MSN 672 Psychopathopharmacology Final Exam at Nothern Kentucky University
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Free MSN 672 Psychopathopharmacology Final Exam at Nothern Kentucky University Questions
A patient with generalized anxiety disorder is taking a benzodiazepine. What role do benzodiazepines play in GABA neurotransmission?
- A. Increases GABA via direct agonist actions
- B. Increases GABA via direct antagonist actions
- C. Increases GABA via negative allosteric modulation
- D. Increases GABA via positive allosteric modulation
Explanation
Benzodiazepines enhance the effects of GABA (gamma-aminobutyric acid), the major inhibitory neurotransmitter in the brain, by positively modulating the GABA-A receptor. Rather than acting as a direct agonist (which would directly activate the receptor), benzodiazepines bind to an allosteric site on the GABA-A receptor and increase the receptor's affinity for GABA. This leads to increased GABAergic neurotransmission, resulting in inhibition of neuronal activity and a calming or anxiolytic effect. This positive allosteric modulation helps reduce symptoms of anxiety and promotes relaxation without directly activating GABA receptors.
Correct Answer: D. Increases GABA via positive allosteric modulation
Which of the statements are true regarding Valproate? (Select all that apply).
- A. Should check ammonia level in patients with confusion while on valproate
- B. Valproate is metabolized primarily in the kidneys
- C. Valproate is effective for acute manic phase
- D. Half-life of lamotrigine increases from 25 hrs to 70 hrs with co-administration of valproate
Explanation
A. Should check ammonia level in patients with confusion while on valproate
Valproate can cause hyperammonemia (elevated ammonia levels), which may lead to confusion, lethargy, or encephalopathy, especially at higher doses or in patients with impaired liver function. It is crucial to monitor ammonia levels in patients presenting with confusion or other signs of neurological impairment while on valproate.
C. Valproate is effective for acute manic phase
Valproate is commonly used to treat the acute manic phase of bipolar disorder. It is an effective mood stabilizer that can help control the symptoms of mania by regulating neurotransmitter balance, especially in the manic phase.
D. Half-life of lamotrigine increases from 25 hrs to 70 hrs with co-administration of valproate
When valproate is co-administered with lamotrigine, it inhibits the metabolism of lamotrigine, leading to a significant increase in the half-life of lamotrigine (from 25 hours to up to 70 hours). This interaction can result in increased risk of lamotrigine toxicity, so dose adjustments may be needed.
Correct Answer: A. Should check ammonia level in patients with confusion while on valproate
C. Valproate is effective for acute manic phase
D. Half-life of lamotrigine increases from 25 hrs to 70 hrs with co-administration of valproate
A patient with a history of opioid use disorder is requesting a prescription for buprenorphine, instead of the combination formulation with buprenorphine and naloxone. You analyze the patient's request, because as a PMHNP, you are aware that the combination formulation of buprenorphine and naloxone... (Select the best answer):
- A. Is more effective for withdrawal symptoms
- B. Is significantly cheaper
- C. Produces a "high"
- D. Prevents intravenous abuse
Explanation
The combination formulation of buprenorphine and naloxone is designed to reduce the potential for misuse, particularly intravenous abuse. Naloxone is an opioid antagonist that has minimal effect when taken orally but will induce withdrawal symptoms if the medication is injected. This discourages individuals from attempting to misuse the medication intravenously.
Correct Answer: D. Prevents intravenous abuse
Which antidepressant has a long half-life of 2 to 3 days and an active metabolite half-life of 2 weeks?
- A. Escitalopram
- B. Sertraline
- C. Fluoxetine
- D. Paroxetine
Explanation
Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) known for its long half-life. The half-life of fluoxetine itself is 2 to 3 days, but it has an active metabolite called norfluoxetine, which has a significantly longer half-life of 2 weeks. This extended half-life means that fluoxetine remains in the body for a prolonged period, even after discontinuation. This characteristic is important for drug accumulation and potential drug interactions, but it also means the medication can be beneficial for patients who may have trouble adhering to a strict daily regimen, as it maintains therapeutic levels longer than SSRIs with shorter half-lives.
Correct Answer: C. Fluoxetine
What 2 neurotransmitters may lead to ADHD if excessive or deficient?
- A. Histamine and Glutamate
- B. Norepinephrine and Dopamine
- C. Histamine and Acetylcholine
- D. Nitric Oxide and Serotonin
Explanation
Norepinephrine and dopamine are the two primary neurotransmitters that are associated with Attention-Deficit Hyperactivity Disorder (ADHD). Dysregulation in the levels of these neurotransmitters in the brain, particularly in areas such as the prefrontal cortex, can contribute to the symptoms of ADHD, including inattention, impulsivity, and hyperactivity.
