1. A rehab facility is request- ing labs. What do you need to do before sending them over?
2. What ethnic group in the US has the highest rate of SI and
... [Show More] SA?
Obtain informed consent
Native Americans
3. Which ethnic group may be- Native Americans
lieve in a Healing Stick?
4. Can traditional Native American healers receive a patient's health informa- tion?
Yes, with a request and informed consent from the patient.
5. What is a normal TSH level 0.5-5.0 mU/L
6. Does hypothyroidism have a TSH lower or higher than the normal level?
7. What is a serious side ef- fect of Kava Kava
8. What are serious side ef- fects of Divalproex Sodium (Depakote)
9. Can patients on Kava Kava receive benzodiazpines?
10. What are the symptoms of Stevens Johnson Syn-
drome and what two mood stablilzers carry a risk for SJS
Higher TSH level and lower T3/T4
liver damage, must check LFT Hepatic toxicity and pancreatitis
No, Kava Kava is used to treat insomnia. There- fore, sleeping agents and other medications that can cause a patient to be tired should be avoided.
Red rash, fever, body ahes, swollen face and tongue; carbamazepine and lamictal
11. Which mood stabilizer has the lowest risk of weight gain?
12. What tests should be com- pleted prior to starting a pa- tient on an atypical antipsy- chotic?
13. A patient is stable on Sero- quel but has started to gain a substantial amount of weight. What should your next step be?
14. What are the 3 As that
are risk factors with Carba- mazepine?
15. What lab level requires
the provider to immediately discontinue treatment with Clozapine?
16. What is the therapeutic lev- el for Lithium?
17. What is the gold standard pharmacological treatment for mania?
18. What are signs of Lithium toxicity?
19. What is the one antipsy- chotic shown to reduce the risk of suicide?
Lamictal
Lipid panel, A1C or serum glucose, BMI, and girth
Continue the medication as it appears to be working, develop a nutritional and exercise plan for patient, if the patient continues to gain weight. Switch to medications Geodone, Abilify, or Lurasidone.
Aplastic anemia, agranulocytosis, Asian eth- nicity
ANC less than 1000
0.6-1.2 mEq/L
Lithium
severe NVD, confusion, drowsiness, muscle weakness, heart palpitations, tremor, ataxia. Immediately discontinue lithium and recheck lithium level, then check vitals and ecg.
Clozapine
20. Which medications reduce renal clearance of Lithium?
21. What are the main symp- toms of Neuroleptic Malig- nant Syndrome and what is the cause?
Thiazide, NSAIDS, ACE inhibitors and some other cardiac meds.
extreme muscle rigidity, mutism, elevated CPK, WBC and LFTs.
22. How do you treat NMS? discontinue offending agent, and start
Bromocriptine or Dantrolene.
23. What are the symptoms
of serotonin syndrome and what causes it?
24. What is the treatment of Serotonin Syndrome?
25. Why should you wait 2 weeks when switching a patient between SSRIs, SNRIs, TCAs and MAOIs?
26. When switching between Prozac to MAOI how long should you wait?
27. What is the safest washout period of a medication to minimize drug-drug inter- actions?
28. What is the risk factor for patients who are on Trip- tans and a n antidepres- sant?
hyperflexia, myoclonic jerks, SSRIs.
Discontinue SSRI and give Cyprohepatadine (antihistamine)
To allow the previous medication to degenerate
5-6 weeks due to increased half-life of Prozac.
5 half lives
Triptan can increase serotonin levels leading to serotonin syndrome.
29. They are the safer in an overdose.
Why are SSRIs the first line
of therapy when starting an antidepressant?
30. Which antidepressants Escitalopram and Citalopram
have the lowest risk of it-
neractions and are com-
monly used when treating
cancer patients?
31. Which class of antidepres- SNRI-Cymbalta
sants are best if a pa-
tient has depression and fi-
bromyalgia?
32. SSRI that is best for pa- NDRI-Wellbutrin
tients who are worried
about sexual side effects
33. Which antidepressant Wellbutrin
should not be used in pa-
tients with a history of
seizures or eating disor-
ders?
