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What is serotonin syndrome? - ANSWER ✓ - Increased serotonergic activity in
the CNS
- Can be due to therapeutic med use, inadvertent drug interactions, or self-OD
Serotonin in the Body:
CNS: Modulates attention, behavior, and thermoregulation
PNS: Regulates GI motility, vasoconstriction, uterine contraction, and
bronchoconstriction, promotes PLT aggregation
PE of serotonin syndrome 11 - ANSWER ✓ - Hyperthermia, flushed skin,
diaphoresis
- Agitation
- Slow, continuous, horizontal eye movements (ocular clonus)
- Dilated pupils
- Tremor, akathisia
- Deep tendon hyperreflexia (common)
- Inducible or spontaneous muscle clonus (common)
- Muscle rigidity
- Bilateral babinski
- Dry mucus membranes
- Increased bowel sounds
What is discontinuation syndrome (from SSRIs)?
"FINISH" - ANSWER ✓ 2-3 days after stopping SSRIs abruptly
F: flu-like SS
I: insomnia
,N: nausea
I: imbalance
S: sensory disturbances
H: hyperarousal
Bupropion
- MOA
- BENFITS
AE
CONTRA - ANSWER ✓ MOA
- act to inhibit reuptake of NE, dopamine, and serotonin
BENFIT
- Depression
- Smoking cessation
- Seasonal affective disorder
- Treat sexual dysfunction relative to SSRI therapy
AE
- weight loss
- increases libido ⇒ combine with SSRI
- can cause seizures by lowering the seizure threshold
CONTRA
- History of seizures
- Do not prescribe to pts with psych disorders ⇒ ↑ risk for delusions or
hallucinations
RF for ETOH abuse 4 - ANSWER ✓ Younger adults (18-29 yrs)
Men > women
Native americans
Genetics (low response to ETOH), environment (peer influences), specific
personality traits (impulsivity, extroversion), cognitive fxn
What are predisposing factors impacting the likelihood of someone developing a
SA issue? - ANSWER ✓ Predisposing Factors:
- Unhealthy use of one substance increases the likelihood of unhealthy use of other
substances
- Family history
,- Social history
- Partner or friends with SA, living in a community with poverty, violence, and/or
high ETOH/drug use
Use of:
- Caffeine, tobacco, ETOH, prescription meds, marijuana, illicit drugs
- Mental health disorders
- Highest in personality disorders
What is withdrawal - ANSWER ✓ process of removal of the drug of dependence
from the body
SS of substance abuse withdrawal 3 - ANSWER ✓ Can last days to weeks
- NVD
- Flu-like SS: lacrimation, rhinorrhea, diaphoresis, shivering, piloerection
- SNS/CNS Arousal: mydriasis, mild HTN and tachy, anxiety, irritability,
insomnia, agitation, restless leg, general restlessness, tremor, low grade temp
Which medications are central nervous system sedatives? - ANSWER ✓ Include
sedatives, tranquilizers, hypnotics
- Good for treating anxiety, panic, acute stress reactions, sleep disorders
Examples:
Benzos:
- Diazepam (valium), clonazepam (klonopin), alprazolam (xanax)
Non-Benzo Sedative Hypnotics
- Zolpidem (ambien)
Barbiturates
- Mephobarbital
Initiation Strategies for Antidepressants: - ANSWER ✓ Antidepressants are
considered equivalent in efficacy for depression
Decide on med by:
- History of response
- Family history of response
- Symptoms
- Medical history
- Interactions
, - AE
Rheumatoid arthritis - ANSWER ✓ Autoimmune disorder causing chronic joint
inflammation.
CBC - ANSWER ✓ Complete blood count; measures blood components.
Hgb - ANSWER ✓ Hemoglobin; oxygen-carrying protein in red blood cells.
Hct - ANSWER ✓ Hematocrit; percentage of blood volume from red cells.
MCV - ANSWER ✓ Mean corpuscular volume; average red blood cell size.
Platelet count - ANSWER ✓ Number of platelets per microliter of blood.
WBC count - ANSWER ✓ White blood cell count; immune response indicator.
Serum haptoglobin - ANSWER ✓ Protein that binds free hemoglobin in blood.
Serum iron concentration - ANSWER ✓ Amount of iron in serum, measured in
micrograms.
Total iron binding capacity - ANSWER ✓ Maximum iron that can bind to
transferrin.
Percent saturation - ANSWER ✓ Percentage of transferrin saturated with iron.
Serum ferritin concentration - ANSWER ✓ Indicator of stored iron in the body.
Reticulocyte concentration - ANSWER ✓ Percentage of immature red blood cells
in blood.
Anemia of chronic disease - ANSWER ✓ Anemia due to chronic inflammation or
illness.
Acute blood loss anemia - ANSWER ✓ Anemia resulting from sudden blood
loss.