LMR

Question 1

Osteoporosis risks

Answer 1

-caffeine, smoking
-lack of weight bearing exercises
-lack diet rich in Ca and Vit D

Question 2

What is increased in rheumatoid arthritis?

Answer 2

Erythrocyte Sedimentation Rate

Question 3

What labs should you check with/ macrocytic normochromic anemia?

Answer 3

Vitamin B12 and Folic Acid

(Note: this is a severe form of anemia, RBCs larger than should be

Question 4

What is increased in autoimmune disorders?

Answer 4

Cytokines
(Proteins that effect the immune system)

Question 5

Disseminated encephalomyelitis S/S?

Answer 5

Weakness, paresthesia, *asymmetrical body movement (extremities)
- do neuro exam, this is a neuro d/o w/ inflammation in brain and spinal cord- damages myelin

Question 6

Clozapine is metabolized by____?

Answer 6

CYP1A2* and CYP2B6

Question 7

Limbo system includes:

Answer 7

Amygdala, Hippocampus, thalamus, hypothalamus, basal ganglia, anterior cingulate gyrus

Question 8

Where is Ach synthesized?

Answer 8

Basal nucleus of Meynert

Question 9

Meds that cause Depression

Answer 9

Steroids, beta blockers, interferons, isotrenitoin (Accutane), some retroviral drugs, antineoplastic drugs, benzos, progesterone

Question 10

Lithium S/E

Answer 10

Hypothyroidism, fine hand tremors, GI upset (cramps, V/D, anorexia) diabetes insipidus, polydipsia, polyuria, t-wave inversion, maculopapular rash, Leukocytosis

Question 11

Lithium toxicity

Answer 11

Severe N/V/D, coarse hand tremors, muscle weakness, ataxia, heart palpitations

Question 12

Drugs that reduce renal clearance

Answer 12

NSAIDS, thiazides, ACE inhibitors

-increases concentration of drugs cleared by kidney like lithium

Question 13

Lithium can be increased due to ___ and _____

Answer 13

Hyponatremia and dehydration

Question 14

Signs of hepatotoxicity

Answer 14

RUQ pain, reddish brown urine, yellowing of skin/whites of eyes, fatigue

-if taking depakote: DC depakote and check LFT

Question 15

Signs of depakote toxicity

Answer 15

N/V, lethargy, disorientation, respiratory depression

-DC depakote, check serum dep levels, LFTs and ammonia

Question 16

S/S pancreatitis

Answer 16

Fever, tachy, N/V/ oily stools
Upper abd pain, abd pain radiating to back, tender abd w/out touch

Question 17

Aplastic anemia s/s
(Stop producing new blood cells)

Answer 17

Pallor, fatigue, SOB, HA, fever, skin rash, bleeding gums, nose bleed

Question 18

S/S infection

Answer 18

Sore throat, sudden fever, chills, weakness

Question 19

Alpha delta 2 ligands

Answer 19

Gabalin and pregabalin - can use for chronic pain w/out depression

Question 20

Labs NMS

Answer 20

Increased CPK, LFTs, WBCs (leukocytosis) and myoglobinuria

Question 21

Tx NMS

Answer 21

DC offending agent first
Bromocriptine (Parlodel) =D2 agonist
Dantrolene (Dantrium) = muscle relaxant

Question 22

3 meds that delay gastric emptying

Answer 22

Omeprazole, famotidine, ranitidine

Question 23

Negative symptoms of schizophrenia

Answer 23

Affective flattening, avolition, alogia, anhedonia, apathy, attention deficits, abstract thinking probs

Question 24

DMDD med for severe irritability

Answer 24

Ritalin

Question 25

Signs of stimulant abuse

Answer 25

Insomnia, tremor, heart palpitations, Anxiety, Agitation, irritable, mood swings, increased HR and BP,

Question 26

What med for delirium agitation /psychosis

Answer 26

Low dose Haldol

Question 27

Check what labs of suspect dementia?

