Download Nurs 6630 Psychopharmacology Midterm Exam 2023 Latest Update Questions And Answers and more Exams Nursing in PDF only on Docsity!
• Nurs 6630 Psychopharmacology Midterm Exam 2023 Latest Update
Questions And Answers.
• Question 1
What is the strongest established risk factor for bipolar disorder? Family History Response Feedback: “The^ strongest^ established^ risk^ factor^ for^ BPD^ is^ a^ family^ history^ of^ BPD.”
- Question 2 Which of the following medications are known as selective serotonin re-uptake inhibitors (SSRIs)? i. Nortriptyline ii. Citalopram iii. Duloxetine iv. Fluoxetine v. Venlafaxine
- Question 3 Which disease state of a non-adherent patient is at greater risk for substance use, violence, and victimization as well as worse overall quality of life? Schizophrenia Response Feedback: “Moreover, non-adherent patients with schizophrenia are at greater risk for substance use, violence, and victimization as well as worse overall quality of life.”
- Qu est ion 4 old ma le wit h a pas t me dic al his tor y sig nifi can t for atri al fibr illa tio n an d CO PD wit h a ne w dia gn osi s of ma jor de pre ssi on disorder. Based on his comorbid conditions, what antidepressant would you recommend as first-line? Atomoxetine Response Feedback:
Which medication has been studied and recommended in patients with a social anxiety disorder who also suffer from an alcohol use disorder?
Response Feedback: “Suggested that treatment with the SSRI paroxetine decreased the anxiety and may have reduced the alcohol use as well”
- Question 11 M. B. was just diagnosed with Generalized Anxiety Disorder and pharmacotherapy is needed. Which of the following would be a first-line treatment option for M. B.? I. Duloxetine II. Quetiapine III. Diazepam IV. Escitalopram Response Feedback: “As is true for panic and the other anxiety disorders, the SSRIs and SNRIS are generally considered first-line agents for the treatment of GAD because of their favorable side effect profile….”
- Question 12 The serotonin system is involved in many processes in psychiatry, including, most prominently, mood, sleep, and psychosis. Of the following neurons listed, from where is serotonin synthesized? Response Feedback: under^ serotonin^ subheading^ and^ figure^ 1-18^ on^ page^ 16: Locus Coeruleus: Norepinephrine Nucleus basalis: cholinergic neurons Substantia Nigra: dopamine Ventral Tegmental area: dopamine
- Question 13 Which of the following symptoms is NOT part of the diagnostic features for bipolar disorder? Response Feedback: “Psychosis is not represented in the diagnostic features for BPD.” - “Psychosis typically resolves along with the mood symptoms, though diagnostic criteria acknowledge that psychotic symptoms may linger beyond the end of the episode.”
- Question 14 A 32-year-old males calls you complaining of decreased libido since starting Paroxetine 20 mg 2 weeks ago. He reported stopping the medication 1 day ago and is now experiencing extreme irritability and nervousness. He wishes to stop this medication due to side effects. What do you recommend? Response Feedback: under selective serotonin re-uptake inhibitors discontinuation syndrome subtitle: “The risk of such adverse events occurring seems to be inversely related to the half-life of the SSRI, with fluoxetine reported as having a significantly lower risk than paroxetine in two studies. For more severe
It is appropriate to start lamotrigine in combination with another atypical antipsychotic in treatment of an acute manic episode in bipolar disorder. Response Feedback: “Lamotrigine^ has^ also^ been^ extensively^ studied^ in^ bipolar^ depression^ as^ well….”
- Question 16 Which antiepileptic drugs should we avoid in pregnant women in the treatment of bipolar disorder? . Depakote i. Lamotrigine ii. Topiramate iii. Carbamazepine iv. Gabapentin Response Feedback: All the others listed except for lamotrigine are not used in treatment of bipolar disorder.
- Question 17 A 23-year-old female was just diagnosed with major depressive disorder and is being started on escitalopram 10 mg daily. The patient should be counseled about which Black Box warning? Response Feedback: “In 2004, the FDA asked manufacturers of almost all the new antidepressant drugs to include in their labeling a warning statement that recommends close observation of adult and pediatric patients treated with these drugs for worsening depression or the emergence of suicidality."
