PMHNP Boards Test Bank 2024 PDF

Study Partner PMHNP Boards Test Bank 2024 | 500+ Questions and Answers | Psychiatric Mental Health Nurse Practitioner Certification Exam Questions and Answers | Guaranteed A+ Buy and sell summaries, lecture notes, practice exams and other study document...

Study Partner PMHNP Boards Test Bank 2024 | 500+ Questions and Answers | Psychiatric Mental Health Nurse Practitioner Certification Exam Questions and Answers | Guaranteed A+ Buy and sell summaries, lecture notes, practice exams and other study documents or get support from other students who want to help you with your studies. Downloaded by: Bdmusic - [email protected] This document is protected by copyright, the distribution of this document is illegal.  PMHNP Boards Test Bank 2024 | 500+ Questions and Answers | Psychiatric Mental Health Nurse Practitioner Certification Exam Questions and Answers | Guaranteed A+ What is true of interprofessionality? Answer- All health professionals have individual professional competencies What is the significance of an experimental p-value of 0.05 Answer- There is a 5% chance of a similar result occurring by chance alone What percentage of children with oppositional defiance disorder will develop conduct disorder? Answer- 30% In the DSM-5, selective mutism is now considered what type of disorder? Answer anxiety disorder Symptoms of selective mutism must persist for at least Answer- 1 month Common competencies Answer- overlap more than one health care professional, although not necessarily all health care professionals, and are competencies expected of all health care professionals Complementary competencies Answer- enhance the qualities of other professions in provision of care Collaborative competencies Answer- those that each individual profession must possess to work with others, including those who practice within different specialties within a profession. Interpersonal collaboration is centered Answer- patient Cognitive therapy is recommended for patients that have Answer- negative cognitive distortions irrational beliefs faulty conceptions Humanistic Therapy focuses on assisting patients with Answer- self-actualization and self-directed growth Behavioral Therapy focuses on Answer- changing maladaptive behaviors through the Downloaded at Knoowy - Upload your own study documents and earn money use of behavioral modification techniques Existential therapy is for Answer- reflection on life confronting self 120 who got diarrhea ate lettuce. 80 with diarrhea did not eat lettuce. 40 without diarrhea ate lettuce. 160 without diarrhea ate lettuce. What is the odds ratio of eating lettuce and developing diarrhea? Answer- 6 ((120X160)/(80x40)) The New Freedom Commission on Mental Health (NFCMH) released a report that suggested Answer- implementation a national campaign to reduce the stigma of seeking care Focusing on promoting recovery and building resilience The efficacy of mental health treatments was found to be well documented in Answer- influential report issued by US Surgeon General in 1999 State of high negative emotion and pessimism Answer- neuroticism Commonly known as an optimistic outlook on life They are are outgoing, like social interaction, respond to external rewards, have more active dopamine networks, and are responsive to positive reinforcement. Answer- Extraversion (high levels protect from psychiatric illness) Introverts are more likely to be motivated and more likely to respond to reinforcement Answer- internally negative (more likely to interact with internal motivation/self-image) Interpersonal trait of cooperation, easy going nature. Tend to have smooth relationships often at the expense of self-assertion Answer- Agreeableness Associated with self-control and a focused, organized approach to life. Are achievement-oriented goal setters who can delay immediate gratification to obtain their long term desired outcome. They are considered responsible, reliable, and dependable. Answer- conscientiousness In behavioral couples therapy, the initial sessions are spent doing a functional analysis of behavior (FAB). What is true about FAB? Answer- FAB is concerned only with observable stimuli connected to operant behavior FAB is based on operant conditioning (identifying antecedent stimuli, operant behaviors, and consequent stimuli) The goal of FAB is modifying willful operant behavior Gestalt theory deals with , not Answer- perceptual psychology behavior Medication that can delay ejaculation in patients with premature ejaculation Answer- Paroxetine (and other SSRIs) (others include: Topical anesthetic Tramadol Phosphodiesterase-5 inhibitors) Downloaded at Knoowy - Upload your own study documents and earn money First line treatment for lithium induced diabetes insipidus Answer- Amiloride (K potassium diuretic) in addition to dc lithium when possible. Ways to reduce polyuria associated with lithium toxicity Answer- reduce lithium dose to minimum effective dose take once daily at night (may be 5-30% lower than when given in divided doses over the day) Encourage adequate fluid intake What is true about ECT in Parkinson's disease Answer- it's more likely to cause transient delirium (worsened dyskinesias induced by l-dopa) Lithium effects with Parkison's disease Answer- may worsen tremor nonselective MAOIs decrease the efficacy of and increase the risk of a Answer- l-dopa products hypertensive crisis Selegiline is selective for Answer- MAO-B (after 10mg there is an increase in risk of serotonin syndrome if given with other meds that increase serotonin) SSRI's can Parkinsonism tremor Answer- worsen (and decrease 'off time') Process describes the mechanism by which the hippocampus stores memories Answer- long-term potentiation loss of memory relating to a particular category of information (inability to recall important autobiographical information, usually of a traumatic or stressful nature, that is inconsistent with ordinary forgetting) Answer- systematized amnesia Lack of memories from a circumscribed period of time, usually immediately following a traumatic event Answer- localized amnesia Person can recall some but not all of events from a particular time period Answer- selective amnesia Lack of memory of the patient's entire life Answer- generalized amnesia The drugs that are FDA approved for GAD Answer- Paroxetine Citalopram Escitalopram Venlafaxine Duloxetine Buspar A surrogate has the right to terminate pregnancy if Answer- the pregnancy threatens her Downloaded at Knoowy - Upload your own study documents and earn money health or life or she is a genetic parent If the surrogate receives both ovum and sperm from couple, she loses the right to Answer- determine whether or not child will be aborted (this is up to the couple) Which medication is most effective for treating social phobia/social anxiety disorder, especially when refractory? Answer- Phenelzine A 55-year-old female patient has Stg II HTN. On exam, she has trace pedal edema bilaterally, but her lungs are clear. Her ECG reveals 2nd degree heart block. Which of the following BP medications should be avoided? Answer- Calcium Channel Blockers 3 Contraindications to use a calcium channel blocker Answer- 1st or second degree heart block Bradycardia CHF 4 Side effects of calcium channel blockers Answer- Headache Lower extremity edema Bradycardia Heart Block An NP is evaluating a 78 year old female with depression. She suspects the patient may have Parkinson's disease. Which of the following is consistent with that diagnosis? Answer- Postural instability Pill-rolling tremor Shuffling Gait Difficulty initiating movement Mask-like facies (difficulty initiating movement) Writhing movements occur with Answer- Huntington's chorea 10 Non-motor manifestations of Parkinsons Answer- Autonomic dysfunction Gastrointestical dysfunction Rhinorrhea Sleep disturbance Fatigue Mood disorder Cognitive dysfunction Dementia Psychosis Hallucinations What type of therapy is most useful in depressed HIV positive outpatients? Answer- Interpersonal psychotherapy What type of therapy is most useful in patients with borderline personality disorder? Answer- Dialectical behavioral therapy Downloaded at Knoowy - Upload your own study documents and earn money The NP is caring for a patient dying of lymphoma. The pt's wife states that the pt has been mismanaged and that another practitioner must be assigned to the patient for him to improve. This NP suspects that this individual is in which stage of grief according to Elizabeth Kugler-Ross? Answer- Bargaining Involves resisting or refusing to remember information that has been supplied Answer- Denial Pica and spoon shaped nails are associated with Answer- Iron-deficiency anemia (microcytic) 2 common causes of microcytic anemia Answer- iron deficiency anemia of inflammation/chronic disease (TB, HIV, endocarditis, RA, Chrohn's DM, kidney disease, CA) (Other causes: lead toxicity, alcohol/drug use, zinc excess (copper deficiency)) Initial symptoms of B12 deficiency Answer- Generalized weakness Paresthesias Possible ataxia Late symptoms of B12 deficiency Answer- Memory impairment Depressed mood 5 P's of Vitamin B12 deficiency Answer- Pancytopenia (Peripheral and Posterior spinal cord) neuropathy Pyramidal tract signs Papillary atrophy of tongue (atrophic glossitis) 2 causes of megaloblastic macrocytic anemias Answer- Vitamin B12 deficiency Folate deficiency What neurotransmitter is thought to play the most significant role in social phobia? Answer- dopamine What neurotransmitter is thought to mediate social interest, gregariousness, confidence and sensitivity to rejection? Answer- dopamine According to Gonzalez-Jaimes and Turnbull-Plaza (2003, which type of therapy with psychocorporal, cognitive, and neurolinguistic components and a holistic focus is significantly more effective in patients diagnosed with adjustment disorder? Answer- mirror psychotherapy The is part of the treatment to encourage a patient to accept his physical condition Answer- mirror Discussing medical diagnoses and the reaction to it, as well as treatment modalities Answer- medical conversation Downloaded at Knoowy - Upload your own study documents and earn money Therapy that emphasizes personal responsibility, focusing on the individual's experience at the present moment, the therapist-patient relationship, the context of the person's life, and adjustments people make as a result of their overall situation Answer- Gestalt Therapy PANDAs is associated with infections and results in symptoms Answer- Group A beta-hemolytic strep OCD After camping trip, pt began to have a petechial rash on her legs/trunk, parts of which are turning dark red and purple, temp 102.8, HR 1115, BP 88/50, mm pain, neck stiffness, severe HA. What is the dx? Answer- meningococcemia 1 mg of Xanax = mg of Ativan Answer- 2 1mg of Xanax = mg of phenobarbital Answer- 30 1mg Xanax = mg of Clonazepam (Klonopin) Answer- 1 1mg Xanax = mg of chlordiazepoxide (Librium) Answer- 25 1mg of Xanax = mg of diazepam (Valium) Answer- 10 Pt wanting something immediate and non-addictive for breakthrough anxiety Answer- Hydroxyzine How long do GAD symptoms need to occur to make the diagnosis? Answer- 6 months First lab test to check for Sjogren's Answer- Anti-nuclear antibody tests To diagnose Cyclothymic disorder, it must be present for in adults Answer- 2 years To diagnose Cyclothymic disorder, it must be present for in pediatrics Answer- 1 year 4 physiological disturbances that may explain some of the symptoms of panic Answer- impaired lactate metabolism abnormality of locus coeruleus (Ser, NE, GABA, Dop, cholecystokinin) carbon dioxide hypersensitivity (hyperventilation) A 45-year-old man presents to the ER for "panic attack". He appears agitated, confused, and dizzy. He became more agitated and combative with staff upon further questioning. He states he was prescribed Xanax 0.5mg 3x daily by outpatient psychiatrist. His vitals are WNL. What is most likely his dx Answer- Benzodiazepine intoxication