Maryville nurs 663 Exam 2 -2023-2024
Lithium labs - ANSWER level, NA, Ca, P, EKG, Creatinine, Urinalysis, CBC, TSH
bipolar meds: depression - ANSWER lurasidone (13+), olanzapine + fluoxetine
(10+)(symbyax)
bipolar acute and mixed mania - ANSWER aripiprazole, risperidone, olanzapine (13+),
quetiapine (acute only), asenapine (10+)
classic mood stabilizers - ANSWER Lamotrigine (excellent medication to use), lithium,
Depakote (avoid in females if possible due to PCOS and Pregnancy), Tegretol, Trileptal (no
evidence for true Bipolar disorder)
anti-depressants - ANSWER class not used w/bipolar disorder
lithium - ANSWER Anti-manic, antidepressant, anti-suicidal
Lithium side effects - ANSWER Frequent urination, increased thirst, weight gain, sedation
lithium toxicity - ANSWER sudden onset tremors, N/V/D, muscle weakness, slurred speech,
confusion, seizures (slowing down, feel really out of it)
Persistent Motor or Vocal Tic Disorder - ANSWER pt in front of you only has one or the other
but not both—they usually don't even know it is a tic, it is only meaningful if it's affecting
their quality of life
Tourette's d/o - ANSWER Multiple motor and at least one vocal tic (some tics come and go,
they don't have them all at the same time to receive the diagnosis)
HRT - ANSWER habit reversal training can be used to manage tics
Tics tx - ANSWER Alpha agonists (clonidine, guanfacine); Haldol is not the first-line txt
Developmental Coordination Disorder - ANSWER a motor disorder characterized by marked
impairment in the development of motor coordination; movement isn't consistent w/age
Stereotypic Movement Disorder - ANSWER a motor disorder characterized by repetitive,
seemingly driven, and apparently purposeless motor behavior, such as hand waving or head
banging, but not include ASD sx
Specific Learning Disorders - ANSWER difficulties in the acquisition and use of listening,
speaking, reading, writing, reasoning, or mathematical abilities; dx by other professionals
,w/specialized training; NP tx comorbid d/o
Anorexia nervosa - ANSWER an eating disorder in which an irrational fear of weight gain
leads people to starve themselves; restrictive or binge/purge/exercise
Bulimia nervosa - ANSWER an eating disorder characterized by episodes of overeating,
usually of high-calorie foods, followed by vomiting, laxative use, fasting, or excessive exercise
Binge-eating disorder - ANSWER significant binge-eating episodes, followed by distress,
disgust, or guilt, but without the compensatory purging, fasting, or excessive exercise
Avoidant/restrictive eating disorder - ANSWER avoiding or restricting foods in childhood.
significantly low BMI; no distortion of body image or fear of gaining wt. r/o delusions around
food
Pica - ANSWER an abnormal craving or appetite for nonfood substances, such as dirt, paint,
or clay that lasts for at least 1 month; decrs incidence with incr age
Feeding and Eating Disorders tx - ANSWER Talk therapy (counseling is needed for the
distress) (intensive outpatient, partial inpatient or actual inpatient admission may be
needed); most have associated depression and/or anxiety
Feeding and Eating Disorders meds - ANSWER fluoxetine help but not direct tx
Vyvanse approved for binge eating but not because of stimulant effects
Encopresis - ANSWER a childhood disorder characterized by repeated defecating in
inappropriate places, such as one's clothing
Enuresis - ANSWER involuntary urination
Encopresis Treatment - ANSWER Behavior management: toilet refusal behavior, scheduled
toileting time, incentives.
Prevention of constipation
Counseling
Enuresis treatment - ANSWER 1. First line is behavioral interventions: bed alarms, toileting
at bedtime and during the night, bladder training
2. reassurance, resolves spontan, normal 4-5 yo
Enuresis meds - ANSWER Desmopressin nasal spray;
Major Depressive Disorder Dx - ANSWER 5+ for at least a 2-week period; either #1 or 2 req
, 1. Depressed mood most of the day, nearly every day (can be irritability in children &
adolescents)
2. Diminished interest or pleasure in all, or almost all, activities
3. Change appetite/weight; kids not wt goals
Insomnia or hypersomnia nearly every day
4. Up or down Psychomotor
5. Fatigue or loss of energy
6. Worthlessness/excessive or inappropriate guilt
7. Diminished ability to think or concentrate, or indecisiveness (don't confuse with ADHD,
address mood first)
8. Recurrent thoughts of death, thoughts of suicide, or suicidal plan/intent: if hosp then 2 wk
not req.
