substantia nigra
dopamine is produced here<\/p>\n\n\n\n
Aplastic anemia
Tegretol side effect<\/p>\n\n\n\n
Serotonin discontinuation syndrome
Sensory disturbance, sleeping disturbance, disequilibrium, flu like sx, dizzy, n\/v<\/p>\n\n\n\n
Sign of fetal alcohol syndrome
small head, smooth palpebral fissure, inner epicanthal folds<\/p>\n\n\n\n
*sign of serotonin syndrome
hyperthermia, shivering, anxiety, diaphoresis, diarrhea<\/p>\n\n\n\n
to get reluctant patient to engage use what
open ended questions<\/p>\n\n\n\n
Rhett syndrome
a rare disorder found virtually exclusively in girls, is a neurodevelopmental disorder in which the child usually develops normally unitl about 6 to 18 months of age at which characteristics of the syndrome emerge; characteristics include: hypotonia (loss of muscle tone), reduced eye contact, decelerated head growth, and disinterest in play activities<\/p>\n\n\n\n
Risk factor for serotonin syndrome
more than 1 SSRI, St Johns wart, tramadol, demerol, Ultram<\/p>\n\n\n\n
State board of nursing, ANA, regulates what
Scope of practice<\/p>\n\n\n\n
PHQ-9 over 20
Severe depression<\/p>\n\n\n\n
Cranial nerve VII, sensory and motor
Puff cheeks<\/p>\n\n\n\n
Trichotillomania\/OCD
Pulling hair out<\/p>\n\n\n\n
Raphi Nuclei
Serotonergic neurons in the brain, produce serotonin<\/p>\n\n\n\n
“I don’t know answers”
Pseudo dementia, depression<\/p>\n\n\n\n
PANDAS associated with
Strep, Pediatric autoimmune neuropsychiatric disorder. If OCD, did they have strep recently<\/p>\n\n\n\n
Lyrica
Patient has neuropathic pain, gabapentin not helping. What med may<\/p>\n\n\n\n
Almost completely absorbed, 3 times more than gabapentin
Why Lyrica works better for pain<\/p>\n\n\n\n
Conversion syndrome
Patient lost friend and now experiences paralysis. Repressed unconscious intrapsychic conflicts<\/p>\n\n\n\n
Tardive dyskinesia
a person with EPS will most likely experience<\/p>\n\n\n\n
Alpha 2 delta protein
pain is linked to ability to bind to what<\/p>\n\n\n\n
Double Serum Lithium level
NSAID and Ace inhibitors do what to lithium<\/p>\n\n\n\n
NMS labs
increased creatinine kinase, WBC, LDH, LFT’s (rhabdomyolysis due to muscle tremors and rigidity)<\/p>\n\n\n\n
Norepinephrine
helps control alertness and arousal, mood hunger and sleep<\/p>\n\n\n\n
This is synthesized in the Locus Coeruleus
Norepinephrine<\/p>\n\n\n\n
Identify NMS with these key features
Rigidity, Autonomic instability, fever, change LOC, drooling<\/p>\n\n\n\n
Meningitis
nuchal rigidity, stiffness in cervical neck<\/p>\n\n\n\n
These can cause mania
steroids, antabuse, isonaizid, antidepressants in bipolar<\/p>\n\n\n\n
MMSE
test for abstract versus concrete operations<\/p>\n\n\n\n
MMSE 0-17 shows
Severe cognitive impairment<\/p>\n\n\n\n
MMSE 24-40
No cognitive impairment<\/p>\n\n\n\n
Dopamine and GABA
Neurotransmitters involved in alcoholism<\/p>\n\n\n\n
Dantrolene
Muscle relaxant for NMS<\/p>\n\n\n\n
Bromocriptine
Dopamine receptor agonist, for NMS<\/p>\n\n\n\n
Phallic state age 3-6
masturbate is normal<\/p>\n\n\n\n
Primary prevention
Classes, education, modify environment, prevent and promote<\/p>\n\n\n\n
Secondary prevention
screening and early detection, crisis hotline<\/p>\n\n\n\n
Tertiary prevention
Rehab, day treatment, social skills, treat to prevent further deterioration<\/p>\n\n\n\n
Lithium toxicity hits at what value
1.5 with nausea and vomiting<\/p>\n\n\n\n
startle reflex (moro)
last 5-6 months, if absent do an xray<\/p>\n\n\n\n
motivational interviewing is
non-confrontational style, helps patients move further along the continuum of change, based on transtheoretical model of stages of change<\/p>\n\n\n\n
Ace and Arbs
Two classes of meds shouldn’t be used together<\/p>\n\n\n\n
Renal dysfunction
Don’t give Ace and Arbs together because they cause this<\/p>\n\n\n\n
Anxiety
SSRI started in 65yr old can cause this. Expect increased side effects, do ekg<\/p>\n\n\n\n
Accutane
This can cause depression and birth defect<\/p>\n\n\n\n
Congestive heart failure
Drugs known as ace inhibitors ending in “pril” can cause this<\/p>\n\n\n\n
Nucleus basal is of Meynert
These are vulnerable in age related neurodegenerative disease such as Alzheimer’s due to decreased acetylcholine in brain<\/p>\n\n\n\n
Hip disease
Abnormal trendelenberg test indicates<\/p>\n\n\n\n
Adjustment disorder
Symptoms within 3 months but not more than 6 months. Reaction to specific life event (stressor)<\/p>\n\n\n\n
Normal Tanner stage, start by 16
14yr old no axillary hair no period<\/p>\n\n\n\n
Concern for rhabdomyalysis
Adolescent with substance abuse but works out and muscle aches. What may this indicate<\/p>\n\n\n\n
What does Erythromycin do to Tegretol
Inhibitor, so it increases the level, you need to decrease the dose<\/p>\n\n\n\n
What is first line neuroprotective med for bipolar
Lithium<\/p>\n\n\n\n
First symptom of metabolic syndrome
Large waist circumference<\/p>\n\n\n\n
Flonase interacts with what mood stabilizer
Tegretol<\/p>\n\n\n\n
Flonase has what in it
Steroids<\/p>\n\n\n\n
Steroids are an inhibitor and lead to increase in what level
Tegretol<\/p>\n\n\n\n
Tegretol has a known risk for what, which means if you give it with steroid you do what to dosing
Agranulocytosis, decrease<\/p>\n\n\n\n
First sign of frontal lobe dementia
Personality changes, social changes<\/p>\n\n\n\n
Patient with irritability, depression, edginess should be screened for what
Bipolar if 7\/13 bipolar likely<\/p>\n\n\n\n
How long does Parkinsonism take to develop
Months<\/p>\n\n\n\n
How long does akathisia take to develop
Days<\/p>\n\n\n\n
How long does tardive dyskinesia take to decelop
Years<\/p>\n\n\n\n
Grade 2\/5 hoarse systolic heart murmur indicates
Aortic stenosis<\/p>\n\n\n\n
Most commonly used anxiety scale is what
Hamilton<\/p>\n\n\n\n
Hamilton anxiety scale 14 indicates, 18-24 indicates, 25-30 indicates
Lower is mild, over 25 severe<\/p>\n\n\n\n
Hamilton depression scale normal range is what
0-7<\/p>\n\n\n\n
Hamilton depression scale mild is scored as what
8-13<\/p>\n\n\n\n
Hamilton depression scale of 19-23 indicates what and what do you monitor for
Severe depression, suicide<\/p>\n\n\n\n
Health care policy is assess, cost, and what
Quality<\/p>\n\n\n\n
How does Tegretol interact with Cipro
Cipro and erythromycin are inhibitors, decrease dose<\/p>\n\n\n\n
How you get paid for Medicare
CPT, current procedural terminology<\/p>\n\n\n\n
How does ibuprofen effect lithium
Increases serum level of lithium to double<\/p>\n\n\n\n
Organization accountability focus on universal safety in healthcare to find error and what went wrong is defined as
Just culture<\/p>\n\n\n\n
What is quantitative data
In numbers<\/p>\n\n\n\n
What is qualitative data
Measures natural setting like observation<\/p>\n\n\n\n
Research like experimental design but uses naturally occurring groups rather than assigning subjects to groups
Quasi-experimental design<\/p>\n\n\n\n
Rare complication anorexia nervosa binge purge includes
Delayed gastric emptying and motility<\/p>\n\n\n\n
How To check for decreased gastric motility
Measure stomach<\/p>\n\n\n\n
Delayed intervention of delayed gastric emptying can lead to
Gastric necrosis, perforation, shock, death<\/p>\n\n\n\n
Male with more than 1 X chromosome (xxy) Little to no sperm, fertility treatment indicates
Klinefelter syndrome<\/p>\n\n\n\n
Keeping chronically mental ill in community is part of what therapy model
Assertive community therapy model (ACT)<\/p>\n\n\n\n
Labs for macrocyclic anemia
Folic avid, b12, ESR\/CRP, HGB, MCV liver<\/p>\n\n\n\n
Labs for rheumatoid arthritis
ESR elevation, synovial fluid analysis, X-ray joints, crp, hgb, Rheumatoid factor titer<\/p>\n\n\n\n
Labs on lithium
