Nsg 552 Wilkes University EXAM 2 QUESTIONS WITH verified SOLUTIONS, Exams of Nursing

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Nsg 552 Wilkes University EXAM 2 QUESTIONS

WITH verified SOLUTIONS

1. Acute anxiety-correct answer- First line for acute panic may be short term benzo use. short acting benzos cause rebound anxiety and are the most abused
2. Benzodiazepines-correct answer- Withdrawal can be dangerous, even deadly. Stopping abruptly is not advised. Symptoms of agitation, tension, irritability, and sz. may occur
3. anxiety disorders-correct answer- psychological disorders characterized by distressing, persis- tent anxiety or maladaptive behaviors that reduce anxiety
4. anxiety disorders treatment-correct answer- - non-activating antidepressants area good place to start. for this disorder
5. first line treatment anxiety disorders-correct answer- SSRI- Fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil) TCAs often effective but with riskier SE
6. may interfere with psychotherapy in TX of AD-correct answer- Benzodiazepines- short acting Alprazolam are most abusable
7. Rapid onset BZD-correct answer- used for acute panic disorder
8. BZD with long half- life (20- 80 hours)-correct answer- Diazepam (avoid in elderly)

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9. BEERS criteria-correct answer- A list of medications that are generally considered inappropriate when given to elderly people
10. BEERS criteria-correct answer- Identifies High Risk Meds to Generate Wide List of Meds That Should be Avoided The "Beers Criteria for Potentially Inappropriate Medication Use in Older Adults", commonly called the Beers List, are guidelines for healthcare professionals to help improve the safety of prescribing medications for older adults.
11. concomitant with pharmacological tx in AD-correct answer- Psychotherapy
12. First line for specific phobias like clowns, blood, animals-correct answer- Psychotherapy medications not all that helpful for specific phobias
13. OCD treatment-correct answer- SSRI and CBT
14. BZD in treatment of OCD-correct answer- Xanax, Valium, Klonipin
15. Trauma and Dissociative Disorders-correct answer- Consider and treat and comorbid disor- ders as well
16. Trauma and Dissociative Disorders first line pharmocology- correct answer- Antidepres- sants Psychotherapy are treatment of choice
17. Dissociative disorders-correct answer- the degree of insight the patient has is crucial to the outcome of psychotherapy

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18. DID- Dissociative identity disorder-correct answer- may consider multi pronged approach to treatment but strongly linked to childhood trauma so treating underlying PTSD s/s is often helpful
19. DID-correct answer- discourage use of BZD
20. DID-correct answer- beta blockers and alpha blockers useful for reducing sympathetic nervous system activation
21. Prazosin-correct answer- alpha 1 blocker helpful for nightmares and flashbacks
22. anorexia nervosa-correct answer- An eating disorder characterized by an obstinate and willful refusal to eat, a distorted body image, and an intense fear of being fat
23. Meds for anorexia-correct answer- Prozac Anafranil Pariactin Thorazine Zyprexa
24. Used in anorexia nervosA-correct answer- atypical antipyschotics
25. binge eating disorder-correct answer- significant binge-eating episodes, followed by distress, disgust, or guilt, but without the compensatory purging, fasting, or excessive exercise that marks bulimia nervosa
26. treatment of binge eating disorder-correct answer- Antidepressants and other medication, cognitive behavioral and interpersonal therapy.
27. psychosomatic goal-correct answer- reduce discomfort, improve depression, improve anxi- eties or obsessive thoughts

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28. SSRI indications-correct answer- Major depression, OCD, GAD, panic disorder, social anxiety disorder and premenstrual dysphoric disorder
29. SSRI side effects-correct answer- BAD SSRI B - Body weight increase; A - Anxiety/Agitation; D - Dizziness; Dry mouth S - Serotonin syndrome; S - Stimulated CNS; R - Reproductive/Sexual dysfunction I - Insomnia;
30. antidepressants used in eating disorders-correct answer- SSRIs (high doses), TCAs
31. TCAs-correct answer- tricyclic antidepressants
32. TCA side effects-correct answer- 3Cs - cardiotoxicity, coma, convulsions antihistamine - weight gain, sedation anti adrenergic - orthostasis, reflex tachy, arrythmias, wide QRS/QT/PR anti-muscarinic - dry mouth, constipation, urinary retention, blurred vision, tachycardia, narrow angle glaucoma serotoninergic side effects - erectile/ejaculatory dysfunction in males, anorgasmia in females

