MSN 672 Psychopathopharmacology Final Exam at Nothern Kentucky University
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Free MSN 672 Psychopathopharmacology Final Exam at Nothern Kentucky University Questions
Which of the following medications inhibits both the serotonin transporter and the norepinephrine transporter (SNRI) and may also contribute to the efficacy for painful symptoms?
- Duloxetine
- Bupropion
- Trazodone
- Histamine
Explanation
Duloxetine is a serotonin-norepinephrine reuptake inhibitor (SNRI). It works by inhibiting the serotonin transporter (SERT) and norepinephrine transporter (NET), increasing the levels of serotonin and norepinephrine in the synaptic cleft. This dual action contributes to its antidepressant and analgesic effects, making it effective not only for treating depression and anxiety but also for managing painful symptoms associated with conditions such as diabetic neuropathy and fibromyalgia. Unlike bupropion, which primarily affects dopamine and norepinephrine, or trazodone, which is mainly used for its sedative effects, duloxetine is specifically designed to target both serotonin and norepinephrine for both mood and pain relief.
Correct Answer: A. Duloxetine
Compared to newer antidepressants such as serotonin selective reuptake inhibitors (SSRIs) or serotonin norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs) have:
- Less favorable efficacy profiles
- Less favorable side effect profiles
- A & B
- None of the above
Explanation
Tricyclic antidepressants (TCAs) are older medications that are effective for treating depression but generally have less favorable side effect profiles compared to newer antidepressants like SSRIs and SNRIs. TCAs are associated with a range of side effects, including anticholinergic effects (dry mouth, constipation, urinary retention), sedation, weight gain, and cardiovascular effects (e.g., orthostatic hypotension, arrhythmias). These side effects can make TCAs less tolerable for many patients. Additionally, while TCAs are effective for depression, newer agents like SSRIs and SNRIs have a better overall side effect profile and are considered first-line treatments due to their safer tolerability and more favorable efficacy profiles. Hence, TCAs are typically reserved for cases where other treatments are not effective or appropriate.
Correct Answer: C. A & B
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
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
A 16-year-old male is being prescribed an atypical antipsychotic for first-episode psychosis. What measures should be taken prior to prescribing and during treatment with the antipsychotic?
- Blood pressure
- Blood pressure and body mass index (BMI)
- Blood pressure, BMI, and fasting triglycerides
- Blood pressure, BMI, fasting triglycerides, and fasting glucose
Explanation
Atypical antipsychotics are associated with metabolic side effects, including weight gain, increased blood glucose, and dyslipidemia, which can be particularly concerning in adolescents. Therefore, prior to prescribing and during treatment, it is important to monitor:
Blood pressure: Antipsychotics can cause orthostatic hypotension or other cardiovascular issues.
Body mass index (BMI): Atypical antipsychotics are linked to weight gain, so regular monitoring of BMI helps assess risk for obesity-related complications.
Fasting triglycerides: These medications can increase triglyceride levels, contributing to metabolic syndrome.
Fasting glucose: Antipsychotics, particularly atypical ones, can increase the risk of developing insulin resistance and type 2 diabetes.
By monitoring these parameters, the nurse can detect early signs of metabolic changes and intervene appropriately. This comprehensive approach helps minimize long-term health risks in adolescents taking atypical antipsychotics.
Correct Answer: D. Blood pressure, BMI, fasting triglycerides, and fasting glucose
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).
- Hair loss
- Amenorrhea
- Weight Gain
- 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
Trazodone is a serotonin antagonist/reuptake inhibitor (SARI) that is thought to have different actions at different doses. Which most accurately describes these actions?
- Antidepressant at low doses, antipsychotic at high doses
- Antidepressant at high doses, antipsychotic at low doses
- Antidepressant at low doses, hypnotic at high doses
- Antidepressant at high doses, hypnotic at low doses
Explanation
D. Antidepressant at high doses, hypnotic at low doses
At higher doses, typically between 150-300 mg, Trazodone is used primarily as an antidepressant. It works by inhibiting serotonin reuptake and antagonizing 5-HT2A receptors, which help in treating depression and associated symptoms. However, at lower doses (typically around 50-100 mg), Trazodone is more commonly used as a hypnotic for treating insomnia due to its sedating properties, which result from its histamine receptor antagonism.
Correct Answer: D. Antidepressant at high doses, hypnotic at low doses
When providing education to a patient that will be taking a MAOI, which of the following is correct?
- Avoid dried, smoked, and fermented meat
- Avoid aged cheese
- Avoid tyramine-containing supplements
- A, B, & C
Explanation
When taking Monoamine Oxidase Inhibitors (MAOIs), it is crucial to avoid foods and supplements containing tyramine due to the risk of a hypertensive crisis. Tyramine is a naturally occurring substance found in certain foods, and MAOIs inhibit the enzyme that normally breaks down tyramine, leading to dangerous increases in blood pressure if these foods are consumed.
Correct Answer: D. A, B, & C
In the general population, which factor is the most common cause of Attention-Deficit Hyperactivity Disorder?
- Acquired childhood diseases/infections
- Hereditary factors
- Fragile X syndrome
- Atrophy of the parietal, temporal, and occipital lobes
Explanation
Hereditary factors are the most common cause of Attention-Deficit Hyperactivity Disorder (ADHD) in the general population. Research has consistently shown that genetic predisposition plays a significant role in the development of ADHD. Children with a family history of ADHD are at a higher risk of developing the disorder themselves.
Correct Answer: B. Hereditary factors
The PMHNP understands that insufficient dACC can cause symptoms such as carelessness, losing items, and being easily distracted, which is often associated with selective attention. The PMHNP also knows assessing selective attention can be executed with using what test? Please select an answer below.
- Stroop Task Test
- Attention Deficit and Hyperactive Task Orientation Test
- Mini Mental State Exam
- None of the above
Explanation
The Stroop Task Test is a well-known psychological test used to assess selective attention and the ability to inhibit cognitive interference. It involves presenting participants with color names printed in incongruent colors (e.g., the word "red" printed in blue ink), and the task is to say the color of the ink rather than reading the word itself. This test evaluates cognitive flexibility and attention control, particularly selective attention and the ability to focus on relevant information while ignoring distractions.
Correct Answer: A. Stroop Task Test
When prescribing clonidine (Catapres) or guanfacine (Intuniv), what should the provider discuss with the patient?
- Taking the medication in the morning to avoid insomnia
- Monitoring blood pressure often to check for hypertension
- Watching for induced activation of hyperarousal
- Slow tapering of the medication to avoid rebound hypertension
Explanation
Clonidine and guanfacine are alpha-2 adrenergic agonists that are commonly used to treat hypertension and ADHD. One important aspect of their use is that abrupt discontinuation can lead to rebound hypertension, where the blood pressure can rise dramatically. Therefore, it is crucial to slowly taper the medication under the guidance of a healthcare provider to avoid this risk.
Correct Answer: D. Slow tapering of the medication to avoid rebound hypertension
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