Leukocytes is, creatinine, BUN, NA, 4+ protein in urine<\/p>\n\n\n\n
Law makes sure people with mental health issues get same financial treatment
Mental health parity act requires annual lifetime dollar limits be no lower than any medical surgical benefits. 1996<\/p>\n\n\n\n
Pt with severe diarrhea, n\/v, metallic taste, tremor, slurred speech, May be going through what
Lithium toxicity<\/p>\n\n\n\n
What intervention for lithium toxicity and what level is emergent
Give fluids, 3<\/p>\n\n\n\n
Tegretol strong inducer of what neurotransmitter
3A4<\/p>\n\n\n\n
Tergretol (carbamazepine) induces Flonase so you need to do what to flonase
Increase the Flonase<\/p>\n\n\n\n
How to test for fungal Infection
Shavings of toes<\/p>\n\n\n\n
How to check for dementia
Have patient tell you risk\/benefits and test capacity<\/p>\n\n\n\n
Involuntary, spasmodic, twitching, uncontrolled vocal sounds, inappropriate words indicates
Tourette’s<\/p>\n\n\n\n
What does Tagamet (cimetidine) do
Prevents acid from backing up into esophagus and causing heartburn<\/p>\n\n\n\n
Tagamet is an antacid and blocks what neuro receptor
H2<\/p>\n\n\n\n
What to do for patient on Tagamet but also Benzo or coumadin
Increase benzo increase coumadin<\/p>\n\n\n\n
To be diagnosed Tourette’s the patient has to have symptoms for how long and usually occurs by what age
1 year and by 3-9<\/p>\n\n\n\n
A patient has to have these symptoms by what age to get diagnosed..involuntary vocal sounds, twitching, spasmodic
Tourette’s 18<\/p>\n\n\n\n
Serotonin and Norepinephrine are the two associated with
Depression<\/p>\n\n\n\n
This medicine can cause glaucoma
Trazodone<\/p>\n\n\n\n
Patient starting trazodone (desyrel) should have what Base line test completed
EKG<\/p>\n\n\n\n
Most severe reaction to trazodone perhaps by overdose is what
Priapism, QT prolongation, respiratory arrest, seizure<\/p>\n\n\n\n
Normal development 6yr old diagnosed leukemia 1 month ago what do you expect
Thinks he is being punished for doing something wrong<\/p>\n\n\n\n
When should a patient take Vardenafil (Levitra)
45 minutes prior to sex<\/p>\n\n\n\n
This is a statistical measure of 2 independent samples significantly different
T test<\/p>\n\n\n\n
Chromosomal disorder in female X chromosome missing making coffee instead of xx, or part of X chromosome deleted, delayed puberty, amenorrhea, poor social skills, web neck, osteoporosis
Turner syndrome<\/p>\n\n\n\n
In schizophrenia most all structures decrease but what
Ventricles<\/p>\n\n\n\n
To start a consulting firm you need what to show economic viability
Revenue and expenses<\/p>\n\n\n\n
What birth control pills do to lamictal
Inducer so lowers the level of lamictal<\/p>\n\n\n\n
What does a 17 indicate on mmse
Moderate cognitive impairment<\/p>\n\n\n\n
What does a decreased reticulocyte count indicate
Anemia, acute or chronic bleeding<\/p>\n\n\n\n
What does an abnormal reticulocyte count indicate in general
Doesn’t diagnose anything first step is to identify source of issue<\/p>\n\n\n\n
What does increased reticulocyte count indicate
Bone marrow disorder or vitamin deficiency<\/p>\n\n\n\n
A test to measure reticulocyte in your blood and should range 0.5 to 1.5%
Reticulocyte count<\/p>\n\n\n\n
I’ll<\/p>\n\n\n\n
Hamilton depression scale 14-18 indicates what
Moderate depression<\/p>\n\n\n\n
What are two important things to measure when using zyprexa
Lipid and abdomen circumference<\/p>\n\n\n\n
What class controlled substance is Np approved prescribing
Schedule II-V only<\/p>\n\n\n\n
What cranial nerve assessed when patient shrug shoulders
Spinal accessory 11 (XI)<\/p>\n\n\n\n
What cranial nerve tested patient clench jaw and assess temporal muscle
Trigeminal 5 V<\/p>\n\n\n\n
What schedule drug is PCP, heroin, MDMA
1 nobody has these<\/p>\n\n\n\n
What schedule drug significant abuse potential
2, morphine, methadone, methylphenidate<\/p>\n\n\n\n
What schedule has moderate abuse potential
3 hydrocodone, codeine<\/p>\n\n\n\n
What schedule has low abuse potential
Benzo, ambien, phentermine<\/p>\n\n\n\n
What schedule has very low abuse potential
5 antitussive, lomotil<\/p>\n\n\n\n
What 3 atypical can be used for teens
Seroquel, ability, zyprexa<\/p>\n\n\n\n
These are the three CK muscle enzyme test
CKBB, CKMM, CKMB<\/p>\n\n\n\n
To qualify for GAD, or must have 3 symptoms for how long
6 months, worry, anxiety, tension, sleep trouble, restless, energy loss<\/p>\n\n\n\n
If an Asian makes no eye contact with provider it indicates
Respect<\/p>\n\n\n\n
What does messenger RNA code for
Amino acids<\/p>\n\n\n\n
What is normal lab for ANC
1500-8000<\/p>\n\n\n\n
What to do if or on Tegretol and ANC is less than 1000
Stop and repeat lab<\/p>\n\n\n\n
What erythromycin does to trileptal
Inhibits so increases Trileptal you need to decrease trileptal<\/p>\n\n\n\n
Patient with HIV dementia lab shows CD4 level as
Less than 200 and viral load is high<\/p>\n\n\n\n
Delano year inhibits lamictal so what does it do to the lamictal level
Increases lamictal level<\/p>\n\n\n\n
Risk in using tramadol
Serotonin syndrome<\/p>\n\n\n\n
Often times this is mistaken for depression in the neginning
Hiv related dementia<\/p>\n\n\n\n
What is often common in patient with fibromyalgia
Sexual abuse<\/p>\n\n\n\n
Refeeding syndrome
Anorexic teen with pain when eating due to delayed gastric emptying<\/p>\n\n\n\n
Aggression in the brain
Dysfunction in the amygdala and prefrontal cortex leading to violent tendencies can cause<\/p>\n\n\n\n
hypothalmus
believed to regulate aggression<\/p>\n\n\n\n
apoptosis
programmed cell death, neuron loss due to suffocation ,enzyme breakdown<\/p>\n\n\n\n
CN V Trigeminal
Clenched teeth<\/p>\n\n\n\n
CBT
Best therapy for negative thinking<\/p>\n\n\n\n
WBC and ANC
Labs to check if patient is on clozaril<\/p>\n\n\n\n
1000
Stop clozaril if ANC is less than what<\/p>\n\n\n\n
What does low dopamine do to prolactin
Increases and cause milk extract<\/p>\n\n\n\n
High dopamine in the hypothalmus does what to prolactin
decrease<\/p>\n\n\n\n
If FSH is inhibited what happens
Amenorrhea, galactorrhea<\/p>\n\n\n\n
What does antipsychotic do to mesolimbicc pathway
decreases dopamine but too much causes parkinsonism<\/p>\n\n\n\n
Greatest risk of EPS and NMS comes from typical or atypical antipsychotic
Typical such as Haldol<\/p>\n\n\n\n
This atypical antipsychotic increases prolactin
Risperidone<\/p>\n\n\n\n
This drug causes high risk of agranulocytosis and what lab should you obtain
clozaril, run CBC<\/p>\n\n\n\n
Oculogyric crisis, sustained muscle contraction is example of what
Dystonia<\/p>\n\n\n\n
Restless, Pacing, knees tapping quickly, example of what
Akathesia<\/p>\n\n\n\n
A patient having akathesia should be given what
Beta blocker to relax<\/p>\n\n\n\n
Cogwheel rigidity, shuffling gait, tremor, example of what
parkinsonism<\/p>\n\n\n\n
Treatment for dystonia or parkinsonism
Anticholinergic, cogentin or benadryl<\/p>\n\n\n\n
Lip, tongue smacking repetitive is an example of
tardive dyskinesia<\/p>\n\n\n\n
treatment for tardive dyskinesia
discontinue antipsychotic and start clozaril<\/p>\n\n\n\n
Danrolene is what
dopamine agonist<\/p>\n\n\n\n
Which lobe impacted if working memory or impulse control issue
frontal lobe<\/p>\n\n\n\n
Which lobe cause auditory visual hallucinations, aphasia, amnesia
temporal<\/p>\n\n\n\n
Obsession is
a recurrent, unwanted thought, idea, or image<\/p>\n\n\n\n
Compulsion is
uncontrollable urge to perform an act repeatedly<\/p>\n\n\n\n
Babinski reflex disappears, (goes up and other toes fan out)
9 months<\/p>\n\n\n\n
MMSE score 25-30
normal<\/p>\n\n\n\n
MMSE: Score that indicates mild cognitive impairment
21-24<\/p>\n\n\n\n
