at risk for toxicity
Category D
Lithium and pregnancy
Lactation category L3
More sensitive due to
decreased intracellular water
Protien binding
Elderly and psychotropics
Low muscle mass
decreased metabolism
increased body fat
Occurs when MAOI (isocarboxazid, phenelzine, selegiline, and tranylcypromine) are
taken with foods containing tyramine
Hypertensive Crisis
When MAO is inhibited (like in MAOI) tyramine exerts a strong vasopressor effect,
stimulating the release of catecholamines, epi and nor eip, which increase BP and HR
Tyramine Precursor to Norepinephrine
Isocarboxazid
Phenelzine
MAOIs
Selegiline
Tranylcypromine
Fermented soy products
Yeast extracts
Chocolate and cocoa
Vinegar-based foods and condiments
Alcohol - wine, non alcoholic beer, cola
Bananas, figs, raisins,
Foods containing Tyramine
Fava beans, broad beans
Overripe avacado - fruits and vegetables
Pickled foods, sourkraut
Smoked processed and cured meats
Liver
Smoked or pickled fish
BP 180/120 or greater
Elevated BP
Sudden explosive-like headache, occipital region
Facial flushing
Hypertensive Crisis S/S
Palpitations
Pupillary Dilation
Diaphoresis
Fever
DC the offending agent (MAOI)
MAOI Hypertensive Crisis Treatment Administer phentolamine
Stabilize fever
Follow a Tyramine Free Diet (prevention)
Life-threatening crisis - Cannot be reversed unless more MAOI is produced by the
MAOI HTN crisis prevention
body
Can cause death
reversible non-selective alpha adrenergic antagonist used for vasodilatory effect
Phentolamine
(treatment of HTN Crisis)
Answers
>1.5
Lithium Toxicity
Narrow therapeutic window
Manic Episodes
Lithium Gold Standard has some slight effects on depressive symptoms
Long-standing history
Thyroid Panel (TSH)
Serum Creatinine (.06-1.2)
Baseline Labs for Lithium Blood Urea Nitrogen (BUN) 10-20
Pregnancy test (HCG) - all females 12-51 on psychotropics
EKG 50+
Endo (wt gain, hypothyroid)
CNS (fine hand tremor, fatigue, brain fog, HA, nystagmus)
Dermatological (maculopapular rash, acne, pruritis)
GI (Diarrhea, vomiting, cramps, anorexia)
Side effects of Lithium
Renal (Diabetes insipidus, polyuria/polydypsia, edema, tubular changes in the
kidneys)
Cardiac (T wave inversion, dysrhythmia)
Hematologic (leukocytosis - increased WBC)
Kidney disease
NSAIDS (Ibuprophen, Indocin)
Thiazides (HCTZ)
Drugs that reduce renal clearance
Ace Inhibitors (Lisinopril)
these drugs cause an increase in serum concentration of the drugs excreted by the
kidney such as Lithium
Lithium excretion Kidney - impacted by drugs that reduce renal clearance
First: DC med, Check serum levels
Treatment for Lithium Toxicity
Management secondary: Vital signs, ekg,
, Narrow therapeutic window
Therapeutic effect of Lithium Draw at trough level, 12 hours post dose
Level at 1.2 and above is at risk for toxicity
Category D
Lithium and pregnancy
Lactation category L3
More sensitive due to
decreased intracellular water
Protien binding
Elderly and psychotropics
Low muscle mass
decreased metabolism
increased body fat
Occurs when MAOI (isocarboxazid, phenelzine, selegiline, and tranylcypromine) are
taken with foods containing tyramine
Hypertensive Crisis
When MAO is inhibited (like in MAOI) tyramine exerts a strong vasopressor effect,
stimulating the release of catecholamines, epi and nor eip, which increase BP and HR
Tyramine Precursor to Norepinephrine
Isocarboxazid
Phenelzine
MAOIs
Selegiline
Tranylcypromine
Fermented soy products
Yeast extracts
Chocolate and cocoa
Vinegar-based foods and condiments
Alcohol - wine, non alcoholic beer, cola
Bananas, figs, raisins,
Foods containing Tyramine
Fava beans, broad beans
Overripe avacado - fruits and vegetables
Pickled foods, sourkraut
Smoked processed and cured meats
Liver
Smoked or pickled fish
BP 180/120 or greater
Elevated BP
Sudden explosive-like headache, occipital region
Facial flushing
Hypertensive Crisis S/S
Palpitations
Pupillary Dilation
Diaphoresis
Fever
DC the offending agent (MAOI)
MAOI Hypertensive Crisis Treatment Administer phentolamine
Stabilize fever
Follow a Tyramine Free Diet (prevention)
Life-threatening crisis - Cannot be reversed unless more MAOI is produced by the
MAOI HTN crisis prevention
body
Can cause death
reversible non-selective alpha adrenergic antagonist used for vasodilatory effect
Phentolamine
(treatment of HTN Crisis)
