NR 546 MIDTERM EXAM 2024-2025 ACTUAL EXAM TEST BANK 200+ QUESTIONS AND CORRECT DETAILED AN, Exams of Nursing

Download NR 546 MIDTERM EXAM 2024-2025 ACTUAL EXAM TEST BANK 200+ QUESTIONS AND CORRECT DETAILED AN and more Exams Nursing in PDF only on Docsity! NR 546 MIDTERM EXAM 2024-2025 ACTUAL EXAM TEST BANK 200+ QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES |ALREADY GRADED A+ What should the PMHNP consider when prescribing chemical restraints? - correct answer - allergy status -prior med hx for adverse drug reactions r/t the meds ordered in the chemical restraint -state regulations regarding chemical restrains must be reviewed Are the PMHNP and other staff liable if the client has an allergic reaction or adverse side effects to the drugs used for chemical restraint? - correct answer No. The client has been court-ordered to take the prescribed medications and the standing order for chemical restraints is approved. The PMHNP and other staff are not liable if the patient has an allergic reaction or adverse side effects. How does reviewing the genetic makeup of a client help guide the PMHNP in selecting medication for clients? - correct answer -Genetic testing can assist by providing more information on how clients may respond to certain psychotropic medications -provides information on how a client may break down and metabolize medications based on the cytochrome P450 system. Tanrıkulu and Erbaş (2020) investigated identical twins to determine the presence of an inherited link for schizophrenia and why one twin may develop schizophrenia when the other does not. When two people have 100% identical DNA, why don't both persons develop the exact illnesses? Studies of identical Danish twins found that if one twin had schizophrenia, the other twin had a 50% lifetime risk of developing schizophrenia (Lemvigh et al., 2020). Why is there only half the risk? - correct answer Both environmental and psychosocial stressors can impact mental health. Although twins may have identical genes, their gene expression may be different. There may be an environmental exposure that turned a gene "on" that should have been "off" for one twin to develop schizophrenia and not the other. central sulcus - correct answer separates the frontal lobe from the parietal lobe frontal lobe - correct answer associated with movement, intelligence, abstract thinking broca's area - correct answer speech production temporal lobe - correct answer involves object identification and auditory signals cerebellum - correct answer coordination wernicke's area - correct answer speech comprehension occipital lobe - correct answer primary visual area NR 546 MIDTERM EXAM 2024-2025 ACTUAL EXAM TEST BANK 200+ QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES |ALREADY GRADED A+ parietal lobe - correct answer keeps us alert to what is going on around us sensory cortex - correct answer pain, heat, and other sensations motor cortex - correct answer movement hippocampus - correct answer involved in both memory and anxiety nucleus accumbens - correct answer involved in the reward process thalamus - correct answer involved in sensory organ and motor command processing striatum - correct answer involved in complex motor actions, also links cognition to motor actions limbic system - correct answer includes circuits that are associated with pleasure and reward basal ganglia - correct answer group of structures involved in voluntary motor movements amygdala - correct answer involved in emotional regulation and perception of odors corpus callosum - correct answer controls the communication between the two brain hemispheres white matter - correct answer contains nerve fibers that connect neurons from different regions into functional circuits grey matter - correct answer contains nerve cells and dendrites brain tissue - correct answer made up of grey matter and white matter dorsal striatum - correct answer involved in complex motor actions and linkage of cognition to motor actions -main input area for basal ganglia *activated when anticipating or engaging in pleasure The field of epigenetics is rapidly growing and can help explain how gene expression is: - correct answer influenced by environmental factors and how epigenetics contributes to the manifestation of mental illness How does epigenetics impact a person's mental health? - correct answer internal or external factors activate portions of the genome that result in the manifestation of mental health symptoms -activation is often a result of a stressful event, which, when combined with the genetic risk, results in the disease -genes being on or off NR 546 MIDTERM EXAM 2024-2025 ACTUAL EXAM TEST BANK 200+ QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES |ALREADY GRADED A+ *Most individuals have "normal" rates of drug metabolism from the major CYP450 enzymes and are said to be "extensive metabolizers", most drug doses are set for these individuals. *genetic variants of these enzymes can make poor metabolizers or ultra rapid metabolizers Five of the most important: CYP450 1A2, 2B6, 2D6, 2C9, 2C19, and 3A4. ultra rapid metabolizers - correct answer elevated enzyme activity subtherapeutic drug levels poor efficacy with standard doses genotyping - correct answer the patient for pharmacogenomic use -genes for these CYP450 enzymes can now be readily measured and used to predict which patients might need to have dosage adjustments -measurement of genes for drug metabolism most common targets of psychotropic drugs - correct answer G-protein receptors -Drug actions at these receptors occur in a spectrum, from full agonist actions, to partial agonist actions, to antagonism, and even to inverse agonism. Pharmacokinetics concepts - correct answer absorption distribution metabolism excretion Flockhart Table - correct answer drug interactions that are mediated by cytochrome P450 enzymes comprehensive list of drugs and the interactions related to the cytochrome P450 system Neurotransmitters - correct answer chemicals released by neurons to send communication across synaptic clefts to other neurons -impact human emotion and behavior Neurotransmission: - correct answer the chemical transmission of information between neurons and their target cells NR 546 MIDTERM EXAM 2024-2025 ACTUAL EXAM TEST BANK 200+ QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES |ALREADY GRADED A+ -the chemicals, or neurotransmitters, are released from their transport vesicles to bind with receptor sites to perform their duties, which are excitatory or inhibitory -neurotransmitter then either returned and stored for future use (reuptake) or inactivated and dissolved by enzymes -Types: Classic, Retrograde, Volume Classic neurotransmission - correct answer neurons send electrical impulses from one part of the cell to another part of the same cell via their axons -one neuron hurling a chemical messenger, or neurotransmitter, at the receptors of a second neuron -electrical impulse converted chemical signal at the synapse in a process known as excitation- secretion coupling, the first stage of chemical neurotransmission, then back into electrical impulse in second neuron -chemical information from the first neuron triggering a cascade of further chemical messages within the second neuron to change that neuron's molecular and genetic functioning Retrograde neurotransmission - correct answer postsynaptic neurons "talk back" to their presynaptic neurons -second neuron to the first at the synapse between them -Chemicals