Georgette’s 2025 LMR PMHNP Certification Exam Master Review

Georgette’s 2025 LMR PMHNP Certification Exam Master Review

� Psychiatry & Endocrine Quick Review Notes
🌿 Herbal Interactions

Kava Kava – Drugs to Avoid:

 Alprazolam
 CNS depressants (e.g., phenobarbital, zolpidem)
⚠️ Risk: Excessive sedation and CNS depression



🌍 Cultural Formulation Interview (CFI)

Primary Functions of CFI:

1. Clarifies the meaning of illness for the patient
2. Empowers the patient through cultural understanding
3. Validates symptoms within the patient’s cultural context

➡️ In short: The CFI is a structured cultural assessment tool that bridges psychiatry and cultural
identity.



� Thyroid Function Tests

Normal TSH Range: 0.5 – 5.0 mU/L

Hyperthyroidism Labs:

 ↓ TSH
 ↑ T4 & T3

Hypothyroidism Labs:

 ↑ TSH
 ↓ T4 & T3



🔥 Hyperthyroidism vs. ❄� Hypothyroidism

Key Symptoms – Hyperthyroidism (5):

 Heat intolerance

,  Agitation, anxiety, irritability
 Tachycardia
 Mood swings
 Weight loss

Key Symptoms – Hypothyroidism (4):

 Cold intolerance
 Lethargy
 Weight gain
 ↓ Libido

Psychiatric Mimics:

 Hypothyroidism → Depression-like symptoms
 Hyperthyroidism → Mania-like symptoms



💊 Valproic Acid (VPA)

Teratogenic Effect: Spina bifida (neural tube defect)
Primary Organ Toxicity: Liver (hepatotoxicity)

What are 4 signs of hepatoxicity? - Abdominal pain in the URQ
Reddish-brown urine
Yellowing of the skin and sclera
Fatigue

Abdominal pain in the URQ, Reddish-brown urine, Yellowing of the skin and sclera,
and Fatigue are signs of - Hepatoxicity

What is the therapeutic range for valproic acid? - 50-125 mcg/ml

What is a toxic level of valproic acid? - >150 mcg/ml

What are 4 signs of valproic acid toxicity? - Disorientation
Lethargy
Respiratory depression
Nausea/vomiting

Disorientation, Lethargy, Respiratory depression, and Nausea/vomiting are symptoms
of toxicity with what drug? - Valproic acid

With suspected toxicity with valproic acid, what labs should be drawn? - DC drug
Check drug level
Obtain LFTs

,Obtain ammonia level

What is the major side effect with Kava Kava? - Liver damage

What herbal supplement is sued for anxiety, stress, and insomnia? - Kava Kava

What are 5 symptoms of Stephen's Johnson Syndrome? - Fever
Body aches
Severe red rash
Peeling skin
Facial and tongue swelling

Severe red rash, Fever, Body aches, Peeling skin, and Facial and tongue swelling are
symptoms of - Stephen's Johnson Syndrome

Which mood stabilizer causes the least weight gain? - Lamotrigine (Lamictal)

, Which 3 SGAs cause the least weight gain? - Lurasidone (Latuda)
Aripiprazole (Abilify)
Ziprasidone (Geodon)

Which SGA is the least sedating? - Aripiprazole (Abilify)

What are 3 hallmark symptoms of delirium? - Acute disturbance of LOC
impaired cognition
inattention

Acute disturbance of LOC, cognition, and inattention are hallmark symptoms of -
Delirium

How are agitation and psychotic symptoms treated in delirium? - Low dose Haldol

What 4 drugs can cause mania? - Steroids
Disulfiram (Antabuse)
Isoniazid (INH)
Antidepressants (in BPD)

Steroids, Disulfiram (Antabuse), and Isoniazid (INH) can induce - Mania

What 6 drugs can induce depression? - Steroids
Beta blockers
Interferon, Isotretinoin (Accutane)
Retroviral drugs, Antineoplastic drugs
Benzodiazepines
Progesterone

Steroids can induce what 3 psychiatric states? - Mania
Depression
Psychosis

What medication to treat acne cause cause birth defects? - Isotretinoin (Accutane)

What is the therapeutic range for lithium? - 0.6-1.2 mEq/L

What medication has a neuroprotective effect for bipolar disorder? - Lithium

What is the gold standard for treating manic episodes - Lithium