Final Exam Test Questions
1. Question 18:
Christine is a 9-year-old female who presents for care after having been placed in the local
foster care system. She has been in and out of foster care for the last 4 years after her
parents were killed in an automobile accident. Christine has
been placed in a variety of homes and residential care facilities. The PMHNP recognizes
that Christine is at high risk for:: A. Dissociative disorders
B.Post-traumatic stress disorder
C. Impulse-control disorder
D. Attachment disorder
2. Question 7:
Caylee is a 5-year-old girl who is referred for evaluation by child protective services. She
was recently removed from her biological family and placed in foster care, as her home
environment was reportedly unsafe due to conditions of extreme neglect. Her foster
mother reports that Caylee is very quiet and withdrawn and always appears sad and
disinterested in her surroundings; however, she becomes very irritable when anything
unexpected or unplanned occurs. The foster mother became very concerned when it
appeared that
Caylee was hallucinating. The PMHNP considers that:: A. Caylee is at high risk for suicide
and precautions should be taken
B. The hallucinations are consistent with brief psychotic disorder or schizophrenia
C.The history and reported symptoms are typical of depressive disorder in young children
D. This is a common situation when prepubertal children are removed from the
biological parents regardless of how dysfunctional they are
3. Question 2:
Debi is a 15-year-old girl who is currently being treated for depression. Her parents have
been very proactive and involved in her care, and Debi has achieved remission 2 months
after beginning treatment with a combination of pharmacotherapy and cognitive
behavioral therapy. While counseling Debi's parents about important issues in
management, the PMHNP advises that:: A.
,Final Exam Test Questions
There is a > 50% likelihood that Debi's younger sibling will develop depressive symptoms
B.The mean length of major depressive episode in adolescents is 4 months
C. 20 to 40% of adolescents who have major depressive disorder will develop bipolar I
within 5 years
D. Adolescent-onset depression typically need long-term pharmacologic management
to prevent relapses
4. Agomelatine: Brand: Valdoxan
-Melatonin multimodal (Mel-MM)
-Agonist at melatonergic 1 and melatonergic 2 receptors
-Antagonist at 5HT2C receptors
-Not FDA approved: Rx for Depression, Generalized anxiety disorder
-Initial 25 mg/day at bedtime; after 2 weeks can increase to 50
mg/day at bedtime
5. Amitriptyline (Elavil): Tricyclic antidepressant.
6. Aripiprazole (Abilify): Treatment for depression. Atypical antipsychotic. "Dopamine
stabilizer". Dopamine receptor antagonist in high concentration and also stimulates
increase of dopamine in low concentrations. Side effects: insomnia, akathisia.
7. Brexpiprazole (Rexulti): Treatment for depression. Atypical antipsychotic
8. Bupropion (Wellbutrin): Antidepressant and smoking cessation aid, It can treat
depression and help people quit smoking. It can also prevent depression caused by
seasonal affective disorder (SAD).
9. Citalopram (Celexa): Antidepressant, SSRI: 20-40 mg qd.
10. Clomipramine (Anafranil): -Serotonin reuptake inhibitor (S-RI)
-Tricyclic antidepressant (TCA)
-Parent drug is a potent serotonin reuptake inhibitor
Active metabolite is a potent norepinephrine/noradrenaline reuptake inhibitor
-Increases serotonergic neurotransmission by blocking the serotonin reuptake pump
(transporter), -Desensitization of serotonin receptors, especially serotonin 1A receptors
-Increases noradrenergic neurotransmission by blocking the norepinephrine reuptake
pump (transporter), -Desensitization of beta adrenergic receptors
,Final Exam Test Questions
-Dopamine is inactivated by norepinephrine reuptake in the frontal cortex
-Lacks dopamine transporters
-Increases dopamine neurotransmission in this part of the brain
**FDA Approved for Pediatrics in tx Obsessive-compulsive disorder (OCD) (ages 10 and
older)
*Off-Label for Pediatric Use: Depression, Severe and treatment-resistant, depression,
Cataplexy syndrome, Anxiety, Insomnia,
Neuropathic pain/chronic pain
-Full therapeutic benefits may take 2-8 weeks
-Dosing: in Peds/Adolescents/Adults:
100-250mg/day
11. Cyamemazine (Tercian): Treatment for
depression. -Known as cyamepromazine
-Typical antipsychotic drug of the phenothiazine class.
