Modules 1-5 Flashcards
Hypertensive crisis is life-threatening and cannot be reversed unless more MAO is produced by the body: True or False
True
What is a hypertensive crisis?
Hypertensive crisis occurs when MAOIs are taken in conjunction with foods containing tyramine, a dietary precursor to norepinephrine
Hypertensive crisis and death also can occur when MAOIs are taken in conjunction with certain medications. What is a specific medication that can cause this?
Stimulants and other sympathomimetics
Symptoms of HTN crisis. Just read
a. Elevated BP
b. Sudden, explosive-like headache, usually in occipital region
c. Facial flushing
d. Palpitations
e. Pupillary dilation
f. Diaphoresis
Treatment for HTN crisis
a. D/C the offending agent
b. Administer PHENTOLAMINE
Teratogenic risks: Benzos
a. floppy baby syndrome
b. cleft palate
Teratogenic risks: Depakote/Carbamazepine
Neural Tube defect
(Spina bifida for Depakote)
Teratogenic risks: Lithium
Ebstein anomaly (especially in the first trimester)
What age should you check in women for mood stabilizers? And why?
Check pregnancy status before starting females of childbearing age (12-51) on a mood stabilizer - Mood stabilizers increase risk of neural tube defects
What should you encourage if a woman is taking a mood stabilizer? And why?
Encourage Folic Acid (0.4-0.8mg qd) if taking mood stabilizers
This supports neural tube development during the first month that a woman is pregnant.
a. Low BMI
b. Amenorrhea
c. Emaciation (abnormally thin)
d. Bradycardia
e. Hypotension
Anorexia symptoms
Main treatment for anorexia?
Therapy
Recurrent, episodic binge eating
a. Weight usually withing normal range (BMI)
b. Russel’s sign
c. Rectal prolapse
d. Erosion of dental enamel
Main symptoms for Bulimia?
Scarring or calluses on the dorsum of the hand, secondary to self induced vomiting
Russell’s sign?
What medication to consider for chronic neuropathic pain and depression?
SNRI such as Cymbalta – duloxetine
Medication FDA approved for Bulimia?
fluoxetine (Prozac)
Mnemonic for Inducers
BullShit CRAP GPS- Induces my rage
Inducer Medications- Just read and memorize
Barbiturates,
St. John,
Carbamazepine,
Rifampin,
Alcohol,
Phenytoin,
Griseofulvin,
Phenobarbital,
Sulfonylureas.
Other inducers include
Cigarette smoking and Oral contraceptives
Mnemonic for Inhibitors
SICKFACES.COM
Inhibitor Medications- Just read and memorize
Sodium Valproate,
Isoniazid,
Cimetidine,
Ketoconazole,
Fluconazole,
Alcohol,
Chloramphenicol,
Erythromycin,
Sulfonamide,
Ciprofloxacin,
Omeprazole,
Metronidazole
What drug is an atypical antipsychotic drug that is metabolized to a major extent by the CYP450 enzyme CYP1A2?
Clozapine
Where is acetylcholine synthesized in?
Basal of Meynart
What is GABA?
It is a universal inhibitory neurotransmitter and it’s
MOST ABUNDANT INHIBITORY NEUROTRANSMITTER IN THE BRAIN
What is in the amygdala, hippocampus & locus of coeruleus and INCREASES anxiety
Neuropeptides
What is produced in the adrenal glands?
Epinephrine
Increased levels of corticotrophin releasing hormone in the amygdala, hippocampus and locus coeruleus increases what?
Increases symptoms of anxiety
Sensorimotor information exchange between the two hemispheres.
Both hemispheres connected by the Corpus Callosum.
What is the Cerebellum function?
largest and most developed lobe (language expression)
-executive functions (memory, understanding language, problem solving, emotions, behavioral control, decision making)
What is the frontal lobe function?
Where is the Broca’s area located and what does it do?
a. Located in the frontal lobe
b. Function: Expressive speech
What is the Limbic System focuses on?
Emotions and memories
This part of the brain is in charge of:
a. Appetite
b. Sensations of hunger/thirst,
c. Water balance,
d. Circadian rhythms
e. Body temp,
f. libido
g. hormonal regulation
Hypothalamus
(A hungry hippo needs to eat and sleep after sex)
Regulates emotions, memory and related affective behaviors
What does the Thalamus regulate?
The Thalamus contains 5HT2A. What is that?
