Nursing weekly quiz., Summaries of Nursing

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A. Harrison,

Nursing weekly quiz

Week 1 Quiz The amygdala is associated with anxiety and perception of odors. The hippocampus is involved in memory and anxiety. The amygdala is associated with anxiety and perception of odors. The prefrontal cortex is associated with executive function. The thalamus is associated with motor command processing The client’s cognitive status can result in an ethical concern if the client is unable to self-determine care or is a danger to self or others. Ability to pay is not an ethical issue. basal ganglia are a group of structures involved in voluntary motor movements. Basal ganglia are also involved in cognition and emotion. Limbic system is associated with emotion and learning hippocampi are associated with long term memory Wernicke's area is associated with speech comprehension. Review activity the dorsolateral prefrontal cortex (DLPFC) is concerned with higher level functioning. The VLPFC is involved with motor inhibition the IFG contains Broca's area which is associated with speech production understanding grammar. Pliska Ch. 8 the OFC is involved in decision making and social behavior with a focus on punishment and rewards. The OFC inhibits and activates the amygdala and is activated when a risk assessment is required. Some behaviors associated with the OFC include sex, sugar, pain, social humiliation, money, rewards, fame, and aggression. The amygdala will identify a threat and then the OFC will determine the risk or benefit of an action based on past experience. Pliska Ch. 8, p. At this time, 20 % of the world’s population is suffering from a neurologic and/or psychiatric disorder. Week 2 Quiz G protein linked systems, one of the signal transduction cascades, pass the message from a first receptor to a second messenger. Glutamate is an excitatory neurotransmitter. (NEI glutamate video- the glutamate sisters) CYP 3A4 is one of the 5 most important NT which include CYP 1A2, 2D6, 2C9, 2C19, 3A4. Dosing adjustments may be required. Stahl p. 46-51. Smoking induces CYP1A2. Stahl p. partial agonist- drug does not fully activate receptors; antagonist- drug binds to receptor but does not activate a response; inverse agonist- drug cause opposite effect of the agonist ;agonist- ;agonist- drug binds to the receptor and activates a biological response G protein Linked systems and ion channel linked cascades are triggered by neurotransmitters. Stahl p. 11

Major current hypothesis for the cause of schizophrenia proposes that glutamate activity at N-methyl-d- aspartate (NMDA) receptors is hypofunctional due to abnormalities in the formation of glutamatergic NMDA synapses during neurodevelopment. Stahl p. 107 Although individual effects may vary from patient to patient, in general conventional antipsychotics share the same primary mechanism of action and do not differ much in their therapeutic profiles. There are, however, differences in secondary properties, such as degree of muscarinic, histaminergic, and/or alpha-adrenergic receptor antagonism, which can lead to different side-effect profiles. Stahl p. (including table 5- 1 and Figure 5-2). This question addressed affinity. Nearly all atypical antipsychotics have an affinity for blocking serotonin 2A receptors that is equal to or greater than their affinity for blocking dopamine 2 receptors. The “pines”

• clozapine, olanzapine, quetiapine, and asenapine – all bind much more potently to the serotonin 2A receptor than they do to the dopamine 2 receptor. The “dones” – risperidone, paliperidone, ziprasidone, iloperidone, and lurasidone – also bind more potently to the serotonin 2A receptor than to the dopamine 2 receptor or show similar potency at both receptors. Stahl p.141- 143 The tuberoinfundibular pathway is associated with hyperprolactinemia Stahl p. 136 The mesolimbic pathway is associated with positive symptoms. The mesocortical pathway is associated with negative symptoms. The nigrostriatal pathway is part of the extrapyramidal nervous system and associated with extrapyramidal symptoms (EPS). the tuberoinfundibular pathway is associated with hyperprolactinemia After failure of two sequential adequate trials of antipsychotic monotherapy, the recommended and evidence-based treatment strategy is to switch to clozapine. Stahl p. 182 Hello NR546 students, Week 5 Quiz SSRIs are first line treatment for depression. Stahl Ch. 7 sexual dysfunction is common with SSRIs. Stahl Ch. 7 Rapid cycling is a minimum of 4 episodes/year. Stahl Ch 6, Figure 6. the goal of antidepressant treatment is complete remission of symptoms. Stahl p.