Anxiety, tremors, nightmares, insomnia, anorexia, nausea, vomiting, hypotension, seizures, delirium and hyperprexia are sx of. which can result in Downloaded at Knoowy - Upload your own study documents and earn money Answer- Benzodiazepine withdrawal (serious medical complications including death) Confusion, AH, VH following a period of insomnia can be a sx of Answer- withdrawal delirium Female patients with PTSD commonly have this comorbid diagnoses Answer- Major depressive disorder (50%) Percentage of people with PTSD who have alcohol use disorder Answer- male 50% female 27% Percentage of people with PTSD who have simple or social phobias Answer- 30% both male and female Percentage of people with PTSD who have persistent depressive disorder ( previously dysthymia) Answer- 20% for both male and female Treatment plan for OCD Answer- SSRI or Clomipramine Psychotherapy Normal Rinne test is for this nerve Answer- CN VIII What ethnic groups are at higher risk for social phobia Answer- Native American What ethnic groups are at lower risk for social phobia Answer- Asian Black Latino Onset of social phobia is Answer- Usually begins in late adolescence or early adulthood (13-20 years) 3 CBT techniques for social phobias Answer- exposure cognitive restructuring social skills training Medication used to help with social phobia for public speaking Answer- propranolol FDA approved SSRI for social phobia Answer- paroxetine What type of fracture is a red flag for child abuse? Answer- Spiral of long bone (caused by twisting of extremity) Bruises on the torso in different stages of healing often indicate Answer- abuse Tanner Stage: Breast buds undeveloped with papilla elevation only. Villus hair only Answer- I Tanner Stage: Breast buds palpable, straight pubic hair mostly on labia Answer- II Downloaded at Knoowy - Upload your own study documents and earn money Tanner Stage: Areola begins to enlarge and pubic hair becomes darker, coarser, and curly Answer- III Downloaded at Knoowy - Upload your own study documents and earn money Tanner Stage: Areola forms a secondary mound on the breast and hair is of adult quality Answer- IV Tenderness at McBurney's point is suggestive of Answer- appendicitis About 30% of patients with this disorder have OCD thoughts Answer- Tourette's disorder Rx that can cause anxiety Answer- Steroids (prednisone) Albuterol Amphetamines Appetite suppressants Medical conditions that can cause anxiety Answer- Adrenal tumors Alcohol use disorder Hypoglycemia Hyperthyroidism Cushing's disease Arrhythmias Parathyroid Tumors Some types of seizures Depression screening tool used specifically for pregnancy and postpartum Answer- Edinburg Depression Scale How long do symptoms have to be present to diagnose PTSD Answer- 1 month Lab value that would indicate that parathyroid was removed during thyroidectomy Answer- Low Calcium For PCOS, which medication will help with hirsutism? Answer- Spironolactone Lab that is an indicator of inflammation Answer- C-reactive protein Pain medication that inhibitis serotonin and NE reuptake (risk of serotonin syndrome if also on antidepressants) Answer- Tramadol an over-the-counter nonnarcotic drug found in cough preparations which inhibits serotonin reuptake and could cause serotonin syndrome in patients on SSRI's Answer- Dextromethorphan (Delsym) Pre-cursor for Serotonin production Answer- L-tryptophan Downloaded at Knoowy - Upload your own study documents and earn money In panic disorder, 1 of the attacks is followed by at least of persistent worry about having additional attacks, worry about implications of attacks or its consequences, or significant change in behavior related to attacks. Answer- 1 month The origins of panic disorder include Answer- childhood trauma With delayed onset of PTSD, how much time must have past from trauma to onset of symptoms Answer- 6 months First line medication for polymyalgia rheumatica Answer- oral prednisone Acute stress disorder is diagnosed if the characteristic symptoms present within what period of time after experiencing the traumatic event? Answer- 1 month In what Tanner's stage will a male's penis grow more in length than width Answer- III In what Tanner's stage will a male's scrotum begins to grow and redden. Where pubic hair will be straight, fine and sparse Answer- II In what Tanner's stage will a male's pubic hair look more like an adult, but will not cover as much area. Where penis will thicken, testes and scrotum continue to grow. Answer- IV Brain structure R/T development of GAD Answer- Amygdala What circumstance(s) are often correlated to the onset of panic disorder Answer- separation from family serious illness of friend/family accident major relationship loss/change abusing substances postpartum Lifetime prevalence of anxiety disorders in the US Answer- 25-35% (18% prevalence) Buspar needs to have similar efficacy to benzodiazepines Answer- 4 weeks How many panic symptoms must be present for diagnoses. Answer- 4 Part of Brain responsible for smell Answer- Limbic Part of brain (lobe) responsible for visual functions Answer- Occipital Part of brain (lobe) responsible for sensory integration and somatosensory function Answer- Parietal Downloaded at Knoowy - Upload your own study documents and earn money Part of brain (lobe) responsible for executive function, social conduct, judgement, and some motor function Answer- Frontal Occasional crossing of eyes is not normal after the infant is older than Answer- 2 months If strabismus is left untreated, what may result? Answer- ambylopia (affected eye decrease in vision) What would be the normal testosterone level of a Tanner V male Answer- 265-800 ng/dl Bactrim is contraindicated in Answer- Glucose-6-phosphatase deficiency Folate deficiency anemia patients with significant hepatic impairment pregnant patiens Pt has severe headache behind right eye with eye pain and tearing, sees halos around light fixtures. C/o N/V. R pupil fixed more oval than round, mid-dilated and cloudy. What might be happening Answer- Acute angle closure glaucoma (Emergency) What STD is not reportable in all 50 states Answer- HPV Romberg test is a test of Answer- balance A child will recognize faces and smile appropriately at familiar faces by age Answer- 3 A typical can count up to 20 with minimal assistance of an older child or parent Answer- 4 year old A typical can run/walk up and down the stairs Answer- 21 month old A typical is beginning to acquire language skills Answer- 14 month old What herbal supplement is effective for a pt with an adjustment disorder with anxiety according to RCT Answer- Kava Kava What herbal supplement is effective for somatoform disorders according to RCT Answer- St. John's Wort Recurrent spontaneous episodic vertigo, hearing loss. Must have aural fullness or tinnitis on one size to make dx. Answer- Meniere's Disease ADPIE stands for Answer- Assessment Diagnosis Planning Downloaded at Knoowy - Upload your own study documents and earn money Implementation Evaluation If diagnosed with an adjustment disorder, which dx is most guarded: that of an adult or that of an adolescent? Answer- adolescent (more likely to develop major psychiatric illness) Gastrointestinal lithium toxicity symptoms can overlap with Answer- normal side effects (N/V) What is FDA approved for suicidality in schizophrenia Answer- Clozapine Clozapine can cause this CBC abnormality Answer- leukopenia (agranulocytosis) What is the dependent variable of a study examining the effects of a certain medication on hypertension? Answer- Blood pressure What is the independent variable of a study examining the effects of a certain medication on hypertension? Answer- Medication Effect of a variable that is not controlled Answer- Confounding effect Type of error that results in the way the experiment is conducted, often due to the expectations of the researcher Answer- Bias Pharmacological treatment of alcohol use disorder Answer- Start Naltrexone at 25mg PO daily (1-hour observation for rxn). Naltrexone maintenance dose is usually 50mg PO q day or 380mg IM q 4 weeks Naltrexone side effects Answer- Elevated LFTs Mild dysthymia GI upset Resembles GABA and is possibly an NMDA antagonist Answer- Acamprosate Aldehyde dehydrogenase inhibitor Answer- Disulfiram (Antabuse) Modest efficacy, may work better in combination with Naltrexone for alcohol use disorder Answer- Acamprosate No convincing efficacy found for use of this Alcohol Use Disorder pharmacological treatment Answer- Disulfiram (Antabuse) Most commonly reported side effect of ECT Answer- Retrograde amnesia Downloaded at Knoowy - Upload your own study documents and earn money Neurodevelopmental disorder of biological origin that manifests in learning difficulties and problems in acquiring academic skills markedly below age level and manifested in the early years for at least 6 months that is not attributed to intellectual disabilities, development disorders or neurological or motor disorders Answer- Specific Learning Disorder Specific Learning Disorders can be specified as impairment in Answer- Reading Written Expression Mathematics The MOST important component when developing evidence based guidelines Answer- An evidence review How does botox improve depression? Answer- Reducing frown lines when injected into glabellar region According to a study in the 1990s mothers of anorexic pts have an increased prevalence of this disorder Answer- Obsessive-compulsive disorder The AST:ALT ratio in patients with Alcoholic liver disease Answer- 1.5 Liver biopsy reveals fibrosis, necrosis of liver cells, and nodule formation Answer- Liver cirrhosis Acute condition with nystagmus, ataxia, confusion, and opthalmoplegia Answer- Wernicke-Korsacoff syndrome Elevated bilirubin level is often found in Answer- Alcoholic hepatitis Which drug's mechanism of action includes blockage of the voltage dependent sodium channel blockers, augmentation of gamma amino butyrate activity of GABA-A receptors, antagonism of AMPA/kainate subtype of glutamate receptor, and inhibition of carbonic anydrase enzyme? Answer- Topiramate Ex of drugs that are partial agonists at postsynaptic serotonin receptors Answer- Hallucinogens like LSD and MDMA Drug associated with inhibition of catecholamine reuptake in neurons and blockage of NMDA glutamate receptors Answer- PCP Individuals with panic disorder are most commonly affected by which other psychiatric disorder Answer- Agoraphobia Downloaded at Knoowy - Upload your own study documents and earn money When is the use of transdermal selegiline not beneficial? Answer- For patients with pheochromocytoma (excess NE can cause HTN crisis) and with planned surgery (need to dc patch for 10 days prior to elective surgery) Responsible for the catabolism of serotonin, norepinephrine and dopamine Answer- Monoamine oxidase (MAO) Medication that is an irreversible MAO inhibitor that works by selectively inhibiting both MAO-A and MAO-B in the CNS with preservation of MAO-A in the gut. Unless high dosed, little need to follow tyramine restricted diet. Answer- Selegiline Adverse effect of carbamazepine that can be an emergency Answer- hyponatremia toxic epidermal necrolysis Erythema multiform Steven's Johnson Thrombocytopenia Aplastic Anemia Agranulocytosis SLE arrhythmias Hepatitis An NP advises a patient with a significant family hx of breast cancer to perform monthly self-examinations. What term helps to identify this measure? Answer- Secondary Prevention Prevention type designed for early detection of a disease so that morbidity and mortality may be reduced Answer- Secondary Prevention Preventing the disease or condition from occurring Answer- Primary Prevention WIC and promotion of workplace safety laws designated by OSHA are this type of prevention Answer- Primary Prevention Rehabilitation and prevention of complications of disease Answer- Tertiary prevention A support group for a disease or condition is this type of prevention Answer- Tertiary Prevention Exercise for an obese patient is this type of prevention Answer- Tertiary Antisocial