25 pg and 5 pg – REVIEW – Notes – January 2021
1. Increase prolactin
- Stop prolactin (stop the agent that cause increase prolactin)
2. 3-year-old masturbates, play with self, says naughty things
- FREUD’s PSYCHOSOCIAL STAGES OF DEVELOPMENT – PHALLIC STAGE – 3-6 years old
- This is NORMAL for children this age.
- PNEUMOIC – Old Age Parents Love Grandchildren
- Oral (0-18 months), Anal (18 months – 3 years), Phallic (3 years to 6 years), Latent (6 to 12),
Genital (12 +)
- ACUTE STRESS DISORDER
o A d/o resulting from exposure to a major stressor, with SX of ANX, depression,
dissociation, recurring nightmares, sleep disturbances, problems in
concentrations, reliving the event, dreams, flashbacks – UP to ONE MONTH – Less
than 1 month.
o If LONGER than 1 month = PTSD
3. 5-year-old tells you his brother sodomized him
- Tell mom don’t leave him alone with patient and call CPS implement crisis
- QUESTION – Child is playing with doll in a sexual way – You SUSPECT sexual abuse -
Perform FURTHER ASSESSMENT and GATHER ENOUGH INFO BEFORE Calling CPS to
report suspected Sexual Abuse – You HAVE to report but you have to have something
(assessment data) to report – Assess = FIRST
4. 13-year-old want to smoke
- Ask him of his plan to stop smoking
-
5. 14-year-old girl clenching her teeth
- Cranial nerve V-Trigeminal nerve (FIVE)
- 7 = Facial Paralysis – Bells Palsy
Know Cranial Nerves
6. 16-year-old falls with the wrong crowd
- Conduct disorder
7. 16-year-old refuse treatment
- Send to psych specialist for acting out kids – Referrals – Have to see if you are going to
refer the same patient to the same provider – Cannot refer the patient to another
provider that is the same as you (ie psych) – you must refer to a neurologist or another
specialist or PCP
8. 16-year-old shows up with mother for first therapy
- Confidential (mom sits in lobby)
9. ACE inhibitors
, - HTN & Heart Failure
- This medication can cause increased lithium levels to toxic levels – must collaborate
with PCP to determine whether to change ACE or change Lithium – Can’t use both
10. ACE inhibitors are the drug of choice for what?
- Heart failure/HTN
11. Acute stress disorder
(ASD)
- LESS THAN 1 MONTH
- Can be 2 to 4 weeks
- A disorder resulting from exposure to a major stressor, with symptoms of anxiety,
dissociation, recurring nightmares, sleep disturbances, problems in concentration, and
moments in which people seem to “relive” the event in dreams and flashbacks for as long
as 1 month following the event
- Symptoms that occur immediately after the event but resolve in less than 3 days would
not meet criteria for acute stress disorder (PB)
- Acute stress disorder must occur within 1 month of the traumatic event and resolve
within that 1-month period. If the symptoms persist for more than 1 month and meet
criteria for PTSD, the diagnosis is changed from acute stress disorder to PTSD (PB)
LITHIUM
• First-line neuro-protective fort bipolar
• Ibuprofen & Lithium
o INCREASES the serum level up to double
• Lab Values concerning for patient on Lithium:
o Leukocytosis
o Creatinine
o BUN
o NA+
o 4 + PORTEIN in Urine
o + Pregnancy Test
• NSAID, dehydration and Thiazides increases risk of lithium toxicity:
o Lithium Toxicity
o LITHIUM LEVEL – 0.5 – 1.2 mEq/L
o MONITOR for TOXICITY: Toxicity = > 1.2 mEq/l
• TOXICITY:
o Slurred speech, confusion, severe GI effect – diarrhea/nausea/vomiting, metallic
taste and SEVERE tremor.
• PREGNANCY CATEGORY D
o Lactation Category L3
o Risk of Hypothyroidism
o AVOID in pregnancy, especially 1st trimester – Ebstein anomaly, cardiac defect.
