ANCC CERTIFICATION PMHNP CHAPTER 7 LATEST UPDATE 2024 RATED A+, Exams of Nursing

Download ANCC CERTIFICATION PMHNP CHAPTER 7 LATEST UPDATE 2024 RATED A+ and more Exams Nursing in PDF only on Docsity! ANCC CERTIFICATION PMHNP CHAPTER 7 LATEST UPDATE 2024 RATED A+ ANCC CERTIFICATION PMHNP CHAPTER 7 LATEST UPDATE 2024 RATED A+ Mood Disorders - Most common psych illnesses Primary characteristic is persistent disturbance in mood - Major Depressive Disorder Often occurs without precipitating event - MDD Object loss theory - Fairbairn, Winnicott & guntrip Aggression turned inward theory of MDD - Freud Cognitive Theory - Beck Learned Helplessness-Hopelessness Theory - Seligman Genetic predisposition - 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 - Probably related to etiology of MDD Sleep disturbances, appetite disturbances, libido disturbances, lethargy, anhedonia are neurovegitative symptoms that are related to functions of the - Hypothalamus and pituitary gland secretions Endocrine dysfunction and pregnancy - A high incidence of postpartum mood disturbances is suggested with this Hypothalamic-pituitary-adrenal axis (HPA) - A theory of MDD, may be a result of an abnormal stress response related to dysregulation of this system ANCC CERTIFICATION PMHNP CHAPTER 7 LATEST UPDATE 2024 RATED A+ HPA axis - Controls the physiological response to stress and is composed of interconnective feedback pathways between the hypothalamus, pituitary gland, and adrenal gland. Hypothalamus releases - corticotropin-releasing hormone (CRH) Adrenocorticotropin hormone (ACTH) - Released by pituitary in response to CRH by hypothalamus Cortisol - Released by adrenal glands in response to ACTH by pituitary gland Hyperactivity of the HPA axis - Demonstrated to be present in individuals with MDD. May also have elevated cortisol levels Elevated cortisol levels - Over time damages the CNS by altering neurotransmission and electrical signal conduction. Cortisol over time can cause changes in size and function of brain tissue Dexamethasone suppression test (DST) - Not commonly used in clinical practice for screening of depression as it is too non specific. Hypovolemic hippocampus and hypovolemic prefrontal cortex-limbic striatal regions - Abnormalities demonstrated by neuroimaging in individuals with chronic and severe depression Brain damage, including that from stroke and trauma - Depression is a acommon comorbidity in individuals who have experienced these events What is the Chronobiological theory of MDD - Desynchronization of the circadian rhythms produces the symptom constellation collectively called MDD ANCC CERTIFICATION PMHNP CHAPTER 7 LATEST UPDATE 2024 RATED A+ If patient has prior episodes of depression, than consider using antidepressants - For longer than 8-12 months Medication and counseling - 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: - Selective Serotonin Reuptake Inhibitors (SSRIs) Elevate serotonin and norepinephrine levels primarily by inhibiting their reuptake - Tricyclic Antidepressants (TCAs) Elevate serotonin and norepinephrine levels primarily by inhibiting MAO, the enzyme that destroys neurotransmitters - Monoamine Oxidase Inhibitors (MAOIs) Serotonin Norepinephrine Reuptake Inhibitors (SNRIs) - Inhibit dual reuptake; action very selective on neurotransmitters; elevate serotonin and norepinephrine levels by inhibiting their reuptake. Norepinephrine Dopamine Reuptake Inhibitors (NDRIs) - Inhibit dual reuptake; action very selective on neurotransmitters; elevate dopamine and norepinephrine levels by inhibiting their reuptake. Serotonin Agonist and Reuptake Inhibitors (SARIs) - Dual action; agonist of serotonin 5HT-2 receptors; action very selective on neurotransmitters; elevates serotonin levels by inhibiting serotonin reuptake SSRIs side effects - Most common side effects of this class: gi upset, sexual dysfunction, nervousness, headache and dry mouth Name the six SSRIs - Celexa, Lexapro, Prozac, Luvox, Paxil (Pexeva), Zoloft. ANCC CERTIFICATION PMHNP CHAPTER 7 LATEST UPDATE 2024 RATED A+ Which is safer in overdose, Paxil or Nortriptyline? - Paxil. SSRIs are safer in overdose than TCAs. SSRI's are also effective for treatment of panic disorder, OCD, bulimia, GAD social phobia and - PTSD and premenstrual dysphoric disorder Which SSRI has long half-life? - Prozac Two SSRIs have potential for teratogenic effects, name them. - Paxil and Zoloft This SSRI has a black box warning for liver toxicity. - Luvox GI upset, sexual dysfunction, nervousness, headache and dry mouth are common side effects associated with... - SSRIs Second line drugs for treatment of MDD: - Tricyclic Antidepressants (TCAs) The side effect profile for TCAs - Dirty side-effect profile Dirty side effect profile contributes to - Poor patient compliance Anticholinergic dirty side effects associated with TCA's: - Dry mouth, blurred vision, constipation, memory problems. Caused due to muscarinic receptor blockade. Antiadrenergic dirty side effects associated with TCAs: - Orthostatic hypotension (from alpha 1 receptor blockade) Antihistaminergic dirty side effects associated with TCAs: - Sedation and