personality disorder criteria must show a pattern of disregard of others since age Answer- 15 How many criteria does a pt who meets criteria for an Antisocial personality disorder have to have Answer- 3 of 7 Downloaded at Knoowy - Upload your own study documents and earn money Name the 7 criteria that pts with Antisocial personality disorder have (must meet 3 of them) Answer- Breaking the law Deceitfulness for personal profit or pleasure Impulsivity/failure to plan ahead Aggressiveness/Irritability (physical fights/assaults) Reckless disregard for safety of self or others Consistent irresponsibility Lack of remorse How old does an individual need to be in order to be diagnosed with antisocial personality disorder? Answer- 18 years The occurrence of antisocial behavior is not exclusively during the course of Answer- schizophrenia bipolar disorder What is a precursor for antisocial personality disorder Answer- conduct disorder List of Cluster B personality disorders Answer- antisocial borderline histrionic narcissistic List the cluster A personality disorders Answer- paranoid schizoid schizotypal List of Cluster C personality disorders Answer- avoidant dependent obsessive-compulsive pervasive pattern of excessive emotionality and attention seeking beginning in early adulthood and present in a variety of contexts Answer- Histrionic Personality Disorder A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness must last at least for Oppositional Defiant Disorder diagnosis Answer- 6 months Oppositional defiant disorder does not include: Answer- aggression toward people or animals destruction of property pattern of theft or deceit Recurrent behavioral outburst representing a failure to control aggressive impulses. Answer- Intermittent Explosive Disorder Downloaded at Knoowy - Upload your own study documents and earn money In Intermittent Explosive disorder, physical aggression does not result in Answer- damage or destruction to property physical injury to animals or other individuals Kubler-Ross's stages of grief Answer- denial anger bargaining depression/sadness acceptance Symptoms can be associated with another medical condition Answer- Somatic symptom disorder Somatic symptom disorder symptoms persist for Answer- >6 months Despite frequent doctors visits and tests, this pt is rarely reassured and can feel that his/her medical care is insufficient Answer- Somatic symptom disorder In order to meet DSM V criteria for somatic symptom disorder, in addition to somatic symptoms, pts must have Answer- maladaptive thoughts, feelings, and behaviors that define the disorder, in addition to their somatic symptoms. The Mental Health Party Act (1996) provides Answer- equal lifetime and annual limits for mental health care as compared to physical health care. The zoster vaccination is recommended for Answer- adults over the age of 60 The pneumococcal vaccination is recommended for Answer- adults over the age of 65 The Tdap vaccination is recommended Answer- every 10 years Understanding the objective reality of a situation coupled with the motivation and emotional impetus to master the situation or change behavior is: Answer- true insight Form of thinking that is logical, organized, reality oriented, and influenced by the demands of the environment Answer- second process thinking What percentage of the population meets the criteria for 1 or more personality disorders? Answer- 15% Study on daily exercise improving sleep quality in seniors. What is the dependent variable Answer- Sleep quality The federal law that allows parents to provide insurance coverage for their children up to age 26 is Answer- Affordable Care Act (ACA) Downloaded at Knoowy - Upload your own study documents and earn money Pedophiles attracted to female victims usually prefer females of what age? Answer- 8- 10 years old What is true of appropriation bills? Answer- They provide for spending authority for a single fiscal year What bills establish laws or programs and although they recommend dollar amounts in some cases, do not allocate the funds or guarantee funds for the program Answer- Authorization bills What bills usually originate in the House of Representatives and provide spending authority for a single fiscal year Answer- Appropriation Bills Provide additional funding for projects as needed thought the current fiscal years Answer- Supplemental appropriations Authorization bills are funded by Answer- Appropriation Bills What is required for entry to practice as a Nurse Practitioner Answer- Competency in nine content domains The NP is caring for a 16 year old who is depressed with suicidal ideation. The pt asked the nurse NOT to tell her parents. The most appropriate intervention for the nurse to do is: Answer- Talk to parents and pt together to help the family discuss the pt's depression According to Mahler, which of the following stages of infant development is disrupted in children who develop borderline personality disorder Answer- Rapproachment According to Mahler, which of the following stages of development was disrupted int children who developed narcissistic personality disorder Answer- Symbiotic phase Phase during first weeks of life, characterized by total detachment and self-absorption, infant spends most of his or her time sleeping Answer- Autistic stage When does the symbiotic phase occur Answer- about 5 months of age According to Mahler, separation-individuation has 3 stages Answer- Hatching (5-9 months) Practicing (9-16 months) Rapproachment (15-24 months) Phase where infant explores the outside world but requires that the mother is present and able to support the child appropriately and emotionally in completing the task? Answer- Rapprochment (15-24 months) Downloaded at Knoowy - Upload your own study documents and earn money Phase in which infant develops the physical ability to separate from mother Answer- Practicing (9-16 months) Disturbance of the rapprochement subphrase is associated with Answer- persistent longing for and dread of fusion with object that is thought to be secondary to aggression or withdrawal in the mother. Thought to contribute to the development of borderline personality disorder. Phase in which infant shows increased interest in outside world Answer- Hatching Stage where infant recognizes his or her mother but lacks a sense of individuality Answer- symbiotic Narcissistic personality disorders are likely due to Answer- inadequate soothing during the symbiotic phase and inadequate refueling during the separation-individuation Describes the child's understanding that his or her mother is a separate individual and he or she is also separate Answer- Object constancy Object constancy leads to the formation of Answer- internalization, which will allow the child to have an internal representation of mother in turn allowing healthy separation, exploration, and development of self-esteem The three most common causes of secondary obesity Answer- Cushing's syndrome Hypothyroidism Genetic conditions Compassion, a desire to do good Answer- beneficence Avoidance of harm Answer- Nonmaleficence the equal and fair distribution of resources, regardless of other factors Answer- Justice Dedication, fairness, honesty, advocacy and commitment to patients. It involves an agreement to keep promises and commitments based on the virtue of caring. Answer- Fidelity Most widely used tool for assessing the healthcare safety culture within an organization Answer- Culture of Patient Safety Assessment developed by AHRQ The Iowa Model of EBP (evidence-based practice) is characterized by which statement? Answer- It is important to determine if an identified issue is a priority of the organization The trigger for change can be Answer- Knowledge focused or Problem focused Downloaded at Knoowy - Upload your own study documents and earn money Identification of a problem and determination of its priority Answer- first step in Iowa Model Review and critique of available literature Answer- Second step in Iowa Model Identification of research evidence to support a change in clinical practice Answer- 3rd stage of Iowa Model Implementation of change Answer- 4th step of Iowa Model Monitoring of Outcomes Answer- 5th and final step of Iowa Model Knowledge-focused triggers include Answer- new research practice guidelines Problem-Focused Triggers include Answer- Clinical problems Issues in risk management The first step in getting a bill to the floor is? Answer- Drafting a bill Probability results of study are due to chance Answer- P value Medicare part A coverage includes Answer- 1. hospital care and medicines received in hospital 2. SNF 3. nursing home care 4. hospice 5. home health services Sampling used when the proportion of the study population belonging to each group of interest in known, to obtain an adequate study sample from a small group in the study population. Answer- Stratified sampling Selection of groups under study is random Answer- Cluster sampling Choosing individuals at regular intervals from a sampling frame by selecting a number to determine where to begin selecting individual subjects from a list. Answer- Systematic sampling Making a numbered list of all units in a population from which you want to draw a sample, deciding on the sample size, and selecting the required number of sampling used using a table of random numbers or a lottery method Answer- Simple random sampling What is the prevalence of borderline personality disorder in psychiatry outpatients? Answer- 10% Downloaded at Knoowy - Upload your own study documents and earn money What is the prevalence of borderline personality disorder in psychiatric inpatients Answer- 20% Diagnosis of borderline personality disorder includes 5 or more of the following criteria Answer- frantic avoidance of abandonment unstable relationships disturbance of identity recurrent suicidality unstable mood/affect chronic feelings of emptiness intense bouts of difficult-to-control anger transient paranoia or dissociation Pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation Answer- Avoidant Pervasive pattern of detachment from social relationships and a restricted range of expression Answer- Schizoid Pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent Answer- Paranoid Pervasive pattern of social and interpersonal discomfort with, and reduced capacity for, close relationships as well as cognitive or perceptual distortions and eccentricities Answer- Schizotypical Pervasive pattern of grandiosity, need for admiration, and lack of empathy Answer- Narcissistic Pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation Answer- Dependent The prevalence of borderline personality disorder in primary care Answer- 6% The prevalence of borderline personality disorder in the general population Answer- 1.5- 5.9% What best determines the effectiveness of an educational intervention? Answer- Pt's behavior modification and compliance rates After suffering the loss of a child, more than 50% of parent couples go through the following Answer- Divorce Rubbing against non-consenting people Answer- frotteurism Downloaded at Knoowy - Upload your own study documents and earn money Fantasies about watching unsuspecting individuals undressed or in sexual activity Answer- voyeurism Use of non-living objects for sexual stimulation Answer- fettishism Exposing one's genitals to strangers Answer- exhibitionism Besides therapy in Borderline Personality Disorder, impulse behavioral dyscontrol symptoms that present serious risk to patient are treated by adding Answer- an antipsychotic to an SSRI In borderline personality disorder, cognitive-perceptual symptoms respond best to Answer- low dose antipsychotics Impulsive-behavioral dyscontrol symptoms in borderline personality disorder Answer- aggression self-mutilation reckless spending promiscuity substance abuse Affective dysregulation in borderline personality disorder is treated with Answer- SSRI or venlafaxine For histrionic personality disorder, which type of therapy helps them focus on their unconscious motivations