5HT2A makes an antipsychotic atypical and LESS likely to cause EPS.
The Hippocampus regulates memory: True or false
True: It regulates memory and converts short-term memory into long-term memory
Nigrostriatal pathway: What does the blockage of D2 receptors lead to?
What is decreased D2 lead to?
a. Can lead to EPS (dystonia, parkinsonian symptoms and akathisia)
b. Decreased D2 = increased Acetylcholine
Tardive Dyskinesia- First line of treatment is Cogentin: True or false
False: It can worsen
Tardive Dyskinesia- Reglan (metoclopramide) can cause TD: True or False
True
What medication to use with Tardive Dyskinesia?
Tetrabenazine and VMAT-2 inhibitors (Ingrezza)
What type of medications can worsen both depression and mania?
Steroids
Risk factors for Serotonin Discontinuation Syndrome? (just read)
a. Medications with a short ½ life
b. Abrupt discontinuation
c. Non-compliance
d. High dose range
e. Long-term treatment
f. Prior hx of discontinuation syndrome
Do you stop serotonin medications if a patient has serotonin discontinuation syndrome?
Don’t D/C SSRI, TCA, MAOI abruptly
This disease has acute onset that causes short-term changes in cognition, ALOC, and inattention.
Delirium
One year mortality rate of clients with delirium is how much?
Up to 40%
Treatment for Delirium
a. Haldol
b. AVOID benzos unless the patient is at risk and has not
responded to Haldol.
What type of dementia affect language and memory?
Cortical Dementia
What type of dementia effects depression, apathy, and motor symptoms?
Subcortical Dementia
This disease has a gradual onset / progressive decline.
Alzheimers Dementia
This does not have focal neurological deficits (problems with nerve, spinal cord or brain function)
What is the second most common dementia?
Vascular Dementia
a. Carotid bruits
b. Fundoscopic abnormalities
c. Enlarges cardiac chambers
Hallmarks for Vascular Dementia
Subcortical Dementia is:
HIV Dementia
AVOID Benzos in patients with delirium if at all possible in most patients with dementia as they are particularly vulnerable to their adverse effects such as sedation, falls and delirium
Just read
Decreasing new cases
- prevention
Primary Prevention
-Early case finding
- Screening
Secondary prevention
Avoid or postpone complications (rehabilitative services)
- ALREADY HAS
- Key word: rehabilitation
Tertiary Prevention
The tendency of some regions of the brain to react to repeated low-level bioelectrical stimulation by progressively boosting synaptic discharges, thereby lowering seizure thresholds.
Kindling Definition
Compulsive substance use despite harmful consequence.
Addiction definition
The amount of drug required to produce an effect of given intensity
Potency Definition
The process of becoming less responsive to a particular drug over time. Decreased effects of the same dose of a medication over time
Tolerance Definition
What is the criteria for ADHD
a. At least 5 symptoms per category in adults.
b. For children after 6 months but before 12 years, it has to be noticable in at least 2 different settings.
ADHD: Abnormalities of frontal-subcortical pathways (2 pathways)
a. Frontal Cortex
b. Basal Ganglia-Abnormalities of the reticular activating system
The development of specific deficits such as hand movement following a period of normal functioning after birth.
Rett’s Syndrome
Rett’s Syndrome is common in both boys and girls: True or false
False: Primarily in girls
Main symptom for Rett’s Syndrome?
Loss of purposeful hand skills
Stereotypic hand movements
SIG E CAPS mnemonic- Depression
Sleep disturbances
Interest decreased
Guilt
Energy decreased
Concentration problems,
Appetite/weight changes, Psychomotor agitation,
SI
NO HARM AGREEMENT is NOT a protective factor
Just read
Olanzapine/Prozac combo drug: FDA approved for treatment of bipolar depression
Symbyax –
Labs elevated in Alcohol Use Disorder
MCV
Total cholesterol
Triglycerides
Unlike major depression, what is usually preserved in the grieving person
self-esteem
Schizophrenia: Neurobiological defect, everything is decreased except?