- Question 18 Which statement is TRUE regarding the use of selective serotonin reuptake inhibitors (SSRI)/serotonin- norepinephrine reuptake inhibitors (SNRI) in patients with Generalized Anxiety Disorder? Response Feedback: “Because the SSRI/SNRIs have the potential to cause initial restlessness, insomnia, and increased anxiety, and because the patients are commonly sensitive to somatic sensations, the starting doses should be low, typically half (or less) of the usual starting dose….”
- Question 19 Which of the following statements below is NOT considered an appropriate treatment strategy for treatment-resistant depression? Response Feedback: “Combination of an SSRI OR an SNRI with a norepinephrine- dopamine re-uptake inhibitor (bupropion) or a serotonin- norepinephrine antagonist (mirtazapine or mianserin) is a commonly used combination”
- Question 20 Which atypical antipsychotic(s) require a meal for better absorption? . Quetiapine
- Question 25 A 27-year-old female presents to your emergency room today with a rash that started about 1 week ago and has now spread to her whole body. She has a past medical history significant for type 2 diabetes,
hypertension, and bipolar disorder. The patient reports, “The only thing that is different is that I’ve been on this new medication for my bipolar for a few weeks.” Of the following medications, which one is likely to be causing this severe rash?
- Question 26 Glia cells play a supportive role in the neuron. A few of the functions of the glial cells include providing nutrition, maintaining homeostasis, stabilizing synapses, and myelinating axons. The glial cells are categorized as microglia or macroglia. Of the macroglia cells, which one plays a role in myelinating axons, which may contribute to mood disorders if altered?
- Question 27 Which of the following medications used for treatment of bipolar disorder may increase stroke risk among older patients, particularly those with dementia? Response Feedback: “Notably, pharmacovigilance studies suggest that atypical antipsychotics may increase stroke risk among older patients, particularly those with dementia, so use of SGA requires more caution in this group.”
- Question 28 Which of the following receptors below would likely result in extra-pyramidal symptoms, tardive dyskinesia, and hyperprolactinemia? Response Feedback: first generation antipsychotics all share the common property of D blockade, which can produce EPS, TD, and hyperprolactinemia
- Question 29 Which anticonvulsant below induces its own metabolism over time?
- Question 30 K. B. is a 28-year-old male who was started on Venlafaxine 75 mg about 2 weeks ago and is now calling you asking how long it should take for this medication to begin to work. He is concerned his girlfriend will leave him if he doesn’t get better quickly. What is the appropriate amount of time to allot to see a therapeutic response? Response Feedback: “It has been consistently observed and reported that remission of depression often requires 4 weeks of treatment or more;” Page 33: “Use of antidepressant for at least 6– 12 weeks to determine whether it is helping or not”
- Question 31 Selection of an antipsychotic agent is usually guided by the side-effect profile and by available formulations.
II. Skills III. Logistics
- Question 36 Of the following medications, which ones are considered first-line in treatment of an acute manic episode of bipolar disorder (assuming monotherapy)? . Lithium
I. Fluoxetine II. Aripiprazole III. Risperidone IV. Ziprasidone V. Venlafaxine VI. Quetiapine VII. Valproa te V
- Question 37 Which drug below has an interaction with cigarette smoking and should be adjusted based on patient’s tobacco use/non-use? Response Feedback: “Clozapine blood levels are significantly lowered by cigarette smoking and by other hepatic enzyme-inducers.”
- Question 38 In order for the NMDA receptor to fully open and allow an influx of calcium, both glutamate and glycine must bind to cause a depolarization of the cell that will ultimately displace which ion? Is the NMDA receptor an ionotropic or metabotropic receptor?
- Question 39 When initiating lithium, how long should you wait before checking a lithium level? What is the therapeutic goal level of lithium?
- Question 40 Choose the appropriate pair regarding acetylcholine receptors. Response Feedback: “There are two classes of ACh receptors: muscarinic and nicotinic. While muscarinic receptors are G-protein-coupled, nicotinic receptors are ion channels, which allows for rapid influx of NA+ and Ca2+ into the post- synaptic neuron.”