for being unable to commit to a stable and meaningful relationship, and instead seeking out disappointing partners Answer- psychodynamic Temporal lobe abnormalities and differences in the corpus callous and thalamic nuclei have been identified on MRI studies of patients with which condition Answer- schizotypical personality disorder Schizotypical personality disorder can be differentiated from schizophrenia by the absence of Answer- psychotis Prevalence of schizotypical personality Answer- 3% (more cases occur in biological relatives with schizophrenia) Affective aggression can be treated with which medication? Answer- Lithium Which personality disorder is often present with pts with anorexia-nervosa who restrict rather than binge-purge Answer- Obsessive-compulsive A type of identification that is seen often in borderline personality disorder pts Answer- projective identification Downloaded at Knoowy - Upload your own study documents and earn money 3 steps of projective identification Answer- 1. pt assigns component of self to another individual 2. pt manipulates this individual into integrating this component into his or her consciousness 3. process leads to increased feeling of closeness between parties Analyst's emotional response to pt Answer- countertransference When pt tends to identify aspects as either completely good or completely bad about a person Answer- Splitting Mental process that gives rise to lack of connection in the pt's thoughts, memory, and sense of identity Answer- Dissociation Substance that is found in lower concentrations in the CSF of impulsive, violent individuals Answer- 5-HIAA In addition to an assessment of pathological personality traits, alternate model in Section III of the DSM-5 requires an assessment of which category or a personality disorder diagnosis Answer- level of impairment in personality functioning A diagnosis of a personality disorder who require at least a level impairment Answer- 2 ("moderate") What is the prevalence of obsessive-compulsive personality disorder in the general population Answer- 5-10% Which personality disorder's criteria includes magical thinking Answer- Schizotypical Females with have a virilized clitoris Answer- Congenital adrenal hyperplasia (CAH) A higher degree of has been reported in individuals with CAH, which correlates to the degree of virilization Answer- homosexuality A 2-year old girl with 21-hydroxylase deficiency undergoes genitoplasty. Which statement is true concerning her condition Answer- There is a correlation between virilization degree and gender dysmorphia What is the prevalence of paranoid personality disorder among psychiatric patients? Answer- 10-30% Gender identity usually begins to form by this age Answer- 2 Anti-hypertensive effects on sexuality Answer- impaired vaginal lubrication and erectile dysfunction d/t antiadrenergic effects Downloaded at Knoowy - Upload your own study documents and earn money Spironolactone effects on sexuality Answer- decreased desire secondary to decreased testosterone Estrogen effects on sexuality Answer- decreased desire secondary to decreased testosterone Steroid effects on sexuality Answer- decreased desire secondary to decreased testosterone TCA effects on sexuality Answer- erectile dysfunction or impaired vaginal lubrication secondary to anticholinergic effects MAOI effects on sexuality Answer- erectile dysfunction or impaired vaginal lubrication secondary to anticholinergic effects Antipsychotics effects on sexuality Answer- erectile dysfunction or impaired vaginal lubrication secondary to anticholinergic effects SSRI effects on sexuality Answer- inhibition of arousal and orgasm by increased serotonergic activity The diagnosis of a personality disorder requires a pattern of inner experience and behavior that deviates from the expectations of the individual's culture in 2 or more of which 4 areas? Answer- cognition affectivity impulse control interpersonal functioning Individual is only aroused by and can only achieve orgasm through a single type of sexual contact, usually relegated to a specific anatomical location Answer- Partialism Individuals who attempt to avoid penetrative sex due to a lack of interest may have what? Answer- Partialism (a type of paraphilia) Prevalence of antisocial personality disorder in females in the community Answer- 1% 2 common defense mechanisms seen in obsessive compulsive personality disorder Answer- isolation of affect intellectualization Paraphilia are almost never diagnosed in Answer- females (and rarely in a clinical setting) Age range that is typical for a person that performs frotteurism Answer- 15-25 (declines after that) Downloaded at Knoowy - Upload your own study documents and earn money Pts with a history of childhood separation are more prone to this personality disorder Answer- dependent Pts with dependent personality disorder commonly experience these 2 things from their caretaker? Answer- over-involvement intrusive behavior Childhood experience common in pts with dependent personality disorder Answer- social humiliation - leads them to doubt in their own ability to function independently of others Pts with obsessive compulsive personality disorder often had parents who were Answer- emotionally withholding overprotective over-controlling People with obsessive compulsive personality disorder develop their symptoms as a strategy to Answer- avoid punishment (they were often punished by parents and rarely rewarded) Patients with schizoid personality disorder typically from families that are Answer- emotionally reserved highly formal aloof impersonal (likely were provided inadequate affection prompting their disinterest in forming close relationships later in life) Patients with this personality disorder displayed excessive shyness and fear when confronted with new people and situations as children Answer- avoidant Many of the patients have a history of painful early experiences and chronic parental criticism Answer- avoidant personality disorder Symptoms of personality disorders are usually consistent with patient's Answer- internal sense of self, which is called ego-synodic What is the term for how easily an individual acts on an initial, emotionally based evaluation of events and people Answer- Constraint Purest expression of the biological basis of personality Answer- Temperament What are the 2 distinct temperaments Kagan and colleagues (1988) identified Answer- inhibited uninhibited Downloaded at Knoowy - Upload your own study documents and earn money Which of the following medications is the first-line treatment option for a personality change secondary to epilepsy that results in aggressive episodes? Answer- Carbamazepine What is the second-line treatment option for a personality change secondary to epilepsy that results in aggressive episodes Answer- benzodiazepines What is contraindicated in the treatment of aggressive personality changes due to epilepsy Answer- antipsychotics females that have this are usually infertile have low estrogen levels but do not have higher levels of homosexuality Answer- Turner syndrome(45XO) females with this are typically indistinguishable from other females except they are slightly taller and have increased learning difficulties and low-normal intelligence Answer- Triple X syndrome 46XY with complete androgen insensitivity have Answer- female gender identity equivalent of 46XX individuals Congenital adrenal hyperplasia is associated with increased prenatal Answer- androgen exposure 5-alpha-reductase deficiency is associated with Answer- higher rates of homosexuality in affected females a cause of pseudohermaphroditism Gender identity is generally set by age and very difficult to change Answer- 3 First line agents for treating impulsivity and aggression in personality disordered patients Answer- SSRIs Explain what the following Pyramid Tract Signs result from: spasticity weakness slowing of rapid alternating movements hyper-reflexia Babinski sign Answer- Vitamin B12 deficiency The only TCA levels that can be reliably followed are for Answer- desipramine imipramine nortriptyline A transgender male is sexually attracted to men/masculinity. What is his sexual orientation? Answer- Androphilic Downloaded at Knoowy - Upload your own study documents and earn money A transgender male is sexually attracted to females/femininity. What is his sexual attraction? Answer- Gynephilic A transgender female is sexually attracted to females/femininity. What is her sexual attraction? Answer- Gynephilic A transgender female is sexually attracted to men/masculinity. What is her sexual attraction? Answer- Androphilic Attraction that is combination of androphilia and gynephilia Answer- Ambiphilia Asexual is synonymous with Answer- analophilic Part D of criteria for illness anxiety disorder Answer- performs excessive health-related behaviors or exhibits maladaptive avoidance Physical symptoms are less prominent, while anxiety era preoccupation with having or acquiring a serious medical condition is the core complaint Answer- Illness anxiety disorder In illness anxiety disorder somatic symptoms are Answer- not present or are mild in intensity In illness anxiety disorder, illness preoccupation has to be present for at least months Answer- 6 Prevalence of illness anxiety disorder Answer- 1-5% What are the FDA-approved medications for personality disorders? Answer- There are none Pts with borderline personality disorder and psychotic disorders are particularly likely to have experienced Answer- victimization as a child and/or adult Repeated changes in caregivers, history of neglect, avoidance of social interactions, and resistance to comforting from others is a sign of Answer- reactive attachment disorder indiscriminate sociability and lack of selectivity in authority figures Answer- Disinhibited social engagement disorder Symptoms present for are more consistent with PTSD rather than Acute Stress Disorder Answer- greater than 1 month Estimated lifetime prevalence of PTSD is Answer- 7.8% Downloaded at Knoowy - Upload your own study documents and earn money What ethnic group of combat veterans experience a higher rate of PTSD Answer- Latino especially Puerto Rican PTSD rates among Native Americans are the national average Answer- 3x higher What disorder is often comorbid with body dysmorphic disorder Answer- social phobia Recovering completely within is characteristic of a conversion disorder Answer- 24 hours For pediatrics with conversion disorder (psychogenic seizure), what might be found in this patient's history Answer- She argued with her parents earlier that day over a bad report card Conversions disorders do not show Answer- pain symptoms What is the typical course of illness anxiety disorder Answer- Onset in early adulthood has a chronic waxing/waning course Which medications have the strongest evidence for treatment of PTSD Answer- Paroxetine Sertaline (Venlafaxine also approved by FDA) Pts with this disorder often exhibit emotional blunting that is sometimes referred to as "la belle indifference" Answer- conversion disorder Pts with PTSD typically show a more robust clinical response to SSRIs Answer- non-combat In treating pts with histrionic personality disorder, which therapy type is useful for addressing provocative and attention seeking behavior? Answer- Group therapy (pt may be unaware of behavior and it could help them if others point them out) What term represents a stable and realistic sense of self? Answer- Self-system means of interpreting social situations and understanding the relational motives and actions of others Answer- social system the capacity to observe the self as it relates to others Answer- self-in-relation system What percentage of patients with neurological problems have conversion symptoms? Answer- 1-3% Downloaded at Knoowy - Upload your own study documents and earn money Body dysmorphic disorder is associated with what risk factor and family history Answer- Childhood neglect OCD These symptoms are a sign of which drug