The Ventricles
Erikson Virtue- Trust vs Mistrust
Hope
Erikson Virtue- Autonomy vs Shame
Will
Erikson Virtue- Initiative vs Guilt
Purpose
Erikson Virtue- Industry vs Inferiority
Competence
Erikson Virtue- Identity vs Role confusion
Fidelity
Erikson Virtue- Intimate vs Isolation
Love
Erikson Virtue- Generativity vs Stagnation
Care
Erikson Virtue- Integrity vs Despair
Wisdom
Erikson Virtue Mnemonic
HoW PoCo FooL CoW
Erikson
a. Ability to form meaningful relationships, hope about the future, trust in others
b. Faith in the environment
Trust vs Mistrust
Erikson
a. Self-control, self-esteem, willpower
b. Sense of adequacy
Autonomy vs Shame/Doubt (Early childhood)
Erikson’s
a. Self-directed behavior, goal formation, sense of purpose
b. Ability to be a “self-starter”, to initiate one’s own activities
Initiative vs Guilt (Late childhood)
Erikson’s
a. Ability to work, sense of competency and achievement
b. Ability to lean how things work, to understand and organize
Industry vs Inferiority (School Age)
Erikson’s
a. Personal sense of identity
b. Seeing oneself as a unique and integrated person
Identity vs Role Confusion (Adolescence)
Erikson’s
a. Committed relationships, capacity to love
b. Unfavorable: inability to form affectionate relationships
Intimacy vs Isolation (Early Adulthood)
Erikson’s
a. Committed relationships, capacity to love
b. Unfavorable: inability to form affectionate relationships
Generativity vs Stagnation (Middle Adulthood)
Erikson’s
a. Fulfillment and comfort with life, willingness to face death, insight and balance life events.
Integrity vs Despair (Late Adulthood)
The adolescent can reason abstractly and think in hypothetical terms.
Formal Operational (12 yr- Adult)
The child can think logically about concrete objects and can thus ass/subtract. The child also understands conversation.
Concrete operational (7-12 years)
The infant explores the world through direct sensory and motor contact. Object permanence and separation anxiety developed during this stage.
Sensorimotor (0-2 years)
The child uses symbols (words and images) to represent objects but does not reason logically. The child also has the ability to pretend. During this stage, the child is egocentric.
Preoperational (2-6 years)
Piaget’s
Object permanence-ability to know that objects continue to exist even though they can no longer be seen or heard
Sensorimotor
Piaget’s
Start using language and symbols, able to use magical thinking
a. Sleep and dream about monsters
b. Imaginary thoughts
Preoperational
Piaget’s
Able to understand concepts, like conservation & reversibility
a. Able to understand if you take a plastic cup and heat it, it can change shape but the properties remain the same
Concrete
Piaget’s
Able to use logic
a. Able to do a science project and test a hypothesis o Can think abstractly
b. Can solve algebra
Formal
Sigmund Freud’s- Oral Stage
a. Age
b. What happens during this stage?
a. 0-1 year old
b. Children derive pleasure from oral activities, including sucking and tasting. Put things in their mouth.
Sigmund Freud’s- Anal Stage
a. Age
b. What happens during this stage?
a. 2-3 years
b. Children begin potty training
Sigmund Freud’s- Phallic Stage
a. Age
b. What happens during this stage?
a. 3-6 years old
b. Boys are more attracted to mom and girls attracted to dad.
Sigmund Freud’s- Latency Stage
a. Age
b. What happens during this stage?
a. 6 years old to puberty
b. Children spend more time and interact mostly with same sex peers.
Sigmund Freud’s- Genital Stage
a. Age
b. What happens during this stage?
a. Beyond puberty.
b. Individuals are attracted to opposite sex peers
The person has NO intention to change. The person is not aware that there is even a problem with their behavior
Transtheoretical Model of Change- Precontemplation stage
Provide information and feedback to raise the person’s awareness of the problem and the possibility of change. Do not give prescriptive advice.
Precontemplation stage- Action step
The person is thinking about changing.
The person is aware that there is a problem, but not committed to changing
Contemplation stage
Help the person tip the balance in favor of change. Help the person see the benefits of changing and the consequences of not changing.
Contemplation stage- Action step
The person has made the decision to change. The person is ready for action.
Preparation stage
Help the person by asking “what are the steps in the plan that you have made”.
Help the person find a strategy that is realistic, acceptable,
accessible appropriate and effective .
Preparation stage- Action step
The person in engaging in specific, overt actions to change
Action stage
Support and be an advocate for the person. Help accomplish the steps for change .
Action Stage- Action Step
The person is engaging in behaviors to prevent relapse
Maintenance stage
Help the person identify the possibility of relapse and identify and use strategies to prevent relapse .
