Georgette Review 2022 Graded A

What should you not do when advocating for a patient? - ANSWER Judge or confront What class of medication is contraindicated with tics? - ANSWER Stimulants What should you provide for prior to assessing abuse victi ...

What should you not do when advocating for a patient? - ANSWER Judge or confront What class of medication is contraindicated with tics? - ANSWER Stimulants What should you provide for prior to assessing abuse victims? - ANSWER A safe environment What are your actions if a child reports abuse? - ANSWER First interview separately from parents then report to CPS What should you do if a child plays with toys in a way that you suspect abuse? - ANSWER Report to CPS In what setting as an inpatient provider should you interview a patient? - ANSWER Use a private room with the door partially open How should you begin your interview with adolescents? - ANSWER By building rapport with them by ensuring confidentiality absent exceptions Should you interview adolescents with or without parents? - ANSWER Without What if an adolescent tells you they are homosexual and they don't want their parents to know? - ANSWER This is confidential The patient is being discharged and would like their labs faxed to the rehab facility. What is your initial action? - ANSWER Get informed consent/ROI What do you do if a medical evaluation is needed? - ANSWER Refer out - this is out of scope What do you do if a patient is takes something and is feeling really funny/unwell in your office? - ANSWER Collect UDS and then refer out Is it considered a mental illness if it is an expected response culturally? What do you offer as treatment? - ANSWER No; brief supportive therapy - not medication A mother states her child is experiencing a cultural illness. What is your initial action? - ANSWER Respect the mother's cultural understanding of illness prior to assessment Native Americans view mental illness and SUDs as? - ANSWER An imbalance between the individual and the world What ethnic group has the highest rate of suicidality in the US? - ANSWER Native Americans If a patient believes they need a healing stick in their room, but the staff nurses removed it from them - what should you do? - ANSWER Teach cultural sensitivity and make accommodations for patient to have healing stick available such as 1:1 Psychoeducation should be based on? - ANSWER Cultural context How do you promote health in a location with multiple ethnicities and education levels? - ANSWER Multiple cultural education and ethnospecific assessment parameters What if a patient wants a traditional healer? - ANSWER Allow this - remember ROI/informed consent Normal TSH? - ANSWER 0.5-5.0 TSH < 0.5 = ? - ANSWER Hyperthyroidism TSH > 5.0 = ? - ANSWER Hypothyroidism Relationship between TSH & T3/T4? - ANSWER Inverse Hyperthyroidism can present as? - ANSWER Mania Hypothyroidism can present as? - ANSWER Depression Normal depakote level? - ANSWER 50-125 Toxic depakote level? - ANSWER 150+ Birth defect caused by depakote? - ANSWER Spina Bifida S/S of depakote toxicity? - ANSWER Disorientation, lethargy, decreased respiratory rate, and N/V What to do if there is depakote toxicity? - ANSWER D/C depakote and check VPA level, LFTs, and ammonia S/S of hepatotoxicity? - ANSWER RUQ pain, reddish brown urine, jaundice, fatigue, and elevated LFTs Normal AST? - ANSWER 5-40 Normal ALT? - ANSWER 5-35 Kava kava can cause? - ANSWER Liver damage and heavy sedation Kava kava is c/i with? - ANSWER Benzos or sedatives Mood stabilizer most associated with SJS? - ANSWER Lamictal Mood stabilizer with least weight gain? - ANSWER Lamictal SGAs with least weight gain? - ANSWER ziprasidone, abilify, and latuda Least sedating SGA? - ANSWER Abilify Routine labs with SGAs? - ANSWER BMI, hip to waist ratio, glucose, A1C, and lipid panel Management of metabolic syndrome with SGAs? - ANSWER 1. Nonpharm = exercise or nutritional counseling 2. Pharm = switch to other SGA with lower chance of metabolic syndrome Carbamazepine can cause? - ANSWER Agranulocytosis and aplastic anemia What should you screen for prior to starting Asians on carbamazepine and why? - ANSWER HLAB1502 Allele; risk of SJS When should you d/c carbamazepine if agranulocytosis is suspected? - ANSWER If ANC is < 1000 with or without s/s of infection Lithium range? - ANSWER 0.6 - 1.2 What to do if lithium is 1.3 or 1.4? - ANSWER Monitor What to do if lithium is 1.5+? - ANSWER D/C Benefits of lithium? - ANSWER Gold standard for mania, neuroprotective, and antisuicidal effects S/S of lithium toxicity? - ANSWER Severe N/V, polydipsia, polyuria, leukocytosis, palpitations, coarse tremor What to do if lithium toxicity is suspected? - ANSWER D/C and check serum levels prior to checking VS Kidney disease and drugs that reduce renal clearance can raise lithium levels. What are these drugs? - ANSWER NSAIDs, ace inhibitors for heart failure (-pril), and thiazides (HCTZ) What demonstrates understanding of education on lithium? - ANSWER Taking extra water with patient when they go hiking NMS s/s? - ANSWER Extreme muscle rigidity, mutism, elevated CPK (muscle contraction and destruction), myoglobinuria (breakdown of muscle cells, rhabdomyolysis), increased WBCs, and increased LFTs Treatment of NMS and MOAs? - ANSWER D/C med, bromocriptine (D2 agonist), and dantrolene (muscle relaxant) Serotonin syndrome s/s? - ANSWER Hyperreflexia and myoclonic jerks Serotonin syndrome causes? - ANSWER SSRIs, SNRIs, MAOIs, -triptans (for migraines like sumatriptan/imitrex) Treatment for serotonin syndrome? - ANSWER D/C med and administer cyproheptadine Wash out from SSRI to MAOI or vice-versa? - ANSWER 14 