MMSE score of less than _<\/em> is suggestive of dementia (total maximum is 30). Dementia due to HIIV disease If person age 5 or even 40 can complete project they are in what stage Lack of self control or self esteem shows failure when A failure of infancy stage leads to Inability to set goals or self initiated behavior is a failure when Psych disorder schizo, substance abuse, paranoia associated with failure of what stage Inability to form social relationships is failure of what stage Depressive disorders associated with failure of what stage This therapy focuses on emotional regulation This therapy focus is present focus on life and self confrontation This therapy is self directed growth and self actualization- each person has potential to find meaning This therapy identifies distorted thoughts and substitutes reality oriented interpretations This therapy most common use is PTSD Biofeedback is used for what Family Systems Theory This family therapy uses only genogram Interventions are problem focused, more symptom focused with straightforward directives Paradoxical directive Solution focused therapy Wash out period for patient on SSRI to MAOI Prozac to MAOI what do serial 7 test where do you document SI or HI Ask patient where they ate breakfast and they tell whole story before answer is an example of Ask patient what they ate and they tell you about a vacation To test concentration or attention have patient do what Sensory perceptual disturbance or taste associated with this lobe The largest part of the brain is the mechanism of action that makes antipsychotic atypical is yes, yes, yes example of what (repeating words) ADHD is linked to problem in what lobe This diagnosis thinks their thoughts and actions caused something to occur- magical thinking-if look at computer 5 times it will fly Neologisms antipsychotic with least weight gain Grouping words usually rhyming is known as what association There is a medication class that is contraindicated when a patient has tics. What is that class of medication? What action do you take if a patient reports being a victim of abuse. If you work inpatient, what do you do before discharging a patient who says they have been abused? If you work inpatient, is a safety contract sufficient to determine that you are releasing a patient into a safe home? Inpatient–for safety, where should the NP interview the patient and why? If a child comes into the office with their parents and say they have been abused, what action does the NP take? If a child comes into an appointment without their parents and plays with a toy in a sexual way, what action does the NP take? What is the cornerstone of building a therapeutic alliance with adolescents? Do we interview adolescents with their parents in the room? If an adolescent comes in with their parents, do you keep the parents and adolescent together or separate theme? Which ethnic group has the highest incidence of suicide and suicide attempts ? Native Americans believe in their healing stick. If a staff member tries to take it away, what should the NP do? If a patient wants a traditional healer to accompany them to an appointment, what does the NP have to do ? Which labs should be taken before treating for depression or mania? What is the normal range of TSH? Symptoms of hypothyroidism mimic which mental illness? Symptoms of hyperthyroidism mimic which mental illness? If TSH is low i.e. 0.4 or lower, what is happening to T4 an T3 and what condition does patient have? If TSH is high e.g. 7.0, what is happening to T4 an T3 and what condition does patient have? What are the symptoms of hyperthyroidism that can mimic mania? And what are other symptoms? Other symptoms are heat intolerance and tachycardia<\/p>\n\n\n\n What are symptoms of hypothyroidism that mimic depression? And what are other symptoms? And, cold intolerance<\/p>\n\n\n\n What is the Black Box warning for Depakote? What are physical side effects\/ dangers of Depakote (Divalproex)–for patient or fetus If a patient taking depakote has signs of hepatotoxicity what would those signs and symptoms be ? If patient taking depakote has signs of hepatotoxicity, what should the NP do? Signs of valproic acid toxicity? What action do we take at signs of valproic acid (Divalproex\/Depakote) toxicity? What are the signs and symptoms of pancreatitis tenderness when touching the abdomen What in mental illness is Kava (or Kava Kava) used for ? anxiety What is the major side effect of Kava? What do we monitor? Kava is contraindicated with which meds\/med classes? Benzos (CLonazepam\/Klonopin), (Lorazepam\/ Ativan),<\/p>\n\n\n\n phenobarbital (Donnatal)<\/p>\n\n\n\n Zolpidem (Ambien)<\/p>\n\n\n\n Lamictal and weight Lamictal and rash What are the symptoms of Stevens Johnson syndrome? Which antipsychotics cause the least weight gain? For patients taking antipsychotics that have caused weight gain, what routine labs do we check? Non-pharm treatment of antipsychotic induced weight gain (AIWG)–1st line This is first line treatment<\/p>\n\n\n\n Pharm intervention for Antipsychotic Induced Weight Gain Black Box Warning for Carbamazepine symptoms of Aplastic anemia If prescribing Carbamazepine for an Asian patient, what gene do you screen for ? ANC level that indicates NP should DC clozapine or Carbamazepine? What are signs of infection for which we should monitor patients on Clozapine or Carbamazepine to DC it? Lithium and neuroprotection What is the therapeutic range of Lithium At what Lithium level does lithium toxicity occur? Lithium is the gold standard for treating what? Lithium and suicide. What is the therapeutic range of depakote? What is the toxic range of depakote(valproic acid)? Necessary labs for Lithium Signs of lithium toxicity weakness, worsening tremor, mild ataxia, poor concentration and diarrhea.<\/p>\n\n\n\n With worsening toxicity, vomiting, the development of a gross tremor, slurred speech, confusion and lethargy emerge<\/p>\n\n\n\n When to DC Lithium with or without symptoms if 1.5 serum level –toxicity level<\/p>\n\n\n\n If creatinine or BUN are high because Lithium is processed through kidney<\/p>\n\n\n\n Preventative tests when prescribing antipsychotics to women If patient has 4+ protein in urine while on lithium what do we do ? What are side effects of Lithium? What do we do in cases of Lithium toxicity? What are some factors that can increase Lithium levels? What causes Neuroleptic Malignant Syndrome (NMS)? What are the symptoms of Neuroleptic Malignant syndrome (NMS)? Elevated CPK (happens due to muscle contraction and destruction)<\/p>\n\n\n\n Myoglobinuria What is the treatment for NMS? There are two with different MOAs:<\/p>\n\n\n\n Bromocriptine (Parlodel) which is a Dopamine (2) agonist<\/p>\n\n\n\n Dantrolene which is a Muscle Relaxant<\/p>\n\n\n\n What are the signs of both NMS and serotonin syndrome? What are the signs of Serotonin Syndrome? What causes serotonin syndrome? How do we treat Serotonin Syndrome? Cyproheptadine<\/p>\n\n\n\n When switching from an SSRI to an MAOI, how long wait before starting the MAOI? When switching from fluoxetine (Prozac) to MAOIs how long to wait before starting the MAOI? When switching from an MAOI to Prozac how long wait until start Prozac? Why the wait times for switching from between SSRIs and MAOIs? Due to risk of Serotonin Syndrome, which combination of meds to we avoid? If we see “regenerate” in answers related to serotonin, what do you do ?