PMHNP Boards Exam 2022/2023 Test Bank With Full & Revised Questions And Answers 100% CORRECT

What is not a reasonable way to treat hypotension caused by an MAOI Answerintroduce a small amount of cheese into diet (amount of tyramine differs among types of cheeses) What are safe ways to increase BP in person taking MAOI Answer- increase salt intake fludrocortisone 0.6-0.8mg daily wear support stocking ensure adequate hydration stimulant medication When is the best time to measure plasma levels of lithium during therapy? Answer- 12 hours after last dose A substance that decreases the metabolism of drugs Answer- inhibitor Is echinacea an inducer or inhibitor? Answer- Inhibitor Mechanism of atomoxetine Answer- blocks reuptake of norepinephrine Atomoxetin increases NE and DA levels by _____ in the _______ Answer- 3x prefrontal cortices (no change in striatum or nucleus accumbans) Increased NE has been shown to improve Answer- depressive symptoms fatigue hypersomnia motoric retardation anhedonia Common side effects of atomoxetine are Answer- dry mouth insomnia constipation urinary hesitancy Valproic acid ________ the elimination half life of lamotrigine Answer- doubles Which med is used to tx alcohol use disorder by inhibiting a step in alcohol metabolism, leading to buildup of a toxic metabolite Answer- Disulfiram Disulfiram blocks _______ leading to Answer- aldehyde dehydrogenase unpleasant hangover like side effects from drinking ETOH (accumulation of acetaldehyde) ______ and ______ block the activation of the reward system associated with alcohol and opiates Answer- Naltrexone Nalmefene Cognitive affects of taking benzodiazepines are greatest in _____ Answer- elderly (especially at risk is pts with delirium and dementia) Initial side effects of benzodiazepines can persist and worsen in pts Answer- with liver disease taking longer-acting agents (diazepam) What antidepressants significantly increase dopamine? Answer- Phenelzine Selegiline (Bupropion is slight) Which antidepressants significantly increase NE? Answer- Desipramine Amitriptyline Buproprion Duloxetine Phenelzine Selegiline Which antidepressants increase does not increase DA or 5-HT but increases NE? Answer- Desipramine Which antidepressants increase NE and 5-HT, but not DA Answer- Amitriptyline Duloxetine Effexor Which antidepressants increase NE, 5HT and DA Answer- Phenelzine Selegiline _____ of every _____ black or white persons may have an exaggerated response to beta-blockers due to a polymorphism in CYP450 enzymes Answer- 1 15 Sialorrhea Answer- excessive salivation Sialorrhea is associated with side effects of Answer- Clozapine (31-48%) Clozapine has a boxed warning concerning Answer- AGRANULOCYTOSIS (severe neutropenia is associated with significant risk of serious infection or death) orthostatic hypotension bradycardia syncope (more likely to occur during initiation of tx and titration of dose) Baseline ANC must be at least ___________ before initiation of Clozapine tx Answer1500 Due to _________ clozapine is available only under a Risk Evaluation Mitigation Strategy (REMS) program. Answer- risk of severe neutropenia (ANC500) Acute alcohol ingestion _______ the rate of drug metabolism Answer- lowers (inhibits) Acute alcohol ingestion causes benzodiazepine level to Answer- increase Hypnotic drug of choice for pt with insomnia who wants to take it in the middle of the night without causing significant grogginess in the morning Answer- Zalepon Half life of Zalepon Answer- 1-2 hours What is the mechanism of action of galantamine? Answer- competitive inhibitor of acetylcholinesterase According to the Lilly Worldwide Pharmacovigilance Safety Database, what is the rate of spontaneous abortion in olanzapine exposed pregnancy? Answer- 13% (falls within range of normal historic control rates) Exposure during gestation to this medication can cause arrhythmias, polyhydramnios, nephrogenic diabetes insidious, and "floppy infant syndrome" Answer- LIthium Desvenlafaxine is ________ protein bound with ____ likelihood of displacing tightly protein-bound medication like phenytoin and warfarin Answer- weakly reduced The SNRIs have an ______ onset of action compared to SSRIs due to _________ Answer- earlier rapid down-regulation of beta-adrenergic receptor-coupled cAMP Do stimulants cause an increase in tics Answer- no (can worsen for a short interval, then go back to baseline) Most prescription and nonprescription medications can be used safely with _________ Answer- stimulants (MAOI formally contraindicated but can be used with caution in tx resistant cases) Excessive caffeine intake with stimulants may _________ the effectiveness of the stimulant Answer- decrease (increase sleep problems) Use of stimulants with anticonvulsants may require Answer- dosage adjustment and blood levels of both medication due to decreased effects of anticonvulsants SSRI associated with the greatest weight gain Answer- Paroxetine Amiloride is used to treat which side effect of lithium Answer- Renal side effects TCA for OCD Answer- Clomipramine Induction of a seizure with ECT occurs when an applied electrical stimulus causes which of the following? Answer- Depolarization of cell membranes of neurons in brain synchronously A 14 year old boy is dced on carbamazepine after an admission for acute mania. About 4 weeks later, he is again acutely manic despite having been initially stabilized on carbamazepine. What is the likely cause of this medication failure? AnswerAutoinduction transcription up regulation of genes involved in its own metabolism AnswerAutoinduction How long does auto induction of carbamazepine take Answer- 3-5 weeks (after ignition of a fixed dose when taken consistently) Meds that can increase serum concentration of 3A4 temporarily (but ultimately act as an inhibitor) Answer- Cimetidine Erythromycin Grapefruit juice Vagus nerve stimulation is FDA approved for Answer- epilepsy treatment resistant depression it involves surgical implantation of a device in the carotid sheath Answer- vagus nerve stimulation Adding ginseng to lithium can cause Answer- irritability, insomnia and mania Adding ginseng to neuroleptics or phenelzine can cause Answer- irritability, insomnia and mania What adverse reaction is associated with mirtazapine use? Answer- Agranulocytosis (1/1000)