LMR Part 1 Flashcards
What medications can exacerbate TICs?
Stimulants
If TICs are developed with stimulants what should you do?
If tics developed when placed on stimulants, you must D/C and place on non-stimulants.
What are top three things to prioritize?
- ABCs
- Maslow’s Hierarchy (food, warmth, rest).
- Nursing process (assessment before intervention)
Safety for the patients or others is usually the right answer.
Just read
What to do if the patient is a victim of abuse or rape?
Reassure their personal safety, make sure the patient can be safe and can cope.
For victims of abuse or rape, what is priority before reporting or assessment?
Safety before reporting/assessment
If you are working inpatient and a patient is about to discharge, what do you have to make sure?
Make sure that the patient can be safe and cope effectively
For board purposes, what do you know about safety/no harm contracts?
On the boards, it will most likely be incorrect.
When is behavioral management/support started?
This starts immediately after a patient is admitted
If you are working inpatient, were should you interview the patient?
Do not interview patient in their room (not safe), do not interview in day room due to confidentiality issues.
Interview in private area/office with the door open/cracked.
What do you do if a child comes in appointment without parents and you notice the child is holding/playing with a toy in a sexual manner?
You suspect sexual abuse and immediately report to DCS.
What do you do if a child comes to an appointment with their parents and the child reports abuse?
Interview the child separately from parents, then report to DCS.
How do you build a therapeutic rapport with adolescents?
For adolescent assessment, you let them know that information can be confidential unless they are DTS/DTO.
For adolescent assessment, should you interview parent in room?
Separating patient from parent may create an ethical dilemma because the parent may feel they have the right to know everything, but you are advocating for adolescent patient.
On the boards, if answers have collaborate it is most likely:
The correct answer
On the boards, if the answers have delegating it is most likely:
The incorrect answer
If a woman attempts SI during postpartum depression, it’s because their OB doctors didn’t do a risk assessment before discharged. What is the most appropriate way to close this Gap in care?
Collaborate with OB doctor to do risk assessment to close gap in care.
If you work in an inpatient hospital and the patient is discharging to a rehab facility what do you have to do if they request labs while you were taking care of them?
Get informed consent and fax labs over.
When is it appropriate to refer a patient out?
Refer out is the last option. Try to do something within your scope first and then refer out if there is nothing you can do.
A 15-year-old patient tells you that they feel funny or weird because they inhaled acetone, what do they have and what should you order?
Acetone has ETOH so order a UDS.
What does it mean if a patient has a cultural expected response to a stressor?
This does not mean they have a mental illness. Have them make cultural context/meaning of their symptoms.
What to offer for cultural syndrome?
offer them brief supportive therapy
What to offer for patients that lost their job or house?
offer them brief supportive therapy
How do you validate patient symptoms within their cultural context?
Validate patient symptoms within a cultural context, such as:
a. somatic complaints of pain
b. validate pain
c. understand cultural context.
In a cultural formulation interview (cultural assessment), what should you clarify, and what should you contextualize?
a. Clarify the meaning of illness
b. Contextualize their situation in their local world while empowering them.
What does psychoeducation from someone from a specific culture mean? Just read
Info based on cultural context.
What kind of assessment should you use to educate a diverse population?
Multicultural education: Use ethnospecific assessment parameters.
Culture = respect important, respect what they believe is causing illness for example: Just read
Native American believe imbalance between individuals relationship with the world causes mental illness and SUD
Which ethnic group has the highest rate in US with SI and SA?
Native Americans are the ethnic group with the highest rate of SI/SA in the US.
What do Native Americans believe in regarding mental health?
The believe in the healing stick
What to teach staff about healing sticks?
Teach staff members if inpatient about healing stick through cultural competency, make accommodations for cultural significance.
Can you release info t a traditional healer?
Only release if you have clearance or informed consent.
What do you do if a patient does not understand English?
Make accommodations for an interpreter. Culturally sensitive.
