80 Questions
What should the NP monitor for in patients taking non-stiumulant or Z-drugs?
Suicidal ideation
Which drug class is not considered 1st line treatment for insomnia due to its potential for misuse?
Benzodiazepines
All of the following are other risk factors for ADHD EXCEPT?
Multiple siblings
Why should extended-release (ER) formulas be avoided?
They increase the risk of next-day drowsiness
What should be avoided in older adults when prescribing hypnotics?
All of the above
What is recommended as an alternative to z-drugs in older adults?
Melatonin
Why does Ritalin have a low risk for adverse effects?
Because it blocks DA & NE NTMs
All of the following meds block the reuptake of DA & NE because they are inhibitors EXCEPT?
Vyvanse
All of the following coexisting conditions are common causes of insomnia EXCEPT?
COPD, bronchitis, sleep apnea
What percentage of clients with major depressive disorder have insomnia?
60-90%
What medication is more potent than Ritalin?
Dexmehtylphenidate (Focalin)
What type of medication is Ropinirole (Requip)?
Dopamine receptor agonist
What is primary insomnia associated with?
None of the above
What is the difference between primary insomnia and psychiatric insomnia?
Primary insomnia is not associated with psychiatric conditions
What stimulant should be avoided when an MAOI has been taken in the past 14 days?
Amphetamine (Adzenys)
What stimulant is the most abused and diverted drug?
Dextroamphetamine (Adderall)
What is the primary reason to prescribe Z-drugs for PRN use?
Due to the potential for abuse and dependence
What is the effect of higher doses or extended use sleep meds on next-day drowsiness?
It increases the risk
What are the potential adverse effects of Z-drug medication?
All of the above
What is the proportion of clients older than 65 years who have persistent insomnia?
1/3
What are common characteristics of insomnia according to the American Psychiatric Association?
all of the above
What stimulant is least abused or diverted and is considered a prodrug?
Lisdexamfetamine (Vyvanse)
What is a common trigger for insomnia?
Acute stress
What is the proportion of adults who experience chronic insomnia?
10%
Which type of firing is associated with reward, feeling of euphoria, and abuse potential?
Phasic firing
What type of stimulants have a higher risk of abuse due to it's effect of rapidly increasing phasic firing of DA &NE?
Immediate-release stimulants
What is the effect of extended-release formulations on NE and DA signals that leads to gradual & sustained increases?
They amplify tonic firing
What is the mechanism by which extended-release formulations reduce abuse potential?
By occupying the NE transporter in the prefrontal cortex that enhances tonic firing
Why does atomoxetine lack abuse potential?
It increases DA levels in the PFC, but not in the nucleus accumbens
What non-stimulant enhances precordial function to improve mental focus?
Clonidine
Bupropion (Wellbutrin) is considered?
DA-NE reuptake inhibitor
What non-stimulant is best for patients with concurrent depression and tobacco abuse?
Bupropion (Wellbutrin)
Which medication is a first-line agent for treating Restless Leg Syndrome (RLS)?
Ropinirole (Requip)
What is the location of the 'on switch' in the brain?
Tuberomammillary nucleus (TMN)
What is the function of Guanfacine?
Alpha 2 agonist NE inhibitor (non-stimulant)
What is the effect of Methylphenidate on neurotransmitters?
Blocks DAT and NET
What is the main difference between ADHD symptoms in children and adults?
Children present with hyperactivity, while adults report internal restlessness & difficulty sitting still
What is the function of Melatonin and melatonin receptor agonists?
They are effective hypnotics for sleep onset
Which brain region is responsible for modulating impulsivity?
Orbitofrontal cortex and dorsal anterior cingulate cortex
What part of the brain is associated with hyperactivity in ADHD?
Prefrontal cortex
What is a characteristic of non-stimulant medications?
They are effective for the long-term treatment of comorbid anxiety, depression, or substance abuse because it has no potential for abuse or diversion
All of the following are reasons why non-stimulant medications be used?
