Which patient is at highest risk for SI

Which patient is at highest risk for SI

• 30y/o married AA female with previous SI attempt *1 risk factor
• 35 y/o single Asian male with previous SI attempt *3 risk factors
• 38 y/o single AA male who is a manager of a bank *2 risk factors
• 68 y/o single white male with depression *5 risk factors (age, male, white,

depression)answer== D. 68 y/o single white male with depression *5 risk factors (age, male, white, depression)

Count the risk factors

When interview teenagers (16 y/o) that arrive with their parents what should you do?answer== interview them separately from parents.-This helps Build therapeutic rapport with teens by telling them the info is confidential.Parents may be upset but remember you are advocating for the child.

Which Ethnic group has the highest rate of suicide?answer== Native Americans

Example A patient is being treated for schizophrenia with olanzapine. Which of the following is the most common side effect of olanzapine?

• Increased waist circumference
• EPS (not as common in atypical antipsychotics d/t 5HT2A)-receptor antagonism
• Increased Lipids
• Metabolic Syndromeanswer== D. Metabolic Syndrome (UMBRELLA ANSWER)

Which antipsychotics have the least weight gain?answer== Latuda, Abilify, (also least sedating), Geodon-if patient has metabolic syndrome consider switching to one of the medications above. Or if the patient is overly sedated try switching to ABILIFY

Which mood stabilizer have the least weight gain?answer== Lamictal -But remember all mood stabilizers cause some weight gain

When presented with a question about typical vs atypical antipsychotic the answer is usually to start of aanswer== atypical

A client presents with complains of changes in appetite, feeling fatigued, problems with sleep-rest cycle, and changes in libido. What is the neuroanatomical area of the brain that is responsible for the normal regulation of these functions?

• Thalamus
• Hypothalamus
• Limbic System

• Hippocampusanswer== Hypothalamus

A, B, & D are all part of the limbic system so you can rule that out

When a patient is hesitant to participate in treatment you should encourage?answer== Bring a support person like a husband

Thyroid-Stimulating hormone normal level answer== 0.5-5.0 Mu/L

When T4 and T3 are high and TSH is low what is the diagnosis answer==

HYPERTHYROIDISM, TSH secretion decreases: TSH LOW à key symptoms HEAT

INTOLERANCE

Key symptoms of Heat Intolerance answer== Hyperthyroidism

When T4 and T3 are Low and TSH is high what is the diagnosis answer==

(HYPOTHYROIDISM) TSH secretion increased: TSH HIGH à COLD INTERANCE

Key symptoms of Cold Intolerance answer== Hypothyroidism

Hyperthyroid can mimic answer== Mania

Hypothyroid can mimic answer== Depression

A patient on depakote complains of RUQ pain and has reddish/brown urine answer== Hepatoxicity -Check LFTs

Signs of Depakote toxicity answer== Disorientation, confusion, lethargy

You suspect depakote toxicity what do you do? answer== Check -LFT -Ammonia -Depakote Level

What herbal supplement can cause hepatoxicity? answer== Kava Kava

When taking Kava Kava in combinations with other medications you should caution about answer== Risk of Hepatoxicity and Sedation

TCAs carry a risk of answer== Hepatotoxicity

Signs of Stevens-Johnson Syndrome answer== -fever, mouth pain, swelling, burning eyes, blisters, skin pain

two psychotropics known to cause steven johnson syndrome answer== lamictal and tegretol

What nationality is most suseptible of getting steven johnson? answer== Asians

When treating asians with tegretal screen for? answer== HLAB-1502 Allele

What two medications cause agranulocytosis? answer== Clozaril & Tegretal

Agranulocytosis when to discontinue medication answer== Less than 1000

When monitoring for agranulocytosis in patients look for s/s of what? answer== Infection -Fever, sore throat, fatigue, chills

Before starting any mood stabilizer in a female of childbearing age be sure to check? answer== HCG

Which two medications may decrease the risk of suicide? answer== clozaril and lithium

Medications that increase lithium level answer== NSAID-ibuprofen, INDOCIN THIAZIDES-hydrochlorithiazide ACE INHIBITORS-lisinopril

Ace inhibitors are treatment of choice for? answer== Heart Failure

Certain medications are known to increase lithium level, but HOW? answer== by reducing renal clearance

When educating a patient about lithium teach them about answer== Hyponatremia Dehydration-hot days, exercise

Normal Lithium Level answer== 0.6-1.2

Lithium Toxicity answer== 1.5 or above Discontinue and re-order lithium level

Lithium level of 1.4 answer== Monitor for toxicity

Labs before starting lithium answer== TSH, BUN, CREATININE, HCG, U/A to check for presence of protein in the urine (4+ protein is concerning for renal impairment)à4+ protein in urine=MONITOR FOR TOXICITY

4+ protein in the urine of a patient on lithium answer== 4+ protein is concerning for renal impairment 4+ protein in urine=MONITOR FOR TOXICITY

Lithium side effects answer== hypothyroid, leukocytosis, maculopapular rash, t- wave inversion, Coarse Hand Tremor, GI upset (nausea, vomiting, anorexia)

-Some of these are also signs of toxicity

Signs of lithium toxicity answer== confusion, ataxia, GI upset, palpitation, tremor

NMS answer== muscle rigidity, mutism (because of muscle rigidity), increased CPK (caused by muscle contraction and muscle destruction), increase WBC, increased WBC, myoglobinuria (also from muscle destruction)

Cherry colored urine in a patient that exercises a lot answer== test for myoglobinuria may be a sign of rhabdo

Serotonin Syndrome answer== With any drug that increases 5-HT (e.g., MAO inhibitors, SNRIs, TCAs) hyperthermia, confusion, myoclonus, cardiovascular instability, flushing, diarrhea, seizures.

-Treatment: cyproheptadine (5-HT2 receptor antagonist).

Treatment for NMS answer== Stop Offending Medication -Dantrolene (muscle relaxer) -Bromocriptine (Dopamine D2 agonist).*In question focus on what they are asking for. .. dopamine agonist vs muscle relaxer

Treatment for Serotonin Syndrome answer== Stop Med (1 or more SSRI, SSNRI,

TCA, MOAI)

-Cyproheptadine

Triptans answer== Used for MIGRAINES -These meds increase serotonin example SUMATRIPTAN

patient taking Prozac and started on sumatriptan answer== -call PCP to ask them to switch the migraine med if patient already on SUMATRIPTAN do not start antidepressant without talking to PCP

How long do you wait when switching between an SSRI to an MAOI? answer== 2 weeks

How long do you wait when switching between Prozac and MAOI? answer== 5-6 weeks wash out period

What is the first line treatment for depression and why? answer== SSRI-First line treatment for depression due to less risk of injury from OVERDOSE

If a cancer patient has depression what should you consider? answer== Treating with a medication with minimal drug/drug side effects like Lexapro

Patient with depression worries about sexual dysfunction what would be the medication of choice? answer== Wellbutrin