intoxication: elation euphoria increased physical activity anxiety tachycardia arrhythmias, hypertension, mydriasis (pupil dilation), agitation cognitive impairment Answer- cocaine Most serious complications of cocaine abuse Answer- myocardial ischemia and infarction Signs of : dysphoria, psychomotor slowing, fatigue, increased appetite, craving Answer- cocaine withdrawal Signs of : piloerection lacrimation and rhinorrhea pain in joints and muscles dysphoria diarrhea nausea vomiting dilated pupils insomnia autonomic hyperactivity yawning Answer- Opioid withdrawal signs of : euphoria drowsiness impaired coordination dizziness confusion feeling of heaviness in the body slowed or arrested breathing constipation flushing of feelings of warmth pinpoint pupils Answer- opioid intoxication Signs of Nystagmus Dissociative symptoms Downloaded at Knoowy - Upload your own study documents and earn money anxiety tremor numbness memory loss analgesia psychosis aggression violence slurred speech poor coordination hallucination Answer- Phencyclidine intoxication Signs of : stimulation loss of inhibition headache N/V slurred speech poor motor coordination Answer- Inhalant intoxication Signs of : Exhilaration loss of inhibitions slurred speech staggering gait euphoria marked motor impairment confusion stupor coma Answer- Sedative hypnotic (alcohol and benzodiazepine) intoxication Sign of : sweating flushed face insomnia hallucinations seizure disorientation tremors increased autonomic activity Answer- Sedative hypnotic (alcohol and benzodiazepine) withdrawal Sign of : Altered states of perception and feeling hallucinations nausea increased Downloaded at Knoowy - Upload your own study documents and earn money body temperature HR and BP pupillary dilation poor appetite sweating sleeplessness numbness dizziness rapid shifts in emotion depression anxiety Answer- Hallucinogen intoxication A 30-year-old female presents to the ED with severe anxiety, palpitations, restlessness, and irritability. She reports no previous history of these symptoms. Her BP is 160/100, pulse is 115 beats/min, temperature 98 degree F, and pupils are dilated What condition explains her symptoms Answer- cocaine intoxication Which statement differentiates the actions of cocaine and amphetamines Answer- Cocaine prevents dopamine reuptake but amphetamines both slow dopamine reuptake and induces dopamine release In the COMBINE trial for alcohol dependent patients acamprosate faired compared to various combinations of naltrexone and combined behavioral intervention Answer- poorly For Alcohol dependent patients, the COMBINE trial found that Answer- any combination of therapies including CBT, naltrexone, or both performed better than any combinations that did not include these interventions Buprenorphine is a at mu receptors and binds with Answer- partial agonist high affinity (20x stronger per gram weight of morphine) This is resistant to cases of overdose to reversal by naloxone Answer- buprenorphine d/t high binding affinity DSM-5 requires of 9 criteria to be met for persistent and recurrent maladaptive gambling behavior Answer- 4 What drug should be administered to address patient's aggression on PCP Answer- Benzodiazepines What medications should be avoided d/t risk of hyperthermia, lower the seizure threshold, cause dystonia, or induce dysrhythmias when pt is intoxicated with PCP Answer- haldol chlorpromazine Downloaded at Knoowy - Upload your own study documents and earn money Which of the following is not a feature of kleptomania Answer- individual feels great pleasure and excitement leading to the theft (usually individual feels tension) Chronic alcohol use disorder reflects an personality Answer- oral-dependent Excessive alcohol use is associated with traits such as Answer- oral dependence and depression Men are more than as likely as women to develop chronic alcohol use disorder Answer- 2x Delirium tremens usually develops from the person's last drink, with an average durage of Answer- 2-4 days =60mg A maximum of is recommended for initial treatment with paroxetine Answer- 50mg Which of the following findings is expected in a patient who is an ultra-rapid metabolizer Answer- High urinary concentration of the drug's metabolite Low plasma concentration of the drug Which statement correctly describes the inducer/inhibitor pharmacology of sertraline and tramadol when a patient is taking both medications? Answer- Sertraline at 200mg is a potent inhibitor of 2D6 and increases levels of tramadol (increased risk seizures) Inhibitors reduce the metabolism of leading to elevated levels of Answer- medications/substrates medications/substrates To have lower levels of tramadol, a patient must take a CYP2D6 Answer- inducer What medications selectively inhibit the reuptake of both serotonin and norepinephrine Answer- SNRIs: duloxetine venlafaxine desvenlafaxine Antidepressant with relatively weak reuptake inhibitor of dopamine and norepinephrine Answer- Bupoprion Noradrenergic and specific serotonergic antidepressant (NaSSA) that acts by antagonizing the adrenergic alpha-2 autoreceptors and alpha2-heteroreceptors, as well as by blocking 5-HT2 and 5-HT3 receptors Answer- mirtazapine Mechanism of action of ramelteon (Rozerem) Answer- melatonin MT1 and MT2 receptor agonist GABA-a receptor agonists are better known as Answer- benzodiazepine receptor agonists Side effects of chlorpromazine Answer- photosensitivity very rarely Neuroleptic malignant syndrome (NMS) Cholestatic jaundice occurs at a rate of 0.1% with Answer- chlorpromazine Downloaded at Knoowy - Upload your own study documents and earn money What medication taken in large doses can cause mild pigmentary changes in the retina Answer- chlorpromazine This medication (dosed at ) is associated with irreversible pigmentary retinopathy, and blindness can occur Answer- Chlorpromazine >800mg/day What lab would you order on a reproductive aged female patient prior to beginning depakote? Answer- human chorionic gonadotropin (HCG) Depakote can cause this in pregnant woman Answer- major congenital malformation, particularly neural tube defects Cyclophosphamide (Cytoxan) and carbamazepine Answer- auto-induce their own respective metabolisms Theophylline, ifosfamide and aminogluthimide Answer- induce their own metabolisms Valproic acid and isoniazid are both Answer- inhibitors Chronic doses of ethanol = , but in acute, binge doses = Answer- induction inhibition Ziprasidone may cause Answer- weight loss In which neuropsychiatric condition are levels of coenzyme Q10 lower than normal Answer- Parkinson's disease Initial studies show that supplementation of CoQ10 Answer- lower BP improve CHF What medication requires monitoring of symptoms like bruising and bleeding? Answer- Carbamazepine Discontinuation of Valproate is recommended if Answer- signs of bleeding develop (dose-related thrombocytopenia) Carbamazepine can cause suppression of Answer- bone marrow (agranulocytosis, aplastic anemia, thrombocytopenia) When used with lamictal, depakote dose should be Answer- reduced in half May be best for mixed episodes, more effective in mania vs depression Answer- depakote Downloaded at Knoowy - Upload your own study documents and earn money Blockade of voltage gated sodium channels, decreases glutamate release Answer- cabamazepine lamictal Use reserved for treatment resistant bipolar disorder due to multiple drug-drug interactions Answer- carbamazepine Unique side effects of aplastic anemia, Stevens Johnson syndrome and SIADH Answer- carbamazepine Unique side effect of hyponatremia (especially with SSRI). No association with SJS or aplastic anemia. CYP3A4 inducer Answer- oxcarbazepine Unusual side effect of metabolic acidosis, kidney stones Answer- topiramate Unusual rare side effect of hepatoxicity and pacreatitis Answer- depakote Unusual side effect of thyroid dysfunction, chronic renal insufficiency, decreased cardiac conduction efficiency, hypercalcemia, mild leukocytosis Answer- Lithium Linezolid, dextromethorphan, meperidine, propoxyphene, methadone, tramadol and high-dose sumatriptan all have this in common Answer- greater risk of serotonin syndrome when added to an SSRI. All triptan medications used for migraine treatment will cause cause a significant increase in at higher levels Answer- serotonin Smoking and clozapine Answer- decreases clozapine level Tobacco is a enzymes Answer- potent inducer of 1A2 Daily smoking causes antipsychotics to be Answer- cleared more quickly necessitating higher doses St. John's wort is an agent for Answer- inducer 3A4 3A5 Substrates affected by St. John's wort include Answer- amprazolam amlodipine atorvastatin diazepam cyclosporine serotinergic meds Cruciferous vegetables induces the metabolism of Answer- 1A2 Downloaded at Knoowy - Upload your own study documents and earn money Increasing consumption of cruciferous vegetable would clozapine levels Answer- lower (need higher dose to decrease risk for psychosis) For the ER form of divalproex sodium, what is the correct dosing adjustment compared with regular formula Answer- increase ER dose by 15% What is an appropriate loading dose of valproic acid for a hospitalized patient with significant manic symptoms? Answer- 20-30mg/kg Ventricular arrhythmia and seizures can be the result from overdose Answer- TCA Cardiac conduction defects are most severe with overdose Answer- desipramine TCAs are structurally similar to Answer- class I arrhythmias (20% proarrythmic & 20% with preexisting conduction disturbances have cardiac complications when taking) Tyramine-containing foods should be avoided in pts treated with Answer- MAOI Stevens-Johnson syndrome is associated with Answer- Lamictal (Lamotrigine) SIADH, leading to hyponatremia, has been associated with Answer- carbamazepine (Tegretol) Primary consideration when dosing fluoxetine for 9 year old boy Answer- height and weight Adult values for the cytochrome 450 enzymes are generally achieved by what age? Answer- 1 years old Psychotropic medications are not generally prescribed to children under the age of Answer- 5 years Fluoxetine is FDA-approved in the treatment of depression for what ages Answer- ages 8 years and older Monitor ADHD patients on stimulants for Answer- palpitations syncope CP vital signs including high blood pressure What supplement can cause easy bruising? Answer- Ginkgo biloba Gingko biloba should be avoid with Answer- antiplatelet and anticoagulant medications Downloaded at Knoowy - Upload your own study documents and earn money Supplement contraindicated when taking warfarin Answer- gingko biloba Anti-inflammatory and immune enhancing supplement with no known drug interactions Answer- Echinacea purpurea Another name for garlic Answer- Allium sativum Why should garlic be used cautiously with warfarin? Answer- anti-platelet effects Which SSRI has been associated with hyponatremia and SIADH, particularly in elderly females Answer- sertraline Appropriate ED treatment for panic disorder Answer- benzodiazepine Recurrent episodes with at least four of the following symptoms: --trembling, diaphoresis, nausea --CP/palpations/dyspnea/choking sensation --intense anxiety/fear of dying or losing control --derealization --depersonalization --dizziness --paresthesias --anxiety about additional attacks --avoidance behavior Answer- panic disorder First line tx of panic disorder Answer- SSRI (fluoxetine, paroxetine, sertraline) or SNRI (venlafaxine) MAO-B inhibitor with FDA indication for depression, Parkinson's disease and major depression Answer- selegiline pheochromocytoma Answer- a benign tumor of the adrenal medulla that causes the gland to produce excess epinephrine It is associated with episodes of tachycardia, HA, diaphoresis, and paroxysmal or sustained HTN SSRI-induced sexual dysfunction occurs in Answer- men mostly (tends not to dissipate with ongoing tx but does dissipate on dc tx) L-carnitine is effective in the treatment of methamphetamine toxicity via which mechanism Answer- preventing formation of free radicals and peroxynitrite