NR546 Midterm Exam (2023/2024) 100% Verified Questions and Answers

NR546 Midterm Exam Are the PMHNP and other staff liable if the client has an allergic reaction or adverse side effects to the drugs used for chemical restraint? - Answer-No. The client has been court-ordered to take the prescribed medications and the standing order for chemical restraints is approved. The PMHNP and other staff are not liable if the patient has an allergic reaction or adverse side effects. How does reviewing the genetic makeup of a client help guide the PMHNP in selecting medication for clients? - Answer--Genetic testing can assist by providing more information on how clients may respond to certain psychotropic medications -provides information on how a client may break down and metabolize medications based on the cytochrome P450 system. Tanrıkulu and Erbaş (2020) investigated identical twins to determine the presence of an inherited link for schizophrenia and why one twin may develop schizophrenia when the other does not. When two people have 100% identical DNA, why don't both persons develop the exact illnesses? Studies of identical Danish twins found that if one twin had schizophrenia, the other twin had a 50% lifetime risk of developing schizophrenia (Lemvigh et al., 2020). Why is there only half the risk? - Answer-Both environmental and psychosocial stressors can impact mental health. Although twins may have identical genes, their gene expression may be different. There may be an environmental exposure that turned a gene "on" that should have been "off" for one twin to develop schizophrenia and not the other. central sulcus - Answer-separates the frontal lobe from the parietal lobe frontal lobe - Answer-associated with movement, intelligence, abstract thinking broca's area - Answer-speech production temporal lobe - Answer-involves object identification and auditory signals cerebellum - Answer-coordination wernicke's area - Answer-speech comprehension occipital lobe - Answer-primary visual area parietal lobe - Answer-keeps us alert to what is going on around us sensory cortex - Answer-pain, heat, and other sensations motor cortex - Answer-movement hippocampus - Answer-involved in both memory and anxiety nucleus accumbens - Answer-involved in the reward process thalamus - Answer-involved in sensory organ and motor command processing striatum - Answer-involved in complex motor actions, also links cognition to motor actions limbic system - Answer-includes circuits that are associated with pleasure and reward basal ganglia - Answer-group of structures involved in voluntary motor movements amygdala - Answer-involved in emotional regulation and perception of odors corpus callosum - Answer-controls the communication between the two brain hemispheres white matter - Answer-contains nerve fibers that connect neurons from different regions into functional circuits grey matter - Answer-contains nerve cells and dendrites brain tissue - Answer-made up of grey matter and white matter dorsal striatum - Answer-involved in complex motor actions and linkage of cognition to motor actions -main input area for basal ganglia *activated when anticipating or engaging in pleasure The field of epigenetics is rapidly growing and can help explain how gene expression is: - Answer-influenced by environmental factors and how epigenetics contributes to the manifestation of mental illness How does epigenetics impact a person's mental health? - Answer-internal or external factors activate portions of the genome that result in the manifestation of mental health symptoms -activation is often a result of a stressful event, which, when combined with the genetic risk, results in the disease -genes being on or off -occurrence of symptoms may be the result of inheritance of an abnormal gene or of normal genes being "on" when they should be "off." Types of epigenetic changes: - Answer-DNA Methylation Histone modification Non-coding RNA The potential legal and ethical issues impacting mental health treatment must also be taken into account, including: - Answer--informed consent -competence to make healthcare decisions -off-label prescribing Informed consent - Answer-Clients have the right to receive enough information to make decisions about treatment. -must also be informed about potential risks associated with medications. -have the right to refuse treatment -cannot be forcibly medicated in non-emergencies. However, clients can be forcibly medicated if they are violent toward themselves or others and when less restrictive methods have failed Compliance - Answer-A court order may be issued for a client to receive treatment against their wishes if they are considered a danger to themselves or others. -Examples: clients with schizophrenia or sex offenders -Guardians can provide consent for clients who have limited cognitive capabilities or are incompetent to make decisions -PMHNPs are responsible for being knowledgeable about their state laws and abiding by them. Off-Label Prescribing - Answer-Some clients may benefit from the unapproved use of a drug for symptom management. -Example: many SSRIs used to tx anxiety and OCD but are not FDA approved for use in this disorder. -potentially raises ethical and legal concerns -PMHNP must remain up to date with the latest recommendations for off-label prescribing. Incidence of mental illness-what factors are increasing the incidence - Answer- Psychological and sociological factors Lifestyle factors such as a client's smoking status, diet, exercise, history of medication adherence, or history of addiction should be considered when prescribing psychotropic medications Adherence - Answer-Persistence -taking med over intended time period Compliance -taking med as prescribed left hemisphere - Answer--speech comprehension -word recognition -grammar -sequential processing -recognition of detail -conscious mental processing right hemisphere - Answer--prosody of speech -emotional modulation -visual-spatial skills -recognition of facial expression -music -abstract mathematical skills -holistic processing -unconscious mental processing Pharmacokinetics - Answer-the study of what happens to a drug from the time of administration