1. Which patient is at highest risk for SI
A. 30y/o married AA female with previous SI attempt *1 risk factor
B. 35 y/o single Asian male with previous
... [Show More] SI attempt *3 risk factors
C. 38 y/o single AA male who is a manager of a bank *2 risk factors
D. 68 y/o single white male with depression *5 risk factors (age, male, white, depression): D. 68 y/o single white male with depression *5 risk factors (age, male, white, depression)
Count the risk factors
2. When interview teenagers (16 y/o) that arrive with their parents what should you do?: interview them separately from parents.
-This helps Build therapeutic rapport with teens by telling them the info is confiden- tial. Parents may be upset but remember you are advocating for the child.
3. Which Ethnic group has the highest rate of suicide?: Native Americans
4. Example A patient is being treated for schizophrenia with olanzapine. Which of the following is the most common side effect of olanzapine?
A. Increased waist circumference
B. EPS (not as common in atypical antipsychotics d/t 5HT2A)-receptor an- tagonism
C. Increased Lipids
D. Metabolic Syndrome: D. Metabolic Syndrome (UMBRELLA ANSWER)
5. Which antipsychotics have the least weight gain?: 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
6. Which mood stabilizer have the least weight gain?: Lamictal
-But remember all mood stabilizers cause some weight gain
7. When presented with a question about typical vs atypical antipsychotic the answer is usually to start of a: atypical
8. A client presents with complains of changes in appetite, feeling fatigued, problems with sleep-rest cycle, and changes in libido. What is the neu- roanatomical area of the brain that is responsible for the normal regulation of these functions?
A. Thalamus
B. Hypothalamus
C. Limbic System
D. Hippocampus: Hypothalamus
A, B, & D are all part of the limbic system so you can rule that out
9. When a patient is hesitant to participate in treatment you should encour- age?: Bring a support person like a husband
10. Thyroid-Stimulating hormone normal level: 0.5-5.0 Mu/L
11. When T4 and T3 are high and TSH is low what is the diagnosis: HY- PERTHYROIDISM, TSH secretion decreases: TSH LOW à key symptoms HEAT INTOLERANCE
12. Key symptoms of Heat Intolerance: Hyperthyroidism
13. When T4 and T3 are Low and TSH is high what is the diagnosis: (HY- POTHYROIDISM) TSH secretion increased: TSH HIGH à COLD INTERANCE
14. Key symptoms of Cold Intolerance: Hypothyroidism
15. Hyperthyroid can mimic: Mania
16. Hypothyroid can mimic: Depression
17. A patient on depakote complains of RUQ pain and has reddish/brown urine: Hepatoxicity
-Check LFTs
18. Signs of Depakote toxicity: Disorientation, confusion, lethargy
19. You suspect depakote toxicity what do you do?: Check
-LFT
-Ammonia
-Depakote Level
20. What herbal supplement can cause hepatoxicity?: Kava Kava
21. When taking Kava Kava in combinations with other medications you should caution about: Risk of Hepatoxicity and Sedation
22. TCAs carry a risk of: Hepatotoxicity
23. Signs of Stevens-Johnson Syndrome: -fever, mouth pain, swelling, burning eyes, blisters, skin pain
24. two psychotropics known to cause steven johnson syndrome: lamictal and tegretol
25. What nationality is most suseptible of getting steven johnson?: Asians
26. When treating asians with tegretal screen for?: HLAB-1502 Allele
27. What two medications cause agranulocytosis?: Clozaril & Tegretal
28. Agranulocytosis when to discontinue medication: Less than 1000
29. When monitoring for agranulocytosis in patients look for s/s of what?: -
Infection
-Fever, sore throat, fatigue, chills
30. Before starting any mood stabilizer in a female of childbearing age be sure to check?: HCG
