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 neurotransmitter helps maintain wakefulness, and whose effects can be blocked by diphenhydramine, leading to sedation?
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Acetylcholine
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Histamine
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Dopamine
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Orexin
Explanation
Correct Answer:
B. Histamine
Explanation of Correct Answer
Histamine, produced in the tuberomamillary nucleus (TMN) of the hypothalamus, is a key wake-promoting neurotransmitter. It activates cortical arousal pathways, keeping the brain alert and attentive. When histamine H1 receptors are blocked by first-generation antihistamines like diphenhydramine, the result is sedation and drowsiness. This is why such medications are often marketed as sleep aids but can also cause next-day grogginess.
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.
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.
............................................................. 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.
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.
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.
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.
Lewy Body Dementia patients are highly sensitive to traditional antipsychotics. If antipsychotic treatment is necessary, what type of medications are recommended?
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First-generation antipsychotics (e.g., haloperidol)
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High-potency dopamine antagonists (e.g., risperidone)
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Atypical antipsychotics with lower D2 blockade (e.g., quetiapine, brexpiprazole)
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Stimulant medications (e.g., methylphenidate)
Explanation
Correct Answer:
C. Atypical antipsychotics with lower D2 blockade (e.g., quetiapine, brexpiprazole)
Explanation of Correct Answer
Lewy Body Dementia patients often develop severe neuroleptic sensitivity reactions when exposed to first-generation or high-potency antipsychotics. This can worsen parkinsonism, cause profound rigidity, or even trigger neuroleptic malignant syndrome. If antipsychotics are required for hallucinations or behavioral symptoms, atypical agents with weaker dopamine D2 receptor blockade, such as quetiapine or brexpiprazole, are preferred. These options balance symptom control with lower risk of worsening motor function.
Which combination best represents the underlying pathological mechanisms of Alzheimer’s disease?
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Excess serotonin, dopamine imbalance, and tau protein clearance
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Loss of acetylcholine, amyloid plaques, neurofibrillary tangles, and glutamate excitotoxicity
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Reduced norepinephrine, increased GABA, and myelin sheath degeneration
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Elevated histamine, iron accumulation, and cortical thinning
Explanation
Correct Answer:
B. Loss of acetylcholine, amyloid plaques, neurofibrillary tangles, and glutamate excitotoxicity
Explanation of Correct Answer
Alzheimer’s disease arises from multiple pathological mechanisms. The loss of acetylcholine impairs cholinergic neurotransmission, leading to memory and cognitive decline. Amyloid-beta plaques accumulate extracellularly, disrupting neural signaling, while neurofibrillary tangles composed of hyperphosphorylated tau damage intracellular transport. The glutamate hypothesis adds that excessive activation of NMDA receptors causes excitotoxicity and neuronal death. Together, these processes drive progressive neurodegeneration.
Blocking histamine H1 receptors interferes with histamine’s wake-promoting actions. What is the clinical effect of this mechanism?
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Improved alertness and concentration
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Sedation and drowsiness, sometimes used as a sleep aid
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Enhanced gastric acid secretion for digestion
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Increased motor activity and vigilance
Explanation
Correct Answer:
B. Sedation and drowsiness, sometimes used as a sleep aid
Explanation of Correct Answer
Histamine acting at H1 receptors promotes wakefulness and alertness in the brain. When H1 receptors are blocked, as with first-generation antihistamines (e.g., diphenhydramine, hydroxyzine), this disrupts histamine’s arousal function, producing sedation, drowsiness, and sleepiness. This is why some antihistamines are marketed as over-the-counter sleep aids. However, the downside is next-day grogginess and impaired alertness due to their relatively long half-lives and anticholinergic effects.
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