<\/p>\n\n\n\n eliminate. “Regenrate” is wrong answer<\/p>\n\n\n\n Why are SSRIs the 1st line antidepressants used in depression Serotonin Syndrome and triptans? Which antidepressant to do we give a patient who is depressed and has cancer? Which antidepressant to do we give a patient who is depressed and has neuropathic pain? What do we prescribe for patients in chronic neuropathic pain? antidepressants and sexual dysfunction Important info about Wellbutrin Patient depressed +Low energy +fatigue give Wellbutrin<\/p>\n\n\n\n Wellbutrin contraindicated in hx of seizures or eating d\/o = Wellbutrin increase seizure risk<\/p>\n\n\n\n Black Box Warning on all depressants and responsibiltity of NP assess for frequency and severity of these thoughts at every visit.<\/p>\n\n\n\n Alcohol and depression Prozac and Insomnia Mental illnesses that cause thoughts of self-harm mental illness most often associated with Homicidal ideation Placebo rate, children, antidepressants positive symptoms of schizophrenia Negative symptoms of schizophrenia age of onset of schizophrenia What is going on in brain of a schizophrenic that we see in an MRI\/PET scan? Everything else is decreasing in size What are the parts of the brain in which abnormalities or changes\/deficits cause agression, impulsitivity, and abstract thinking problems in schizophrenia? Medications for which schizophrenics have a low tolerability so they are not as neuroprotective for schizophrenics as they are for others Why should we not give stimulants to schizophrenics? Non-pharm management of schizophrenia What is ACT? If a schizophrenic has a long-term history of non-adherence what may they need for in home care? What level of care is social skills training for a schizophrenic? How does exercise help schizophrenics? A schizophrenic is taking oral Haldol and is at high risk of relapse (multiple hospitalizations), what should we do about administering medication Dosing for switching from oral Haldol to Haldol Decanoate 5 mg PO BID What is the dose limit of LAI Haldol that can be given in one week? same for 300 mg= 100 mg day one What is a delusion? If doing a MSE of preschooler(3-5y\/o), what is the most important approach to Components of a Mental Status Exam–what do you assess with thought process assessment? Components of a Mental Status Exam–what do you assess with thought content assessment? Mental status exam–when evaluating thought process or thought content, what are we evaluating? Are we evaluating organization of speech? NO, we are not evaluating organization of speech<\/p>\n\n\n\n The Folstein Mini Mental Status Examination is used with which population and for what ? What are some important components of the mini-mental status examination Orientation: Year, season, date, day, month, country, town, hospital, floor<\/p>\n\n\n\n Registration\/ability to learn new material: say names of three unrelated objects clearly and slolwy, ask patient to repeat immediately<\/p>\n\n\n\n Recall (memory): Ask patient if they can recall the three object words previously asked to remember 5 minutes after introducing the object words<\/p>\n\n\n\n Fund of knowledge: Who is president\/govenor<\/p>\n\n\n\n What is the purpose of the Clock drawing test ? If there are impairments on the CDT (Clock Drawing Test), which part of the brain may be damaged? What makes an antipsychotic atypical? Lower chance of EPS syndromes<\/p>\n\n\n\n Which type of antipsychotic for first psychotic episode? Dopamine Pathway: Mesocortical pathway relationship between dopamine and schizophrenic symptoms Nigrostriatal pathway of brain controls what ? Dopamine blockade in this pathway can lead to increase acetylcholine levels–increase salivation, teary eyes, diarrhea<\/p>\n\n\n\n Dopamine Pathway: Nigrostriatal pathway relationship between dopamine and EPS Long standing D2 blockade in the nigrostriatal pathway can lead to Tardive Dyskinesia.<\/p>\n\n\n\n Neurotransmitters and EPS EPS and metoclopramide How do you treat EPS except Tardive Dyskinesia? How do we treat Tardive Dyskinesia? Dopamine Pathway: Tuberoinfundibular pathway relationship between dopamine and physical symptoms Long term hyperprolactinemia can be associated with osteoporosis.<\/p>\n\n\n\n Normal prolactin levels impact of Cytocrome P450 enzyme CYP1A2 inducers on drugs metabolized on the pathway impact of Cytocrome P450 enzyme CYP1A2 inhibitors on drugs metabolized on the pathway Olanzapine (Zyprexa) and Clozapine are both metabolized on which enzyme? If a patient on olanzapine or clozapine stops smoking what do we do with the dose Which are more worrisome? Inhibitors or Inducers? Is Tegretol(carbamazapine) an Inducer or Inhibitor ? Are clarithromycin and erithromycin inducers or inhibitors? If a patient is taking tegretol (carbamazapine) and clarithromycin, tegretol an inducer and clarithromycin an inhibitor, what should an NP do? Medications that cause mania Medications that cause depression Steroids and psychosis Are flonase and prednisone steroids? When taking medications that cause mania and depression, how do you dose the antidepresant or antipsychotic? Neurotransmitters involved in addiction What causes pain in anorexics after eating? medications that can delay gastric emptying If a med decreases the absorption of psychotropic medications, what is the best way to take it? Some medications that decrease absorption of psychotropics? If a patient aged 65+ is given SSRIs, for what should we monitor them? What is a paradoxical effect of a medication? Heart issues and Geodon and Citalopram What is the maximum recommended dosage per day for Citalopram? What is the greatest risk factor for bipolar If a person’s first bipolar episode is after the age of 45, what is the likely cause? What are the symptoms of Mania? What is apoptosis Primary symptoms of Borderline Personality Disorder What is the only treatment for Borderline Personality Disorder? Who created DBT? What is the diagnostic process for borderline Medication for a pateint with borderline presenting with irritability, anger and self-harming behavior Specific Medication for a patient with borderline presenting with depressed mood, emotional lability, interpersonal problems, rejection sensitivity, aggresion, hostility What is conversion disorder? Treatment is therapy<\/p>\n\n\n\n What is an adjustment disorder? What are symptoms of adjustment disorder with mixed disturbance of emotion and conduct — A child has a mix of symptoms from anxiety, depression and conduct dysfunction–possible peer conflict, verbal altercations, insomnia, frequent crying<\/p>\n\n\n\n Differentiation between Adjustment disorder and MDD How do we treat Oppositional Defiant Disorder? Child and parent problem-solving skills training<\/p>\n\n\n\n In ODD therapy, if no parenting skills are developed, what can ODD turn into What are key symptoms of conduct disorder Lack of remorse for ill deeds done<\/p>\n\n\n\n Pharmacological treatment for conduct disorder Diagnosing Tourette Syndrome Tics are not caused by using a subtance or other medical condition<\/p>\n\n\n\n When children have motor tics are they rare and permanent ? Primary neurotransmitter involved in Tourette Syndrome Hyperactivity of Dopaminergic systems in brain can lead to Tourette’s<\/p>\n\n\n\n Pharmacological treatment of Tourette Syndrome What is acute stress disorder? What are hallmark symptoms of PTSD? Pharmacological management of PTSD Non-Pharmacological management of PTSD What are the phases of EMDR? Which parts of the brain are affected in ADHD? ADHD — age amphetamines are approved for Heart and ADHD meds There can be elevated heart rate and BP; increase risk of heart attack and stroke<\/p>\n\n\n\n ADHD — age methylphenidate are approved for ADHD– what does the dorsolateral prefrontal cortex control? Signs of stimulant abuse ADHD–If patient starts having symptoms again during the day, what does that indicate; what should be done? If parent is anxious or scared of child starting stimulants what should be done? What is OCD? Which autoimmune illness should be considered with sudden onset OCD symptoms in children? Differentiate OCD from Tourettes OCD = intrusive\/ persistent thoughts and tics<\/p>\n\n\n\n Factitious disorder Malingering factitious disorder imposed on another Reactive Attachment Disorder GAD (general anxiety disorder) Panic Attack Panic Disorder SSRIs for treatment of panic disorder Definition and Symptoms of DMDD (disruptive mood dysregulation disorder) Treatment for panic attacks Contraindications for propranolol Anorexia Nervosa symptoms Action if Anorexic with BMI less than 15? BMI of bulimia nervosa What is the non-pharm treatment for Oppositional Defiant Disorder?