PMHNP Diagnosis and Treatment III
graded A+
What is phentolamine used for?
Hypertensive crisis associated with MAOI administration - it blocks norepinephrine receptor sites
What is the therapeutic range of Lithium?
0.6 to 1.2 mEq/L
What labs should be checked before initiation of lithium?
Thyroid panel
Serum Creatinine
Blood Urea Nitrogen
Pregnancy Test
ECG for clients older than age 50
Adverse effects associated with Lithium
- Endocrine: hypothyroidism, weight gain
- CNS: fine hand tremors, fatigue, brain fog, headaches, coarse hand tremors w/toxicity, nystagmus
- Derm: maculopapular rash, pruritus, acne
- GI: severe GI upset w/toxicity, diarrhea, vomiting, cramps, anorexia
- Renal: diabetes insipidus: polyuria, polydipsia; edema, microscopic tubular changes
- Cardiac: T-wave inversions, dysrhythmia
- Hematologic: Leukocytosis (increased WBCs)
Signs of Lithium Toxicity
- Severe nausea, vomiting, diarrhea, confusion, convulsions, drowsiness, blurred vision, slurred speech,
muscle weakness, heart palpitations, coarse hand tremors, and unsteadiness while standing or walking
(ataxia)
--> DC lithium and check serum drug level
Teratogenic Risk of Lithium
Epstein Anomaly (congenital heart defect)
Teratogenic Risk of Depakote
, Neural tube defects, particularly spina bifida, atrial septal defect, cleft palate, and long-term
developmental deficits
Teratogenic Risk of Benzodiazepines
floppy baby syndrome, cleft palate
Teratogenic Risks of Carbamazepine (Tegretol)
Neural tube defects
FDA Pregnancy Categories for Medications
A: controlled studies show no risk
B: no evidence of risk in humans
C: Risk cannot be ruled out
D: Positive evidence of risk
X: Absolutely contraindicated in pregnancy
Black Box Warning for Lamictal
Stevens Johnson Syndrome (severe rash)
Signs and Symptoms of Stevens Johnson Syndrome
Fever
Sore Throat
Facial Swelling
Tongue Swelling
Rash
Skin Sloughing
Prodromal: headache, malaise, arthralgia (joint stiffness) and painful mucous membranes
Black Box Warning for Depakote
hepatotoxicity and pancreatitis
(may also cause SJS)
Black Box Warning for Carbamazepine (Tegretol)
Agranulocytosis (decreased white blood cells) and aplastic anemia (pallor fatigue, headache, fever,
nosebleeds, bleeding gums, skin rash, shortness of breath.)
(may also cause SJS)
graded A+
What is phentolamine used for?
Hypertensive crisis associated with MAOI administration - it blocks norepinephrine receptor sites
What is the therapeutic range of Lithium?
0.6 to 1.2 mEq/L
What labs should be checked before initiation of lithium?
Thyroid panel
Serum Creatinine
Blood Urea Nitrogen
Pregnancy Test
ECG for clients older than age 50
Adverse effects associated with Lithium
- Endocrine: hypothyroidism, weight gain
- CNS: fine hand tremors, fatigue, brain fog, headaches, coarse hand tremors w/toxicity, nystagmus
- Derm: maculopapular rash, pruritus, acne
- GI: severe GI upset w/toxicity, diarrhea, vomiting, cramps, anorexia
- Renal: diabetes insipidus: polyuria, polydipsia; edema, microscopic tubular changes
- Cardiac: T-wave inversions, dysrhythmia
- Hematologic: Leukocytosis (increased WBCs)
Signs of Lithium Toxicity
- Severe nausea, vomiting, diarrhea, confusion, convulsions, drowsiness, blurred vision, slurred speech,
muscle weakness, heart palpitations, coarse hand tremors, and unsteadiness while standing or walking
(ataxia)
--> DC lithium and check serum drug level
Teratogenic Risk of Lithium
Epstein Anomaly (congenital heart defect)
Teratogenic Risk of Depakote
, Neural tube defects, particularly spina bifida, atrial septal defect, cleft palate, and long-term
developmental deficits
Teratogenic Risk of Benzodiazepines
floppy baby syndrome, cleft palate
Teratogenic Risks of Carbamazepine (Tegretol)
Neural tube defects
FDA Pregnancy Categories for Medications
A: controlled studies show no risk
B: no evidence of risk in humans
C: Risk cannot be ruled out
D: Positive evidence of risk
X: Absolutely contraindicated in pregnancy
Black Box Warning for Lamictal
Stevens Johnson Syndrome (severe rash)
Signs and Symptoms of Stevens Johnson Syndrome
Fever
Sore Throat
Facial Swelling
Tongue Swelling
Rash
Skin Sloughing
Prodromal: headache, malaise, arthralgia (joint stiffness) and painful mucous membranes
Black Box Warning for Depakote
hepatotoxicity and pancreatitis
(may also cause SJS)
Black Box Warning for Carbamazepine (Tegretol)
Agranulocytosis (decreased white blood cells) and aplastic anemia (pallor fatigue, headache, fever,
nosebleeds, bleeding gums, skin rash, shortness of breath.)
(may also cause SJS)
