What drugs should be avoided with Kava Kava? Alprazolam CNS depressants (e.g., phenobarbital, zolpidem) What is the normal range for TSH? 0.5 - 5.0 mu/L What are lab values in Hyperthyroidism Decreased TSH Increased T4 and T3 What are labs in Hypothyroidism? Increased TSH Decreased T4 and T3 What are 5 primary symptoms of Hyperthyroidism? Heat intolerance Agitation, Anxiety, Irritability Tachycardia Mood swings Weight loss What are 4 primary symptoms of Hypothyroidism? Cold intolerance Lethargy Weight gain Decreased libido Hypothyroidism mimics symptoms of what psychiatric disorder? Depression Hyperthyroidism mimics symptoms of what psychiatric disorder? Mania Valproic acid produces what teratogenic effect? Spina bifida (neural tube defect) What is the primary organ where valproic acid is toxic? Liver (hepatoxicity) What are 4 signs of hepatoxicity? Abdominal pain in the URQ Reddish-brown urine Yellowing of the skin and sclera Fatigue What is the therapeutic range for valproic acid? 50-125 mcg/ml What is a toxic level of valproic acid? >150 mcg/ml What are 4 signs of valproic acid toxicity? Disorientation Lethargy Respiratory depression Nausea/vomiting A pt on Depakote C/O Abdominal pain in the URQ and Reddish-brown urine. What do you suspect? What do you do? Hepatotoxicity; hold med, draw LFT's (priority), DVP level With suspected toxicity with valproic acid, what steps/labs should be drawn? D/C drug Check drug level Obtain LFTs Obtain ammonia level A pregnant pt is taking accutane, zyprexa and abilify; what med needs to be d/c'd? Accutane (used for acne; Causes birth Defects!!!) What herbal supplement is used for anxiety, stress, and insomnia? What is the major side effect with Kava Kava? Kava Kava liver damage What are 5 symptoms of Stephen's Johnson Syndrome? Fever -Key sx to suspect SJS; high yield (HY) burning of mouth/eyes -HY Body aches Severe red rash Peeling skin Facial and tongue swelling Which mood stabilizer causes the least weight gain? Lamotrigine (Lamictal) Which 3 SGAs cause the least weight gain? Lurasidone (Latuda) Aripiprazole (Abilify) Ziprasidone (Geodon) Which SGA is the least sedating? Aripiprazole (Abilify) Your pt is taking Kava and you need to add an AS to manage their SCZ, which do you add? Aripiprazole (least sedating) What are 2 hallmark symptoms of delirium? Acute onset disturbance of LOC impaired cognition inattention How are agitation and psychotic symptoms treated in delirium? Low dose Haldol (QTc check first) 16 y/o C/O feeling funny after inhaling Acetone (nail polish remover). What is your action? Do UDS; chances are they may be abusing other substances What 4 drugs can cause mania? "SAID" Steroids Antidepressants (in BPD) Isoniazid (INH) Disulfiram (Antabuse) What 6 drugs can induce depression? "SIP BARB" Steroids Interferon, Progesterone Beta blockers Accutane, (Isotretinoin) Retroviral drugs, Antineoplastic drugs Benzodiazepines Steroids can induce what 3 psychiatric states? Mania Depression Psychosis REMEMBER SAFETY FIRST; pt s/p assault, 1st thing you do is_____. What is the best environment to interview this pt in? reassure safety, provide environment of safety private area with door open/partially open What is the therapeutic range for lithium? 0.6-1.2 mEq/L Many postpartum women have SI after delivery, yet they don’t have psych evals before leaving the hospital, what could a possible solution be? collaborating care between psych and OBGYN to provide the best care for that pt If collaborating with a provider who is not in the same clinic or hospital, the informed consent [does/does not] apply? Does not, ie pt will need to sign consent for labs/ chart to be sent When discharging from inpatient you want [to fax/print off-give to pt.] labs for the outpatient provider before pt discharge? fax; so the new provider has them for follow-up appointment Before referring a pt out or discharging them, it is good to ask yourself what question? is there something that I could do for this patient first? What 3 things are MUST KNOWS about Lithium? has neuroprotective effect for bipolar disorder the gold standard for treating manic episodes the mood stabilizer w/ anti-suicidal effects What mood stabilizer has anti-suicidal effects? Lithium What 5 labs should be drawn with lithium? Thyroid panel (TSH) Serum creatinine BUN Urinalysis HCG What is a normal SerumCr range? 0.6-1.2 mg/dL What is the normal range for BUN? 10-20 mg/dL When should you suspect kidney disease with a urinalysis?