Georgettes LMR study set | PMHNP Review items
When questions ask for a priority action...think about... - ABC, airway breathing,
circulation
Maslows hierarchy
If undecided on an answer due to high similarities, choose: - the umbrella answer
What is the most common side effect of olanzapine/zyprexa - metabolic syndrome
what is the difference between typical and atypical antipsychotics - Atypical
5HT2A specific
1st psychotic break... two actions to take - UDS and r/o sub
Consider IM Geodon or Invega
Three AP with least weight gain - Latuda, Abilify, Geodon
Always encourage interprofessional collaboration - between
therapists/pcps/SW/RN, the ENTIRE team
TSH High, then....t3/t4 - T3, T4 low
TSH low, then...t3/t4 - T3, T4 high
cold/hot sensitivity with t3/t4 relationship - T3/T4 low, hypothyroid, cold, slow
T3/T4 high, hyperthyroid, hot, flushed, tachy
What birth defect can be caused by depakote? - Spina bifida
What organ does depakote cause toxicity? and what sx would you expect to see?
labs to run? - Hepatotoxicity: RUQ pain, reddish brown urine-
Do LFTs
kava kava is used to treat - anxiety and insomnia
,Rash and fever associated with tegretol, suspect -
What allele is HLAB 1502 associated? - Asians. They CANNOT have tegretol.
Test all asians for this allele.
what rare and dangerous side effects are associated with tegretol - Aplastic anemia
Agranulocytosis-DC at ANC less than 1000
Sx's of agranulocytosis - unusual bleeding or bruising, mouth sores, infections,
fever, sore throat, fatigue
if starting a woman on lithium what test should be done? why? - HCG--risk of
ebstein anomaly
adverse s/e of lamictal/lamotrigine - SJS
labs to checke BEFORE starting on lithium - BUN
CRE
urine protein
What does protein in urine indicate - kidney impairment; 4+ protein in urine=you
cannot start on lithium
best choice med for decreasing si in bipolar disorder. - lithium
best choice med for si in schizophrenia - clozaril
best choice med for SI in borderline - lithium
What medications will INCREASE Li levels - NSAIDS
ACE's
Thiazides/HCTZ
Besides medications, what else can cause increased Li levels - dehydration
hyponatremia
lithium s/e inc N/V, which will effect electrolytes, and dehydration status
,what type of tremors will you see with lithium toxicity? - course tremors
lithium can cause what other comorbidities? - hypothyroidism
maculopapular rash
leukocytosis
twave inversion
what is a defining characteristic of NMS vs SS - muscle rigidity
Sx's/labs associated with NMS - Inc CPK, WBC, LFT
Rhabdomyolosis
myoglobinuria
Can lead to mutism
myoglobinuria/rhabdo can cause cherry colored urine
Treatment for NMS and what each does - DC the offending agent
bromocriptin-D2 agonis
dantrolene: muscle relaxant
Make sure if ? is asking for agonist or relaxant
Sx of SS - HYPERREFLEXIA
myoclonic jerks
treatment for SS - ciproheptadine
how to best PREVENT SS - follow proper transition protocols
SSRI to MAOI=14 days
Prozac to MAOI=5-6 weeks
Triptans can also cause SS due to serotonin increase with use
Why are SSRIs considered the safest for use in depression - safest for OD
depressed patient presents with fatigue and low energy, consider: - NDRI
wellbutrin
, sexual s/e with ssri? try... - wellbutrin due to lower risk of sexual s/e
What medication must be avoided if client has seizure history or eating disorder?