produced specifically as retrograde neurotransmitters at some synapses include: endocannabinoids, gaseous neurotransmitter nitric oxide (NO), nerve growth factor (NGF). Volume neurotransmission - correct answer Neurotransmission without a synapse or nonsynaptic diffusion neurotransmission -Chemical messengers sent by one neuron to another can spill over to sites distant to the synapse by diffusion -neurotransmission can occur at any compatible receptor within the diffusion radius of the neurotransmitter -neurotransmission occurs in chemical "puffs" -sophisticated "chemical soup." -example: dopamine action in the prefrontal cortex, at the sites of autoreceptors on monoamine neurons Excitatory neurotransmitters: - correct answer increase the likelihood that the neuron will fire an action potential NR 546 MIDTERM EXAM 2024-2025 ACTUAL EXAM TEST BANK 200+ QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES |ALREADY GRADED A+ inhibitory neurotransmitters: - correct answer decrease the likelihood that a neuron will fire an action neurotransmitters that most impact mental health can be classified into four major categories: - correct answer cholinergics -acetylcholine monoamines -norepinephrine, dopamine, serotonin, histamine amino acids -gamma- amino-butyric acid and glutamate neuropeptides Inhibitors: VISA CKGQ - correct answer Valproate Isoniazid Sulfonamides Amiodarone Chloramphenicol Ketoconazole Grapefruit Juice Quinidine -decrease medication metabolism Inducers: CRAP GPS - correct answer Carbamazepine Rifampin Alcohol Phenytoin Griseofulvin NR 546 MIDTERM EXAM 2024-2025 ACTUAL EXAM TEST BANK 200+ QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES |ALREADY GRADED A+ During a follow up appointment after 4 weeks, the PMHNP should assess for the need to add which medication to Ernesto's treatment plan? - correct answer The nurse should assess for sexual dysfunction and anticipate the potential need for a phosphodiesterase inhibitor such as sildenafil (Viagra). -After 4 to 6 weeks, the client should be experiencing full effects of the SSRI, so the need for a short-term medication like a benzodiazepine or a beta blocker are not anticipated. St. John's Wort is contraindicated with an SSRI and can cause serotonin syndrome. Glu - correct answer Glutamate -amino acid -excitatory neurotransmitter -"workhorse" of the brain-can affect almost every neuron in the brain -affects: energy, memory, learning, neural plasticity -relay sensory info. and regulate spinal and motor reflexes -too much: schizophrenia, epilepsy, mania -receptors: NMDA, AMPA GABA - correct answer inhibitory neurotransmitter -decrease neuroexcitability across the brain -"chill", take the edge off stress, help people calm down, relax, destress, sleep -to little: may experience anxiety or schizophrenia -slows down everything, even breathing -affect executive function and motor coordination, increase risk for accidents -Increased levels of gamma-aminobutyric acid have a calming effect. 5HT - correct answer Serotonin -help regulate mood -makes relaxed, comfortable, decreases stress, regulate sleep, arousal, libido, aggression, pain perception NE - correct answer norepinephrine -monoamine neurotransmitter -focus and productivity NR 546 MIDTERM EXAM 2024-2025 ACTUAL EXAM TEST BANK 200+ QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES |ALREADY GRADED A+ -too much due to stress, meds, caffein, stimulants can cause: nervous, antsy, affect focus DA - correct answer dopamine -monoamine neurotransmitter -regulate mood -associated with executive function, ability to perform well, be organized, emotional intelligence -movement and coordination -to little: lose pleasure, interest, alertness, self-confidence, parkinson's disease -to much: schizophrenia and psychosis -reward center: can lead to addiction -has own pathways Ach - correct answer acetylcholine -in CNS: affects arousal, motivation, attention, learning, REM sleep, impacts sleep, pain perception, memory -in PNS: makes you sweat and salivate -link between brain and muscles -not enough: Alzheimer's, Parkinson's, Schizophrenia -too much: Depression -Role in addiction -Receptors: nicotinic & muscarinic Histamine (Neurotransmitter) - correct answer Histamine impacts alertness, pain sensation, and inflammatory responses; increased levels result in depression. Melatonin (neurotransmitter) - correct answer Act at MT1-3 G-protein coupled receptors Sleep/wake cycle insomnia: melatonin agonists Psychotropic drug metabolism may be impacted by factors such as: - correct answer -age -smoking NR 546 MIDTERM EXAM 2024-2025 ACTUAL EXAM TEST BANK 200+ QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES |ALREADY GRADED A+ -caffeine intake -other medications -Some drugs or foods may inhibit or induce the rate of drug metabolism. One-third of psychotropic drugs bind to a ______________, and one-third bind to ___________________. - correct answer neurotransmitter, G-protein-linked receptors. The six main neurotransmitters are: - correct answer serotonin (5HT) norepinephrine (NE) dopamine (DA) acetylcholine (Ach) glutamate (Glu) gamma-aminobutyric acid (GABA) Signal transduction cascades can produce: - correct answer downstream (delayed) and/or long-lasting effects -explains why some psychopharmacological drugs do not provide an immediate response but require time to see the drug effects Signal transduction cascades - correct answer communication from the genome of the presynaptic neuron to the genome of the postsynaptic neuron, and then back from the genome of the postsynaptic neuron to the genome of the presynaptic neuron via retrograde neurotransmission -process involves long strings of chemical messages within both presynaptic and postsynaptic neurons -initial events occur in less than a second, but the long-term consequences are mediated by downstream messengers that take hours to days to activate, yet can last for many days or even for the lifetime of a synapse or neuron -somewhat akin to a molecular "pony express" Signal transduction cascades: Each molecular site within the cascade of transduction of chemical and electrical messages is a potential location for: - correct answer a malfunction associated with a mental illness -also a potential target for a psychotropic drug Retrograde - correct answer NR 546 MIDTERM EXAM 2024-2025 ACTUAL EXAM TEST BANK 200+ QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES |ALREADY GRADED A+ Low dopamine in basal ganglia-akathisia & dystonia. Hyperactivation of pathway-tics, dyskinesias, chorea. Chronic blockade of D2 pathway-tardive dyskinesia. dopamine pathway: tuberinfundibular - correct answer location: projects from hypothalamus to anterior pituitary gland function: dopamine inhibits prolactin release from pituitary symptoms: disruption of pathway causes prolactin level to rise resulting in gynecomastia & galactorrhea. Females-amenorrhea Both may get sexual dysfunction neurobiological factors that contribute to psychosis and schizophrnia - correct answer - genetics -neuroanatomy -neural networks -neural signaling neuroanatomy: symptoms associated with mesocortical and ventromedial prefrontal cortex - correct answer negative and affective symptoms neuroanatomy: symptoms associated with dorsolateral - correct answer cognitive symptoms neuroanatomy: symptoms associated with orbitofrontal and connections to amygdala - correct answer aggressive, impulsive symptoms Worst toxin for someone who has at risk genes for schizophrenia - correct