31. Which two medications may decrease the risk of suicide?: clozaril and lithium
32. Medications that increase lithium level: NSAID-ibuprofen, INDOCIN THIAZIDES-hydrochlorithiazide ACE INHIBITORS-lisinopril
33. Ace inhibitors are treatment of choice for?: Heart Failure
34. Certain medications are known to increase lithium level, but HOW?: by reducing renal clearance
35. When educating a patient about lithium teach them about: Hyponatremia Dehydration-hot days, exercise
36. Normal Lithium Level: 0.6-1.2
37. Lithium Toxicity: 1.5 or above Discontinue and re-order lithium level
38. Lithium level of 1.4: Monitor for toxicity
39. Labs before starting lithium: TSH, BUN, CREATININE, HCG, U/A to check for presence of protein in the urine (4+ protein is concerning for renal impair- ment)à4+ protein in urine=MONITOR FOR TOXICITY
40. 4+ protein in the urine of a patient on lithium: 4+ protein is concerning for renal impairment
4+ protein in urine=MONITOR FOR TOXICITY
41. Lithium side effects: hypothyroid, leukocytosis, maculopapular rash, t-wave inversion, Coarse Hand Tremor, GI upset (nausea, vomiting, anorexia)
-Some of these are also signs of toxicity
42. Signs of lithium toxicity: confusion, ataxia, GI upset, palpitation, tremor
43. NMS: 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)
44. Cherry colored urine in a patient that exercises a lot: test for myoglobinuria may be a sign of rhabdo
45. Serotonin Syndrome: With any drug that increases 5-HT (e.g., MAO in- hibitors, SNRIs, TCAs) hyperthermia, confusion, myoclonus, cardiovascular insta- bility, flushing, diarrhea, seizures.
-Treatment: cyproheptadine (5-HT2 receptor antagonist).
46. Treatment for NMS: Stop Offending Medication
-Dantrolene (muscle relaxer)
-Bromocriptine (Dopamine D2 agonist).
*In question focus on what they are asking for....dopamine agonist vs muscle relaxer
47. Treatment for Serotonin Syndrome: Stop Med (1 or more SSRI, SSNRI, TCA, MOAI)
-Cyproheptadine
48. Triptans: Used for MIGRAINES
-These meds increase serotonin example SUMATRIPTAN
49. patient taking Prozac and started on sumatriptan: -call PCP to ask them to switch the migraine med if patient already on SUMATRIPTAN do not start antidepressant without talking to PCP
50. How long do you wait when switching between an SSRI to an MAOI?: 2 weeks
51. How long do you wait when switching between Prozac and MAOI?: 5-6 weeks wash out period
52. What is the first line treatment for depression and why?: SSRI-First line treatment for depression due to less risk of injury from OVERDOSE
53. If a cancer patient has depression what should you consider?: Treating with a medication with minimal drug/drug side effects like Lexapro
54. Patient with depression worries about sexual dysfunction what would be the medication of choice?: Wellbutrin
55. Primary symptoms of depression include fatigue and low energy what med would you chose?: Wellbutrin
56. Wellbutrin is contraindicated in patients with: Seizures and anorexia
57. Which medications are best for neuropathic pain?: SNRI Gabapentin
TCA
58. Secondary to the black box warning providers caring for patients on anti- depressants should assess for?: Suicidality, frequency, and severity at EVERY appointment
59. Which meds have the worse serotonin discontinuation syndrome: Those with short half lives
such as zoloft
60. Symptoms of serotonin withdrawal syndrome: Fever, achiness, soreness, lethargy, fatigue, impaired memory, decreased concentration, GI UPSET
Shits and Shivers
61. Ages of onset for schizophrenia in males vs females: -MALES 18-25 years
-FEMALE 25-35 years
62. Schizophrenia increases the risk for: SUICIDE
*HIGH RISK OF SI in SCHIZOPHRENIA*
Just having schizophrenia increases your risk of suicide.