in neurons decreases free radicals in the neuron needed to transport long-chain fatty acids into the mitochondria for fatty acid oxidation Downloaded at Knoowy - Upload your own study documents and earn money Which cytochrome P450 enzyme is predominantly present at but levels fall quickly and are undetectable in most adults? Answer- 3A7 Last P450 cytochrome to develop Answer- 1A2 P450 enzymes present in newborns at very low concentration but surge quickly to about 20-30% of adult values within the first week of life Answer- 3A4 2D6 2C9/19 Erythromycin the metabolism of drugs Answer- decreases (inhibits) sick-faces.com/g is a mnemonic to remember Answer- inhibitors list drugs on the sick-faces.com/g mnemonic of inhibitors Answer- sodium valproate isoniazid cimetidine ketoconazole fluconazole alcohol binge chloramphenicol erythromycin sulfonamides ciprofloxacin omeprazole metronidazole grapefruit juice smoking, griseofulvin and carbamazepine are all Answer- inducer What birth defect has been associated with lithium use in pregnancy (only psychoactive drug associated with this) Answer- Ebstein's anomaly PCOS is associate with use in pregnancy Answer- valproic acid Narcolepsy with cataplexy and excessive daytime sleepiness FDA approved treatment Answer- sodium oxybate (Xyrem) What antidepressants can reduce cataplexy attacks Answer- clomipramine fluoxetine duloxetine venlafaxine 1.5 meq/L Life-threatening toxicity of Lithium occurs at Answer- >2.0 meq/L At Lithium level of seizures, coma, arrhythmias, and permanent neurological impairment may occur Answer- >2.5 meq/L In acute toxicities with lithium levels >4.0 meq/L is the only way to get lithium out of the bloodstream Answer- hemodialysis Medications associated with higher level of Lithium Answer- diuretics ACE NSAIDs COX-2 inhibitors Lifestyle risk factors for elevated Lithium level Answer- Salt-restricting diets dehydration high heat poor PO intake Lithium levels should be checked after an increase or any time prior to an increase Answer- 5 days (sooner in acute mania) Target level for Lithium in tx of mania Answer- 0.8-1.0 meq/L Fewer lithium side effects (but more manic episodes) are seen in this level Answer- 0.4- 0.6meq/L In stable patients on chronic lithium treatment, levels should be drawn every and renal/thryoid function every Answer- 6 months 6-12 months When taking lithium, renal function should be evaluated every months during the first 6 months of treatment Answer- 2-3 months Downloaded at Knoowy - Upload your own study documents and earn money Sexual side effects from antipsychotics are due to Answer- alpha-2 receptors Long term effects of typical antipsychotics Answer- weight gain photosensitivity sexual side effects hyperprolactinemia TD is associated with all and occurs at a rate of approximately per year Answer- typical antipsychotics 5% Whta is the most effective treatment for major depression? Answer- ECT Valproate competes with lamotrigine at Answer- glucuronidation site 2B7 Anything that blocks either or will increase lamotrigine levels Answer- (UGT) 1A4 or 2B7 Depakote competes with lamotrigine at Answer- glucuronidation site 2B7 Tamoxifen (Novadex) competes with lamotrigine at Answer- glucuronidation site 1A4 Imipramine competes with lamotrigine at Answer- glucuronidation site 1A4 Amitriptyline (Elavil) competes with lamotrigine at Answer- glucuronidation site 1A4 Doxepin competes with lamotrigine at Answer- glucuronidation site 1A4 Nicotine competes with lamotrigine at Answer- glucuronidation site 1A4 Olanzapine competes with lamotrigine at Answer- glucuronidation site 1A4 Promethazine (Phenergen) competes with lamotrigine at Answer- glucuronidation site 1A4 Meperidine (Demerol) competes with lamotrigine at Answer- glucuronidation site 1A4 Downloaded at Knoowy - Upload your own study documents and earn money Clozapine (Clozaril) competes with lamotrigine at Answer- glucuronidation site 1A4 Clorpromazine (Thorazine) competes with lamotrigine at Answer- glucuronidation site 1A4 Androsterone and Testosterone competes with lamotrigine at Answer- glucuronidation site 1A4 Progestins (progesterone) competes with lamotrigine at Answer- glucuronidation site 1A4 Diphenhydramine (Benadryl) competes with lamotrigine at Answer- glucuronidation site 1A4 Asenapine (Saphris) competes with lamotrigine at Answer- glucuronidation site 1A4 Atorvastatin (Lipitor) competes with lamotrigine at Answer- glucuronidation site 2B7 buprenorphine/naloxone competes with lamotrigine at Answer- glucuronidation site 2B7 Ibuprofen (Advil, Motrin) competes with lamotrigine at Answer- glucuronidation site 2B7 Fenofibrate (Tricor) competes with lamotrigine at Answer- glucuronidation site 2B7 Oxycodone/APAP (Percocet) competes with lamotrigine at Answer- glucuronidation site 2B7 Hydromorphone (Dilaudid) competes with lamotrigine at Answer- glucuronidation site 2B7 Methadone competes with lamotrigine at Answer- glucuronidation site (2B7) Tacrolimus (Prograf) competes with lamotrigine at Answer- glucuronidation site 2B7 Codeine competes with lamotrigine at Answer- glucuronidation site 2B7 Downloaded at Knoowy - Upload your own study documents and earn money Temazepam (Restoril) competes with lamotrigine at Answer- glucuronidation site 2B7 Valproic Acid (Depakote) competes with lamotrigine at Answer- glucuronidation site 2B7 Simvastatin (Zocor) competes with lamotrigine at Answer- glucuronidation site 2B7 carvediolol (Coreg) competes with lamotrigine at Answer- glucuronidation site 2B7 Cyclosporine competes with lamotrigine at Answer- glucuronidation site 2B7 Lorazepam (Ativan) competes with lamotrigine at Answer- glucuronidation site 2B7 Oxazepam (Serax) competes with lamotrigine at Answer- glucuronidation site 2B7 Benzodiazepines that undergo glucuronide conjugation 2B7 (not via the cytochrome p450 system) Answer- Oxazepam Temazepam Lorazepam (OTL mnemonic: Outside The Liver). What drug has been associated with insulin-like effect responsible for lowering blood glucose and increasing appetite and weight gain? Answer- Lithium What drug has been associated with myocarditis? Answer- Clozapine What drug has been associated with eosinophilic colitis Answer- Clozapine In studies, which ECT modality reduces cognitive side effects but is less effective in terms of symptom reduction? Answer- unilateral non dominant A patient discharged on valproate has been stable for many years on lamotrigine, and you would like to initiate therapy with this medication and reach a therapeutic level before tapering off the valproate. What would be the starting dose of lamotrigine? Answer- Half of what it would normally be since half life effect is doubled Between olanzapine, clozapine, quetiapine, and haldol, which is least associated with sedation? Answer- Haldol 3 antipsychotics with high anticholinergic effects Answer- clozapine Downloaded at Knoowy - Upload your own study documents and earn money thioridazine chlorpromazine 4 antipsychotics associated with high sedation Answer- clozapine quetiapine thioridazine chlorpromazine Olanzapine is associated with sedation Answer- mild What antipsychotic is not associated with EPS? Answer- Clozapine Risperidone is anticholinergic, sedation EPS Answer- low low low Haloperidol is anticholinergic, sedation, EPS Answer- low low high Thiroidazine is anticholinergic, sedation, EPS Answer- high high low Chorpromazine (Thorazine) is anticholinergic, sedation ) EPS Answer- high high low Quetiapine is anticholinergic, sedation, EPS Answer- low high low Olanzapine (Zyprexa) is anticholinergic, sedation, EPS Answer- low mid low Ziprasidone (Geodon) is anticholinergic, sedation, EPS Answer- low low low Aripiprazole (Abilify) is anticholinergic, sedation, EPS Answer- low low Downloaded at Knoowy - Upload your own study documents and earn money low Another name for Abilify Answer- Aripiprazole Another name for Aripiprazole Answer- Abilify Another name for Clozapine Answer- Clozaril Another name for Clozaril Answer- Clozapine Another name for Seroquel Answer- Quetiapine Another name for Quetiapine Answer- Seroquel Another name for Invega Answer- Paliperidone Another name for Paliperidone Answer- Invega Another name for Thioridazine Answer- Mellaril Another name for Mellaril Answer- Thioridazine Another name for Clorpromazine Answer- Thorazine Another name for Thorazine Answer- Clorpromazine Another name for Tegretol Answer- Carbamazepine Another name for Valproate Answer- Depakote Another name for Depakote Answer- Valproate Sodium Valproic Acid Divalproex Sodium Another name for Valproic Acid Answer- Valproate Sodium Depakote Divalproex Sodium Another name for Oxcarbazepine Answer- Trileptal Another name for Trileptal Answer- Oxcarbazepine Another name for Luvox Answer- Fluvoxamine Another name for Fluvoxamine Answer- Luvox Downloaded at Knoowy - Upload your own study documents and earn money Another name for Prozac Answer- Fluoxetine Another name for Fluoxetine Answer- Prozac Another name for Sertaline Answer- Zoloft Another name for Zoloft Answer- Sertraline Another name for Paroxetine Answer- Paxil Another name for Paxil Answer- Paroxetine Another name for Lexapro Answer- Escitalopram Another name for Citalopram Answer- Celexa Another name for Celexa Answer- Citalopram Another name for Escitalopram Answer- Lexapro Another name for Cymbalta Answer- Duloxetine Another name for Duloxetine Answer- Cymbalta Another name for Effexor Answer- Venlafaxine Another name for Venlafaxine Answer- Effexor Another name for Pristiq Answer- Desvenlafaxine Another name for Desvenlafaxine Answer- Pristiq Pt's meds include lisinopril, atorvastatin, bupropion, ibuprofen. Which medication is responsible for his insomnia? Answer- Bupropion Bupropion is also known as Answer- Wellbutrin Wellbutrin is also known as Answer- Bupropion What SSRI is known to cause activation and insomnia Answer- Fluoxetine There are no for ECT Answer- ABSOLUTE contraindications Space-occupying intercerebrayl lesion has traditionally been considered a Answer- contraindication of ECT since ECT increases intracerebral pressure, however Downloaded at Knoowy - Upload your own study documents and earn money slow growing meningiomas without mass effect and other similar lesions do not present a high risk While caution needs to be applied weighing risks and benefits, ECT has been safely administered (after appropriate subspecialty consultation) to pts with a hx of Answer- brain surgery deep brain stimulators cardiac pacemakers AICD vagus nerve stimulator seizures space occupying intracerebral lesions ADHD patients may have side effects from stimulants that represent Answer- manifestation or exacerbation of comorbid disorder (ie GAD) Side effect of treatment Antihistamine is used to increase appetite Answer- Cyproheptadine Medications to treat sleep problems associated with stimulant use Answer- Melatonin Clonidine Diphenhydramine Trazodone Mirtazapine Hyperparathyroidism is associated with which medication Answer- Lithium hyperparathyroidism Answer- excessive levels of parathyroid hormone Ketoconazole is of the enzyme Answer- inhibitor 3A4 Cannabinoids is a of the enzyme Answer- inhibitor 3A4 Phenytoin, Carbamazepine, and St John's wort have this in common Answer- 3A4 inducer Ketoconazole, amiodarone, and erythromycin have this in common Answer- 3A4 inhibitor Regarding ECT treatment for depression in adolescents, which of the following statements is correct Answer- response to ECT is similar in adolescents and adults Downloaded at Knoowy - Upload your own study documents and earn money Before ECT is used on an adolescent Answer- 2 child and adolescent psychiatrists who are not the primary caregivers for the adolescent should be consulted and agree that it is indicated Which antidepressant is least likely to cause significant drug-drug interactions in the elderly Answer- Venlafaxine (most SSRIs cause some inhibition of the 2D6 enzyme which leads to increased plasma level of other drugs (ie antiarrhythmics, benztropine, TCA, many antipsychotics) A 26 