answer marijuana Medications to treat psychosis are classified as either: - correct answer first generation antipsychotics (FGAs) or second- generation antipsychotics (SGAs) Antipsychotics are prescribed based on their: - correct answer -pharmacological properties -side effect profiles -adverse effects according to the unique symptoms and needs of individuals across the lifespan NR 546 MIDTERM EXAM 2024-2025 ACTUAL EXAM TEST BANK 200+ QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES |ALREADY GRADED A+ First-generation antipsychotics (FGAs) - correct answer typical antipsychotics, non-selectively blocks dopamine D2 receptors, specifically in mesolimbic pathway -for the acute and chronic management of schizophrenia and psychosis -Desired effect: improve (+) symptoms -risk for developing hyperprolactinemia & extrapyramidal symptoms Extrapyramidal symptoms (EPSs) - correct answer group of symptoms related to motor control and coordination, caused by dopamine blockade or depletion in the basal ganglia -dystonia -akathisia -parkinsonism -bradykinesia -tremors -tardive dyskinesia dystonia - correct answer Involuntary contractions of muscles; can cause pain akathisia - correct answer Inner restlessness leading to repetitive motion (rocking, tapping fingers). parkinsonism - correct answer Combination of abnormal movements like those seen in Parkinson's Disease, including tremor, slow movement, impaired speech, or muscle stiffness -akinesia, rigidity, tremor bradykinesia - correct answer Slowness of movement tardive dyskinesia - correct answer hyperkinetic movement disorder characterized by abnormal facial and tongue movements and quick, jerky limb movements -Can occur from long-term blockade of D2 receptors in the nigrostriatal DA pathway -25% of clients will develop symptoms within 5 years of medication start -Failure to discontinue typical antipsychotics prior to symptom onset can result in this permanent condition Hyperprolactinemia - correct answer when the serum prolactin level rises due to the blockade of dopamine in the hypothalamus -may be asymptomatic NR 546 MIDTERM EXAM 2024-2025 ACTUAL EXAM TEST BANK 200+ QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES |ALREADY GRADED A+ -irregular menses -male gynecomastia -nipple discharge -osteoporosis -sexual dysfunction and infertility (both genders) Neurolepsis - correct answer antipsychotic medication effects on psychotic clients, with respect to cognition and behavior. -Neurolepsis syndrome has three major features (PEA acronym) Psychomotor slowing-extreme form of slowness or absence of motor movement (nigrostriatal pathway) Emotional quieting-worsening of (-) & cognitive symptoms (mesocortical pathways) Affective indifference-worsening of affective symptoms (mesocortical pathway) Additional adverse effects of excessive D2 receptor blockade (D2 antagonist actions) include: - correct answer -cardiac concerns: QT prolongation, torsades de pointes, and sudden cardiac death -blood dyscrasias (neutropenia, leukopenia, and agranulocytosis) -esophageal dysmotility, aspiration -increased fall risk imbalance of dopamine (DA) and acetylcholine (ACh) can result in anticholinergic effects such as: - correct answer -dry mouth -blurred vision -racing heart -constipation -drowsiness *due to muscarinic blockade effects due to histamine blockade: - correct answer weight gain and drowsiness effects due to α1-adrenergic blockade: - correct answer orthostatic hypotension, dizziness, and drowsiness NR 546 MIDTERM EXAM 2024-2025 ACTUAL EXAM TEST BANK 200+ QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES |ALREADY GRADED A+ Neuroleptic malignant syndrome (NMS) - correct answer Medical emergency, rare, sometimes life-threatening reaction to antipsychotic medications S/S: -diaphoresis -anxiety -tachypnea -muscle stiffness -altered mental status -tachycardia -hyperthermia Tx of Neuroleptic malignant syndrome (NMS) - correct answer stop the administration of antipsychotic medications and provide supportive therapy. Treatment and pharmacologic management may include hydration, benzodiazepines, and muscle relaxants The PMHNP must monitor for adverse effects in clients who are prescribed SGAs. Which of the following physical exams and labs should be ordered or requested from another provider? - correct answer BMI -monthly x3 months then quarterly Fasting lipids -within first three months then check annually Electrocardiogram -baseline electrocardiogram should be obtained to evaluate for prolonged QT syndrome BP Fasting plasma glucose -within first three months then check annually Carbamazepine - correct answer glutamate, voltage-gated sodium and calcium channel blocker NR 546 MIDTERM EXAM 2024-2025 ACTUAL EXAM TEST BANK 200+ QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES |ALREADY GRADED A+ -Primary target symptoms: Seizures, unstable mood, mania, pain. -Side Effects: SEDATION, dizziness, confusion, unsteadiness, headache, nausea, vomiting, diarrhea, blurred vision, rash, benign leukopenia (up to 10%) -Before starting: blood count, liver, kidney, and thyroid function tests ✽SUBSTRATE for CYP450 3A4 and an inducer of CYP450 3A4 thus, carbamazepine induces its own metabolism, often requiring an upward dosage adjustment Carbamazepine drug interactions - correct answer -Enzyme-inducing antiepileptic drugs (carbamazepine itself as well as phenobarbital, phenytoin, and primidone) may increase the clearance of carbamazepine and LOWER its plasma levels -CYP450 3A4 inhibitors, such as nefazodone, fluvoxamine, and fluoxetine, can INCREASE plasma levels of carbamazepine Olanzapine (zyprexa) - correct answer SGA - Atypical serotonin-dopamine antagonist Indication: schizophrenia age 13 and older, acute agitation, acute mania/mixed mania, bipolar maintenance, bipolar depression, borderline personality disorder, PTSD -Starting dose: Initial 5-10 mg once daily orally Risk: High metabolic risk Highest risk for weight gain, sedation, blood dyscrasias, QT prolongation, cardiovascular disease, cerebrovascular effects, hyperglycemia, and hyperprolactinemia quetiapine (seroquel) - correct answer SGA - Atypical serotonin-dopamine antagonist Indication: schizophrenia ages 13 and older, mania, bipolar maintenance, depression, severe treatment-resistant anxiety, PTSD, behavioral disturbances in dementias, Parkinson's disease, children, and adolescents. -Starting dosing: initial 25 mg/day twice a day; increase by 25-50 mg twice a day each day until desired efficacy is reached; maximum approved dose 800 mg/day Risk: NR 546 MIDTERM EXAM 2024-2025 ACTUAL EXAM TEST BANK 200+ QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES |ALREADY GRADED A+ Sedation Moderate metabolic risk Low EPS risk Risk of orthostatic hypotension, blood dyscrasias (neutropenia, leukopenia, and agranulocytosis), QT prolongation, weight gain, and renal and hepatic impairment asenapine (Saphris) - correct answer SGA - Atypical dopamine, serotonin, norepinephrine receptor antagonist Indication: schizophrenia ages 10 and older, mania, bipolar, depression, impulse control, PTSD, behavior disturbances in dementia and in children and adolescents -Starting dosing: usual dosage range Schizophrenia and bipolar mania (sublingual): 10-20 mg/day in 2 divided doses, Schizophrenia (transdermal): 3.8 mg/24 hours Risk: Low metabolic risk Tardive dyskinesia (reduced risk compared to conventional antipsychotics) clozapine (Clozaril) - correct answer SGA - Atypical serotonin-dopamine antagonist Indication: