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Maryville Nurs 663 Exam 1 Study Guide
1. Lithium labs: level, NA, Ca, P, EKG, Creatinine, Urinalysis, CBC, TSH
2. bipolar meds: depression: lurasidone (13+), olanzapine + fluoxetine (10+)(sym- byax)
3. bipolar acute and mixed mania: aripiprazole, risperidone, olanzapine (13+),
quetiapine (acute only), asenapine (10+)
4. classic mood stabilizers: Lamotrigine (excellent medication to use), lithium,
Depakote (avoid in females if possible due to PCOS and Pregnancy), Tegretol, Trileptal (no evidence for true Bipolar disorder)
5. anti-depressants: class not used w/bipolar disorder
6. lithium: Anti-manic, antidepressant, anti-suicidal
7. Lithium side effects: Frequent urination, increased thirst, weight gain, sedation
8. lithium toxicity: sudden onset tremors, N/V/D, muscle weakness, slurred
speech, confusion, seizures (slowing down, feel really out of it)
9. Major Depressive Disorder Dx: 5+ for at least a 2-week period; either #1 or 2 req
1. Depressed mood most of the day, nearly every day (can be irritability in children &
adolescents)
2. Diminished interest or pleasure in all, or almost all, activities
3. Change appetite/weight; kids not wt goals
Insomnia or hypersomnia nearly every day
4. Up or down Psychomotor
5. Fatigue or loss of energy
6. Worthlessness/excessive or inappropriate guilt
7. Diminished ability to think or concentrate, or indecisiveness (don't confuse with
ADHD, address mood first)
8. Recurrent thoughts of death, thoughts of suicide, or suicidal plan/intent: if hosp
then 2 wk not req.
10. SLAP: Social supports; lethal; access to means; plan and previous attempt
11. Suicide risk: IS PATH WARM: Ideation, substance abuse, purpose to live gone;
anxiety, trapped feeling; hopelessness, w/d from soc supports, anger w/rage; reck- less, dramatic moods
12. SIGECAPS: Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychomo- tor,
Suicide
15. Mania: elevated, expansive, energetic + 3, (unless irritable
mood then requires 4+)
1. SX Lastat least one week-any duration if hosp
2. Inflated self-esteem, grandiosity
3. Decreased need for sleep
4. More talkative, pressure to keep talking
5. Flight of ideas or racing thoughts
6. Distractibility: r/o ADHD (constant) intermit w/BD
7. Increase in goal-directed activity
8. Risky, impulsive behaviors (sex, money, pot for harm)
16. hypomania vs mania: a milder form of elevated mood that are less severe and cause
less impairment than and (usually) don't require hospitalization
17. Mania impairment: severe in work, social activities, or relationships or to neces- sitate
hosp or there are psychotic features
18. Hypomania impairment: cause a change in functioning but not severe
19. Mood disorder r/o: No symptoms can be due to a substance or general medical
condition
20. SNRI mechanism of action: Inhibit reuptake of both serotonin and norepineph- rine
21. Anti-depressant education: Always teach the Black Box warning for incr SI risk up to
24 y/o.
22. Third generation anti-psychotics (TGA): Abilify, Vraylar and Rexulti--partial
dopamine agonists
23. metabolic syndrome: A syndrome marked by the presence of three or more of a
group of factors: high blood pressure, abdominal obesity, high triglyceride levels, low HDL levels, Elevated BG Decreased insulin sensitivity
24. metabolic syndrome tx: assess family hx for diabetes Start
metformin prophylactically
25. CBT: Anxiety and depression
Change behavior to change thoughts and feelings Highly
31. Pregnancy risks for meds: SSRIs generally okay
Depakote: for any woman of child bearing age Mood stabilizers: cardiac anomolies, neural tube defects Drugs in 3rd tri rarely teratogenic
32. Lithium uses: 1. manic episodes of manic-depressive illness
2. maintenance treatment for manic-depressive pts with a hx. of mania
3. bipolar depression
4. MDD (adjunctive)
5. treatment -resistant depression
6. Reduces suicide risk
7. Works well in combination with atypical antipsychotics and/or mood stabilizing
anticonvulsants such as valproate
33. lithium common SE: 1. tremor, ataxia, dysarthria, delirium memory problems
2. polyuria, polydipsia,
3. diarrhea, nausea, vomiting
4. Weight gain
34. Lithium: Life-Threatening SE's: 1. toxicity
2. Renal impairment
3. Nephrogenic diabetes insipidus
4. Arrhythmia, CV changes, sick sinus syndrome, bradycardia, hypotension, T-wave
flattening and inversion
5. rare seizures
35. Lithium mgmt: 1. Lower the dose
2. Take at night
3. Change to different preparation (e.g. controlled-release)
4. Reduce dosing from TID to BID
5. If toxicity symptoms- DISCONTINUE
6. Stomach upset- take with food
7. Tremor- avoid caffeine
8. May need to switch to another agent
36. Lithium lab monitoring: frequent levels-every 1-2 weeks until de-
sired serum concentration achieved, then every 2-3 months for 1st 6 months, then every 6-12 months if remains stable
37. lithium range: 1.0-1.5 mEq/L for acute treatment and 0.6- 1.2 mEq/L for chronic
