Exam 4 V2: NURS 660 / NURS660 Psychopharmacology and Advanced Mental Health | Complete Questions and Verified Answers (Latest 2026 / 2027)100% Correct - Maryville

Exam 4 V2: NURS 660 / NURS660 Psychopharmacology and Advanced Mental Health | Complete Questions and Verified Answers (Latest 2026 / 2027)100% Correct - Maryville Q: The core symptoms of ADHD are linked to what area of the brain? Answer prefrontal cortex Q: Selective attention is due to what area of the PFC malfunctioning? Answer dorsal ACC (anterior cingulate cortex) Q: sustained attention and problem solving linked to what area of the brain? Answer DLPFC Q: hyperactivity is linked to what area of the brain? Answer prefrontal motor cortex Q: what test assessing sustained attention? Answer N-back test Q: where is sustained attention modulated in brain? Answer CSTC loop in the DLPFC insufficient activation in the DLPFC can cause inattention "sustaiNed attention- N back" Q: what test assesses selective attention? Answer Stroop test "Selective, Stroop, Cingulate" Q: where in the brain is selective attention modulated? Answer the CSTC loop, Dorsal anterior cingulate cortex Q: issues with sustained attention are: Answer difficulty completing tasks disorganization trouble sustaining mental effort Q: issues with selective attention are: Answer difficulty with detail carless mistakes not listening losing things being distracted forgetting things Q: what part of the brain modulates impulsitivity? Answer orbitofrontal cortex Q: what symptoms of impulsitivity are observed? Answer talking excessively blurting things out not waiting ones turn interrupting Q: what part of the brain modulates hyperactivity? Answer prefrontal cortex Q: what are some key observations in the prefrontal cortex as it relates to ADHD? Answer orbitofrontal cortex (OFC)-- impulsivity and hyperactivity DLPFC/DaCC-- sustained/selective attention issues Q: how do NE and DA amounts manifest in relation to fatigue/anxiety? Answer too little NE and DA = fatigue too much = anxiety Q: what two receptors in the PRC are thought to be involved with ADHD treatment? Answer alpha 2 a D1 Q: how does ADHD affect NE and DA levels? Answer NE levels low, signal reduced DA levels low, noise increased results in: fidget and inattention Q: how should you treat NE and DA in adhd? Answer increase NE Increase DA Q: what receptors does NE stimulate in the postsynapse? Answer alpha 2 a; even better effect when beta1 receptors also stimulated Q: what effect does DA have on receptors and what does this cause? Answer decreases the noise and prevents inappropriate connections from taking place through stimulating D1 receptors Q: what effect does NE have on receptors and what does this cause? Answer increases the incoming signal and allows for increase connections between prefrontal networks through stimulation of alpha 2A receptors Q: what effect do slow dose stimulants have? Answer amplify tonic NE and DA signals block NET in PFC block DAT in nucleus accumbens Q: why do slow dose stimulants have less abuse potential? Answer they dont occupy DAT too quickly or extensively, which is thought to reduce abuse potential what is salience provoked phasic firing? Answer - bursts of DA release this can reinforce learning and reward conditioning which can lead to motivation to pursue rewarding experiences (education, career development) Can also lead to drug abuse.... how do pulsatile stimulants affect NE and DA? Answer rapid increase in both can lead to feelings of euphoria and abuse ex: methylphenidate and amphetamine what is a big factor in if stimulants are abused? Answer route and dose what stimulant is a competitive inhibitor of DAT and NET? Answer amphetamine are both methylphenidate and amphetamine taken into the DA terminal? Answer no, only amphetamine this is bc amphetamine and VMAT what happens when amphetamine is taken in to the terminal? Answer can go into the vesicle and displace DA; this can lead to a fast release of DA which causes euphoric (and abuse causing) what is the MOA of methylphenidate on DA neurons? Answer works on DAT similarly to SSRI (blocks reuptake of DA into terminal) this leads to more DA availability -- not taken into the terminal itself what is the MOA of methylphenidate on NE neurons? Answer works on NET adverse effects of stimulants (methylphenidate, amphetamine) Answer generalized anxiety adverse affects of atomoxetine (strattera?) Answer dysuria, erectile dysfunction, decreased libido, liver damage (rare) adverse effect of wellbutrin/ bupropion Answer sweating adverse effects of desipramine (norpramin) Answer increased BP and HR, orthostatic hypotension, prolonged QT interval what are some adverse effects of stimulants in the pediatric and adolescent population should be aware of? Answer - serious cardiovascular events/sudden death - mania, aggression - growth suppression - seizures - peripheral vasculopathy (raynauds) - blurred