Random Facts Flashcards
What meds should not be given with metoprolol and why
Paroxetine, fluoxetine, and Wellbutrin
Metabolized by same CYP450 enzyme; the antidepressants can increase the effects of metoprolol leading to SE
What’s susto & sx
Cultural syndrome (Spanish). Frightening/shocking event causes soul to leave body.
Symptoms include weight loss, fatigue, muscle pains, headache, diarrhea, unhappiness, troubled sleep, lack of motivation, and low self-esteem
Kava kava use and major SE
Anxiety & insomnia
Sedating and liver damage
3 antipsychotics & 1 antidepressant with QT prolongation
Ziprasidone, quetiapine, haldoperidol
Citalopram
Least sedating SSRIs
Prozac and lexapro
Medical med that increases risk SJS with lamictal
Tramodol
Mood stabilizer and antipsychotics with least weight gain
Lamictal
Ziprasidone, abilify, Latuda
Least sedating antipsychotic
Abilify
Labs for gout and hepatitis
Uric acid, LFT, CBC
Labs for antibiotics
CBC, RFT, LFT, electrolytes
Meds with risk agranulocytosis
Clozaril and carbamazepine
Meds that decrease effectiveness of OCP
Topamax, phenytoin, and antiepileptics in general
Med with risk SJS in Asians and why
Carbamazepine due to HLAB-1502 allele
Lab values that indicate agranulocytosis/DC med (clozaril or carbamazepine)
ANC < 1000
WBC < 2000-3000
What pre screening needed with clozaril
Cardiac due to risk cardiomyopathy
Meds that decrease SI
Lithium
Clozaril in schizophrenia specifically
Normal Cr and BUN
BUN to creatinine ratio
Cr 0.5-1.2
BUN 10-20
Ratio between 10:1 and 20:1
Want to start lithium. BUN 4.5
And Cr 4.5. Which value more concerning?
Cr due to risk of lithium toxicity (if Cr is high, kidneys not functioning well causing it to build up)
Impact sodium has on Lithium levels
Sodium 135-145
Low sodium means decreased lithium clearance and increased lithium levels
Meds that can increase lithium levels
NSAIDs, thiazides, ACEi and meds that decrease renal clearance like colchinine
Main neurotransmitters in addiction
Dopamine and GABA
Two main lab findings in infection
Increased CRP and WBC
Tx for NMS
DC offending agent
#1 bromocriptine
can then use dantrolene for muscle relaxation
Hallmark finding with MSE in schizophrenia
Impaired proverb interpretation
Med class that people with schizophrenia have lower tolerance to
Alpha-2 adrenergic agonists (clonidine, Intuniv)
Brain changes schizophrenia
Enlarged ventricles
Everything else in PowerPoint showed decreased
How to switch from haldol PO to IM and ex
Multiply daily dose x20 but keep in mind can only administer 100mg IM at once
Ex: haldol 10mg PO daily total. 10x20= 200mg IM. Give 100mg IM then 5-14 days later give remaining 100mg IM
How long does someone have to have sx for schizophrenia dx
6 months
> 1 month but < 6 months= schizophreniform
Hallucination before falling asleep
HypnaGOgic
Hallucination upon waking up
HypnoPOmic
What does failure/impairment of clock drawing test indicate
Right parietal lobe damage dysfunction with cognition and executive function
What does the serial seven test for?
Concentration, attention, calculation
Stereognostic exam
Test if patient can identify object by touch alone without seeing it. Assesses sensory pathways and processing, especially in the parietal lobe
Phases of EMDR
Eye Movement Desensitization and Reprocessing (EMDR)
Desensitization
The client visualizes the trauma verbalizes the negative thoughts are maladaptive beliefs, and remains attentive to physical sensations. This process occurs for limited time while the client maintains rhythmic eye movements. Here she is then instructed to block out negative thoughts to breathe deeply and then to verbalize what he or she is thinking feeling or imagining.