treatment-resistant schizophrenia, chronic SUICIDAL behavior in schizophrenia or schizoaffective disorder, treatment-resistant bipolar disorder, violent aggressive patients with psychosis and other brain disorders not responsive to other treatments. -Starting dosing: Initial 25 mg at night, increase 25-50 mg/day every 48-72 hours as tolerated Not indicated in acute presentation of schizophrenia Special Comments: The Absolute Neutrophil Count (ANC) must be >1500/mm3 when used and requires initial and weekly monitoring of WBC, granulocyte, and neutrophil counts. Risk: High metabolic risk NR 546 MIDTERM EXAM 2024-2025 ACTUAL EXAM TEST BANK 200+ QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES |ALREADY GRADED A+ lurasidone (Latuda) - correct answer SGA - Atypical dopamine, serotonin receptor antagonist Indication: schizophrenia ages 13 and older, bipolar maintenance/depression, mania, treatment-resistant depression, impulse control, PTSD, behavioral disturbances in dementias and in children and adolescents -Dosing: 40-80 mg/day for schizophrenia, 20-60 mg/day for bipolar depression -should be taken with food, at least 350 calories, for maximum absorption. Risk: Low metabolic risk Dose-dependent hyperprolactinemia aripiprazole (Abilify) - correct answer SGA - Atypical dopamine, serotonin receptor partial agonist Indication: schizophrenia ages 13 and older, mania, autism, bipolar maintenance/depression, depression, tourette's disorder, acute agitation, obsessive-compulsive disorder, impulse control, PTSD, behavioral disturbances in dementias and in children and adolescents -Dosing: • 15-30 mg/day for schizophrenia & mania • 5-15 mg/day for autism • 5-20 mg/day for Tourette's disorder Risk: Low metabolic risk Low risk for weight gain Low risk for orthostatic hypotension Pearls -less sedation than most other antipsychotics NR 546 MIDTERM EXAM 2024-2025 ACTUAL EXAM TEST BANK 200+ QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES |ALREADY GRADED A+ brexpiprazole (Rexulti) - correct answer SGA - Atypical Dopamine partial agonist Indication: schizophrenia, treatment-resistant depression, mania, bipolar maintenance/depression, impulse control, PTSD, behavioral disturbances in dementias and in children and adolescents -Dosing: schizophrenia 2-4 mg once daily, Depression: 2 mg once daily. Special Comments: Considered procognitive Risk: Low metabolic risk Akathisia TD (reduced) cariprazine (Vraylar) - correct answer SGA - Atypical dopamine-serotonin partial agonist Indication: schizophrenia, mania, bipolar maintenance/depression, depression, impulse control, PTSD, behavioral disturbances in dementias and in children and adolescents -Dosing: • Schizophrenia: 1.5-6 mg once daily • Bipolar mania: 3-6 mg once daily • Bipolar depression: 1.5-3 mg once daily Risk: Low metabolic risk Sedation Akathisia, parkinsonism, TD (reduced) Haloperidol - correct answer Typical FGA (conventional) dopamine receptor antagonist NR 546 MIDTERM EXAM 2024-2025 ACTUAL EXAM TEST BANK 200+ QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES |ALREADY GRADED A+ High potency Indication: Psychotic disorders, tourette's syndrome, schizophrenia, bipolar disorder, behavior disturbances in dementia -Dosing: 1-40 mg/day orally, IR injection 2-5 mg each dose Risks: Neuroleptic-induced deficit syndrome Akathisia Parkinsonism Tardive dyskinesia Galactorrhea, amenorrhea Weight gain and sedation Thioridazine - correct answer Typical FGA (conventional) dopamine and serotonin receptor antagonist Low potency Indication: Schizophrenic patients who fail to respond to treatment with other antipsychotic drugs. -Dosing: 200-800 mg/day in divided doses Risks: Neuroleptic-induced deficit syndrome Akathisia Priapism Parkinsonims Tardive dyskinesia Galactorrhea, amenorrhea Sedation & weight gain QTc prolongation NR 546 MIDTERM EXAM 2024-2025 ACTUAL EXAM TEST BANK 200+ QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES |ALREADY GRADED A+ medications noted for decreased risk of death by suicide - correct answer Clozapine -Reduction in risk of recurrent suicidal behavior in patients with schizophrenia Carla is a 35-year-old woman that is currently taking olanzapine for her diagnosed schizophrenia. She has gained 30 pounds in the last 6 months and her waist circumference is 37 inches. She requests a change in medications. Which of the following medications is less associated with weight gain? - correct answer aripiprazole -associated with the lowest risk weight gain. Alex is a returning client who reports leaking fluid from his nipples. Which of the following is most likely responsible for these undesirable side effects? - correct answer Risperidone -highest risk for galactorrhea, due to hyperprolactinemia. Prescribing Considerations (antipsychotics) - correct answer -Start with lowest dose, eval tolerance, then titrate dose -no evidence that high antipsychotic doses are more effective than standard doses -Dose adjustments should be made after two weeks of taking medication -Establish efficacy and an effective med dose before switching to a long-acting injectable (LAI). dose of LAI will be same as the effective oral dose. -Most antipsychotic side effects and adverse effects are dose-related. When prescribing, document the _____________ at every visit. - correct answer targeted symptoms, response, and any adverse effects Many persons with schizophrenia are treated successfully in an ______________, though some clients may require ________________ for initial treatment and subsequent treatment of psychotic episodes - correct answer outpatient setting, inpatient hospitalizations Why begin with monotherapy? (antipsychotics) - correct answer The use of multiple antipsychotics can increase the risk of QT prolongation. -Combinations considered only after single med have provided inadequate response. If antipsychotics switched too quickly - correct answer can develop agitation, activation, insomnia, and experience withdrawal -due to the binding differences in each medication subcategory *Cross titration over several days to weeks is required to prevent side effects NR 546 MIDTERM EXAM 2024-2025 ACTUAL EXAM TEST BANK 200+ QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES |ALREADY GRADED A+ Clients are more likely to experience side effects when changing from a medication in one ___________ to a medication in another ____________ - correct answer subcategory, subcategory (ex: pine to done) special considerations: Pregnancy (antipsychotics) - correct answer -Risk of withdrawal symptoms in the newborn: extrapyramidal symptoms may be present at delivery. -atypical antipsychotics appear more harmful than typical antipsychotics due to increased risk of gestational metabolic complications, increased gestational age weight, and increased birth weight. -Avoid Clozapine, Ziprasidone, olanzapine, risperidone, and quetiapine, especially in the third trimester special considerations: breast feeding (antipsychotics) - correct answer All antipsychotics are assumed to be secreted in breast milk. -recommended drug is discontinued or the infant bottle feeds. special considerations: Older Adult (antipsychotics) - correct answer 2019 American Geriatric Society (AGS) Beers Criteria recommendations: Avoid the use of haloperidol, ziprasidone, and olanzapine due to an increased risk of cerebrovascular accident (CVA), cognitive decline, and death in persons with dementia and with dementia-related psychosis. special consideration: children (antipsychotics) - correct