Nurs663 exam 2 192Questions & Answers all answers 100%Verified: Updated 2023/2024 A+ Score, Exams of Nursing

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MMSE Scoring - correct answers Donepezil (Aricept) - correct answers cognitive enhancing medication for Alzheimers -Acetylcholinesterase inhibitor Donepezil MOA: - correct answers Inhibits breakdown of acetylcholine by acetylcholinesterase, increasing acetylcholine available at cholinergic synapses donepezil benefits - correct answers -once per day dosing, may be used in vascular dementia -May work in those who have not responded to other cholinesterase inhibitors -May work in those who do not tolerate other cholinesterase inhibitors Donepezil Education: - correct answers -May improve symptoms and slow progression of Alzheimers but does not reverse the process -No tests needed prior to treatment -Non-habit forming -Taper is necessary to avoid withdrawal -May exacerbate asthma and other pulmonary diseases -Increased risk of ulcers, bradycardia, and heartblock -use with caution in those with cardiac impairment. -FDA approved for mild, moderate and severe AD Use of donepezil in the elderly - correct answers -some patients may tolerate lower doses better

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-use of cholinesterase inhibitors may be associated with increased rates of syncope, bradycardia, pacemaker insertion, and hip fracture in older adults with dementia donepezil side effects - correct answers -N/V (GI UPSET) -diarrhea -appetite loss -increased gastric acid secretion -weight loss Life threatening side effects of donepezil: - correct answers Seizures & syncope Donepezil FDA approval: - correct answers Alzheimers disease (mild, moderate, severe) Donepezil Class: - correct answers Cholinesterase inhibitor Donepezil Dosing - correct answers 5-10 mg Donepezil metabolism - correct answers CYP450 2D6, CYP450 3A Donepezil Drug interactions: - correct answers -Anesthetics (discontinue prior to surgery) -CYP2D6 and CYP3A4 inhibitors can increase plasma leavels -CYP2D6 and CYP3A4 inducers will decrease medication levels -anticholinergic agents -beta blockers

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-levodopa -dont combine with another cholinesterase inhibitor Memantine (Namenda) MOA: - correct answers NMDA receptor antagonist Memantine risks: - correct answers -unproven to be effective in mild/moderate Alzheimers disease -patients who have difficulty taking a medication twice per day may not get all the benefits Memantine benefits - correct answers Can be used in those with more advanced Alzheimer disease Memantine Education: - correct answers -no tests are needed prior to treatment -drug may lose effectiveness in slowing disease after 6 months -no withdrawal -abrupt cessation can lead to notable deterioration in behavior/memory which may not be restored. Memantine side effects: - correct answers -dizziness -headache -constipation -LIFE THREATENING=SEIZURES Memantine FDA approval: - correct answers Moderate to severe alzheimers

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Memantine Class: - correct answers NMDA receptor antagonist Memantine Dosing: - correct answers 10mg 2x/day OR28mg once daily (ER) Memantine metabolism: - correct answers Mostly excreted unchanged in the urine -minimal inhibition of CYP450 enzymes Memantine Drug interaction: - correct answers -no interactions with drugs metabolized by CYP450 enzymes -Drugs that raise urine Ph may reduce elimination of the drug and raise plasma levels Galantamine (razadyne) MOA: - correct answers Inhibits centrally active acetylcholinesterase making more AcH available.e -modulates nicotinic receptors, enhancing actions of AcH Risks of Galantamine: - correct answers Reduced efficacy in those who cannot remember to take medications twice daily Galantamine benefits: - correct answers -helps treat Alzheimer disease with cerebrovascular disease but does not reverse degenerative process -may have therapeutic benefits for memory and behavior in some Alzheimer patients -Medication may also provide efficacy for cognitive disorders other than Alzheimer disease Galantamine Education: - correct answers -slows progression of disease but does not reverse it