vision - tics what are examples of NET inhibitors for adhd? Answer atomoxetine (strattera) buproprion (wellbutrin) venlafaxine (effexor) duloxetine (cymbalta) desvenlafaxine (prystiq) milnacipran (savella) desipramine nortriptyline what ADHD medication doesnt have abuse potential? Answer atomoxetine (strattera) what drug class is atomoxetine? Answer NE reuptake inhibitor How does Atomoxetine (Strattera) work? Answer causes NE and DA levels to increase in PFC relative lack of NETs in nucleus accumbens prevents atomoxetine from increasing DA and NE levels in the brain area, thus reducing abuse potential increases attention, decreases hyperactivity what ADHD medication can cause liver injury? Answer strattera if a patient develops jaundice and evidence of liver injury while taking strattera, what should you do? Answer stop the med and dont restart it what med metabolism pathway dose strattera work? Answer CYP2D6 keep in mind when rx with paroxetine, fluoxetine, quinidine what causes guanfacine to absorb quicker? Answer high-fat meals is guanfacine or clonidine more alpha 2a selective? Answer guanfacine, which also means it has less side effects Guanfacine (Intuniv) Answer α2A-adrenergic agonist prescribed for the treatment of ADHD. Guanfacine is believed to improve attention and memory by stimulating α2A-adrenergic receptors in the prefrontal cortex. once daily dosing Clonidine (Catapres) Answer Alpha-2 agonist (centrally acting) also inihibts imidolazine receptors Decreases sympathetic outflow Used for primary htn, migraine, ADHD, alcohol withdrawal Can cause sedation, dry mouth, rebound htn Do not d/c abruptly Contraindicated w/ anticoagulants Do not use w/ prazosin, MAOIs, TCAs, CNS depressants Twice daily dosing w/ larger dose at bedtime what type of adhd symptoms might atomoxetine not work well with? inattentive in addition to ADHD, modafinil might help what? substance use disorder 2 alpha 2 adrenergic agonists are? clonidine guanfacine what is the pathology of alzheimers? -Extracellular amyloid plaque build up - Intracellular formation of neurofibrilary tangles (made up of Tau protein) what is the pathology of dementia with lewy bodies? alpha synuclein what type of disorder is related to prion pathology? cruetzfeldt jacobs what are the clinical features of alzheimers? memory defict aphasia apraxia (inability to performed learned behavior) agnosia what are the clinical features of dementia with lewy bodies? memory issues, fluctuating attention extrapyramidal psychosis Frontotemporal Dementia Frontal and temporal regions degenerate, resulting in badly impaired emotional stability, decision-making and language use Huntington's disease Genetic disorder that causes progressive deterioration of brain cells. caused by a dominant allele. symptoms do not appear until about the age of 30. chorea (involuntary muscle movements) executive dysfunction Creutzfeldt-Jakob disease Chronic, progressive, fatal disease of the central nervous system caused by a prion. ataxia (seems like drunk) myoclonus what are normal memory changes with aging? reduced speed of processing Signs of Alzheimer's Disease •Memory loss affecting job skills or other activities •Difficulty performing familiar tasks •Problems with language •Disorientation regarding time or place •Impaired judgment •Problems with abstract thinking •Misplacing objects •Changes in mood or behavior •Changes in personality •Loss of initiative Processing of amyloid precursor protein enzyme B-secretase APP to form 2 peptides and through further process can form plaques what two key brain characteristics are present in alzheimers disease? beta-amyloid plaques neurofibrillary tangles which amyloid protein is soluble? a-APP what is the strongest risk factor for alzheimers? age what two enzymes terminate acetylcholine? ACheE, BuChe Rivistigmine (Exelon) twice daily with meals AChe, BuChe GI side effects NO HEPATOTOXICITY no drug to drug interactions bc not metabolized by CYP450 available in a transdermal patch what dementia medication must be taken 4x daily? tacrine Tacrine (Cognex) * Cholinesterase Inhibitors * 1st to be approved by FDA. * Treats mild to moderate AD. * Improves functioning and slows progression. * NO longer used for Dementia due to HIGH frequency of side effects: elevated liver levels gastrointestinal effects liver toxicity Donezepil (Aricept) cholinesterase inhibitor once daily AChE only Galantamine once-daily, extended release AChE only what medications would you use for mild-mod dementia/alzheimers? what classification are all these medications? donepezil, galantamine, rivastigamine cholinesterase inhibitors what medication would you give for moderate to severe alzheimers? memantine NMDA receptor agonist How do cholinesterase inhibitors work? The make acetylcholine more available by inhibiting enzymes from breaking it down. acetylcholine helps neurons communicate How does Memantine (Namenda) work? blocks