PMHNP Study/practice questions & Answers, 100?curate, rated A+

PMHNP Study/practice questions & Answers, 100?curate, rated A+

Which of the following statements does not reflect current understanding of neurotransmitter pathways implicated in anxiery disorders?

• Increase levels of CRF in amygdala, hippocampus and LC increase symptoms of anxiety.
• Decreaseing GABA in the Mesolimbic cortex diminishes symptoms of anxiery.
• Increasing serotoneric activity in the amygdala diminishes symptoms of anxiety.
• Decreasing NE in the LC diminishes symptoms of anxiety. - ✔✔-A, C & D are all correct so the answer

is B

As a PMHNP, you know anti-psychotic meds have side effects. Which side effects of antipsychotic meds has an insidious delayed-onself of 1-2 after starting the medication? - ✔✔-A. Dry Mouth

• Tardive Dyskinesia
• Wt gain
• Sedation

We know that Dry mouth, drowsiness, dizziness, restlessness, wt gain, constipation & N/V are all SE but, Tardive Dyskinesia does not start for 1-2 years.My answer - B. *Tardive Dyskinesia (TD*) ** long standing blockage of DA2 in nigrostriatal pathway leads to TD

Which Serotonin receptor antagonism makes an antipsychotic "atypical"?

A. 5HT1A

B. 5HT3A

C. 5HT4A

• 5HT2A - ✔✔-Atypical antipsychotic drugs such as clozapine, olanzapine, quetiapine, risperidone,

sertindole, and ziprasidone are potent 5-HT2a receptor antagonists and relatively weaker dopamine D2 antagonists.Commonly Prescribed Typical and Atypical Antipsychotic Medications

Typical antipsychotics include:

Haldol (haloperidol); Loxitane (loxapine); Mellaril (thioridazine); Geodon (ziprasidone) Moban (molindone); Seroquel (quetiapine) Navane (thiothixene); Zyprexa (olanzapine) Prolixin (fluphenazine); Serentil (mesoridazine) Stelazine (trifluoperazine); Trilafon (perphenazine) Thorazine (chlorpromazine)

Atypical antipsychotics include:

Abilify (aripiprazole); Clozaril (clozapine) Geodon (ziprasidone); Seroquel (quetiapine) Zyprexa (olanzapine)

Which medication inhibits both dopamine and norepinephrine?

• Venlafaxine (effexor)
• Duloxetine (Cymbalta)
• Buproprion (Wellbutrin)
• Imipramine (Tofranil) - ✔✔-C. Buproprion (Wellbutrin)

Bupropion inhibits the presynaptic reuptake of both dopamine (DA) and noradrenaline (NA), leading to increased levels of both of these neurotransmitters in the synaptic cleft

Current understanding of Dopamine (DA) pathways & clinical symptoms in schizophrenia is reflected in which statement?

• Neg symptoms are related to DA deficit in meslimbic system and pos (+) symptoms are related to DA

excess in the (SN) substanita nigra & (VTA) ventral tegmental area.

• (-) symptoms are related to DA excess in the CC cerebral cortex; + symptoms are related to DA in the

(NA) nucleus accumbens and mesolimbic system

• (-) related to DA in (MS) mesolimbic system; + are related to DA deficit in the SN and VTA
• (-) related to DA deficit in the CC; (+) related to DA excess in the NA & MS - ✔✔-ANS. D?

In the case of schizophrenia and other psychological disorders, a positive symptom is one that adds a behavior, thought or feeling, whereas a negative symptom takes away a behavior, thought or feeling.Dopamine pathways Mesolimbic => pathway projections from VTA to the NA (nucleus accumbens in the limbic system; Increased dopamine in the Mesolimbic pathway mediates (+) symptoms.VTA => Mesocortical; Decreased DA in Mesocortical => (-)negative symptoms Nigrostriatal Pathway => (SN) Substantia nigra to the basal ganglia or striatum =>decreased DANigrostriatal (NS) Pathway (mediate motor movement)=> (SN) Substantia nigra to the basal ganglia or striatum =>decreased DA => dystonia, parkinsonian symp and akathsia. Hyperactivity of DA in NS pathway => hyper-movements disorders - tics, chorea (jerky movements) and dyskinesias (involuntary muscle movements).Tuberoinfundibular (TI) Pathway: projects from the hypothalamus to anterior pituitary TI pathway decreases prolactin release, increased DA=> positive symptoms (hyperprolactinemia, amenorrhea, galactorrhea & sexual dysfunction)

What medication is recommended to be used in the treatment of NMS? - ✔✔-Dantrolene (Dantrium)

NE is a neuro transmitter that is implicated in alertness and Anxiety. What area of the brain has a large majority of NE neurons?

• Amygdala
• Hippocampus
• Nucleus Accumbens
• Locus Coeruleus - ✔✔-Locus Coeruleus, located in the pons

An inverse agonist produces which effect?

• Opposite of agonist, & causes the receptor to close the ion channel.
• Blocks the agonist from opening the channel, but does not activate the biological responw
• Does not fully activate the receptor and causes only limited actions
• Activates a biological response, and opens the ion channel - ✔✔-A. Opposite of the agonist...

An inverse agonist is a compound that binds to a receptor and produces a pharmacological response that is opposite to that of the corresponding agonist. An agonist increases the activity mediated by a receptor, an inverse agonist reduces it. In the presence of the agonist the inverse agonist acts as an antagonist.

Adverse reactions from Antabuse (Disulfiram) - ✔✔-Do not take disulfiram if you have consumed alcohol within the past 12 hours. Do not drink alcohol while taking disulfiram, and for up to 14 days after you stop taking this medicine. Disulfiram should never be given to a person without his or her knowledge of taking the medicine.

does adding folic acid 0.8mg to lamictal and seroquel help - ✔✔-Folic acid interaction Lamotrigine can inhibit folate metabolism, and it had been thought that adding folate would be useful. Until further data are gathered on folate augmentation in patients taking the combination of lamotrigine and quetiapine,

Assessing an elderly patient who complains of tinnitus, what findings are associated with acoustic neuroma?

• Suppuration of the labyrinth
• Unilateral ringing in the ear
• Perforation of tympanic membrane
• Inflammation of middle ear - ✔✔-B. Unilateral ringing in the ear

The most common presenting feature of acoustic neuromas, occurring in 90 percent of patients, is unilateral hearing loss. ... Other symptoms of the acoustic neuroma include asymmetric tinnitus (ringing in the ear), dizziness and disequilibrium (difficulty with balance).

Which of the following hematologic changes is associated with lithium?

• Anemia
• Agranulocytosis
• Leukocytosis
• Leukopenia - ✔✔-ANS. => C. Leukosytosis

Acute exposure to lithium can cause leukocytosis, whereas chronic exposure can produce aplastic anemia.

Which mood-stabilizing drug has consistently been shown to decrease the risk of suicide for bipolar patients? - ✔✔-

Which mood-stabilizing drug is most associated with a life-threatening rash?