Updated
Georgette
Review
PMHNP. When
many
answers
are
remarkably
similar,
they
are
usually
_____________
-
ANS
wrong
Interprofessional
collaboration
is
encouraged.
-
ANS
Collaborate
is
usually
right.
Delegate
is
usually
wrong.
ADPIER
-
ANS
Assessment,
diagnosis,
Plan,
intervention,
evaluate,
refer
out
last.
Lithium
-
ANS
Normal
0.6-1.2
Lithium
toxicity
occurs
at
levels
-
ANS
>
1.5
Signs
of
Lithium
toxicity
-
ANS
severe
nausea,
diarrhea,
vomiting,
confusion,
drowsiness,
muscle
weakness,
heart
palpitation,
coarse
hand
tremors,
unsteady
gait
Lithium
is
gold
standard
for
-
ANS
MANIA
Lithium
has
evidence
shown
to
-
ANS
reduce
suicidal
ideation
What
does
lithium
cause
in
neonate,
especially
1st
trimester
-
ANS
Ebstein
anomaly
(congenital
heart
defect)
dehydration
and
hyponatremia
cause
lithium
levels
to
-
ANS
rise
Baseline
labs
before
initiation
of
lithium
-
ANS
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
-
ANS
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
-
ANS
staying
hydrated
avoiding
NSAIDS
compliance
Depakote
normal
level
-
ANS
50-125
Depakote
toxicity
level
-
ANS
greater
than
150
Teratogenic
effects
of
Depakote
-
ANS
spina
bifida
Adverse
effects
of
depakote
-
ANS
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
-
ANS
disorientation,
lethargy,
respiratory
depression,
nausea/vomiting
Intervention
for
depakote
toxicity
-
ANS
DC
med
check
level
LFT
ammonia
MAOI
+
tyramine
causes
-
ANS
hypertensive
crisis
Symptoms
of
hypertensive
crisis
-
ANS
elevated
BP
sudden
explosive
like
headache
facial
flushing
palpitations
pupillary
dilation
diaphoresis
fever
Hypertensive
crisis
occurs
with
MAOI
+
-
ANS
MEPERIDINE
STIMULANTS
decongestants
TCAs
atypicals
St.
John's
wart
L-tryptophan
asthma
meds
Treatment
for
hypertensive
crisis
-
ANS
DC
offending
agent
Administer
PHENTOLAMINE Teratogenic
effects
of
benzos
-
ANS
floppy
baby,
cleft
palate
Teratogenic
effects
of
tegratol
-
ANS
neural
tube
defect
teratogenic
effects
of
lithium
-
ANS
ebstein
anomaly
(heart
defect)
(avoid,
especially
1st
trimester)
teratogenic
effects
of
depakote
-
ANS
neural
tube
defects/spina
bifida
Adverse
reaction
to
Lamictal
-
ANS
Steven
Johnson's
Syndrome
Signs
of
SJS
-
ANS
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
-
ANS
sedation
or
weight
gain
Carbamazepine
(tegretol)
black
box
warning
-
ANS
agranulocytosis
(decrease
WBCs)
aplastic
anemia
(pallor,
fatigue,
HA,
fever,
nosebleeds,
bleeding
gums,
skin
rash,
SOA)
Carbamazepine
and
asians
-
ANS
Screen
for
HLAB-1502
allele
before
initiating,
due
to
high
incidence
of
SJS
if
positive
for
allele.
Child-bearing
aged
women
-
ANS
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
-
ANS
agranulocytosis
and
neutropenia
For
monitoring
neutropenia
in
Clozaril,
monitor
-
ANS
ANC
DC
clozarli
if
ANC
-
ANS
less
than
1000
DC
clozaril
if
WBC
-
ANS
2000-3000,
risk
of
agranulocytosis When
on
clozaril
monitor
for
-
ANS
signs
and
symptoms
of
infection:
sudden
fever,
chills,
sore
throat,
weakness
Clozaril
only
known
antipsychotic
to
-
ANS
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
-
ANS
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
D.
Acetaminophen
-
ANS
Answer:
Methylphenidate
You
are
treating
a
client
with
schizophrenia
who
takes
clozapine.
What
lab
values
will
indicate
the
client
needs
to
discontinue
treatment?
A.
WBC
less
than
1800
and
ANC
less
than
1200
B.
ANC
less
than
1,000
C.
WBC
less
than
5,000
D.
ANC
less
than
2000
-
ANS
Answer:
ANC
less
than
1000
If
given
during
pregnancy,
socium
valproate
can
cause
which
of
the
following
medical
problems
in
the
baby?
A.
SJS
B.
Ebstein's
anomaly
C.
Spina
bifida
D.
Cleft
palate
-
ANS
A.
Spina
bifida
Which
mood
stabilizer
is
associated
with
potential
life-threatening
rash
in
the
Asian
population?
A.
Carbamazepine
(tegretol)
B.
Depakote
C.
Lithium
D.
Lamictal
-
ANS
A.
Carbamazepine
Bulimia,
weight
is
___________
-
ANS
within
the
normal
range.