,12. ADPIE
- Assessment
- Diagnosis
- Planning
- Implementation
- Evaluation
CBT – Daily Log – Depression & Anxiety
13. Adult panic disorder
- Buspar
Pharmacological Management (PB PG 209)
- SSRIs
- BNZs, usually used for short-term symptom control or “bridge” medication when
- starting an SSRI or other antidepressant
• Buspar effective as an adjunct to an antidepressant
• Other non-benzodiazepine anxiolytic meds used as adjuncts
14. Aggressive patient to give
- IM Geodon
15. Agoraphobia
- Fear of open spaces
16. Agoraphobia treatment
- BZs: Short term symptom relief
- SSRIs: long term maintenance
• Fluoxetine (Prozac)
• Paroxetine (Paxil)
• Sertraline (Zoloft)
- SNRIs: long term maintenance
• Venlafaxine (Effexor)
- TCAs: long term maintenance
- Pharmacological Management (PB page 211)
- SSRIs
- BNZs for short-term use
- Beta blockers (off-label use) used for discrete episodes of social anxiety –
contraindicated for clients with asthma
17. Alprostadil (PGE1)
- Ductal-dependent Congenital Heart disease (all forms)
- Prostaglandin E1 (PGE1), also known as alprostadil, is a naturally occurring
prostaglandin which is used as a medication. In babies with congenital heart defects, it
is used by slow
, injection into a vein to open the ductus arteriosus until surgery can be carried out. By
injection into the penis or placement in the urethra, it is used to treat erectile dysfunction.
- 0.05-0.1 mg/kg/min IV/IO infusion initially, then 0.01-0.05 mg/kg/min IV/IO
18. Amygdala:
- Fear, anxiety, and
aggression 19. Amygdala
- A limbic system structure involved in memory and emotion, anxiety, particularly fear
and aggression
20. Anorexia (SAFETY = KEY)
- Set up family therapy (especially adolescent pts since they have no control over food
choices)
21. Anorexia admission criteria for hospitalization
- Weight loss over 30 % over 6 months, severe hypothermia (temp lower than 36 C or
96.8 F), heart rate less than 40 beats per minute, systolic blood pressure less than 70
mm hg, and hypokalemia (less than 3 mEq/L).
22. Anorexia nervosa
- BMI less than 18.5
- BMI < 16 = AUTOMATIC ADMISSION
- An eating disorder in which an irrational fear of weight gain leads people to
starve themselves
23. ANOVA (analysis of variance)
- 3 or more
- An inferential statistical test for comparing the means of three or more groups
24. Antidepressant takes
- 5 weeks to take effect
- 4 – 6 weeks
PROZAC Causes What?
• Increase Anxiety in Elderly
25. Apoptosis
- Cell death in aging/elderly
26. Appreciative inquiry
-
1. Increase prolactin
- Stop prolactin (stop the agent that cause increase prolactin)
2. 3-year-old masturbates, play with self, says naughty things
- FREUD’s PSYCHOSOCIAL STAGES OF DEVELOPMENT – PHALLIC STAGE – 3-6 years old
- This is NORMAL for children this age.
- PNEUMOIC – Old Age Parents Love Grandchildren
- Oral (0-18 months), Anal (18 months – 3 years), Phallic (3 years to 6 years), Latent (6 to 12),
Genital (12 +)
- ACUTE STRESS DISORDER
o A d/o resulting from exposure to a major stressor, with SX of ANX, depression,
dissociation, recurring nightmares, sleep disturbances, problems in
concentrations, reliving the event, dreams, flashbacks – UP to ONE MONTH – Less
than 1 month.
o If LONGER than 1 month = PTSD
3. 5-year-old tells you his brother sodomized him
- Tell mom don’t leave him alone with patient and call CPS implement crisis
- QUESTION – Child is playing with doll in a sexual way – You SUSPECT sexual abuse -
Perform FURTHER ASSESSMENT and GATHER ENOUGH INFO BEFORE Calling CPS to
report suspected Sexual Abuse – You HAVE to report but you have to have something
(assessment data) to report – Assess = FIRST
4. 13-year-old want to smoke
- Ask him of his plan to stop smoking
-
5. 14-year-old girl clenching her teeth
- Cranial nerve V-Trigeminal nerve (FIVE)
- 7 = Facial Paralysis – Bells Palsy
Know Cranial Nerves
6. 16-year-old falls with the wrong crowd
- Conduct disorder
7. 16-year-old refuse treatment
- Send to psych specialist for acting out kids – Referrals – Have to see if you are going to
refer the same patient to the same provider – Cannot refer the patient to another
provider that is the same as you (ie psych) – you must refer to a neurologist or another
specialist or PCP
8. 16-year-old shows up with mother for first therapy
- Confidential (mom sits in lobby)
9. ACE inhibitors
, - HTN & Heart Failure
- This medication can cause increased lithium levels to toxic levels – must collaborate