<\/p>\n\n\n\n If no parenting skills are developed what can ODD develop into? What are the primary symptoms of Conduct disorder What is the pharm treatment for conduct disorder? What are the defining symptoms of Tourette Syndrome\/Disorder<\/p>\n\n\n\n What is the expected permanence of children’s motor tics? What are the primary neurotransmitters involved in tourette’s syndrome? Hyperactivity of Dopaminergic systems in the brain can lead to Tourette’s<\/p>\n\n\n\n What is the primary pharm treatment for Tourette’s What are secondary pharm treatments for Tourette’s ? DSM-5 of Acute Stress Disorder Features include anxiety, insomnia, poor concentration, intense fear or helplessness, re-experiencing the event and avoidance behaviors–<\/p>\n\n\n\n It presents as PTSD but the onset of symptoms is less than PTSD<\/p>\n\n\n\n What is the minimum length of time that PTSD has to last? Hallmark symptoms of PTSD What is the pharm management of PTSD? What is primary important non-pharm treatment for PTSD? What are the different Non-pharm treatments for PTSD? CBT<\/p>\n\n\n\n What are the parts of the brain involved in ADHD? Basal ganglia<\/p>\n\n\n\n Abnormalities in reticular activating system<\/p>\n\n\n\n Frontal cortex<\/p>\n\n\n\n abnormalities in the Prefrontal cortex–inattentive type<\/p>\n\n\n\n Cardiology and ADHD stimulant If history or family hx of cardiac issues, get an ECG before starting.<\/p>\n\n\n\n What are the ages for amphetamines? what are the ages for methylphenidate? What are the ages for Alpha agonist or alpha 2 adrenergic receptors agonist? What are the ages for Strattera? Which aspect of ADHD does the Dorsolateral prefrontal cortex control? Signs of Stimulant Abuse If a patient is having ADHD symptoms during the day after having taken their stiumlant, what does that indicate and what should we do? We should consider an extended release<\/p>\n\n\n\n What to do if parent is really anxious or scared about Medication for their kid? Differentiate OCD from Tourettes Tourettes: Tics only<\/p>\n\n\n\n Symptoms of OCD What does PANDAS stand for and which mental illness’ acute onset may be an indication of having PANDAS? Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections<\/p>\n\n\n\n Malingering factitious disorder Reactive Attachment Disorder GAD Panic Attack Panic Disorder Treatment for Panic disorder SNRI–venlafaxine<\/p>\n\n\n\n Beta Blocker–this manages the elevated BP that occurs with a panic attack<\/p>\n\n\n\n Can also give benzos which aren’t as safe<\/p>\n\n\n\n Beta blockers can cause bronchospasms so they are contraindicated with DMDD–Disruptive mood dysregulation disorder Chronic dysregulated mood Hallmark symptoms of Anorexia Nervosa Amenorrhea BMI for Bulimia Nervosa if a patient has an irritable, depressed, labile mood, what is the first thing we should do ? When should we assess for nightmare disorder? Which neurotransmitters are affected in autism? What are the symptoms of autism? Broken mirror theory of autism If delirium is caused by ETOH or substance abuse what treatment can we give patient? What are often the causes of delirium in older people and what should we test them for? Dementia and which vitamins levels should be checked Differentiating between depression and dementia Also, in combination with memory issues, they have depression issues. Dementia memory decline happens over time i.e. over 12 months or longer<\/p>\n\n\n\n Pseudodementia Which parts of the brain are involved in Dementia Cortical: Language (aphasia) and memory impairments<\/p>\n\n\n\n Early signs of HIV dementia Lewy Body Disease symptom of importance for the test Pick’s disease Personality, behavioral, and language changes (slurred) in early stage<\/p>\n\n\n\n What meds treat HIV dementia? if patient has history of high risk behavior and HIV dementia symptoms, what should we do? Pharm treatment of psychosis and agitation in dementia? What does the amygdala control? What does the Hippocampus control? What does dopamine produced in the substantia nigra regulate? If you are taking care of a terminal infant what do you do with the parents? How should we speak of and refer about grief to children What is the most important factor in children’s healing from grief? mood disorder neurotransmitters What are most important risk factors for osteoporosis? substantia nigradopamine is produced here Aplastic anemiaTegretol side effect Serotonin discontinuation syndromeSensory disturbance, sleeping disturbance, disequilibrium, flu like sx, dizzy, n\/v Sign of fetal alcohol syndromesmall head, smooth palpebral fissure, inner epicanthal folds *sign of serotonin syndromehyperthermia, shivering, anxiety, diaphoresis, diarrhea to get reluctant patient to engage use whatopen ended questions Rhett syndromea rare disorder […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[],"tags":[],"class_list":["post-109641","post","type-post","status-publish","format-standard","hentry"],"_links":{"self":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts\/109641","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/comments?post=109641"}],"version-history":[{"count":0,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts\/109641\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/media?parent=109641"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/categories?post=109641"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/tags?post=109641"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
10<\/p>\n\n\n\n
Subcortical dementia<\/p>\n\n\n\n
formal operation<\/p>\n\n\n\n
Early childhood<\/p>\n\n\n\n
unable to form meaningful relationship<\/p>\n\n\n\n
late childhood<\/p>\n\n\n\n
Oral according to Freud<\/p>\n\n\n\n
Latency<\/p>\n\n\n\n
Anal stage<\/p>\n\n\n\n
DBT<\/p>\n\n\n\n
Existential<\/p>\n\n\n\n
Humanistic<\/p>\n\n\n\n
Cognitive Behavioral Therapy<\/p>\n\n\n\n
EMDR<\/p>\n\n\n\n
Anxiety and pain, not depression<\/p>\n\n\n\n
focus on chronic anxiety within family, Use triangles and genograms with goal to increase self-differentation<\/p>\n\n\n\n
Structural family therapy<\/p>\n\n\n\n
Strategic therapy<\/p>\n\n\n\n
A negative task assigned when family resistant to change<\/p>\n\n\n\n
emphasizes solutions that worked previously<\/p>\n\n\n\n
Wait 2 weeks before initiate<\/p>\n\n\n\n
wait 5-6 weeks due to longer half life<\/p>\n\n\n\n
concentration<\/p>\n\n\n\n
Thought content<\/p>\n\n\n\n
Circumstantial<\/p>\n\n\n\n
tangential<\/p>\n\n\n\n
Count backward from 100 by 7s<\/p>\n\n\n\n
parietal lobe<\/p>\n\n\n\n
cerebrum<\/p>\n\n\n\n
serotonin 5H2A antagonism<\/p>\n\n\n\n
perservation<\/p>\n\n\n\n
Executive functioning, frontal lobe<\/p>\n\n\n\n
schizotypal<\/p>\n\n\n\n
use of made up words<\/p>\n\n\n\n
geodon<\/p>\n\n\n\n
clang<\/p>\n\n\n\n
Stimulants –often used for ADHD<\/p>\n\n\n\n
Safety first!