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-no tests needed prior to treatment -May exacerbate asthma or other pulmonary disease -increased risk of ulcers, bradycardia, or heart block -Use with caution in those with renal , cardiac, and hepatic impairment -Drug may lose effectiveness in slowing degenerative course of Alzheimer disease after six months -can be effective in some patients for several years -tapering not necessary -Use of cholinesterase inhibitors may increase rates of syncope, bradycardia, pacemaker insertion and hip fracture in older adults with dementia. Galantamine side effects: - correct answers N/D/V (GI UPSET) -appetite loss -increased gastric acid secretion -weight loss -GI upset (may be lessened if taken with food) -LIFE THREATENING=SEIZURES AND SYNCOPE **OVERDOSE CAN BE LETHAL) Galantamine FDA approval: - correct answers mild to moderate alzheimer disease Glantamine class: - correct answers cholinesterase inhibitor (cognitive enhancer) Dosing of Galantamine - correct answers 16-24 mg/day Galantamine metabolism: - correct answers CYP 2D6 and 3A

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Galantamine drug interactions - correct answers -med should be D/C before anesthesia -Inhibitors of 2D6 and 3A4 can increase plasma levels -anticholiergic agents -beta blockers (bradycardia) -Levodopa -not rational to combine with another cholinesterase inhibitor. Anorexia nervosa binging type diagnostic criteria: - correct answers - restriction of food intake relative to requirements leading to a low body weight -intense fear of gaining weight/becoming fat. Persistent behavior that interferes with weight gain even if they are at a low weight -Disturbance in the way in which ones body weight or shape is experienced, undue influence of body weight or shape on self evaluation, or persistent lack of recognition of the seriousness of the current low body weight -**Bing eating/purging type: During the last three months, the individual has engaged in recurrent episodes of binge eating or purging behaviors (self induced vomiting or the misuse of laxative, diuretics, or enemas) -Specify if in partial remission, full remission, and severity based on BMI Binge Eating Disorder (BED) DSM criteria. An episode of eating is characerized by both of the following: - correct answers Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following: -Eating, in a discrete period of time (within any 2 hour period), an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances -A sense of lack of control over eating during the episode

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DSM-V criteria: for BED. The episodes are associated with 3 or more of the following: - correct answers -Eating much more rapidly than normal -Eating until feeling uncomfortably full -Eating large amounts of food when not feeling physically hungry -Eating alone because of feeling embarrassed by how much one is eating -Feeling disgusted with oneself, depressed, or very guilty afterward -Marked distress regarding binge eating is present -The binge eating occurs, on average, at least once a week for three months The binge eating is not associated with the reucurrent use of inappropriate compensatory behavior as in bulimia nervosa and does not occur exclusively during the course of bulimisa nervosa or anorexia nervosa **Specify in partial/full remission How to rate the severity of BED: - correct answers Mild: 1-3 episodes Moderate: 4-7 episodes Severe: 8-13 episodes Extreme: 14+ episodes PICA DSM-V criteria: - correct answers -Persistent eating of nonnutritive, nonfood substances over a period of at least one month. -The eating of nonnutritive, nonfood substances is inappropriate to the developmental level of the individual -The eating behavior is not part of a culturally supported or socially normative practice. -If the eating behavior occurs in the context of another mental disorder or medical condition, it is sufficiently severe to warrant additional clinical attention.

