LMR Flashcards
Osteoporosis risks
-caffeine, smoking
-lack of weight bearing exercises
-lack diet rich in Ca and Vit D
What is increased in rheumatoid arthritis?
Erythrocyte Sedimentation Rate
What labs should you check with/ macrocytic normochromic anemia?
Vitamin B12 and Folic Acid
(Note: this is a severe form of anemia, RBCs larger than should be
What is increased in autoimmune disorders?
Cytokines
(Proteins that effect the immune system)
Disseminated encephalomyelitis S/S?
Weakness, paresthesia, *asymmetrical body movement (extremities)
- do neuro exam, this is a neuro d/o w/ inflammation in brain and spinal cord- damages myelin
Clozapine is metabolized by____?
CYP1A2* and CYP2B6
Limbo system includes:
Amygdala, Hippocampus, thalamus, hypothalamus, basal ganglia, anterior cingulate gyrus
Where is Ach synthesized?
Basal nucleus of Meynert
Meds that cause Depression
Steroids, beta blockers, interferons, isotrenitoin (Accutane), some retroviral drugs, antineoplastic drugs, benzos, progesterone
Lithium S/E
Hypothyroidism, fine hand tremors, GI upset (cramps, V/D, anorexia) diabetes insipidus, polydipsia, polyuria, t-wave inversion, maculopapular rash, Leukocytosis
Lithium toxicity
Severe N/V/D, coarse hand tremors, muscle weakness, ataxia, heart palpitations
Drugs that reduce renal clearance
NSAIDS, thiazides, ACE inhibitors
-increases concentration of drugs cleared by kidney like lithium
Lithium can be increased due to ___ and _____
Hyponatremia and dehydration
Signs of hepatotoxicity
RUQ pain, reddish brown urine, yellowing of skin/whites of eyes, fatigue
-if taking depakote: DC depakote and check LFT
Signs of depakote toxicity
N/V, lethargy, disorientation, respiratory depression
-DC depakote, check serum dep levels, LFTs and ammonia
S/S pancreatitis
Fever, tachy, N/V/ oily stools
Upper abd pain, abd pain radiating to back, tender abd w/out touch
Aplastic anemia s/s
(Stop producing new blood cells)
Pallor, fatigue, SOB, HA, fever, skin rash, bleeding gums, nose bleed
S/S infection
Sore throat, sudden fever, chills, weakness
Alpha delta 2 ligands
Gabalin and pregabalin - can use for chronic pain w/out depression
Labs NMS
Increased CPK, LFTs, WBCs (leukocytosis) and myoglobinuria
Tx NMS
DC offending agent first
Bromocriptine (Parlodel) =D2 agonist
Dantrolene (Dantrium) = muscle relaxant
3 meds that delay gastric emptying
Omeprazole, famotidine, ranitidine
Negative symptoms of schizophrenia
Affective flattening, avolition, alogia, anhedonia, apathy, attention deficits, abstract thinking probs
DMDD med for severe irritability
Ritalin
Signs of stimulant abuse
Insomnia, tremor, heart palpitations, Anxiety, Agitation, irritable, mood swings, increased HR and BP,
What med for delirium agitation /psychosis
Low dose Haldol
Check what labs of suspect dementia?
B12 and folic acid
Inducers
Carbamazepine, tobacco, phenobarbital, phenytoin, St John’s Wart
Inhibitors
Grapefruit, SSRIs, bupropion, cimetidine, clomipramide, clarythromycin, fluoroquinolones, nefazodone, kentoconazole,
Meds contraindicated with MAOIs
Meperidine, decongestants, TCAs, stimulants, atypicals, St. John’s wart, asthma meds, l-tryptophan
HTN crisis S/S
Fever, occipital HA, flushing, sweating, dilated pupils, increased BP
HTN crisis tx
DC med
phentolamine- brings BP down
Stabilize fever
S/S lead poison
Development delay, learning difficulties, loss of appetite, weight loss, irritable, sluggish/fatigue, abd pain, V, constipation, hearing loss, pica, seizures
Tx EPS except TD
Benztropine (Cogentin)
Subcortical
Lack coordination, ataxia, tremors, dystonia
Huntington’s, Parkinson’s, HIV
Cortical
Language (aphasia) and memory (amnesia)
Alzheimer’s and Creutz-feldt Jacob
Early signs HIV dementia
Motor (dystonia, tremors, ataxia, loss coordination), cog decline, behavior
Hallmarks vascular dementia
Carotid bruits, fundoscopic abnormalities, enlarged cardiac chambers
1st line pts psychotic symptoms with dementia
Nonpharm first, then
Atypical antipsychotics
NO BZNz
COWS
N/V/D, muscles aches, insomnia, yawning, piloerection, dilated pupils, anxiety/ irritable, lacrimation, rhinorrhea, sweating
Cows start tx at?
7, clonidine
>13 give SL suboxone or buprenorphine
CIWA
Tremor, paroxysmal sweating, anxiety, agitation, HA, audio/visual/tactile distortions, N/V
CIWA start tx at?
8, PRN only
>15 scheduled and PRN
Tx ETOH
Disulfiram, acamprosate, naltrexone
Residential Tx
Perjury
Lying under oath
Perjury
Lying under oath
Rights of pt
Least restrictive environment, informed consent, confidentiality
4 components health policy
Process, policy reform, policy environment, policy makers
Rennie v Klein
Right to refuse psychotropic meds
Rennie v Klein
Right to refuse psychotropic meds
Tarasoff
Duty to warn, diff per state, check with state BON
Suicide risk factors
Male >45, female >55, male, white, single/divorced/separated, living alone, psych or physical illness substance abuse, previous suicide attempt, fam hx suicide, recent loss
Greatest risk bipolar
Fam hx across multiple generations
Med approved for bulimia
Prozac
Anorexia s/s
Low BMI, emaciated, amenorrhea, bradycardia, hypotension, t-wave inversion, prolonged QT interval
Hospitalize if BMI <15
S/s discontinuation syndrome SSRI
Flu-like: fatigue, lethargy, myalgia, N/V, decreased concentration, impaired memory, paresthesias, shock-like sensations, anxiety, irritable, insomnia, crying, dizzy
Occurs 24-72 hrs, resolve 1-14 days
Contraindications ECT
Heart disease, compromised pulmonary status, hx head injury/tumor, anesthesia complications
Adverse effects ECT
Arrhythmias, headache, drowsiness, myalgia, memory disturbance, confusion
Labs in ETOH
Increased GGT, MCV, PT, uric acid, total cholesterol, triglycerides
AST/ALT ratio greater than 2
Decreased Ca, Mg, K, BUN, albumin, platelets, hematocrit, hemoglobin
4 dimensions recovery
Health home purpose community
Increased ach
Teary eyes, salivation, diarrhea
Other med that can cause EPS
Metoclopromide (Reglan)
Serotonin syndrome Tx
Cyrpoheptadine
SS Tx
Cyrpoheptadine
Other med that causes SS
Triptans like sumitriptan (imitrex)
FDA approved panic d/o
Prozac, Paxil, Zoloft
Effexor
Pharm Tourette’s
Atypicals
Haldol, Pimozide, abilify
Guanfacine/clonadine for impulse/rage control
SSRI
