MSN 671 : Psychopathopharmacology I - NKU Module 4 quiz 6
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Free MSN 671 : Psychopathopharmacology I - NKU Module 4 quiz 6 Questions
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.
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.
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.
What is considered the first-line treatment for chronic insomnia, offering effectiveness comparable to medications but with longer-lasting benefits and no risk of dependence?
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Cognitive Behavioral Therapy for Insomnia (CBT-I)
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Benzodiazepines
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Antihistamines (e.g., diphenhydramine)
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Melatonin supplements
Explanation
Correct Answer:
A. Cognitive Behavioral Therapy for Insomnia (CBT-I)
Explanation of Correct Answer
CBT-I is the gold-standard, first-line treatment for chronic insomnia. It targets maladaptive sleep behaviors and thoughts, using strategies such as stimulus control, sleep restriction, cognitive restructuring, and relaxation training. Evidence shows CBT-I is as effective as medications in the short-term but with longer-lasting results and without risks like dependence, tolerance, or next-day sedation. This makes it the safest and most sustainable intervention.
The PMHNP has a 71-year-old female that is accompanied to the mental health clinic by their daughter. The patient has a chronic documented history of constipation and memory problems. The patient complains of difficulty with sleep. Which medication would you avoid administering this patient for sleep?
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Diphenhydramine
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Melatonin
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Lemborexant
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Doxepin
Explanation
Correct Answer:
A. Diphenhydramine
Explanation of Correct Answer
A. Diphenhydramine
Diphenhydramine is an antihistamine with strong anticholinergic side effects, including worsening constipation, urinary retention, and cognitive impairment. In older adults, it can significantly worsen memory problems and increase fall risk. Because of its anticholinergic burden, diphenhydramine is listed on the Beers Criteria as inappropriate for elderly patients.
Melatonin, lemborexant, and low-dose doxepin are safer alternatives for treating insomnia in geriatric populations, with careful monitoring.
_______, 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.
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.
Suvorexant, used for the treatment of insomnia, belongs to which drug class and works by what mechanism?
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Benzodiazepine that enhances GABA activity in the sleep circuit
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Orexin receptor antagonist that blocks wake-promoting signals
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Melatonin receptor agonist that resets circadian rhythm
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Histamine H1 antagonist that reduces arousal and promotes sedation
Explanation
Correct Answer:
B. Orexin receptor antagonist that blocks wake-promoting signals
Explanation of Correct Answer
Suvorexant is a dual orexin receptor antagonist (DORA). By blocking orexin 1 and orexin 2 receptors in the hypothalamus, it prevents orexin from stimulating arousal systems that stabilize wakefulness. This allows sleep-promoting pathways (like VLPO–GABA) to dominate, improving both sleep onset and maintenance. Unlike GABA enhancers, suvorexant directly targets the wake-promoting orexin system, reducing risk of dependence.
Histamine _____ receptors are best known for their role in gastric acid secretion and as the target of anti-ulcer drugs. Postsynaptically, they activate a G-protein second messenger system involving cyclic adenosine monophosphate (cAMP), protein kinase A (PKA), and the gene product CREB.
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H1
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H2
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H3
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H4
Explanation
Correct Answer:
B. H2
Explanation of Correct Answer
Histamine H2 receptors are located in the stomach lining, where they regulate gastric acid secretion, making them the target of anti-ulcer drugs such as ranitidine and famotidine. Beyond the gut, H2 receptors are postsynaptic receptors that couple to G-proteins and signal through cAMP, PKA, and CREB. This cascade influences gene expression and neuronal activity, linking histamine signaling to functions beyond the gastrointestinal system.
Too much dopamine in the mesolimbic pathway, as seen in schizophrenia, leads to __________.
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Hallucinations
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Parkinsonian tremors
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Memory enhancement
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Increased REM sleep
Explanation
Correct Answer:
A. Hallucinations
Explanation of Correct Answer
Excess dopamine activity in the mesolimbic pathway is strongly linked to the positive symptoms of schizophrenia, including hallucinations, delusions, and disorganized thought. The overstimulation of dopamine receptors in this pathway disrupts normal perception and reality testing, leading to sensory misinterpretations such as hearing voices or seeing things that are not present. This is why dopamine-blocking antipsychotics target this pathway
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