NURS 6630 - Midterm Exam (Week 6) 2021

NURS 6630 - Midterm Exam (Week 6) 2021. Which of the following medications are known as selective serotonin re-uptake inhibitors (SSRIs)? i. Nortriptyline ii. Citalopram iii. Duloxetine iv. Fluoxetine v. Venlafaxine vi. • Question 3 Which disease state of a non-adherent patient is at greater risk for substance use, violence, and victimization as well as worse overall quality of life? Schizophrenia Response Feedback: “Moreover, non-adherent patients with schizophrenia are at greater risk for substance use, violence, and victimization as well as worse overall quality of life.” • Question 4 Patient is a 72-year-old male with a past medical history significant for atrial fibrillation and COPD with a new diagnosis of major depression disorder. Based on his comorbid conditions, what antidepressant would you recommend as first-line? Atomoxetine Response Feedback: (Options C & D are both TCA antidepressants and, based on the patient’s age and comorbid conditions, a TCA would likely result in more side effects, such as increased fall risk due to potential for orthostatic hypotension and anticholinergic-related side effects. In addition, patient has a history for cardiac abnormalities due to A. fib diagnosis - TCAs result in electrocardiographic changes in susceptible individuals, therefore, would likely avoid. Choice B is used more for ADHD purposes than as an antidepressant) Page numbers used: Page 39 for TCA side-effect profile • Question 5 Which of the following is an appropriate strategy for managing treatment-resistant depression? Use both SSRI and SNRI • Question 6 Which of the following medications is best to AVOID in maintenance treatment of bipolar disorder and why? Response Feedback: “As noted previously, antidepressants may contribute to an increase in mood episode frequency.” • Question 7 With second-generation antipsychotics, what is the main side effect that requires frequent monitoring? Response Feedback: table 7-6 & page 80, table 7-7; Page 78: “However, attention over the past decade has focused on effect of second-generation antipsychotics on glucose metabolism and lipids and associated metabolic syndrome.” • Question 8 Which amino acid is involved in the synthesis of both norepinephrine and dopamine? • Question 9 An 81-year-old male comes to your clinic today complaining of dry mouth, blurred vision, and constipation. He has a past medical history significant for hypertension, heart failure, and depression. Of the following medications, which one is likely contributing to these side effects? Response Feedback: Only TCA is listed with most anticholinergic effects; Page 39 for TCA side effect profile: “dry mouth, blurred vision, constipation, urinary hesitancy, tachycardia, memory difficulties, and ejaculatory difficulties” • Question 10 Which medication has been studied and recommended in patients with a social anxiety disorder who also suffer from an alcohol use disorder? Response Feedback: “Suggested that treatment with the SSRI paroxetine decreased the anxiety and may have reduced the alcohol use as well” • Question 11 M. B. was just diagnosed with Generalized Anxiety Disorder and pharmacotherapy is needed. Which of the following would be a first-line treatment option for M. B.? I. Duloxetine II. Quetiapine III. Diazepam IV. Escitalopram V. Response Feedback: “As is true for panic and the other anxiety disorders, the SSRIs and SNRIS are generally considered first-line agents for the treatment of GAD because of their favorable side effect profile….” • Question 12 The serotonin system is involved in many processes in psychiatry, including, most prominently, mood, sleep, and psychosis. Of the following neurons listed, from where is serotonin synthesized? Response Feedback: under serotonin subheading and figure 1-18 on page 16: Locus Coeruleus: Norepinephrine Nucleus basalis: cholinergic neurons Substantia Nigra: dopamine Ventral Tegmental area: dopamine • Question 13 Which of the following symptoms is NOT part of the diagnostic features for bipolar disorder? Response Feedback: “Psychosis is not represented in the diagnostic features for BPD.” - “Psychosis typically resolves along with the mood symptoms, though diagnostic criteria acknowledge that psychotic symptoms may linger beyond the end of the episode.” • Question 14 A 32-year-old males calls you complaining of decreased libido since starting Paroxetine 20 mg 2 weeks ago. He reported stopping the medication 1 day ago and is now experiencing extreme irritability and nervousness. He wishes to stop this medication due to side effects. What do you recommend? Response