Installation
The client installs and increases the strength of the positive thought that he or she has declared as a replacement of the original negative thought
Body scan
The client visualizes the trauma along with positive thoughts, and then scans his or her body mentally to identify any tension within
Nightmares in children can be …..?
Genetic; assess family patterns
Neurotransmitters in ASD
Glutamate, GABA, serotonin
Parallel play normal/abnormal
Normal age 1-3
Suspect ASD if after that
Subcortical versus cortical dementia
Subcortical think motor symptoms. HIV and Huntington’s.
Cortical think language and memory. Alzheimer’s.
What type of dementia?
Recurrent visual hallucinations, fluctuating cognitive impairment, decreased executive function, Parkinson features
Lewy body
Picks disease- what is it & main characteristics?
Frontotemporal dementia
Personality, behavior, LANGUAGE (slurred speech) , social behaviors inappropriate, decreased empathy, aggression
Treatment of Parkinson’s disease, dementia
acetylcholinesterase inhibitors
Donepezil and/or rivastigmine or galantamine
Antipsychotics not recommended a especially typical antipsychotics
Structural and neurotransmitter changes in Alzheimer’s dementia
Cerebral atrophy, enlarged ventricles
Decrease acetylcholine and nor epinephrine
What are the components of the limbic system?
amygdala, hippocampus, hypothalamus, thalamus, cingulate gyrus, and basal ganglia
Where is dopamine created in the brain?
ventral tegmental area and substantia nigra
Rhomberg test
Test balance. Negative stay stable. Balance regulated in cerebellum.
Trendelenburg test
Assess hip dysfunction. Positive equals weakness and hip abductor muscles.
Where is norepinephrine made in the brain
Locus ceruleus and medullary reticular formation
Where is serotonin made in the brain?
Raphe nuclei
Where is acetylcholine made in the brain brain?
Nucleus of meynert
Highest risk factor for intellectual disability
Genetic
Humanistic therapy
Carl Rogers
Self directed and self actualization
Logotherapy
Type of existential therapy created by Victor Frankel. Focuses on the meaning of life.
What is a specific approach used in strategic therapy
Strategic therapy has problem, focused, and symptom focused. Paradoxical directive/intervention is used with caution.
What is something specifically used in solution focused therapy
Miracle questions
Family systems therapy/Systemic Family Therapy
Created by Murray Bowen. Seeks to help self differentiation and decrease triangles. Uses genograms
Structural family therapy approach
Clearly defined boundaries and hierarchy. Enactment = map, track and modify family structure.
What is a normal behavior seen in Freud’s phallic stage of development (3-6 years old)
Normal to masturbate/play with genitals. It is self exploration.
What lab to order if suspect rheumatoid arthritis?
ESR which will be increased
What can a shrill/high-pitched cry indicate in an infant
Increased intracranial pressure
Infant reflex of rooting timeframe
Starts at birth and disappears between 4 to 6 months
Infant reflex grasp/Palmer timeframe
From birth to 5 to 6 months
Infant reflex grasp/Palmer timeframe
From birth to 5 to 6 months
Infant reflex landau reflex what is it and timeframe?
Superman response. Starts at three months and stops between 12 to 24 months.
Infant reflex Moro/startle timeframe
From birth to 5 to 6 months
Infant reflex, Babinski timeframe
From birth to two years old
Why do women have an increased risk of liver issues due to drinking?
Decreased alcohol dehydrogenase which breaks down the alcohol. Also more prone to being drunk because of this.
What is macrocytic normochromic anemia
Folic acid and B12 deficiency
What is Habeas corpus law
Protects patient against unlawful hospitalization
Signs of diabetic ketoacidosis
Nausea, vomiting
Abdominal pain
Polyuria & polydipsia
Dyspnea/kussmaul breathing
Malaise
Confusion
Elevated blood sugar levels
Fruit scented breath
High levels of ketones in the urine
Should you discontinue a medication if the FDA releases a black box warning?
No, don’t automatically discontinue. Research the benefits/risks.