days Wash out from Prozac to MAOI? - ANSWER 5-6 weeks Drug choice for patient that is depressed and also has cancer? - ANSWER Celexa or lexapro d/t fewer drug to drug interactions Drug choice for patient with low energy and fatigue with depression? - ANSWER Wellbutrin Drug choice for patient with sexual problems d/t medication or depression? - ANSWER Wellbutrin C/I for Wellbutrin? - ANSWER Seizure disorder or hx or present eating disorder Drug choices for patient with chronic neuropathic pain and depression? - ANSWER 1. SNRI (cymbalta) 2. TCA (amitriptyline) 3. Alpha 2 delta ligand (gabapentin or lyrica) Black box warning for SSRIs in children, adolescents, and young adults? Intervention for this? - ANSWER Increased risk of SI; always assess SI, frequency, and severity Alcohol is a form of _______-_________ and a __________ to the treatment of depression. - ANSWER self-medication; barrier Prozac can cause? Intervention? - ANSWER Insomnia; take in AM Disorder that most greatly increases thoughts of self-harm? - ANSWER Depression Disorder that most greatly increases homicidal ideation? - ANSWER Antisocial personality Why is there less evidence available supporting the use of antidepressants in children? - ANSWER Lower placebo rates Schizophrenia age of onset in men? Women? - ANSWER 18-25; 25-35 Findings on PET scan or MRI in schizophrenia? - ANSWER INCREASED ventricle size; DECREASED everything else No stimulants in schizophrenia due to? - ANSWER Increased dopamine release Tertiary prevention for schizophrenia? - ANSWER Social skills training Why should you refer a patient with schizophrenia to exercise programs, especially aerobic exercise? - ANSWER It improves cognition, quality of life, and long term health Benefits of assertive community treatment (ACT)? - ANSWER Rehab post-hospitalization, case management approach, and good for long term hx of noncompliance Oral haldol to IM conversion? - ANSWER 20x daily dose of oral dose Max IM dose of haldol per visit? How long until next injection? - ANSWER 100 mg; 5-7 days 5 mg oral haldol BID = ? IM - ANSWER 200 mg Firm belief that is maintained despite lack of evidence? - ANSWER Delusion Example of a delusion? - ANSWER Believing church members or class members are a cult MSE in preschooler (3-5 yo)? - ANSWER Listen and observe; dependent on clinical observation Thought process? - ANSWER Organization of patients thoughts and ideas Circumstantial speech? - ANSWER Go in circles but eventually answers Tangential speech? - ANSWER Never gets to answer of question Thought content? - ANSWER What themes occupy patient's mind; i.e. SI, HI, and A/VH MMSE also known as? - ANSWER Folstein scale Serial 7s or months backwards assesses patient's? - ANSWER Concentration, attention, and calculation Name 3 objects assesses? - ANSWER Registration Name 3 objects after 5 minutes assesses? - ANSWER Recall/memory Asking patient to name president of governor assesses? - ANSWER Fund of knowledge If a clock drawing test is abnormal this indicates? - ANSWER Right parietal lobe/hemisphere damage What makes SGAs different from FGAs? - ANSWER 5HT2A = less likely to experience EPS SGAs that can be administered IM? - ANSWER Invega, geodon, zyprexa, and abilify Mesolimbic DA pathway? - ANSWER Increased DA leads to + symptoms Mesocortical DA pathway? - ANSWER Decreased dopamine leads to - symptoms Nigrostriatal DA pathway? - ANSWER Decreased dopamine and increased acetylcholine lead to EPS (dystonia, akathisia, and TD) Tuberoinfundibular pathway? - ANSWER Decreased dopamine and increased prolactin lead to amenorrhea, galactorrhea, sexual dysfunction, and gynecomastia Long term increased prolactin causes? - ANSWER Osteoporosis Normal prolactin levels for men? Women? - ANSWER <20; <25 Which CYP450 enzyme metabolizes clozaril? - ANSWER 1A2 Cigarettes are inducers of what CYP450 enzyme? - ANSWER 1A2 Cigarette smoking in patients taking clozaril requires increased or decreased doses? - ANSWER Increased Cigarette cessation in patients taking clozaril requires increased or decreased doses? - ANSWER Decreased Most antibiotics are inducers or inhibitors? Intervention with substrate? - ANSWER Inhibitors; reduce substrate Medications that cause mania? - ANSWER Steroids, antabuse, isoniazid (INH), and antidepressants in patients with bipolar disorder Medications that cause depression? - ANSWER Steroids, accutane, interferon, retrovirals, antineoplastics, BZDs, progesterone, and beta blockers Accutane can cause? - ANSWER Birth defects Steroids can also cause? - ANSWER Psychosis Intervention for patient on flonase or prednisone? - ANSWER Increase mood stabilizer, antidepressant, or antipsychotic based on targeted disorder Neurotransmitters indicated in addiction? - ANSWER Dopamine and GABA S/S of stimulant abuse? - ANSWER Insomnia, anxiety, irritability, tremors, palpitations, increased HR, and increased BP Patients with anorexia complain of pain, bloating, and fullness with eating due to? - ANSWER Delayed gastric emptying Other causes of delayed gastric emptying? - ANSWER Ranitidine, famotidine, and omeprazole Education for patient taking both psychotropics and antacids/PPIs? - ANSWER Take 2 hours apart What to monitor for in older adults on SSRIs? - ANSWER Increased anxiety and hyponatremia Paradoxical effect? Examples? Intervention? - ANSWER Opposite reaction from expected; i.e. BZDs -> increased anxiety or trazodone -> insomnia; avoid med in future Apoptosis? - ANSWER Neuronal loss or cell death Greatest risk factor for bipolar disorder? - ANSWER Family history, it is very inheritable Patient presenting with first manic episode after age 45? - ANSWER Look for medical cause