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Rumination DSM-V criteria: - correct answers -Repeated regurgitation of food over a period of at least one month. Regurgitated food may be rechewed, re swallowed, or spit out -The repeated regurgitation is not attributable to an associated gastrointestinal or other medical condition -The eating disturbance does not occur exclusively during the course of anorexia nervosa, bulimia nervosa, binge-eating disorder, or avoidant/restrictive food intake disorder. -If the symptoms occur in the context of another mental disorder they are sufficiently severe to warrant additional clinical attention. Treatment for Anorexia Nervosa: - correct answers -Family based therapy (especially in those under 18), CBT, dynamic psychotherapy -Sometimes olanzapine for weight gain, if using atypical antipsychotics, the metabolic and cardiac risks are to be weighed. Antidepressants (SSRI's), TCA have shown variable results. treatment of binge eating disorder - correct answers -CBT, interpersonal therapy, DBT -Lisdexamfetamine (can treat both weight loss and reduction of binge eating episodes) -Antidepressants improve binge eating but do not lead to sustained weight loss (Fluoxetine, fluvoxamine, citalopram, escitalopram, sertraline, duloxetine, buproprion) -Anticonvulsants (topiramate & Zonisamide) may improve BED and with moderate weight loss ***Medication and CBT together is more effective than medication alone. Treatment of Bulimia Nervosa: - correct answers -CBT-benchmark, first line treatment (18-20 sessions over 5-6 months). Family based therapy -Antidepressant medications help treat bulimia nervosa, particularly fluoxetine. ---Fluoxetine can reduce binge eating and purging, independent of

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the presence of a mood disorder (60-80 mg). -----Other SSRI's may also be helpful (with Lexapro watch about prolonged qt intervals), TCA's, trazodone, MAOIs, buproprion is contraindicated due to increased risk of seizure Topiramate and lisdexamfetamine may also be effective Most effective is fluoxetine with CBT -Most other SSRI's are effective at the doses given at for depression What is the mini mental status exam? - correct answers Screening tool used to document changes in mental status and cognitive impairment -procides superficial assessment of memor, language, and visualperceptual function -processing speed and executive function are not tested MMSE scoring chart - correct answers -24+ Normal cognition; no dementia -19-23: Mild dementia -10-18: moderate dementia -9 and lower: severe dementia DSM-V criteria for Bulimia Nervosa - correct answers -Recurrent episodes of bing eating. An episode of bing eating is characterized by both of the following -Eating in a discrete period time an amount of food that is definitely larger than what most individuals would eat in a similar period of time -A sense of lack of control over eating during the episode (cannot control what or how much one is eating) **recurrent inappropriate compensatory behaviors in order to prevent weight gain, such as self induced coming; misuse of laxatives, diuretics, fasting, or excessive exercse

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**bing eating and inappropriate behaviors occur at least once a week for three months ** self evaluation is unduly influenced by body shape and weight **the disturbance does not occur exclusively during episodes of anorexia nervosa in bulimia nervosa you can expect to see: - correct answers -electrolyte abnormalities (more than in anorexia) -dehydration -hypomagnesemia -hyperamylasemia -hypotension -bradycardia Purging disorder - correct answers Eating disorder characterized by recurrent purging behavior to influence weight or shape, such as self-induced vomiting, misuse of laxatives, diuretics, or other medications, in the absence of binge eating. Lewy body dementia - correct answers A form of dementia characterized by an increase in Lewy body cells in the brain. -Patient must have sufficient cognitive decline to interfere with social or occupational functioning -Symptoms include: visual hallucinations, momentary loss of attention, falling, and fainting, parkinsonian features (cog wheeling, bradykinesia, resting tremor) What is the #1 gold standard for treatment of insomnia - correct answers CBT -Sleep hygiene education!

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Contraindications for Benzodiazepine use - correct answers -narrow angle glaucoma -untreated OSA -History of Substance abuse Benzodiazepine adverse effects - correct answers -drowsiness -dizziness -Risk of falls/ MVA's -cognitive and functional decline -tolerance -rebound insomnia **reduce dosing in older adults T/F benzos can have additive effects when used with alcohol and CNS depressants - correct answers True Zolpidem (Ambien) - correct answers -Decreases sleep onset latency -improves sleep quality -increases stage 2 of sleep and slow wave sleep -DOES NOT exhibit tolerance or rebound following five weeks of continuous use at recommended doses -Should not be readministered following nocturnal awakenings -not recommended to give women full dose -Have to have at least 8 hours of sleep T/F adverse effects of ambien occur at 20mg or more - correct answers True