What is essential if you use medication off label
Full disclosure of the benefits and risks in documentation is essential and you can include evidence as well
MMSE scale
0-30 with lower numbers being severe dementia
10-20 moderate cognitive impairment
25-30 is NORMAL
When can you initiate buprenorphine in opioid withdrawal?
When client is in moderate withdrawal 13+
(COWS 0-36)
What do mobile lymph nodes mean?
Benign
CRAFFT
Screening tool for children less than 21 years old for substance use
If score 2+ need to assess further
Car; Relax; Alone; Forget; Friends; Trouble
CAGE
Screening tool for AUD
Cut, annoyed, guilty, eye-opener
If score 2+ need to assess further
Signs of hypoglycemia
Looking pale (pallor)
Shakiness.
Dizziness or lightheadedness.
Sweating.
Hunger or nausea.
An irregular or fast heartbeat.
Difficulty concentrating.
Feeling weak and having no energy (fatigue)
What cranial nerve tests facial movements, and how to test
Cranial nerve VII (7)
facial movement and expression, taste, and tear production
Raise eyebrows, smile, puff out cheeks, stick out tongue, taste test
Alcohol versus Parkinson’s tremor
Alcohol causes bilateral and symmetrical essential tremor that alcohol relieves
Parkinson’s tremor starts on one side first and alcohol does not impact it
What is the most comprehensive screening tool to diagnose alcohol use disorder?
SBIRT
What determines scope of practice?
State legislator statutes
What determines standard of practice and why?
ANA to judge nature of care
Just culture
ANA
Support collaboration efforts among state boards of nursing, etc. Hold people accountable for their behaviors and investigates errors. Goal of creating open and learning environment to design safe systems and manage choices.
Mindset that affects work environment, proactively look for system, breakdowns, and identify ways to improve systems
PDSA cycle
Process of quality improvement
P plan the change
D (do) carry out the plan
S Study the results
A act -decide what actions will improve the process
What are four components of health policy?
Process, policy reform, policy environment, policy makers
Caring theory
Gene Watson
Holistic and transpersonal, humanistic
Tarasoff principal
Duty to warn potential victim of eminent danger of homicide. Doesn’t apply in every state.
The Mental Health Parity and Addiction Equity Act (MHPAEA)
insurance must provide some level of mental healthcare
Donaldson versus O Connor
Ruling determined a mentally ill individual cannot be placed in a hospital against his will for the purpose of raising his standard of living
Piaget pre-operational stage of development
Age 2-7
Magical thinking is normal
Piaget formal operational stage of development
12 years old+
Abstract logic/reasoning
How would a child in the pre-operational stage of development (age 2 to 7) understand illness
Likely attributes feelings to something more personal like in response to something they did wrong
Meds FDA approved for TD
VMAT2 inhibitors: deutetrabenzene (Austedo) & valbenazine (Ingrezza)
Antipsychotics most likely and least likely to cause galactorrhea
caused by elevated prolactin from decreased dopamine in tuberoinfundibular pathway
most likely= risperidone
least likely= quetiapine & aripiprazole
What enzyme is clozapine metabolized by
CYP1A2
What enzyme is nicotine metabolized by and is it an inducer or inhibitor?
CYP2A6
inducer (increases metabolism & will thus decrease med levels like antipsychotics)
Concern with co-administration of Depakote & Lamictal & why?
SJS
depakote is CYP enzyme inhibitor which can cause increased levels of Lamictal
Is carbamazepine (Tegretol) a CYP enzyme inhibitor or inducer?
inducer
Antibiotics that are CYP enzyme inhibitors that can then lead to increased levels of other medications?
doxycycline, clarithromycin, erythromycin, & fluoroquinolones
What would you be most concerned about if a CYP enzyme inducer is given with a CYP enzyme inhibitor?
inhibitor will take over the inducer thus leading to increased levels of the inducer risking toxicity/adverse effects
What should you do if pt stable on Tegretol is prescribed doxycycline? Why?
