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PMHNP certification
Exam 2023/24(Actual test
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**1. Which patient is at highest risk for SI A. 30y/o married AA female with previous SI attempt *1 risk factor B. 35 y/o single Asian male with previous SI attempt *3 risk factors C. 38 y/o single AA male who is a manager of a bank 2 risk factors D. 68 y/o single white male with depression 5 risk factors (age, male, white, depression): D. 68 y/o single white male with depression *5 risk factors (age, male, white, depression) Count the risk factors 2. When interview teenagers (16 y/o) that arrive with their parents what should you do?: interview them separately from parents. -This helps Build therapeutic rapport with teens by telling them the info is confiden- tial. Parents may be upset but remember you are advocating for the child. 3. Which Ethnic group has the highest rate of suicide?: Native Americans 4. Example A patient is being treated for schizophrenia with
Study online at https://quizlet.com/_c1ts1x olanzapine. Which of the following is the most common side effect of olanzapine? A. Increased waist circumference B. EPS (not as common in atypical antipsychotics d/t 5HT2A)-receptor an- tagonism C. Increased Lipids D. Metabolic Syndrome: D. Metabolic Syndrome (UMBRELLA ANSWER)
5. Which antipsychotics have the least weight gain?: Latuda, Abilify, (also least sedating), Geodon-if patient has metabolic syndrome consider switching to one of the medications above. Or if the patient is overly sedated try switching to ABILIFY 6. Which mood stabilizer have the least weight gain?: Lamictal -But remember all mood stabilizers cause some weight gain 7. When presented with a question about typical vs atypical antipsychotic the answer is usually to start of a: atypical
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9. When a patient is hesitant to participate in treatment you should encour- age?: Bring a support person like a husband 10. Thyroid-Stimulating hormone normal level: 0.5-5.0 Mu/L 11. When T4 and T3 are high and TSH is low what is the diagnosis: HY- PERTHYROIDISM, TSH secretion decreases: TSH LOW à key symptoms HEAT INTOLERANCE 12. Key symptoms of Heat Intolerance: Hyperthyroidism 13. When T4 and T3 are Low and TSH is high what is the diagnosis: (HY- POTHYROIDISM) TSH secretion increased: TSH HIGH à COLD INTERANCE 14. Key symptoms of Cold Intolerance: Hypothyroidism 15. Hyperthyroid can mimic: Mania 16. Hypothyroid can mimic: Depression 17. A patient on depakote complains of RUQ pain and has reddish/brown urine: Hepatoxicity -Check LFTs 18. Signs of Depakote toxicity: Disorientation, confusion, lethargy 19. You suspect depakote toxicity what do you do?: Check -LFT -Ammonia -Depakote Level 20. What herbal supplement can cause hepatoxicity?: Kava Kava 21. When taking Kava Kava in combinations with other medications you should caution about: Risk of Hepatoxicity and Sedation 22. TCAs carry a risk of: Hepatotoxicity 23. Signs of Stevens-Johnson Syndrome: -fever, mouth pain, swelling, burning eyes, blisters, skin pain 24. two psychotropics known to cause steven johnson syndrome: lamictal and tegretol 25. What nationality is most suseptible of getting steven johnson?: Asians 26. When treating asians with tegretal screen for?: HLAB-1502 Allele 27. What two medications cause agranulocytosis?: Clozaril & Tegretal
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28. Agranulocytosis when to discontinue medication: Less than 1000
Study online at https://quizlet.com/_c1ts1x increased CPK (caused by muscle contraction and muscle destruction), increase WBC, increased WBC, myoglobinuria (also from muscle destruction)
44. Cherry colored urine in a patient that exercises a lot: test for myoglobinuria may be a sign of rhabdo
