MSN 672 Psychopathopharmacology Final Exam at Nothern Kentucky University

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Free MSN 672 Psychopathopharmacology Final Exam at Nothern Kentucky University Questions

1.

Which statement best describes the fundamental differences between first and second generation antipsychotics?

  • First generation antipsychotics are D2 antagonists and associated with higher EPS rates. Second generation antipsychotics are 5HT2A/D2 antagonists, which are associated with lower risk of EPS but a higher risk for developing metabolic syndrome.

  • First generation antipsychotics are associated with lower risk of EPS and are 5HT2A/D2 antagonists. Second generation antipsychotics have a higher rate of EPS and are associated with a lower risk for developing metabolic syndrome.

  • First and second generation antipsychotics are generally the same with antagonist effects of D2. Both first and second generation antipsychotics have low risk for developing EPS and metabolic syndrome.

  • None of the above

Explanation

Explanation
A. First generation antipsychotics (FGAs), also known as typical antipsychotics, primarily work by antagonizing D2 dopamine receptors, which leads to a higher risk of extrapyramidal symptoms (EPS), including tremors, rigidity, and bradykinesia. These medications are more likely to cause movement-related side effects but are effective for managing positive symptoms of schizophrenia (e.g., hallucinations, delusions).
Second generation antipsychotics (SGAs), or atypical antipsychotics, have lower affinity for D2 receptors and additionally antagonize 5HT2A serotonin receptors. This mechanism helps reduce the risk of EPS, but SGAs are more commonly associated with metabolic side effects, including weight gain, diabetes, and hyperlipidemia, collectively referred to as metabolic syndrome.
Correct Answer: A. First generation antipsychotics are D2 antagonists and associated with higher EPS rates. Second generation antipsychotics are 5HT2A/D2 antagonists, which are associated with lower risk of EPS but a higher risk for developing metabolic syndrome.
2.

Prior to prescribing a stimulant, which topic is most important for the provider to discuss with the patient?

  • Cardiac History

  • Eating Patterns

  • Weight

  • Family History of ADHD

Explanation

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
3.

Lithium levels are checked at steady state. How many days after lithium is initiated should a level be checked? Please select the best answer.

  • 1-3

  • 3-4

  • 5-7

  • 2-4

Explanation

Explanation
Lithium reaches steady state after approximately 5-7 days of consistent dosing. After this time, the lithium blood level is typically checked to ensure it is within the therapeutic range. Checking the levels too early (e.g., at 1-3 days) would not give an accurate reflection of the steady state. Therefore, the correct answer is 5-7 days after initiation of therapy.
Correct Answer: C. 5-7
4.

A 35-year-old cigarette smoker would like to quit but is nervous because she typically craves a cigarette approximately every 2 hrs. The craving and withdrawal are due to:

  • Desensitization of nicotinic receptors

  • Resensitization of nicotinic receptors

  • Desensitization of muscarinic receptors

  • Resensitization of muscarinic receptors

Explanation

Explanation
When a person smokes regularly, nicotine binds to nicotinic acetylcholine receptors, and over time, these receptors become desensitized due to the constant stimulation by nicotine. However, when nicotine use is reduced or stopped (such as when trying to quit), the body attempts to resensitize the nicotinic receptors in response to the lack of nicotine. This resensitization causes increased cravings for nicotine as the receptors "become more sensitive" again, leading to the withdrawal symptoms like craving a cigarette. This process underlies the intense cravings and the difficulty in quitting smoking.
Correct Answer: B. Resensitization of nicotinic receptors
5.

Mood stabilizers such as topiramate and valproate should be taken regularly as prescribed. The PMHNP should caution patients not to suddenly stop Topamax or Depakote due to what potential risk?