answer Black box warnings: -Aripiprazole: Increased risk of suicide in children. -Quetiapine: Increased risk of suicidal ideation and suicidal behavior in adolescents/young adults during the initial 1-2 months of treatment special considerations: caution (antipsychotics) - correct answer -Olanzapine - exercise caution in suspected alcohol withdrawal, stimulant intoxication, or anticholinergic intoxication -High and repeated doses of amphetamines or cocaine can mimic positive symptoms of paranoid schizophrenia legal issues/considerations when prescribing antipsychotics - correct answer informed consent -required due to serious side effects challenges NR 546 MIDTERM EXAM 2024-2025 ACTUAL EXAM TEST BANK 200+ QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES |ALREADY GRADED A+ -psychosis can be an obstacle -provide education before obtaining a signature in outpatient setting contingency planning -establish a plan with client and family for emergencies -designate a mental healthcare proxy if possible Prescribing Pearls - correct answer -Use the lowest effective dose and slow dosage titration. -Avoid agents with anticholinergic properties. -Avoid combining benzodiazepines with intramuscular olanzapine due to an increased risk of sudden death. -Avoid the combination of intramuscular benzodiazepines with clozapine due to a risk of respiratory failure. Terence is a 23-year-old male who presented to the emergency department (ED) with hallucinations. He is highly agitated, and nonpharmacological treatment methods have not been able to calm his behaviors. His agitation continues to escalate which is interfering with their ability to gain an accurate history and assessment. Limited information is available regarding his past medical and psychiatric history. The attending providers are unclear whether his presentation is due to a mental health disorder with a need to intervene or an underlying non-psychiatric medical condition. The PMHNP is called to assist in calming the client. Which of the following statements is inaccurate regarding the management of Terence's agitation? - correct answer Aggressive pharmacological intervention should be done early to fully sedate this client so that a full evaluation can occur. Rationale: Aggressive pharmacological intervention (such as full sedation) interferes with the ability to perform a full evaluation, including history and physical examination. Terence requires medication that will support the completion of an evaluation and differential diagnosis without putting the patient or staff at risk. Early aggressive pharmacological treatment can result in masking underlying conditions. NR 546 MIDTERM EXAM 2024-2025 ACTUAL EXAM TEST BANK 200+ QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES |ALREADY GRADED A+ Low-potency medications - correct answer -require higher doses to achieve efficacy -have more anticholinergic, antihistaminic, and α1- properties, can result in more sedation Targeting mesolimbic/mesostriatal dopamine D2 receptors causes: - correct answer antipsychotic actions Targeting dopamine D2 receptors in Mesolimbic/mesostriatal and mesocortical pathways causes: - correct answer secondary negative symptoms Targeting tuberoinfudibular dopamine D2 receptors causes: - correct answer elevation of prolactin -associated with gynecomastia, galactorrhea, amenorrhea Targeting nigrostriatal dopamine D2 receptors causes: - correct answer motor side effects -can cause drug induced parkinsonism overactivity of the mesolimbic dopamine system - correct answer may mediate the positive symptoms of psychosis any abnormal motor symptoms caused by D2 receptor blockers are lumped together and called collectively: - correct answer extrapyramidal symptsom (EPS) -motor side effects of D2 antagonists caused by chronic blockade of D2 receptors in the nigrostriatal dopamine pathway - correct answer tardive dyskinesia (TD) -tx: interventions that lower dopamine neurotransmission, inhibiting the vesicular monoamine transporter type 2 (VMAT2) lowers the "go" signals - deuterated tetrabenazine (deutetrabenazine), Valbenazine (most selective and potent) , the most common side effect of drugs that target D2 receptors for psychosis - correct answer Drug induced parkinsonism (DIP) -akinesia, bradykinesia, rigidity, and tremor *anticholinergics-drugs that block muscarinic cholinergic receptors adding 5HT2A antagonism: - correct answer improve side effects of D2 blockade and enhance the antipsychotic efficacy of D2 blockade Sedative-hypnotic agents - correct answer benzodiazepine & barbiturates, clinical indications for use: -sedation & anxiolysis -treatment of insomnia NR 546 MIDTERM EXAM 2024-2025 ACTUAL EXAM TEST BANK 200+ QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES |ALREADY GRADED A+ -general anesthesia -seizures -alcohol withdrawal states -as adjunctive management with neuromuscular blockage/muscle relaxation -to induce or maintain sleep sedative-hypnotic medications: use - correct answer -1 in 8 adults -Higher incidence in older adults -Often co-prescribed with opioids sedative-hypnotic medications: misuse - correct answer -Taken outside of prescriptive guidelines -Taken without prescription -polysubstance Abuse -Are common as second drugs of abuse, often taken with opioids and/or alcohol -Increased respiratory and CNS depression -Increased risk of emergency department visits sedative-hypnotic medications: Withdrawal - correct answer -May be severe -Signs and symptoms include psychosis, hallucinations, delirium, seizures -Mild signs and symptoms: irritability, tremor, anxiety, palpitations, insomnia, nausea, vomiting, diaphoresis, headache Benzodiazepine intoxication - correct answer Can resemble alcohol intoxication: unsteady gait, cognitive impairment, discoordination, slurred speech -Overdose may lead to respiratory depression and stupor/coma Anxiety - correct answer response to situations that are perceived as stressful or dangerous -increases alertness, heart rate, and respirations, preparing the body to respond to perceived threatening environmental stimuli *when symptoms of anxiety persist and become intense or excessive, a diagnosis of an anxiety disorder may be warranted, and treatment is required anxiety disorder - correct answer -affects more women than men -one of the most common mental health concerns in the United States NR 546 MIDTERM EXAM 2024-2025 ACTUAL EXAM TEST BANK 200+ QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES |ALREADY GRADED A+ -about 25% of people develop pathological anxiety during their lifetime -can be debilitating and negatively impact the quality of life Types of anxiety disorders - correct answer -separation anxiety disorder -selective mutism -specific phobias (animal, natural environment, blood-injection-injury, situational, other) -social anxiety disorder -panic disorder -agoraphobia -generalized anxiety disorder -substance/medication-induced anxiety disorder -anxiety disorder due to another medical condition Other closely related disorders include: -obsessive-compulsive disorder -acute stress disorder -posttraumatic stress disorder. Neurobiological factors that contribute to anxiety - correct answer Genetics -(GAD) has genetic heritability of approximately 30% -Children of parents with GAD are twice as likely to experience anxiety as those who do not have a positive family history -stressful life events are environmental components with potential to impact genetic expression Neuroanatomy -fear has