5 / lethal in overdose weight gain seizures

33. meds to treat Binge Eating Disorders-correct answer- Vyvanse (lisdexamfetamine)
34. pharmacology indications for anorexia nervosa-correct answer- No medications are ap- proved to treat anorexia because none has been found to work very well. However, antidepressants or other psychiatric medications can help treat other mental health disorders you may also have, such as depression or anxiety.
35. pharmacotherapy indications for bulimia nervosa-correct answer- The only antidepressant specifically approved by the Food and Drug Administration to treat bulimia is fluox- etine (Prozac), a type of selective serotonin reuptake inhibitor (SSRI), which may help even if you're not depressed.
36. Binge Eating Disorder Treatment-correct answer- - responds more rapidly to treatment than other eating disorders

• self-help groups
• learn to eat only when hungry
• idenify personal needs
• find healthful ways to express its emotions

37. Binge Eating Disorder Treatment-correct answer- CBT
38. Contraindicated in eating disorders due to eating disorders having elevat- ed risk of sz-correct answer- Buproprion- "poor man's cocaine" hallmark of toxicity is sz.

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39. Buproprion contraindications-correct answer- increases risk of seizures, anorexia, bulimia. avoid with any condition that increases seizure-- abrupt etoh withdrawl, head in- juries.
40. antidepressants in binge eating disorders-correct answer- SSRI are first line if you are going to choose an antidepressant to treat as they are often very co-morbid with depression and anxiety disorders
41. If a patient has both eating disorder and comorbid depression or anxiety, treatment should follow indications for the comorbidity- ex. if they have OCD comorbid with anorexia nervosa then what ( ?) would be indicated for the OCD should be your choice-correct answer- SSRI
42. Insomnia treatment-correct answer- nonpharmacologic treatments for insomnia include sleep hygeine, stimulus control, relaxation, sleep restriction, and cognitive behavioral therapy. Stimulus control focuses on eliminating stimulating bedroom activities and getting into bed only when sleepy.
43. benzodiazepine hypnotics (tx of insomnia)-correct answer- Diazepam, Midazolam, Zo- lazepam, Triazolam, flurazepam, temazepam Potentiates the inhibitory action of GABA ( inhibitory neurotransmitter that reduces feelings of fear and anxiety). Activation of the receptor causes an influx of Cl-

7 / ion movement into the neuron and hyperpolarization and inhibition of membrane depolarization

44. Benzodiazepine hypnotics affect-correct answer- REM sleep, tolerance, risk of abuse, re- bound insomnia
45. Non-BZD hypnotics for insomnia-correct answer- Zolpidem (Ambien) Zaleplon (Sonata) Eszopiclone (Lunesta)
46. non-benzo and OTC for insomnia-correct answer- tolerance to sedative effects can develop
47. half life meds for insomnia in elderly-correct answer- pay particular attention,
48. Ambien contraindications-correct answer- hypersensitivity
49. zaleplon N considerations (Sonata)-correct answer- used in short- term insomnia treatment; Zalepion (Sonata) does not prolong sleep time or decrease awakenings; elderly patients generally benefit the most; because of rapid onset, patients should take immediately before bedtime; avoid alcohol while using this med; may be habit-form- ing; "sleep driving" may occur; Rx; C-IV; Preg Cat C
50. Eszopiclone Contraindications (Lunesta)-correct answer- - Hypersensitivity reaction

• Pregnancy
• Lactation
• Depression

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• Impaired hepatic function
• Impaired respiratory function
• Elderly with hepatic impairment or debilitating conditions *Not recommended for children

