When many answers are remarkably similar, they are usually _____________ >>> wrong
Interprofessional collaboration is encouraged. >>> Collaborate is
... [Show More] usually right.
Delegate is usually wrong.
ADPIER >>> Assessment, diagnosis, Plan, intervention, evaluate, refer out last.
Lithium >>> Normal 0.6-1.2
Lithium toxicity occurs at levels >>> > 1.5
Signs of Lithium toxicity >>> severe nausea, diarrhea, vomiting, confusion, drowsiness, muscle weakness, heart palpitation, coarse hand tremors, unsteady gait
Lithium is gold standard for >>> MANIA
Lithium has evidence shown to >>> reduce suicidal ideation
What does lithium cause in neonate, especially 1st trimester >>> Ebstein anomaly (congenital heart defect)
dehydration and hyponatremia cause lithium levels to >>> rise
Baseline labs before initiation of lithium >>> 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 >>> 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 >>> staying hydrated
avoiding NSAIDS
compliance
Depakote normal level >>> 50-125
Depakote toxicity level >>> greater than 150
Teratogenic effects of Depakote >>> spina bifida
Adverse effects of depakote >>> 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 >>> disorientation, lethargy, respiratory depression, nausea/vomiting
Intervention for depakote toxicity >>> DC med
check level
LFT
ammonia
MAOI + tyramine causes >>> hypertensive crisis
Symptoms of hypertensive crisis >>> elevated BP
sudden explosive like headache
facial flushing
palpitations
pupillary dilation
diaphoresis
fever
Hypertensive crisis occurs with MAOI + >>> MEPERIDINE
STIMULANTS
decongestants
TCAs
atypicals
St. John's wart
L-tryptophan
asthma meds
Treatment for hypertensive crisis >>> DC offending agent
Administer PHENTOLAMINE
Teratogenic effects of benzos >>> floppy baby, cleft palate
Teratogenic effects of tegratol >>> neural tube defect
teratogenic effects of lithium >>> ebstein anomaly (heart defect) (avoid, especially 1st trimester)
teratogenic effects of depakote >>> neural tube defects/spina bifida
Adverse reaction to Lamictal >>> Steven Johnson's Syndrome
Signs of SJS >>> FEVER --high yield
sore throat
facial swelling
tongue swelling
red rash
skin sloughing [Show Less]