Exam 3: NURS 660 / NURS660 Psychopharmacology and Advanced Mental Health | Complete Questions and Verified Answers (Latest 2026 / 2027)100% Correct - Maryville

Exam 3: NURS 660 / NURS660 Psychopharmacology and Advanced Mental Health | Complete Questions and Verified Answers (Latest 2026 / 2027)100% Correct - Maryville Q: What is the medication that is the antidote for alprazolam? Answer flumazenil Q: What is the MOA of pregabalin that makes it alleviate pain for people with fibromyalgia or chronic fatigue? Answer binds to the alpha 2 delta sub-units of voltage sensitive calcium channels Q: What is an antagonist of caffeine Answer adenosine Q: Diagnose this pt: Patient comes in with a CC of anxiety. She has been excessively worrying, increased arousal, increased tiredness and irritability. What is the primary and least likely diagnosis? Answer GAD; Panic Disorder Q: Somebody w/ anxiety worries about having a panic attack, in addition has mood changes to avoid things in order to not have a panic attack. Answer Panic disorder Q: A woman was raped, and continues to have fear of opposite sex on her way to parking garage. Which two areas of the brain are involved? Answer amygdala and hippocampus Q: MOA of modafinil (Provigil). How does it promote normal wakefulness Answer histamine, NE at alpha adrenergic receptor sites, dopamine at D2 receptors Q: What is the MOA of eszopiclone? What receptors does it act on? Answer Binds to GABA receptors to increase GABA to increase sleepiness Q: Which would be the first line appropriate pharmacological agent for PTSD? Answer Paroxetine Q: What mediation is used to alleviate to help cognitive pain and physical symptoms in fibromyalgia? Answer Milnacepran (Savella) Q: With the difficulty breathing is related hypothetically to the activation of what area of the brain? Answer parabrachial nucleous Q: What medications are good for falling asleep "sleep induction" and are not addictive? Answer Suvorexant (Belsmora) Q: Know the MOA of buspirone. Which receptor does it primarily act upon? Answer serotonin 1a 5HT1A partial agonist Q: How does melatonin improve sleep? What receptors does it act on? Agonist or antatonist? Answer Secreted by the pineal glad to attach to receptors in the suprachiasmic nucleus to regulate the circadian rhythm; agonist Q: Current dx of generalized anxiety disorder (GAD), difficulty concentrating as well as problems falling asleep. She gets very angry over basic things and is very moody in general, excessive stressful reactions, concentrate, irritability. What is going on in her brain? Answer a. Dysfunction of amygdale and CTSC (serotonin/nor-einephrine) Q: Pt is coming in for detox with a long hx of alcohol abuse, HTN, and cirrhosis. He reports 12 beers daily for weeks. Has w/d seizures when he tries to stop drinking on his own. So he has elevated AST, LFT....what agent would you choose to detox him? Answer lorazepam Q: Someone comes in with chronic hepatitis, also has chronic neuropathic pain. What medication would you AVOID prescribing to this patient and why? Answer Cymbalta; elevates LFTs Q: Benzodiazepine patient education Answer Avoid ETOH may cause dizziness, may slow heart rate, avoid sedating antihistamines Q: What medication or drug class, is second line treatment for fibromyalgia? Answer cyclobenzaprine Q: What drug is a melatonin receptor agonist? Answer ramelteon, tasimeltion Q: What is the MOA of trazodone? Answer 5HT2C antagonist, H1 antagonist Q: What is the MOA of lorazepam? Answer positive allosterioc modulator binds to GABA Q: Which neurotransmitter is affected by light and activity? Answer Melatonin Q: What condition does this describe a. worry, anxiety, arousal, fatigue, sleeplessness, muscle tension? Answer GAD Q: What condition does this describe anticipatory anxiety, worry about panic, unexpected panic attacks, trying to avoid future attacks? Answer Panic disorder Q: What condition does this describe anxiety/fear over social performance? Answer social anxiety disorder Q: What condition does this describe anxiety while re-experiencing, increased arousal and startle responses, nightmares? Answer PTSD Q: What part of the body produces a substance that helps promote jet lag? Answer pineal glad Q: The patient has been recently dx with hypothalamous tumor experiencing trouble sleeping and staying awake. What neurotransmitters are being affected in the hypothalamus. What is more activating and what is more sedating. Answer GABA vs HISTAMINE Q: What meds are used to treat narcolepsy? Answer Methyphenylate Pemoline Modafinil Q: What would be the two things you suggest who needs something to help them relax to fall asleep and what would promote waking up in the