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PMHNP Flashcards

1
Q

Narrow down to ____ right answers

A

2

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2
Q

For medical evaluation..

A

refer out

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3
Q

Priority questions

A
  1. Airway
  2. Maslows hierarchy of needs
  3. Nursing process (assess before intervention)
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4
Q

Adolescents have a right to

A

confidentiality

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5
Q

Interprofessional collaboration is encouraged..

A

If answer has “collaborate” in it, high chance of being right

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6
Q

If there is something within the PMHNP scope of practice…

A

do that before referring out

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7
Q

Get informed consent

A

before faxing

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8
Q

A patient inhaled acetone, feeling weird and funny

A

Do a UDS to check if they do other drugs for the high

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9
Q

Culture Assessment

A

-if culture is mentioned, its prob a cultural question
- Is it a culturally expected response to a stressor?
- If someone is having a cultural syndrome then offer brief supportive therapy
- clarify meaning of illness, validate symptoms
- somatic complaints of pain, validate with cultural significance
- psychoeducation on schizophrenia is tailored towards a culture significance

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10
Q

TSH range

A

0.5-5.0

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11
Q

If patient is depressed, screen for

A

hypothyroidism

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12
Q

If patient has mania or bipolar disorder, screen for

A

hyperthyroidism

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13
Q

elevated T3 & T4, decreased TSH

A

hyperthyroidism

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14
Q

decreased T3 & T4, increased TSH

A

hypothyroidism

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15
Q

hyperthyroidism s/s

A
  • heat intolerance
  • agitation
  • anxiety
  • irritability
  • tachycardia
  • mood swings
  • weight loss
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16
Q

hypothyroidism s/s

A
  • cold intolerance
  • lethargy
  • weight gain
  • decreased libido
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17
Q

divalproex sodium during pregnancy can cause

A

spina bifida (neural tube defect)

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18
Q

divalproex sodium black box warning

A

HEPATOTOXICITY ( abd pain in RUQ, reddish brown urine, yellowing of skin and whites of eyes, fatigue)
**Intervention- d/c offending agent and do LFT
- AST 5-40
- ALT 5-35

PANCREATITIS (upper abd pain radiating towards back, tender when touching abd, fever, rapid pulse, nausea, vomiting, oily stools)

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19
Q

Therapeutic valproic acid level & toxicity

A
  • 50-125
  • toxicity occurs >150
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20
Q

S/S of valproic acid toxicity

A
  • disorientation
  • lethargy
  • respiratory depression
  • nausea/vomiting
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21
Q

what to do for valproic acid toxicity

A
  • d/c offending agent
  • check valproic acid levels
  • LFTs
  • ammonia levels
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22
Q

KAVA (kava kava)

A

herbal supplement for anxiety, stress, insomnia
- can cause liver damage - do LFT

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23
Q

major kava kava interactions

A
  • alprazolam (xanax) - increased drowsiness
  • sedative meds (CNS depressants), may increase sleepiness and drowsiness
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24
Q

Lamictal

A
  • can cause SJS/severe rash
  • s/s: fever, body aches, red rash, peeling skin, facial and tongue swelling
    ** mood stabilizer with least amount of weight gain **
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25
Q

antipsychotics with least amount of weight gain

A
  • least amount of weight gain : Ziprasidone, aripiprazole, lurasidone ZAL
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26
Q

labs for antipsychotics that cause weight gain

A
  • BMI
  • hip-to-waist ratio
  • glucose
  • lipid panel
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27
Q

management for antipsychotic-induced weight gain

A
  • nonpharmacologic: exercise & nutritional counseling
  • pharmacologic: switching to another antipsychotic with less potential to cause weight gain
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28
Q

Carbamazepine (Tegretol) black box

A
  • agranulocytosis (decreased WBC): sudden fever, chills sore throat, weakness
  • aplastic anemia: pallor, fatigue, HA, fever, nose bleeds, bleeding gums, skin rash, SHOB
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29
Q

carbamazepine & Clozaril

A

can cause agranulocytosis

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30
Q

Carbamazepine and Asians

A
  • SJS
  • HLAB-1502 allele before initiating
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31
Q

When to d/c carbamazepine and/or clozaril

A

if ANC is <1000

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32
Q

Lithium therapeutic range

A

0.6-1.2

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33
Q

lithium toxicity level

A

1.5 or higher

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34
Q

Lithium

A

gold standard for manic episodes and anti-suicidal effects

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35
Q

Labs for lithium

A
  • thyroid panel (check for hyperthyroidism)
  • serum creatinine (0.6-1.2)
  • BUN (10-20)
  • UA (check for proteins in urine; protein 4+ may indicate AKI)
  • HCG (ages 12-51) choose if HCG is an answer for psychotropic medications
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36
Q

side effects of lithium

A
  • hypothyroidism
  • fine hand tremor
  • maculopapular rash
  • GI upset
    -poly- uria, dypsia
  • diabetes insipidus
  • T-wave inversions
  • leukocytosis (increased WBC)
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37
Q

