MSN 671 : Psychopathopharmacology I - NKU Module 4 quiz 6
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Free MSN 671 : Psychopathopharmacology I - NKU Module 4 quiz 6 Questions
Which of the following symptom clusters is most characteristic of sleep apnea?
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Difficulty falling asleep, sleepwalking, vivid dreams, and restless legs
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Loud snoring, frequent nocturnal awakenings, excessive daytime sleepiness, morning headaches, memory and cognitive problems, irritability
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Early morning awakenings, depressed mood, poor appetite, and low energy
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Nightmares, hypervigilance, flashbacks, and exaggerated startle response
Explanation
Correct Answer:
B. Loud snoring, frequent nocturnal awakenings, excessive daytime sleepiness, morning headaches, memory and cognitive problems, irritability
Explanation of Correct Answer
Sleep apnea is a sleep-related breathing disorder marked by repeated airway obstruction during sleep. Its hallmark features include loud snoring, frequent awakenings at night, and excessive daytime sleepiness due to fragmented sleep. Additional symptoms include morning headaches, memory/cognitive impairment, and irritability from chronic sleep disruption and intermittent hypoxia. Recognizing these symptoms is essential for screening and referral for sleep studies.
What type of medications should be avoided in dementia patients if at all possible due to risk of worsening cognition, falls, and dependence?
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Benzodiazepines
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Cholinesterase inhibitors
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Atypical antipsychotics (e.g., quetiapine)
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SSRIs (e.g., sertraline)
Explanation
Correct Answer:
A. Benzodiazepines
Explanation of Correct Answer
Benzodiazepines should generally be avoided in dementia patients. They can worsen cognitive impairment, increase confusion, and significantly raise the risk of falls and fractures due to sedation and impaired coordination. Long-term use also carries a risk of dependence and withdrawal complications. In dementia care, safer alternatives such as non-pharmacological approaches or SSRIs for anxiety and agitation are preferred.
Melatonin receptor agonists (e.g., ramelteon) are most useful in treating circadian rhythm disorders and are especially helpful for which groups of patients?
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Children, adolescents, and athletes
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Shift workers, jet lag travelers, and older patients
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Patients with Parkinson’s disease, epilepsy, and migraines
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College students, postpartum mothers, and individuals with ADHD
Explanation
Correct Answer:
B. Shift workers, jet lag travelers, and older patients
Explanation of Correct Answer
Melatonin receptor agonists such as ramelteon mimic the action of endogenous melatonin by binding to MT1 and MT2 receptors in the suprachiasmatic nucleus (SCN). They help regulate the circadian rhythm, making them particularly effective for shift workers, individuals with jet lag, and older patients, who naturally experience reduced melatonin secretion. By resetting the sleep-wake cycle, they improve sleep onset without significant risk of dependence.
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.
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.
Which of the following is thought to be a hallmark of the underlying causes of Alzheimer's disease, negatively impacting the effectiveness of cholinergic projection and potentially resulting in a "steady leak" of glutamate?
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Amyloid Deposits and Neurofibrillary tangles
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Iodine and Cystine Deposits
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Tacrine Deposits and Neurocyanosis
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Amylase Deposits and Neurofibrillary tangles
Explanation
Correct Answer:
A. Amyloid Deposits and Neurofibrillary tangles
Explanation of Correct Answer
Amyloid-beta plaques and neurofibrillary tangles are the hallmark pathological features of Alzheimer’s disease. These abnormal protein accumulations impair cholinergic transmission and lead to excitotoxicity, including the “steady leak” of glutamate. Together, they cause progressive neuronal dysfunction and cognitive decline, forming the biological basis for the disease.
Antihistamines such as hydroxyzine and diphenhydramine have sedative effects that can help with sleep, but they may also cause what?
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Cognitive enhancement
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Next-day drowsiness
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REM sleep stabilization
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Improved concentration
Explanation
Correct Answer:
B. Next-day drowsiness
Explanation of Correct Answer
Hydroxyzine and diphenhydramine are first-generation antihistamines that block H1 receptors in the brain. This promotes sedation and can help with sleep initiation. However, because of their relatively long half-lives, they frequently cause next-day drowsiness, grogginess, and impaired alertness. This hangover effect can interfere with daily functioning and is a common drawback of using these medications for 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.
Which statement best describes the role of adenosine in sleep regulation?
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Adenosine is a neurotransmitter that directly stimulates orexin neurons to promote wakefulness
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Adenosine is an endogenous neuromodulator that builds up during wakefulness, inhibits arousal systems, and promotes sleep onset
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Adenosine acts as a hormone released from the pineal gland to regulate circadian rhythms
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Adenosine levels decrease throughout the day, reducing sleep pressure and allowing for extended wakefulness.
Explanation
Correct Answer:
B. Adenosine is an endogenous neuromodulator that builds up during wakefulness, inhibits arousal systems, and promotes sleep onset.
Explanation of Correct Answer
Adenosine is an endogenous neuromodulator that steadily accumulates in the brain as wakefulness is prolonged. High levels of adenosine inhibit wake-promoting neurons in arousal systems and facilitate GABAergic activity in the VLPO, which promotes sleep onset. This build-up creates the homeostatic “sleep pressure” that ensures the body eventually transitions into sleep after extended wakefulness.
_______, produced in the lateral hypothalamus, plays a key role in stabilizing wakefulness by activating multiple arousal systems. Deficiency in ______ is linked to narcolepsy.
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Dopamine
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Orexin
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Serotonin
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Melatonin
Explanation
Correct Answer:
2. Orexin
Explanation of Correct Answer
Orexin, also called hypocretin, is produced in the lateral hypothalamus and is crucial for maintaining stable wakefulness. It activates multiple arousal pathways, including histamine, dopamine, and norepinephrine systems, to prevent sudden transitions into sleep. Deficiency in orexin is directly linked to narcolepsy, which is characterized by excessive daytime sleepiness and sleep attacks due to instability of the sleep–wake cycle.
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