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LMR - GEORGETTE'S EXAM COMPREHENSIVE QUESTIONS WITH VERIFIED ANSWERS ALREADY PASSED!!,,,Alpha
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LMR - GEORGETTE'S EXAM COMPREHENSIVE QUESTIONS WITH VERIFIED ANSWERS ALREADY PASSED!!,,,Alpha
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LMR - GEORGETTE'S EXAM COMPREHENSIVEQUESTIONS WITH VERIFIED ANSWERS ALREADY
PASSED!!
What drugs should be avoided with Kava Kava?
Alprazolam
CNS depressants (e.g., phenobarbital, zolpidem)
What is the normal range for TSH?
0.5 - 5.0 mu/L
What are lab values in Hyperthyroidism
Decreased TSH
Increased T4 and T3
What are labs in Hypothyroidism?
Increased TSH
Decreased T4 and T3
What are 5 primary symptoms of Hyperthyroidism?
Heat intolerance
Agitation, Anxiety, Irritability
Tachycardia
Mood swings
Weight loss
What are 4 primary symptoms of Hypothyroidism?
Cold intolerance
Lethargy
Weight gain
Decreased libido
Hypothyroidism mimics symptoms of what psychiatric disorder?
Depression
Hyperthyroidism mimics symptoms of what psychiatric disorder?
Mania
Valproic acid produces what teratogenic effect?
Spina bifida (neural tube defect)
What is the primary organ where valproic acid is toxic?
Liver (hepatoxicity)
What are 4 signs of hepatoxicity?
Abdominal pain in the URQ
Reddish-brown urine
Yellowing of the skin and sclera
Fatigue
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
A pt on Depakote C/O Abdominal pain in the URQ and Reddish-brown urine. What
do you suspect? What do you do?
Hepatotoxicity; hold med, draw LFT's (priority), DVP level
With suspected toxicity with valproic acid, what steps/labs should be drawn?
D/C drug
Check drug level
Obtain LFTs
Obtain ammonia level
A pregnant pt is taking accutane, zyprexa and abilify; what med needs to be
d/c'd?
Accutane (used for acne; Causes birth Defects!!!)
What herbal supplement is used for anxiety, stress, and insomnia? What is the
major side effect with Kava Kava?
Kava Kava
liver damage
What are 5 symptoms of Stephen's Johnson Syndrome?
Fever -Key sx to suspect SJS; high yield (HY)
burning of mouth/eyes -HY
Body aches
Severe red rash
Peeling skin
Facial and tongue swelling
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)
Your pt is taking Kava and you need to add an AS to manage their SCZ, which do
you add?
Aripiprazole (least sedating)
What are 2 hallmark symptoms of delirium?
Acute onset
disturbance of LOC
impaired cognition
inattention
How are agitation and psychotic symptoms treated in delirium?
Low dose Haldol (QTc check first)
16 y/o C/O feeling funny after inhaling Acetone (nail polish remover). What is your
action?
,Do UDS; chances are they may be abusing other substances
What 4 drugs can cause mania?
"SAID"
Steroids
Antidepressants (in BPD)
Isoniazid (INH)
Disulfiram (Antabuse)
What 6 drugs can induce depression?
"SIP BARB"
Steroids
Interferon,
Progesterone
Beta blockers
Accutane, (Isotretinoin)
Retroviral drugs, Antineoplastic drugs
Benzodiazepines
Steroids can induce what 3 psychiatric states?
Mania
Depression
Psychosis
REMEMBER SAFETY FIRST; pt s/p assault, 1st thing you do is_____.
What is the best environment to interview this pt in?
reassure safety, provide environment of safety
private area with door open/partially open
What is the therapeutic range for lithium?
0.6-1.2 mEq/L
Many postpartum women have SI after delivery, yet they don't have psych evals
before leaving the hospital, what could a possible solution be?
collaborating care between psych and OBGYN to provide the best care for that pt
If collaborating with a provider who is not in the same clinic or hospital, the
informed consent [does/does not] apply?
Does not, ie pt will need to sign consent for labs/ chart to be sent
When discharging from inpatient you want [to fax/print off-give to pt.] labs for the
outpatient provider before pt discharge?
fax; so the new provider has them for follow-up appointment
Before referring a pt out or discharging them, it is good to ask yourself what
question?
is there something that I could do for this patient first?
What 3 things are MUST KNOWS about Lithium?
has neuroprotective effect for bipolar disorder
the gold standard for treating manic episodes
the mood stabilizer w/ anti-suicidal effects
What mood stabilizer has anti-suicidal effects?
Lithium
What 5 labs should be drawn with lithium?
, Thyroid panel (TSH)
Serum creatinine
BUN
Urinalysis
HCG
What is a normal SerumCr range?
0.6-1.2 mg/dL
What is the normal range for BUN?
10-20 mg/dL
When should you suspect kidney disease with a urinalysis?
4+ protein; if pt on Lithium-->monitor closely toxicity
What are 7 side effects of lithium?
Hypothyroidism
Fine hand tremors
Maculopapular rash
GI upset (N/V/D, cramps, anorexia)
Polyuria, polydipsia, diabetes insipidus
T-wave inversions
Leucocytosis
What are 7 signs of lithium toxicity?
Severe nausea, vomiting, diarrhea
Confusion
Drowsiness
Muscle weakness
Heart palpitations
Coarse hand tremor
Unsteadiness while standing or walking
Bold =must knows
Which 3 drugs can increase lithium levels by decreasing renal clearance?
NSAIDs (ibuprofen, indomethacin)
Thiazides
ACE-I
What is a toxic level of lithium?
1.5 mEq/L or higher
At what level do you monitor lithium closely
(but not discontinue)?
1.3 -1.4 mEq/L or higher
With suspected lithium toxicity, what do you do first?
D/C Li and draw Lithium level (not VS)
What is the appropriate action if lithium level is 1.5 mEq/L?
D/C lithium
Check lithium level
What 2 conditions can increase lithium levels?
If this pt is going on a hike, what would you recommend ?
Dehydration
Hyponatremia
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