DLC questions Flashcards
For neural tube defect prevention in bipolar patients on Valproic Acid
Folic acid
a. 0.4-0.8mg PO QD for pregnant patients on mood stabilizers
a. Can elevate LFT
b. Must be alcohol free for 24 hours prior to starting
Disulfiram (Antabuse)
This medication is taken in conjunction with Selegiline or any MAOI, risk of hypertensive crisis.
Meperidine (Demerol)
a. Do not use in patients with who are on Selegiline (MAOI)?
Normal A1C + High blood sugar =???
Usually medication side effect, not diabetes
a. Occurs with acute dystonia (a type of EPS)
b. Eyes roll upward
c. This is an adverse effect of antipsychotics
Oculogyric crisis
Oculogyric crisis Treatment
a. stop offending agent immediately
b. Administer Cogentin IM and continue PO x5 days
Alpha 1 adrenergic blockade from meds can lead to orthostatic hypotension.
a. Common antipsychotics include?
b. Should doses be increased slowly or rapidly?
a. Common with clozapine and chlorpromazine and doses should be increased SLOWLY
a. This neurotransmitter is what makes atypical antipsychotics “atypical”
b. Major neurotransmitter implicated in mood disorders and anxiety disorders
c. sleep
Serotonin 5HT2A
a. ExciTes as in Bipolar
b. Excitatory neurotransmitter
c. Implicated in seizure disorders, bipolar d/o, and psychosis
Glutamate
Low levels of glutamate = ???
a. memory and learning difficulty
b. negative symptoms of schizophrenia
High levels of glutamate = ???
Increases anxiety levels
a. “Pain”
b. Substance
c. Body’s response to stress, injury and is involved in pain perception
Neuropeptide
(neurotransmitter)
a. “memory”
b. Learning, short-term memory, arousal and reward
Acetylcholine
Involved with recognitions of facial expressions, music, and visual images. Disturbances in area lead disturbances in drawing, such as clock drawing.
Right hemisphere
a. Modulates pain and perceptions of pain; TMS can help reduce pain; chronic pain is associated with loss of grey matter.
b. Impulsive and motivational drives
Prefrontal Cortex (pain = pre)
Where positive symptoms occur r/t DA excess. (portion of the brain)
a. Mesolimbic system
b. Nucleus accumbens
Center for fear, anxiety, and panic
Amygdala
a. Used in assessing and identifying AKATHISIA severity
b. This can be very useful in systematically assessing patients in identifying akathisia assess its severity, monitor change in symptoms.
BARS
Tardive dyskinesia (TD) Treatment
a. Tx: stop offending agent
b. Tx: start Clozaril
c. Can also give Ingrezza
1st degree relative (especially in men) is a risk factor for development
Antisocial personality Dx
a. Large structural structures
b. Short stature
Fragile X Syndrome
a. Smaller/underdeveloped structures
b. Small head, thin upper lip, smooth philtrum, short nose, underdeveloped jaw, short eyelid opening
c. Low birth weight and height
Fetal Alcohol Syndrome
a. Subcategory of ASD
b. Delay in social development skills
Asperger’s syndrome
Unilateral ringing in the ear (tinnitus)
Acoustic Neuroma
When diagnosing a child with a psychiatric illness, what is the the initial priority?
The initial priority is to educate the family and child.
CAGE-C
Do you feel the need to Cut down?
CAGE-A
Have people Annoyed you by criticizing your drinking?
CAGE-G
Have you ever felt Guilty about your drinking?
CAGE-E
Have you ever felt you need a drink first thing in the morning – Eye opener to steady your nerves
a. Tasks that enhance performance of ADLs
b. Shopping
c. Using telephone
Instrumental ADL’s
a. Bathing
b. Toileting
c. Dressing
d. Functions necessary for self-care
Functional ADLs
a. Higher order activities
b. Balancing check book
c. Filing taxes
d. Driving
Cognitive executive function
1 predictor of violence
History of rage and violence
a. Individuals attributing their own unacceptable thoughts, feelings and motives to another person
b. Example – You hate someone knowing that is wrong, you try to solve the problem by telling yourself that they hate you
Projection definition
a. The redirection of an impulse (usually aggression) onto a powerless substitute target
b. Example – Someone who is frustrated by their boss at work might go home and kick their cat
Displacement definition
Elderly person with recent mental status changes, should be checked for which labs?
