Intervention before assessment - When intervention is safety
e.g. discontinuing lithium when toxic
Suspecting child abuse - - Immediate report to
... [Show More] CPS
- Do not assess, can tamper with evidence
- If child reports it, interview separate from parent
Requests for Traditional Healer - make accommodations after signed release of info and clearance of informed consent
EPS not common side effect in... - atypical
Least weight gaining atypical - Aripiprazole....next is ziprazidone and lurasidone
(Switch to this if metabolic syndrome)
Administration of antipsychotic after first break - Administer IM
Class of meds that causes weight gain - mood stabilizers
TSH level - 0.5-5
Mood stabilizer that can cause hepatic toxicity - Depakote
- Look for c/o upper right quad pain and brown/red urine
- Order LFT
Kava - - Herbal that treats anxiety and insomnia
- Educate about hepatoxic toxicity potential
- Can cause sedation....do not give with other meds that cause drowsiness (e.g. xanax)
Antidepressant that can cause hepatic toxicity - TCA (Order LFT)
Depakote toxicity - - Symptom = confusion and lethargy
- Can cause hepatic toxicity
- Check LFT, ammonia levels and Depakote level
Stevens-Johnson Syndrome - - Can occur with Lamotrigine
- S/s: burning, mouth swelling and fever
Blood test prior to administer mood stabilizer - HCG of any female that is of child bearing age
What increases lithium levels - - NSAIDS, ACE Inhibitors, Thiazides (hydrochlorothiazide)
- Because they all reduce kidney clearance
Lithium heck prior to administration - - Thyroid, BUN, Creatinine, urine analysis (protein in urine 4+ ketones - protein uria)
Lithium side effects - - Hypothyroidism, leukocytosis, Twave inversion, maculopapular rash, Fine and coarse tremors, GI upset (diarrhea, vomit, anorexia), muscle weakness, drowsy, palpations and coordination impairment
- D/c med and order lithium level
NMS causes and symptoms - - Caused by antipsychotics
- Leads to muscle rigidity (mutism), elevated CPK (muscle break down), high LFT, high WBC, myoglobinuria.
Fluoxetine half life - Longer so must wait 5-6 weeks before switching to MAOI
Triptans - - Treats migranes
- Can cause serotonin syndrome
- If on antidepressant contact PCP to discontinue this med.
If depressed and has cancer give... - SSRI (Escitalopram) because less drug to drug interactions with cancer tx
Wellbutrin cotraindication - Sz d/o and eating d/o
Neuropathic pain tx - - First use SNRI
- Then TCA and GABA
Med with bad serotonin d/c syndrome - Sertraline because short half life
What to ask depressed patients - Alcohol use b/c can make depression worse
Serotonin discontinuation syndrome - Flu symptoms (muscle aches, soreness, lethargy, fatigue, gi upset: nausea and vomiting) and decreased concentration
Mental illness with highest risk for SI - Schizophrenia
Mental illness with highest risk of HI - Antisocial PD.
Avoid this when positive symptoms of schizo exists - Avoid stimulants b/c excess dopamine already is present [Show Less]