excessive extrasynaptic activity of N-methyl-D-aspartate (NMDA) it is non-competitive, and low affinity binds to magnesium site when it is open blocks the downstream release of glutamate by acting as a "plug" at the NMDA receptor site How does Donepezil (Aricept) work? It increases acetylcholine concentrations at receptor sites and inhibits acetylcholinesterase present in both central and peripheral nervous system in the CNS, acetylcholine can help with cognition in the gut/perihperal, causes GI side effects has a very long half life (once daily administration) How does rivastigmine work? inhibits AChE and BuChe RENALLY excreted How does Galantamine treat Alzheimer's disease? allosterically potentiating ligand that modulates nicotinic receptors to increase acetylcholine release as well as acetylcholine inhibitor what part of the brain circuit is responsible for impulsivity and reward? ventral striatum what part of the brain circuit is responsible for compulsivity and motor response? dorsal striatum what neurotransmitter is essential to the reward circuit? dopamine What pathway is responsible for the reward response? mesolimbic - VTA to NA what is the action of alcohol in the VTA? what receptors does it act on? acts on mu receptors- releases endogenous opioids acts on VSCCs- inhibits glutamate release enhances GABA release how does acute alcohol use affect medications? increases liver enzymes, which increases rate of metabolism how does chronic use of alcohol effect medications? causes liver damage which impairs metabolism How does naltrexone work? By blocking opioid receptors this blocks the reward of drinking dont use in liver patients How does acamprosate work? works on GABA and glutamate pathway and is very effective in maintaining abstinence in dependent drinkers even in severe cases dont use in renal patients How does Disulfiram (Antabuse) work? if someone drinks, causes build up of acetyldehyde in system which causes very unpleasant effects of alcohol what is an important consideration when prescribing naltrexone? patient must be completely free of opioids can be given IM what effect do hallucinogenics have on 5ht2a receptors? agonism How does nicotine work? It Directly Stimulate Dopaminergic Neurons heading to the Nucleus Accumbens. long term stimulation of receptors leads to desensitization- where no longer react to nicotine as receptors resensitize, they initiate craving and withdrawal receptors will upregulate to compensate, which can increase cravings further What SSRI should be avoided in pregnancy? Paxil - cardiac and congenital abnormalities what 3 medications carry risk of congenital malformation to fetus? lithium, carbamazepine, valproate what medication carries risk of neurotube defects? valproate if you are going to taper off paroxetine (paxil) what must you remember? taper slowly if a patient is taking paxil while pregnant, what additional test should be ordered? ultrasound to monitor for fetal malformations what factors could affect drug absoprtion and distribution in the elderly? increased total body fat, decreased lea muscle, decreased total body water, decreased GI motility what might affect drug metabolism in the elderly? decreased hepatic mass, decreased hepatic flow - results in reduced first-pass metabolism what factors might impair elimination of medications in the elderly? decreased cardiac output, decreased flow to kidneys, decreased renal clearance - increased elimination half life what second-generation antipsychotic has the most efficacy for treating aggression in to the elderly? risperidone What are the 4 ADHD symptoms and their associated brain regions? - Inattention, selective: dorsal anterior Singulet - inattention, sustained: dorsolateral PFC - hyperactive: prefrontal motor cortex - impulsive: orbitofrontal cortex what loop or brain circuit is responsible for hyperactivity and impulsivity? CSTC what symptoms of ADHD does too little NE and DA cause? distraction, forgetful, fatigue what types of symptoms does too much NE and DA cause? mania, psychosis what is the mechanism of action for amphetamine? - Competitively inhibit dopamine transporter - Works on VMAT o Taken up into dopamine terminal o Packaged into vesicles o Displaces dopamine into terminals - DIRECT release what is the mechanism of action of methylphenidate? Blocks dopamine and norepinephrine transporter Does not get taken up by transports - No direct release, just more availability what med class might help most with hyperactivity, but not as much with inattention? alpha 2 a agonist clonidine, guanfacine clinidine has more side effects (sedation, hypotension, dry mouth" what twp types of dementia have TAU pathophysiology? alzheimers, frontotemporal what is the pathology of lewy body demenita? Alpha-synuclien what type of dementia is prion related? cruetzfeldt jacobs what are the signs and symptoms of alzheimers? Memory deficit Aphasia