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Starting dose of Ambien - correct answers -5-10 mg Zaleplon (Sonata) - correct answers Decreases sleep latency -Has short half life (1 hour) -enables read ministration following nocturnal awakenings Which medication is useful in patients who have trouble falling and maintaining sleep? - correct answers Zaleplon (Sonata) -can be administered up to four hours before the anticipated wake time T/F zaleplon causes less memory and psychomotor impairment than Bezos and zolpidem - correct answers True The onset of action of zaleplon may be delayed in take with a ___________ - correct answers high fat meal Some report visual disturbances such as a change in color perception with_______ - correct answers Zaleplon (Sonata) Eszopiclone (Lunesta) - correct answers -Only hypnotic FDA approved for use longer than 35 days -significant and sustained decreases in sleep onset latency, wake time, number of awakenings, and number of night awakened per week -Also improves total sleep time and quality of sleep Dosing of luniest (eszopiclone) - correct answers -2-3 mg are more effective at sleep maintenance -1-2mg suitable for difficulty falling asleep

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**onset of action may be delayed if taken with a high fat meal Rare cases of fatal overdose when taken with other CNS depressants has been reported with - correct answers Luniest (Eszopiclone) Ramelteon (Rozerem) - correct answers selective melatonin receptor agonist -reduces sleep onset latency and increases sleep periods -can be taken long term and daily -low likelihood of abuse Common side effects of ramelteon - correct answers somnolence -headache -fatigue -nausea -dizziness serious adverse effects are rare What is the only non-scheduled drug approved for insomnia - correct answers Ramelteon -hepatic metabolism Vascular dementia - correct answers -cerebrovascular diseases both cortical and sub cortical

symptoms of vascular dementia - correct answers -executive dysfunction -reduced interest in activities

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-Pyschomotor retardation -cognitive impairment and impaired insight -impairment in instrumental activities of daily living and poor prognosis -unsteady gait -urinary frequency, urgency, incontinence -night wandering -decline in ability to organize thoughts/actions and difficulty planning (difficulty with memory, communicating, and learning new info) How to dx vascular dementia - correct answers -general sx are similar to that of Alzheimers, so requires either clinical or laboratory evidence in support This is the second more common dementia after Alzheimers - correct answers -vascular dementia What causes vascular dementia - correct answers damage to the brain caused by problems with arteries serving the Brian and heart -25-30% of all dementias are vascular dementias Risk factors/Causes f\of vascular dementia - correct answers -DM -high blood pressure/cholesterol -CAD/PAD Treatment of vascular dementia: - correct answers -damage caused by infarcts cannot be reversed -Future events can be controlled by control of cardiovascular risk factors

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Frontal temporal dementia (AKA picks, frontal lobe) is: - correct answers -A group of diseases characterized by the degeneration of nerve cells in the frontal temporal areas of the brain

Frontal temporal areas of the brain are associated with...... - correct answers personality, behavior, language T/F frontal temporal dementia progreses faster than Alzheimers disease - correct answers -True T/F frontal temporal dementia occurs at younger ages? - correct answers - True -40-70 years Pick's disease - correct answers -affects part of the brain that contain fibrous tangles made up of an abnormal protein called tau protein Causes of frontal temporal dementia - correct answers -possible genetic mutations -unknown Symptoms of frontal temporal dementia - correct answers -Socially inappropriate behaviors -loss of mental flexibility ( everything is black and white) -Decline in personal hygiene -language problems -movement disorders -difficulty concentrating and thinking