until the parent drug and all metabolites leave the body CYP450 - Answer-CYP450 enzymes in the gut wall or liver convert drug substrate into a biotransformed product in the bloodstream, responsible for degradating of a large # of psychotropic drugs -Not all ind. have same genetic form of CYP450 enzymes, determined with pharmacogenetic testing *Most individuals have "normal" rates of drug metabolism from the major CYP450 enzymes and are said to be "extensive metabolizers", most drug doses are set for these individuals. *genetic variants of these enzymes can make poor metabolizers or ultra rapid metabolizers Five of the most important: CYP450 1A2, 2B6, 2D6, 2C9, 2C19, and 3A4. ultra rapid metabolizers - Answer-elevated enzyme activity subtherapeutic drug levels poor efficacy with standard doses genotyping - Answer-the patient for pharmacogenomic use -genes for these CYP450 enzymes can now be readily measured and used to predict which patients might need to have dosage adjustments -measurement of genes for drug metabolism most common targets of psychotropic drugs - Answer-G-protein receptors -Drug actions at these receptors occur in a spectrum, from full agonist actions, to partial agonist actions, to antagonism, and even to inverse agonism. Pharmacokinetics concepts - Answer-absorption distribution metabolism excretion Flockhart Table - Answer-drug interactions that are mediated by cytochrome P450 enzymes comprehensive list of drugs and the interactions related to the cytochrome P450 system Neurotransmitters - Answer-chemicals released by neurons to send communication across synaptic clefts to other neurons -impact human emotion and behavior Neurotransmission: - Answer-the chemical transmission of information between neurons and their target cells -the chemicals, or neurotransmitters, are released from their transport vesicles to bind with receptor sites to perform their duties, which are excitatory or inhibitory -neurotransmitter then either returned and stored for future use (reuptake) or inactivated and dissolved by enzymes -Types: Classic, Retrograde, Volume Classic neurotransmission - Answer-neurons send electrical impulses from one part of the cell to another part of the same cell via their axons -one neuron hurling a chemical messenger, or neurotransmitter, at the receptors of a second neuron -electrical impulse converted chemical signal at the synapse in a process known as excitation-secretion coupling, the first stage of chemical neurotransmission, then back into electrical impulse in second neuron -chemical information from the first neuron triggering a cascade of further chemical messages within the second neuron to change that neuron's molecular and genetic functioning Retrograde neurotransmission - Answer-postsynaptic neurons "talk back" to their presynaptic neurons -second neuron to the first at the synapse between them -Chemicals produced specifically as retrograde neurotransmitters at some synapses include: endocannabinoids, gaseous neurotransmitter nitric oxide (NO), nerve growth factor (NGF). Volume neurotransmission - Answer-Neurotransmission without a synapse or nonsynaptic diffusion neurotransmission -Chemical messengers sent by one neuron to another can spill over to sites distant to the synapse by diffusion -neurotransmission can occur at any compatible receptor within the diffusion radius of the neurotransmitter -neurotransmission occurs in chemical "puffs" -sophisticated "chemical soup." -example: dopamine action in the prefrontal cortex, at the sites of autoreceptors on monoamine neurons Excitatory neurotransmitters: - Answer-increase the likelihood that the neuron will fire an action potential inhibitory neurotransmitters: - Answer-decrease the likelihood that a neuron will fire an action neurotransmitters that most impact mental health can be classified into four major categories: - Answer-cholinergics -acetylcholine monoamines -norepinephrine, dopamine, serotonin, histamine amino acids -gamma- amino-butyric acid and glutamate neuropeptides Inhibitors: VISA CKGQ - Answer-Valproate Isoniazid Sulfonamides Amiodarone Chloramphenicol Ketoconazole Grapefruit Juice Quinidine -decrease medication metabolism Inducers: CRAP GPS - Answer-Carbamazepine Rifampin Alcohol Phenytoin Griseofulvin Phenobarbital Sulfonylureas -increase medication metabolism neurotransmitters that may be responsible for a client's symptoms of depression - Answer-Imbalanced levels of acetylcholine, norepinephrine, serotonin, histamine, or glutamate can contribute to symptoms of depression client who is a poor metabolizer: - Answer-has a lower concentration of the necessary enzyme to metabolize a drug, which results in higher blood concentrations of the drug. -increase the risk of side effects and adverse reactions Why is trazodone not used as a front-line antidepressant - Answer-Its antidepressant that has a secondary effect of blocking histamine and adrenergic receptors -causes sedation and somnolence and as a result *often used as an adjunct in therapy when a depressed patient has difficulty sleeping effect on neurotransmitters and side effects: Selective Serotonin Reuptake Inhibitors (SSRIs) - Answer-Inhibits the reuptake of serotonin, which can cause nausea, agitation, headache, and sexual dysfunction effect on neurotransmitters and side effects: Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs) - Answer-Inhibits the reuptake of serotonin and norepinephrine, which can cause nausea, sweating, insomnia, tremors, sexual dysfunction effect on neurotransmitters and side effects: Tricyclic Antidepressants - Answer--Inhibits the reuptake of serotonin and norepinephrine, which can cause sexual dysfunction -Blocks norepinephrine receptors, which can cause hypotension and tachycardia -Blocks histamine receptors, which can cause sedation and weight gain -Blocks acetylcholine receptors, which can cause dry mouth, constipation, blurred vision, and urinary retention effect on neurotransmitters and side effects: Monoamine Oxidase Inhibitors (MAOIs) - Answer-Increases norepinephrine and serotonin by inhibiting the enzyme that inactivates it, which can cause sedation, dizziness, sexual dysfunction, and hypertensive crisis