psychiatry

Question 1

lithium can cause

Answer 1

diabetes insipidus - antiduiruetic hormone (ADH) kidneys are not able to properly concentrate urine

Question 2

concerns in lithium toxicity, lab levels, and monitoring

Answer 2

ekg for monitoring
lithium lab level 0.6-1.2 mmol/L (narrow therapeutic index)
concerns: cardiac toxicity - av block, sinus bradycardia
seizures, hypotension

Question 3

what do do to avoid serotonin syndrome, what are the signs, dx, tx

Answer 3

avoid fentanyl, tramadol, ondansetron, dextromethorphan
2) htn, diarrhea, tachycardia, hyperthermia, diaphoresis, hallucinations, confusion, ataxia (similar to hyperthyroidism), can get rhabdo, ventricular arrhythmia, coma
3)no dx available
4) tx 1. lorazepam, 2. methysergide and cyproheptadine to counteract serotonin, 3. labetolol for htn and tachycardia

Question 4

what med avoid with TCAs

Answer 4

macrolides - azithromycin and erythromycin

Question 5

eating disorders pre - op

Answer 5

prefer to do in the hospital, if forced to do in the office on boards:
1) pre operative labs - EKG, CBC, Chem 10 panel BMP? for electrolytes imbalances , chemistry the morning of the procedure.
2) increase NPO time for delayed gastric emptying
3) titrate medications very slowly if forced to do it in the office.

Question 6

what concern with antipsychotics as it relates to the heart

Answer 6

prolonged qt with may degenerate into tornadoes de pointes and cardiac arrest.
get pre-operative ekg
and avoid qt prolonging medications (look up?)

Question 7

what drug can you use in neuroleptic malignant syndrome

Answer 7

bromocriptine

Question 8

patient has an elevated temperature, hypertonia, and diaphoresis ddx?

Answer 8

serotonin syndrome, neuroleptic malignant syndrome and malignant hyperthermia

Question 9

drugs that can potentiate serotonin syndrome

Answer 9

ssri, snri, tryptans, Tricyclic antidepressants, and several seizure mediations
drugs we give, - fentanyl, zofan, tramadol,