PMHNP Boards - Scientific Foundation and Advance Practice Skills, 2024.

PMHNP Boards - Scientific Foundation and Advance Practice Skills, 2024. Which of the following is a contraindication to benzodiazepines? a. Acute alcohol intoxication b. Acute narrow angle glaucoma c. Psychosis d. All the above a. Acute alcohol intoxication In the pharmacological treatment of psychosis, when antipsychotics are administered, which block dopamine, a secondary effect is blocking in another tract, which causes potential prolactin problems, such as gynecomastia in males. This tract is the: a. mesolimbic b. tuberoinfundibular c. nigrostrial dopamine tract d. mesocortical b. tuberoinfundibular A six-year-old patient with autism spectrum disorder has not responded to six months of psychosocial interventions and continues to demonstrate aggressive tendencies toward a younger sibling. The psychiatric-mental health nurse practitioner prescribes: 1. carbamazepine (Tegretol) 200 mg once a day. 2. haloperidol (Haldol) 2 mg once a day. 3. risperidone (Risperdal) 0.25 mg once a day. 4. venlafaxine ER (Effexor XR) 37.5 mg once a day. 3. risperidone (Risperdal) 0.25 mg once a day. Which drug is likely to produce liver failure and hepatitis? 1. Lamotrigine 2. Gabapentin 3. Carbamazepine 4. Topiramate 3. Carbamazepine EPS arises from: a. D2 blockade in the nigrostriatial tract b. D2 blockade in the tuberoinfundibular tract c. D2 blockade in the alpha-1 adrenergic receptor blockade d. D2 blockade in the HPA axis a. D2 blockade in the nigrostriatial tract Which drug carries a higher risk of metabolic effects than the other second generation antipsychotics: weight gain, diabetes, dyslipidemia ? a. Clozaril b. Zyprexa c. Risperdal d. Geodon b. Zyprexa A patient has not had any relief of symptoms with Fluoxetine, and is going to be started on an MAOI. How long before starting the MAOI should the Fluoxetine be withdrawn? a. 2 weeks b. 3 weeks c. 4 weeks d. 5 weeks a. 2 weeks Which drug can produce serious side effect of rash in some Asians, and the FDA has mandated genetic testing before the administration of this drug? a. Dilantin b. Lamictal c. Depakote d. Tegretol d. Tegretol Which is considered the most sedating SSRI? a. Paroxetine b. Sertraline c. Fluoxetine d. Escitalopram Oxalate a. Paroxetine (Paxil is EVIL) Brain structure responsible for mediating mood, fear, emotion, and aggression; also responsible for connecting sensory smell information with emotions amygdala Regulates memory and converts short-term memory into long-term memory Plays key roles in various regulatory functions such as appetite, sensations of hunger and thirst, water balance, circadian rhythms, body temperature, libido, and hormonal regulation Patient on lithium and cipro Cipro _____________ lithium level Patient on psych meds and dexamethasone will complain of what? Patient w/ schizophrenia, structural changes of the brain on CT Which lab is checked with clozaril? ANC Lobes of the Brain - Fred Tore his Pants Off Frontal - executive fx, logical thinking Temporal (tempo) sound Occipital (optic) vision Parietal (pat) touch You ask a patient to clench her teeth, which cranial nerve are you testing? Cranial nerve 5 - TRIGEMINAL What does the frontal lobe affect? (LIMP) Executive functions: Language Intelligence (cognitive functoning) Motor Function Personality What does temporal lobe affect? (LAME) Language Affective Component of speech Memory Emotion In which lobe of the brain does the limbic system reside? The temporal lobe What is Wernicke's area responsible for and where does it reside in the brain? Wernicke's area is responsible for receptive speech and it resides in the temporal lobe. What is the first line drug for OCD? SSRIs What is the drug of choice for ADHD for 8 y.o and above? Stimulants (specifically ritalin - methyphenidate) If child develops tics, what do you prescribe? Guanfacine What does parietal lobe affect? (VAST) Visual