emotional and physical components -amygdala interprets stress or fear and sends a distress signal to the hypothalamus, hypothalamus initiates the fight-or-flight response by activating the sympathetic nervous system, adrenal glands send out adrenaline to prepare the body to fight or flee in the presence of a threat, hypothalamus activates the hypothalamic-pituitary-adrenal (HPA) axis-release of NR 546 MIDTERM EXAM 2024-2025 ACTUAL EXAM TEST BANK 200+ QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES |ALREADY GRADED A+ -sertraline (Zoloft) SSRI's: Adverse effects and monitoring - correct answer -anorexia -diarrhea -headache -weight gain -sexual side effects -serotonin syndrome Monitoring: akathisia, increased anxiety, suicidal ideation SSRI's: clinical pearls - correct answer -Dosage should be started at half the recommended dose for depression, increase dosage after 2-4 weeks as needed to control anxiety. -SSRIs should not be stopped abruptly because it can result in rebound anxiety. SNRI's - correct answer Serotonin-norepinephrine reuptake inhibitors (SNRIs) are used to treat all anxiety disorders except OCD. -preventing the reuptake of 5-HT and norepinephrine (NE) by synapses in the brain. Compared with venlafaxine and desvenlafaxine, which have serotonin reuptake inhibition (SRI) activity and dose-related affinity for norepinephrine reuptake inhibition (NRI) primarily, duloxetine has more balanced SRI and NRI activities. Levomilnacipran has higher activity at NRI than SRI. -desvenlafaxine (Pristiq) -duloxetine (Cymbalta) -venlafaxine (Effexor, Effexor XR) -levomilnacipran (Fetzima) SNRIs: adverse effects and monitoring - correct answer -elevated blood pressure -sweating -anxiety -dizziness -insomnia -constipation -serotonin syndrome Monitoring: increased anxiety and suicidal ideations NR 546 MIDTERM EXAM 2024-2025 ACTUAL EXAM TEST BANK 200+ QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES |ALREADY GRADED A+ SNRIs: contraindication - correct answer liver problems hypertension SNRIs: clinical pearls - correct answer -Due to the presence of norepinephrine, SNRIs can exacerbate anxiety. -Dosage should be started at half the recommended dose for depression to minimize side effects. Buspirone - correct answer Azapirones are Federal Drug Administration (FDA) approved for short-term anxiety treatment and are used alone or as an adjunct to antidepressants. -bind to serotonin and dopamine receptors in the brain and increase norepinephrine metabolism in the brain. -Buspirone (Buspar) Buspirone: adverse effects - correct answer -dizziness -headache -sedation -nervousness -nausea Buspirone: contraindications - correct answer -severe renal impairment -severe hepatic impairment -concurrent use of monoamine oxidase inhibitors (MAOIs) Buspirone: clinical pearls - correct answer -Buspirone is not habit-forming, does not have abuse potential, causes withdrawal reactions, or potentiates alcohol and sedative-hypnotic effects. -It is prescribed for two or three times a day due to the short half-life; it is not prescribed as needed (PRN). -It has a gradual onset of action of 2 weeks, but over time provides the same efficacy as a benzodiazepine. -BuSpar may decrease sexual side effects when used in combination with an SSRI. Alpha 2 Delta Ligands - correct answer used off-label for general anxiety disorder (GAD). NR 546 MIDTERM EXAM 2024-2025 ACTUAL EXAM TEST BANK 200+ QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES |ALREADY GRADED A+ -bind with glutamate calcium channel blockers (Glu-CB) to inhibit the release of several neurotransmitters. --Pregabalin has anxiolytic properties with selective binding to the α-2-delta subunit of voltage-gated calcium channels. -pregabalin (Lyrica) -gabapentin (Neurontin) Alpha 2 Delta Ligands: adverse effects - correct answer -sedation -dizziness -impaired attention -confusion -dry mouth -constipation -blurred vision -possible weight gain Alpha 2 Delta Ligands: Precautions & Contraindications - correct answer Precautions: -suicidal ideation -substance abuse -heart failure -renal impairment Contraindications: -myopathy -avoid prescribing concurrently with benzodiazepines (BZOs) Alpha 2 Delta Ligands: clinical pearls - correct answer -works quickly to reduce anxiety symptoms -pregabalin reduces anxiety with a similar onset to alprazolam. Beta blockers - correct answer can be used to treat somatic anxiety effects such as tachycardia and physical tension symptoms. -block the effects of norepinephrine and epinephrine. NR 546 MIDTERM EXAM 2024-2025 ACTUAL EXAM TEST BANK 200+ QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES |ALREADY GRADED A+ appropriate first-line medication treatment information for anxiety disorder's: PTSD - correct answer Post-traumatic stress disorder paroxetine sertraline Josie is a 36-year-old who was diagnosed with generalized anxiety disorder. She was prescribed paroxetine (Paxil) 12 weeks ago. She has been taking the medication as prescribed, and although she has tolerated the medication well, she has not achieved relief of anxiety symptoms with increases in dosing at each follow-up visit. Place the following medications in order of what would be prescribed next for Josie. - correct answer The correct order of prescription is: escitalopram (Lexapro) duloxetine (Cymbalta) buspirone (BuSpar) pregabalin (Lyrica) hydroxyzine (Atarax) alprazolam (Xanax) Rationale: Use a stepwise plan to change drug treatment if the initial medication was either ineffective or poorly tolerated. Paroxetine requires a taper while you start the new medication. Do not stop abruptly due to discontinuation syndrome. Switching Rx can be helpful in switching medications. Switch medications.Switch from one SSRI to another.Switch from SSRI to SNRI.Augment with buspirone.Augment with pregabalin. If standard drugs are not effective, nonstandard drugs approved for other anxiety disorders may be used.hydroxyzinebenzodiazepine (if clinically justified) are for short-term use only Benzodiazepines (BZOs) - correct answer Controlled substance enhance gamma-aminobutyric acid's (GABA's) inhibitory effects in the brain by acting on GABA receptors outside of the receiving neuron to open a channel that allows negatively charged chloride ions to pass into the neuron -negative ions "supercharge" the neuron making it less responsive to neurotransmitters that would normally excite it. -also react at specific benzodiazepine receptors on the GABA neuron. Benzodiazepine receptor subtypes have slightly different actions: NR 546 MIDTERM EXAM 2024-2025 ACTUAL EXAM TEST BANK 200+ QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES |ALREADY GRADED A+ *Alpha one is responsible for sedative effects. *Alpha two is responsible for anti-anxiety effects. *Alpha one, alpha two, and alpha five are responsible for anticonvulsant effects. Benzodiazepines use - correct answer short-term relief of acute anxiety -do not treat underlying cause not intended for long-term -risk of tolerance, dependence, uncomfortable withdrawal Benzodiazepines (BZO): adverse effects - correct answer oversedation -drowsiness, poor concentration, incoordination, muscle weakness, dizziness and mental confusion -increased risk of accidents, falls, and injury. memory impairment -cause "blackouts" -lack of concentration and attention, impair learning depression -inability to feel pleasure or pain. -increase suicide risk tolerance and dependence -can occur in as little as 2 weeks -psychologically and physically