weight gain from histamine receptor blockade Cardiac side effects associated with TCAs: - EKG changes and cardiac dysrythmias ANCC CERTIFICATION PMHNP CHAPTER 7 LATEST UPDATE 2024 RATED A+ TCAs are inexpensive and.... - Available in generic form TCAs tend to "slow down" the gut, so - Are good for patients with gi problems Lethal dose of TCA's - 1000 mg or more (usually equal to a week's supply of an average dose). Avoid abrupt withdrawal of TCAs due to - Significant abstinence syndrome TCAs should not be prescribed with - MAOIs due to potential for lethal reaction What can happen if you prescribe TCAs with an SSRI due to - Risk of elevated TCA concentration in the bloodstream - need to monitor TCA levels Name the eight TCAs: - Elavil, Anafranil, Norpramin, Sinequan, Tofranil, Pamelor, Vivactil and Surmontil. A TCA also used for enuresis and ADHD - Pamelor A TCA also used for enuresis and separation anxiety - Tofranil (imipramine) A TCA also used for insomnia - Sinequan (doxepin) Two TCAs are also used for ADHD: - Pamelor & Norpramin (desipramine) A TCA approved for OCD: - Anafranil (clomipramine) Dose Anafranil no higher than ______ mg. due to increased seizure risk. - 250 mg/day A TCA with multiple uses that include chronic pain, insomnia, sciatica, fibromyalgia, trigeminal neuralgia and diabetic neuropathy. - Elavil. ANCC CERTIFICATION PMHNP CHAPTER 7 LATEST UPDATE 2024 RATED A+ Wellbutrin can increase: - Energy level Wellbutrin in contraindicated in patients with eating disorders and ___________. - Seizures. Dosing for Wellbutrin SR: - 150-400 mg/day Remeron has an ________ relationship between dosage and sedation. - Inverse Must monitor LFT's with this antidepressant. - Serzone (nefazodone) Most commonly used as hypnotic; not well tolerated at antidepressant dosage due to sedation; may potentially prolong QTc interval. - Trazodone (Desyrl) (an SARI) Can raise BP and is a potent inhibitor of cyp450 system; safer in overdose than TCAs - Effexor (an SNRI) Effexor should be tapered when stopping the drug due to... - Significant discontinuation syndrome Could possibly elevate LFTs, can possibly elevate BP, usually given once daily, an SNRI that is helpful in pain control: - Cymbalta There is strong potential for discontinuation syndrome with Cymbalta so the drug - Should not be stopped abruptly Non-pharmacological treatment for depression involving 6-12 initial treatments - .ECT.. Neurotransmitter theory of ECT - Increases dopamine, serotonin, and norepinephrine ANCC CERTIFICATION PMHNP CHAPTER 7 LATEST UPDATE 2024 RATED A+ Neuroendocrine theory of ECT - Releases hhormones such as prolactin, thyroidstimulating hormone, pituitary hormones, endophins, and adrenocorticotropic hormone Anticonvulsant theory of ECT - Exerts an anticonvulsant effect, which then produces an antidepressant effect. Contraindications for ECT - Cardiac disease, compromised pulmonary status, h/o brain injury or brain tumor, anesthesia medical complications Adverse effects of ECT - 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 - CBT and Brief (Solution focused) Therapy, Group therapy, Family therapy Identify 12 risk factors for suicide - >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: - Irritability, somatic complaints and social withdrawal. Core symptoms of depression that are less common in children before onset of puberty: - Psychosis, motor retardation, hypersomnia and increased appetite. In children, MDD has a - strong separation anxiety component Population that responds better to SSR's than to TCA's: - Children ANCC CERTIFICATION PMHNP CHAPTER 7 LATEST UPDATE 2024 RATED A+ Children taking antidepressants should be monitored closely for - Suicide Individuals admitted to long term care facilities are ____% more likely to die within the first year than the normal control population - 65 It is important to complete a _______ __________ for elderly individuals with depression. - Functional Assessment One reasons to complete a functional assessment on an elderly patient is to - Identify whether problems are related to dementia or depression. Drug combinations that may cause serotonin syndrome: - SSRIs & MAOIs; Durg and herbal interactions; SSRIs & St. John's wort Autonomic instability, restlessness, agitation, myoclonis, hyperreflexia, hyperthermia, diaphoresis; altered sensorium, tremor, cills, diarrhea and cramps, ataxia, headache and insomnia: - Symptoms of serotonin syndrome Flu-like symptoms, fatigue and lethargy, myalgia, decreased concentration, nausea/vomiting, impaired memory, shock-like sensations; irritability, anxiety, insomnia, crying without provocation, dizziness and vertigo: - Symptoms of discontinuation syndrome Why should TCAs be discontinued slowly? - Clients can get cholinergic rebound syndrome: nausea, gi upset, diaphoresis, myalgias, especially of neck muscles. Patients who have had two or more episodes of MDD usually require - Lifelong medication. Time criteria for MDD - Symptoms present over a two week period Symptom criteria for MDD - Either depressed mood OR loss of interest or pleasure AND four other symptoms: Weight loss/gain, insomnia/hypersomnia, psychomotor