Feedback: under selective serotonin re-uptake inhibitors discontinuation syndrome subtitle: “The risk of such adverse events occurring seems to be inversely related to the half-life of the SSRI, with fluoxetine reported as having a significantly lower risk than paroxetine in two studies. For more severe discontinuation-related adverse events, re-institution of the SSRI and slow taper may be necessary to alleviate these symptoms.” • Question 15 It is appropriate to start lamotrigine in combination with another atypical antipsychotic in treatment of an acute manic episode in bipolar disorder. Response Feedback: “Lamotrigine has also been extensively studied in bipolar depression as well….” • Question 16 Which antiepileptic drugs should we avoid in pregnant women in the treatment of bipolar disorder? . Depakote i. Lamotrigine ii. Topiramate iii. Carbamazepine iv. Gabapentin v. Response Feedback: All the others listed except for lamotrigine are not used in treatment of bipolar disorder. • Question 17 A 23-year-old female was just diagnosed with major depressive disorder and is being started on escitalopram 10 mg daily. The patient should be counseled about which Black Box warning? Response Feedback: “In 2004, the FDA asked manufacturers of almost all the new antidepressant drugs to include in their labeling a warning statement that recommends close observation of adult and pediatric patients treated with these drugs for worsening depression or the emergence of suicidality." • Question 18 Which statement is TRUE regarding the use of selective serotonin reuptake inhibitors (SSRI)/serotoninnorepinephrine reuptake inhibitors (SNRI) in patients with Generalized Anxiety Disorder? Response Feedback: “Because the SSRI/SNRIs have the potential to cause initial restlessness, insomnia, and increased anxiety, and because the patients are commonly sensitive to somatic sensations, the starting doses should be low, typically half (or less) of the usual starting dose….” • Question 19 Which of the following statements below is NOT considered an appropriate treatment strategy for treatment-resistant depression? Response Feedback: “Combination of an SSRI OR an SNRI with a norepinephrine-dopamine re-uptake inhibitor (bupropion) or a serotonin-norepinephrine antagonist (mirtazapine or mianserin) is a commonly used combination” • Question 20 Which atypical antipsychotic(s) require a meal for better absorption? . Quetiapine i. Ziprasidone ii. Asenapine iii. Olanzapine iv. Lurasidone v. Response Feedback: - Ziprasidone – best with a fatty meal - Lurasidone – best with a meal of at least 350 calories (no effect of fat composition) • Question 21 Choose the correct statement(s) regarding lithium levels. SELECT ALL THAT APPLY. Response Feedback: under pharmacokinetics and pharmacodynamics subtitle - “NSAIDs or other COX-2 inhibitors may decrease renal blood flow and thereby increase lithium levels by up to 25%.” - “Therefore, thiazide diuretics, which act distally, will tend to increase lithium levels by up to 50% while those that act more proximally generally have less of an effect on lithium levels.” • Question 22 Which of the following are NOT primary target(s) symptom for antipsychotic agents in schizophrenia? . Depression, anxiety, demoralization, suicidality, excitability, and agitation i. Delusions, hallucinations, disorganized thoughts ii. Affective flattening, alogia, avolition, anhedonia, social withdrawal iii. Attention, memory, and executive functions iv. Response Feedback: “For schizophrenia, the primary target symptoms for antipsychotic agents fall into three categories: psychotic symptoms (e.g., hallucinations, delusions, disorganization); agitation (e.g., distractibility, affective lability, tension, increased motor activity); and negative symptoms (e.g. apathy, diminished affect, social withdrawal, poverty of speech.” AND “Although cognitive deficits are an important contributor to disability in schizophrenia, cognitive deficits usually are not considered a target for antipsychotic agents because they are not very responsible to current agents.” • Question 23 Of the following antipsychotic medications listed below, which one has a Black Box Warning for seizure, agranulocytosis, and seizures? Response Feedback: Box 7-5 * indicated clozapine-specific black box warnings • Question 24 Which neurotransmitter is considered the major inhibitory neurotransmitter? • Question 25 A 27-year-old female presents to your emergency room today with a rash that started about 1 week ago and has now spread to her whole body. She has a past medical history significant for type 2 diabetes,