39. Suicide evaulation: 1. Is there active plan?
2. Any steps towards activation (accessed gun),
3. given away possessions, completed un nished tasks,
4. comments to peers/others: no longer being around
5. said "goodbye" or written notes
40. Child Mania Rating Scale: 1. 21-item to identify symptoms of mania in children and
adolescents aged 9-
- assesses the child's mood and behavior symptoms, asking parents or teachers to rate how often the symptoms have caused a problem for the youth in the past month
41. PHQ-9: 1. "over the last 2 weeks". assesses interest, mood/hopeless, energy, sleep,
apetite feeling bad, psychomotor, passive/active SI. #10 is how difficult have any checked probs made if for you to do work, take care of home, get along w/other.
2. rating: 2-4 shaded section checked consider, other depressive; 5 or more check in
shaded area consider MDD.
3. Used initially and to monitor improvements over time and response to tx interven-
tions.
42. Common comorbidity r/t bipolar: 1. Anxiety (panic disorder, OCD, phobias, and
post-traumatic stress disorder are also common in this group),
2. ADHD,
3. substance abuse,
4. metabolic syndrome: affects 1:5 to 1:
5. obesity 3/4 people are overweight: high levels of cortisol
6. personality disorders: 1:3 cluster B
7. ASD: 1:3 comorbid w/
43. Bipolar risk factors for bipolar: 1. more common in high-income than low
income countries.
2. Separated, widowed, divorced persons higher risk for bipolar I but not sure why.
3. genetic and physiological: family history is one of the strongest and most
consistent risk factors; Magnitude incr with incr of kinship. Schizophrenia and share genetic origin: co-aggregation of both in families.
4. Responses to trialed SSRIs (NOT a dx confirmation)
4. comorbid substance use
5. Anxiety disorder
44. bipolar and females: more likely to experience rapids cycling and mixed states and
more likely to experience depression
6. Increase prolactin; med dependent--high for risperdal lower for others
51. Depressive Disorder Due to Another Medical Condition: medical condition with
depression causing clinically significant distress or impairment in social, occu- pational, or other important areas of functioning.
52. Substance/Medication-Induced Depressive Disorder: direct result of a sub- stance
(e.g., a drug of abuse, a medication, or toxin exposure) and causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
53. premenstrual dysphoric disorder: markedly depressed mood, excess anxiety, mood
swings, and decreased interest in activities during the week prior to menses, improving shortly after the onset of menstruation, and becoming minimal or absent in the week postmenses
54. Persistent Depressive Disorder (Dysthymia): Depressed mood occurring most of
the day, more days than not, for at least 2 years, or at least 1 year in children and adolescents No psychotic sx
55. MDD with seasonal pattern: episodes that occur at characteristic times of the year.
Commonly, fall or winter months, and remit in the spring. Less commonly, there may be recurrent summer episodes
56. MDD with psychotic features: includes the presence of delusions and/or hal-
lucinations.
57. MDD with anxious distress: Feelings of restlessness, anxiety, and worry ac-
company the mood.
58. MDD with mixed features: accompanied by intermittent symptoms of mania or
hypomania.
59. MDD with melancholic features: profound despondency and despair. There is an
absence of the ability to experience pleasure and expression of feelings of excessive or inappropriate guilt. Psychomotor agitation or retardation and anorexia or weight loss are evident
60. MDD with atypical features: Includes the ability for cheerful mood when pre-
sented with positive events. There may be increased appetite or weight gain and hypersomnia. Additional symptoms include long-standing sensitivity to interpersonal rejection and heavy, leaden feelings in the arms or legs
61. MDD with catatonia: accompanied by additional symptoms associated with
catatonia (e.g., stupor, waxy flexibility, mutism, posturing
62. MDD with peripartum onset: occurs during pregnancy or in the 4 weeks
nature
4. One is more agitated; the other is more hyperactive
5. One is pressured/diff to stop/may not make sense; the other is just hypertalkative
6. One may not need sleep; the other usually not impaired sleep
66. SSRIs starting doses: Prozac 10mg
Sertraline 25mg Lexapro 5mg
67. SSRI side effects: insomnia or sleepiness, sexual dysfunction, and weight gain.
68. Lamotrigine MOA: blocks voltage gated sodium channels
69. Lithium mechanism of action: Not established, possibly related to inhibition of
phosphoinosital cascade
70. Bipolar vs ADHD: same: irritability, hyperactivity, restlessness, impulsivity, op-
positional, increased energy
71. Sedation: SGAs; worst to best: Quetiapine, clozapine, olanzapine, asenapine,
ziprasidone, risperidone, paliperidone, lurasidone, iloperidone, aripiprazole
72. SGA EPS risks worst to best: risperidone, paliperidone, ziprasidone, olanza- pine,
lurasidone, asenapine, aripiprazole, quetiapine iloperidone, clozapine