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45. Serotonin Syndrome: With any drug that increases 5-HT (e.g., MAO in- hibitors, SNRIs, TCAs) hyperthermia, confusion, myoclonus, cardiovascular insta- bility, flushing, diarrhea, seizures. -Treatment: cyproheptadine (5-HT2 receptor antagonist). 46. Treatment for NMS: Stop Offending Medication -Dantrolene (muscle relaxer) -Bromocriptine (Dopamine D2 agonist). *In question focus on what they are asking for....dopamine agonist vs muscle relaxer 47. Treatment for Serotonin Syndrome: Stop Med (1 or more SSRI, SSNRI, TCA, MOAI) -Cyproheptadine 48. Triptans: Used for MIGRAINES -These meds increase serotonin example SUMATRIPTAN 49. patient taking Prozac and started on sumatriptan: -call PCP to ask them to switch the migraine med if patient already on SUMATRIPTAN do not start antidepressant without talking to PCP 50. How long do you wait when switching between an SSRI to an MAOI?: 2 weeks 51. How long do you wait when switching between Prozac and MAOI?: 5-6 weeks wash out period 52. What is the first line treatment for depression and why?: SSRI-First line treatment for depression due to less risk of injury from OVERDOSE 53. If a cancer patient has depression what should you consider?: Treating with a medication with minimal drug/drug side effects like Lexapro 54. Patient with depression worries about sexual dysfunction what would be the medication of choice?: Wellbutrin 55. Primary symptoms of depression include fatigue and low energy what med would you chose?: Wellbutrin 56. Wellbutrin is contraindicated in patients with: Seizures and anorexia 57. Which medications are best for neuropathic pain?:
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58. Secondary to the black box warning providers caring for patients on anti- depressants should assess for?: Suicidality, frequency, and severity at EVERY appointment 59. Which meds have the worse serotonin discontinuation syndrome: Those with short half lives such as zoloft 60. Symptoms of serotonin withdrawal syndrome: Fever, achiness, soreness, lethargy, fatigue, impaired memory, decreased concentration, GI UPSET Shits and Shivers 61. Ages of onset for schizophrenia in males vs females: -MALES 18- years -FEMALE 25-35 years 62. Schizophrenia increases the risk for: SUICIDE HIGH RISK OF SI in SCHIZOPHRENIA Just having schizophrenia increases your risk of suicide. MUST ASK ABOUT SI, EVERYTIME (frequency, severity of thoughts) 63. What increases the causes or increases the risk or schizophrenia: exces- sive pruning of synapses -inadequate synapse formation, -intrauterine insults such as maternal exposure to toxins, viral agents, maternal substance use, maternal illness, maternal malnutrition, fetal oxygen deprivation, -first order relative (mom/dad) 64. MRI or PET scan what is seen in schizophrenia: EVERYTHING DECREAS- ES EXCEPT VENTRICLES -You will see VENTRICULAR ENLARGEMENT 65. Stimulants can potentiate the release of what neurotransmitter?: - Dopamine which can worsen symptoms of schizophrenia 66. Assertive Community Treatment (ACT): a form of rehabilitation post hospi- talization, in home treatment 67. What level of prevention is ACT?: Tertiary 68. What adjunctive treatment is important in schizophrenia: -social
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85. Nigrostriatal Pathway: -This pathway mediates motor movements -Dopamine blockade in this pathway can lead to increase acetylcholine levels
Study online at https://quizlet.com/_c1ts1x -Blockade of dopamine (D2) receptors in this pathway can lead to EPS, i.e dysto- nia, parkinsonian symptoms and akathisia
