80 Questions
What percentage of clients with dementia may experience neuropsychiatric symptoms including behavioral disturbances?
Up to 90%
Why is intervention sometimes necessary for clients with dementia and behavioral disturbances?
For the safety of the client and others
What is the primary risk associated with using antipsychotic medication for behavioral disturbances in dementia?
Mortality and cardiovascular side effects
What is the first-line pharmacologic treatment for aggression and agitation in dementia?
SSRI/SNRI therapy
Which stage of dementia is characterized by short-term memory deficits and difficulty recalling the date?
Early
Alzheimer's Dz is most prevalent in people over?
65
What is a common symptom of dementia in the middle stage?
Agitation and aggression
Alzheimer's Dz affects which ethic group the most at 13.8%?
African American
What is believed to contribute to the formation of toxic amyloid plaques in the brain of clients with AD?
Abnormal processing of amyloid precursor protein
What is the result of cell death in the brain due to AD?
Atrophy of brain tissue
What is affected by the atrophy of brain tissue in AD?
Hippocampus and cerebral cortex
What is the result of decreased acetylcholinesterase activity in AD?
Permanent loss of cholinergic neurons
What is necessary for processing memory and learning in AD?
Acetylcholine
What is associated with neurotransmitter failure and neuronal death in AD? Known as Neural networks.
All of the above
What is the result of abnormal activation of N-methyl-d-aspartate receptors by glutamate in AD?
Neuronal damage
What plays a strong role in late-onset Alzheimer's Dz?
Genes
What is the suitable medication for a 65-year-old male with Alzheimer's disease, anxiety, smokes cigarettes, and COPD?
Donepezil
Why is Rivastigmine not an appropriate medication for a pt. with COPD?
It can worsen his COPD
Genetic coding abnormalities are associated with amyloid precursor protein. What chromosome are affected in early onset AD?
14
Why is Galantamine not an appropriate medication for a pt. with anxiety?
It cannot address his anxiety
What is the consequence of discontinuing medication for Alzheimer's disease?
The medication may not work as well if restarted & return of cognitive symptoms may occur
Which of the following medications requires tapering?
Donepezil
What is the reason why a client might want to stop taking the medication for Alzheimer's disease?
Due to gastrointestinal side effects
What medication should be eliminated from the treatment plan if a pt. is taking simvastatin and lisinopril due to its ability to increase plasma levels of the statin? This will increase the risk of muscle damage & Rhabdomyolysis.
fluoxetine (Prozac)
Which medication is a good option for a pt. with bipolar disorder who may be forgetful or non-compliant?
IM aripiprazole
Which medication is a good option for a patient who abuses illicit drugs and needs to manage withdrawal symptoms for 24 hrs and provides a steady control of cravings throughout the day?
Methadone
Where is methadone typically administered?
In a federally regulated opioid treatment program
What is a benefit of using methadone in medication-assisted treatment for opioid use disorder?
It extends client survival
What is a characteristic of methadone clinics?
They require daily attendance for the first several months
This term describes two hallmarks of AD (too many or not enough removal of amyloid & neurofibrillary tangles).
Neuroanatomy
What is a risk associated with stopping methadone treatment?
High likelihood of relapsing
Which medication might be prescribed to a patient trying to get pregnant?
Lurasidone (Latuda)
Acetylcholine (ACh) is an NTM necessary for processing memory & learning, decreased cholinergic function is linked to memory dysfunction (esp. short-term). This is known as?
Neural signaling
Which medication is the safest option for a patient who takes a daily aspirin, atorvastatin, and digoxin?
Escitalopram (Lexapro)
Which medication can help alleviate anxiety and excessive sleepiness in a patient with depression?
Sertraline (Zoloft)
Which MDD medication is effective for a 75-year-old patient with urinary retention and chronic pain related to fibromyalgia?
Duloxetine (Cymbalta)
What is a characteristic of SNRIs?
They can increase anxiety in some patients
Which medication should be considered for a patient who has concerns about the sexual side effects of antidepressants?
Bupropion (Welbutrin)
Which medication is suitable for a patient with anorexia related to MDD?
Mirtazapine (Rameron)
Statin is a CYP450 3A4 _________ & Prozac is a CYP450 ____________.
Substrate, inducer
Which medication inhibits both dopamine and norepinephrine?
Bupropion (Wellbutrin)
What is a correct intervention for a patient who took haloperidol and suddenly experiences a fever, muscle rigidity, and altered mental status?
Advise the patient to go to the emergency room and begin the patient on Dantrolene
What should the PMHNP consider when prescribing valproic acid with Lamotrigine (Lamictal) for a patient with bipolar type II disorder?
Reduce the dosage of valproic acid by half
Which laboratory values need to be monitored for a patient on lithium?
All of the above
What is a characteristic of a pt. who has lost his ability to speak and requires around-the-clock care for ADLs?