Provide patient with an environment of safety and reassure them of their safety in the clinic\/hospital.<\/p>\n\n\n\n
Make sure the patient will be safe.<\/p>\n\n\n\n
No. A safety contract is not enough. The NP has to confirm that the patient is going to be safe for themselves or their environment is safe.<\/p>\n\n\n\n
Safety is more important than privacy. In an office with a door open or partially open. The day room would be a breach of confidentiality and a closed door or in their room would give the patient access to harming the NP.<\/p>\n\n\n\n
interview the child separately from the parents THEN report to CPS<\/p>\n\n\n\n
This makes the NP suspect abuse so initial action is to immediately report to CPS.<\/p>\n\n\n\n
Confidentiality with the explanation that confidentiality must be broken if they are a danger to self or others<\/p>\n\n\n\n
No because the adolescent may have info that they want kept confidential from their parents.<\/p>\n\n\n\n
Separate them and speak to adolescent alone because the adolescent has a right to confidentiality.<\/p>\n\n\n\n
Native American<\/p>\n\n\n\n
Educate the staff member in cultural competency and sensitivity.<\/p>\n\n\n\n
Get consent from the patient and allow the traditional healer to attend as well. With permission from the patient, you can include the healer in the care plan as follow up.<\/p>\n\n\n\n
TSH<\/p>\n\n\n\n
0.5-5.0 mu\/L<\/p>\n\n\n\n
Depression<\/p>\n\n\n\n
Mania<\/p>\n\n\n\n
T4 and T3 will be high and patient will have hyperthyroidism<\/p>\n\n\n\n
T4 and T3 will be low and patient will have hypothyroidism.<\/p>\n\n\n\n
agitation, anxiety, irritability, mood swings, weight loss.<\/p>\n\n\n\n
lethargy, weight gain, decreased libido.<\/p>\n\n\n\n
Pancreatitis<\/p>\n\n\n\n
Spina bifida in fetuses
Hepatotoxicity<\/p>\n\n\n\n
Abdominal pain in upper right quadrant of abdomen
Reddish brown urine
Yellowing of the skin and whites of eyes
Fatigue<\/p>\n\n\n\n
A liver function test –check AST and ALT levels<\/p>\n\n\n\n
Disorientation
lethargy
Respiratory depression
Nausea\/vomiting<\/p>\n\n\n\n
Dc medication and check depakote levels, do a LFT and check ammonia levels<\/p>\n\n\n\n
upper adbominal pain
abdominal pain that radiates to patient’s back<\/p>\n\n\n\n
fever
rapid pulse
nausea
vomiting
oily stools<\/p>\n\n\n\n
Kava Calms<\/p>\n\n\n\n
stress
insomnia<\/p>\n\n\n\n
Liver damage
We monitor patient for RUQ pain and do LFTs<\/p>\n\n\n\n
Xanax (Alprazolam)
CNS depressants\/ sedative medications<\/p>\n\n\n\n
Lamictal is the mood stabilizer that causes the least weight gain<\/p>\n\n\n\n
Can cause Stevens Johnson<\/p>\n\n\n\n
Body aches, red rash, peeling skin, facial and tongue swelling<\/p>\n\n\n\n
ZAL
Ziprasodone (Geodon)
Aripriprazole (Abilify)
Lurasidone (Latuda)<\/p>\n\n\n\n
bmi
hip-to-waist ratio
glucose
lipid panel<\/p>\n\n\n\n
Exercise and nutritional counseling<\/p>\n\n\n\n
Switch to antipsychotic with lower potential for weight gain: ZAL<\/p>\n\n\n\n
agranulocytosis, aplastic anemia, Stevens –Johnson syndrome<\/p>\n\n\n\n
pallor
fatigue
HA
fever
nosebleeds
bleeding gums
skin rash
SOB<\/p>\n\n\n\n
HLA-B* 1502 allele is highly associated with Carbamazepine-induced Stevens-Johnson syndrome<\/p>\n\n\n\n
An ANC less than 1000 mm3 whether patient is showing signs of infection or not.<\/p>\n\n\n\n
Sudden fever
Chills
sore throat
weakness<\/p>\n\n\n\n
Lithium is neuroprotective treatment of choice for bipolar disorder– can protect nerve cells from damage.<\/p>\n\n\n\n
0.6-1.2 mEq\/L<\/p>\n\n\n\n
1.5 mEq\/L or higher<\/p>\n\n\n\n
Mania<\/p>\n\n\n\n
Lithium is the only mood stabilizer with evidence of anti-suicidal effects in bipolar<\/p>\n\n\n\n
50-125 micrograms (ug\/ml)<\/p>\n\n\n\n
150 microgrms (ug\/ml)<\/p>\n\n\n\n
TSH
Serum creatinine
BUN
Urinalysis
HCG for females age 12-51<\/p>\n\n\n\n
In mild lithium toxicity, symptoms include WATCAD–Weakness, Ataxia, Tremor, Concentration poorness and Diarrhea.<\/p>\n\n\n\n
serum level of 1.3 or 1.4 and signs of Lithium toxicity.<\/p>\n\n\n\n
Take HCG test\/ aka pregnancy test before placing any woman on antipsychotic -for females of age 12-51.<\/p>\n\n\n\n
Monitor closely for lithium toxicity<\/p>\n\n\n\n
hypothyroidism, ebstein anomaly, and nephrogenic diabetes insipidus, fine hand tremors, Maculopapular rash, GI upset(Diarrhea, vomiting, cramps, anorexia), polyuria, polydispsia, T-wave inversions, Leukocytosis (increased WBCs)<\/p>\n\n\n\n
DC Li and check serum Li levels<\/p>\n\n\n\n
Kidney disease or drugs that reduce renal clearance
NSAIDS(ibuprofen, Indocin)
Thiazides (hydrochlorothiazide)
ACE inhibitors
Medications used for cardiac failure (lisinopril)
Dehydration
Hyponatremia (low sodium levels)<\/p>\n\n\n\n
Antipsychotics<\/p>\n\n\n\n
Extreme musclular rigidity
Mutism<\/p>\n\n\n\n
Elevated WBCs(leukocytosis)
Elevated LFTs<\/p>\n\n\n\n
DC the antipsychotic and treat with:<\/p>\n\n\n\n
Hyperthermia
Tachycardia
Diaphoresis
Altered level of consciousness<\/p>\n\n\n\n
Hyperreflexia
Myoclonic jerks<\/p>\n\n\n\n
SSRIs\/SNRIs\/TCAs\/MAOIs<\/p>\n\n\n\n
DC the offending agent and treat with<\/p>\n\n\n\n
wait 14 days<\/p>\n\n\n\n
5-6 weeks<\/p>\n\n\n\n
wait 2 weeks<\/p>\n\n\n\n
need a washout period of 5 half-lives between cessation of previous drug and introduction of new drug. This is the time it takes for the medication to degenerate out of the system<\/p>\n\n\n\n
Combinations of SSRIs and SNRIs or TCAs or MAOIs or St. John’s Wort<\/p>\n\n\n\n
because they are safer in cases of overdose<\/p>\n\n\n\n
Triptans can cause serotonin syndrome so no triptans (for migraines) or sumatriptan (imitrex)<\/p>\n\n\n\n
Citalopram or escitalopram because lower incidence of drug-drug interaction.<\/p>\n\n\n\n
SNRI or TCA
An SNRI is safer<\/p>\n\n\n\n
Alpha 2 Delta Ligands= Gabapentin and Pregabalin (Lyrica)<\/p>\n\n\n\n
SSRIs\/SNRIs can cause sexual dysfunction<\/p>\n\n\n\n
NDRIs do not cause sexual dysfunction = Wellbutrin<\/p>\n\n\n\n
increase thoughts of self-harm in adolescents.<\/p>\n\n\n\n
If patient is depressed, assess alcohol intake because some patients use alcohol to self-medicate and this can become a barrier to treatment<\/p>\n\n\n\n
Prozac can cause insomnia; encourage pt to take Prozac in the morning<\/p>\n\n\n\n
Depression
bipolar
alcohol abuse
eating disorder
schizophrenia<\/p>\n\n\n\n
Antisocial personality disorder<\/p>\n\n\n\n
few experimental studies exist that investigate the placebo effect of antidepressants in children and adolescent (When compared to adults, children with depression have a reduced placebo representation in studies but a higher placebo rate).<\/p>\n\n\n\n
\u2022Hallucination, Delusion, Loose association
\u2022Ideas of reference (paranoia\/ paranoid delusions)
\u2022Agitated and bizarre behavior<\/p>\n\n\n\n
\u2022Avolition – Asociality (Hygiene, Work)
\u2022Anhedonia – Asociality (Interest, Relationship)
\u2022Blunted affect
\u2022Paucity of thought<\/p>\n\n\n\n
18-25 males
25-35 in females<\/p>\n\n\n\n
Ventricular enlargement<\/p>\n\n\n\n
–Different lobes
–Different parts of limbic system