Lithium can cause what anomaly

A

Epstein (congenital heart defect)

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38
Q

interventions for lithium toxicity

A

discontinue lithium, check serum levels

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39
Q

S/S of lithium toxicity

A
  • severe nausea
  • vomiting
  • diarrhea
  • confusion
  • drowsiness
  • muscle weakness
  • heart palpitation
  • coarse hand tremors
  • ataxia (unsteadiness while standing/walking)
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40
Q

drugs that increase serum lithium levels

A
  • NSAIDs (ibuprofen, Indocin)
  • kidney damage/drugs that reduce renal clearance
  • thiazides (hydrochlorothiazide)
  • ACE inhibitors (lisinopril)
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41
Q

dehydration and hyponatremia can cause what

A

increase lithium level

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42
Q

Neuroleptic Malignant Syndrome

A

caused by antipsychotics

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43
Q

s/s of NMS

A
  • extreme muscle rigidity *
  • mutism*
  • hyperthermia
  • tachycardia
  • diaphoresis
  • altered level of consciousness
  • differ from Serotonin syndrome
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44
Q

labs for NMS

A
  • elevated CPK (creatine phosphokinase): muscle contraction/destruction*
  • myoglobinuria (breakdown of muscle): rhabdomyolysis
  • elevated WBC (Leukocytosis)
  • elevated LFT
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45
Q

treatment for NMS

A
  • discontinue offending agent
  • bromocriptine (Parlodel)- dopamine (D2) agonist given when exam asks for a dopamine agonist
  • Dantrolene- muscle relaxant given when asked for muscle relaxant on exam or something to help for muscle rigidity
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46
Q

Serotonin Syndrome

A

caused by antidepressants

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47
Q

S/S of Serotonin syndrome

A

-hyperreflexia*
-myoclonic jerks*
* differ from NMS*

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48
Q

treatment for serotonin syndrome

A
  • discontinue offending agent
  • cyproheptadine
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49
Q

drugs that increase serotonin

A
  • triptans (sumatriptin[Imitrex]), if patient is taking these stay away from these medications, consider starting on NDRI or talk to PCP to switch imitrex
  • St. Johns Wort
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50
Q

SSRI

A
  • first line treatment in depression
  • safer in overdose
  • If patient is depressed and has cancer consider citalopram or escitalopram d/t less drug interactions
  • SSRI cause sexual dysfunction
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51
Q

Antidepressants black box

A
  • increase in suicidality
  • screen all patients for thoughts of self-harm, frequency, and severity*
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52
Q

What to prescribe for patient who is depressed and low energy

A

Wellbutrin

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53
Q

Wellbutrin contraindications

A
  • seizure hx.
  • eating disorders
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54
Q

Neuropathic pain

A
  • SNRI helps with pain (TCAs can help, but dangerous)
  • Alpha2 delta ligand medications (gabapentin & pregabalin)
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55
Q

Prozac

A

can cause insomnia if taken in the AM

56
Q

SSRI to MAOI

A

wait 2 weeks

57
Q

Prozac to MAOI

A

wait 5-6 weeks

58
Q

MAOI to prozac

A

wait 2 weeks

59
Q

washout period

A

5 half-lives between cessation of previous drug and introduction of new drug is the safest
* you want medication to degenerate*

60
Q

Schizophrenia onset

A

-males: 18-25 y/o
-females: 25-35 y/o

61
Q

schizophrenia imaging

A
  • MRI/PET will show ventricles have an increase in size, everything else is decreased
62
Q

abnormalities/changes in brain with schizophrenia

A
  • prefrontal cortex
  • amygdala
  • basal ganglia
  • hippocampus
  • limbic regions
  • can cause aggression, impulsivity, and abstract thinking problems*
63
Q

alpha 2 adrenergic receptor agonist in schizophrenua

A
  • clonidine & guanfacine- low tolerability in schizophrenic patients
64
Q

stimulants and schizophrenia

A

not recommended especially those with positive symptoms due to increasing dopamine release