86. Low Dopamine in the nigrostriatal pathway increases which neurotrans- mitter: -Dopamine has a reciprocal relationship with acetylcholine (Ach) (LOW DOPAMINE INCREASE Ach) 87. Long-standing D2 blockade in the nigrostriatal pathway can lead to: - tardrive dyskinesia 88. Tuberoinfundibular pathway: -Blockade of D2 receptors in this pathway can lead to increase prolactin levels leading to hyperprolactinemia which clinically manifests as amenorrhea, galactorrhea, and sexual dysfunction, gynecomastia -DECREASE DOPAMINE INCREASED PROLACTIN 89. Long-term hyperprolactinemia can be associated with what condition: - osteoporosis 90. Normal Prolactin Level in Men: level less than 20ng/ml 91. Normal Prolactin Level in Women: less than 25ng/ml 92. Which medication is the highest offender for increasing prolactin: - Risperdal 93. Acute Dystonia + Treatment: neck stiffness, muscle spasm of upper body especially neck/face/tongue -Treatment is IM COGENTIN + continue PO COGENTIN for several days 94. Akathisia + Treatment: may mimic anxiety, restlessness, can't sit still, rocking, pacing -First line Treatment is BETA-BLOCKERS like PROPANOLOL (Inderal) -Second line treatment is COGENTIN -Third line treatment is benzos 95. Beta-Blockers such as Inderal are contraindicated with what type of asthma medication: -DO NOT GIVE WITH BROCHODIALATOR such as AL- BUTERAL this combination can cause bronchospasm 96. akinesia/bradykinesia + treatment: A. difficulty initiating movement; slow- ness of movement
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97. PSEUDOPARKINSON or PARKINSONIAN + Treatment: caused by dopamine blockade, results in muscle rigidity, mask like facial expression, may look blunted, pill rolling tremors in fingers, shuffling gait, motor slowing -Treatment COGENTIN 98. tardive dyskinesia + Treatment: abnormal facial movements, grinding teeth, lip smacking, protruding tongue -Treatment DECREASE DOSE OF MED, DISCONTINUE MED, Switch to CLOZARIL, Switch to different med, VINPAT 99. Does Cogentin Treat TD: COGENTIN MAKES TD WORSE 100. Typical onset of TD: OCCURS 1-2 years TYPICALLY, but can be ACUTE ONSET ALSO 101. What non-psych med can cause TD?: REGLAN (Metoclopramide) can CAUSE Tardive Dyskinesia must educate patient that this med or the combination of this PLUS antipsychotic can increase risk of TD*** encourage them to discon- tinue reglan if TD develops 102. InDucers CYP450: DECREASE Carbamazepine Rifampin Alcoholics (chronic) Phenytoin Grisiofulvin Phenobarb Sulphonylure as Crap GPS Induces me to Madness! 103. InhIbitors of CYP450: INCREASE Ciprofloxaci n Ritonavir Amiodaron e
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112. Neurotransmitters involved in Addiction: Dopamine and GABA 113. Symptoms of Stimulant Abuse: 1. agitation/aggression 2.impaired judgment
Study online at https://quizlet.com/_c1ts1x 3.euphoria 4.elevated BP 5.tachycardia 6.dilated pupils 7.hallucinations 8.TREMORS 9.IMSOMNIA
- If an anorexic patient complains of pain or bloating after eating this may indicate: delayed gastric emptying
- Medications that delay gastric emptying: Omeprazole, ranitidine, famoti- dine
- Proton Pump Inhibitors (omeprazole & Protonix): Decrease absorption of antipsychotics & SSRI -MUST WAIT TWO HOURS BEFORE TAKING ANTIPSYCHOTIC OR SSRI 117. When initiating an SSRI on an elderly patient you should advise about- : increased anxiety
- Paradoxical effect: when meds cause the opposite effect than expected
- Apoptosis: programmed cell death/neuronal loss
- At age 45 and above the patient displays mania for first time what should be ruled out: MEDICAL CONDITION
- Patient with bipolar disorder presents with depressed mood & emotion- al lability: Give Depakote
- Hallmark sx of Borderline Personality: Recurrent self harm
- Treatment for Borderline Personality: DBT
- Creator of DBT: Marsha Linehan 125. What activity is helpful in making a diagnosis of borderline personality- : Journaling or diary keeping
- Conversion Disorder: STRESS leads to neurological symptoms such as seizures, paresthesia, blindness, mutism
- Adjustment Disorder: adjusting to a situation resulting in depression or anxiety or both or mixed disturbance of emotions and conduct (this type is more common in children: insomnia, peer
