NURS-6630A-2/NURS-6630N-2/NURS-6630D-2/NURS-6630C-2- Approaches to Treatment-2021 QUESTIONS AND ANSWERS

Which medication(s) requires a test dose to determine accurate use of the drug (i.e., how addicted the patient truly is on a certain drug) before beginning a titration schedule to withdrawal the patient? I. Butalbital II. Lorazepam III. Hydrocodone Response Feedback: “Treatment should begin with an oral test dose of 200 mg of pentobarbital, a short-acting-barbiturate.” Drug addiction includes many prescription medications and illegal substances. Of the drugs listed, which ones can be withdrawn abruptly WITHOUT medical intervention to prevent withdraw seizures? Response Feedback: “Amphetamines can be withdrawn abruptly” What should our treatment goal be with our patients when it comes to managing chronic pain? Response Feedback: “In general, treatment goals are reports of pain less than 5 out of 10 and an improvement in function.” Which of the following psychiatric conditions is present in both domains (i.e., core psychopathology & pain-related psychological symptoms) of chronic pain that will likely lead to an outcome of disability, pain, and poor quality of life? Response Feedback: Figure 17-4 and in the text on the page discussing how anxiety is present in both, therefore, a review is needed of the exact cause of the anxiety Which of the following drugs is structurally similar to tramadol; thus, its opioid-mediated analgesia can be reversed by naloxone in mice? Response Feedback: “Structurally, venlafaxine is similar to tramadol, and in mice, venlafaxine demonstrates opioid-mediated analgesia that is reversed by naloxone.” Daytrana is the MPH transdermal system of methylphenidate approved for the treatment of ADHD in children aged 6 years and older. What is the difference in terms of the metabolism compared to the other formulations in this class? Response Feedback: referring to MPH transdermal system (MTS; Daytrana): “Since the MPH is absorbed through the skin, it does not undergo first-pass metabolism by CES-1 in the liver, resulting in higher plasma MPH levels” T. C. is an 88-year-old male who is diagnosed at your clinic with Dementia with Lewy Bodies. He currently has some debilitating gait issues, which makes his quality of life very poor. His memory is still intact with minor deficits. Which medication would likely benefit T. C. as his initial therapy? Response Feedback: “Low dosages of levodopa/carbidopa (dopamine replacement) are sometimes helpful for the motor symptoms of DLB, although higher dosages of dopamine replacement therapy and direct dopamine agonists may exacerbate neuropsychiatric symptoms.” - Motor symptoms = gait issues Which of the following drugs is often used in the management of opioid addiction due to its ceiling effect? Response Feedback: “Because of the ceiling effect seen with partial opiate agonists, there is no pharmacological benefit from doses higher than 32 mg/day.” The experience of pain is ALWAYS subjective Response Feedback: “The experience of pain is always subjective.” Which neurotransmitters are likely involved in the pathophysiology of withdrawal seizures? I. Serotonin II. Endorphins III. Glutamate IV. GABA V. Dopamine Response Feedback: “Thus when an individual suddenly ceases alcohol use, the decrease in inhibitory effects in combination with fewer GABA receptors and increased glutamatergic discharge contributes to over-excitation and possible withdrawal seizures.” What is the difference between Ritalin and Focalin? Response Feedback: “The primarily active form of MPH appears to be the d-threo isomer, which is available in both immediate-release tablets (Focalin 2.5, 5, and 10 mg)” When can buprenorphine be initiated in a patient who is suffering from an opioid overdose? Response Feedback: “To avoid this problem, the initial buprenorphine dose should not be administered until the patient demonstrates mild-to-moderate symptoms of withdrawal.” Which enzyme does disulfiram inhibit leading to a build-up of the ethanol metabolite acetaldehyde? Response Feedback: “Disulfiram inhibits acetaldehyde dehydrogenase leading to a build-up of the ethanol metabolite acetaldehyde” In the pathophysiology of Alzheimer’s Disease, there are certain proteins that lead to the plaques and tangles that result in this progressive, irreversible brain disorder. Choose the appropriate protein with its corresponding pathology. I. Tau – tangles II. Beta-amyloid – tangles III. Tau – plaques IV. Beta-amyloid – plaques Of the following medications, which one is contraindicated with stimulants such as Ritalin or Adderall? Response