serotonin is associated with GI side effects due to the presence of 90% of 5HT receptors in the GI tract. See Explore section clinical pearls 10% brain escitalopram is considered the best tolerated SSRI with the fewest CYP interactions. Stahl Ch 7 p. 296 Lithium levels can be increased by NSAIDs and ACE inhibitors, decreased by caffeine and mania, and unchanged by amiloride, furosemide, and sulindac. Course Explore section - clinical pearls Lamotrigine is well tolerated except for the propensity to cause a rash. Stahl p. monoamine neurotransmitters are norepinephrine, dopamine and serotonin. Stahl p. 237 week 5 Course Explore section : special populations discusses medication associated pregnancy risks (carbamazepine- neural tube defect) Lithium is well established to help prevent suicide in clients with mood disorders. NR546 Week 6 Quiz

1. SSRIs are approved for 1st line treatment of OCD (Fluoxetine). BZOs are not first line treatment for OCD. Stahl p. 575
2. The primary action of hallucinogenic drugs such as LSD, mescaline, psilocybin, and MDMA are agonism of 5HT2A receptors. Hallucinogens may have additional actions at other serotonin receptors (particularly 5HT1A and 5HT2C) and at other neurotransmitter systems, and MDMA in particular also blocks the serotonin transporter (SERT). Stahl p. 562 - Figure 14 - 19. Mechanism of hallucinogens at 5HT2A receptors
3. The hypothalamus serves as the brain center that controls appetite by utilizing a complex set of circuits and regulators. One formulation of how the hypothalamus does this is the notion that there is a major appetite-stimulating pathway whose actions are mediated by two peptides (neuropeptide Y and agouti-related protein).. Stahl p.564- 566
4. Appetite is regulated by the balance between an appetite-stimulating pathway (on the left) that releases agouti-related peptide (AgRP) and neuropeptide Y (NPY), and an appetite-suppressing pathway (on the right) that releases α-melanocyte-stimulating hormone (α-MSH). Stahl p.564-

The tuberomammillary nucleus (TMN) contains the on switch, the off switch is located in the ventrolateral preoptic nucleus (VLPO). Stahl p. 445 Guanfacine is an alpha 2 agonist, methylphenidate is a dopamine norepinephrine multimodal; amphetamine is a is a dopamine norepinephrine reuptake inhibiter (DN-RIRe),; Wellbutrin is an amphetamine is a is a dopamine reuptake inhibitor(D-RIRe).. Stahl Ch 12 Hyperactivity is modulated by the prefrontal cortex. Impulsivity is modulated by the orbitofrontal cortex. Stahl p. 475, Figure 11. Children present with hyperactivity, the hyperactive symptoms are going to decline markedly with age, becoming more subjective, less apparent or obvious to others. Adults are not hyperactive but do report on internal restless and difficulty sitting still. ADHD symptoms presentation in your course under Explore: Week 7: Medications for ADHD and see core symptoms Fig 11. Melatonin and melatonin receptor agonists are effective hypnotics for sleep onset. They do not help with sleep maintenance Classic ADHD presents around age 7 due to the abnormalities in the prefrontal cortex circuits. dACC is associated with impulsivity, one of the symptoms of ADHD Z drugs are Schedule IV medications. A DEA license is required to prescribe these medications Methylphenidate Section. Methylphenidate blocks DAT and NET Norepinephrine (NE) and Dopamine (DA) are associated with the symptoms of inefficient information processing in the prefrontal circuits. Rather than a deficiency, Stahl (2013) posits that NE and DA are “out of tune”. DA agonists are first line treatment for insomnia related to RLS Melatonin, secreted by the pineal gland, regulates circadian rhythms.