MSN 671 : Psychopathopharmacology I - NKU Module 4 quiz 6
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Free MSN 671 : Psychopathopharmacology I - NKU Module 4 quiz 6 Questions
Identify the core features of Lewy bodies. Select all that applies:
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Fluctuating attention and concentration
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Spontaneous parkinsonism
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Mutism
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Recurrent well-formed visual hallucinations
Explanation
Correct Answer: A. Fluctuating attention and concentration, B. Spontaneous parkinsonism, D. Recurrent well-formed visual hallucinations
Explanation of Correct Answer
A. Fluctuating attention and concentration
Fluctuations in cognition, especially attention and concentration, are a hallmark of Lewy body dementia. Patients may have dramatic variations in alertness throughout the day, which distinguishes it from Alzheimer’s disease.
B. Spontaneous parkinsonism
Lewy body dementia is characterized by parkinsonian motor features such as rigidity, bradykinesia, and tremor that appear spontaneously and are not solely due to medication side effects. This overlaps with Parkinson’s disease but occurs earlier in dementia with Lewy bodies.
D. Recurrent well-formed visual hallucinations
Patients commonly experience vivid, recurrent, and detailed visual hallucinations, often of people or animals. These hallucinations are considered a core clinical feature and are highly suggestive of Lewy body dementia.
In the brain, histamine is produced solely in which location?
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Locus coeruleus of the pons
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Tuberomamillary nucleus (TMN) of the hypothalamus
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Raphe nuclei of the brainstem
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Substantia nigra of the midbrain
Explanation
Correct Answer:
B. Tuberomamillary nucleus (TMN) of the hypothalamus
Explanation of Correct Answer
Histamine is synthesized exclusively by neurons in the tuberomamillary nucleus (TMN) of the posterior hypothalamus. From there, histaminergic axons project widely throughout the brain to regulate arousal, attention, and wakefulness. The TMN is the brain’s only source of histamine, making it a central hub in the sleep–wake cycle. Loss or dysfunction of TMN histamine activity contributes to excessive sleepiness and impaired alertness.
............................................................. is one of the key neurotransmitters that regulates wakefulness and is the ultimate target of many wake-promoting drugs when enhanced and sleep-promoting drugs when blocked.
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Prolactin
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Histamine
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Acetylcholine
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Dopamine
Explanation
Correct Answer:
B. Histamine
Explanation of Correct Answer
Histamine, released from neurons in the tuberomammillary nucleus of the hypothalamus, plays a central role in promoting wakefulness. When histamine activity is enhanced, it stimulates arousal, which is why histamine agonists or stimulants support wakefulness. Conversely, blocking histamine receptors (as with many antihistamines) promotes drowsiness and sleep, making histamine the ultimate neurotransmitter target for both sleep- and wake-promoting drugs.
Rivastigmine is best described as which type of cholinesterase inhibitor?
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Reversible selective acetylcholinesterase (AChE) inhibitor that works centrally
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Pseudo-irreversible inhibitor of both acetylcholinesterase (AChE) and butyrylcholinesterase (BuChE)
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Dopamine reuptake inhibitor that enhances reward pathways
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NMDA receptor antagonist that decreases glutamate excitotoxicity
Explanation
Correct Answer:
B. Pseudo-irreversible inhibitor of both acetylcholinesterase (AChE) and butyrylcholinesterase (BuChE)
Explanation of Correct Answer
Rivastigmine is a pseudo-irreversible cholinesterase inhibitor that blocks both AChE and BuChE. This dual action makes it especially beneficial in more advanced stages of Alzheimer’s disease, where BuChE activity increases as AChE activity declines. By enhancing acetylcholine availability in cortical and subcortical areas, rivastigmine helps improve cognition, attention, and function in patients with dementia.
Hypervigilance-related insomnia is most commonly seen in which of the following conditions?
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Anxiety, PTSD, and stimulant overuse
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Depression, dementia, and circadian rhythm disorder
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Narcolepsy, epilepsy, and restless legs syndrome
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Chronic pain, diabetes, and cardiovascular disease
Explanation
Correct Answer:
A. Anxiety, PTSD, and stimulant overuse
Explanation of Correct Answer
Hypervigilance insomnia occurs when the brain remains in a heightened state of arousal, preventing normal sleep initiation and maintenance. This is commonly seen in anxiety disorders, where worry prevents relaxation, PTSD, where trauma-related hyperarousal and nightmares disturb sleep, and stimulant overuse (e.g., caffeine, amphetamines), which directly activate wake-promoting systems. These conditions disrupt the brain’s ability to “switch off,” leading to persistent insomnia.