When clients response to stimulants alone
What should be monitored when taking non-stimulant drugs?
All of the above
What is a contraindication for concurrent use of non-stimulants?
All of the above
What may non-stimulant medications exacerbate in clients with a history of the disorder?
Depression
What is a characteristic of non-stimulant medications in terms of effectiveness?
They take longer to achieve desired effects than stimulants
Why is withdrawal from non-stimulant medications tapered?
To prevent rebound hypertension and neurological side effects
What is a significant cause of societal morbidity, lost productivity, and reduced quality of life?
Disruption of healthy sleep
What is the recommended approach when using z-drugs?
Use them for the shortest duration possible
This part of the brain contains the "off" switch
Ventrolateral preoptic nucleus
All of the following are sedating antidepressants EXCEPT?
Trazadone
Z-drugs are considered what schedule controlled substance?
IV
Restless Leg Syndrome (RLS) is idiopathic and associated with which of the following conditions
All of the above
Why should z-drugs be avoided in clients with dementia?
Because they can cause falls & cognitive impairment
What is considered a psychiatric 'vital sign'?
Sleep
All of the following are BZOs EXCEPT?
Clonidine
What is the function of dual orexin receptor antagonists (DORA)?
Regulating arousal, wakefulness, and appetite
What is the effect of Valarian root on other sleep medications?
It increases the effects of other sleep medications (e.g, alcohol, BZOs, & narcotics)
What is the function of Ramelteon?
Prescription melatonin receptor 1 & 2 agonist, produced by the pineal gland in response to darkness to help regulate sleep-wake cycle
Daytime NTMs include all of the following EXCEPT?
GABA & Melatonin
Why should Suvorexant be decreased when combined with CYP 450 inhibitors such as diltiazem, erythromycin, & ketoconazole?
Because it can lead to increased sedation and next-day drowsiness
What is the mechanism of action of Z drugs?
Producing a calming effect by binding to GABA receptors
When prescribing non-stimulants it is important to pay special attention to what parts of the clients history?
All of the above
Beers criteria includes all of the following
Avoid prescribing medication at night to prevent falls
alking excessively, blurting out answers in class, & not waiting thier turn are all examples of which ADHD symptoms?
Impulsivity
What medication is recommended to control irritability and help with sleep if taken at bedtime?
Guanfacine
Not listening & making careless mistakes is an example of what ADHD symptoms?
Selective attention
Inability to find the motivation to complete his homework or pay attention in class is an example of what ADHD symptoms?
sustained attention
What is the recommended 1st step to increasing the dose of methylphenidate from 5 mg q day?
Consider a second dose after lunch if appetite is affected
running & climbing on the chairs & desks, trouble playing quietly, & refusing to stay in seat are examples of what ADHD symptoms?
Hyperactivity
Inhibiting NE NTM in the PFC increases what?
Both
Benadryl can cause anticholinergic effects due to the _________ ________.
muscarinic antagonism
What is the primary reason for treating alcohol abuse before treating ADHD and anxiety disorders?
To address the highest degree of impairment
What is the effect of pulsed stimulation on dopamine and norepinephrine firing?
Pulsatile stimulation amplifies undesirable phasic DA & NE firing, which can lead to euphoria and abuse
All of the following medications are good alternatives for sleep in pt.s with insomnia EXCEPT?
Exercise for 30 min before sleep
Which brain region is involved in the reward center of the brain?
Nucleus accumbens
Amitriptyline is an acceptable sleep medication not typically used first line due to risk for falls. It is classified as?
Tricyclic antidepressant
All of the following should be monitored when RLS is suspected EXCEPT?
CBC
Which medication is a DA-NR reuptake inhibitor?
Amphetamine
Wellbutrin is a _______________?
DA reuptake inhibitor
Test your knowledge on the best practices for treating insomnia with sedatives, including dosage, formulation, and potential risks. This quiz is designed for nursing professionals and students.
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