year old F with dx of bipolar on lithium presents to ED with marked tremor, ataxia, and confusion after a suspected suicide attempt less than an hour before admission. Her lithium level is 2.1. Over the next half hour, the pt becomes increasingly confused and then unresponsive, what is the next step in management? Answer- Alert nephrology for emergent hemodialysis Which medication has been helpful in women with stress incontinence Answer- Duloxetine Another name for Lurasidone Answer- Latuda Another name for Latuda Answer- Lurasidone Indicated for bipolar depression Answer- Latuda (Lurasidone) What medication given in combination with Latuda may cause orthostatic hypotension Answer- beta blocker Which substance or technique was first used to induce convulsion to treat psychiatric illness and catatonia Answer- Camphor What medication when given with SSRI is most likely to predispose patients to serotonin syndrome Answer- Meperidine (Demerol) Valproic acid is superior to lithium in patients with Answer- mixed symptoms prominent depressive symptoms during mania multiple prior mood episodes is more effective than Valproic acid in reducing symptoms of acute mania Answer- Olanzapine Valproic acid and are equally efficacious in the treatment of acute mania Answer- haldol (response rate 48-53%) Divalproex sodium is also known as Answer- Depakote Valproic acid Valproate Sodium Downloaded at Knoowy - Upload your own study documents and earn money Max dose of Divalproex Sodium Answer- 60mg/kg/day Depakote is also known as Answer- Divalproex Sodium Valproic Acid Volproate Sodium Carbamazepine may the effectiveness of Risperidone Answer- Decrease Carbamazepine is metabolized in the by substrate Answer- liver 3A4 requires monitoring for signs of bruising and bleeding Answer- Carbamazepine What medication causes metabolic acidosis via carbonic anhydrase inhibition? Answer- Topiramate What does metabolic acidosis via carbonic anhydrase inhibition initiate? Answer- kidney stone formation Carbamazepine acts as a CYP 450 3A4 , the effectiveness of other CYP 3A4 substrates Answer- inducer lowering What anti-epileptic medication causes bone marrow suppression, resulting in agranulocytosis and leukopenia Answer- Carbamazepine (Tegretol) What antidepressant should be used in caution with a patient taking a protease inhibitor (ritonavir, saquinavir) because of toxic interaction Answer- Nefazodone Nefazodone is also know as Answer- Serzone Serzone is also known as Answer- Nefazodone Trazodone is also known as Answer- Desyrel Desyrel is also known as Answer- Trazodone Nefazodone and Trazodone are both blockers Answer- 5-HT2a Nefazodone and Trazodone side effects Answer- sedation, GI distress, postural hypotension (alpha block), trazaBONE-sexual side effects Which drugs is only an antiepileptic (not used as a mood stabilizer)? Answer- Levetiracetam Downloaded at Knoowy - Upload your own study documents and earn money What is the minimum amount of time to continue maintenance ECT treatment to achieve the best outcome after pt has discharged. He responded to 3 administrations of ECT? Answer- 6 months 3 specific indications for continuation ECT are Answer- 1. hx of recurrent episodes responsive to ECT AND 2. ineffectiveness of or intolerance to prophylactic pharmacotherapy OR 3. patient preference Average duration of continuation ECT Answer- 10 weeks Continuation ECT following successful ECT typically involves gradual shifting from Answer- frequent weekly to monthly treatments over 1-3 months and then maintaining the monthly administration schedule for at least 6 months after remission Long term use of continuation maintenance ECT is indicated when Answer- pt hx suggest high risk of delayed relapse on medication alone or evidence of decompensation occurs during attempts to stretch interval between treatments during the continuation phases When someone is on continuation maintenance ECT, the need should be reviewed by practitioner and patient at least Answer- twice a year Consent for continuation maintenance ECT should be reobtained at least every Answer- 6 months What needs to be reevaluated every 6 months with continuation maintenance ECT Answer- need/indication anesthetic/medical complications cognitive tests (presence of persistent memory deficits weighed against anticipated benefits) Even in patients who do not have a hx of diabetes, a possible side effect of olanzapine Answer- Diabetic ketoacidosis Hyperosmolar nonketotic coma What is considered a side effect of antipsychotics and is treated by beta blockers (propranolol) Answer- Akathisia Nefazodone is a potent of CYP 450 Answer- inhibitor Downloaded at Knoowy - Upload your own study documents and earn money Medication can be used as an antidote to SSRI induced impotence Answer- Nefazodone Unlike other antidepressants, this medication enhances rapid eye movement (REM) and may increase restful sleep in some patients Answer- Nefazodone This antidepressant medication is not usually given first line for depression or at all anymore due to risk of liver failure (need to do liver function tests) Answer- Nefazodone Haldol should be avoided in Answer- pregnant women (d/t risk for birth defects) Common reasons for inadequate response to antidepressants include Answer- inadequate dosing pt non-compliance misdiagnosis substance abuse (especially ETOH) Dc medications too quickly/early Young female brought to ED after being found in coma next to empty bottle of Vicodin. She is unresponsive. Medication that is indicated in management Answer- Naloxone Naloxone is also called Answer- Narcan Narcan is also called Answer- Nalaxone Flumazenil is also called Answer- Romazicon Naltrexone is also called Answer- ReVia Which MAOI antidepressant has the lowest incidence of sexual dysfunction? Answer- Tranylcypromine Which MAOIs have a high incidence of sexual dysfunction Answer- Isocarboxazid Phenelzine Tranylcypromine is also known as Answer- Parnate (MAOI) Isocarboxazid is also known as Answer- Marplan (MAOI) Phenelzine is also known as Answer- Nardil (MAOI) The 2015 Beers criteria contains a strong recommendation against using SSRI in combination with other in older adults based on moderate evidence for Answer- CNS acting medications increased fall and fx risk Downloaded at Knoowy - Upload your own study documents and earn money Memantine is also known as Answer- Namenda Memantine mechanism of action Answer- NMDA receptor antagonist Potent allosteric potentiating ligand of human nicotinic acetylcholine receptors Answer- Galantamine Galantamine is also known as Answer- Razadyne an acetylcholinesterase inhibitor that inhibits both butyrlcholinesterase and acetylcholinesterase Answer- Rivastigmine Selectively inhibits acetylcholinesterase unlike Rivastigmine Answer- Donepezil Donepezil is also known as Answer- Aricept Precursor to the neurotransmitters dopamine, norepinephrine and epinephrine (collectively known as catecholamines) Answer- L-DOPA 2 typical antiparkinsonian drugs that are ineffective in the tx of antipsychotic-induced Parkinsonism Answer- Levodopa Selegiline antipsychotic-induced Parkinsonism medication that works for tx, but its effects tend to wear off Answer- Amantadine Lithium is associated with risk of Ebstein's anomaly which is malformation of which structure Answer- Tricuspid valve What is true regarding methylphenidate and amphetamine? Answer- Both stimulants increase intrasynaptic levels of NE and Dopamine Through which receptor dose mirtazapine exert its effect Answer- Alpha-2 adrenergic antagonism. What do oral contraceptives, reserpine, clonidine, ETOH, hydralazine, amantadine, benzodiazepines, and guanethidine have in common Answer- can cause depression Reserpine (Serpasil) Answer- peripherally-acting sympathetic antagonist used for HTN; depletes stores of catecholamines in neurons; decreases TPR and CO Guanethidine (Ismelin) Answer- adrenergic neuron blocker can cause depression Loxapine (Loxitane) Answer- typical tetracyclic antipsychotic with antidepressant properties Downloaded at Knoowy - Upload your own study documents and earn money It's active metabolite is amoxapine which is a secondary amine tricyclic antidepressant Answer- Loxapine (Loxitane) Patients with atypical depression respond particularly well to this MAOI Answer- Phenelzine (Nardil) What is the most appropriate medication for melancholic depression in the geriatric population? Answer- Nortriptyline Nortriptyline is also called Answer- Pamelor Which of the following is the safest short acting barbiturate that can be used as an induction for anesthesia? Answer- Sodium thiopental What medication should be avoided in patient with hx of epilepsy and hyperlipidemia who wants to quit tobacco use? Answer- Bupropion What is the best medication option for pt who wants to quit tobacco use who has a hx or seizures Answer- Varenicline can be combined with NRT Nephrolithiasis occurs in about of topiramate pts Answer- 15% Associated with acute myopia and secondary closure glaucoma, causing ocular pain and blurred vision d/t increased intraocular pressure Answer- Topiramate Metabolic acidosis is associated with , levels should be monitored during use Answer- topiramate serum bicarbonate These side effects do not improve over time with topiramate use Answer- Decreased appetite paresthesias cognitive slowing Weight loss is a significant side effect of Answer- topiramax Placing electromagnetic coil on scalp and running electricity through it Answer- TMS When was ECT first used in the US Answer- 1940s Which TCA has been found in considerably higher concentration in breast milk compared to other medications in the same class? Answer- Doxepin Doxepin is also known as Answer- Sinequan (TCA) Downloaded at Knoowy - Upload your own study documents and earn money Inhibits voltage-dependent sodium channels and presynaptic sodium channels Answer- Carbamazepine (Tegretol) Increases GABA in brain Answer- Depakote Inhibits glutamate releases Answer- Carbamazepine Inhibits sodium channels, enhances GABA-a receptors, and antagonizes kainite at AMPA receptors Answer- Topiramate Duloxetine should not be given to patients who Answer- consume large amounts of alcohol or have chronic liver disease Duloxetine has a half-life than venlafaxine Answer- Longer (dc syndrome less likely) Duloxetine increases this enzyme Answer- hepatic transaminases What do charcoal broiled beef, tobacco, marijuana, modafinil, omeprazole and cruciferous vegetables have in common? Answer- 1A2 inducer What do caffeine, clozapine, duloxetine, imipramine, olanzapine, ramelteon and amitriptyline have in common? Answer- 1A2 substrate What do fluvoxamine, cimetidine, ciprofloxacin, grapefruit juice, ketoconazole have in common Answer- 1A2 inhibitors Which pair is least likely to cause weight gain? Answer- Lamotrigine and topiramate Which pair of antipsychotics is most likely to cause weight gain Answer- Clozapine and olanzapine Which pair of mood stabilizers is most likely to cause weight gain? Answer- Valproic acid and lithium Drugs that can induce mania Answer- stimulants bromides cocaine antidepressants isoniazid procarbazine steroid amphetamines Medical conditions that can cause mania Answer- syphilis Downloaded at Knoowy - Upload your own study documents and earn money brain tumors influenza Q fever multiple sclerosis delirium Which of the following symptoms characterizes the toxicity of clomipramine Answer- Convulsions and coma Mechanism of action of Clomipramine Answer- blocks reuptake of NE and 5-HT (TCA) Patients require weekly for the first months if they are using clozapine to monitor Answer- CBC with a differential 6 ANC for agranulocytosis When starting clozapine, CMP, Fasting lipid and fasting glucose should be monitored at some point within the first of treatment to screen for metabolic syndrome, then if check does not demonstrate sx of metabolic syndrome, screening can be done Answer- 3 months annually Which medication side effect is NOT associated with lithium or valproic acid Answer- eosinophilic