–Cerebral blood flow<\/p>\n\n\n\n
prefrontal cortex
amygdala
basal ganglia
hippocampus
limbic regions<\/p>\n\n\n\n
Alpha 2 adrenergic receptor agonist (guanfacine and clonidine)<\/p>\n\n\n\n
Because stimulants can potentiate dopamine release<\/p>\n\n\n\n
manualized group therapy and assertive community treatment (ACT)<\/p>\n\n\n\n
ACT is a form of rehabilitation post-hospitalization<\/p>\n\n\n\n
Referral to case management team so a nurse can go to their home and administer their medication. And, referral to aerobic exercise program<\/p>\n\n\n\n
Tertiary<\/p>\n\n\n\n
Improve cognition
Improve quality of life
Improve long term health<\/p>\n\n\n\n
switch to intramuscular Haldol<\/p>\n\n\n\n
20 X the total daily oral doses=Decanoate dose–example:<\/p>\n\n\n\n
LAI–20 X 10 mg = 200 mg<\/p>\n\n\n\n
100 mg
If they need 200 mg then give 100 mg on day one and come back in 5-7 days for another 100 mg;<\/p>\n\n\n\n
5-7 days for second 100 mg
and 5-7 days for third 100 mg<\/p>\n\n\n\n
Firm belief maintained despite evidence to the contrary.<\/p>\n\n\n\n
listen and observe cues\u2014depends on clinical observation<\/p>\n\n\n\n
Assess the organization of the patient’s thoughts and ideas.<\/p>\n\n\n\n
Refers to the themes that occupy the patient’s thoughts and perceptual disturbances. Ex:
Suicidal ideations
homicidal ideations
SI or HI plan
visual hallucinations
auditory hallucinations<\/p>\n\n\n\n
We are evaluting thoughts and ideas<\/p>\n\n\n\n
Adults–to assess cognitive decline<\/p>\n\n\n\n
Concentration\/attention\/ calculation–examples: count backward from 100 by 7s<\/p>\n\n\n\n
Very quick way to screen for possible dementia– takes 1-2 minutes to complete<\/p>\n\n\n\n
right parietal lobe i.e. the right hemisphere of the brains<\/p>\n\n\n\n
Atypical antipsychotics have both dopamine and 5HT2A receptor antagonism<\/p>\n\n\n\n
Atypical antipsychotic that can be administered IM like Invegga, Geodon or Abilify.<\/p>\n\n\n\n
Meso–not major depression but meso depression + other negative symptoms
decreased dopamine in the mesocortical pathway is thought to be responsible for negative and depressive symptoms of schizophrenia<\/p>\n\n\n\n
Nigrostriatal pathway mediates motor movements<\/p>\n\n\n\n
Blockade of dopamine receptors in the nigrostriatal pathways can lead to EPs e.g. acute dystonia, parkinsonism, and akathisia<\/p>\n\n\n\n
Increased acetylcholine and decreased dopamine can cause EPS’<\/p>\n\n\n\n
Metoclopramide (Reglan) can cause EPS like Tardive dyskinesia and parkinsonism<\/p>\n\n\n\n
Benztropine<\/p>\n\n\n\n
stop\/decrease meds, switch to new anti psych that doesn’t cause tardive dyskinesia (possibly clozapine)<\/p>\n\n\n\n
Blockade of D2 receptors in this pathway can lead to increased prolactin levels leading to hyperprolactinemia which clinically manifests as amenorrhea, galactorrhea (Risperidone), sexual dysfunction, and gynecomastia.<\/p>\n\n\n\n
Men–less than 20 ng\/ml
Women — less than 25 ng\/ml<\/p>\n\n\n\n
decrease serum levels of drugs that are substrates of CYP1A2 enzymes which causes subtherapeutic drug levels<\/p>\n\n\n\n
Increase serum levels possibly causing toxic levels of drug<\/p>\n\n\n\n
Cytochrome P450 Enzyme CYP1A2<\/p>\n\n\n\n
Decrease the dose because smoking is an inducer and it is no longer decreasing the serum levels of the drug.<\/p>\n\n\n\n
Inhibitors because they can cause toxic levels of a drug in the body.<\/p>\n\n\n\n
Inducer<\/p>\n\n\n\n
Inhibitors<\/p>\n\n\n\n
Decrease the tegretol (carbamazapine) to avoid the inhibitors causing a toxic level of tegretol in the blood<\/p>\n\n\n\n
Steroids
Disulfram (Antabuse)
Isoniazid(INH)
Antidepressants in persons with bipolar<\/p>\n\n\n\n
Steroids
Beta blockeres
Interferon
Isotretinoin (Accutane)
Some retroviral drugs
Antineoplastic drugs
benzodiazepines
progesterone<\/p>\n\n\n\n
Steroids can cause psychosis<\/p>\n\n\n\n
Yes<\/p>\n\n\n\n
Increase the dose.<\/p>\n\n\n\n
Dopamine and GABA<\/p>\n\n\n\n
Delayed gastric emptying<\/p>\n\n\n\n
Ranitidine–Antihistamine and Antacid
Famotidine–Antihistamine and Antacid
Omeprazole–proton pump inhibitor<\/p>\n\n\n\n
Take 2 hours apart<\/p>\n\n\n\n
Antacids
PPIs like Protonix, Omeprazole<\/p>\n\n\n\n
monitor for increased anxiety<\/p>\n\n\n\n
when medication causes opposite effect for which is was prescribed. Avoid giving in the future<\/p>\n\n\n\n
Geodon and Citalopram can cause QT prolongation<\/p>\n\n\n\n
40 mg
for those 65+– 20 mg<\/p>\n\n\n\n
multigenerational bipolar<\/p>\n\n\n\n
A medical condition like a stroke<\/p>\n\n\n\n
Distractability
Insomnia
Grandiosity
Flight of ideas
Agitation\/Activity increase
Sexual indiscretions (or other pleasurable activity)
Talkativeness
DIG FAST<\/p>\n\n\n\n
programmed cell death<\/p>\n\n\n\n
self-harming behavior
recurrent suicidal behavior<\/p>\n\n\n\n
DBT–decreases suicidality in Borderlines<\/p>\n\n\n\n
Marsha Linehan<\/p>\n\n\n\n
use their journals\/diaries to help diagnose borderlines<\/p>\n\n\n\n
Lithium<\/p>\n\n\n\n
Depakote<\/p>\n\n\n\n
a mental condition–usually begining suddenly after a stressful experience– in which a person has blindness, paralysis, or other nervous system (neurologic) symptoms that cannot be explained by medical evaluation<\/p>\n\n\n\n
An unhealthy or excessive response to an event or change within 3 months of it happening<\/p>\n\n\n\n
with depressed mood — feelings of sadness, decreased interest, sleep disturbance, appetite changes<\/p>\n\n\n\n
Adjustment disorder has a specific cause.<\/p>\n\n\n\n
Family therapy with emphasis on child management skills; teaching parents about positive reinforcement and boundary settings.<\/p>\n\n\n\n
Conduct Disorder<\/p>\n\n\n\n
Aggression toward people or animals and property.<\/p>\n\n\n\n
Targets mood and aggression–treat with antipsychotics, mood stabilizers, SSRIs and alpha agonists (Clonidine and guanfacine)<\/p>\n\n\n\n
At least 2 motor tics and at least 1 vocal tic have been present, not necessarily at the same time–for more than a year<\/p>\n\n\n\n
No. Children’s tics are common and often temporary<\/p>\n\n\n\n
Dopamine, Norepinephrine, serotonin (DNS)<\/p>\n\n\n\n
Clonidine (Catapres or Kapvay) or Guanfacine (Intuniv)<\/p>\n\n\n\n
Psychiatric diagnosis that may occur in patients within 4 weeks after a traumatic event Features include anxiety, insomnia, re-experiencing, avoidance behaviors–basically PTSD symptoms but duration of symptoms is less than a month. (PTSD has to last at least one month)<\/p>\n\n\n\n
Intrusive re-experiencing
Increased arousal (hyperarousal)
Avoidance of stimuli associated with trauma<\/p>\n\n\n\n
SSRIs, TCAs, Prazosin for nightmares<\/p>\n\n\n\n
EMDR (preferred over CBT)
CBT<\/p>\n\n\n\n
Desensitization phase
Installation phase
body scan phase<\/p>\n\n\n\n
Frontal cortex
Basal ganglia
Abnormalities in prefrontal cortex–inattentive
Abnormalities of reticular activating system<\/p>\n\n\n\n
children age 3 to adult<\/p>\n\n\n\n
Assess cardiac hx before beginning stimulants.<\/p>\n\n\n\n
children age 6 to adult<\/p>\n\n\n\n
Executive function
