Georgette Review 100% SOLUTION 2023//2024

Georgette Review 100% SOLUTION 2023//2024 When many answers are remarkably similar, they are usually _____________ - ANSWER wrong Interprofessional collaboration is encouraged. - ANSWER Collaborate is usually right. Delegate is usually wrong. ADPIER - ANSWER Assessment, diagnosis, Plan, intervention, evaluate, refer out last. Lithium - ANSWER Normal 0.6-1.2 Lithium toxicity occurs at levels - ANSWER 1.5 Signs of Lithium toxicity - ANSWER severe nausea, diarrhea, vomiting, confusion, drowsiness, muscle weakness, heart palpitation, coarse hand tremors, unsteady gait Lithium is gold standard for - ANSWER MANIA Lithium has evidence shown to - ANSWER reduce suicidal ideation What does lithium cause in neonate, especially 1st trimester - ANSWER Ebstein anomaly (congenital heart defect) dehydration and hyponatremia cause lithium levels to - ANSWER rise Baseline labs before initiation of lithium - ANSWER TSH creatinine (0.6-1.2) BUN (10-20) HCG (all psychotropics females 12-51) EKG 50+ Urinalysis (check for proteins, 4+ may indicate kidney disease) Side Effects of Lithium - ANSWER hypothyroidism coase hand tremors with toxicity maculopapular rash diarrhea, vomiting, cramps--signs of toxicity. Monitor closely. anorexia t wave inversions leukocytosis Pt education for lithimum - ANSWER staying hydrated avoiding NSAIDS compliance Depakote normal level - ANSWER 50-125 Depakote toxicity level - ANSWER greater than 150 Teratogenic effects of Depakote - ANSWER spina bifida Adverse effects of depakote - ANSWER alopecia hepatotoxicity (RUQ pain or brown/red urine--order LFTs) AST 5-40, ALT 5-35, yellowing of skin or eyes, fatigue Signs of Depakote toxicity - ANSWER disorientation, lethargy, respiratory depression, nausea/vomiting Intervention for depakote toxicity - ANSWER DC med check level LFT ammonia MAOI + tyramine causes - ANSWER hypertensive crisis Symptoms of hypertensive crisis - ANSWER elevated BP sudden explosive like headache facial flushing palpitations pupillary dilation diaphoresis fever Hypertensive crisis occurs with MAOI + - ANSWER MEPERIDINE STIMULANTS decongestants TCAs atypicals St. John's wart L-tryptophan asthma meds Treatment for hypertensive crisis - ANSWER DC offending agent Administer PHENTOLAMINE Teratogenic effects of benzos - ANSWER floppy baby, cleft palate Teratogenic effects of tegratol - ANSWER neural tube defect teratogenic effects of lithium - ANSWER ebstein anomaly (heart defect) (avoid, especially 1st trimester) teratogenic effects of depakote - ANSWER neural tube defects/spina bifida Adverse reaction to Lamictal - ANSWER Steven Johnson's Syndrome Signs of SJS - ANSWER FEVER --high yield sore throat facial swelling tongue swelling red rash skin sloughing body aches prodromal headache malaise arthralgia painful mucus membranes Lamotrigine is least likely to cause - ANSWER sedation or weight gain Carbamazepine (tegretol) black box warning - ANSWER agranulocytosis (decrease WBCs) aplastic anemia (pallor, fatigue, HA, fever, nosebleeds, bleeding gums, skin rash, SOA) Carbamazepine and asians - ANSWER Screen for HLAB-1502 allele before initiating, due to high incidence of SJS if positive for allele. Child-bearing aged women - ANSWER check for pregnancy before starting mood stabilizer start on folic acid to support neural tube development during the first month that a woman is pregnant Clozaril/clozapine can cause - ANSWER agranulocytosis and neutropenia For monitoring neutropenia in Clozaril, monitor - ANSWER ANC DC clozarli if ANC - ANSWER less than 1000 DC clozaril if WBC - ANSWER , risk of agranulocytosis When on clozaril monitor for - ANSWER signs and symptoms of infection: sudden fever, chills, sore throat, weakness Clozaril only known antipsychotic to - ANSWER decrease risk of suicide in patients with schizophrenia. Your patient with bipolar disorder is admitted to a medical hospital. The internist contacts your office and asks whether the lithium you prescribed him is effecting his ECG. How do you respond? A. Lithium can prolong the QT interval B. Lithium has no effect on his ECG C. Lithium can invert the t waves D. Lithium can shorten the PR interval - ANSWER Answer: Lithium can invert the t waves. Mary is a 45-year-old African American female who has been treated on Isocarboxazid (Marplan) for over 6 years. Mary is going in for a surgical procedure. Which medication is strictly contraindicated with Isocarboxazid? A. Morphine B. NSAIDS C. Methylphenidate