addictive Paradoxical Effects -increased anxiety, irritability, hyperactivity, aggression, insomnia, nightmares, hallucinations at the onset of sleep, cases of assault and homicide have been reported NR 546 MIDTERM EXAM 2024-2025 ACTUAL EXAM TEST BANK 200+ QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES |ALREADY GRADED A+ Benzodiazepines (BZO): Patient education - correct answer -rationale for benzodiazepine prescription -expected length of treatment (short term only) -avoiding alcohol -adverse effects -risks of tolerance and dependence -avoiding driving while taking this medication Benzodiazepines Safety and Prescribing Guidelines - correct answer Set ground rules: -Client uses only one pharmacy. -BZO should be prescribed by only one provider. -Check the state prescription monitoring program (PMP) controlled substance database. -No early refills. Do not prescribe if the client is concurrently taking: -opioids -other benzodiazepines -z-drugs (medications for sleep) -muscle relaxants -marijuana Schedule regular follow-up: -frequency based on client risk, older and younger clients clients with history of substance use disorder -Required components during follow-up: *symptom assessment *PMP prescription monitoring review *urine drug screening *care plan with informed consent NR 546 MIDTERM EXAM 2024-2025 ACTUAL EXAM TEST BANK 200+ QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES |ALREADY GRADED A+ starts at 0.25 mg and increases slowly -rapid onset and less sedating, but does cause some sedation and fatigue -longer duration of action -only Category C benzodiazepine; not recommended with breastfeeding -increases salivation -contraindicated with liver disease -easier to taper dosing than other BZOs due to the long half-life diazepam (Valium) - correct answer Long-acting Use: acute myocardial infarction-related anxiety, night terrors, alcohol withdrawal Half-life: 20-50 hours Equivalence: 10 mg Dosage: 2-10 mg two times to four times daily -rapid onset -available in rectal gel -can cause sedation, fatigue, forgetfulness, and confusion -contraindicated in angle closure glaucoma -risk of dependence after 12 weeks -risk for seizures with rapid discontinuation; taper 2 mg every 3 days The PMHNP is prescribing alprazolam for a client with panic disorder. The PMHNP should be concerned if the client is also prescribed which medication? - correct answer zolpidem Rationale: Alprazolam presents a risk for respiratory depression, especially when taken concurrently with another central nervous system depressant like zolpidem. SSRIs, SNRIs, and buspirone may be taken with alprazolam. NR 546 MIDTERM EXAM 2024-2025 ACTUAL EXAM TEST BANK 200+ QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES |ALREADY GRADED A+ BZO Tapering and Deprescribing - correct answer Withdrawal symptoms tend to occur faster with shorter-acting agents (within 2 to 3 days) than with longer-acting agents (within 5 to 10 days). The Ashton Model (UK plan)Links to an external site. recommends reducing daily dosing by 10- 20% every 1-2 weeks. lifespan and lifestyle factors that are foundational to safe prescribing: Pregnancy - correct answer -Paroxetine is contraindicated, risk of atrial septal defects -Hydroxyzine is contraindicated in the 1st trimester. -Benzodiazepines cross the placenta, increased risk of neonatal complications even with therapeutic doses, use during pregnancy can cause: *intrauterine growth restriction *oversedation at birth can cause floppiness, difficulty breathing, and difficulty feeding *potential for learning disabilities, autism, and attention-deficit/hyperactivity disorder (ADHD) *neonatal withdrawal syndrome which benzodiazepine is safe in lactation - correct answer lifespan and lifestyle factors that are foundational to safe prescribing: Breast feeding - correct answer Contraindicated when breastfeeding: -gabapentine -benzodiazepines -histamine receptor agents -alpha 2 ligands lifespan and lifestyle factors that are foundational to safe prescribing: Older adult - correct answer decline in renal and liver function may contribute to the prolonged elimination of medications leading to increased sedative effects and fall risk -Consider decreasing the dosage of sedative-hypnotics -taper whenever possible 2019 American Geriatric Society (AGS) Beers Criteria include the following recommendations: -avoid barbiturates (increased dependence, tolerance, risk of overdose) NR 546 MIDTERM EXAM 2024-2025 ACTUAL EXAM TEST BANK 200+ QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES |ALREADY GRADED A+ -avoid benzodiazepines (increased sensitivity, decreased metabolism) -avoid gabapentin and pregabalin (falls due to sedation) -avoid hydroxyzine (clients with dementia, cognitive impairment, delirium, lower urinary symptoms, or benign prostatic hyperplasia [BPH]) lifespan and lifestyle factors that are foundational to safe prescribing: Children - correct answer -Anxiety disorders often begin in childhood and are often comorbid with depression or bipolar disorder. -For children and adolescents, psychotherapy is the first choice of treatment. SSRIs may be used for severe symptoms or when psychotherapy is not effective. *There is an increased risk of suicide in clients less than 30 years using SSRIs. -Gabapentin is not approved for anxiety in children, it may only be used for seizures. Sofia presents to the PMHNP with a report of being overwhelmed with stress and worry. Sofia reports she has always dealt with these feelings, but it has been worse since she has taken a more advanced role in her work with significant responsibility. She has difficulty relaxing and is often fatigued. The PMHNP diagnoses Sofia with generalized anxiety disorder. - correct answer sertraline 25 mg po once daily. Rationale: Anxiety can often be treated with antidepressants. The best choice for Sofia is the SSRI, sertraline because it is half the recommended dose for depression. The duloxetine dosage listed is an appropriate dose for depression. When treating anxiety, the dosage should start at 30 mg and be titrated up. Buspirone is not the first drug of choice and it is typically used short- term. A benzodiazepine should not be the first drug of choice. Sofia was prescribed sertraline 25 mg po once daily. Sofia's dosage was increased to 50 mg after week 1, increased to 100 mg after week 2, and increased to 150 mg after week 3. At Sofia's 4- week follow-up visit, she is tolerating the medication well and symptoms are slightly improved. Which is the best action by the PMHNP? - correct answer increase the sertraline dose to 200 mg Rationale: The PMHNP should increase the sertraline dose to the maximum dose of 200 mg because the client has slightly improved symptoms. It may take several months for the client to see full relief, so it is best to wait before adding additional drugs or switching drugs. At Sofia's 12-week follow-up visit, the client is taking the maximum dose of sertraline and is experiencing improvement in symptoms, but not full relief from symptoms. Which is the best action by the PMHNP? - correct answer augment with buspirone NR 546 MIDTERM EXAM 2024-2025 ACTUAL EXAM TEST BANK 200+ QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES |ALREADY GRADED A+ -GABA -dopamine -norepinephrine -glutamate -voltage-gated ion channels Excessive amygdala activity is theoretically reduced by: - correct answer benzodiazepines -enhance phasic inhibition of GABA (γ-aminobutyric acid) by positive allosteric modulation of postsynaptic