a. CBC
b. CMP
c. UA
This personality is:
a. Characterized by ideas of reference
b. Characterized by magical thinking
Schizotypal personality (the weird doctor from back to the future)
Prior to starting patient on Antipsychotics. Check & document:
a. Waist circumference (to compare for risk of weight gain with antipsychotics)
b. Fasting lipids
c. Fasting glucose
Serotonin discontinuation resembles what kind of symptoms
Flu like symptoms
Men more prone to have manic episodes & Women more prone to have depressive episodes: True or false
True
a. Strong association with drug and alcohol abuse
b. 5x more common in 1st degree biological relatives for men
c. Found in many cultures
d. Correlates with low dopamine levels in front cortex implicated in aggression and impulsivity
Antisocial personality d/o
Associated with development of dementia like symptoms
Low B12
If patient has liver disease (such as hepatitis), choose lorazepam over diazepam because lorazepam has shortest half life
Just read
Olanzapine + Fluoxetine
a. FDA approved for bipolar depression
Being over empathetic as a therapist can lead to transference and dependency and can lead to acting-out: True or False
True
a. Children who come from parents w/ high emotional expression and unresolved losses tend to develop disorganized attachment characterized by not feeling safe with caregiver and an inability to feel soothing comfort.
What theory is this?
BOWLBY Attachment Theory
Places primary emphasis on role of choice and responsibility in therapeutic progress. This is based on assumption people can exercise their freedom to change situations
Existential theoretical framework
Seeks equilibrium in the face of change for the family (homeostasis)
Family Systems Theory
Sexually provocative behaviors beyond normal growth and developmental age or stage could indicate sex abuse, and is a concern: True or False
True
Children who struggle with syllogistic reasoning in stage of concrete operations (Piaget) (ages 7-11) can be overinvested in rules and develop what kind of behaviors?
OCD behaviors
When a provider receives a ROI (request of information) on behalf of a patient, all chart may be sent Including psychotherapy notes: True or False
False: except psychotherapy notes
What are Core values for APRNs and culturally competent care?
Care
Advocacy
Partnership
Law that forbids a provider to refer to a family member for treatment of your patients
Stark Law
14-year-old girl clenching her teeth
Cranial nerve V-Trigeminal nerve (FIVE)
Cranial nerve: Facial Paralysis – Bells Palsy
CN VII
Adult panic disorder medications
Buspar, SSRI, or both
Can a patient with panic disorders take benzos?
BNZs, usually used for short-term symptom control or “bridge” medication when
- starting an SSRI or other antidepressant
injection into the penis or placement in the urethra, it is used to treat erectile dysfunction.
Alprostadil (PGE1)
PROZAC causes what in elderly adults?
It increases anxiety
Can asthma medications cause depression?
Yes
- Examples: INTERFERON
- ACCUTANE (Acne Tx) (Vit A)
o Can cause depression & birth defect
Clomipramine (Anafranil) - TCA Can be used for what disorder?
OCD and Depression
Grape-fruit juice and grapefruit are Inhibitors
Will cause Increase trazodone levels because it is an INHIBITOR – see above – you would
need to DECREASE the Trazodone dose in this case.
Assesses whether the means of two groups are statistically different from each other.
T-Test
Tests the differences among three or more groups
Analysis of variance (ANOVA):
Tests the relationship between two variables
Pearson’s r correlation
The independent variable (the treatment) caused a change in the dependent variable (the outcome)
Internal validation
The sample is representative of the population and the results
can be generalized.
External validation
Little boy wet his sheets, what kind of therapy would you suggest?
Behavioral therapy
A federal program of health insurance for persons 65 years of age and older
Medicare definition
Medicare A
Inpatient services
Medicare B
Outpatient services
Medicare C
Private insurance can provide Medicare benefits
Medicare D
Drugs
Beta blocker Inderal is contraindicated with Albuterol.
Increased risk of what?
the risk of increased CNS stimulation
What can help with NEGATIVE SX of Schizophrenia?
Clozaril c: but you have to try TWO other medications
and document BEFORE Clozaril.
Patient on antidepressants for 3 weeks and attempted suicide
Stop medication immediately
Sensory-perceptual disturbances and agnosia (inability to perceive objects)
- R-L confusion
- Difficulty writing (agraphia)
- Aphasia (difficulty of language)
Problems in the parietal lobe
What does Depakote do to Lamictal?
Depakote inhibit Lamictal metabolism and cause INCREASING Lamictal level
What does Erythromycin to Trileptal?
Erythromycin is INHIBITOR which Increase Trileptal level
- You will need to decrease Trileptal dose
What do you do when a patient is on Tegretol and their ANC < 1000?
Stop and repeat lab
- Normal is 1500-8000 mm3
What happens when taking Lithium and NSAIDS?