51. Ramelteon side effects (meletonin)-correct answer- fatigue and dizziness Headache Long term use can increase prolactin = sex dysfunction
52. Narcolepsy treatment-correct answer- Modafinil (Provigil)
53. Cataplexy (narcolepsy)-correct answer- loss of muscle control & sudden REM sleep during waking hours emotionally triggered
54. GHB sodium oxybate-correct answer- CIII
55. What is GHB-correct answer- Sodium oxybate, sold under the brand name Xyrem among others, is a medication used to treat two symptoms of narcolepsy;sudden muscle weakness and excessive daytime sleepiness.
56. Treatment of restless leg syndrome-correct answer- Mild/intermittent sxs;

• Supplementation iron when serum ferritin < 75
• use supportive measures (leg massage, heating pads, exercise)
• avoid aggravating factors (sleep deprivation, meds)

9 / Persistent/moderate severe sxs; First line;Dopamine agonists (pramipexole) (antiparkinson therapy) Alternate;Alpha- 2 - delta calcium channel ligands (gabapentin enacarbil)

57. What is pramipexole?-correct answer- Dopamine receptor agonist
58. Ropinerole (Requip)-correct answer- dopamine agonist (PD)
59. Ropinerole in restless leg syndrome-correct answer- Ropinirole is used alone or with other medicines to treat Parkinson's disease. Ropinirole tablets are also used to treat a condition called Restless Legs Syndrome (RLS). RLS is a neurologic disorder that affects sensation and movement in the legs and causes the legs to feel uncomfortable
60. psychopharmacologic treatment in sleep/ wake disorders-correct answer- Be mindful of the onset and half lives of these meds
61. Benzodiazepine half life-correct answer- alprazolam Xanax 12 - 15 hours lorazepam Ativan 10 to 20 hours oxazepam 6 to 20 hours
62. Flurazepam half life-correct answer- 2.3 hours
63. Zoldipem half life-correct answer- 2.5- 3 hours
64. Zaleplon half life-correct answer- 1 hour
65. rebound insomnia-correct answer- in a person with insomnia, the

10 / worsened sleep problems that can occur when medications are used to treat insomnia and then withdrawn

66. rebound insomnia and effect on REM sleep-correct answer- Like rebound sleep in general, REM rebound sleep3 usually occurs in response to sleep deprivation or stress. REM rebound can also occur in response to a suppression of REM sleep in particular
67. Narcolepsy treatment options-correct answer- Stimulants. Drugs that stimulate the central nervous system are the primary treatment to help people with narcolepsy stay awake during the day. modafinil (Provigil) or armodafinil (Nuvigil) first for narcolepsy
68. • correct answer-?
69. GBH sodium oxybate-correct answer- Sodium oxybate is another name for GHB, a substance that is often illegally sold and abused, especially by young adults in social settings such as nightclubs.
70. Somatic disorders-correct answer- Marked by somatic (bodily) symptoms that cause signifi- cant stress or impairment. Somatic Symptom Disorder Illness Anxiety Disorder Conversion Disorder

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71. Somatic Disorders-correct answer- Treatment; - CBT to address maladaptive thoughts about illness

• Exposure to bodily sensations
• Can be helpful in group format
• May involve PCP
• Validation and empathy important, reinforcement of "no pain" behaviors

72. Somatic disorders-correct answer- significant anxiety component so pharmacologic treatment often is geared toward the anxiety.
73. Treating Somatic Symptom Disorders-correct answer- SSRIs, St. John's wart, muscle relax- ation, biofeedback, CBT, relieve social stressors, family therapy Generally first line would be treatment of anxiety with SSRI
74. SSRIs in chronic pain-correct answer- Tricyclic antidepressants are the most common type of antidepressant used for pain. They include; Amitriptyline Nortriptyline (Pamelor) Protriptyline (Vivactil) Doxepin (Silenor) Imipramine (Tofranil) Clomipramine (Anafranil) Desipramine (Norpramin)
75. SNRIs-correct answer- Venlafaxine (Effexor) Duloxetine (Cymbalta) Some SNRIs, such as venlafaxine (Effexor XR), duloxetine (Cymbalta, Drizalma Sprinkle), milnacipran (Savella) and desvenlafaxine (Pristiq), may help relieve chron- ic pain. People with chronic pain often develop

12 / depression along with their chronic pain. Venlafaxine and duloxetine offer the advantage of being effective for depression and anxiety at the same dosages useful for treating pain.