DLC questions Flashcards by Michael Meehleib

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

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a. Can elevate LFT
b. Must be alcohol free for 24 hours prior to starting

Disulfiram (Antabuse)

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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)?

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Normal A1C + High blood sugar =???

Usually medication side effect, not diabetes

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a. Occurs with acute dystonia (a type of EPS)
b. Eyes roll upward
c. This is an adverse effect of antipsychotics

Oculogyric crisis

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Oculogyric crisis Treatment

a. stop offending agent immediately
b. Administer Cogentin IM and continue PO x5 days

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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

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a. This neurotransmitter is what makes atypical antipsychotics “atypical”
b. Major neurotransmitter implicated in mood disorders and anxiety disorders
c. sleep

Serotonin 5HT2A

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a. ExciTes as in Bipolar
b. Excitatory neurotransmitter
c. Implicated in seizure disorders, bipolar d/o, and psychosis

Glutamate

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Low levels of glutamate = ???

a. memory and learning difficulty
b. negative symptoms of schizophrenia

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High levels of glutamate = ???

Increases anxiety levels

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a. “Pain”
b. Substance
c. Body’s response to stress, injury and is involved in pain perception

Neuropeptide
(neurotransmitter)

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a. “memory”
b. Learning, short-term memory, arousal and reward

Acetylcholine

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Involved with recognitions of facial expressions, music, and visual images. Disturbances in area lead disturbances in drawing, such as clock drawing.

Right hemisphere

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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)

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Where positive symptoms occur r/t DA excess. (portion of the brain)

a. Mesolimbic system
b. Nucleus accumbens

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Center for fear, anxiety, and panic

Amygdala

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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

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Tardive dyskinesia (TD) Treatment

a. Tx: stop offending agent
b. Tx: start Clozaril
c. Can also give Ingrezza

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1st degree relative (especially in men) is a risk factor for development

Antisocial personality Dx

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a. Large structural structures
b. Short stature

Fragile X Syndrome

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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

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a. Subcategory of ASD
b. Delay in social development skills

Asperger’s syndrome

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Unilateral ringing in the ear (tinnitus)

Acoustic Neuroma

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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