Answer 27

B12 and folic acid

Question 28

Inducers

Answer 28

Carbamazepine, tobacco, phenobarbital, phenytoin, St John’s Wart

Question 29

Inhibitors

Answer 29

Grapefruit, SSRIs, bupropion, cimetidine, clomipramide, clarythromycin, fluoroquinolones, nefazodone, kentoconazole,

Question 30

Meds contraindicated with MAOIs

Answer 30

Meperidine, decongestants, TCAs, stimulants, atypicals, St. John’s wart, asthma meds, l-tryptophan

Question 31

HTN crisis S/S

Answer 31

Fever, occipital HA, flushing, sweating, dilated pupils, increased BP

Question 32

HTN crisis tx

Answer 32

DC med phentolamine- brings BP down Stabilize fever

Question 33

S/S lead poison

Answer 33

Development delay, learning difficulties, loss of appetite, weight loss, irritable, sluggish/fatigue, abd pain, V, constipation, hearing loss, pica, seizures

Question 34

Tx EPS except TD

Answer 34

Benztropine (Cogentin)

Question 35

Subcortical

Answer 35

Lack coordination, ataxia, tremors, dystonia Huntington’s, Parkinson’s, HIV

Question 36

Cortical

Answer 36

Language (aphasia) and memory (amnesia) Alzheimer’s and Creutz-feldt Jacob

Question 37

Early signs HIV dementia

Answer 37

Motor (dystonia, tremors, ataxia, loss coordination), cog decline, behavior

Question 38

Hallmarks vascular dementia

Answer 38

Carotid bruits, fundoscopic abnormalities, enlarged cardiac chambers

Question 39

1st line pts psychotic symptoms with dementia

Answer 39

Nonpharm first, then Atypical antipsychotics NO BZNz

Question 40

COWS

Answer 40

N/V/D, muscles aches, insomnia, yawning, piloerection, dilated pupils, anxiety/ irritable, lacrimation, rhinorrhea, sweating

Question 41

Cows start tx at?

Answer 41

7, clonidine >13 give SL suboxone or buprenorphine

Question 42

CIWA

Answer 42

Tremor, paroxysmal sweating, anxiety, agitation, HA, audio/visual/tactile distortions, N/V

Question 43

CIWA start tx at?

Answer 43

8, PRN only >15 scheduled and PRN

Question 44

Tx ETOH

Answer 44

Disulfiram, acamprosate, naltrexone Residential Tx

Question 45

Perjury

Answer 45

Lying under oath

Question 46

Perjury

Answer 46

Lying under oath

Question 47

Rights of pt

Answer 47

Least restrictive environment, informed consent, confidentiality

Question 48

4 components health policy

Answer 48

Process, policy reform, policy environment, policy makers

Question 49

Rennie v Klein

Answer 49

Right to refuse psychotropic meds

Question 50

Rennie v Klein

Answer 50

Right to refuse psychotropic meds

Question 51

Tarasoff

Answer 51

Duty to warn, diff per state, check with state BON

Question 52

Suicide risk factors

Answer 52

Male >45, female >55, male, white, single/divorced/separated, living alone, psych or physical illness substance abuse, previous suicide attempt, fam hx suicide, recent loss

Question 53

Greatest risk bipolar

Answer 53

Fam hx across multiple generations

Question 54

Med approved for bulimia

Answer 54

Prozac

Question 55

Anorexia s/s

Answer 55

Low BMI, emaciated, amenorrhea, bradycardia, hypotension, t-wave inversion, prolonged QT interval Hospitalize if BMI <15

Question 56

S/s discontinuation syndrome SSRI

Answer 56

Flu-like: fatigue, lethargy, myalgia, N/V, decreased concentration, impaired memory, paresthesias, shock-like sensations, anxiety, irritable, insomnia, crying, dizzy Occurs 24-72 hrs, resolve 1-14 days

Question 57

Contraindications ECT

Answer 57

Heart disease, compromised pulmonary status, hx head injury/tumor, anesthesia complications

Question 58

Adverse effects ECT

Answer 58

Arrhythmias, headache, drowsiness, myalgia, memory disturbance, confusion

Question 59

Labs in ETOH

Answer 59

Increased GGT, MCV, PT, uric acid, total cholesterol, triglycerides AST/ALT ratio greater than 2 Decreased Ca, Mg, K, BUN, albumin, platelets, hematocrit, hemoglobin

Question 60

4 dimensions recovery

Answer 60

Health home purpose community

Question 61

Increased ach

Answer 61

Teary eyes, salivation, diarrhea

Question 62

Other med that can cause EPS

Answer 62

Metoclopromide (Reglan)

Question 63

Serotonin syndrome Tx

Answer 63

Cyrpoheptadine

Question 64

SS Tx

Answer 64

Cyrpoheptadine

Question 65

Other med that causes SS

Answer 65

Triptans like sumitriptan (imitrex)

Question 66

FDA approved panic d/o

Answer 66

Prozac, Paxil, Zoloft Effexor

Question 67

Pharm Tourette’s

Answer 67

Atypicals Haldol, Pimozide, abilify Guanfacine/clonadine for impulse/rage control SSRI