colitis Pancreatitis is a rare but potentially deadly side effect of Answer- valproic acid Hepatic failure is associated with Answer- valproic acid hyperparathyroidism and hyperglycemia have been associated with Answer- Lithium Hyperplasia and ademomas of parathyroid glands have been associated with Answer- Lithium Mechanism of action of varenicline Answer- partial agonist of alpha4beta2 and full agonist of alpha7 mechanism of action of bupropion (Zyban) that helps with smoking cessation Answer- partial agonist of alpha4beta2 and partial agonist of alpha7 mechanism of action of NRT that helps with smoking cessation Answer- Full agonist at alpha4beta2 and full agonist at alpha7 Neuroleptics and antiemetic drugs such as metoclopramide are dopamine Answer- receptor antagonists Downloaded at Knoowy - Upload your own study documents and earn money Rifampicin is an of CYP Answer- inducer 2D6 Clozapine leads to seizures in of patients taking >=6--mg Answer- 4% is most likely to cause seizures among typical antipsychotics Answer- Chlorpromazine Which drug is effective in improving sexual dysfunction in men but when given with an antidepressant to counter its adverse sexual effects can be counterproductive because it is actually anxiogenic? Answer- Yohimbine Can help reverse some sexual dysfunction caused by SSRIs at 4-12mg/day, but also can reverses the antidepressant or anti-obsessive effects of SSRIs Answer- Cyproheptadine The use of has been more effective than placebo in men with SSRI-induced sexual dysfunction Answer- Sildenafil (Viagara) Has been reported to increase overall sexual satisfaction in both men and women Answer- Sildenafil (Viagara) Valproic acid is a CYP450 Answer- inhibitor What is NOT true regarding typical antipsychotic overdose Answer- Dialysis is useful in treating it. (It is often lethal due to significant cardiovascular effects) What seizure medications are considered safe for use in breastfeeding mothers Answer- Carbamazepine (Tegretol) Valproic Acid (Depakote) Phenytoin (Dilantin) Phenobarbital Primidone (Mysoline) If > %of the body surface area is involved it is termed Toxic Epidermal Necrolysis Answer- >30 In it involves % of the skin surface area it is known as Steven-Johnson Syndrome (SJS) Answer- 50 different CYP450 enzymes enzymes metabolize approximately of all medications Answer- 6 90% Enzyme inhibition is a process than enzyme induction Answer- faster Enzyme induction generally occurs over the course of Answer- 1-2 weeks Downloaded at Knoowy - Upload your own study documents and earn money Who exhibits enzyme inhibition Answer- premature infants elderly men and women patients with liver disease What medication is a tetracyclic antidepressant Answer- mirtazapine OD of this medication presents as dizziness, ataxia, ophthalmoplegia, hyponatremia, and thrombocytopenia Answer- Carbamazepine Drugs tend to be absorbed more slowly when a patient has a full stomach. Which medication should be taken on an empty stomach? Answer- Sedatives/hypnotics What is the difference in side effects between SNRIs and SSRIs Answer- SNRIs may cause HTN SSRIs cause more wt gain, especially paroxetine SNRIs cause less sexual dysfunction when compared to SSRIs Withdrawal tends to be worse with SNRIs Which of the following is a three question screening tool used for dx of ETOH abuse and dependence in pt who is acutely ill or otherwise poorly disposed to speak with the practitioner? Answer- AUDIT-C AUDIT has multiple choice questions regarding the and is the for screening for identification of Answer- 10 quantity and frequency of alcohol consumption, drinking behavior and alcohol related problems Gold standard Alcohol Use Disorders CAGE is a item screening took with a sensitivity and specificity for AUD Answer- 4 50-75% 80% C in CAGE Answer- Have you ever felt you should Cut down on your drinking? A in CAGE Answer- Have people ANNOYED you by criticizing your drinking? G in CAGE Answer- Have you ever felt bad or guilty about your drinking? E in CAGE Answer- Have you ever had a morning eye-opener MAST stands for Answer- Michigan Alcohol Screening Test MAST has screening questions with _ answers Answer- 25 yes/no Downloaded at Knoowy - Upload your own study documents and earn money On administration of a drug that causes CYP2D6 inhibition, which side effect of methylphenidate will increase? Answer- none because it does not have any significant metabolism via that enzyme and the majority of metabolism occurs at first pass and outside the liver Due to a high risk for dependence, for which hypnotic must a test dose be given if a pt's dose is not known Answer- Barbiturates If a pt is given too large of a dose of Barbituates, this will happen Answer- nystagmus slurred speech ataxia sedation What change in the dose-response curve is observed when a pt becomes tolerant of a medication Answer- shift to right Buspirone primarily acts on which receptor Answer- 5-HT1A Which medications (not yet FDA approved) can be used to treat kleptomania? Answer- Fluoxetine Naltrexone Which of the following is characteristic of fetal phenytoin syndrome Answer- Hypertelorism Hypertelorism Answer- eyes spaced widely apart fetal valproate syndrome features Answer- bifrontal narrowing midface hypoplasia broad nasal bridge short nose with anteverted nares epicanthic folds micrognathia shallow philtrum thin upper lip thick lower lip NSAID Lithium clearance and can cause side effects such as Answer- decrease tremor What antidepressant is associated with significant sexual side effects and weight gain Answer- Phenelzine Downloaded at Knoowy - Upload your own study documents and earn money Some patients on chronic lithium treatment may have gradually Answer- increased creatinine Development of hypothyroidism that is not responsive to thyroxine constitutes a valid reason to consider Answer- discontinuation of lithium ECG effects common in LIthium Answer- changes in depolarization phase worsening existing arrhythmias With most modern devices, the dosage of ECT is changed by varying which aspect Answer- time of exposure to fixed current When drug is quickly metabolized to inactive metabolites, which of the following statements may be true of this patient Answer- She is a poor metabolizer Donazepil is believed to improve Answer- memory in neurocognitive disorder by increasing the amount of acetylcholine available in the synaptic cleft by inhibiting its breakdown by acetylcholinesterase. This inhibition is reversible. Barbituates plasma TCA, the antidepressant effects because of their induction of and accelerated Answer- lower diminishes liver microsomal enzymes degradation of the TCA Barbiturates act on receptors Answer- GABA For gastrointestinal issues associated with Lithium use Answer- change to longer-acting oral preparation or use lithium citrate syrup For lithium associated edema Answer- administer spironolactone (25mg/day) and follow lithium levels closely For lithium tremor Answer- administer propranolol (10-30mg TID) or primidone (25- 100mg/day) as second-line For lithium hypothyroidism treat with Answer- thyroid hormone and continue lithium therapy When in the body is melatonin made Answer- Pineal gland (Serotonin derivative) Hormones hypothalamus makes Answer- TRH (thyrotropin releasing hormone) dopamine GHRH (growth hormone releasing hormone) SS (somatostatin) GnRH (gonadotropin releasing hormone) Downloaded at Knoowy - Upload your own study documents and earn money CRH (corticotropin releasing hormone) oxytocin vasopressin (ADH) The posterior pituitary stores and releases Answer- oxytocin and vasopressin (ADH) The anterior pituitary makes Answer- ACTH TSH FSH LH GH prolactin What pharmacological treatment is clinically supported for treating kleptomania Answer- Lithium Which of the following medication has the least effect on the CYP-450 system: carbamazepine, valproate, levetiracetam, phenytoin, Lamictal Answer- Levetiracetam Which of the following hypnotic agents is preferred for the elderly Answer- Ramelteon What is the rate of malformation among fetuses exposed to SSRI medications Answer- 2.6% (consistent with reports in general population) Studies suggest that TMS may be most useful for which symptom in schizophrenia? Answer- Hallucinations Second generation drugs are more effective for treating in schizophernia Answer- negative symptoms Used for aggression and impulsivity in schizophrenics Answer- Beta blockers Lithium ECT is most often used for in schizophrenia Answer- catatonia TMS is effective for in OCD Answer- impulsivity Second generation antipsychotic with high D2 blocking/binding Answer- Risperidol Second generation antipsychotic with lower D2 blocking/binding Answer- Clozapine Quetiapine Blockade of or more of the D2 receptors is associated with increased EPS Answer- 80% Lower D2 blockade of % is safer and still clinically effective Answer- 60-70% Downloaded at Knoowy - Upload your own study documents and earn money Bupropion is an NDRI that should be avoided in patients with Answer- anorexia nervosa hx of seizures heavy alcohol use Clomipramine is a TCA that the seizure threshold Answer- lowers What can cause phalangeal hypoplasia in 2.5kg baby girl whose mom has a past medical history of epilepsy Answer- Phenytoin Short limbs and phalangeal hypoplasia Answer- teratogenicity caused by phenytoin Higher doses of are recommended for women taking anti-epileptics such as phenytoin or valprate Answer- folate These medication are excreted unchanged in urine Answer- Desvenlafaxine Milnacipram Venlafaxine and desvenlafaxine are % protein-bound Answer- 27% Which potential neonatal risk is associated with continuing antidepressants during pregnancy Answer- discontinuation syndrome (seen in higher rates with paroxetine) Only medication approved by FDA for the treatment of bulimia nervosa Answer- Fluoxetine Infantile anorexia interferes with which important developmental event Answer- somatopsychological differentiation When an infant's feeding is directed by his or her emotional needs instead of physiological sensation of hunger and satiety, he or she fails to develop Answer- somatopsychological differentiation the ability to differentiate sensations in the body (results in infant's emotional needs (affection, dependency, anger, and frustration) rather than hunger needs dictating behavior Answer- somatopsychological differentiation Posttraumatic feeding disorder (PTFD) usually has a onset after Answer- sudden choking or insertion of a gastric tube Which of the following is a behavioral therapy technique for anorexic or bulimic patients who binge and purge? Answer- Have a supervisor watch them for 2-3 hours after every meal because they rarely feel conf Downloaded at Knoowy - Upload your own study documents and earn money Studies suggest that family therapy is most helpful in which population of anorexia nervosa patients Answer- younger patients with shorter illness Anorexic pt asks for treatment for her severe constipation. What should be administered Answer- docusate An NP is interviewing a client who is incapacitated by a fear of public speaking who must give presentations as part of her job. Which non-pharmacological treatment is most likely to be effective to resolve this problem? Answer- Behavioral therapy (Systemic desensitization) systemic desensitization therapy is a a type of behavioral therapy is effective for eliminating ? Answer- phobias OCD anxiety disorder Systematic desensitization therapy consists of Answer- relaxation training hierarchical construction of situations in order of increasing anxiety desensitization of the stimulus Brief psychotherapy that focuses on resolving interpersonal problems Answer- interpersonal psychotherapy Interpersonal psychotherapy takes to complete Answer- 12-16 weeks Psychotherapy used for people struggling with longstanding difficulties in the way they think and feel about themselves, their environment, and other people Answer- psychoanalysis The principles that govern behavioral therapy are based on early studies of