why? - wellbutrin due to decreasing the seizure threshold
if client has depression and neuropathic pain - SNRI or TCA for treatment of
BOTH
What med class treats neuropathic pain well - alpha 2 delta ligands
Gabapentin
Lyrica
What medication class is good for depression with comorbid CA - SSRI
least chance of drug drug interactions
Celexa and lexapro are good choices
Black box warning on SSRI - inc SI in kids, esp
Required education for rx ssri - long time for effect
side effects esp n/v/d
NO ABRUPT stopping d/t Serotonin discontinuation syndrome
Sx's of serotonin discontinuation syndrome - fever, shivering, muscle aches and
nausea diarrhea, agitation, cog impairment... (think flu like sx's)
disequilibrium
What are some scenarios that place patients at risk of a hypertensive crisis? -
MAOI and tyramine
MAOI and TCA
MAOI and Atypical AP
MAOI and decongestant
MAOI and stimulants
MAOI and asthma meds
Sx of Hypertensive crisis - HA
When questions ask for a priority action...think about... - ABC, airway breathing,
circulation
Maslows hierarchy
If undecided on an answer due to high similarities, choose: - the umbrella answer
What is the most common side effect of olanzapine/zyprexa - metabolic syndrome
what is the difference between typical and atypical antipsychotics - Atypical
5HT2A specific
1st psychotic break... two actions to take - UDS and r/o sub
Consider IM Geodon or Invega
Three AP with least weight gain - Latuda, Abilify, Geodon
Always encourage interprofessional collaboration - between
therapists/pcps/SW/RN, the ENTIRE team
TSH High, then....t3/t4 - T3, T4 low
TSH low, then...t3/t4 - T3, T4 high
cold/hot sensitivity with t3/t4 relationship - T3/T4 low, hypothyroid, cold, slow
T3/T4 high, hyperthyroid, hot, flushed, tachy
What birth defect can be caused by depakote? - Spina bifida
What organ does depakote cause toxicity? and what sx would you expect to see?
labs to run? - Hepatotoxicity: RUQ pain, reddish brown urine-
Do LFTs
kava kava is used to treat - anxiety and insomnia
,Rash and fever associated with tegretol, suspect -
What allele is HLAB 1502 associated? - Asians. They CANNOT have tegretol.
Test all asians for this allele.
what rare and dangerous side effects are associated with tegretol - Aplastic anemia
Agranulocytosis-DC at ANC less than 1000
Sx's of agranulocytosis - unusual bleeding or bruising, mouth sores, infections,
fever, sore throat, fatigue
if starting a woman on lithium what test should be done? why? - HCG--risk of
ebstein anomaly
adverse s/e of lamictal/lamotrigine - SJS
labs to checke BEFORE starting on lithium - BUN
CRE
urine protein
What does protein in urine indicate - kidney impairment; 4+ protein in urine=you
cannot start on lithium
best choice med for decreasing si in bipolar disorder. - lithium
best choice med for si in schizophrenia - clozaril
best choice med for SI in borderline - lithium
What medications will INCREASE Li levels - NSAIDS
ACE's
Thiazides/HCTZ
Besides medications, what else can cause increased Li levels - dehydration
hyponatremia
lithium s/e inc N/V, which will effect electrolytes, and dehydration status
,what type of tremors will you see with lithium toxicity? - course tremors
lithium can cause what other comorbidities? - hypothyroidism
maculopapular rash
leukocytosis
twave inversion
what is a defining characteristic of NMS vs SS - muscle rigidity
Sx's/labs associated with NMS - Inc CPK, WBC, LFT
Rhabdomyolosis
myoglobinuria
Can lead to mutism
myoglobinuria/rhabdo can cause cherry colored urine
Treatment for NMS and what each does - DC the offending agent
bromocriptin-D2 agonis
dantrolene: muscle relaxant
Make sure if ? is asking for agonist or relaxant
Sx of SS - HYPERREFLEXIA
myoclonic jerks
treatment for SS - ciproheptadine
how to best PREVENT SS - follow proper transition protocols
SSRI to MAOI=14 days
Prozac to MAOI=5-6 weeks
Triptans can also cause SS due to serotonin increase with use
Why are SSRIs considered the safest for use in depression - safest for OD
depressed patient presents with fatigue and low energy, consider: - NDRI
wellbutrin
, sexual s/e with ssri? try... - wellbutrin due to lower risk of sexual s/e
What medication must be avoided if client has seizure history or eating disorder?
why? - wellbutrin due to decreasing the seizure threshold
if client has depression and neuropathic pain - SNRI or TCA for treatment of
BOTH
What med class treats neuropathic pain well - alpha 2 delta ligands
Gabapentin
Lyrica
What medication class is good for depression with comorbid CA - SSRI
least chance of drug drug interactions
Celexa and lexapro are good choices
Black box warning on SSRI - inc SI in kids, esp
Required education for rx ssri - long time for effect
side effects esp n/v/d
NO ABRUPT stopping d/t Serotonin discontinuation syndrome
Sx's of serotonin discontinuation syndrome - fever, shivering, muscle aches and
nausea diarrhea, agitation, cog impairment... (think flu like sx's)
disequilibrium
What are some scenarios that place patients at risk of a hypertensive crisis? -
MAOI and tyramine
MAOI and TCA
MAOI and Atypical AP
MAOI and decongestant
MAOI and stimulants
MAOI and asthma meds
Sx of Hypertensive crisis - HA