34. Which antidepressant can Fluoxetine (Prozac), should be taken in the
cause insomnia? morning.
35. What black box warning SSRIs may increase the risk of death and sui-
must be taught and docu- cide. Provider must always assess and chart
mented prior to starting an risk of suicide.
SSRI on children and ado-
lescents?
36. Which disorder carries the Antisocial personality disorder.
greatest risk of homicidal
ideation?
37. Men 19-25 yrs old; Women 25-35 yrs old.
What is the average age of onset for schizophrenia in men and women
38. What does a PET scan show of the brain in schiz- ophrenia?
39. Why shouldn't stimulants be prescribed to patients with schizophrenia?
40. What is the preventative level of care of Social Skills
Enlarged cerebral ventricles and smaller brain structure overall.
Stimulants can increase dopamine release
Tertiary, should start after discharge and in- clude referal to aerobic exercise, nutrition, case
Training in patients with schizophrenia management team.
41. What is the dosing rate 20x the daily dose, max 100mg per dose, 5-7
for the first month when days later can receive additional dose.
switching a patient from
oral Haldol to IM and what is
the max dose per injection?
42. What is a delusion? A false fixed belief, idea or thought.
This has no sensory component.
43. On the MSE What is thought the way a person thinks (requires assessment
process? of thoughts and ideas)
44. What is tangenital think- The patient continues to move from thoughtto
ing? thought and never gets to the point.
45. What is Circumstantial The person goes in circles before finally getting
thinking? to the point.
46. What is assessed in the Thoughts that occupy a person's mind in-
MSE for Thought Content? cluding hallucinations and suicidal/homicidal
ideation.
47.
What are the scores on an MMSE (Folstein Scale)?
48. What is a clock drawing test used for?
49. What receptor does
an Atypical antipsychotic work on?
50. For patients with acute psy- chosis which medications should be given?
51. What P450 enzyme metabo- lizes Clozapine?
52. What is the difference be- tween an enzyme inducer vs inhibitor?
53. What medications can in- duce mania?
54. What medications can in- duce depression?
55. What medication can in- duce psychosis?
56. What medications can de- lay gastric emptying?
57. What neurotransmitters play a role in addiction?
25-30 normal
21-24 mild impairment
10-20 moderate impairment
0-9 severe impairment
very quick neurological assessment for Alzheimers or dementia. Shows damage to the right hemisphere.
Serotonin Antagonist
An atypical antipsychotic with IM component, geodone, Invega, Abilify, Olanzapine
CYP1A2
Inducer decreases serum levels of of drugs IE smoking. Inhibitor increases levels of drug. If a patient is exposed to inducer and inhibitor the inhibitor will overtake causing an increase.
Steroids, disulfiram, isonilzoid, antidepres- sants in patients with bipolar disorder.
steroids, beta blockers, benzodiazepines, prog- esterone, retrovirals, antiemetics, isotretinoin.
Steroids
Ranitidine, famotadine, omeprazole GABA and Dopamine
58. What contributes to pain, bloating, and fullness in pa- tients with anorexia after eating?
59. What is Citalopram Dos- ing?
Delayed gastric emptying.
20-40 mg/day due to high risk of QT prolonga- tion
60. What is Apoptosis? programmed cell death
61. What is a risk factor of SS- RIs in adults older than 65?
62. At what age is a patient's symptoms more likely due to a medical condition than bipolar disorder?
63. What is the greatest risk factor of Bipolar Disorder?
64. What are common symp- toms of Borderline Person- ality Disorder?
Monitor for increases anxiety Aged 45.
Inherited across multiple family generations
Recurrent SI/SH, rejection sensitivity, intense interpersonal problems. Requires a journal of symptoms to complete diagnosis.
65. Who originated DBT? Marsha Linehan
66. What is Conversion Disor- der?
sudden-onset neurologic sx preceded by an obvious stressor, symptoms may include mute- ness, blindness, paralysis, paresthesia or other neurological sx. [Show Less]