65
Q

treatment for helping schizophrenic get back into community

A
  • assertive community treatment
  • long history of noncompliance, refer to case management for home health nurse to visit and do medications
  • social skills training - tertiary level of prevention
66
Q

aerobics and schizophrenia

A

can help improve cognition, quality of life, and overall long-term health

67
Q

haldol PO to decanoate

A

20 x (daily dose) = mg
*max of 100mg at once, give next dose 5-7 days later

68
Q

Delusions

A

false belief despite evidence to contrary, different from paranoid

69
Q

mental status exam for 3-5 year olds

A

list and observe cues, based on clinical observation

70
Q

Thought process

A

Assess the organization of the patient’s thoughts and ideas
-Normal: logical, linear, coherent, and goal-orinted
-Abnormal- associations are not clear, organized, or coherent
-Tangentiality: move from thought to thought that may or may not relate in someway but never get to the point
-Circumstantial: provide unnecessary detail but eventually gets to the point, patient goes in circles

71
Q

Thought content

A

refers to themes that occupy the patient’s thought and perceptual disturbances

examples: suicidal ideation, homicidal ideation, and plan; hallucinations

72
Q

Mini Mental Status Exam (MMSE)

A
  • concentration/attention: I would like for you to count backward from 100 by 7s
    -Orientation: what year is it?
    -Registration/Ability to learn: say the names of 3 unrelated objects clearly and slowly; ask the patient to repeat
  • Recall: ask the patient if he or she can recall the three words you asked him to remember
73
Q

Clock drawing test

A

a simple tool used to screen people for signs of neurological problems such as Alzheimers
- impairments on this test are associated with damage to the right parietal lobe (right hemisphere)
- constructional apraxia is the inability or difficulty to build, assemble, or draw objects can be caused by lesion in the parietal lobe following a stroke or may be indicator of alzheimers

74
Q

Atypical antipsychotic

A

-serotonin (5HT2A) receptor antagonism: less likely to cause EPS
-first psychotic episode, give atypical antipsychotic, especially one that can be given IM (invega, haldol, geodon, abilify)

75
Q

Mesolimbic pathway

A

-increased D2 positive psychotic symptoms
-hyperactivity of dopamine in the mesolimbic pathway mediates positive psychotic symptoms HYPER

76
Q

Nigrostriatal pathway

A
  • mediates motor movement
    -dopamine blockade can lead to EG, EPS, acute dystonia (painful neck, stiff neck, muscle spasms), akathisia
  • long standing d2 blockade can lead to tardive dyskinesia
  • reglan can cause EPS
    -EPS: increased acetylcholine and decreased dopamine levels, treatment is benztropine, for TD lower dose or switch to an atypical
77
Q

Mesocortical pathway

A

-decreased D2 negative and depressive symptoms
-decreased dopamine in the mesocortical projection to the dorsolateral prefrontal cortex is postulated to be responsible for negative and depressive symptoms of schizophrenia

78
Q

Tuberoinfundibular pathway

A

-blockade of D2 receptors can lead to increase prolactin levels –> hyperprolactinemia, which manifests as amenorrhea, galactorrhea (risperidone), and sexual dysfunction, gynecomastia
longterm hyperprolactinemia can be associated with osteoporosis

79
Q

prolactin levels M/F

A

-male: less than 20ng/ml
-female: less than 25ng/ml

80
Q

clozapine

A

metabolized by cytochrome enzyme CYP1A2

81
Q

enzyme inducers

A

decrease the serum level of other drugs that are substrates of that enzyme, which can cause subtherapeutic drug levels (tobacco)

82
Q

enzyme inhibitors

A

increase the serum level of other drugs that are substrates of that enzyme, possibly causing toxic levels (erythromycin)

83
Q

Medications that can cause mania

A
  • steroids (can also cause psychosis)
  • dilsulfiram (antabuse)
  • isoniazid
  • antidepressants in someone with bipolar
84
Q

medications that can cause depression

A
  • steroids
    -beta-blockers
    -interferon
    -isotretinoin (can also cause birth defects)
  • some retroviral drugs
  • benzodiazepines
  • antineoplastic drugs
  • ## progesterone
85
Q

bipolar disorder risk factor

A

-inheritable

86
Q

bipolar and medical condition

A

-related to medical condition at 45 years old or older, think of a stroke or a medical cause of the symptoms

87
Q

mania/hypomania

A

mania is much longer than hypomania, can be irritable or agitated

88
Q

symptoms of mania/hypomania

A

-distractibility and easily frustrated
-irresponsibility, indiscretion, impulsivity
- grandiosity
-flight of idea
-activity increased
-sleep decreased (denies feeling tired)
-talkativeness (pressured, rapid speech)

89
Q

Borderline personality disorder

A
  • self-harming behavior
  • recurrent suicidal behavior
  • interpersonal problems
    -have patients keep a diary/journal of symptoms to establish diagnosis
    -DBT can help decrease in suicidality
90
Q

