MSN 672 Psychopathopharmacology Final Exam at Nothern Kentucky University
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Free MSN 672 Psychopathopharmacology Final Exam at Nothern Kentucky University Questions
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 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:
- A. Desensitization of nicotinic receptors
- B. Resensitization of nicotinic receptors
- C. Desensitization of muscarinic receptors
- D. Resensitization of muscarinic receptors
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
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
Compared to newer antidepressants such as serotonin selective reuptake inhibitors (SSRIs) or serotonin norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs) have:
- A. Less favorable efficacy profiles
- B. Less favorable side effect profiles
- C. A & B
- D. 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
Which of the following is true regarding selective serotonin reuptake inhibitors?
- A. They inhibit actions at the dopamine transporter
- B. They have 5HT2C antagonist properties
- C. They inhibit the serotonin transporter (SERT)
- D. They are potent inhibitors of CYP 2D6
Explanation
Selective serotonin reuptake inhibitors (SSRIs) primarily inhibit the serotonin transporter (SERT), which is responsible for the reuptake of serotonin from the synaptic cleft back into presynaptic neurons. By blocking this transporter, SSRIs increase serotonin availability in the synaptic cleft, enhancing serotoninergic neurotransmission. This action is the mechanism of action for SSRIs in the treatment of depression, anxiety, and other mood disorders.
Correct Answer: C. They inhibit the serotonin transporter (SERT)
A 44-year-old male with schizophrenia has been taking an antipsychotic medication since initial diagnosis twelve years ago. He has recently begun experiencing difficulty with smooth movement of his arms as well as involuntary facial grimaces. Which of the following likely underlies these symptoms?
- A. Upregulation of serotonin 2A receptors
- B. Downregulation of serotonin 2A receptors
- C. Upregulation of dopamine 2 receptors
- D. Downregulation of dopamine 2 receptors
Explanation
The difficulty with smooth movement and involuntary facial grimaces are classic symptoms of tardive dyskinesia (TD), a long-term side effect of antipsychotic medications, particularly dopamine receptor antagonists (which are common in many antipsychotics). TD is characterized by abnormal, involuntary movements and typically involves the dopamine D2 receptors. The mechanism behind tardive dyskinesia involves downregulation of dopamine D2 receptors over time due to chronic blockade by the antipsychotic drugs. This downregulation leads to a dopaminergic imbalance, resulting in the movement disorders observed in TD. Therefore, downregulation of dopamine 2 receptors is the most likely explanation for the client's symptoms.
Correct Answer: D. Downregulation of dopamine 2 receptors
Which statement best describes the fundamental differences between first and second generation antipsychotics?
- 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.
- B. 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.
- C. 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.
- D. None of the above
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.
This is a rare but potentially fatal adverse syndrome that can occur at any time during treatment with antipsychotics. The onset of symptoms is over 24 to 72 hours with increased temperature, severe muscular rigidity, confusion, agitation, elevation in white blood cell count, elevated creatinine phosphokinase concentrations, elevated liver enzymes, myoglobinuria, and acute renal failure. What is the name of this potentially fatal adverse syndrome?
- A. Extrapyramidal Syndrome
- B. Dystonia Neurological Syndrome
- C. Neuroleptic Malignant Syndrome
- D. None of the above
Explanation
Neuroleptic Malignant Syndrome (NMS) is a rare but potentially fatal condition associated with antipsychotic medications. It typically develops within 24 to 72 hours of starting treatment or increasing the dose. The hallmark features of NMS include hyperthermia (high fever), severe muscular rigidity, altered mental status (such as confusion and agitation), elevated creatine phosphokinase (CPK), elevated liver enzymes, leukocytosis (increased white blood cell count), myoglobinuria, and acute renal failure due to muscle breakdown.
Correct Answer: C. Neuroleptic Malignant Syndrome
Trazodone is a serotonin antagonist/reuptake inhibitor (SARI) that is thought to have different actions at different doses. Which most accurately describes these actions?
- A. Antidepressant at low doses, antipsychotic at high doses
- B. Antidepressant at high doses, antipsychotic at low doses
- C. Antidepressant at low doses, hypnotic at high doses
- D. 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?
- A. Avoid dried, smoked, and fermented meat
- B. Avoid aged cheese
- C. Avoid tyramine-containing supplements
- D. 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
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