MSN 672 Psychopathopharmacology Final Exam at Nothern Kentucky University
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Free MSN 672 Psychopathopharmacology Final Exam at Nothern Kentucky University Questions
Carbamazepine (Tegretol) and oxcarbazepine (Trileptal) can both potentially cause which side effect?
- Hyponatremia
- Decrease in bicarbonate
- Hypercholesterolemia
- Decrease in bicarbonate
Explanation
Both carbamazepine (Tegretol) and oxcarbazepine (Trileptal), which are anticonvulsants, can cause hyponatremia as a potential side effect. This occurs due to the synergistic effect of these medications on vasopressin secretion, which can increase water retention, thereby diluting sodium levels in the blood. Hyponatremia can lead to symptoms such as nausea, headache, confusion, and seizures, making it important for patients on these medications to be regularly monitored for electrolyte imbalances.
Correct Answer: A. Hyponatremia
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 patient with depression has had 3 therapeutic trials of serotonin reuptake inhibitors (SRIs) without notable improvement. His clinician is now considering switching the patient's SRI to a monoamine oxidase inhibitor (MAOI). Which of the following is an appropriate switching strategy in this situation?
- Discontinue SRI, then initiate MAOI
- Cross-titrate SRI with MAOI
- Discontinue SRI, then wait 5 half-lives before initiating MAOI
- Discontinue SRI, then wait 14 days before initiating MAOI
Explanation
When switching from a serotonin reuptake inhibitor (SRI) to a monoamine oxidase inhibitor (MAOI), it is crucial to wait a sufficient amount of time to avoid the risk of serotonin syndrome. Serotonin syndrome is a potentially life-threatening condition caused by excessive serotonin levels due to the combination of SRIs and MAOIs, which can result in symptoms such as agitation, confusion, rapid heart rate, and high blood pressure. The recommended waiting period is typically 14 days after discontinuing the SRI before starting an MAOI. This allows enough time for the SRI to be cleared from the system, reducing the risk of serotonin syndrome.
Correct Answer: D. Discontinue SRI, then wait 14 days before initiating MAOI
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
As a PMHNP, you have a 26-year-old male patient, admitted to your mental health facility. The patient has a well-documented history of ADHD and cocaine use. What is the best medication option for this patient, to assist with treatment of ADHD?
- Atomoxetine
- Adderall
- Ritalin
- Vyvanse
Explanation
The patient has a history of cocaine use, which makes stimulant medications like Adderall, Ritalin, and Vyvanse less ideal due to the risk of misuse or addiction. Stimulants work by increasing dopamine and norepinephrine levels, which can be reinforcing for someone with a substance use disorder, especially a history of stimulant abuse. Atomoxetine, on the other hand, is a non-stimulant medication that selectively inhibits the reuptake of norepinephrine. It is not addictive and carries no risk of abuse, making it a safer option for individuals with a history of substance use disorder, including those with ADHD and cocaine use.
Correct Answer: A. Atomoxetine
These medications are a highly selective agonist of the Alpha 2a adrenergic receptor, that are utilized for treatment of symptoms associated with ADHD. Select the medications that apply to this description (Select all that apply).
- Atomoxetine
- Guanfacine
- Bupropion
- Clonidine
Explanation
B. Guanfacine
Guanfacine is a selective alpha-2 adrenergic agonist that is used to treat ADHD. It works by stimulating the alpha-2a receptors, which helps to reduce hyperactivity and improve attention and impulse control in individuals with ADHD. The extended-release formulation (Intuniv) is commonly prescribed for ADHD in both children and adults.
D. Clonidine
Clonidine is another alpha-2 adrenergic agonist that is used for ADHD. Similar to guanfacine, it works by stimulating alpha-2 receptors in the brain, leading to a calming effect that helps improve attention and reduce impulsivity. The extended-release formulation (Kapvay) is typically used for ADHD.
Correct Answer: B. Guanfacine
D. Clonidine
Low-potency First Generation Antipsychotics (FGAs), like chlorpromazine, commonly cause orthostatic hypotension, which is influenced by the sympathetic nervous system. This adverse effect is caused by ------------ and often occurs when starting treatment.
- Alpha-beta agonism
- Alpha-adrenergic antagonism
- NET-agonism deficit
- B & C
Explanation
Alpha-adrenergic antagonism is the primary cause of orthostatic hypotension seen with low-potency first-generation antipsychotics like chlorpromazine. These medications block alpha-1 adrenergic receptors, which are normally involved in vasoconstriction and maintaining vascular tone. When these receptors are blocked, the blood vessels are less able to constrict properly, leading to decreased blood pressure upon standing, which results in orthostatic hypotension.
Correct Answer: B. Alpha-adrenergic antagonism
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
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 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
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
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