If a patient with borderline personality disorder presents with depressed mood, emotional lability, interpersonal problems, rejection sensitivity, aggression, and hostility…treat with

A

depakote

91
Q

If a patient with borderline personality disorder presents with irritability, anger, and self-harming behaviors….treat with

A

lithium

92
Q

Conversion disorder

A

-mental condition where person has blindness, mutism, paralysis, or parathesia, another nervous system symptoms that cannot be explained by medical evaluation
- symptoms usually begin after stressful experience
-therapy

93
Q

Oppositional Defiant Disorder (ODD)

A

-diagnosed in children 6-17 years old; usually 6-10 years old
-enduring pattern of angry/irritable mood and argumentative, defiant, vindictive behavior lasting at least 6 months with at least 4 associated symptoms

94
Q

ODD S/S

A

-loses temper
-touchy or easily annoyed
-angry/resentful
-argues with authority
-actively defies or refuses to comply with rules
-blames others
-deliberately annoys others
-spiteful/vindictive

95
Q

ODD nonpharmacological treatment

A

-therapy
- family therapy with emphasis on child management skills, teaching parents positive reinforcement, and boundary settings
- child and parent problem-solving skills training

96
Q

Conduct disorder

A

-repetitive and persistent pattern of behavior in which the rights of others or societal norms or rules are violated (think antisocial personality disorder but cannot diagnose a personality disorder until they are 18 years old)

97
Q

conduct vs ODD

A

conduct is much more intense, think if child should go to juvenile prison

98
Q

conduct disorder s/s

A

-aggression towards people/animals (bullies, threatens, intimidates, initiates physical fights, uses weapons to cause harm, physically cruel
-destruction of property (example: fire setting)
- deceit or theft (broke into house, cars; lies and steals)
-lack of remorse

99
Q

conduct disorder treatment

A

-pharmacological treatment- target mood and aggression
- aggression and agitation with antipsychotics, mood stabilizers, SSRIs, and alpha agonists (clonidine and guanfacine)

100
Q

Adjustment disorder

A

emotional or behavioral reaction to a stressful event or change in a persons life.
-reaction is considered an unhealthy or excessive response to the event or change, within 3 months of it happening
-stressful events or changes in the life of your child or adolescent may be a family move, parents divorce, loss of a pet, birth of a sibling
**If you read a question and can identify a stressor then symptoms start after that then it is an adjustment disorder rather than MDD or GAD

101
Q

Adjustment disorder with depressed mood

A

presents with feelings of sadness, decreased interest, sleep disturbance, and appetite changes

102
Q

Adjustment disorder with anxiety

A

presents with symptoms of feeling restless, nervous, lack of concentration

103
Q

adjustment disorder with mixed anxiety and depression

A

patient has a mix of symptoms from both depressed mood and anxiety

104
Q

adjustment disorder with disturbances of conduct

A

a child may violate other peoples rights/social norms, rules,
- examples: not going to school, destroying property, driving recklessly, fighting

105
Q

adjustment disorder with mixed disturbance of emotions and conduct

A

stressor in a child’s life results in a mix of symptoms from all the above subtypes
-examples: child may present with truancy, peer conflict, verbal altercations, insomnia, frequent crying

106
Q

Tourette’s syndrome diagnosis

A

atleast 2 motor tics (hand, leg, face) and atleast one vocal (phonic) tic have been present, not necessarily at the same time
-tics may wax and wane in frequency, but have occurred for more than 1 year
-tics have not started before the age of 18 (childrens motor tics are fairly common and can be temporary)

107
Q

Tourette’s neurotransmitters involved

A
  • dopamine
  • norepinephrine (noradrenaline)
    -serotonin
    **DNS ** (hyperactivity of dopaminergic symptoms in the brain can cause tics
108
Q

Tourette’s management

A
  • atypical antipsychotic
    *FDA approved: haldol, pimozide, abilify
  • clonidine and guanfacine can help control behavioral symptoms such as impulse control and rage attacks
109
Q

Acute stress disorder

A

may occur in patients within/less than 4 weeks of a traumatic event

110
Q

acute stress disorder s/s

A

-anxiety
-insomnia
-poor concentration
-intense fear
-helplessness
-reexperiencing the event
-avoidance behaviors
- traumatic incident and patient does not want to go back to work, insomnia, avoidance and startle for less than 4 weeks

111
Q

PTSD s/s

A
  • intrusive re-experiencing of an extremely traumatic event
  • increased arousal (hyperarousal)
  • avoidance of stimuli associated with the trauma
112
Q