- Question 41 Patient is a 59-year-old male with a past medical history significant for bipolar disorder I, hypertension, and COPD. He calls your clinic today complaining of extreme fatigue and a new tremor in his hand. He reports starting lithium 600 mg at bedtime about 5 days ago and thinks that may be the cause. What is the appropriate next step for this patient? Response Feedback: “Other bothersome adverse effects” Patient is likely experiencing lithium toxicity and labs should be verified first before continuing with other treatments for the tremor.
Response Feedback: Carbamazepine induced metabolism of lamotrigine – increase dose of lamotrigine; Valproate may inhibit clearance of lamotrigine, so dose reduction of lamotrigine is needed
- Question 43 Choose the correct option regarding the major classes of GABA receptors and the ions involved in inhibition of the neurotransmitter pathway Response Feedback: “GABAB receptors, akin to the metabotropic glutamate receptors, are G- protein-coupled receptors rather than ion channels. Activation of GABAB causes downstream changes in potassium (K+) and Ca+2 channels, largely via G-protein-mediated inhiation of cAMP.”
- Question 44 A 25-year-old female comes into your clinic today informing you she is ready to have a baby and wishes to discontinue her birth control at this time. After reviewing her chart, you notice she has a history of bipolar disorder and was previously prescribed valproic acid by another doctor. What is your concern with this medication in this specific patient? Response Feedback: “Valproic acid may produce teratogenic effects.”
- Question 45 How do you manage a patient who develops neuroleptic malignant syndrome while on an atypical antipsychotic?
- Question 46 The following patient case is considered an example of treatment-resistant depression. B. B. is a 26-year old-female at your clinic today with the diagnosis, “treatment-resistant depression.” She is currently on Bupropion 300 mg daily and has been at this dose for 6 weeks with no alleviation in depressive symptoms. She has trialed the following medications in the past with treatment duration listed:
- Paroxetine 40 mg daily for 4 weeks
- Citalopram 20 mg daily for 2 weeks Response Feedback: “At least one trial with an antidepressant with established efficacy in MDD (with sufficient duration and doses) is considered to be adequate antidepressant treatment.”
- Question 47 What is the therapeutic plasma level of carbamazepine?
A. Female^ >^ Male B. Family^ history^ of^ bipolar^ disorder C. Male^ >^ female D. Being^ diagnosed^ with^ Major^ Depressive^ Disorder Which of the following medications are known as selective serotonin re-uptake inhibitors (SSRIs)? i. Nortriptyline ii. Citalopram iii. Duloxetine iv. Fluoxetine v. Venlafaxine A. i, iii, and v only B. iii and v only C. i only non-adherent patient is at greater risk for substance use, violence, and victimization quality of life? Parkinson’s Disease Multiple Sclerosis Schizophrenia Major depressive disorder Patient is a 72-year-old male with a past medical history significant for atrial fibrillation and COPD with a new diagnosis of major depression disorder. Based on his comorbid conditions, what antidepressant would you recommend as first-line? A. Fluoxetine as ll as worse overall we E. i, ii, iii, iv, and v Whic h disease state of a D. ii and iv only My answers to some of the questions – Some Right some wrong What is the strongest established risk factor for bipolar disorder?
With second-generation antipsychotics, what is the main side effect that requires frequent monitoring? Which of the following medications is best to AVOID in maintenance treatment of bipolar disorder and why? Which of the following is an appropriate strategy for managing treatment-resistant depression? Patient is a 72-year-old male with a past medical history significant for atrial fibrillation and COPD with a new diagnosis of major depression disorder. Based on his comorbid conditions, what antidepressant would you recommend as first-line? A. Fluoxetine Atomoxetine Nortriptyline Imipramine Metabolic Syndrome Extra-pyramidal symptoms Parkinsonism Dystonia Valproate, because it is only used in the treatment of acute manic episodes. Lithium, because it is only used in the treatment of acute manic episodes. Venlafaxine, because it can possibly increase frequency of mood episodes. Lamotrigine, because it is only used in initial treatment of bipolar depression, but not maintenance. Switch from one SSRI to another SSRI Switch from one SSRI to a SNRI Combine two antidepressants with different mechanisms of action Augment with lithium Any of the above would be an appropriate strategy