Cognitive process such as planning, working memory
Problem solving
How to direct and maintain attention to a task<\/p>\n\n\n\n
Insomnia
Tremors
Increased BP
Heart palpitations<\/p>\n\n\n\n
Medication has been cleared by the body; consider an extended release dose.<\/p>\n\n\n\n
address their anxiety\u2014give them some support before continuing with psychoedcation<\/p>\n\n\n\n
Presence of anxiety-provoking obsessions (recurrent and persistent thoughts, impulses, or images) or compulsions (for example motor tics) that function to reduce the person’s subjective anxiety level<\/p>\n\n\n\n
PANDAS–Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections.<\/p>\n\n\n\n
Tourettes= tics only<\/p>\n\n\n\n
Condition in which a person presents with physical or mental illness symptoms that are induced.<\/p>\n\n\n\n
symptoms are faked for secodary gain such as avoiding work or prison<\/p>\n\n\n\n
a condition in which one person induces illness symptoms in someone else<\/p>\n\n\n\n
product of severely dysfunctional early relationships between principle caregiver and child —- results when caregiver disregards child’s physical\/emotional needs–> behavioral\/interpersonal problems later in life (fearful\/inhibited\/withdrawn\/apathetic\/shows no emotion towards caregivers\/ disruptive\/disorganized)<\/p>\n\n\n\n
excessive worry for at least 6 months<\/p>\n\n\n\n
surge of intense fear or discomfort that reaches a peak within minutes as well as a sense of impending doom<\/p>\n\n\n\n
diagnosis given when patient experiences recurrent panic attacks without apparent triggers<\/p>\n\n\n\n
fluoxetine
Paroxetine
Sertraline
Venlafaxine<\/p>\n\n\n\n
Childhood (<18) depressive disorder that includes
Chronic dysregulated mood (“moody”)
Frequent intense temper outburts\/temper tantrums
Severe irritability
Anger<\/p>\n\n\n\n
Betablocker like propranolol.<\/p>\n\n\n\n
Can cause bronchospasms so contraindicated in patients using bronchodilators like albuterol<\/p>\n\n\n\n
Low BMI (<15)
Amenorrhea
Emaciation
Bradycardia
Hypotension<\/p>\n\n\n\n
Refer for hospitalization. If parent refuses, report to CPS<\/p>\n\n\n\n
Usually in normal range<\/p>\n\n\n\n\n
CD-conduct disorder<\/p>\n\n\n\n
Aggression towards human and animals and lack of remorse<\/p>\n\n\n\n
Meds that target mood and aggression:<\/p>\n\n\n\n\n
\n
They are fairly common and can be temporary.<\/p>\n\n\n\n
DNS= Dopamine, Norepinephrine, Serotonin<\/p>\n\n\n\n
Clonidine (Catapres, Kapvay)
Guanfacine (Intuniv)<\/p>\n\n\n\n
Atypical Antipsychotic
Haldol, Pimozide, Aripiprazole<\/p>\n\n\n\n
Acute stress disorder occurs within 4 weeks of traumatic event.<\/p>\n\n\n\n
One month<\/p>\n\n\n\n
Intrusive re-experiencing
Increased arousal
Avoidance of stimuli associated with the trumatic event<\/p>\n\n\n\n
Prazosin for nightmares
SSRIs
TCAs<\/p>\n\n\n\n
EMDR<\/p>\n\n\n\n
EMDR<\/p>\n\n\n\n
BAFaP<\/p>\n\n\n\n
Assess cardiac history before placing patient on stimulants as they can cause elevated heart rate and bP and increase risk of Heart attack and stroke<\/p>\n\n\n\n
3 and up<\/p>\n\n\n\n
Ages 6 and older<\/p>\n\n\n\n
Age 6 and up<\/p>\n\n\n\n
Ages 6 and up<\/p>\n\n\n\n
Executive function<\/p>\n\n\n\n
Insomnia
tremors
increased blood pressure and HR
Heart palpitations<\/p>\n\n\n\n
Indicates the medication has been cleared by the body<\/p>\n\n\n\n
Address their anxiety–support them then continue with psychoeducation<\/p>\n\n\n\n
OCD–intrusive\/persistent thoughts and tics<\/p>\n\n\n\n
presence of anxiety provoking obsessions–recurrent and persistent thoughts, impulses, or images or compulsions for example motor tics that funtion to reduce the person’s subjective anxiety level<\/p>\n\n\n\n
Should be considered in all children with sudden onset OCD symptoms<\/p>\n\n\n\n
Deliberate faking of a physical or psychological disorder motivated by secondary gain.<\/p>\n\n\n\n
Condition in which a person does things to make themselves sick when they are not organically sick<\/p>\n\n\n\n
in children, a pattern of inhibited, withdrawn, apathetic behavior toward adult caregivers and show no emotion towards caregivers.
The product of a severely dysfuntional early relationship between the principal caregiver and the child<\/p>\n\n\n\n
General Anxiety Disorder:
excessive worry for at least 6 months<\/p>\n\n\n\n
Abrupt surge of intense fear of discomfort that reaches a peak within minutes; a variety of psychological and physical symptoms including a sense of impending doom<\/p>\n\n\n\n
Patient experiences recurrent unexpected panic attacks<\/p>\n\n\n\n
Fluoxetine
Paroxetine
sertraline<\/p>\n\n\n\n
bronchodilators like albuterol<\/p>\n\n\n\n
Childhood depressive and mood disorder–diagnosis age 6-17<\/p>\n\n\n\n
Frequent intense temper outbursts\/ temper tantrums<\/p>\n\n\n\n
Low BMI (15 or less than 15)<\/p>\n\n\n\n
Emaciation
Bradycardia
Hypotension<\/p>\n\n\n\n
BMI usually in normal range<\/p>\n\n\n\n
Administer the mood questionnaire<\/p>\n\n\n\n
if pt reports a nightmare and parents or other family members have nightmares<\/p>\n\n\n\n
Glutamate, GABA, Serotonin<\/p>\n\n\n\n
Persistent deficits in social communication and social interaction
No response when called by name
Nonverbal communication
Little or no eye contact
often like to line up, stack, or organize objects and toys in long, tidy rows<\/p>\n\n\n\n
Claims that dysfunction of the mirror neuron system may be the cause of poor social interaction and cognition<\/p>\n\n\n\n
Benzos<\/p>\n\n\n\n
Infections
We should do a urinalysis with culture and sensitivity<\/p>\n\n\n\n
Progressive mental decline; personality changes occur, irritability
Check Vit B12 and Folic Acid levels<\/p>\n\n\n\n
with depression it is acute onset of memory problems like happening over 5 months.<\/p>\n\n\n\n
“I do not know” responses are commonly depression. In dementia, patient often confabulates answers–will not say “I do not know”<\/p>\n\n\n\n
Primary diagnosis is depression
acute onset of memory problems like happening over 5 months<\/p>\n\n\n\n
subcortical–motor symptoms: lack of coordination, tremors, ataxia, dystonia<\/p>\n\n\n\n
Cognitive decline
motor abnormalities
behavioral abnormalities<\/p>\n\n\n\n
Presents with recurrent visual hallucinations<\/p>\n\n\n\n
AKA frontotemporal dementia\/frontal lobe dementia<\/p>\n\n\n\n
Antiretrovirals<\/p>\n\n\n\n
give them an HIV test<\/p>\n\n\n\n
atypical antipsychotics<\/p>\n\n\n\n
aggression
fear
anxiety
emotions<\/p>\n\n\n\n
emotions
stress
learning
memory<\/p>\n\n\n\n
motor movements<\/p>\n\n\n\n
give infant to parents and allow them to grieve for their loss<\/p>\n\n\n\n
Normalize grief and loss in children\u2014psychoeducation on grief responses; group therapy
Grief responses vary so do not tell a patient or family how they should grieve<\/p>\n\n\n\n
an intact family so they can adapt easily<\/p>\n\n\n\n
DNS (dopamine, nor, serotonin+ GABA+ Glutamate )<\/p>\n\n\n\n
Smoking
Caffeine
Lack of weight bearing exercises
Lack of dietary calcium and vitamin D<\/p>\n","protected":false},"excerpt":{"rendered":"