MSN 672 Psychopathopharmacology II at Northern Kentucky University
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Free MSN 672 Psychopathopharmacology II at Northern Kentucky University Questions
A 25-year-old patient comes into the clinic for treatment of alcoholism. The PMHNP decides to prescribe disulfiram for treatment of alcoholism. Which of the following statements best describes the action of disulfiram?
- When alcohol is ingested in the presence of disulfiram, alcohol metabolism is inhibited and the result is the build-up of toxic levels of acetaldehyde. This creates an aversive experience with flushing, nausea, vomiting, and hypotension
- When alcohol is ingested in the presence of disulfiram, alcohol metabolism is inhibited and the result is the build-up of toxic levels of acetanilide. This creates an aversive experience with flushing, nausea, vomiting, and hypertension
- When alcohol is ingested in the presence of disulfiram, alcohol metabolism is promoted and the result is the build-up of toxic levels of glutathione. This creates an aversive experience with flushing, nausea, vomiting, and hypertension
- When alcohol is ingested in the presence of disulfiram, alcohol metabolism is promoted and the result is the build-up of toxic levels of acetonitrile. This creates an aversive experience with flushing, nausea, vomiting, and hypotension
Explanation
Disulfiram works by inhibiting the enzyme aldehyde dehydrogenase, which is necessary for the breakdown of acetaldehyde, the toxic intermediate of alcohol metabolism. When alcohol is consumed while on disulfiram, acetaldehyde accumulates rapidly and produces an unpleasant reaction—flushing, severe nausea, vomiting, headache, chest pain, palpitations, and hypotension. This aversive reaction is intended to condition patients to avoid alcohol use.
Correct Answer Is:
A. When alcohol is ingested in the presence of disulfiram, alcohol metabolism is inhibited and the result is the build-up of toxic levels of acetaldehyde. This creates an aversive experience with flushing, nausea, vomiting, and hypotension
Which statement below best describes the difference between methadone or buprenorphine?
- Buprenorphine is a full agonist at μ-opioid receptors and can suppress withdrawal symptoms completely given orally and usually administered daily at a clinic. Methadone is a μ-opioid partial agonist that has less powerful agonist effects and taken as an outpatient instead of returning daily to a clinic
- Methadone and Buprenorphine are both full antagonists. Buprenorphine is a weaker antagonist than Methadone. Both can be taken outpatient daily
- Methadone is a full antagonist at μ-opioid receptors and can suppress withdrawal symptoms completely given orally and usually administered daily at a clinic. Buprenorphine is a μ-opioid partial antagonist that has less powerful antagonist effects and taken as an outpatient instead of returning daily to a clinic
- Methadone is a full agonist at μ-opioid receptors and can suppress withdrawal symptoms completely given orally and usually administered daily at a clinic. Buprenorphine is a μ-opioid partial agonist that has less powerful agonist effects and taken as an outpatient instead of returning daily to a clinic
Explanation
Methadone is a full μ-opioid agonist, meaning it fully activates opioid receptors and can completely suppress withdrawal and cravings. Because of overdose risk and regulation, methadone is typically administered daily in a specialized clinic. Buprenorphine is a partial μ-opioid agonist, producing a ceiling effect that lowers overdose risk. Its pharmacology allows it to be prescribed for outpatient use, making it more flexible while still treating withdrawal and cravings effectively.
Correct Answer Is:
D. Methadone is a full agonist at μ-opioid receptors and can suppress withdrawal symptoms completely given orally and usually administered daily at a clinic. Buprenorphine is a μ-opioid partial agonist that has less powerful agonist effects and taken as an outpatient instead of returning daily to a clinic
A 25-year-old female patient diagnosed with bipolar depression comes into the mental health clinic for treatment. The PMHNP decides to prescribe a combination medication to assist with control of symptoms. Which combination medication has been FDA-approved for bipolar depression?
- Risperdal and Benztropine
- Olanzapine and Fluoxetine
- Quetiapine and Cariprazine
- Clozapine and Trazodone
Explanation
B. Olanzapine and Fluoxetine
The olanzapine–fluoxetine combination (brand name Symbyax) is FDA-approved specifically
for bipolar depression. Olanzapine provides antimanic and mood-stabilizing effects, while
fluoxetine treats the depressive phase. This combination has proven efficacy when depressive
symptoms dominate and when monotherapy is insufficient.
Empathogens produce an altered state of consciousness described as experiences of emotional communion, oneness, relatedness, and emotional openness. Using the options below, please select the prototype empathogen.
- 3,4-methylenedioxymethamphetamine (MDMA)
- Phencyclidine (PCP)
- Tropane Alkaloid (TK)
- Gamma-hydroxybutyrate (GHB)
Explanation
MDMA is the prototype empathogen, known for enhancing empathy, emotional closeness, and feelings of connection with others. It increases serotonin, dopamine, and oxytocin release, creating the emotional openness and interpersonal bonding characteristic of empathogens. PCP, tropane alkaloids, and GHB belong to different substance classes and do not produce the unique empathogenic effects seen with MDMA.
Correct Answer Is:
A. 3,4-methylenedioxymethamphetamine (MDMA)
A 55-year-old female patient taking buspirone for generalized anxiety disorder for the past year returns to the clinic for a refill. She gladly notes that recently she has begun to experience an increased ability to concentrate and is more interested in participating in volleyball, which she used to enjoy. "I'm not afraid to enjoy myself anymore." The patient reports to the PMHNP that her anxiety symptoms have improved tremendously. What may be the underlying mechanism of this patient's positive response to buspirone? Additionally, what subtype of anxiety does buspirone treat?