decrease dose of Tegretol while taking the doxycycline
Tegretol is a CYP enzyme inducer but doxy is an inhibitor which can increase Tegretol levels and increase risk of adverse effects like SJS and agranulocytosis
In order for sx to be considered mania, how long do they have to occur? how about hypomania?
mania= at least a week
hypomania= at least 4 days & are less severe
main neurotransmitters in ADHD
*dopamine (low), *norepinephrine (low), serotonin
areas of brain affected in adhd
frontal cortex
basal ganglia
abnormalities in reticular activating system
(prefrontal cortex= inattention)
most comprehensive screening tool for ADHD
Connor’s parent & teacher rating scales
(Vanderbilt less comprehensive & public domain)
how do alpha 2 adrenergic receptor agonists work
decrease the amount of norepinephrine released by stimulating alpha-2 adrenergic receptors in certain areas of brain which can enhance the signal strength of norepinephrine in the prefrontal cortex, ultimately improving attention and reducing hyperactivity symptoms associated with ADHD
It’s not about simply lowering norepinephrine overall, but rather modulating its activity in key areas of the brain that are crucial for cognitive function.
acute stress disorder vs PTSD
acute stress= lasts days to 4 weeks
PTSD= sx for at least a month
neurotransmitters in ocd
Low serotonin and norepinephrine
main neurotransmitter in anxiety disorders
**Low GABA
Increased norepinephrine, decreased serotonin
court case that determined an individual isn’t criminally responsible if unlawful act was result of mental illness
Durham vs US
court case that ruled harmless mentally ill pts cannot be confined against their will if they can survive outside
O’Connor vs Donaldson
court case that determined pts have the right to refuse any treatment and use an appeal process
rennie vs klein
Pearson’s r correlation
tests relationship btwn two variables
t-test
whether the means of two groups are statistically significant
p value
aka level of significance
probability of particular result occurring by chance alone
analysis of variance “ANOVA”
tests the difference among 3+ groups
FRAMES
FRAMES brief intervention in MI that’s non-confrontational and designed to motivate people to make positive changes.
Feedback: Provide information about the risks of continuing the behavior
Responsibility: Emphasize that the individual is responsible for making changes
Advice: Offer non-judgmental guidance on how to reduce or stop the behavior
Menu: Provide a range of strategies for change
Empathy: Show warmth, respect, and understanding
Self-efficacy: Encourage the individual to believe in their ability to succeed
contraindication to beta blocker
asthma/albuterol bc can cause bronchospasms
how to treat hyperactivity, impulsivity, inattentiveness in ASD
stimulants which work by increasing dopamine in certain areas of the brain
early signs HIV dementia
cognitive decline, motor abnormalities (poor coordination, balance issues, etc), behavioral abnormalities
huntington’s
onset usually age 30-45 but can occur anytime
subcorticol dementia
psychomotor slowing/motor abnormalities, difficulty with complex tasks, depression and psychosis common
kids have 50% chance of getting; can screen through no risk direct genetic test
hypothalamus
limbic system
hunger, thirst, water balance, circadian rhythm, body temp, libido, hormonal regulation
hippocampus
learning, memory, emotions, stress
structural changes in severe mental illness
cortical thinning
decreased hippocampal volume
signs of lead poisoning
Pica, weight loss, sluggishness, fatigue, loss of appetite, developmental delays, learning difficulties, irritability, vomiting, constipation, hearing loss
what causes enmeshment and parentification in a family
unclear, diffuse boundaries
Structural Family Therapy focuses on these
4 dimensions of recovery
health, home, purpose, and community
Mature healthy defense mechanisms
altruism, sublimation, humor, and suppression
What is a quality improvement initiative for a PMHNP? Ex?
Characterized by a focus on patient-centered care, evidence-based practices, data-driven decision making, collaboration with stakeholders, measurable outcomes, continuous monitoring, and a commitment to improving the quality of mental health care delivery
Reducing readmissions
Improving patient safety
Improving patient flow
Using data
Tailoring care
Ex pg 397 purple book
Engaging in quality improvement initiative: PMHNP asked to do retrospective chart review of all hospital DC clients who received f/u within 7 days of DC and within 30 days of DC.