-Treatment for
schizophrenia and
psychosis-associated
anxiety
-Behaves like an atypical antipsychotic, due to its potent
anxiolytic effects (5-HT2C) and lack of extrapyramidal side
effects (5-HT2A).
-Conventional antipsychotic (neuroleptic, phenothiazine, dopamine 2 antagonist,
serotonin dopamine antagonist) -Commonly Prescribed for (not FDA approved): -
Schizophrenia
-Anxiety associated with psychosis (short-term)
-Anxiety associated with nonpsychotic disorders, including mood disorders and
personality disorders (short-term) -Severe depression
-Bipolar disorder
-Other psychotic disorders
-Acute agitation/aggression (injection)
, Final Exam Test Questions
-Benzodiazepine withdrawal
12. Desiprimine (Norpramine): Treats depression
Brand: Norpramin
-TCA
-Norepinephrine noradrenaline reuptake inhibitor.
-FDA approved for treating depression.
-Off-label: Anxiety, Insomnia,
Neuropathic pain/chronic pain, Treatment-resistant depression.
-More potent inhibitor of norepinephrine reuptake pump than serotonin reuptake pump
(serotonin transporter).
-May have immediate effects in treating insomnia or anxiety.
-If it is not working within 6-8 weeks for depression, it may require a dosage increase or it
may not work at all -100-200 mg/day (for depression) 50-150 mg/day (for chronic pain).
13. Desvenlafaxine (Pristiq): Dual serotonin and norepinephrine reuptake inhibitor-
often classified as an antidepressant.
-FDA approved to tx MDD.
-Off-label: Vasomotor sx's, fibromyalgia, GAD, Social Anx d/o, panic d/o, PTSD, PMDD
-Dopamine is inactivated by norepinephrine reuptake in frontal cortex (which lack
dopamine transporters) med can increase dopamine neurotransmission in this part of the
brain
-
14. Risperidone (Risperdal): Atypical Antipsychotic (most "typical" of atypicals)
Side effects: EPS (dose-dependent), TD, significant increases in PRL
(check PRL levels) --> most dopaminergic of Atypicals
IM formulation is available
15. Amphetamines: drugs that stimulate neural activity, causing speeded-up body
functions and associated energy and mood changes
16. Dextroamphetamine: CNS stimulant
*Mech*: Inc catecholamines at the synaptic cleft, especially NE and dopamine.
1. Question 18:
Christine is a 9-year-old female who presents for care after having been placed in the local
foster care system. She has been in and out of foster care for the last 4 years after her
parents were killed in an automobile accident. Christine has
been placed in a variety of homes and residential care facilities. The PMHNP recognizes
that Christine is at high risk for:: A. Dissociative disorders
B.Post-traumatic stress disorder
C. Impulse-control disorder
D. Attachment disorder
2. Question 7:
Caylee is a 5-year-old girl who is referred for evaluation by child protective services. She
was recently removed from her biological family and placed in foster care, as her home
environment was reportedly unsafe due to conditions of extreme neglect. Her foster
mother reports that Caylee is very quiet and withdrawn and always appears sad and
disinterested in her surroundings; however, she becomes very irritable when anything
unexpected or unplanned occurs. The foster mother became very concerned when it
appeared that
Caylee was hallucinating. The PMHNP considers that:: A. Caylee is at high risk for suicide
and precautions should be taken
B. The hallucinations are consistent with brief psychotic disorder or schizophrenia
C.The history and reported symptoms are typical of depressive disorder in young children
D. This is a common situation when prepubertal children are removed from the
biological parents regardless of how dysfunctional they are
3. Question 2:
Debi is a 15-year-old girl who is currently being treated for depression. Her parents have
been very proactive and involved in her care, and Debi has achieved remission 2 months
after beginning treatment with a combination of pharmacotherapy and cognitive
behavioral therapy. While counseling Debi's parents about important issues in
management, the PMHNP advises that:: A.
,Final Exam Test Questions
There is a > 50% likelihood that Debi's younger sibling will develop depressive symptoms
B.The mean length of major depressive episode in adolescents is 4 months
C. 20 to 40% of adolescents who have major depressive disorder will develop bipolar I
within 5 years
D. Adolescent-onset depression typically need long-term pharmacologic management
to prevent relapses
4. Agomelatine: Brand: Valdoxan
-Melatonin multimodal (Mel-MM)
-Agonist at melatonergic 1 and melatonergic 2 receptors
-Antagonist at 5HT2C receptors
-Not FDA approved: Rx for Depression, Generalized anxiety disorder
-Initial 25 mg/day at bedtime; after 2 weeks can increase to 50
mg/day at bedtime
5. Amitriptyline (Elavil): Tricyclic antidepressant.
6. Aripiprazole (Abilify): Treatment for depression. Atypical antipsychotic. "Dopamine
stabilizer". Dopamine receptor antagonist in high concentration and also stimulates
increase of dopamine in low concentrations. Side effects: insomnia, akathisia.