GABA receptors -blunt fear-associated outputs modulate excessive output from worry loops - correct answer benzodiazepines -enhancing the actions of inhibitory interneurons in CSTC circuits -reduce symptoms of worry also known as α2δ ligands since they bind to the α2δ subunit of presynaptic N and P/Q VSCCs, block the release of excitatory neurotransmitters such as glutamate that occurs when neurotransmission is excessive, as postulated in the amygdala to cause fear (Figure 8-17A) and in CSTC circuits to cause worry - correct answer Gabapentin and pregabalin key neurotransmitter that innervates the amygdala as well as all the elements of CSTC circuits - correct answer Serotonin -regulate both the symptoms of fear and worry Noradrenergic hyperactivity in anxiety - correct answer Norepinephrine is another neurotransmitter with important regulatory input to the amygdala, and to the prefrontal cortex and thalamus in CSTC circuits __% of the population will develop an anxiety disorder - correct answer 30% Treatment for anxiety disorder subtypes: Generalized Anxiety Disorder - correct answer SSRIs, SNRIs, benzodiazepines, buspirone, and α2δ ligands such as pregabalin and gabapentin Other "off-label" treatments for anxiety can include mirtazapine, trazodone, vilazodone, tricyclic antidepressants, or even sedating antihistamines such as hydroxyzine. NR 546 MIDTERM EXAM 2024-2025 ACTUAL EXAM TEST BANK 200+ QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES |ALREADY GRADED A+ Treatment for anxiety disorder subtypes: PTSD - correct answer psychopharmacological treatments -not as effective as these same treatments are in anxiety disorders -more effectively aimed at comorbidities: depression, insomnia, substance abuse, and pain Benzodiazepines are to be used with caution -limited evidence from clinical trials for efficacy in PTSD -many PTSD patients abuse alcohol and other substances unique treatment for PTSD is the administration of α1 antagonists at night to prevent nightmares The amygdala hypothetically plays a central role in the _______________. Cortico-striato- thalamo-cortical (CSTC) circuits are thought to play a key role in mediating the symptom of __________. - correct answer fear response, worry ________,_________,_________,________ are all key modulators of the hypothetical fear and worry circuits - correct answer Serotonin, norepinephrine, alpha-2 delta ligands and GABA Amygdala-centered circuit - correct answer Fear -panic -phobia cortico-striato-thalamo-corical (CSTC) circuit - correct answer worry -anxious misery -apprehensive expectation -obsession Gabapentin - correct answer Anxiolytic glutamate voltage-gated calcium channel blocker, Anticonvulsant; alpha 2 delta ligand at voltage-sensitive calcium channels -Indication: Partial seizures with or without secondary generalization, postherpetic neuralgia, restless leg syndrome, neuropathic pain/chronic pain, anxiety, bipolar disorder. -Dosing: 900-1800 mg/day in 3 divided doses Risks: CNS side effects: NR 546 MIDTERM EXAM 2024-2025 ACTUAL EXAM TEST BANK 200+ QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES |ALREADY GRADED A+ Sedation Ataxia fatigue nystagmus tremor Pearls: -Most use if off-label -Off-label use for first-line treatment of neuropathic pain may be justified Pregabalin - correct answer Anxiolytic glutamate voltage-gated calcium channel blocker, Anticonvulsant; alpha 2 delta ligand at voltage-sensitive calcium channels -Indication: Diabetic peripheral neuropathy, postherpetic neuralgia, fibromyalgia, neuropathic pain associated with spinal cord injury, partial onset seizures, peripheral neuropathic pain, GAD, panic disorder, social anxiety disorder. -Dosing: IR: 150-600 mg/day in 2-3 doses, CR: 330 mg once per day Risks: CNS side effects: Sedation Pearls: -First treatment approved for fibromyalgia -Off-label use for GAD, panic disorder, and social anxiety disorder may be justified in the USA Buspirone - correct answer Anxiolytic serotonin receptor partial agonist -Indication: Anxiety, depression, treatment-resistant depression -Dosing: usual 20-30 mg/day. Initial 15 mg twice a day; increase in 5 mg/day increments every 2-3 days until desired efficacy reached (max 60 mg/day) NR 546 MIDTERM EXAM 2024-2025 ACTUAL EXAM TEST BANK 200+ QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES |ALREADY GRADED A+ -forgetfulness, confusion -hyperexcitability, nervousness Pearls: -not recommended during pregnancy, especially during first trimester -Recommended either D/C drug or bottle feed -most popular and useful benzodiazepines for treatment of agitation -often used to induce pre-operative anterograde amnesia to assist in anesthesiology Clonazepam - correct answer Anxiolytic BENZODIAZEPINE GABA positive allosteric modulator -Indication: Panic disorder, lennox-gastaut syndrome, akinetic seizure, myoclonic seizure, absence seizure, atonic seizure, other seizure disorders, acute mania, acute psychosis, insomnia, catatonia. -Dosing: •Seizures 1.5 mg divided into 3 doses, raise by 0.5 mg every 3 days until desired effect (up to 20 mg/day) •Panic start at 0.25mg divided into 2 doses, raise to 1mg after 3 days (max 4 mg/day) Risks: -Sedation, fatigue, depression -dizziness, ataxia, slurred speech, weakness -forgetfulness, confusion -hyperexcitability, nervousness Pearls: -not recommended during pregnancy, especially during first trimester -Recommended either D/C drug or bottle feed NR 546 MIDTERM EXAM 2024-2025 ACTUAL EXAM TEST BANK 200+ QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES |ALREADY GRADED A+ -Easier to taper than some other benzodiazepines because of long half-life (elimination half-life approximately 30-40 hours) Diazepam - correct answer Anxiolytic BENZODIAZEPINE GABA positive allosteric modulator -Indication: Anxiety, acute agitation, tremor, delirium tremens, HALLUCINOSIS in acute alcohol withdrawal, skeletal muscle spasm, spasticity, athetosis, stiff-person syndrome, convulsive disorder, status epilepticus, insomnia, catatonia. -Dosing: •Oral (anxiety, muscle spasm, seizure): 2-10 mg, 2-4 times/day. •Oral (alcohol withdrawal): initial 10 mg, 3-4 times/day for 1 day; reduce to 5 mg, 3-4 times/day, continue prn Risks: -Sedation, fatigue, depression -dizziness, ataxia, slurred speech, weakness -forgetfulness, confusion -hyperexcitability, nervousness Pearls: -not recommended during pregnancy, especially during first trimester -Recommended either D/C drug or bottle feed -often the first-choice benzodiazepine to treat status epilepticus, and is administered either intravenously or rectally Propranolol - correct answer Anxiolytic Beta blocker, antihypertensive -Indication: Migraine, tremor, hypertension, angina pectoris, cardiac arrhythmias, myocardial infaction, hypertrophic subaortic stenosis, pheochromocytoma, akathisia, parkinsonian tremor, violence, aggression, PTSD, GAD, prevention of variceal bleeding, CHF, tetralogy of fallot, hyperthyroidism. NR 546 MIDTERM EXAM 2024-2025 ACTUAL EXAM TEST BANK 200+ QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES |ALREADY GRADED A+ -Dosing: 40-400 mg/day Risks: -bradycardia -hypotension -dizziness -hypoglycemia -weight gain -bronchospasm, cold/flu symptoms, sinusitis, pna's -sexual dysfunction Pearls: -May worsen depression, but helpful for anxiety medication can be prescribed after an acute trauma to prevent a permanent fear response - correct answer both β blockers and opioids -potentially mitigate the conditioning of the original traumatic memory