Correct Answer: B. Norepinephrine and Dopamine
Which statement is true regarding common side-effects of Lithium?
- A. Hypothyroidism
- B. Leukocytosis
- C. Loss of bladder control
- D. Fine hand tremors
Explanation
D. Fine hand tremors
Lithium is commonly associated with fine hand tremors as a side effect, especially at therapeutic doses. These tremors are often dose-dependent and are typically the first noticeable effect that patients experience. The tremors can be bothersome but are often manageable through dose adjustments or the use of medications like beta-blockers to alleviate them.
Correct Answer: D. Fine hand tremors
Prior to prescribing a stimulant, which topic is most important for the provider to discuss with the patient?
- A. Cardiac History
- B. Eating Patterns
- C. Weight
- D. Family History of ADHD
Explanation
Cardiac history is the most important factor to discuss before prescribing stimulants, such as those used to treat ADHD (e.g., methylphenidate and amphetamine-based medications). Stimulants can increase heart rate and blood pressure, and there is a risk of cardiovascular events (such as arrhythmias) in patients with underlying heart conditions. Therefore, it is critical to assess whether the patient has any cardiac history, such as hypertension, arrhythmias, or heart disease, prior to prescribing stimulants.
Correct Answer: A. Cardiac History
The PMHNP understands that cocaine withdrawal primarily causes a decrease in --------- and --------- (Select all that apply).
- A. Norepinephrine
- B. Dopamine
- C. Acetylcholine
- D. Glutamate
Explanation
A. Norepinephrine
During cocaine use, norepinephrine levels are significantly increased by blocking its reuptake, which contributes to the stimulating effects of the drug, such as increased heart rate, alertness, and euphoria. When a person undergoes cocaine withdrawal, these heightened levels of norepinephrine are no longer sustained, leading to a drop in norepinephrine. This decrease can cause fatigue, low energy, depression, and difficulty concentrating, as norepinephrine is involved in arousal and mood regulation.
B. Dopamine
Cocaine is a potent dopamine reuptake inhibitor, leading to an increase in dopamine levels, especially in the reward system of the brain. The intense euphoria associated with cocaine use is largely due to this increase in dopamine. During withdrawal, dopamine levels fall significantly, leading to anhedonia (inability to experience pleasure), depression, and low motivation. This drop in dopamine can also cause cravings for the drug, making cocaine withdrawal particularly challenging for individuals.
Correct Answer: A. Norepinephrine
B. Dopamine
The nurse practitioner is providing education for a 24-year-old female patient that is prescribed Depakote for bipolar disorder. The nurse practitioner provides patient education and informs the patient of the potential side-effects of VPA (valproic acid). Which of the following are the potential side effects? (Select all that apply).
- A. Hair loss
- B. Amenorrhea
- C. Weight Gain
- D. Hyperactivity
Explanation
A. Hair loss
A common side effect of valproic acid (Depakote) is hair loss (alopecia). This can occur due to the medication’s effect on the hair growth cycle, which may lead to thinning or shedding of hair, particularly early in treatment.
B. Amenorrhea
Amenorrhea, or the absence of menstrual periods, is another potential side effect of valproic acid, especially in females of reproductive age. It can be caused by hormonal changes due to the medication’s impact on the endocrine system.
C. Weight Gain
Weight gain is a well-documented side effect of valproic acid. The medication can cause increased appetite and fluid retention, both of which contribute to weight gain. This can be particularly problematic for long-term users of the medication.
Correct Answer: A. Hair loss
B. Amenorrhea
C. Weight Gain
A 35-year-old man with depression has had 3 trials of SSRIs without notable improvement. His clinician is now considering switching the patient's SSRI to a monoamine oxidase inhibitor (MAOI). Which of the following is an appropriate switching strategy in this situation?
- A. Cross-titrate SSRI with MAOI
- B. Initiate MAOI upon discontinuation of SSRI
- C. Discontinue SSRI, then wait 5 half-lives of the SSRI before initiating MAOI
- D. Add MAOI as adjunctive therapy
Explanation
When switching from a Selective Serotonin Reuptake Inhibitor (SSRI) to a Monoamine Oxidase Inhibitor (MAOI), it's essential to avoid serotonin syndrome, a potentially life-threatening condition caused by excessive serotonin levels. To prevent this, the clinician should discontinue the SSRI and wait for 5 half-lives of the SSRI to pass before initiating the MAOI. This allows enough time for the SSRI to be cleared from the system, reducing the risk of serotonin toxicity when starting the MAOI.
Correct Answer: C. Discontinue SSRI, then wait 5 half-lives of the SSRI before initiating MAOI
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