MSN 672 Psychopathopharmacology II at Northern Kentucky University
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Free MSN 672 Psychopathopharmacology II at Northern Kentucky University Questions
Sam is a 73-year-old patient with Alzheimer's disease. Sam has been on donepezil, 10 mg/day for approximately 8 months to aid in improving his cognitive functioning. Sam's wife has begun to notice a loss of effectiveness over the past months of donepezil. Sam's wife is requesting an intervention. The PMHNP decides to augment the donepezil with memantine 5 mg/day at hs. Which of the following properties of memantine listed below may be useful in treating Alzheimer's disease?
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Serotonin 3 (5HT3) antagonism
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Sigma antagonism
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N-methyl-D-aspartate (NMDA) antagonism at the PCP site
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N-methyl-D-aspartate (NMDA) antagonism at the magnesium site
Explanation
Memantine works by blocking excessive activation of NMDA receptors at the PCP (phencyclidine) binding site, which reduces glutamate-mediated excitotoxicity in the brain. In Alzheimer's disease, chronic overstimulation of NMDA receptors contributes to neuronal damage and cognitive decline. By modulating this pathway, memantine helps protect neurons and can improve or stabilize cognitive functioning, especially when used together with cholinesterase inhibitors like donepezil.
Correct Answer Is:
C. N-methyl-D-aspartate (NMDA) antagonism at the PCP site
This particular mood stabilizer has a profound immediate suppressant effect upon the bone marrow, requiring initial monitoring of blood counts and notable induction of the cytochrome P450 enzyme. Which mood stabilizer is this?
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Lithium
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Carbamazepine
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Valproate
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Topiramate
Explanation
B. Carbamazepine
Carbamazepine can cause bone marrow suppression, including leukopenia, anemia, and, in
severe cases, aplastic anemia or agranulocytosis. Therefore, baseline and ongoing CBC
monitoring is required. Additionally, carbamazepine is a strong inducer of cytochrome P450
(CYP3A4), which can significantly lower serum levels of many medications by speeding their
metabolism. This combination—bone marrow suppression plus CYP450 induction—uniquely
fits carbamazepine.
The PMHNP understands that anxiety can be triggered internally from traumatic memories stored in the ______________ and activated by connections with the ______________, especially in conditions such as PTSD.
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Hippocampus and Amygdala
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Parietal Lobe and Basal Forebrain
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Nucleus Caudate and Prefrontal Cortex
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Periaqueductal Gray and Nucleus Accumbens
Explanation
In post-traumatic stress disorder (PTSD), traumatic memories are stored in the hippocampus, the brain region responsible for memory formation and contextual processing.
When these memories are recalled or triggered, they activate the amygdala, which governs fear,
emotional response, and threat detection. This hippocampus–amygdala connection explains
why certain cues or internal thoughts can evoke intense anxiety, hyperarousal, or flashbacks in
PTSD patients.
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?
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Hippocampus
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Hypothalamus
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Parabrachial nucleus
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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.
Which of the following neurotransmitters are considered part of the ascending reticular activating system in the brain that works together to regulate arousal? (Select all that apply.)
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Histamine
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Dopamine
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Orexin
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Methylation
Explanation
The ascending reticular activating system (ARAS) is responsible for regulating arousal,
wakefulness, and attention. Several neurotransmitters play a central role in this process:
A. Histamine
Histamine is produced in the tuberomammillary nucleus of the hypothalamus and promotes
alertness and wakefulness. Antihistamine medications that cross the blood-brain barrier often
cause drowsiness due to histamine inhibition.
B. Dopamine
Dopamine, released from the ventral tegmental area (VTA) and other midbrain regions, is
essential for maintaining arousal, motivation, and cognitive alertness. It supports the brain’s
reward and activation pathways that sustain wakefulness.
C. Orexin
Orexin (also known as hypocretin), produced in the lateral hypothalamus, stabilizes
wakefulness by stimulating other arousal-promoting systems. Deficiency in orexin is associated
with narcolepsy.
The PMHNP decides to prescribe carbamazepine for a patient diagnosed with bipolar disorder. What is the initial intervention needed prior to prescribing carbamazepine?
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Screen for HLA-B*1502 allele
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Screen for GM2 gangliosidosis
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Screen for CFTR allele
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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.
During smoking cessation, resensitized nicotinic receptors no longer receiving nicotine, and the individual experiences cravings due to an absence of dopamine release in the nucleus accumbens. What type of antidepressant medication may the PMHNP choose to assist with boosting dopamine in the nucleus accumbens to assist with the treatment of smoking cessation?
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Selective serotonin reuptake inhibitor (SSRI)
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Serotonin and norepinephrine reuptake inhibitor (SNRI)
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Norepinephrine and dopamine reuptake inhibitors (NDRI)
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Tricyclic antidepressants (TCA)
Explanation
Norepinephrine and dopamine reuptake inhibitors (NDRIs), such as bupropion, are effective in smoking cessation because they increase dopamine levels in the nucleus accumbens, the brain’s reward center. When nicotine is removed, dopamine release drops, leading to cravings and withdrawal. NDRIs counter this deficit by boosting dopamine and norepinephrine, reducing cravings and helping with abstinence. This mechanism makes NDRIs the preferred antidepressant class for smoking cessation.
Correct Answer Is:
C. Norepinephrine and dopamine reuptake inhibitors (NDRI)
The PMHNP is aware that Carbamazepine (Tegretol) and Oxcarbazepine (Trileptal) can both potentially cause which side effect?
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Decrease in bicarbonate
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Hyponatremia
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Hypercholesterolemia
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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.
A 28-year-old male returns to the clinic and reports worsening of nightmares after taking Trazodone for one month. The PMHNP reviewed the patient’s records and notices the patient has a chronic history of PTSD and alcoholism. What is likely the most appropriate alternative treatment for this patient?
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Switch to a Benzodiazepine
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Switch to Aripiprazole
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Switch to Wellbutrin
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Switch to α1 antagonists
Explanation
α1 antagonists, such as Prazosin, are effective in treating PTSD-related nightmares and sleep disturbances. Prazosin works by blocking adrenergic activity, reducing the excessive
noradrenergic response during sleep that contributes to vivid dreams and nightmares. Unlike
benzodiazepines or antidepressants, it has minimal risk for dependency—making it particularly
appropriate for a patient with a history of alcoholism. It improves sleep quality and decreases the
frequency and severity of trauma-related nightmares.
Which medications listed below are considered "off-label" treatments of panic attacks in anxiety disorders? (Select all that apply.)
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Trazodone
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Mirtazapine
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Risperidone
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Haloperidol
Explanation
While SSRIs, SNRIs, and benzodiazepines are first-line treatments for panic disorder, several
other medications have been used off-label when standard therapies are ineffective or poorly
tolerated:
A. Trazodone
Although primarily prescribed for depression and insomnia, trazodone’s serotonergic
modulation can help reduce anxiety and panic symptoms in some patients.
B. Mirtazapine
An atypical antidepressant that enhances serotonergic and noradrenergic transmission,
mirtazapine has been shown in studies to reduce panic frequency and anxiety intensity,
making it an off-label option.
C. Risperidone
An atypical antipsychotic, risperidone has been used off-label in refractory anxiety and panic
disorders due to its serotonin 5-HT₂ and dopamine D₂ receptor blockade, which can stabilize
mood and reduce panic severity.
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