PTSD pharmacologic

A
  • SSRIs
    -TCAs
  • prazosin
113
Q

PTSD nonpharmacologic

A
  • EMDR** - desensitization phase, installation phase, body scan phase
  • CBT
114
Q

ADHD

A
  • DNS
    -frontal cortex
    -basal ganglia
    -abnormalities of reticular activating systems
  • abnormalities in the prefrontal cortex- inattentive type
115
Q

ADHD treatment- stimulant

A
  • assess cardiac hx before initiating stimulant ( if family hx. do ekg)
  • amphetamines approved for children 3 years and older
    -methylphenidate approved 6 years and older
    *Tics are contraindication for stimulants (if you start on stimulants and they develop tic, stop the stimulant and switch to non-stimulant)
116
Q

s/s of stimulant abuse

A
  • insomnia
    -tremor
    -increased blood pressure/HR
  • heart palpitation
    -agitation
    -anxiety
    -irritability and mood swings
117
Q

Non-stimulants for ADHD

A
  • alpha agonist or alpha 2 adrenergic receptors agonist (guanfacine and clonidine FDA approved in ages 6-17 with ADHD)
118
Q

Strattera

A

approved for children ages 6 and older with ADHD

119
Q

ADHD diagnosis

A
  • must assess in atleast 2 different settings, school, and parents
  • if symptoms are worsening, you can start the patient stimulant, if pt is re-experiencing the symptoms shortly after you can start them on multiple doses a day or extended-release
    -parents may have anxiety from diagnosing child - give psychoeducation/therapy to parents
120
Q

OCD (serotonin and norepinepherine)

A

presence of anxiety-provoking obsessions (recurrent and persistent thoughts, impulses or images), or compulsions, that function to reduce the persons subjective anxiety level

121
Q

What to consider in pediatric patients with sudden onset OCD?

A
  • PANDAS (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections)
122
Q

TIP for OCD vs Tourettes

A
  • OCD: persistent thoughts and tics
  • Tourettes: tics only
123
Q

Factitious disorder

A

presents with physical or mental symptoms that are induced (for example: drinking contaminated urine samples, taking hallucinogens)

124
Q

Malingering

A

similar to factitious disorder in that symptoms are faked, but the motive is malingering for secondary gain such as getting out of jail, or staying in the hospital for bed/food

125
Q

Factitious disorder imposed on another

A

someone falsely claims that another person has physical or psychological s/s of illness or caused injury or disease in another person with the intention of deceiving others

126
Q

Reactive attachment disorder

A

-product of severely dysfunctional relationship with the principal caregiver and the child
-when the caregiver consistently disregards the physical/emotional needs of the child and fails to develop a secure and stable attachment
- can cause child to be fearful, withdrawn, apathetic, and show no emotions towards caregiver
- some children are more aggressive, disruptive and disorganized

127
Q

Generalized anxiety disorder

A

excessive worry, apprehension, or anxiety about events or activites
-occurs more days then not for a period of atleast 6 months

128
Q

Panic Attack (acute)

A

abrupt surge of intense fear or discomfort that reaches a peak within minutes and during which time a variety of psychological and physical symptoms occur
- rapid HR
- sweating/shaking
-SHIB
-hot flashes/lightheadedness
-impending doom
-chills
-nausea/ abd pain
-chest pain
-HA
- numbness/tingling

129
Q

Acute panic attack treatment

A
  • beta blockers (propanolol) - can cause bronchospasms if pt is taking albuterol
  • benzodiazepines- habit forming, give BB first if possible
130
Q

panic disorder (chronic)

A

given to people who experience recurrent unexpected panic attacks (come from nowhere)

131
Q

panic disorder treatment

A
  • SSRI (prozac, paroxetine, sertraline)
  • SNRI ( venlafaxine)
132
Q

Disruptive Mood Dysregulation

A

most likely borderline personality disorder, but since child cannot be diagnosed until 18 with a personality, they are diagnosed with this.
-childhood depressive disorder diagnosed in ages 6-18
- chronic dysregulated mood “moody”
- frequent intense temper outbursts/temper tantrums
- severe irritability/anger

133
Q

Anorexia Nervosa

A
  • low BMI
    -amenorrhea
    -emaciation
    -hypotension
    **BMI <15– refer out for med. eval and hospitalization
    **If parents unwilling to get treatment for child, call CPS
134
Q

Autism spectrum disorder (Glutamate, GABA, serotonin)

A
  • persistent deficits in social communication, and social interaction across multiple settings
  • no response when called by name
  • nonverbal communication
  • little to no eye contact
    -line up, stack or organize objects
135
Q
A

PMHNP (1 decks)

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