Symptoms of HYPOthyroidism mimic symptoms of what?
symptoms of depression
Symptoms of HYPERthyroidism mimic symptoms of what?
symptoms of mania
What happens when T4/T3 are high? What are the main symptoms?
TSH secretion decreases
Symptoms include
a. Heat intolerance
b. agitation
c. anxiety
d. irritability
e. tachycardia,
f. mood swings
h. weight loss
What happens when T4/T3 are Low? What are the main symptoms?
TSH secretion increase.
Symptoms include:
a. cold intolerance
b. lethargy
c. weight gain
d. Decreased libido
What labs to check first if T4/T3 are low?
Check TSH first
What can Depakote cause in pregnant women?
Can cause Spina bifida (neural tube defect)
What is a black box warning for Depakote?
Hepatotoxicity (Liver)
If a patient is taking Depakote, what are the main signs of hepatotoxicity (5 symptoms to look out for)?
- Abd pain in RUQ of abdomen
- Reddish brown urine
- Yellow skin/white of the eye
- Fatigue
What is the intervention for a patient taking Depakote at risk for toxicity?
D/C offending agent and do LFT lab test. Also check AST/ALT.
What are the main signs of valproic acid toxicity (4 symptoms to look out for)?
- Disorientation
- Lethargy
- Respiratory Depression
- N/V
What is the intervention for a patient with valproic acid toxicity?
DC med, check valproic acid, LFTs, and ammonia levels.
Depakote can cause pancreatitis: What are the main symptoms for pancreatitis?
- RUQ abd pain
- Abd pain that radiates to back.
- tenderness whe touching abd
- fever
- rapid pulse
- N/V
- oily stools
What is Kava?
Herbal supplement for anxiety, stress, and insomnia.
What is the main side effect and what is the priority? (For depakote?)
Liver damage and priority is do LFT test
What medications interacts with Kava and what does it do?
Alprazolam (Xanax)
both makes you drowsy so avoid taking together
What can sedative medications do when they interact with KAVA?
Sedative (CNS depressants) and Kava are both sedating. Don’t take together due to increased sleepiness.
Sedative medications include: just read
a. Clonazepam (Klonipine)
b. lorazepam (Ativan)
c. phenobarbital (Donnatal)
d. zolpidem (Ambien)
What is the main component for Steven Johnsons syndrome?
Severe rash- Black box warning.
Other symptoms include fever, body aches, red rash, peeling skin, and facial/tongue swelling.
Lamictal (mood stabilizer) causes weight gain: True or false?
False: This medication causes the least weight gain
Which antipsychotics cause the least weight gain? (ZAL)
- Ziprasidone
- aripiprazole
- lurasidone
Which antipsychotic is the least sedating?
aripiprazole
Patients on antipsychotics can cause weight gain. Routine labs and check ups include?
- Checking BMI
- hip-to-waist ratio
- Labs = lipid panel and glucose
Management of Antipsychotic-induced weight gain:
Non-pharm strategies
Exercise and nutritional counseling
Management of Antipsychotic-induced weight gain:
Pharm strategies
Pharmacological therapies consist of switching to another antipsychotic which has less potential to gain weight.
Carbamazepine (Tegretol)- AAA issues. What is AAA?
Agranulocytosis, aplastic anemia, and Asians
What is the main black box warning symptoms for Tegretol?
Agranulocytosis (decrease WBCs) and aplastic anemia
Other symptoms for Tegretol (just read)
(pallor, fatigue, headache, fever, nosebleeds, bleeding gums, skin rash, SOB)
For Asian patients that have Steven Johnson syndrome, what should you screen before initiating?
Screen for HLAB-1502 allele before initiating.
This is highly associated with the outcome of carbamazepine induced Steven Johnson syndrome.
HLAB-B 1502
Carbamazepine/Clozaril can cause agranulocytosis: What do you look for when it comes to signs of infection?
Sudden fever
Chills
Sore throat
Weakness
Carbamazepine/Clozaril can cause agranulocytosis: True or false- Repeat/recheck labs whether they show symptoms or not
True
Neuroprotective treatment of choice for Bipolar disorder: What does that mean?