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Lewy body dementia is caused by - correct answers -deposition of levy Bodies in both cortical and subcortical areas T/F Lewy body dementia has features of both Parkinson's dementia and Alzheimers disease - correct answers -true Which dementia has a rapid progression with a prognosis of six years? - correct answers -Lewy body dementia In which dementia do patients lose their memory and have difficulty learning new information - correct answers -Lewy body dementia What is the hallmark symptom of lewy body dementia - correct answers - Visual hallucinations Causes of Lewy body dementia - correct answers -often found in brains of those with parkinsons -otherwise unknown What medications should you avoid in those with lewy body dementia? - correct answers -Atypical antipsychotics Symptoms of Lewy body dementia - correct answers -must have two of the following: fluctuating attention and concentration, recurrent visual hallucinations, newly emerged PD type motor problems Treatment of Lewy body dementia - correct answers -NO antipsychotics -anti dementia medications

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Suggestive features of Lewy body dementia - correct answers -History of REM sleep behavior disorder (violent/sleep walking) -sensitivity to antipsychotic meds Supportive clinical features (don't have to be present) or Lewy body dementia - correct answers Difference between MDD and grief? - correct answers Grief is accompanied with emptiness and loss T/F you should take sleeping meds on an empty stomach? - correct answers True How does Ramelteon (rozerem) work? - correct answers Acts on melatonin (M1 and M2 receptors) good medication choice for older adults!!! What is ramelteon for? - correct answers Insomnia T/F. decrease in psychototor speed is normal in older adults - correct answers True Signs of depression in the elderly - correct answers -Somatic complaints are usually first -"my back hurts, my stomach hurts" -physical symptoms first then, "oh yeah, I am sad"

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Klein Levin Syndrome (KLS) - correct answers Condition of periodic hypersomnia Rare condition that involves episodic hypersomnolence lasting 1 day to 1 month Triad of: irritability, confusion upon waking, hypersomnolence, overeating, hypersexuality More common in boys and occurs in adolescence, usually fades by adulthood sleep restriction therapy - correct answers involves initially restricting the amount of time insomniacs can try to sleep in the night -keep these people out of bed! only for sleep! Stimulus control therapy is used for... - correct answers -those with trouble falling asleep With frontal lob dementia you can expect to see... - correct answers -rapid changes in speech and language problems. S/Sx of ARFID: - correct answers fear and avoidance of foods. -This can include fears of food groups, textures and colors -These patients are underweight to normal weight -they are most likely lacking nutrients. -Can be very isolating T/F MCI is prodromal to dementia? - correct answers -True -The patient may begin to lose a lot of things including memory

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Major side effect of donepezil, galantine, and namenda - correct answers - GI side effects Which medication is approved for the treatment of all the stages of Alzheimers? - correct answers -Donepezil What medication could you give to treat hypersomnia? - correct answers - Modafanil -this medication is also a weight promoting agent, and works for treatment resistant mood disorders an depression. Russel's sign - correct answers Calluses/scars on the knuckles or dorsal hand from self-induced vomiting BED - correct answers -repeated binging of 2-3,000 calories at a time -Tmnt is vyvanse (lisdexamphetamine) Anorexia - correct answers -underweight -prolonged periods or not eating -sense of control -may exercise too much Bulimia - correct answers -bing eating followed by purging -laxative abuse -excessive exercise -NOT UNDERWEIGHT -AVEREAGE TO A LITTLE OVERWEIGHT -** MUST MONITOR BATHROOM HABITS 1-2 HOURS AFTER EATING**

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Purging - correct answers -No binging -look for Russell sign PICA - correct answers -More common in children -Danger to digestive system -potential liver and kidney damage -have they been passing gas or pooping? How to dx PICA - correct answers -need to get a good physical and screening Treatment for PICA - correct answers Useful screening tools in the elderly for depression - correct answers - HAM-D -MMSE -GDS T/F: depression in the elderly is associated with cognitive impairments? - correct answers True SX of depression in the elderly - correct answers -Negative thoughts -sadness, fatigue -anorexia -abandoning hobbies -isolation

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-weight loss -increased use of alcohol -difficulty sleeping Pharmacotherapy for depression in the elderly - correct answers -SSRI's (if bipolar is r/o). -TCA's (amitriptyline good for older females)