NSAIDS can cause lithium levels to increase and may cause lithium toxicity - Known NSAIDS: Indomethacin, Ibuprofen
Getting the research information out to those who need to know it.
Dissemination definition
What is the concern when prescribing Lamictal with Depakote?
Divalproex added to lamotrigine will essentially double lamotrigine blood levels and can
increase risk of a serious rash
Which drug affects Carbamazepine (Tegretol)?
Erythromycin (INHIBITOR) will cause toxic levels. You will need to decrease Tegretol
14-year-old with no axillary hair has not gotten her period yet
Normal tanner stage, start by 16
65 yo started on SSRI: What should you know?
a. May cause increase in anxiety in elderly
b. Expect increased side effects
c. Do an EKG
Autistic child not responding to your verbal commands
This is normal, repetitive patterns of behavior
- Impaired social interactions
- Verbal/nonverbal communication common
MIRROR NEURONS is what makes a child with autism NOT respond to their name
Flonase has steroids which is an inhibitor so it can lead to increased Tegretol levels. What do you want to do?
Tegretol has known risk for agranulocytosis so you want to decrease the dose of Tegretol when those two
meds are combined
If Flonase started after Tegretol, it is responsible for mania –
Medicine that can cause mania - Acronym S-A-I-D
-Steroids
- Antidepressants with Bipolar
- Isoniazid (INH)
- Disulfiram (Antabuse)
NSAIDs and ACE inhibitors effect on LITHIUM
Can double serum lithium level
Nuchal rigidity = Stiffness in cervical neck area. What does this indicate?
INDICATES – Meningitis
Patient abusing stimulants, what does NP assess for?
- Insomnia and tremor
- Irritability
- Weight loss
- Nervous
- Hypertension
- Tachycardia
Patient in hospital with no family and failing cognitive test. What test do you perform?
Perform an MRI
- Labs to rule out substance abuse
What are you looking at when you are assessing the function of elderly individual?
Ability to manage a checkbook
- Instrumental ADLs go first (meds, phone, drive, housework, balancing check book)
- ADLS eating/dressing
- Executive function = judgement planning
When opening independent practice?
Consider cost and revenue,
- must calculate the time spent with patient VS time spent on risk called indirect VS direct
Women (who is pregnant) with GAD advise on medication
Stop Benzos because can cause floppy baby syndrome and cleft palate.
- Continue Buspar
What abx and antipsychotic can cause photosensitivity?
Thorazine and doxycycline
If patient presents with DEPRESSED MOOD and/or EMOTIONAL LABILITY, what do you give?
Depakote
PTSD hallmark symptoms
a. Intrusive re-experiencing of an extremely traumatic event
b. Increased arousal (hyperarousal)
c. Avoidance of stimuli associated with trauma.
OCD treatment
Treatment: Children’s Prozac
Adults: SSRIs (Zoloft) and TCA Clomipramine (Anafranil)
Tip: Know the moderate range – anything above the moderate is going to be severe and below the moderate is going to be
mild. COWS is used to determine when to administer medication to someone who is withdrawing from opioids. For the exam, it
is NOT recommended to choose METHADONE as an answer due to safety reasons.
Just read
BullShit CRAP GPS- B
Barbiturates
BullShit CRAP GPS- S (2)
St. John Worts
Sulfonylureas
BullShit CRAP GPS- C
Carbamazepine
BullShit CRAP GPS- R
Rifampin
BullShit CRAP GPS- A
Alcohol
BullShit CRAP GPS- P(h)
Phenytoin
Phenobarbital
BullShit CRAP GPS- G
Griseo-fulvin
SICKFACES.COM- S(2)
Sodium Valproate
Sulfon-amide
SICKFACES.COM- I
Isoniazid
SICKFACES.COM- C
Cimetidine
Chloramphenicol
Ciprofloxacin
SICKFACES.COM- K
Ketoconazole
SICKFACES.COM- F
Fluconazole
SICKFACES.COM- A
Alcohol
SICKFACES.COM- E
Erythromycin
SICKFACES.COM- O
Omeprazole
SICKFACES.COM- M
Metronidazole
Odd and eccentric behavior cluster type
Cluster A disorder
Paranoid personality
Cluster A
Schizoid and schizotypal personality
Cluster A
The dramatic unpredictable cluster
Cluster B Disorder
Antisocial Personality
Cluster B
Borderline Personality
Cluster B
Histrionic Personality
Cluster B
Narcissistic Personality
Cluster B
The anxious and fearful cluster
Cluster C disorders
Avoidant personality disorder
Cluster C
Dependent personality
Cluster C
Obsessive-Compulsive Disorder
Cluster C
