Georgette’s PMHNP Review
What drugs should be avoided with Kava Kava?
Answer: Alprazolam
CNS depressants (e.g., phenobarbital, zolpidem)
What is the normal range for TSH?
Answer: 0.5 - 5.0 mu/L
What are lab values in Hyperthyroidism
Answer: Decreased TSH
Increased T4 and T3
What are labs in Hypothyroidism?
Answer: Increased TSH
Decreased T4 and T3
What are 5 primary symptoms of Hyperthyroidism?
Answer: Heat intolerance
Agitation, Anxiety, Irritability
Tachycardia
Mood swings
Weight loss
What are 4 primary symptoms of Hypothyroidism?
,Answer: Cold intolerance
Lethargy
Weight gain
Decreased libido
Hypothyroidism mimics symptoms of what psychiatric disorder?
Answer: Depression
Hyperthyroidism mimics symptoms of what psychiatric disorder?
Answer: Mania
Valproic acid produces what teratogenic effect?
Answer: Spina bifida (neural tube defect)
What is the primary organ where valproic acid is toxic?
Answer: Liver (hepatoxicity)
What are 4 signs of hepatoxicity?
Abdominal pain in the URQ
Reddish-brown urine
Answer: Yellowing of the skin and sclera
Fatigue
What is the therapeutic range for valproic acid?
Answer: 50-125 mcg/ml
What is a toxic level of valproic acid?
,Answer: >150 mcg/ml
What are 4 signs of valproic acid toxicity?
Answer: 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?
Answer: Hepatotoxicity; hold med, draw LFT's (priority), DVP level
With suspected toxicity with valproic acid, what steps/labs should be drawn?
Answer: D/C drug
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?
Answer: 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?
Answer: Kava Kava
liver damage
, What are 5 symptoms of Stephen's Johnson Syndrome?
Fever -Key sx to suspect SJS; high yield (HY)
burning of mouth/eyes -HY
Answer: Body aches
Severe red rash
Peeling skin
Facial and tongue swelling
Which mood stabilizer causes the least weight gain?
Answer: Lamotrigine (Lamictal)
Which 3 SGAs cause the least weight gain?
Answer: Lurasidone (Latuda)
Aripiprazole (Abilify)
Ziprasidone (Geodon)
Which SGA is the least sedating?
Answer: Aripiprazole (Abilify)
Your pt is taking Kava and you need to add an AS to manage their SCZ, which
do you add?
Answer: Aripiprazole (least sedating)
What are 2 hallmark symptoms of delirium?
Acute onset
disturbance of LOC
What drugs should be avoided with Kava Kava?
Answer: Alprazolam
CNS depressants (e.g., phenobarbital, zolpidem)
What is the normal range for TSH?
Answer: 0.5 - 5.0 mu/L
What are lab values in Hyperthyroidism
Answer: Decreased TSH
Increased T4 and T3
What are labs in Hypothyroidism?
Answer: Increased TSH
Decreased T4 and T3
What are 5 primary symptoms of Hyperthyroidism?
Answer: Heat intolerance
Agitation, Anxiety, Irritability
Tachycardia
Mood swings
Weight loss
What are 4 primary symptoms of Hypothyroidism?
,Answer: Cold intolerance
Lethargy
Weight gain
Decreased libido
Hypothyroidism mimics symptoms of what psychiatric disorder?
Answer: Depression
Hyperthyroidism mimics symptoms of what psychiatric disorder?
Answer: Mania
Valproic acid produces what teratogenic effect?
Answer: Spina bifida (neural tube defect)
What is the primary organ where valproic acid is toxic?
Answer: Liver (hepatoxicity)
What are 4 signs of hepatoxicity?
Abdominal pain in the URQ
Reddish-brown urine
Answer: Yellowing of the skin and sclera
Fatigue
What is the therapeutic range for valproic acid?
Answer: 50-125 mcg/ml
What is a toxic level of valproic acid?
,Answer: >150 mcg/ml
What are 4 signs of valproic acid toxicity?
Answer: 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?
Answer: Hepatotoxicity; hold med, draw LFT's (priority), DVP level
With suspected toxicity with valproic acid, what steps/labs should be drawn?
Answer: D/C drug
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?
Answer: 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?
Answer: Kava Kava
liver damage
, What are 5 symptoms of Stephen's Johnson Syndrome?
Fever -Key sx to suspect SJS; high yield (HY)
burning of mouth/eyes -HY
Answer: Body aches
Severe red rash
Peeling skin
Facial and tongue swelling
Which mood stabilizer causes the least weight gain?
Answer: Lamotrigine (Lamictal)
Which 3 SGAs cause the least weight gain?
Answer: Lurasidone (Latuda)
Aripiprazole (Abilify)
Ziprasidone (Geodon)
Which SGA is the least sedating?
Answer: Aripiprazole (Abilify)
Your pt is taking Kava and you need to add an AS to manage their SCZ, which
do you add?
Answer: Aripiprazole (least sedating)
What are 2 hallmark symptoms of delirium?
Acute onset
disturbance of LOC