T/F we should not use stimulants in the elderly due to glaucoma - correct answers -true CBT is great for older adults with depression - correct answers -true When is ECT the treatment of choice for depression? - correct answers - when they have severe depression due to poor tolerance of psychotropic meds, psychotic features, significant comorbid medical conditions, or marked disability or urgent risk to life. Most likely population to have depression? - correct answers -Older, single, divorced white males treatment resistance in older patients with depression: - correct answers - combine drugs -lithium -thyroid hormones -beta blockers (pindolol) -atypical antipsychotics

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How to treat depression with psychosis - correct answers -antidepressant and antipsychotic meds -perhaps hospitalization and ECT -(ECT is the first choice when agitation, starvation, dehydration) Erikson elderly life cycle: - correct answers -Integrity versus despair (acceptance of mortality, satisfaction with ones meaning in the world t/f suicide rate are high in the elderly - correct answers true Triple D's in the elderly - correct answers depression, dementia, delirum risk factors for the triple d's in the elderly - correct answers -los of social roles and autonomy -deaths -declining health and increased isolation -financial constraints -decreased cognitive functioning Alzheimers disease - correct answers -neurodegenerative disorder -deterioration in memory and cognition -impairment in performing ADLs -behavioral and neuropsychologist disturbances most common form of dementia Three hypothesis of Alzheimers - correct answers 1. tau protein

2. Amyloid

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3. Cholinergic What stages of alzheimers does donepezil (Aricept) treat - correct answers -all stages What stages of alzheimers does galantine (razadyne) treat? - correct answers -mild to moderate what stages of alzheimers does rivastigmine (exelon) treat? - correct answers -mijld to moderate Medications used for cognitive and functional decline: - correct answers - cholinesterase inhibitors Meds used for agitation in AD - correct answers trazodone Meds used for aggression in AD - correct answers -antipsychotics Meds used for psychosis in AD - correct answers -Donepezil -Antipsychotics t/f frontal lobe dementia may respond adversely to cholinesterase inhibitors - correct answers -true, may lead to agitation and insomnia. Off label uses for donepezil - correct answers -Lewy body dementia -TBI -vascular dementia -Dementia associated with Parkinson's disease

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Rivastigmine is used to treat - correct answers -Mild to moderate AD Rivastigmine Side effects - correct answers -GI effects , weight loss (dose dependent) -titrate 4-6 weeks to help alleviate side effects Rivastigmine administration - correct answers -Take with food -does come in a patch Rivastigmine treats - correct answers -mild to moderate dementia (oral) -mild, moderate, severe (patch) Rivastigmine should be used with caution in those with.. - correct answers -renal impairment -hepatic impairments Memantine is FDA approved to treat - correct answers -moderate to severe AD T/F you can use memantine with other AD meds - correct answers true Side effects of memantine - correct answers -headache, dizziness Do not use memantine in which patients - correct answers -seizure patients -kidney disease

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Treating depression in alzheimers - correct answers ** common early in the course of the illness (40-50%) -USE SSRIs First -avoid anticholinergic antidepressants -ECT can be helpful but may temporarily worsen symptoms glutamate hypothesis of dementia - correct answers over excitation of glutamate leads to damage by allowing calcium to leak into cells Antipsychotic agents in dementia - correct answers -Must have a justifiable use: severe, distressing psychotic symptoms -DO NOT USE FIRST LINE FOR NON PSYCHOTIC BEHAVIORAL DISTURBANCES -lowest amount for shortest amount of time -caution family about risks Avoid antipsychotics in those with... - correct answers lewy body dementia t/f behavior management may be used to reduce depression in people with dementia - correct answers -true Non pharmacological interventins for Alzheimers dementia and depression - correct answers -physical and recreational activities -cognitive stimulation -reality orientation therapy Stages of sleep - correct answers Stage 1: drowsiness (NREM) Stage 2: Asleep (Theta waves, NREM) Stage 3: Delta waves (NREM)