Psychiatric Nurse Practitioner Assessment Spring 2022(100% Verified)

Explain the clinical signifcance of the Stystematic Treatment Enhancement Program for Bipolar Disorder: STEP-BD) - ✔✔As more contempts are tried with SSRIs to relieve depressive symptoms, the client becomes more treatm ...

Explain the clinical signifcance of the Stystematic Treatment Enhancement Program for Bipolar Disorder: STEP-BD) - ✔✔As more contempts are tried with SSRIs to relieve depressive symptoms, the client becomes more treatment resistant leading to poor outcomes. Explain the clinical significance of the Sequenced Treatment Alternative to Relieve Depression STAR D - ✔✔Strong behavioral therapy combined with medications lead to 30% better outcomes as compared to monotherapy or medication or therapy alone. Describe the mechanism of action of Typical Antipsychotics - ✔✔Blocking D2 receptors in the mesolimbic and mesocortical The Blocking D2 receptors in the mesolimbic and mesocortical tract - ✔✔tract reducing positive symptoms of psychosis, does effect the negative symptoms of the disorder, can create EPS symptoms in the nigro-striatal tract, Nigrostriatal - ✔✔involved with muscular movement Mesolimbic - ✔✔source of visual hallucinations and auditory hallucinations, Mesocortical - ✔✔mesocortical area holds affective symptoms, Second generation antipsychotics are pharmacology directed to - ✔✔blocking both D2 and 5HT receptors in the brain and also relieve the negative symptoms of psychosi down regulation blocking Alpha ! receptors - ✔✔Orthostatic hypotension and dizziness which comes down regulation of blocking Muscarinic and Histamine receptors - ✔✔Weight gain, dizzinessserontin down regulation in the gut - ✔✔constipation Neuroleptic malignant syndrome - ✔✔cause by increased medication changes or treatment naive patients What are notable side effects of Clozapine - ✔✔Induced by cigarette smoking which is through the 1A2 pathway Recommended dosing schedule for clozapine - ✔✔Start at 12.5 first day, then in divide doses of 25-50 mg/day up to 300-400 mg per day. Clozapine maxes - ✔✔Maximum dose is 900 mg per day. No single dose should exceed 450 mg Clozapine monitoring - ✔✔Need to register at the clozapine website as a provider Normal levels of WBCs > 3500 Normal levels of ANC > 2000 wbc - ✔✔WBC with differentials, Absolute Neutrophil Count Blood draws are done weekly for the first 6 months, then every other week for 6 months, then monthly Notable side effects of Risperidone - ✔✔Increase risk of seizure Contraindicated for pregnancy Increased prolactin Metabolic syndrome diagnostic criteria - ✔✔Combination of any three of the following Abdominal circumference > 37 in males > 31.5 in femaies Plus any two of the following: Elevated Triglycerides > 150 mg/dlHDL less than 40 mg/dl in men, 50 mg/dl in women Blood pressure >130/85, or receiving treatment for hypertension Fasting blood sugar >110 mg/dl or prior type of DM diagnosis A weight increase of 7% should prompt the provider - ✔✔to consider a different medication. Neuroleptic Malignant Syndrome criteria - ✔✔Within 2 weeks of beginning the medication or a significant medication increase / or present with abrupt withdrawal of levodopa or exposure to a dopamine agonist Classic triad: - ✔✔Hot, Stiff, and Out of it: includes extreme mental status change/confusion, extreme muscle rigidity, and extremem autonomic instability/hyperthermia: What is the appropriate treatment for Neuroleptic Malignant Syndrome - ✔✔Dantrolene bromocriptine to relieve rigidity How are TCA metabolized - ✔✔the 2D6 pathway The importance of TCA to be aware of: - ✔✔Toxicity causes heart block, torsade de pointes arrythmia or sudden death Monoamine Oxidase Inhibitor (MAOIs) concern for treatment - ✔✔Low tyramine diet including red wine, cheese, processed foods, causes a hypertensive crisis (high blood pressure) Buproprion - ✔✔Can lower the seizure threshold, should avoid in children and the elderly, NDRI class Fluoxetine (Prozac) - ✔✔Longer half life 36-40 hours Paroxetine (Paxil) - ✔✔known for withdrawl symptoms if not taken regular, short half-life, good for anxiety disordersCitalopram (Celexa) - ✔✔cardiac effect may require decreased doses (QT prolongation) do not go over 40 mg/day Trazodone - ✔✔Can cause priaprism Sertraline (Zoloft) - ✔✔Dose dependent, need to increase the dose Venlafaxine - ✔✔Elevated blood pressure Signs and symptoms of serotonin syndrome - ✔✔High serotonin levels can cause agitation, confusion, hallucinations, tachycardia, fever, anxiety, muscle rigidity, hyperreflexia, tremors, diarrha, hypo/hypertension Treatment for Serontonin Syndrome - ✔✔Withdraw from the SSRI, Stabilizing temperature, Use benzodiazepines for muscle relaxation, Beta-blocker for the tachycardia Notable side effects of Lithium - ✔✔Muscle weakness, tiredness, slurred speech, fine hand tremor, thirst nausea, diarrhea / vomiting Maintenance value for Lithium is - ✔✔0.8 to 1.0 When do you check the Lithium level