quizletpmhnp (1)

Medication Interactions and Considerations

• ACE Inhibitors and ARBs: Should not be used together.

• Ibuprofen + Lithium: Increases serum lithium levels significantly (up to double).

• Tegretol Interactions:

  • With Cipro and Erythromycin, which are inhibitors, can increase Tegretol levels (black box warning).

  • Should monitor levels and adjust doses accordingly.

• NSAIDs & ACE Inhibitors: Can double lithium levels.

Neurological and Psychiatric Considerations

• 5HT (Serotonin): Originates from the raphe nucleus.

• Adolescent without Axillary Hair and No Period: Normal Tanner stage; should start by age 16.

• Teenage Substance Abuse: Muscular aches, red urine (hematuria) concerning for rhabdomyolysis.

• Schizophrenia Age of Onset in Females: Commonly between 25-35 years.

• Aggression and Brain Structure: Increased amygdala stimulation correlates with enhanced aggressive behavior.

• Anorexic Teen with Eating Pain: Delayed gastric emptying due to refeeding syndrome.

• Apoptosis: Neuronal loss due to enzyme breakdown; linked to suffocation effects.

• Autistic Child Communication: Normal to not respond to verbal commands; common traits include repetitive behaviors and impaired interactions.

Psychological Assessments and Scales

• Beck Inventory: Score of 10 indicates mild depressive symptoms; rates over 30 severe. Therapy recommended over medication initiation.

• GAD-7 Scale: A score above 15 indicates severe anxiety.

• Hamilton Anxiety Scale: 14 mild, 18-24 moderate, 25-30 severe anxiety.

• MMSE Scores:

  • 24-30: No cognitive impairment

  • 18-23: Mild cognitive impairment

  • 0-17: Severe cognitive impairment.

Treatments and Therapy Models

• Best Therapy for Negative Thinking: CBT (Cognitive Behavioral Therapy) is effective.

• Bipolar Patients Not Taking Medication: Encourage patients to articulate how medication functions in their body.

• DBT (Dialectical Behavior Therapy): Recommended for borderline personality disorder to manage emotional reactivity.

• Therapeutic Communication: Utilize open-ended questions to facilitate discussion with reluctant patients.

Mental Health Conditions and Their Management

• Acute Stress Disorder vs. PTSD: Acute stress occurs within a month of the event; PTSD develops after one month.

• NMS (Neuroleptic Malignant Syndrome): Symptoms include fever, rigidity, and autonomic instability; treatment may involve Dantrolene or Bromocriptine.

• Conversion Syndrome: Psychological conflict can manifest as physical paralysis.

Child Development and Anomalies

• Klinefelter's Syndrome: Male with XXY chromosomes; often results in infertility issues.

• Rett Syndrome: Neurodevelopmental disorder mainly in females; signs include loss of milestones, hypotonia, and reduced eye contact.

• Developmental Expected Reflexes:

  • Moro reflex until 4 months

  • Palmer and Plantar reflexes until 4 and 8 months respectively.

Clinical Assessments

• Signs of Serumim Syndrome: Symptoms include shivering, sweating, and hyperthermia.

• Substance Abuse Assessment: Check for symptoms including insomnia, irritability, and hypertension in patients abusing stimulants.

• Patient Restraint Assessment Frequency: Patients in restraints should be assessed face-to-face every 1 hour, then every 8 hours.

Other Notable Considerations

• New Independent Practice Considerations: Assess costs and revenue, ensuring adequate patient time management.

• Reticulocyte Count Test Importance: Essential in evaluating conditions affecting RBCs; low count indicates various anemic conditions.

Laboratory Evaluations

• Labs for Macrocytic Anemia: Check folic acid, vitamin B12 and others.

• Labs for Lithium Patients: Watch for protein in urine, leukocytosis, creatinine, Na levels.

Regulatory and Policy Aspects

• Health Care Policy Components: Include access, cost, and quality control.

• Parity Laws: Ensure equal financial treatment in mental health care.

Closing Notes

• Understanding Serotonin Syndrome: Acknowledge risk factors such as multiple SSRIs and certain drugs like tramadol and demerol that can increase serotonin levels leading to adverse events.