ANCC PMHNP Certification Exam 2024: Mood Disorders - Comprehensive Review and Solutions, Exams of Public Health

Download ANCC PMHNP Certification Exam 2024: Mood Disorders - Comprehensive Review and Solutions and more Exams Public Health in PDF only on Docsity! ANCC PMHNP Certification Exam 2024 Questions with Complete Solutions 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 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 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 Cortisol - ANSWER - Released by adrenal glands in response to ACTH by pituitary gland Hyperactivity of the HPA axis - ANSWER - Demonstrated to be present in individuals with MDD. May also have elevated cortisol levels Elevated cortisol levels - ANSWER - 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) - ANSWER - 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 - ANSWER - Abnormalities demonstrated by neuroimaging in individuals with chronic and severe depression Brain damage, including that from stroke and trauma - ANSWER - Depression is a acommon comorbidity in individuals who have experienced these events What is the Chronobiological theory of MDD - ANSWER - Desynchronization of the circadian rhythms produces the symptom constellation collectively called MDD Circadian rhythms control these biological processes that are frequent problems with depressed individuals - ANSWER - Sleep-rest cycle disturbances * Increased cortisol secretions * REM abnormalities Increased emotional reactivity Frequent waking More intensified dreaming Diurnal variations to circadian-related behaviors Decreased arousal and energy levels Decreased activity patterns * Incidence of MDD - ANSWER - 5% of U.S. population ages 18 and older each year. About 9.9 million Americans Most common psychiatric illness seen in primary care practices; only 50% of people receive treatment - ANSWER - MDD 25% women, 12% men - ANSWER - Risk during reproductive years Risk of MDD is ________ for both genders below puberty and after menopause - ANSWER - equal MDD is (greater) or (lesser) source of morbidity for women than other illnesses. - ANSWER - Greater 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 TCAs are inexpensive and.... - ANSWER - Available in generic form TCAs tend to "slow down" the gut, so - ANSWER - Are good for patients with gi problems Lethal dose of TCA's - ANSWER - 1000 mg or more (usually equal to a week's supply of an average dose). Avoid abrupt withdrawal of TCAs due to - ANSWER - Significant abstinence syndrome TCAs should not be prescribed with - ANSWER - MAOIs due to potential for lethal reaction What can happen if you prescribe TCAs with an SSRI due to - ANSWER - Risk of elevated TCA concentration in the bloodstream - need to monitor TCA levels Name the eight TCAs: - ANSWER - Elavil, Anafranil, Norpramin, Sinequan, Tofranil, Pamelor, Vivactil and Surmontil. A TCA also used for enuresis and ADHD - ANSWER - Pamelor A TCA also used for enuresis and separation anxiety - ANSWER - Tofranil (imipramine) A TCA also used for insomnia - ANSWER - Sinequan (doxepin) Two TCAs are also used for ADHD: - ANSWER - Pamelor & Norpramin (desipramine) A TCA approved for OCD: - ANSWER - Anafranil (clomipramine) Dose Anafranil no higher than ______ mg. due to increased seizure risk. - ANSWER - 250 mg/day A TCA with multiple uses that include chronic pain, insomnia, sciatica, fibromyalgia, trigeminal neuralgia and diabetic neuropathy. - ANSWER - Elavil. Never first-or second-line agents for MDD - ANSWER - MAOIs Occurs with MAOIs are taken with foods containing tyramine - ANSWER - Hypertensive crisis Tyramine - ANSWER - A dietary precursor to norepinephrine When monoamine oxidase is inhibited - ANSWER - Tyramine exerts a strong vasopressor effect What is released when tyramine exerts vasopressor effects? - ANSWER - Catecholamines, epinephrine, and norepinephrine which will increase blood pressure and heart rate Certain medications can cause hypertensive crisis and possible death when administered with an MAOIs. Name them: - ANSWER - Meperidine, SSRIs, decongestants, TCAs, atypical antipsychotics; St. John's wort, L-trytophan, Ritalin, asthma medications. Symptoms of hypertensive crisis: - ANSWER - Sudden, explosive-like headache, usually in occipital region; increased BP, facial flushing, palpitations; pupillary dilation; diaphoresis and fever. What medication is given to treat hypertensive crisis? - ANSWER - Phentolamine Phentolamine - ANSWER - Binds with norepinephrine receptor sites, blocks norepinephrine. MAOI's are ______ in overdose. - ANSWER - Not safe. Dirty side-effect profile and stringent dietary restrictions promote __________________. - ANSWER - Poor patient compliance In addition to hypertensive crisis, clinically significant side effects of MAOIs include: - ANSWER - Insomnia, weight gain, anticholinergic side effects, light-headedness and dizziness, and sexual dysfunction. 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)