From ANCC Review
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| ethical and legal considerations | make accurate diagnosis and identify target symptoms.
phase of illness is important
determine prior personal and family history of response to certain drugs
consider risk to benefit ratio
monitor response and side effects
document
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| these things are important to document | informed consent
patients understanding of target symptoms
benefits
risks
alternatives
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| Prescribing should be done | in accordance with state and federal regulations and based on clinical indicators
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| Monitoring includes that | the effect of the medication is evaluated by target symptom remission
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| Managing includes this | provides information on risks, benefits and adverse effects, treat SE when necessary
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| Evaluating includes this | evaluate therapeutic and potential adverse effects of medication. Make changes in treatment based on evidence.
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| Pharmocologic Interventions includes | Prescribing
Monitoring
Managing
Evaluating
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| Pediatric diagnoses can be | atypical, constantly changing and unusually comorbid with other psychiatric disorders
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| With kids be aware of this | psychosocial aspects related to drug taking
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| Hepatic capacity, glomerular filtration and fatty tissue for children | greater hepatic capacity
more GFR
less fatty tissue
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| Kids are less able to store drugs in fat so | they have quicker elimination and shorter half lives
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| Lithium and anticonvulsants in kids | may take longer to work and are not effective
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| Most malformations in pregnancy occur during this period | embryotic period
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| the embryotic period occurs at | 3rd to 8th week of gestation
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| positive pregnancy tests are possible at weeks | 4-7
may be past window of teratogenic risk
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| No behavioral toxicity found in children exposed to this prenatally | fluoxetine
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| Depakote in pregnancy leads to | neural tube defects
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| Lithium in pregnancy leads to | Epstein's Anomaly
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| Epstein's Anomaly is | congenital defect displacing tricuspid valve
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| these may be safer than mood stabilizers | atypical antipsychotics but they are not well studied
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| To prevent 1st trimester exposure, recommend this | birth control
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| Recommend to pregnant women | avoid substances of abuse
encourage iron and folate
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| During 3rd semester, consider this | antidepressant prophylaxis against postpartum depression in women with a history of depression
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| This antidepressant is Preganancy Category | D
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| Question to ask with tx of women | what are you using for birth control
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| These psychotropics are secreted in breast milk | ALL OF THEM
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| Postpartum time period is | within 4 weeks of delivery
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| Postpartum time is a high risk time for | onset or relapse of psychiatric illnesses
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| Postpartum: NPs should watch for and consider | watch for psychosis: risk of harm
consider impact of untreated illness on maternal infant attachment
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| These medications are good for use with postmenopausal women | Estrogen replacement plus SSRI or SNRI effective for maintenance and prevention of recurrence of depression
Menopause is another risk period
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| Why are geriatric patients susceptible to adverse effects | cardiovascular disease and reduced cardiac output can affect both renal and hepatic drug clearance
lower cholinergenic output results in an increased risk for anticholinergic toxicity
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| Which risks are the highest for geriatric pts | cardiovascular risks - increases risk when using drugs with cardiovascular effects - TCAs, increased risk of orthostatic hypotension and falls
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| Consider this for elderly | More susceptible to adverse effects
metabolize drugs more slowly and require lower doses
have other medical problems and therefore potential drug interactions
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| Why do elderly people need lower doses and metabolize drugs slowly | lean body mass decreases and body fat increases
lipid soluble psych drugs are distributed more widely in fat tissue so the drugs action can be unexpectedly prolonged
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| Elderly people may have GI issues | GI disease and decreased gastric acid secretion may slow absorption
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| Hypertensive crisis in elderly is associated with | MAOI and tyramine ingestion
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| This is used with to treat hypertensive crisis | phentolamine (Regitine)
alpha adrenergic blocker
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