Protecting nerve cells from damage
What is the gold standard treatment for Lithium?
The gold standard for lithium is treating manic episodes
Lithium: Evidence of anti-suicidal effects: True or False
True
What medication is the only known antipsychotic medication that has been shown to reduce the risk of suicide in patients diagnosed with schizophrenia?
Clozaril
What bloodwork to check before placing a patient on Lithium?
TSH, serum creatine, and BUN.
Urine- UA and HCG
UA: What may indicate kidney disease?
large amounts of proteinuria (4+)
HCG: For females of childbearing age of what?
12-51 years old
Common side effects of Lithium: Just read
hypothyroidsim, hadn tremors, maculopapular rash, Gi upset (N/V, diarrhea, cramps, and anorexia), polyuria, polydipsia, Diabetes Insipidus, T-wave inversions, leukocytosis (increased WBC)
What congenital heart defect can lithium cause?
Epstein anomaly
What are the main symptoms of lithium toxicity? (9 symptoms)
Severe N/V
diarrhea
Confusion
Drowsiness
Muscle weakness
Heart palpitation
course hand tremors
Ataxia (unsteadiness)
Intervention for Lithium Toxicity?
DC Lithium and check serum Lithium levels
How does Kidney disease or drugs effect Lithium levels?
Kidney Disease or Drugs that reduce renal clearance, may increase serum concentrations to drugs that are excreted by the kidneys such as Lithium.
What are common medications that reduce renal clearance?
- NSAIDs (Ibu)
- Thiazides
- ACE inhibitors (lisinopril)
What can dehydration and hyponatremia do to Lithium levels?
These both can increase lithium levels.
What is Neuroleptic Malignant Syndrome caused by?
Antipsychotics
The three main symptoms of NMS?
Muscle rigidity
Mutism
Heat/High temp
Other symptoms of NMS include (4 of them)
ALOC- confusion
Tachycardia
Diaphoresis
What labs are elevated in NMS?
Elevated, CPK, WBCs, and LFTs?
What is myoglobinuria?
The result of muscle breakdown aka rhabdo
Treatment for NMS?
DC offending agent and give both bromocriptine (Parlodel) and Dantrolene
What is Bromocriptine (Parlodel)?
Dopamine (D2) agonist
What is Dantrolene?
Muscle relaxant for muscle rigidity
What is Serotonin Syndrome caused by?
Caused by antidepressants
Symptoms to look out for with Serotonin Syndrome?
Hyperreflexia and Myoclonic jerks
How do you treat Serotonin Syndrome?
DC offending agent and offer Cyproheptadine
What can worsen Serotonin Syndrome?
SSRI/SNRI
TCA
MAOI
When switching from SSRIs to MAOIs, how long to wait?
Wait 2 weeks
When switching from Prozac to MAOI, how long to wait?
Wait 5-6 weeks
When switching from MAOI to Prozac how long to wait?
Wait 2 weeks
Note: a washout period of 5 half-lives between cessation of previous drug and the introduction of a new drug is the safest switching strategy from the point of view of drug interaction (degenerate)
Just read
Some migraine medications can cause increase serotonin levels which can result in Serotonin Syndrome: True/False
True
What type of migraine medications can cause SS?
Sumatriptan (Imitrex)
If a patient is on a Triptan medication, what is an alternative antidepressant?
NDRI
On the board exam, if you see the word “regenerate” is it: Correct or Incorrect?
Incorrect
What type of medications is used as the first line treatment for depression and why?
SSRI because it is SAFER in intentional OVERDOSE compared to other classes.
Depression + Cancer = What medication to give and why?
Give SSRI- Citalopram/Escitalopram because of fewer drug to drug interactions
Depression with chronic neuropathic pain/fibromyalgia = What medication to give and why?
SNRI because it is safer. TCA is another alternative
What meds have alpha 2 delta ligand?
Pregabalin and Gabapentin (for chronic neuropathic pain)
If a patient is taking SSRI and has complaints of sexual dysfunction, what other alternative medications can we give?
