ANCC Certification PMHNP Chapter 7 (Latest 2023/2024) Rated A+, Exercises of Nursing

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ANCC Certification PMHNP Chapter 7 (Latest 2023/2024) Rated A+ Mood Disorders - Answer- Most common psych illnesses Primary characteristic is persistent disturbance in mood - Answer- Major Depressive Disorder Often occurs without precipitating event - Answer- MDD Object loss theory - Answer- Fairbairn, Winnicott & guntrip Aggression turned inward theory of MDD - Answer- Freud Cognitive Theory - Answer- Beck When questions ask for a priority action...think about... - Answer- ABC, airway breathing, circulation Maslows hierarchy If undecided on an answer due to high similarities, choose: - Answer- the umbrella answer What is the most common side effect of olanzapine/zyprexa - Answer- metabolic syndrome what is the difference between typical and atypical antipsychotics - Answer- Atypical 5HT2A specific 1st psychotic break... two actions to take - Answer- UDS and r/o sub Consider IM Geodon or Invega Learned Helplessness-Hopelessness Theory - Answer- Seligman Genetic predisposition - Answer- Strong genetic load for depression for child of depressed parent -having 3 fold increase in lifetime risk of MDD & 40% chance of depressive episode before age 18. Endocrine dysfunction Theory - Answer- Probably related to etiology of MDD Sleep disturbances, appetite disturbances, libido disturbances, lethargy, anhedonia are neurovegitative symptoms that are related to functions of the - Answer- Hypothalamus and pituitary gland secretions Endocrine dysfunction and pregnancy - Answer- A high incidence of postpartum mood disturbances is suggested with this piaget 11 and up - Answer- formal operations logical and abstract algebra etc primary prevention example - Answer- screening and community education secondary prevention - Answer- crisis intervention hotlines disaster response tertiary prevention - Answer- rehab active treatment Hypothalamic-pituitary-adrenal axis (HPA) - Answer- A theory of MDD, may be a result of an abnormal stress response related to dysregulation of this system HPA axis - Answer- Controls the physiological response to stress and is composed of interconnective feedback pathways between the hypothalamus, pituitary gland, and adrenal gland. Hypothalamus releases - Answer- corticotropin-releasing hormone (CRH) Adrenocorticotropin hormone (ACTH) - Answer- Released by pituitary in response to CRH by hypothalamus Episodes of MDD do not vary - Answer- Not true. Disease course is variable and can involve isolated episodes separated by many years, clusters of episodes or a severe episode with some remission of symptoms but with chronic symptoms persisting over time. If untreated an episode of MDD - Answer- Usually lasts 4 months or longer Major Depressive Disorder - Answer- Tends to be a chronic, recurrent illness One year after initial diagnosis - Answer- 40% of patients are symptom free Risk of future episodes of MDD: - Answer- First episode = 60% risk of 2nd Second episode = 70% risk of 3rd Third episode - 90% risk of 4th Name 4 risk factors for MDD - Answer- Family history (esp first degree relative); prior episode, female gender, postpartum period, medical comorbidity; single marital status; significant environmental stressors, esp multiple losses Four to six weeks: - Answer- Length of time for therapeutic effect of antidpressants Appearance, speech, affect, mood, thought process, thought content (including suicidal thoughts/behaviors); cognition, orientation, memory, concentration, abstraction, judgment - Answer- Mental Status Exam Endocrine Disorders implicated in MDD - Answer- Hypothyroidism, DM, hyperaldosteronism, and Cushing's/Addison's Disease Infectious and inflammatory states implicated in MDD - Answer- Mono, AIDS, viral and bacterial pneumonia; systemic lupus erythematosus, temporal arteritis, tuberculosis Nutritional disorders implicated in MDD - Answer- Pernicious anemia and pellagra Psychiatric disorders commonly associated with MDD - Answer- Anxiety disorders, eating disorders, Bipolar disorder, substance abuse/dependence disorders One should continue use of antidepressants for a minimum of - Answer- 8-12 months If patient has prior episodes of depression, than consider using antidepressants - Answer- For longer than 8-12 months Medication and counseling - Answer- Research demonstrates that the most effective intervention is a combination of these two treatment modalities Action primarily to increase serotonin levels in CNS by inhibiting their reuptake: - Answer- Selective Serotonin Reuptake Inhibitors (SSRIs) Elevate serotonin and norepinephrine levels primarily by inhibiting their reuptake - Answer- Tricyclic Antidepressants (TCAs) Elevate serotonin and norepinephrine levels primarily by inhibiting MAO, the enzyme that destroys neurotransmitters - Answer- Monoamine Oxidase Inhibitors (MAOIs) Serotonin Norepinephrine Reuptake Inhibitors (SNRIs) - Answer- Inhibit dual reuptake; action very selective on neurotransmitters; elevate serotonin and norepinephrine levels by inhibiting their reuptake. Norepinephrine Dopamine Reuptake Inhibitors (NDRIs) - Answer- Inhibit dual reuptake; action very selective on neurotransmitters; elevate dopamine and norepinephrine levels by inhibiting their reuptake. Serotonin Agonist and Reuptake Inhibitors (SARIs) - Answer- Dual action; agonist of serotonin 5HT-2 receptors; action very selective on neurotransmitters; elevates serotonin levels by inhibiting serotonin reuptake SSRIs side effects - Answer- Most common side effects of this class: gi upset, sexual dysfunction, nervousness, headache and dry mouth Name the six SSRIs - Answer- Celexa, Lexapro, Prozac, Luvox, Paxil (Pexeva), Zoloft. Which is safer in overdose, Paxil or Nortriptyline? - Answer- Paxil. SSRIs are safer in overdose than TCAs. SSRI's are also effective for treatment of panic disorder, OCD, bulimia, GAD social phobia and - Answer- PTSD and premenstrual dysphoric disorder Which SSRI has long half-life? - Answer- Prozac Two SSRIs have potential for teratogenic effects, name them. - Answer- Paxil and Zoloft This SSRI has a black box warning for liver toxicity. - Answer- Luvox GI upset, sexual dysfunction, nervousness, headache and dry mouth are common side effects associated with... - Answer- SSRIs Second line drugs for treatment of MDD: - Answer- Tricyclic Antidepressants (TCAs) The side effect profile for TCAs - Answer- Dirty side-effect profile Dirty side effect profile contributes to - Answer- Poor patient compliance Anticholinergic dirty side effects associated with TCA's: - Answer- Dry mouth, blurred vision, constipation, memory problems. Caused due to muscarinic receptor blockade. Antiadrenergic dirty side effects associated with TCAs: - Answer- Orthostatic hypotension (from alpha 1 receptor blockade) Antihistaminergic dirty side effects associated with TCAs: - Answer- Sedation and weight gain from histamine receptor blockade Cardiac side effects associated with TCAs: - Answer- EKG changes and cardiac dysrythmias MAOI, generic selegiline - Answer- Ensam MAOI, generic isocarboxazid - Answer- Marplan MAOI, generic phenelzine - Answer- Nardil MAOI, generic tranylcypromine - Answer- Parnate No dietary restrictions with 6 mg dosage - Answer- Ensam transdermal patch (Restrictions needed for 12 mg patch) MAOI also used for panic disorder, phobic disorders, and selective mutism - Answer- Marplan, Nardil and Parnate. Oral MAOIs should be given in _______doses. - Answer- Divided doses, bid and qid. Two SNRIs: - Answer- Effexor and Cymbalta NDRI: - Answer- Wellbutrin Wellbutrin and Wellbutrin XL dosing: - Answer- 150-450 mg daily. Headache, nervousness, tremors, tachycardia, insomnia, decreased appetite are side effects from: - Answer- Wellbutrin, an NDRI antidepressant Wellbutrin, bupropion, is also used for ADHD and ___________. - Answer- Smoking cessation. Wellbutrin SR requires _______ __________. - Answer- BID dosing. Wellbutrin can increase: - Answer- Energy level Wellbutrin in contraindicated in patients with eating disorders and ___________. - Answer- Seizures. Dosing for Wellbutrin SR: - Answer- 150-400 mg/day Remeron has an ________ relationship between dosage and sedation. - Answer- Inverse Must monitor LFT's with this antidepressant. - Answer- Serzone (nefazodone) Most commonly used as hypnotic; not well tolerated at antidepressant dosage due to sedation; may potentially prolong QTc interval. - Answer- Trazodone (Desyrl) (an SARI) Can raise BP and is a potent inhibitor of cyp450 system; safer in overdose than TCAs - Answer- Effexor (an SNRI) Effexor should be tapered when stopping the drug due to... - Answer- Significant discontinuation syndrome Could possibly elevate LFTs, can possibly elevate BP, usually given once daily, an SNRI that is helpful in pain control: - Answer- Cymbalta There is strong potential for discontinuation syndrome with Cymbalta so the drug - Answer- Should not be stopped abruptly Non-pharmacological treatment for depression involving 6-12 initial treatments - Answer- .ECT.. Neurotransmitter theory of ECT - Answer- Increases dopamine, serotonin, and norepinephrine Neuroendocrine theory of ECT - Answer- Releases hhormones such as prolactin, thyroid-stimulating hormone, pituitary hormones, endophins, and adrenocorticotropic hormone Anticonvulsant theory of ECT - Answer- Exerts an anticonvulsant effect, which then produces an antidepressant effect. Contraindications for ECT - Answer- Cardiac disease, compromised pulmonary status, h/o brain injury or brain tumor, anesthesia medical complications Adverse effects of ECT - Answer- Possible cardiovascular effects, systemic effects (headaches, anorexia, muscle aches, drowsiness) and cognitive effects such as confusion and memory difficulties Therapies used with the depressed individual - Answer- CBT and Brief (Solution focused) Therapy, Group therapy, Family therapy Identify 12 risk factors for suicide - Answer- >45 & male; >55 & female; divorced, single, separated; white; living alone, psychiatric disorder; physical illness; substance abuse; previous attempt; FH of suicide; recent loss, male gender. Symptoms of depression that may be more pronounced in children: - Answer- Irritability, somatic complaints and social withdrawal. Core symptoms of depression that are less common in children before onset of puberty: - Answer- Psychosis, motor retardation, hypersomnia and increased appetite. In children, MDD has a - Answer- strong separation anxiety component Population that responds better to SSR's than to TCA's: - Answer- Children Children taking antidepressants should be monitored closely for - Answer- Suicide Individuals admitted to long term care facilities are ____% more likely to die within the first year than the normal control population - Answer- 65 It is important to complete a _______ __________ for elderly individuals with depression. - Answer- Functional Assessment One reasons to complete a functional assessment on an elderly patient is to - Answer- Identify whether problems are related to dementia or depression.