Apraxia Agnosia Dementia with Lewy Bodies (DLB) signs and symptoms dementia involving visual hallucinations, cognitive fluctuations, and atypical movements Memory deficit Fluctuating attention Extrapyramidal signs Psychosis (hallucinations) **Rapid eye movement/sleep issues*** Frontotemporal Dementia Frontal and temporal regions degenerate, resulting in badly impaired emotional stability, decision-making and language use Memory deficit Speech/language disorders Disinhibition **Hyperorality*** Huntington's disease symptoms Genetic disorder that causes progressive deterioration of brain cells. caused by a dominant allele. symptoms do not appear until about the age of 30. Memory deficit Executive dysfunction Chorea Creutzfeldt-Jakob disease symptoms Fatal infection; neurological symptoms include trembling Memory deficit Ataxia Myoclonus Language disturbance What breaks down acetylcholine? acetylcholinesterase BuCHE what alzheimers medication causes the most GI upset? Rivastigmine Peripheral blockade why do dementia medications cause GI issues? Cholinergic activity- parasympathetic what part of the brain is responsible for reward? amygdala what part of the brain is responsible for memory? hippocampus what part of the bottom-up mechanism is responsible for for impulsivity and reward pathways? ventral striatum what part of the bottom-up mechanism is responsible for for compulsivity and motor? dorsal striatum what part of the brain is top-down and what does it do? PFC, disinhibition what pathwa does dopamine cause reinforcement and reward? mesolimbic VTA-- nucleaus accumbens How does the ETOH affect VTA stimulate dopamine release? 1. Directly acts on opiate receptors causing release of endogenous opiates which releases dopamine 2. Acts on glutamate receptors; calcium channels, inhibits glutamate release, affects dopamine 3. Enhances GABA release, direct/indirect what are alcohols effects on GABA and glutamate? increases GABA, decreases glutamate if someone abruptly stops drinking, how does this affect GABA and glutamate? decrease GABA, increase glutamate (opposite of its normal effects) what receptor does nicotine bind to? where? alpha 4 beta 2 receptor VTA is amphetamine or methylphenidate transported into neurons via dopamine transporter? amphetamine What is the clinical significance of the difference in mechanism of action of methylphenidate vs. amphetamine? - At high doses, amphetamine can cause rapid release of dopamine into the synapse, which may be linked to euphoria what are two stimulants? amphetamine, methylphenidate Both regulate the activity of dopamine and norepinephrine what typeof modulator is methylphenidate? allosteric how does methylphenidate work? - Binds to dopamine and norepinephrine transporter o Allosteric modulator § Binds to neurotransmitter at a different site than the neurotransmitter binds o Stops the action of the transporter, which blocks the reuptake of the neurotransmitter o Not taken up into presynaptic neuron How does amphetamine work? Amphetamine makes synaptic vesicles containing dopamine "leaky," so dopamine pours into the cytoplasm. It also reverses the transporter, driving dopamine into the synapse - Blocks the transporters for dopamine and norepinephrine o Pseudo substrate and competitive inhibitor § Binds to same site as dopamine or neurotransmitter, and competes- this prevents reuptake o Transported into presynaptic nerve terminal o VMAT binding, which further blocks dopamine o High doses of amphetamine can cause displacement of stored dopamine and norepinephrine which can push into presynaptic terminal § Can cause "dumping" of dopamine and "euphoria" what system do stimulants suppress? limbic how do stimulants effect emotions? blunting what ADHD medication doesnt have negative impact on emotions? strattera Guanfacine alpha 2 agonist activates executive system Vyvanse (lisdexamfetamine) what patients should avoid adderall? - Avoid with heart disease, glaucoma, history of addiction Adderall amphetamine/dextroamphetamine - Activates and speeds up brain o Faster and higher rate of communication between neurons o Increases dopamine (reward system) § Increased risk of addiction - Monitor: BP, pulse, height/weight - Side effects: difficulty sleeping, weight loss, dry mouth - XR lasts 12 hours; IR 4-6 hours ADHD + DE/NA Dopamine: Reward, risk, impulsiveness Norepinephrine: Attention, arousal Biomarkers for Alzheimer's - Amyloid-beta accumulation - Neuronal degeneration/injury o Elevated CSF tau - Decreased fluorodeoxyglucose uptake - Atrophy in the hippocampus an temporoparietal regions what type of dementia are DELUSIONS common in? alzheimers what is a defining feature of dementia lewy body? visual hallucinations what type of dementia is at risk for developing extra pyramidal symptoms? DLB any drug that changes the way you think or feel (def) psychoactive or psychotropic drugs when did psychoactive or psychotropic drug prescriptions begin? 