Give NDRI such as Wellbutrin (no sexual side effects)
Depression + low energy + fatigue = What medication and why?
Wellbutrin because it increases energy levels
What are the contraindications for Wellbutrin?
Hx of seizures or eating disorders
Wellbutrin increases the risk for?
This medication decreases the seizure threshold which would increase seizure risk
Black box warning for antidepressants= what to assess for?
Assess the frequency/severity of SH thoughts
Assess alcohol intake in patients that are depressed = use alcohol to self-medicate for depression = cause barrier to treatment
Just read
Numerous conditions present with HI include?
The main one is antisocial personality disorder.
(just read) Others include: schizoaffective, BPD, paranoia, schizophrenia, OCD, brief psychotic disorder, avoidant, schizoid, and delusions
When compared to adults, children with depression have a reduced placebo rate: True or False
True
Schizophrenia Positive symptoms: What are the main symptoms
a. Hallucinations
b. Delusions
c. Referential Thinking
d. disorganized behavior
e. Hostility
f. Grandiosity
g. Mania
h. Suspiciousness
Schizophrenia Positive symptoms: What is it caused by?
Caused by increased dopamine in the mesolimbic pathway
Schizophrenia Negative symptoms: Symptoms respond better to Typical antipsychotics. True or False?
False
They respond better to atypical antipsychotic medications
Schizophrenia Negative symptoms: What does the symptoms represent?
They represent a decrease or loss of normal functioning
Schizophrenia Negative symptoms: What is it caused by?
These symptoms are caused by a decreased dopamine in the mesocortical pathway
Schizophrenia negative symptoms: All A’s
Affective flattening
Alogia or poverty of speech
Avolitation
Apathy
Abstract thinking
Anhedonia
Attention Deficits
Schizophrenia negative symptoms: Onset for men and women
a. 18-25 for men
b. 25-35 in women
Schizophrenia symptoms: Abnormalities or changes/deficit where (what portion of the brain?) (5 parts of the brain)
a. Prefrontal Cortex
b. Amygdala
c. Basal Ganglia
d. Hippocampus
e. Limbic regions
Changes in the brain for schizophrenia can cause what?
Aggression, impulsivity, and abstract thinking issues.
PET SCAN/MRI for schizophrenia:
a. Limbic system: Increase or Decrease?
b. Ventricles: Increase or decrease
c. Cerebral Blood flow: Increase or decrease?
Every structure decreases except for Ventricles which are enlarged
Can we give stimulants to schizophrenia patients? Why or why not?
It potentiates dopamine release, which makes positive symptoms worse.
Can we give Alpha 2 adrenergic receptor agonists to schizophrenia patients?
This has low tolerability and neuroprotective effects are limited.
What is Assertive Community Treatment (ACT)?
It’s a rehab post hospitalization for SMI.
What do you do if you have a patient with long term history of noncompliance with their medications?
Refer to ACT case management. So RN can go to house to administer medications.
What level of prevention is social skills training in schizophrenia?
Tertiary level of prevention
We can refer schizo patient to aerobic exercise program: What does this do?
This improves
a. cognitive brain function
b. quality of life
c. long term health.
When is a patient a high risk of relapse? What is an example?
When the patient is not compliant with medications, multiple failed meds, or multiple inpatient stays.
Ex: Patient is noncompliant with oral Haldol. Switch to IM.
Patients stabilized on low daily oral doses (up to 10mg/day)
a. 1st month
b. Maintenance
a. 10-15 X daily PO dose
b. 10-15 X daily PO dose
Patient that are on High dose, risk of relapse, or tolerant to oral Haldol
a. 1st month
b. Maintenance
a. 20 X daily PO dose
b. 10-15 X daily PO dose
What is required during initiation and stabilization of Haldol decanoate therapy?
Close clinical supervision is required during initiation and stabilization of Haldol decanoate therapy
When is Haldol decanoate usually administered?
This medication is usually administered monthly or every 4 weeks. It depends on the patient’s response as it may vary and may need an adjustment.