Which statement best explains the role of NMDA receptor antagonists, such as memantine, in the treatment of Alzheimer’s disease?
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They work on the cholinergic system to increase acetylcholine levels in early stages of the disease
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They block dopamine reuptake to improve motivation and cognition
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They act on the glutamatergic system to reduce excitotoxicity, which becomes more prominent in later stages of the disease
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They enhance serotonin signaling to reduce depression and anxiety symptoms in dementia
Explanation
Correct Answer:
C. They act on the glutamatergic system to reduce excitotoxicity, which becomes more prominent in later stages of the disease
Explanation of Correct Answer
NMDA receptor antagonists, such as memantine, work by regulating the glutamatergic system. In Alzheimer’s disease, excessive glutamate activity leads to overactivation of NMDA receptors, causing calcium influx and neuronal damage (excitotoxicity). By blocking this excessive stimulation while preserving normal synaptic transmission, memantine helps protect neurons. This mechanism is especially useful in moderate to severe stages of Alzheimer’s disease, where excitotoxicity plays a greater role in disease progression.
Galantamine’s dual mechanism of action provides added benefits in Alzheimer’s disease. Which description best matches its pharmacology?
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Irreversible AChE inhibitor and NMDA receptor antagonist
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Pseudo-irreversible inhibitor of AChE and BuChE
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Reversible AChE inhibitor and positive allosteric modulator of nicotinic receptors
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Dopamine receptor agonist and serotonin reuptake inhibitor
Explanation
Correct Answer:
C. Reversible AChE inhibitor and positive allosteric modulator of nicotinic receptors
Explanation of Correct Answer
Galantamine enhances cognition in Alzheimer’s disease through a dual mechanism. First, it reversibly inhibits acetylcholinesterase, preventing the breakdown of acetylcholine and boosting cholinergic transmission. Second, it acts as a positive allosteric modulator at nicotinic receptors, which further enhances acetylcholine release and receptor sensitivity. This added action supports improved memory and cognition, giving galantamine a unique therapeutic advantage.
The PMHNP has a 27-year-old male that returns to the clinic for a follow-up. The patient has a documented history of substance abuse. The patient has reported sobriety for 1 month. The patient newly reports lack of sleeping and requesting a sleep aid. As the PMHNP you complete an assessment to include sleep hygiene and determine that the patient may benefit from a sleep aid. The patient reports that Benadryl and Melatonin have been ineffective. Which of the following sleep aids may be trialed first for this patient. Select all that applies:
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Suvorexant
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Trazodone
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Lemborexant
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Zolpidem
Explanation
Correct Answer:
B. Trazodone
Explanation of Correct Answer
B. Trazodone
Trazodone is often considered first-line in patients with a history of substance abuse because it is a non-habit-forming antidepressant with sedative effects. It carries a much lower risk of abuse compared to other hypnotics such as zolpidem or orexin antagonists. For a patient with early recovery from substance use, avoiding medications with addictive potential is essential. Trazodone offers both safety and effectiveness, making it the most appropriate option in this scenario.
The longer an individual is awake, the greater the homeostatic drive to sleep. The homeostatic sleep drive is dependent upon the accumulation of what chemical in the brain? The PMHNP understands this chemical increases as the person tires with fatigue throughout the day, and ultimately leads to the disinhibition of the ventrolateral preoptic (VLPO) nucleus and the release of GABA in the sleep circuit.
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Tyrosine
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Epinephrine
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Adenosine
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Norepinephrine
Explanation
Correct Answer:
C. Adenosine
Explanation of Correct Answer
Adenosine steadily accumulates in the brain during wakefulness as a byproduct of cellular energy metabolism. As adenosine builds up, it creates “sleep pressure,” signaling the need for rest. High adenosine levels inhibit arousal systems and activate the VLPO nucleus, which promotes GABA release and sleep initiation. This mechanism is central to the homeostatic regulation of sleep.
Which of the following best represents the key categories of causes of insomnia?
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Poor diet, lack of exercise, and screen time
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Psychiatric disorders, medical conditions, and substance use
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Aging, genetics, and seasonal changes
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Stress, overwork, and family responsibilities
Explanation
Correct Answer:
B. Psychiatric disorders, medical conditions, and substance use
Explanation of Correct Answer
Insomnia is often secondary to other conditions. The three key categories are:
Psychiatric disorders such as depression, anxiety, and PTSD, which alter sleep patterns.
Medical conditions like chronic pain, cardiovascular or pulmonary disease, and neurological disorders, which interfere with sleep.
Substance use, including caffeine, alcohol, and stimulants, which can disrupt sleep onset and maintenance.
These underlying causes must be assessed and addressed for effective treatment of insomnia.
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