spatial processing Association cortex Symbolic recognition Topographic sense what is sterognosis? how do you test it? Place objects in hand with closed eyes. Ability to differentiate items comes from parietal lobe What does the occipital lobe affect? (VIP) Visual integration Primary visual cortex Patient was prescribed paroxetine 1 month ago and had since developed ED, he is not a candidate for Wellbutrin because of a history of seizure disorder. What can you prescribe? Cialis (tadalafil) or Viagra (sildenafil) phophodiasterase inhibitors What is mechanism of action of phophodiasterase inhibitors? Rapid absorption. They pull blood to corpus cavernosum. What are the main functions of the limbic system? Regulation of emotion and memory Olfactory sense is combined with memories Hippocampus is located here - memory Where are affective domains (emotions, feelings) originating in the brain? Anterior cingulate gyrus (LIMBIC SYSTEM) If a patient with OCD has failed on SSRIs, what should you switch to? TCA - anafranil Mood disorder is most associated with which neurotransmitters? serotonin and norepinephrine Serotonin DOMAINS Depression Obsessions Migraines Anxiety Intestines Nausea Sexual and sleep Where is serotonin produced? The raphe nuclei (distributed near the midline of brainstem) What are the symptoms of SEROTONIN SYNDROME? SHITS AND SHIVERS SHITS (diarrhea) Shivering Hyperreflexia Increased body temp Vital sign instability Encephalopathy Restlessness Sweating What is the treatment for serotonin syndrome? Cyproheptadine (PERIACTIN) Patient has serotonin syndrome what are actions? 1. stop SSRIs/other meds that are contributing 2. Give Cyproheptadine(PERIACTIN) 3. Cooling/Fluids If a patient develops NMS on risperidone, what drug class will be avoided in the future? antipsychotics Treatment for NMS is? 1. dantrolene 2. Bromocriptine (parlodel) If you are giving a patient Latuda and Geodon, what is the patient teaching? 1. QT prolongation 2. Metabolic syndrome 3. Eat with a meal!!!! For pediatric panic disorder, what do you prescribe? Clonidine or guanfacine A patient is being treated for schizophrenia with olanzapine. Which of the following is the most common side effect of olanzapine? A. Increase waist circumference B. Extrapyramidal side effects (not usual because serotonin antagonism - 5HT2A) C. Increase lipids D. Metabolic syndrome D. Metabolic syndrome What is a normal lab value range for lithium? 0.6 - 1.2 Which mood stabilizer is the gold standard for a manic episode? lithium Which mood stabilizer has evidence of anti-suicidal effects? lthium Before starting lithium, the serum creatinine of a patient was 1.8 and the BUN was 24, should you start the medicaton? A) Yes, the level is normal. B) No, the level is not normal B) not the level is not normal. Normal serum creatinine is 0.6 - 1.2, like with lithium and BUN should be 10-20. What labs should be done before starting lithium for safety? Thyroid panel Serum creatinine (0.6 - 1.2mg/dL) Blood urea nitrogen (BUN) (10 - 20 mg/dL) Pregnancy test (HCG) ECG for clients older than 50 What are early signs of lithium toxicity? Gi distress - diarrhea What are late signs of lithium toxicity? seizures and arrythmia What would be a sign that lithium had become nephrotoxic? Proteinuria Which brain structure correlates to the development of anxiety disorder? A) pons B) Amygdala C) Occipital cortex D) hippocampus A) pons - no connects medulla with cerebellum B) Amygdala - yes, anxiety C) Occipital cortex - no, optic D) hippocampus - no, part of the limbic system and has several functions regarding forming new memories, learning and emotions . Damage of the hippocampus is involved in Alzheimer's disease. What are primary side effects of lithium? Hypothyroidism Fine hand tremors Fatigue Mental cloudiness Headaches Coarse Hand tremors occur with toxicity Nystagmus Dermatological Maculopapular rash Pruritus Acne Diarrhea Vomiting