- The potential anxiolytic actions of buspirone could theoretically be due to 5HT1A partial agonist actions at both presynaptic and postsynaptic 5HT1A receptors/generalized anxiety disorder
- The potential anxiolytic actions of buspirone could theoretically be due to an initial increase in serotonin/social anxiety disorder
- The potential anxiolytic actions of buspirone could theoretically be due to a decreased glutamate release/panic disorder
- The potential anxiolytic actions of buspirone could theoretically be due to an increase in antihistamine release/post-traumatic stress disorder
Explanation
Buspirone exerts its anxiolytic effects primarily through partial agonist activity at 5HT1A
serotonin receptors located both presynaptically (inhibiting serotonin release) and
postsynaptically (enhancing serotonergic transmission). This modulation balances serotonin
levels in the brain, leading to reduced anxiety without sedation or dependency. Buspirone is
specifically indicated for generalized anxiety disorder (GAD) and helps improve focus, mood,
and engagement in daily activities. Its slow onset of action makes it ideal for long-term
management rather than acute anxiety relief.
The PMHNP decides to prescribe carbamazepine for a patient diagnosed with bipolar disorder. What is the initial intervention needed prior to prescribing carbamazepine?
- Screen for HLA-B*1502 allele
- Screen for GM2 gangliosidosis
- Screen for CFTR allele
- Screen for Variation AQA2 allele
Explanation
A. Screen for HLA-B1502 allele
Carbamazepine can trigger Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis
(TEN) in individuals who carry the HLA-B1502 genetic variant. This allele is found primarily in
people of Asian descent, but screening is recommended for any patient whose ancestry places
them at risk. Testing must occur before starting carbamazepine to prevent life-threatening
reactions.
A 35-year-old man Army veteran presents with a chief complaint of excessive crying, which he notes is often triggered by thoughts of dying prior to seeing his family again. His wife reports that he is often tense and “flies off the handle,” followed by episodes of difficulty breathing and increased heart rate. The patient’s symptom of difficulty breathing is related to activation of what part of the brain?
- Hippocampus
- Hypothalamus
- Parabrachial nucleus
- Periaqueductal gray
Explanation
The parabrachial nucleus, located in the pons, plays a key role in autonomic and respiratory
regulation. It integrates input from emotional centers such as the amygdala and hypothalamus
and translates those emotional signals into physiological responses—including changes in
breathing and heart rate. In emotionally charged states such as anxiety or panic, activation of
this area can cause the sensation of difficulty breathing and hyperventilation.
The PMHNP is aware that Carbamazepine (Tegretol) and Oxcarbazepine (Trileptal) can both potentially cause which side effect?
- Decrease in bicarbonate
- Hyponatremia
- Hypercholesterolemia
- Hypocalcemia
Explanation
B. Hyponatremia
Both carbamazepine and oxcarbazepine can cause SIADH (syndrome of inappropriate
antidiuretic hormone secretion), leading to dilutional hyponatremia. This is a well-documented
and clinically significant adverse effect. Symptoms can include headache, confusion, lethargy,
and in severe cases seizures. Sodium levels must be monitored regularly when patients are on
either medication.
Which symptoms should be reported immediately due to severity in a 15-year-old patient prescribed valproate? Select all that apply.
- Vomiting
- Severe abdominal pain
- Oily, smelly stools
- Weight gain
Explanation
A. Vomiting
Vomiting can be an early sign of valproate-induced hepatotoxicity or pancreatitis, both of
which are medical emergencies. Any sudden or severe vomiting in a patient taking valproate
requires immediate evaluation.
B. Severe abdominal pain
Severe or persistent abdominal pain is a classic warning sign of acute pancreatitis, a life-threatening adverse reaction to valproate. This symptom must be reported immediately for
emergency assessment.
C. Oily, smelly stools
Oily, foul-smelling stools (steatorrhea) may indicate pancreatic dysfunction, which can occur
in valproate-induced pancreatitis. This is a red-flag symptom requiring urgent medical attention.
A 29-year-old male presents with complaints of not being able to stay awake in the daytime. He falls asleep during exams and conversations with others. The patient was previously diagnosed with narcolepsy. The nurse practitioner understands that narcolepsy is due to the hypothalamic degeneration of what neurons? (Select all that apply.)
- Norepinephrine
- Hypocretin
- Orexin
- Acetylcholine
Explanation
B. Hypocretin:
Hypocretin, also known as orexin, is a neuropeptide produced in the lateral hypothalamus. It
plays a vital role in promoting wakefulness and maintaining stable sleep-wake transitions. The
loss or degeneration of hypocretin-producing neurons disrupts normal sleep regulation, leading
to the hallmark symptoms of narcolepsy such as excessive daytime sleepiness, cataplexy, and
sudden REM sleep episodes. Low levels of hypocretin are often found in the cerebrospinal fluid
of individuals with narcolepsy.
C. Orexin:
Orexin is the same neuropeptide as hypocretin but is named differently depending on its
discovery context. It helps sustain wakefulness, energy metabolism, and arousal by activating
multiple brain regions responsible for alertness. Degeneration of orexin neurons in the
hypothalamus removes this stabilizing influence, causing inappropriate REM sleep transitions
and uncontrollable sleep attacks. Both hypocretin and orexin systems are central to preventing
sudden sleep onset during active periods.
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