7. Brexpiprazole (Rexulti): Treatment for depression. Atypical antipsychotic
8. Bupropion (Wellbutrin): Antidepressant and smoking cessation aid, It can treat
depression and help people quit smoking. It can also prevent depression caused by
seasonal affective disorder (SAD).
9. Citalopram (Celexa): Antidepressant, SSRI: 20-40 mg qd.
10. Clomipramine (Anafranil): -Serotonin reuptake inhibitor (S-RI)
-Tricyclic antidepressant (TCA)
-Parent drug is a potent serotonin reuptake inhibitor
Active metabolite is a potent norepinephrine/noradrenaline reuptake inhibitor
-Increases serotonergic neurotransmission by blocking the serotonin reuptake pump
(transporter), -Desensitization of serotonin receptors, especially serotonin 1A receptors
-Increases noradrenergic neurotransmission by blocking the norepinephrine reuptake
pump (transporter), -Desensitization of beta adrenergic receptors
,Final Exam Test Questions
-Dopamine is inactivated by norepinephrine reuptake in the frontal cortex
-Lacks dopamine transporters
-Increases dopamine neurotransmission in this part of the brain
**FDA Approved for Pediatrics in tx Obsessive-compulsive disorder (OCD) (ages 10 and
older)
*Off-Label for Pediatric Use: Depression, Severe and treatment-resistant, depression,
Cataplexy syndrome, Anxiety, Insomnia,
Neuropathic pain/chronic pain
-Full therapeutic benefits may take 2-8 weeks
-Dosing: in Peds/Adolescents/Adults:
100-250mg/day
11. Cyamemazine (Tercian): Treatment for
depression. -Known as cyamepromazine
-Typical antipsychotic drug of the phenothiazine class.
-Treatment for
schizophrenia and
psychosis-associated
anxiety
-Behaves like an atypical antipsychotic, due to its potent
anxiolytic effects (5-HT2C) and lack of extrapyramidal side
effects (5-HT2A).
-Conventional antipsychotic (neuroleptic, phenothiazine, dopamine 2 antagonist,
serotonin dopamine antagonist) -Commonly Prescribed for (not FDA approved): -
Schizophrenia
-Anxiety associated with psychosis (short-term)
-Anxiety associated with nonpsychotic disorders, including mood disorders and
personality disorders (short-term) -Severe depression
-Bipolar disorder
-Other psychotic disorders
-Acute agitation/aggression (injection)
, Final Exam Test Questions
-Benzodiazepine withdrawal
12. Desiprimine (Norpramine): Treats depression
Brand: Norpramin
-TCA
-Norepinephrine noradrenaline reuptake inhibitor.
-FDA approved for treating depression.
-Off-label: Anxiety, Insomnia,
Neuropathic pain/chronic pain, Treatment-resistant depression.
-More potent inhibitor of norepinephrine reuptake pump than serotonin reuptake pump
(serotonin transporter).
-May have immediate effects in treating insomnia or anxiety.
-If it is not working within 6-8 weeks for depression, it may require a dosage increase or it
may not work at all -100-200 mg/day (for depression) 50-150 mg/day (for chronic pain).
13. Desvenlafaxine (Pristiq): Dual serotonin and norepinephrine reuptake inhibitor-
often classified as an antidepressant.
-FDA approved to tx MDD.
-Off-label: Vasomotor sx's, fibromyalgia, GAD, Social Anx d/o, panic d/o, PTSD, PMDD
-Dopamine is inactivated by norepinephrine reuptake in frontal cortex (which lack
dopamine transporters) med can increase dopamine neurotransmission in this part of the
brain
-
14. Risperidone (Risperdal): Atypical Antipsychotic (most "typical" of atypicals)
Side effects: EPS (dose-dependent), TD, significant increases in PRL
(check PRL levels) --> most dopaminergic of Atypicals
IM formulation is available
15. Amphetamines: drugs that stimulate neural activity, causing speeded-up body
functions and associated energy and mood changes
16. Dextroamphetamine: CNS stimulant
*Mech*: Inc catecholamines at the synaptic cleft, especially NE and dopamine.