Maintenance Stage-Action Step
What led to the relapse and what are your plans for getting past it and avoiding another relapse?
What keeps you from having another relapse?
Relapse stage: What questions to ask
Help the person holistically look at the situation.
Relapse Stage (Action Step)
Who made DBT?
Marsha Linehan
Who made Humanistic Therapy
Carl Rogers
a. Emphasize freedom and making responsible choices
b. Focus on present and on personal responsibility
c. Understand the patient’s subjective experience.
Existential Therapy?
This type of therapy is suited to those facing issues of existence, or example, those with a terminal illness, those contemplating suicide or even those going through a transition in their life.
Existential therapy
What therapy has miracle questions?
Solution focused therapy
What are examples for solution focused therapy?
a. Miracle question- “ if a miracle were to happen tonight while you were asleep, and tomorrow morning you awoke to find that the problem no longer existed, what would be different”
b. Exception finding question-“was there ever a time in your life when the problem didn’t exist”
c. Scaling question- “on a scale of 1-10, how would you rate your anxiety”
Involves individuals attributing their own unacceptable thoughts, feelings, and motives to another person.
Example: You hate someone, knowing that is wrong, so you try to solve the problem by telling yourself they hate you
Projection definition
The redirection of an impulse (usually aggression) onto a powerless substitute target
Displacement definition
Example: Someone who might be frustrated by their boss at work will go home and kick their cat
Similar to displacement but takes place when we manage to displace our unacceptable emotions into behaviors which are constructive and socially acceptable, rather than destructive activities o Redirecting unacceptable feelings into acceptable channel
Sublimination definition
What is this Example: mother of a child killed in a drive-by shooting becomes involved in legislative change for gun laws and gun violence
Sublimination example
This concentrates on intellectual aspects to avoid the emotional aspects of a difficult situation. For example, acts to avoid the emotional aspects of a difficult situation o Example: a patient is diagnosed with cancer, so they go online and start researching their diagnosis.
Intellectualization definition
An attempt to logically justify generally unacceptable behavior
Example: Always go to work late, but tells supervisor “well I’m not the only one that comes to work late, so it’s ok”
Rationalization Definition
Irvin Yalom- Imitative Behaviors
Participants are able to increase their skills by imitating the behaviors of others.
Participants experience openly express their feelings, which were previously suppressed
Irvin Yalom–Catharsis
Irvin Yalom- Existential Factors
Groups enable participants to deal with the meaning of their own existence
Participants reexperience family conflicts in the group, which allows them to recognized and change behaviors that may be problematic
Irvin Yalom-Corrective refocusing
What does the recovery model aim for?
Aims to help people with mental illnesses and distress to look beyond mere survival and existence
This isn’t about “getting rid” of problems but seeing beyond a person’s mental health problems, recognizing and fostering their abilities, interests and dreams
Recovery meaning
Standard of Practice Determined by the ANA
(just read)
The PMHNP is required by law to carryout care in accordance with what other reasonably
prudent nurses would do in the same or similar circumstance.
Only one source of information are required to release information on patient’s chemical/substance history and psych history to a third party: True or False
False: Two separate released of information are required to release information on patient’s chemical/substance history and psych history to a third party
HIPAA does not allow the PMHNP to make most disclosures about psychotherapy notes for a patient’s condition without their authorization: True or False
True
What is the element of informed consent?
Decision capacity (Competency): Patients should have the capacity or ability to make the decision
What if a patient isn’t competent to make decision for informed consent?
If patients are not able to do all the above components, family members, court appointed guardians, or others (as determined by state law) may act as “surrogate decision-makers” and make decision for them.
Health policy is the decisions, actions and plans to achieve specific healthcare goals. What are high yield points for PMHNPs?
a. Assess/address organizational barriers & facilitators
b. Meet with stakeholders
a. Reduce the stigma of mental illness b. Target the wider audience
c. Help clients receive available services
An example of patient advocacy
What does the ANA help design?
It helps design safe systems.
What is Reflective Practice?
Reflective practice enhances critical thinking to problem-solve and enhance clinical reasoning and decision-making.
Includes Debriefing Strategies
a. This helps understand and consider culture, economic and educational status, health literacy level, family patterns and situations, and traditions (including alternative and folk remedies);
b. communicate in language and at a level that the client understands
Patient Centered Care Model- Sociocultural competence definition