morning? Answer evening melatonin, morning sunlight Q: There is a woman who has terrible anxiety who has had for a long time. She has fears her children will be harmed when they are not with her. What circuitry in the brain is in charge of this type of thinking scenario? Answer cortico thalmic striatal circuts Q: What is a potential therapeutic mechanism to promote wakefulness Answer enhance tonic dopamine firing Q: What pain is so debilitating that even if you have mild pressure such as a toddler's hug, the pain is unbearable? Answer allodynia What causes diabetic peripheral neuropathy? How is that pain processed in the body? Answer inflammation in the periphery. Disrupted central processing What are the withdrawal symptoms of paxil? Answer muscle aches, nausea, insomnia, anxiety, dizziness During an initial eval with someone with panic disorder and you start them on an SSRI. Which med is FDA approved until the SSRI effects are shown? Benzodiazepines Which medications are short acting benzodiazepines? alprazolam, triazolam, oxazepam, midazolam Which medications are long acting benzodiazepines? flurazepam, clorazepate, diazepam, Librium What medication drug will you not prescribe d/t an impaired liver? duloxetine What area of the brain controls sleep "off switch" ventrolateral preoptic nucleus What area of the brain controls wake "on switch" tuberomammillary nucleus Name 2 additional receptors that regulate sleep and wake Orexin and hypocretin What are the S/E of taking Benadryl for sleep? If you are taking long term what are some symptoms you may experience? dizziness, xerostomia, memory loss What neuron is only activiated by a noxious stimulous? nociceptor what is the drug class of benzodiazepines for sleep? sedative hypnotics What medication should be used for severe anxiety attacks for people currently taking opioids for pain? SSRI What education would you give to a patient taking zolpidem do not take with food, avoid driving or hazardous actvity after taking medication, monitor for impairment the next moring Neurotransmitters Involved in Wakefulness Histamine, dopamine, norepinephrine, acetylcholine, and serotonin Neurotransmitters Involved in Sleep/Wake Switch Histamine from the TMN GABA from the VLPO A-beta fibers Detect small movements, light touch, hair movement, and vibrations (Non-noxious) C fibers Bare nerve endings only stimulated by noxious mechanical, thermal, or chemical stimuli C=chemical A delta fibers Senses noxious mechanical stimuli and subnoxious thermal stimuli Peripheral Neuropathy pain Damage to/dysfunction of peripheral nervous system. Responds to peripherally and centrally acting drugs, NSAIDs and opioids. Ex: diabetic neuropathy, post herpetic neuralgia Pathophysiology of chronic pain Chronic pain results from changes in sensitivity in both ascending and descending (PGA, RVM, DLPT) pathways. Can lead to grey matter loss and central sensitization. Can be inflammatory or degenerative in nature. Peripheral, can become centralized, or mixture of both. Medications for falling asleep Need medications with short half life Ramelteon Roserem Sonata (middle insomnia, need 4 hours to dedicate) Medications for staying asleep Zolpidem ER, temazepam, belsomra, eszopiclone (lunesta) Areas of brain involved in anxiety Amygdala, periaquductal grey, hippocampus Areas of brain involved in sleep Pituitary gland, pineal gland (melatonin), Two types of anxiety Amgdala-centered circuit: -Fear CSTC-centered circuit: -Worry/obsession loop -anxious misery -apprehension -expectation -ThalamusstriatumDLPFC Neurotransmitters associated with worry Serotonin, GABA, dopamine, norepinephrine, glutamate, voltage gated ion-channels Alprazolam (Xanax) GABA positive allosteric modulator Benzodiazepine anxiolytic Used for generalized anxiety disorder, panic disorder, anxiety associated with depression. High risk for withdrawal, short half life, high potency, quick onset creates high risk for abuse and dependence. Keys of Sleepiness and Wakefulness The hypothalamus is a key control center for sleep and wake, and the specific circuitry that regulates sleep/wake is called the sleep/wake switch. The "off" setting, or sleep promoter, is localized within the ventrolateral preoptic nucleus (VLPO) of the hypothalamus, while "on"—the wake promoter—is localized within the tuberomammillary nucleus (TMN) of the hypothalamus. Two key neurotransmitters regulate the sleep/wake switch: histamine from the TMN and GABA from the VLPO. Modafinil (Provigil) CNS stimulant Dopamine reuptake inhibitor Narcolepsy, obstructive sleep apnea, shift work sleep disorder Activates TMN which releases histamine which increases alertness Pregabalin (Lyrica) Glutamate voltage