MUST ASK ABOUT SI, EVERYTIME (frequency, severity of thoughts)
63. What increases the causes or increases the risk or schizophrenia: exces- sive pruning of synapses
-inadequate synapse formation,
-intrauterine insults such as maternal exposure to toxins, viral agents, maternal substance use, maternal illness, maternal malnutrition, fetal oxygen deprivation,
-first order relative (mom/dad)
64. MRI or PET scan what is seen in schizophrenia: EVERYTHING DECREAS- ES EXCEPT VENTRICLES
-You will see VENTRICULAR ENLARGEMENT
65. Stimulants can potentiate the release of what neurotransmitter?: -
Dopamine which can worsen symptoms of schizophrenia
66. Assertive Community Treatment (ACT): a form of rehabilitation post hospi- talization, in home treatment
67. What level of prevention is ACT?: Tertiary
68. What adjunctive treatment is important in schizophrenia: -social skills training
-Exercise
69. Exercise for mental health patients can promote: Cognition Quality of Life
Long-term health
70. ACT is ideal for patients with a history of: Treatment non-compliance
-Think about making the treatment convenient for them-->bringing it to their home
71. What diagnosis has the highest risk of Homicidality: Antisocial
72. In the MMSE how do you test for abstraction?: proverb interpretation (every- one that lives in glass houses shouldn't throw stones) Are they able to think abstractly
73. Thought Process-Tangential: means that their response has nothing to do with the question
74. Circumstantial: means that their response goes in circles instead of getting to the point of the question
75. Mental Status-Thought Content includes: SI/HI/AH/VH
76. Another name for MMSE: Folstein Scale
77. How to assess concentration on MMSE: Serial 7s or perform an activity backwards i.e list the days of the week backwards
78. Assess ability to learn new material: repeat 3 words after me
79. Assess ability to recall: repeat 3 words after 5 minutes
80. Assess fund of knowledge: Who is the president
81. What is a quick and easy way to assess for neurological issues: Clock drawing test
82. If patient is unable to draw a clock this indicates: Problem with the right hemisphere, cerebrum, or parietal lobe
83. mesolimbic pathway: Hyperactivity of dopamine in the this pathway mediates positive psychotic symptoms
-Antagonism of D2 receptors in this pathway treats positive psychotic symptoms
84. mesocortical pathway: -Decreased dopamine in the this projection to the dorsolateral prefrontal cortex is postulated to be responsible for negative and depressive symptoms of schizophrenia
85. Nigrostriatal Pathway: -This pathway mediates motor movements
-Dopamine blockade in this pathway can lead to increase acetylcholine levels
-Blockade of dopamine (D2) receptors in this pathway can lead to EPS, i.e dysto- nia, parkinsonian symptoms and akathisia
86. Low Dopamine in the nigrostriatal pathway increases which neurotrans- mitter: -Dopamine has a reciprocal relationship with acetylcholine (Ach) (LOW DOPAMINE INCREASE Ach)
87. Long-standing D2 blockade in the nigrostriatal pathway can lead to: -
tardrive dyskinesia
88. Tuberoinfundibular pathway: -Blockade of D2 receptors in this pathway can lead to increase prolactin levels leading to hyperprolactinemia which clinically manifests as amenorrhea, galactorrhea, and sexual dysfunction, gynecomastia
-DECREASE DOPAMINE INCREASED PROLACTIN
89. Long-term hyperprolactinemia can be associated with what condition: -
osteoporosis
90. Normal Prolactin Level in Men: level less than 20ng/ml
91. Normal Prolactin Level in Women: less than 25ng/ml
92. Which medication is the highest offender for increasing prolactin: -
Risperdal
93. Acute Dystonia + Treatment: neck stiffness, muscle spasm of upper body especially neck/face/tongue
-Treatment is IM COGENTIN + continue PO COGENTIN for several days
94. Akathisia + Treatment: may mimic anxiety, restlessness, can't sit still, rocking, pacing
-First line Treatment is BETA-BLOCKERS like PROPANOLOL (Inderal)
-Second line treatment is COGENTIN
-Third line treatment is benzos
95. Beta-Blockers such as Inderal are contraindicated with what type of asthma medication: -DO NOT GIVE WITH BROCHODIALATOR such as AL- BUTERAL this combination can cause bronchospasm
96. akinesia/bradykinesia + treatment: A. difficulty initiating movement; slow- ness of movement
-Treatment Cogentin [Show Less]