Late-stage dementia
How does nicotine affect the clearance of medication?
Increases the clearance
What is a characteristic of a pt. who is unable to recall who they are, the date or time, or where they are?
Late-stage dementia
What is a characteristic of a pt. who is withdrawn, closed off, and moody?
Early-stage dementia
Which stimulant medication should be avoided in a patient with a past medical history of MDD treated with Selegiline, a MAOI?
amphetamine (Adzenys)
A patient taking IR dextroamphetamine (Adderall) states they feel great after taking their morning dose but notice their ADHD symptoms come back in the evening. Which intervention is correct?
Prescribe a nighttime dose of IR dextroamphetamine (Adderall)
Which stimulant medication is the safest option to prescribe to a patient with a past medical history of obesity, alcohol abuse, and substance abuse?
lisdexamfetamine (Vyvanse)
A patient who takes Acamprosate (Campral) for alcohol abuse informs the PMHNP that she recently found out she was pregnant. The patient is compliant with the medication, and she has not had a drink in over 6 months. Which response by the PMHP is correct?
Acamprosate is unsafe for pregnancy, we will switch you to naltrexone instead
Methadone is a full u-receptor agonist with a ____half life?
Long
All of the following are correct about memantine EXCEPT?
Take 1st thing in the morning
Which medication inhibits the presynaptic reuptake of both DA & NE, leading to increased levels of both NTM in the synaptic cleft?
Buprenorphine
Why does the patient taking IR dextroamphetamine (Adderall) experience a return of ADHD symptoms in the evening?
The IR dose of the medication wears off quickly
What is the first-line treatment for restless leg syndrome?
Ropinirole
A patient with alcohol abuse disorder is actively drinking and using opiates but wishes to participate in MAT to change their lifestyle. Which of the following medications is appropriate to prescribe this patient?
Naltrexone (Vivitrol)
Which of the following statements is true about galantamine?
It should be avoided in patients who frequently use NSAIDS
Increased irritability and insomnia can be treated with what class medication which will allow the client to fall asleep.
Low dose non-stimulant
What is the primary concern when using stimulants in clients with no prior history?
Causing psychotic or manic symptoms
A 27-year-old patient presents to the clinic with symptoms of ADHD and requests to be started on clonidine. Which medicaiton is most appropriate?
Atomoxetine
What is the most appropriate medication for a dementia patient with dementia and tobacco use?
Donepezil
What does Suboxone (buprenorphine/naloxone) increase the risk of in pregnant women?
Increases the risk for neonatal abstinence syndrome
Which medication is contraindicated for a patient with a HgB A1C of 8 who has bipolar disorder?
Olanzapine
What is the advantage of Suboxone for a client who may not be able to leave work for medication dosing?
It does not need to be taken under direct observation
Why is Suboxone a less desirable street drug?
Naloxone prevents any rewarding effects from buprenorphine
What is the increased risk associated with buprenorphine use during pregnancy?
Neonatal withdrawal syndrome
John is a prescription drug abuser who wishes to partake in MAT, however, he has a history of abusing and selling street drugs. Which medication option would be most appropriate for him?
Suboxone (buprenorphine)
Why is naloxone added to buprenorphine in Suboxone?
To prevent any rewarding effects from buprenorphine
A patient undergoing MAT for alcohol abuse presents with palpations, headache, vomiting, and flushing. The patient states she had a glass of wine last night at dinner. Which medication is this patient most likely taking?
Disulfiram (antabuse)
Which of the following statements is true? A)Patents who take medications for AD can reverse the presence of amyloid plaques in the brain. B) Clozapine is a first-line medication for the treatment of agitation and behavioral symptoms in patients with dementia . C) Patients who take medication for AD will have an increased life expectancy. D) Galantamine is safe to be used during pregnancy.
C
What is a key teaching point for a patient prescribed memantine and donepezil?
Ensuring the living environment is free of clutter and well-lit
A patient presents with dementia associated with Parkinson’s disease. Which medication would be the best to prescribe to this patient?
Rivastigmine (transdermal)
A patient with GAD presents with new onset insomnia and states she has an uncomfortable urge to move her legs at night. Which of the following medications is the first line treatment for restless leg syndrome?
Ropinirole
Which medication is not safe to use during pregnancy?
Galantamine
What medication relieves spasms, cramping, & tightness of muscles in conditions such as MS?
Dantrolene
What med is approved in pregnancy for heroin-addicted women?
Methadone
How soon will treatment efficacy be seen with stimulants?
1 week
A patient presents to the PMHNP with the following symptoms of dementia: disorientation to date, trouble learning new skills, and newly onset difficulties with cooking and grooming. Which stage of dementia is the patient in?
Late stage
Learn about the role of amyloid plaques and neurofibrillary tangles in Alzheimer's disease, including their impact on neurons and brain tissue. Understand how abnormal processing of amyloid precursor protein leads to the formation of these toxic structures.
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