SLAP - ANSWER Social supports; lethal; access to means; plan and previous attempt
Suicide risk: IS PATH WARM - ANSWER Ideation, substance abuse, purpose to live gone;
anxiety, trapped feeling; hopelessness, w/d from soc supports, anger w/rage; reckless,
dramatic moods
SIGECAPS - ANSWER Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychomotor,
Suicide
bipolar vs unipolar: look at bipolar if - ANSWER 1. family hx: 1st degree relatives
2. Substance use: chasing high or low
3. Response to SSRI: no resp to multiple tries or evidence of mania with use (not diagnostic)
coprolalia - ANSWER involuntary utterance of obscenities or inappropriate remarks
Bipolar I criteria - ANSWER One manic episode required
Mania - ANSWER elevated, expansive, energetic + 3, (unless irritable
mood then requires 4+)
1. SX Lastat least one week-any duration if hosp
2. Inflated self-esteem, grandiosity
Lithium labs - ANSWER level, NA, Ca, P, EKG, Creatinine, Urinalysis, CBC, TSH
bipolar meds: depression - ANSWER lurasidone (13+), olanzapine + fluoxetine
(10+)(symbyax)
bipolar acute and mixed mania - ANSWER aripiprazole, risperidone, olanzapine (13+),
quetiapine (acute only), asenapine (10+)
classic mood stabilizers - ANSWER Lamotrigine (excellent medication to use), lithium,
Depakote (avoid in females if possible due to PCOS and Pregnancy), Tegretol, Trileptal (no
evidence for true Bipolar disorder)
anti-depressants - ANSWER class not used w/bipolar disorder
lithium - ANSWER Anti-manic, antidepressant, anti-suicidal
Lithium side effects - ANSWER Frequent urination, increased thirst, weight gain, sedation
lithium toxicity - ANSWER sudden onset tremors, N/V/D, muscle weakness, slurred speech,
confusion, seizures (slowing down, feel really out of it)
Persistent Motor or Vocal Tic Disorder - ANSWER pt in front of you only has one or the other
but not both—they usually don't even know it is a tic, it is only meaningful if it's affecting
their quality of life
Tourette's d/o - ANSWER Multiple motor and at least one vocal tic (some tics come and go,
they don't have them all at the same time to receive the diagnosis)
HRT - ANSWER habit reversal training can be used to manage tics
Tics tx - ANSWER Alpha agonists (clonidine, guanfacine); Haldol is not the first-line txt
Developmental Coordination Disorder - ANSWER a motor disorder characterized by marked
impairment in the development of motor coordination; movement isn't consistent w/age
Stereotypic Movement Disorder - ANSWER a motor disorder characterized by repetitive,
seemingly driven, and apparently purposeless motor behavior, such as hand waving or head
banging, but not include ASD sx
Specific Learning Disorders - ANSWER difficulties in the acquisition and use of listening,
speaking, reading, writing, reasoning, or mathematical abilities; dx by other professionals
,w/specialized training; NP tx comorbid d/o
Anorexia nervosa - ANSWER an eating disorder in which an irrational fear of weight gain
leads people to starve themselves; restrictive or binge/purge/exercise
Bulimia nervosa - ANSWER an eating disorder characterized by episodes of overeating,
usually of high-calorie foods, followed by vomiting, laxative use, fasting, or excessive exercise
Binge-eating disorder - ANSWER significant binge-eating episodes, followed by distress,
disgust, or guilt, but without the compensatory purging, fasting, or excessive exercise
Avoidant/restrictive eating disorder - ANSWER avoiding or restricting foods in childhood.
significantly low BMI; no distortion of body image or fear of gaining wt. r/o delusions around
food
Pica - ANSWER an abnormal craving or appetite for nonfood substances, such as dirt, paint,
or clay that lasts for at least 1 month; decrs incidence with incr age
Feeding and Eating Disorders tx - ANSWER Talk therapy (counseling is needed for the
distress) (intensive outpatient, partial inpatient or actual inpatient admission may be
needed); most have associated depression and/or anxiety
Feeding and Eating Disorders meds - ANSWER fluoxetine help but not direct tx
Vyvanse approved for binge eating but not because of stimulant effects
Encopresis - ANSWER a childhood disorder characterized by repeated defecating in
inappropriate places, such as one's clothing
Enuresis - ANSWER involuntary urination
Encopresis Treatment - ANSWER Behavior management: toilet refusal behavior, scheduled
toileting time, incentives.
Prevention of constipation
Counseling
Enuresis treatment - ANSWER 1. First line is behavioral interventions: bed alarms, toileting
at bedtime and during the night, bladder training
2. reassurance, resolves spontan, normal 4-5 yo
Enuresis meds - ANSWER Desmopressin nasal spray;
Major Depressive Disorder Dx - ANSWER 5+ for at least a 2-week period; either #1 or 2 req
, 1. Depressed mood most of the day, nearly every day (can be irritability in children &
adolescents)
2. Diminished interest or pleasure in all, or almost all, activities
3. Change appetite/weight; kids not wt goals
Insomnia or hypersomnia nearly every day
4. Up or down Psychomotor
5. Fatigue or loss of energy
6. Worthlessness/excessive or inappropriate guilt
7. Diminished ability to think or concentrate, or indecisiveness (don't confuse with ADHD,
address mood first)
8. Recurrent thoughts of death, thoughts of suicide, or suicidal plan/intent: if hosp then 2 wk
not req.
SLAP - ANSWER Social supports; lethal; access to means; plan and previous attempt
Suicide risk: IS PATH WARM - ANSWER Ideation, substance abuse, purpose to live gone;
anxiety, trapped feeling; hopelessness, w/d from soc supports, anger w/rage; reckless,
dramatic moods
SIGECAPS - ANSWER Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychomotor,
Suicide
bipolar vs unipolar: look at bipolar if - ANSWER 1. family hx: 1st degree relatives
2. Substance use: chasing high or low
3. Response to SSRI: no resp to multiple tries or evidence of mania with use (not diagnostic)
coprolalia - ANSWER involuntary utterance of obscenities or inappropriate remarks
Bipolar I criteria - ANSWER One manic episode required
Mania - ANSWER elevated, expansive, energetic + 3, (unless irritable
mood then requires 4+)
1. SX Lastat least one week-any duration if hosp
2. Inflated self-esteem, grandiosity
