NURS 660 MIDTERM EXAM WITH ANSWERS spring 2021

1. ADHD Medication contraindicated with liver impairment? A. Strattera 2. What is one of the birth defects associated with Lithium? a. ebstein's anomaly – cardiac anomaly 3. Review category A, B, C, D-What is the category, not enough human studies risk can’t be ruled out in pregnancy a. very few recommended b. relatively safe sertraline, latuda c. no data for harm but in animal studies issues occurred d. D cannot be ruled out 4. SSRI cardiovascular malformation during 1st trimester of pregnancy? a. Paroxetine can cause cardio malformations b. Increased risk of cardiovascular malformations (primarily ventricular and atrial septal defects) if taken in 1st trimester. c. Late in pregnancy may be associated with higher risk of neonatal complications, including respiratory distress 5. Mechanism of action of a stimulant for ADHD Methylphenidate and amphetamine? a. by increasing the intrasynaptic levels of both norepinephrine and dopamine b. Increases norepinephrine and especially dopamine actions by blocking their reuptake 6. Cigarette smoker craving withdrawal symptoms are caused from what’s going on inside your body? a. Cigarette craving and withdrawal is from the re- sensitization of the nicotine receptors from Stiles review. b. Nicotine alpha 4 beta 2 post synaptic receptors desensitizes receptors which leads to addiction. Craving and withdrawal is from the resensitization. If a smoker goes a long time in between starts withdrawals 7. What part of the brain is associated with inattentive type ADHD symptoms? Can’t stay focused do work-problems attention sustained and problem-solving? a. Dorsal anterior cinglunate (acc)- selective attention b. Dorsal lateral prefontal cortex- sustained attention and problem solving (CSTC loop per Dr. Stiles) c. Prefrontal motor cortex- hyperactivity d. Orbitofrontal cortex- impulsive symptoms 8. Strattera (atomoxetine)lacks abuse potential because? Where does it work? a. increases dopamine levels in dorsal prefrontal cortex and NOT in the nucleus accumbens b. MOA: Boosts neurotransmitter norepinephrine/ noradrenaline and may also increase dopamine in prefrontal cortex, 9. Valproate what malformation of fetus would it cause? a. spina bifida b. Use during first trimester may raise risk of neural tube defects (e.g., spina bifida) and developmental delay 10. What part of the brain is impulsivity hypothesized to be related to or occur in? a. Orbitofrontal cortex 11. What part of the brain is compulsivity related to? a. dorsal striatum b. Mesolimbic dopamine pathway: Pleasure pathway and link to addiction—pathway of reward in impulsive and compulsive behaviors The mesolimbic pathway regulates incentive salience, motivation, reinforcement learning, and fear, among other cognitive processes. The mesolimbic pathway is involved in motivation cognition. **NEI: Impulsivity is hypothesized to be related to the VENTRAL STRIATUM, while compulsivity is hypothesized to be related to the DORSAL STRIATUM. 12. Mechanism of action atomoxetine? a. Boosts neurotransmitter norepinephrine/ noradrenaline and may also increase dopamine in prefrontal cortex • Blocks norepinephrine reuptake pumps, also known as norepinephrine transporters • Presumably this increases noradrenergic neurotransmission • Since dopamine is inactivated by norepinephrine reuptake in frontal cortex, which largely lacks dopamine transporters, atomoxetine can also increase dopamine neurotransmission in this part of the brain (Stahl, prescribers guide) 13. Amyloid precursor protein (APP) is first cleaved by what enzyme? a. Alpha-secretase (Stahl pscyh