PMHNP CC PART 3 Flashcards
What is the reference range for thyroid stimulating hormone (TSH)?
0.5-5.0 mIU/L
Symptoms of hyperthyroidism can mirror those of _______.
mania
Symptoms of hypothyroidism can mimic _______.
depression
What should be checked first when evaluating thyroid function?
TSH levels
What happens to TSH secretion when T4 and T3 levels are high?
Decreases
Symptoms of hyperthyroidism include:
- Heat intolerance
- Agitation
- Anxiety
- Irritability
- Tachycardia
- Mood swings
- Weight loss
What are the symptoms of hypothyroidism?
- Cold intolerance
- Lethargy
- Weight gain
- Decreased libido
Divalproex sodium (Depakote) carries a Black Box Warning for _______.
liver toxicity and pancreatitis
What is the therapeutic range for Depakote?
50-125 μg/mL
Signs of toxicity for Depakote include levels greater than _______.
150 μg/mL
What are the symptoms of liver toxicity (LIVER)?
- Abdominal pain in URQ
- Reddish-brown urine
- Yellowing of skin and eyes
- Fatigue
What symptoms are associated with pancreatitis?
- Upper abdominal pain
- Pain radiating to the back
- Fever
- Rapid pulse
- Nausea
- Vomiting
- Oily stools
Kava Kava is commonly used for _______.
anxiety, stress, and insomnia
What is a priority lab test for Kava Kava?
Liver Function Test (LFT)
Lamictal can cause _______.
Stevens-Johnson syndrome
Which antipsychotics are associated with the least weight gain?
- Ziprasidone
- Aripiprazole
- Lurasidone
What should be monitored for metabolic syndrome management?
- BMI
- Hip-to-waist ratio
- Glucose
- Lipid panel
What is the Black Box Warning for Carbamazepine?
Agranulocytosis and Aplastic anemia
Aplastic Anemia Symptoms include:
- Pallor
- Fatigue
- Headache
- Fever
- Nosebleeds
- Bleeding gums
- Skin rash
- Shortness of breath
What is the lithium therapeutic range?
0.6-1.2 mEq/L
What is the priority action for lithium toxicity?
Discontinue lithium and check lithium levels
What can increase lithium levels?
- Kidney diseases
- Renal clearance drugs
- Dehydration
- Sodium imbalance
What are the symptoms of Neuroleptic Malignant Syndrome (NMS)?
- Extreme muscular rigidity
- Mutism
- Hyperthermia
- Tachycardia
- Diaphoresis
- Altered level of consciousness
- Elevated CPK
- Myoglobinuria
- Elevated WBC
- Elevated LFT
What is the treatment for Serotonin Syndrome?
Discontinue the offending agent and administer Cyproheptadine
What is a Black Box Warning for antidepressants?
Can increase suicidality or self-harm in children, adolescents, and younger adults
When switching from fluoxetine to MAOI, how long should you wait?
5-6 weeks
What can cause QT prolongation?
Citalopram
Positive symptoms of schizophrenia include:
- Hallucinations
- Delusions
- Thought disorders
- Movement disorders
Negative symptoms of schizophrenia include:
- Decreased ability to initiate and sustain planned activity
- Brief speech
- Lack of pleasure or interest
- Little emotion
What is the age of onset for schizophrenia in males?
18-25
What are the MRI findings in schizophrenia?
Ventricular enlargement
What is Assertive Community Treatment (ACT) beneficial for?
Patients with low medication compliance
What should be assessed in a Mental Status Examination (MSE)?
- Thought process
- Thought content
- Delusions
What does the Mini-Mental Status Examination (MMSE) assess?
- Concentration
- Attention
- Calculation
- Orientation
- Registration
- Recall
- Fund of knowledge
What is the Clock Drawing Test used for?
To screen for neurological problems
What characterizes the atypical dopamine pathway?
Serotonin (5HT2A) receptor antagonism
Increased dopamine in the mesolimbic pathway is associated with _______.
positive symptoms
Decreased dopamine in the dorsolateral prefrontal cortex is linked to _______.
negative and depressive symptoms
What can acute dystonia manifest as?
Painful neck muscle spasms
What is decreased dopamine in the dorsolateral prefrontal cortex linked to?
Negative and depressive symptoms of schizophrenia
This highlights the role of dopamine in mood regulation and schizophrenia pathology.
What happens to acetylcholine levels when dopamine is blocked in the nigrostriatal pathway?
Acetylcholine levels elevate
This can lead to various side effects due to increased cholinergic activity.
What side effects can elevated acetylcholine cause?
- Salivation
- Teary eyes
- Diarrhea
These symptoms are a result of cholinergic overactivity.
What are the extrapyramidal symptoms (EPS) associated with dopamine blockade?
- Acute dystonia
- Parkinsonian symptoms
- Akathisia
These symptoms are related to motor control disruptions.
What is acute dystonia?
Painful neck muscle spasms
It is a type of EPS that can occur suddenly after starting certain medications.
What medications can cause EPS, including tardive dyskinesia (TD) and dystonia?
- Antipsychotic medications
- Metoclopramide (Reglan)
Patients taking both types of medications are at increased risk for EPS.
What is the treatment for acute dystonia, parkinsonian symptoms, and akathisia?
Benztropine (Cogentin), an anticholinergic medication
This medication helps to counteract the symptoms of EPS.
Is Benztropine (Cogentin) effective for tardive dyskinesia?
No, it is not effective
Managing TD may require dose adjustment or switching medications.
How can tardive dyskinesia (TD) be managed?
- Reducing the dose
- Switching to atypical antipsychotics
Atypical antipsychotics tend to have a lower risk of TD.
What side effects are associated with increased prolactin levels due to dopamine blockade in the tuberoinfundibular pathway?
- Amenorrhea
- Galactorrhea
- Sexual dysfunction
- Gynecomastia
Elevated prolactin can have significant endocrine effects.
What long-term effect can elevated prolactin levels lead to?
Osteoporosis
Chronic elevation of prolactin can affect bone density.