1950s use of Rx to treat/improve mental health conditions (def) psychopharmacology what are three issues that arise from the use of psychotropics? 1. unwanted side effects 2. individualizing drug and dosage to needs of each Px 3. use of Rx alone w/o other Tx methods may not be ideal many primary medical conditions have symptoms that mimic what disorders? mental health hypothyroidism mimics what disorder? depression hyperthyroidism mimics what disorder? anxiety toxic metabolic encephalopathy mimics what group of disorders? psychotic disorders dementia mimics what disorders? psychotic disorders and depression hypoxia mimics what group of disorders? psychotic disorders the specific biochemical interaction through which a drug produces its pharmacological effect (def) mechanism of action a substance that binds to a specific receptor and produces an effect identical to that produced by the neurotransmitter affecting that receptor (def) agonist a substance that binds to a receptor that blocks or reduces the physiological action of another substance (def) antagonist the time required for any specified property (e.g. the concentration of a substance in the body) to decrease by half; refers to the duration of action of a drug (def) half-life NE = ? norepinephrine DA = ? dopamine 5HT = ? serotonin second-generation antidepressant meds that inhibit the reuptake of serotonin (def) SSRIs SSRIs replaced the use of what drugs? TCAs and MAOIs what was the first SSRI released? when? fluoxetine (prozac) in 1988 what are three benefits to SSRIs? 1. fewer side effects 2. easier to use 3. generally not fatal in OD what are three other antidepressant medications? 1. monoamine oxidase inhibitors (MAOIs) 2. tricyclic antidepressants (TCAs) 3. serotonin and norepinephrine reuptake inhibitors (SNRIs) what was the first antidepressant developed? when? MAOIs in the 1950s MAOIs inhibit MAO, which is what? an enzyme that breaks down monoamine NTs TCAs inhibit the reuptake of what two neurotransmitters? norepinephrine and serotonin antidepressants can be used for what other five disorders? 1. anxiety 2. OCD 3. bulimia nervosa 4. insomnia and night terrors 5. ADHD (T/F) antianxiety medications provide a cure false what is the most common drug class of anxiolytic? benzodiazepines what is the medication of choice for acute anxiety? benzos benzos enhance _____________ receptor activity GABA what is a new class of antianxiety medication? buspirone (Buspar) (T/F) buspirone is more effective than benzos false, equally buspirone has a (low/high) potential for abuse low buspirone effects (are/are not) immediate are not buspirone act on _________________ functioning serotonergic barbiturates are often prescribed to treat what? anxiety what are the main symptoms of ADHD? - impulsivity - difficulties feeling motivated - impairment in attention and concentration - restlessness and hyperactivity - impaired emotional control - associated features what four drug classes are used to treat ADHD? 1. psychostimulants 2. SNRIs 3. alpha-2 agonists 4. antidepressants what two psychostimulants are used to treat ADHD? amphetamine and mathylphenidate which SNRI is used to treat ADHD? atomoxetine what two alpha-2 agonists are used to treat ADHD? clonidine and guanfacine what two antidepressants are used to treat ADHD? bupropion and TCAs psychostimulants inhibit presynaptic transporters for what two neurotransmitters? dopamine and norepinephrine psychostimulants have a (low/high) potential for misuse high psychostimulant effects last how long? 3-12 hours what are three major side effects of psychostimulants? 1. anxiety 2. trouble sleeping 3. weight loss alpha-2 agonists were traditionally used as ________________________ drugs antihypertensive alpha-2 agonists help what three specific things? 1. attention regulation 2. impulse control 3. sedation SNRIs increase levels of _________________ to help with attention and impulsivity norepinephrine what was the first non-stimulant approved for ADHD in adults? SNRIs what are the two drug classes of antipsychotic medications? 1. first-generation (conventional) 2. second-generation (atypical) antipsychotic medications reduce positive symptoms of schizophrenia by blocking __________________ receptors dopamine which type of antipsychotics are preferred? atypical or second-gen the biochemical mechanism of lithium is (known/unknown) unknown lithium and other mood stabilizers are very effective at resolving manic episodes in ?-? weeks 2-3 weeks lithium and other mood stabilizers are (less/more) reliable at preventing future manic episodes less lithium and other mood stabilizer users often have _________________ issues compliance what are two other mood stabilizer drugs used for treating bipolar disorder? 1. valproic acid 2. carbamazepine what other mood stabilizer drugs are currently being researched? gabapentin, lamotrigine, topiramate, and abilify