Carbamazepine Prescribing Risks

Naloxone Allergy Verification

The PMHNP has assumed care of a 32-year-old patient who is being managed for opioid use disorder with buprenorphine-naloxone 8.2 mg films t.i.d.  The patient’s previous provider has moved out of state and no records are immediately available, the only information available is from the prescription monitoring program. The patient request to be treated with a buprenorphine-only formulation because he says that the he is allergic to naloxone. The NP considers which of the following? Choose all that apply.  A. Naloxone allergy is extremely rare and more likely any adverse reaction was due to precipitated opioid withdrawal B. It is never appropriate to use buprenorphine without naloxone when it is being used for OUD.  C. Because the PMP shows that he has been prescribed a buprenorphine-naloxone combination for the last year is not possible that he is allergic. D. It is easier to misuse buprenorphine without the naloxone component and the NP should evaluate for misuse.

Postural Intention Tremor Evaluation

A 27-year-old female patient presents for a follow-up appointment for generalized anxiety disorder. She has a complex history including polysubstance use disorder and borderline personality disorder, but she had been doing well. She achieved remission of her symptoms over one year ago and has been well managed on escitalopram 10 mg daily. She has been substance free for over one year, and is in therapy for her personality disorder. Today she is not feeling well. She reports some major psychosocial stressors and a brief substance relapse, but she stopped using all substances 2 days ago.   The PMHNP notes a pronounced postural and intention tremor and suspects this is due to withdrawal from which of the following substances?  A. Kratom  B. Opioids  C. Marijuana  D. Alcohol  --- YouTube: https://www.youtube.com/watch?v=16Vg_4HFG1A&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=122 [https://www.youtube.com/watch?v=16Vg_4HFG1A&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=122]

Carbamazepine Prescribing Risks

The PMHNP is managing a patient of Chinese ancestry with a diagnosis of bipolar disorder. The patient is currently experiencing some symptoms consistent with an early manic episode.  When considering prescribing carbamazepine, the NP considers that this patient is at particular risk for which of the following adverse effects?  A. Drug-induced hepatitis  B. Pancreatitis  C. Hypothyroidism  D. Toxic epidermal necrolysis --- YouTube: https://www.youtube.com/watch?v=5MaExNnaFDM&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=121 [https://www.youtube.com/watch?v=5MaExNnaFDM&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=121]

Antipsychotic Adverse Reactions

The PMHNP is called to the emergency department to evaluate a patient with an acute onset mental status change. The patient has a long history of schizophrenia and has been managed on a variety of antipsychotic therapies that have had some success, but the patient has not ever really achieved goal remission.  Most recently he was started on a first generation antipsychotic along with benztropine (Cogentin). Today the patient is in the ED with confusion and muscle stiffness.  Which of the following represents anticipated vital signs? A. T 103.5o F, P 54 bpm, RR 24 bpm, BP 150/100 mm Hg  B. T 102.5o F, P 129 bpm, RR 22 bpm, BP 170/110 mm Hg  C. T 96.4o F, P 60 bpm, RR 24 bpm, BP 190/120 mm Hg  D. T 98.6o F, P 102 bpm, RR 18 bpm, BP 147/99 mm Hg  --- YouTube: https://www.youtube.com/watch?v=9emyKQQhmYc&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=120 [https://www.youtube.com/watch?v=9emyKQQhmYc&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=120]

Major Neurocognitive Disorder Causes

The PMHNP is evaluating a 73-year-old patient who has just been discharged from the hospital after being treated for a urinary tract infection with associated delirium. She has a baseline major neurocognitive disorder and the spouse has been told in the past that the patient cannot take antipsychotics. However, while she was hospitalized she was given an antipsychotic for delirium and it seemed to help a lot. The spouse wants to know why the patient cannot take an antipsychotic for her chronic behavioral symptoms.  The PMHNP knows that the patient most likely has which underlying cause of major neurocognitive disorder?  A. Pick’s disease (FTD) B. Alzheimer’s disease (AD)  C. Vascular disease (VaD)  D. Parkinson’s disease (PD)