  • Stopping suddenly may cause increased risk for seizures

  • Stopping suddenly may cause increased risk for nightmares

  • Stopping suddenly may cause increased risk for hypotension

  • A & C

Explanation

Explanation
Both Topamax (topiramate) and Depakote (valproate) are antiepileptic medications that are used as mood stabilizers in conditions like bipolar disorder. Abruptly stopping these medications can lead to a rebound effect or withdrawal seizures, as they work by stabilizing neuronal activity in the brain. Seizures are a known risk when these medications are suddenly discontinued without tapering.
Correct Answer: A. Stopping suddenly may cause increased risk for seizures
6.

The nurse practitioner is providing education for a 15-year-old male patient and his guardian. The patient has been diagnosed with Disruptive Mood Dysregulation Disorder (DMDD) and prescribed valproate. The nurse practitioner informs the patient and guardian to immediately report which symptom if it occurs? (Select all that apply)

  • Vomiting

  • Severe abdominal pain

  • Dark urine

  • Joint discomfort

Explanation

Explanation
Valproate, a medication commonly used to treat bipolar disorder and epilepsy, carries a risk of serious adverse effects, particularly hepatotoxicity and pancreatitis. The symptoms that should be reported immediately include:
A. Vomiting
Vomiting can be a sign of liver dysfunction or pancreatitis, both of which are serious potential side effects of valproate. If a patient taking valproate develops vomiting, it should be assessed promptly.
B. Severe abdominal pain
Severe abdominal pain is a warning sign of pancreatitis, a potentially life-threatening condition associated with valproate use. This symptom must be reported immediately.
C. Dark urine
Dark urine may indicate hepatic dysfunction or liver toxicity, which are significant concerns when using valproate. This requires immediate attention and possible adjustment of the medication.
Correct Answer: A. Vomiting
B. Severe abdominal pain
C. Dark urine
7.

The PMHNP has a 25-year-old female patient that presents to the clinic for Bipolar II Disorder. The patient informs the PMHNP that she has taken Lamotrigine in the past and it was effective for her symptoms. The PMHNP decides to prescribe Lamotrigine for the patient. During your patient teaching, what are the most important characteristics of Lamotrigine (listed below) to emphasize to the patient?

  • Call your doctor immediately if a skin rash occurs

  • Call your doctor immediately if thoughts of suicide occur

  • Oral Contraceptives increase blood levels of Lamotrigine

  • All of the above

Explanation

Explanation
A. Call your doctor immediately if a skin rash occurs
Lamotrigine is known for its potential to cause serious skin reactions, including Stevens-Johnson Syndrome (SJS), which can be fatal. The presence of a skin rash should be treated as a medical emergency, and the patient must immediately contact their healthcare provider if one appears. This is the most important aspect to emphasize when using Lamotrigine.
Correct Answer: A. Call your doctor immediately if a skin rash occurs
8.

Bupropion inhibits the reuptake of norepinephrine and dopamine neurotransmitters without any significant direct effects on serotonin neurotransmission. Knowing this information, which side-effect is least likely to occur while taking Bupropion?

  • Insomnia

  • Weight loss

  • Sexual dysfunction

  • None of the above

Explanation

Explanation
Bupropion works by inhibiting the reuptake of norepinephrine and dopamine, and it has minimal effect on serotonin. The most important side effects of bupropion are related to its dopamine and norepinephrine activity.
Correct Answer: C. Sexual dysfunction
9.

A patient with generalized anxiety disorder is taking a benzodiazepine. What role do benzodiazepines play in GABA neurotransmission?

  • Increases GABA via direct agonist actions

  • Increases GABA via direct antagonist actions

  • Increases GABA via negative allosteric modulation

  • Increases GABA via positive allosteric modulation

Explanation

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
10.

Which of the statements are true regarding Valproate? (Select all that apply).

  • Should check ammonia level in patients with confusion while on valproate

  • Valproate is metabolized primarily in the kidneys

  • Valproate is effective for acute manic phase

  • Half-life of lamotrigine increases from 25 hrs to 70 hrs with co-administration of valproate

Explanation

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

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