The central dialectical pattern emphasized in DBT involves the tension between:
Radical acceptance and change
What defense mechanisms commonly used in obsessive compulsive personality disorder
Rationalization, isolation and intellectualization
What part of the FRAMES model (which letter) is aimed at increasing motivation for change in client with SUD?
F
Feedback can help to increase awareness about SUD and its consequences to motivate for change
What are the 4 P’s of suicide risk assessment?
past suicide attempts, a plan, probability of completing suicide, and preventive factors
5 As of dementia
Aphasia- difficulty with word finding
Apathy
Agnosia - inability to recognize objects, smells, shapes
Apraxia-difficulty motor planning to perform tasks
Abstract thinking
Expected/normal in mental status exam of:
1. 4 year old + child thought process
2. School aged children memory
3. Abstraction
- By the age of four children should have some understanding of what is real or made up.
- School-age children should be able to remember three objects after five minutes.
- Children, age, 12 or younger, not expected to have abstractive thought abilities.
Evidence based treatment for ODD
Child and parent problem-solving skills training
Neurotransmitter abnormalities in schizophrenia
Increased glutamate, the level of dopamine depends on the pathway
Low serotonin and low GABA
Neurotransmitter changes in Alzheimer’s/impaired memory
Decreased acetylcholine
Decrease norepinephrine
decreased glutamate
increased dopamine
What neurotransmitter changes cause the negative symptoms in schizophrenia
Decreased dopamine in the meso cortical pathway
Decreased serotonin, glutamate, GABA
Main neurotransmitter abnormality in bipolar
Increased glutamate
Main neurotransmitter changes in substance-abuse
Decreased opioid, neuropeptides and decreased dopamine
Main neurotransmitter changes in psychosis
Increased glutamate and increased dopamine
Neurotransmitter changes in antisocial personality disorder
Decreased dopamine
Khyal
cultural syndrome
Cambodian and other Asian cultures
A PTSD-related syndrome that translates to “seized by wind”. Symptoms include dizziness, shortness of breath, and palpitations (like a panic attack)
SAD PERSONS suicide scale
S- sex (male)
A- Age (<20 or > 44 yrs)
D- depression
P - previous SA
E- ETOH use
R- rational thinking loss (psychosis)
S- social support lacking
O- organized suicide plan
N- no spouse
S- sickness
1 point each
3-4 pt = closely monitor
6-5 pt= strongly consider hospital
7-10= hospital
Antipsychotics for BD
Lithium- neuroprotective, mania
Symbyax (Prozac & olanzapine) for bipolar depression
Latuda for bipolar depression
Seroquel for bipolar depression
Non pharm for BD
**supportive groups
CBT, behavioral, interpersonal
What’s rapid cycling BD
4+ mood episodes in a year
More common in women
Stress, substance use, meds, sleep changes can increase risk
Tx self harm, irritability, anger in BPD
Lithium
Tx emotional lability, interpersonal issues, aggression in BPD
Depakote
Tx depression and anxiety in BPD
SSRI
Parts of brain that cause addiction
*nucleus accumbens
Hippocampus, basal ganglia, extended amygdala, prefrontal cortex, cingulate gyrus
Anterior cingulate
Cognitive functions, decision-making, empathy, impulse control, emotions
What is the role of dopamine in substantia nigra
Regulates motor movements
Dopamine also produced here amongst other areas
Main concepts in existential therapy
Emphasizes freedom and making responsible choices
Focuses on facing issues of existence
Try to understand the patient’s subjective experience
Goals are to live authentically and focus on the present and personal responsibility
When is multisystemic family therapy indicated
Use whores with serious antisocial, problematic behavior, and with serious criminal offenses
Level one evidence
Evidence from the systemic review or meta-analysis of all relevant RCTs or evidence based clinical practice guidelines based on systemic review of RCTs or three or more RCTs of good quality to have similar results