gated calcium channel blocker Used for fibromyalgia, neuropathic pain, some use in GAD, social anxiety. Binds to the alpha 2 delta subunit of voltage-sensitive calcium channels (VSCCs). In fact, pregabalin binds preferentially to the open conformation of these channels and thus may be particularly effective in blocking channels that are the most active, with a "use-dependent" form of inhibition. Duloxetine (Cymbalta) SNRI antidepressant Best documented to have efficacy in pain conditions. diabetic peripheral neuropathic pain, fibromyalgia, GAD, chronic musculoskeletal pain Duloxetine targets both descending noradrenergic and serotonergic projections and the patient may benefit from an antidepressant with dual mechanisms, which may help alleviate chronic pain. Risk of elevation of serum transaminase levels and is not recommended for use in individuals with hepatic insufficiency Milnacipran (Savella) SNRI antidepressant Great for fibromyalgia Documented efficacy for treating neuropathic pain. In addition, it can also improve cognitive symptoms through its potent norepinephrine reuptake binding property. Can treat "fibro fog" and cognitive symptoms of fibromyalgia as well. Paroxtine (Paxil) SSRI approved for use in PTSD Works on H2 receptors, sedating. Sexual SE, weight gain. Buspirone (Buspar) Serotonin receptor partial agonist Anxiolytic that does not produce CNS depression like benzodiazepines; indicated for treatment of anxiety and is always given on a scheduled basis, not PRN. Only contraindication is allergy. Onset of action is 2-3 weeks. Serotonin 5-HT1A receptor partial agonist Buspirone's partial agonist actions at presynaptic somatodendritic serotonin autoreceptors may theoretically enhance serotonergic activity and contribute to antidepressant actions. It does not produce significant sedation, hypnotic, anticonvulsant, or musculoskeletal relaxing effects. Not a good drug for panic disorder. How Z drugs work Primarily work on alpha 1 subunit of GABA receptor Ramelteon (Rozerem) Melatonin receptor agonist, targets MT1 and MT2 Helps with circadian rhythm. Short duration, helps with falling asleep Good for patients with hx of drug addiction Doxepin (Sinequan) TCA H1 blockade aids with insomnia. High doses targets alpha-1 adrenergic and muscarinic antagonism, which can cause dizzy spells and constipation. Suvorexant (Belsomra) Makes you less awake, cuts off wake cycle Dual orexin antagonist Takes effect in less than an hour. Safety in those that can't take hypnotics. Lower risk for dependency or abuse potential. Dayvigo (lemborexant) same class. Flumazenil (Romazicon) Antidote for benzodiazepine overdose. Lorazepam (Ativan) GABA-PAM Benzodiazepine anxiolytic LOT, Doesn't have active metabolites Simpler timeline, predictable half-life. Can be used with patients with liver issues. Librium (chlordiazepoxide) GABA-PAM Benzodiazepine Antianxiety Used for alcohol withdrawal. Long half-life, used in detox setting due to this. Hydroxyzine (Atarax, Vistaril) Histamine-receptor antagonist Antihistamine, anxiolytic. drowsiness, dizziness, dry mouth. Tx of pruritus, anxiety, post-op n/v. avoid alcohol and CNS depressant. caution with hazardous activities. High doses can affect QTc SSRIs for anxiety Long-term treatment for anxiety. - escitalopram (Lexapro) - citalopram (Celexa) - fluoxetine (Prozac) - paroxetin (Paxil) Amitriptyline (Elavil) TCA. NE/5HT re-uptake inhibitor. Second line tx for fibromyalgia, neuropathic pain. Used for insomnia Anticholinergic SE Eszopiclone (Lunesta) GABA-PAM Z drug, for insomnia. Targets GABA alpha 1 isomer. Temazepam (Restoril) GABA-PAM Benzodiazepine (insomnia) Doesn't have metabolites, predictable, can be used in alcohol withdrawal (LOT) Cyclobenzaprine (Flexeril) Muscle relaxant/antispasmodic Enhances GABA Used for muscle spasms due to injury Causes CNS depression Physical dependence - do not d/c abruptly Zolpidem (Ambien) GABA-PAM Sedative-hypnotic (non-benzodiazepine) Enhance GABA Can cause daytime sleepiness Low risk of abuse, tolerance, dependence Avoid CNS depressants Diazepam (Valium) GABA-PAM Benzodiazepine anxiolytic Naltrexone (ReVia) Antagonist that blocks euphoric effects of opioids Reduces or eliminates alcohol craving Naloxone (Narcan) Opioid antagonist, treatment for overdose. Allodynia Pain due to a stimulus which does not normally provoke pain Hyperalgesia Excessive sensitivity to painful stimuli Neuropathic pain pain from damage to neurons of either the peripheral or central nervous system Nociceptive Pain Direct activation of pain nerve fibers, either due to chemical, inflammatory or mechanical mediators, and is usually due to tissue irritation, impending injury, or actual injury.