with PCP to determine whether to change ACE or change Lithium – Can’t use both
10. ACE inhibitors are the drug of choice for what?
- Heart failure/HTN
11. Acute stress disorder
(ASD)
- LESS THAN 1 MONTH
- Can be 2 to 4 weeks
- A disorder resulting from exposure to a major stressor, with symptoms of anxiety,
dissociation, recurring nightmares, sleep disturbances, problems in concentration, and
moments in which people seem to “relive” the event in dreams and flashbacks for as long
as 1 month following the event
- Symptoms that occur immediately after the event but resolve in less than 3 days would
not meet criteria for acute stress disorder (PB)
- Acute stress disorder must occur within 1 month of the traumatic event and resolve
within that 1-month period. If the symptoms persist for more than 1 month and meet
criteria for PTSD, the diagnosis is changed from acute stress disorder to PTSD (PB)
LITHIUM
• First-line neuro-protective fort bipolar
• Ibuprofen & Lithium
o INCREASES the serum level up to double
• Lab Values concerning for patient on Lithium:
o Leukocytosis
o Creatinine
o BUN
o NA+
o 4 + PORTEIN in Urine
o + Pregnancy Test
• NSAID, dehydration and Thiazides increases risk of lithium toxicity:
o Lithium Toxicity
o LITHIUM LEVEL – 0.5 – 1.2 mEq/L
o MONITOR for TOXICITY: Toxicity = > 1.2 mEq/l
• TOXICITY:
o Slurred speech, confusion, severe GI effect – diarrhea/nausea/vomiting, metallic
taste and SEVERE tremor.
• PREGNANCY CATEGORY D
o Lactation Category L3
o Risk of Hypothyroidism
o AVOID in pregnancy, especially 1st trimester – Ebstein anomaly, cardiac defect.
,12. ADPIE
- Assessment
- Diagnosis
- Planning
- Implementation
- Evaluation
CBT – Daily Log – Depression & Anxiety
13. Adult panic disorder
- Buspar
Pharmacological Management (PB PG 209)
- SSRIs
- BNZs, usually used for short-term symptom control or “bridge” medication when
- starting an SSRI or other antidepressant
• Buspar effective as an adjunct to an antidepressant
• Other non-benzodiazepine anxiolytic meds used as adjuncts
14. Aggressive patient to give
- IM Geodon
15. Agoraphobia
- Fear of open spaces
16. Agoraphobia treatment
- BZs: Short term symptom relief
- SSRIs: long term maintenance
• Fluoxetine (Prozac)
• Paroxetine (Paxil)
• Sertraline (Zoloft)
- SNRIs: long term maintenance
• Venlafaxine (Effexor)
- TCAs: long term maintenance
- Pharmacological Management (PB page 211)
- SSRIs
- BNZs for short-term use
- Beta blockers (off-label use) used for discrete episodes of social anxiety –
contraindicated for clients with asthma
17. Alprostadil (PGE1)
- Ductal-dependent Congenital Heart disease (all forms)
- Prostaglandin E1 (PGE1), also known as alprostadil, is a naturally occurring
prostaglandin which is used as a medication. In babies with congenital heart defects, it
is used by slow
, injection into a vein to open the ductus arteriosus until surgery can be carried out. By
injection into the penis or placement in the urethra, it is used to treat erectile dysfunction.
- 0.05-0.1 mg/kg/min IV/IO infusion initially, then 0.01-0.05 mg/kg/min IV/IO
18. Amygdala:
- Fear, anxiety, and
aggression 19. Amygdala
- A limbic system structure involved in memory and emotion, anxiety, particularly fear
and aggression
20. Anorexia (SAFETY = KEY)
- Set up family therapy (especially adolescent pts since they have no control over food
choices)
21. Anorexia admission criteria for hospitalization
- Weight loss over 30 % over 6 months, severe hypothermia (temp lower than 36 C or
96.8 F), heart rate less than 40 beats per minute, systolic blood pressure less than 70
mm hg, and hypokalemia (less than 3 mEq/L).
22. Anorexia nervosa
- BMI less than 18.5
- BMI < 16 = AUTOMATIC ADMISSION
- An eating disorder in which an irrational fear of weight gain leads people to
starve themselves
23. ANOVA (analysis of variance)
- 3 or more
- An inferential statistical test for comparing the means of three or more groups
24. Antidepressant takes
- 5 weeks to take effect
- 4 – 6 weeks
PROZAC Causes What?
• Increase Anxiety in Elderly
25. Apoptosis
- Cell death in aging/elderly
26. Appreciative inquiry
-
